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Pages 1-12

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From page 1...
... by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." SSA uses a uses a five-step sequential process to determine whether an adult applicant meets this definition. The agency gathers information, including functional information, from the applicant, relevant health care providers, and third parties about the applicant's 1 With the exception of Box S-2, this summary does not include references.
From page 2...
... The committee's Statement of Task is presented in Box S-1. STUDY APPROACH AND SCOPE The committee conducted an extensive review of the literature pertaining to functional assessment of physical and mental abilities relevant to work requirements, as well as the literature specific to assessment of function and impairment trajectories in individuals with back disorders, cardiac impairments, depression, and traumatic brain injury (TBI)
From page 3...
... functional abilities relevant to work requirements as defined by the U.S. Bureau of Labor Statistics' Occupational Requirements Survey (ORS)
From page 4...
... •  xplain how limitations in functional abilities relevant to work require E ments are more or less associated with particular mental or physical impairments; • dentify particular medical specialties and allied health fields that are likely I to have the training and expertise to perform functional assessments related to work requirements; • dentify tools that signify a functional assessment was performed, and I how likely those reports are to be valid representations of a claimant's functional limitations; • n the context of disability assessment, describe the spectrum of changes I to functional abilities relevant to work requirements related to the progres sion of common disease processes in example impairments. These could include, but are not limited to, back disorders, cardiac impairments, or depression.
From page 5...
... The committee's framework provides a way of conceptually organizing various sources of information and specific types of tools for assessing function. For example, medical records may provide information about an individual's particular health condition and its manifestation in body function and structure, while computer adaptive testing may yield information FIGURE S-1 A conceptual framework for functional assessment of an individual's capacity for work.
From page 6...
... Also reviewed were a variety of instruments for assessing specific physical and mental functional abilities relevant to work requirements. Third, the committee explored the spectrum of changes in work-related functional abilities that may occur during the progression of the four selected impairments (back disorders, cardiac impairments, depression, and TBI)
From page 7...
... an individual's health condition places on his or her ability to function and participate fully in society. In keeping with these models, assessment of individuals' functional abilities relevant to work requirements is an important part of determining whether they are able to meet workplace demands and sustain work performance on a regular and continuing basis.
From page 8...
... Qualitative data provided by applicants, family members, and other key sources who are sufficiently familiar with the applicant's activities, health, and functional status, in combination with a review of medical evidence, complement quantitative information that serves as the basis for disability decisions. The use of measures based on item response theory that can be administered using computer adaptive testing can decrease respondent burden by reducing survey length and administration time while minimizing measurement error.
From page 9...
... Available instruments, whether based on performance, self-report, or proxy, are useful individually, but their value may be increased when different types of instruments are combined to provide a fuller picture of an individual's ability to sustain work on a regular and continuing basis, especially when they can be repeated over time. In addition, "integrated" assessment measures that provide information regarding the integrated effect of individuals' impairments on general daily life and participation 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.
From page 10...
... •  Successful work performance is more than the sum of the spe cific tasks and skills required, and the overall limitation to suc cessful work for an individual is often more than the sum of single impairments. •  hreats to the validity of assessments of functional abilities T include testing of maximal versus typical performance, assess ment of episodic activity versus sustained task performance, absence of standardized testing conditions, mixed-motive incen tives, compromised test integrity owing to prior use of the test in low-stakes testing applications, and diverse test populations on whom tests may not have been validated.
From page 11...
... that are valid and potentially useful, may not be readily available because an individual may be uninsured or underinsured, or the tests may be denied by an insurance plan because they are not deemed medically necessary. Disparities in access to care and consequently poor health outcomes can affect not only the quantity of tests conducted in the context of disability determinations but also the quality of the tests and resulting information.


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