Functional Assessment for
Adults with Disabilities

Committee on Functional Assessment for Adults with Disabilities

Paul A. Volberding, Carol Mason Spicer, and Jennifer Lalitha Flaubert,
Editors

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

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This activity was supported by Contract/Task Order No. SS00-13-60048/0009 with the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-48938-6
International Standard Book Number-10: 0-309-48938-5
Digital Object Identifier: https://doi.org/10.17226/25376
Library of Congress Control Number: 2019945053

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Functional assessment for adults with disabilities. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25376.

COMMITTEE ON FUNCTIONAL ASSESSMENT FOR ADULTS WITH DISABILITIES

PAUL A. VOLBERDING (Chair), Professor, Department of Medicine; Director, AIDS Research Institute, Co-Director, University of California, San Francisco-Gladstone Institute of Virology and Immunology Center for AIDS Research, University of California, San Francisco

MARÍA P. ARANDA, Associate Professor, School of Social Work, University of Southern California

JACK T. DENNERLEIN, Professor, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University

LISA DIXON, Professor, Department of Psychiatry, Columbia University; Director, Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute

JUDITH GREEN-McKENZIE, Director of Clinical Practice, Associate Residency Director, Associate Professor, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine

ALLEN W. HEINEMANN, Director, Center for Rehabilitation Outcomes Research; Professor, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University

ANDREW J. HOUTENVILLE, Associate Professor, Paul College of Business and Economics; Research Director, Institute on Disability, University of New Hampshire

KURT L. JOHNSON, Director, Center for Technology and Disability Studies; Professor, Department of Rehabilitation Medicine; Head, Division of Rehabilitation Counseling, University of Washington

BARBARA L. KORNBLAU, Adjunct Professor of Occupational Therapy, School of Allied Health Science, Florida A&M University, Coalition for Disability Health Equity

PHILIP JORDAN MARION, Medical Director, Polytrauma Amputation Network Site, Washington, DC, Veterans Affairs Medical Center, Medical Director, Capital Medical Services

SUSAN McGURK, Professor, Department of Occupational Therapy; Senior Researcher, Center for Psychiatric Rehabilitation, Boston University

JUAN I. SANCHEZ, Professor, Knight-Ridder Byron Harless Eminent Chair in Management, College of Business, Florida International University

PAUL SHATTUCK, Associate Professor, A.J. Drexel Autism Institute, Drexel University

LYNNE WARNER STEVENSON, Professor of Medicine and Lisa M. Jacobson Chair in Cardiovascular Medicine, Vanderbilt University Medical School; Director of Cardiomyopathy Program, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center

ROBERT B. WALLACE, Irene Ensminger Stecher Professor of Epidemiology and Internal Medicine, Department of Epidemiology, College of Public Health, The University of Iowa

Study Staff

CAROL MASON SPICER, Study Director

JENNIFER LALITHA FLAUBERT, Associate Program Officer

TOM CARTAXO, Research Assistant

SHARYL NASS, Director, Board on Health Care Services

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Sara Rosenbaum, The George Washington University, and Elaine Larson, Columbia University School of Nursing. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Preface

The U.S. Social Security Administration (SSA) annually reviews more than 3 million claims from adults requesting a determination of disability for physical or mental health conditions that prevent them from engaging in substantial gainful employment. Assessment of individuals’ functional abilities relevant to work requirements should be an important part of determining whether they are able to meet workplace demands and sustain work performance on a regular and continuing basis. Over the years, many tests, surveys, and instruments have been developed to collect information about individuals’ physical and mental functional abilities. With support from SSA, the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine convened a committee to identify and describe ways to collect information about individuals’ physical and mental abilities relevant to function in the workplace, to discuss the types of information that support findings of limitations in work-related function, and to provide findings and conclusions about the collection of information and assessment of functional abilities relevant to work requirements.

On behalf of the committee, I sincerely thank the SSA staff who worked closely with the committee to define details of the committee’s task, including Megan Butson, Gina Clemons, Joanna Firmin, Deborah Harkin, Mary Beth Rochowiak, and Melissa Spencer. We also thank the expert and dedicated HMD staff who worked tirelessly to bring together information used in our deliberations. Led by study director Carol Mason Spicer, assisted by Jennifer Lalitha Flaubert (associate program officer) and Tom Cartaxo (research assistant), the committee accomplished a great deal, none of which would have been possible without their hard work, focus, and expertise.

We extend thanks as well to other HMD staff members who played a key role in the production of this report, including Sharyl Nass (senior board director, Board on Health Care Services); Karen Helsing (senior program officer); Patrick Burke, Julie Wiltshire, and Micah Winograd (financial associates). Research assistance was provided by Rebecca Morgan (senior research librarian, the National Academies). We are indebted as well to Rona Brière and Alisa Decatur, who provided exceptional editorial assistance in preparing the final report.

Our thanks go to all of the presenters who shared their time and expertise during the committee’s information-gathering sessions (see Appendix A); to the authors of three papers commissioned by the committee, Laura Ball, Ryan McCreery, Mark Wilkinson, Gislin Dagnelie, and Christopher Johnson; and to the reviewers for their invaluable feedback on an earlier draft of the report.

