Measuring work disability in the U.S.: conceptual, methodological, and diagnostic considerations
Marino, Molly Elizabeth
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The Work-Disability Functional Assessment Battery (WD-FAB) is a self-reported measure, developed to allow the SSA to collect systematic and comprehensive information about claimants’ functioning. It consists of eight scales: Basic Mobility, Upper Body Function, Fine Motor Function, Community Mobility, Cognition & Communication, Resilience/Sociability, Social Interactions, and Mood & Emotions. Three studies were conducted to evaluate the WD-FAB and apply it as an outcome measure to examine questions relevant to work disability measurement. "Examining Activity Domain Structure of the International Classification of Functioning, Disability, and Health (ICF)" empirically tests the structure of the WHO’s ICF Activity subdomains by comparing it to the empirical structure of the WD-FAB. The comparison found good alignment between the physical function WD-FAB scales and ICF Mobility; several Activity subdomains converge into Cognition & Communication in the WD-FAB. Mental Functions and certain Interpersonal Interactions converge. A re-organization of the subdomains into distinct, measurable constructs is presented for future ICF revisions. "Who Applies to Social Security Disability Programs? Demographic and Functional Differences among Claimants" examines how Social Security disability claimants compare sociodemographically to the working age US population, assesses differences in claimants’ functional status by demographic characteristics, and showcases a method to detect Differential Item Functioning (DIF), which, once controlled for, minimizes measurement error. 17 items displayed DIF, primarily based upon gender. Claimants were sociodemographically different from the general sample and reported lower functioning. Within claimants, there were very few differences of consequence in function between different sociodemographic groups. "Determining Functional Profiles of Common Conditions explores the relationship between diagnoses and function." Common patterns of diagnoses among claimants were identified: musculoskeletal, cancer, multisystem, neurological & sensory, and mental conditions. Many of the diagnosis groups showed unique functional features. The identification of functional profiles for different condition groups suggests that WD-FAB scores may add value to the disability determination process. There is no single litmus test for work disability, but incorporating self-reported experiences is becoming an increasingly common focus in the field. This work demonstrates how a conceptually grounded self-reported measure of functioning can be used to understand the condition of individuals whose health limits their ability to work.