Functional Assessment for Adults with Disabilities (2019) / Chapter Skim
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4 Integrated Assessment of Work-Related Functional Ability
4 Integrated Assessment of Work-Related Functional Ability
Pages 75-102
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From page 75... ...
Because successful work performance is more than the sum of the individual functions required, the degree of limitation to perform work often exceeds the sum of individual limitations. Comorbidities (e.g., depression and low back pain)
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From page 76... ...
Such integrated assessments are useful for capturing the additive and sometimes multiplicative effects of multiple impairments and comorbid conditions on an individual's functional ability to meet work requirements. Therefore, the most informative evaluation of function may include integrated assessments in addition to specific assessments of body structures and systems.
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From page 77... ...
These performance-based IADL assessments are more commonly used in specific types of clinical settings, such as rehabilitation hospitals, because of the complexity and time intensity of their administration, which in some cases requires an occupational therapist. An individual's ability to perform ADLs and IADLs depends on his or her motor abilities, cognitive abilities, and perceptual and sensory abilities (Mlinac and Feng, 2016)
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From page 78... ...
A meta-analysis focused on elucidating the cognitive processes that underlie IADLs in community-dwelling older adults, including those with mild cognitive impairment, found that 21 percent of variance in IADL capacity was predicted by cognition. General cognitive functioning was found to be important in multiple studies, with executive functioning and memory accounting for more variance than other cognitive domains (Gold, 2012)
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From page 79... ...
, 1 This literature review focused on assessment instruments commonly available to clinicians, and was conducted using standard databases. During the course of the review, the committee found a compilation of ADL and IADL assessments in a standard reference work on assessments (Asher, 2014)
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From page 80... ...
Activities of Daily Living and Work Although little research exists to connect specific assessments of ADLs and IADLs to an individual's ability to return to work, Cancelliere and colleagues (2016) conducted a best-evidence synthesis of 56 systematic reviews judged to have a low risk of bias based on the Scottish Intercollegiate Guidelines Network.
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From page 81... ...
Yet, while many ADL and IADL assessment instruments exist, no one standard assessment can predict whether a person with a given condition or impairment will be able to return to work. Various ADL and IADL assessments may provide information about individuals' ability to meet their personal hygiene needs or manage their medications, for example, but no ADL and IADL assessments correlate directly with the ability to work for all conditions and/or impairments.
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From page 82... ...
INSTRUMENTS AND BANKS OF INSTRUMENTS FOR ASSESSING PHYSICAL AND MENTAL FUNCTION As stated previously, chronic health conditions, along with comorbidities, can manifest differently in terms of work-related functional and disability limitations at the activity and work task levels -- differences in function that are not captured by assessment instruments specific to impairments and body parts or organ systems. This section describes several evidence-based instruments and sets of instruments that can provide integrated information about individuals' overall functional capabilities and limitations and help inform determinations of work disability, although only the Work Disability Functional Assessment Battery (WD-FAB)
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From page 83... ...
. WD-FAB has demonstrated good test-retest reliability in adults with work disability and general adult samples, very high accuracy for physical function, and moderate to strong convergent validity correlations with legacy measures (Chan, 2018a,b)
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From page 84... ...
In summary, WD-FAB has great potential to enhance SSA's methods of obtaining claimants' perspectives on their function in specific domains that correspond closely to the functional criteria used in disability determination decisions, but further research is required. World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)
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From page 85... ...
Toolbox The NIH Toolbox, developed with funding from the NIH Blueprint for Neuroscience Research, is "a comprehensive set of neuro-behavioral measurements that quickly assess cognitive, emotional, sensory, and
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From page 86... ...
This battery yields the following summary scores: cog nitive function composite score, fluid cognition composite score (includes picture sequence memory, list sorting, and pattern com parison measures) , and crystallized cognition composite score (in cludes picture vocabulary and reading recognition measures)
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From page 87... ...
The adult domains include ability to participate in social roles and activities, satisfaction with social roles and activities, anxiety, bowel function, cognitive function, communication, depression,
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From page 88... ...
INSTRUMENTS FOR MEASURING LIMITATIONS IN WORK ACTIVITY DUE TO HEALTH CONDITIONS For workers, a number of self-report instruments examine interruption of work and quantify functional limitations at work due to health conditions that have been related to worker productivity. Many of these instruments were developed by groups in the United States and Europe and have been translated and used globally, often in the area of occupational health and safety research.
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From page 89... ...
Physical demands include strength, stamina, movement, coordination, and flexibility, while output demands include work quantity and quality. The mental-interpersonal demands subscale includes items related to completing cognitive tasks at work as well as social interaction in the work setting.
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From page 90... ...
Work Ability Index (WAI) WAI is a 7-item questionnaire designed to measure the work ability of individuals in an occupational health clinic environment.
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From page 91... ...
While designed for general health-related issues, it has been modified to ascertain the impact on work of various health conditions, including mental health disorders and musculoskeletal pain and related disorders (e.g., Asami et al., 2015; Reilly et al., 2010)
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From page 92... ...
Specific assessment instruments measure physical and mental func tional abilities at the impairment, body part, or organ system level. Integrated assessments can capture the additive and sometimes mul tiplicative effects of multiple impairments and comorbid conditions on individuals' functional abilities.
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From page 93... ...
measures the work ability of a per son in an occupational health clinic environment and predicts early retirement, work disability, absence due to sickness, and mortality.
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From page 94... ...
4-9. Although there is no evidence to support drawing direct inferences from scores on PROMIS, Neuro-QoL, or the NIH Toolbox to em ployability, scores from these instruments may be very useful in understanding the functioning of an applicant.
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From page 95... ...
4-11. Although many instruments that measure limitations in work activ ity due to health conditions assess work function among current workers, they may be of use for previously employed individuals and for those attempting to return to work but continuing to miss time as a result of their health conditions.
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From page 96... ...
2018b. The Work Disability Functional Assessment Battery (WD-FAB)
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From page 97... ...
2012. An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment.
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From page 98... ...
2013a. Conceptual foun dation for measures of physical function and behavioral health function for Social Security work disability evaluation.
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2018. Improving assessment of work related mental health function using the Work Disability Functional Assessment Battery (WD-FAB)
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2013. Development of a computer-adaptive physical function instrument for Social Security Administration disability determination.
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2014. NIH Toolbox Cognition Battery (NIHTB-CB)
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From page 102... ...
2013. Cognition assessment using the NIH Toolbox.
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