Functional Assessment for Adults with Disabilities (2019) / Chapter Skim
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3 Collection of Information on Function and Disability
3 Collection of Information on Function and Disability
Pages 45-74
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, medical opinion, other medical evidence from medical sources, evidence from nonmedical sources, and prior administrative medical findings of state or federal Disability Determination Services medical and psychological consultants (SSA, 2018b)
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This section provides an overview of these tools and related considerations, including the strengths and weaknesses of different information collection methods; the pitfalls of conducting clinical interviews; the use of proxy respondents; the exploitation of clinical records, including electronic health records (EHRs) ; the conduct of clinical and functional observations; and the direct measurement of function.
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In addition, individuals may be subject to social or other stressors, whether related to work or not, that can impact the quality of the information they provide. In general, even when validated information collection methods 2 simple terms, natural language processing is "a branch of artificial intelligence that helps In computers understand, interpret and manipulate human language" (SAS Institute, 2019a)
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In addition to the results of physiological measures, such as blood pressure measurements, blood tests and imaging procedures, and any functional tests performed, clinical records provide information about diagnoses and treatments, including prescribed medications, appliances, and devices. Professionally witnessed physical or behavioral events or characteristics of patients also may be documented (e.g., seizures or spasticity)
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Health and care disparities can have a significant impact on the collection of health information available to inform disability determinations. In the United States, lower socioeconomic status is associated with less access to high-quality care and health care professionals (AHRQ, 2018; IOM, 2001, 2003)
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Direct performance testing for physical and neurocognitive functional abilities is well developed for various common illnesses and conditions and defined injury-related impairments. Such testing typically is used to assess common disease-specific deficits and
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These testing procedures can be valuable but may require substantial resources, including client transport to and from the testing facility. In situ observation of task/activity A second approach is to test performance abilities by observing the client in a work setting that is identical, or nearly so, to that in which the tasks/activities in question would be carried out.
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methods. Instruments based on classical test theory methods Instruments based on classical test theory are designed to be completed in toto via either selfreport, proxy (surrogate)
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Instruments based on item response theory methods Measurement tools may be built on IRT and computer adaptive testing (CAT)
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. The use of measures developed using IRT that can be administered using CAT can also decrease respondent burden by reducing survey length and administration time while minimizing measurement error.
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suggests evaluating the available evidence related to the eight key instrument properties described by the Scientific Advisory Committee of the Medical Outcomes Trust (2002)
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. Conceptual Model and Measurement Approach The conceptual model on which an instrument is based provides "the rationale for and description of the concepts" (Scientific Advisory Committee of the Medical Outcomes Trust, 2002, p.
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. And criterion validity is the "extent to which scores of the instrument are related to a criterion measure" (Scientific Advisory Committee of the Medical Outcomes Trust, 2002, p.
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. Different types of information contribute to the interpretation of scores, including their relationship to clinical conditions or significant life events (Scientific Advisory Committee of the Medical Outcomes Trust, 2002, p.
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performance-based measures" (Scientific Advisory Committee of the Medical Outcomes Trust, 2002, p.
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Licensed clinical social workers, occupational therapists, physical therapists, and other professionals may administer ongoing assessments in their respective roles on a multidisciplinary team. They may have responsibility for repeated assessments using standardized assessment tools and procedures, and thus may render more detailed and accurate evaluations of an individual's physical and/or mental functioning over time than can be provided by medical specialists who have
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Other clinicians with experience in evaluating and treating impairments -- such as occupational therapists; speech-language pathologists; and physical therapists -- also may be well qualified to conduct these evaluations. Beyond identifying those professionals with appropriate expertise to perform functional assessments, acquiring information helpful in determining individuals' functional abilities relevant to work is facilitated by asking clear and specific questions that target the information of greatest use in making a disability determination.
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diversity in the test population. Testing Maximal Versus Typical Performance In some cases, functional assessments are performed under conditions that best resemble maximal rather than typical performance, which by definition implies continuous and independent performance.
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In the physical realm, the difference between peak capacity and sustained performance can be quantified specifically for aerobic functional capacity by means of cardiopulmonary exercise testing, but similar assessments of function are currently not available for all organ systems. Assessment of Episodic Activity Versus Sustained Task Performance Clearly, sustained and independent performance of a job involves more than the ability to perform each of the work activities separately.
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For instance, test administrators, whether consciously or not, may at times conduct assessments in a manner that provides the examinee with much greater encouragement to perform work activities than is typically encountered in an actual work setting, thereby rendering results unrepresentative of the actual conditions under which the work activities being assessed
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From page 65... ...
, where the objective is to learn the maximum extent to which the person can sustain that activity safely on a regular and continuing basis. It is likely, for instance, that some of the physical functional assessments documented in an individual's health records were conducted by occupational and physical therapists in the context of interventions aimed at helping or motivating the person to perform at maximum capacity, rather than determining his or her capacity to sustain work activities independently over time.
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, prospective examinees could potentially preview the test questions and prepare accordingly, undermining the validity of the results. Therefore, it is important to know the integrity of assessment instruments used to inform disability determinations to the extent possible.
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3-2. It is important to consider eight properties when evaluating the qual ity of functional assessment instruments: • conceptual model and measurement approach, • reliability, • validity, • sensitivity to change and responsiveness, • interpretability of results (e.g., self-report and trained observer rating)
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3-9. Threats to the validity of assessments of functional abilities include testing of maximal versus typical performance, assessment of epi sodic activity versus sustained task performance, absence of stan dardized testing conditions, mixed-motive incentives, compromised test integrity owing to prior use of the test in low-stakes testing ap plications, and diverse test populations in whom tests may not have been validated.
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Conclusions 3-1. The use of measures based on item response theory that can be ad ministered using computer adaptive testing can decrease respondent burden by reducing survey length and administration time while minimizing measurement error.
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2012. Performance of an item response theory based computer adaptive test in identifying functional decline.
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2018. Roles and functions of community health workers in primary care.
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2016. Sensitivity to change of a computer adaptive testing instrument for outcome measurement after hip and knee arthroplasty and periacetabular osteotomy. Journal of Orthopaedic & Sports Physical Therapy 46(9)
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doi: 10.1007/s11606-015-3360-0. Scientific Advisory Committee of the Medical Outcomes Trust.
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2003. Applications of computerized adaptive testing (CAT)
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