Finally, I thank the committee itself. As is so often the case, the National Academies are able to bring together experts across a wide range of expertise, each able to contribute to specific aspects of the task we were assigned. But the ability to bring that individual expertise together to a coherent whole demands an openness to learning from each other and a willingness to work as a team. Our committee did that and more. We each learned a great deal and trust that our report will be useful to SSA as it continues to improve in its essential mission.

Paul A. Volberding, Chair
Committee on Functional Assessment for Adults with Disabilities

Contents

ACRONYMS AND ABBREVIATIONS

SUMMARY

1 INTRODUCTION

Study Charge and Scope

Study Approach

Report Organization

References

2 DISABILITY AND FUNCTION

Evolution of the Concept of Disability

Social Security Administration’s Consideration of Function

Functional Abilities Relevant to Work Requirements

An Ecological Framework for Functional Assessment for Work

Findings and Conclusions

References

3 COLLECTION OF INFORMATION ON FUNCTION AND DISABILITY

Types, Sources, and Quality of Functional Information

Properties of Measurement Instruments

Professionals with the Training and Expertise to Assess Function

Potential Threats to the Validity of Functional Assessment

Findings and Conclusions

References

4 INTEGRATED ASSESSMENT OF WORK-RELATED FUNCTIONAL ABILITY

Activities of Daily Living

Instruments and Banks of Instruments for Assessing Physical and Mental Function

Instruments for Measuring Limitations in Work Activity Due to Health Conditions

Findings and Conclusions

References

5 SELECTED INSTRUMENTS FOR ASSESSMENT OF PHYSICAL FUNCTIONAL ABILITIES RELEVANT TO WORK REQUIREMENTS

Overview

General Assessments of Physical Function

Musculoskeletal Assessments

Physical Function and Pain

Cardiovascular Assessments

Visual Assessments

Hearing Assessments

Speech and Language Assessments

Findings and Conclusions

References

6 SELECTED INSTRUMENTS FOR ASSESSMENT OF MENTAL FUNCTIONAL ABILITIES RELEVANT TO WORK REQUIREMENTS

Mental Functional Abilities Relevant to Work Requirements

Instruments Used to Assess Mental Functional Abilities Relevant to Work Requirements

Findings and Conclusions

References

7 SELECTED IMPAIRMENTS AND LIMITATIONS IN FUNCTIONAL ABILITIES RELEVANT TO WORK

Back Disorders

Cardiac Impairments

Depression

Traumatic Brain Injury

Summary and Comparison of Common Impairments

Findings and Conclusions

References

8 REVIEW OF SELECTED DISABILITY BENEFIT PROGRAMS

Overview of Selected Benefit Programs

Disability Determination (Adjudication) Processes

Collection of Functional Information

Summary

Findings and Conclusions

References

9 OVERALL CONCLUSIONS

Overall Conclusions

Supporting Evidence for the Committee’s Overall Conclusions

APPENDIXES

A Public Session Agendas

B Glossary

C Literature Search Strategies

D Biographical Sketches of Committee Members

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Boxes, Figures, and Tables

BOXES

S-1 Statement of Task

S-2 Definitions

1-1 Statement of Task

9-1 Overall Conclusions

9-2 Overall Conclusions and Supporting Evidence

FIGURES

S-1 A conceptual framework for functional assessment of an individual’s capacity for work

2-1 International Classification of Functioning, Disability and Health (ICF) model of functioning and disability

2-2 The context of work described through the hierarchy of job and task analyses

2-3 A conceptual framework for functional assessment of an individual’s capacity for work

5-1 Relationship between communication skills and environment and impact on functionality

7-1 Alignment of different staging systems to describe heart failure

7-2 Illustration of factors with potential positive and negative effects over time on the trajectory of ability to work

TABLES

2-1 Terms from the Committee’s Conceptual Framework Cross-Linked with Terms and Concepts of the Social Security Administration and the Occupational Requirements Survey

Annex Table 2-1 Examples of Functional Criteria in the Social Security Administration’s Adult Listing of Impairments

5-1 New York Heart Association Functional Classification

5-2 Standard Voice Assessment Procedures, Speech Tasks, and Anticipated Results

Annex Table 5-1 Data Elements on Physical Demands in the Occupational Requirements Survey (ORS)

Annex Table 5-2 Physical Functional Abilities Relevant to Work Requirements

Annex Table 5-3 Selected General Assessments for Physical Function

Annex Table 5-4 Selected Musculoskeletal Assessments

Annex Table 5-5 Selected Cardiovascular Assessments

Annex Table 5-6 Selected Visual Assessments

Annex Table 5-7 Selected Hearing Assessments

Annex Table 5-8 Selected Speech/Fluency and Voice Assessments

Annex Table 5-9 Selected Language Assessments

Annex Table 6-1 Mental Functional Domains Relevant to Work Requirements

Annex Table 6-2 Definitions of Mental Functional Domains

Annex Table 6-3 Selected General Assessments for Mental Function

Annex Table 6-4 Selected Psychological Assessments

Annex Table 6-5 Selected Measures of Disorder Severity and Work-Related Functional Impairment

Annex Table 8-1 Comparison of Selected Benefit Programs

Acronyms and Abbreviations