Selected Health Conditions and Likelihood of Improvement with Treatment (2020) / Chapter Skim
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medi cal conditions for adults in the categories of mental health dis orders (such as depressive disorders, anxiety disorders, attention deficit/hyperactivity disorder) , cancers (such as breast, skin, thy roid)
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SSDI provides disability benefits to working-age Americans who are no longer able to work due to a disabling medical condition or terminal illness. SSI provides income assistance for disabled, blind, and aged people with limited income and resources regardless of their prior participation in the labor force.
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Several disorders required additional searches to include randomized controlled trials, if there were a limited number of systematic reviews or meta-analyses. COMMITTEE'S CONCEPTUALIZATION OF DISABILITY AND FUNCTION The committee members considered the issue of general medical improvement versus functional improvement, as disability models have expanded beyond a one-dimensional conception of medical conditions as the sole determinants of disability.
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DISABLING MEDICAL CONDITIONS AND LIKELIHOOD OF IMPROVEMENT WITH TREATMENT The committee chose to examine disabling medical conditions within the categories of cancer, mental health, and musculoskeletal disorders to carry out the Statement of Task. The following sections summarize the committee's conclusions by disease category.
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rearrangements. Patients' ultimate survival varies dramatically based on the treatments available for the specific cancer sites, the stage of the disease, cell types, molecular and genomic markers, and the individual patient characteristics, including the presence of comorbid disease and the patient's
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, more so than the cancer site and stage, is an appropriate indicator of whether the patient's functional status should be assessed for improvement. If a patient's cancer achieves complete remission, functional status improvement is probable, and it is reasonable to evaluate the patient's functional status 12 months after achieving complete remission; if the cancer achieves stable partial remission, then functional status improvement is possible, and it is also reasonable to evaluate functional status 12 months after achieving stable partial remission; if the patient has no response to treatment or experiences progression of disease, then functional improvement is unlikely.
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. People diagnosed with a mental health disorder are directed to a specific treatment depending on clinical practice treatment guideline recommendations, their treatment history, their treatment preference, and treatment availability, among other factors.
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Fourth, psychiatric disorders generally occur with other psychiatric disorders, chronic pain, and medical conditions, and time to improvement will depend on those and other factors. Any estimates of time to improvement needs to consider the fact that clinical trials generally exclude participants with comorbidities.
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Based on the committee's clinical expertise and knowledge of the medical and research literature on musculoskeletal disorders, the committee determined that those disorders encompass the most disabling musculoskeletal conditions and that although rheumatoid arthritis and psoriatic arthritis are classified by SSA as "immune disorders," their most common -- and, in many cases, most disabling -- manifestation is inflammation of the joints leading to joint destruction and deformity. The committee thus decided that those conditions merited consideration as leading causes of musculoskeletal impairment.
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Other factors associated with worse functional outcomes are co-existing medical and psychiatric conditions and other chronic pain conditions. In addition, the overuse of biomedical approaches to treat chronic low back pain (e.g., opioids and spine surgery)
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Effective treatments exist for rheumatoid arthritis and psoriatic arthritis, and the number of treatment options has expanded significantly in recent years as newer biologic agents have been approved. Because physical functioning is commonly assessed as a secondary outcome in trials of rheumatoid arthritis and psoriatic arthritis therapies, there is more evidence available about the impacts of specific treatments on functional capacity than for many of the other disabling medical conditions considered here.
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