Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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2 Diagnosis, Evaluation, and Disability
2 Diagnosis, Evaluation, and Disability
Pages 31-48
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From page 31... ...
The committee also addresses considerations in the use of diagnostic and evaluative tests to assess children. DIAGNOSING HEALTH CONDITIONS In the context of disability, an individual's diagnosis is relevant because, as stated in Chapter 1, to receive Social Security Administration (SSA)
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From page 32... ...
An echocardiogram measures ejection fraction in patients in heart failure and helps clinicians distinguish between reduced versus preserved ejection fraction, which is needed for a proper diagnosis; the test also measures the level of left heart impairment by quantifying the ejection fraction (Hajouli and Ludhwani, 2022)
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From page 33... ...
For example, an echocardiogram measures functioning at the level of a body part, while the 6-minute walk test measures limitations at the level of a person's activity of walking. The 6-minute walk test does not diagnose the etiology of exercise intolerance or the source of dyspnea but can be used to evaluate before and after treatments or interventions (Crapo et al., 2002)
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. In addition, when considering diagnostic testing options, the potential harm from the procedure itself needs to be weighed against the potential information that could be gained.
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An RFC assessment is based primarily on medical evidence but may also include an observation or description of limitations; it describes what an individual is able to do, despite functional limitations resulting from a medically determinable impairment(s) and impairment-related symptoms, and is an administrative determination of an individual's capacity to perform work-related physical and mental activities (excerpted from SSA, 2023)
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, the evaluation of whole person function reflects a more robust way to examine the collective effects of these conditions. A later section, Functional Capacity and Performance, elaborates on how functional status is affected by the presence of multiple impairments in one or multiple organ systems as well as personal and environmental contextual factors (Anner et al., 2012; NASEM, 2019)
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. For comprehensive information about many of these performance-based measures and the various types of functional assessment instruments used in disability assessments, the committee refers readers to NASEM (2019)
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Patient-reported measures are commonly used to have individuals assess their pain and function and have also been used to measure or approximate individuals' functional status. Dedicated patient-reported functional measures exist for nearly all body regions and conditions.
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From page 39... ...
Social Determinants of Health and Disability In considering disability, understanding what the person is able to do in their typical environment and how the person is able to perform tasks can be more illustrative than objective measures of capacity that eliminate actual environmental and personal factors. Evaluative tests that measure a person's ability to perform tasks without environmental controls more accurately reflect that individual's ability to perform tasks than assessments
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. Taken together, the personal and environmental facilitators of and barriers to carrying out functional tasks are considered contextual factors by the International Classification of Functioning, Disability and Health (ICF)
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Even when two people are diagnosed with the same health conditions, they may have experienced vastly different social determinants of health and circumstances, and, as such, their associated disabilities may be markedly different. CONSIDERATIONS IN THE USE OF DIAGNOSTIC AND EVALUATIVE TESTS TO ASSESS CHILDREN As described in Chapter 1, to qualify for disability a child must have "a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and 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, 2022b)
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Notably, some of these skills, while primarily gross or fine motor tasks, may also require visual acuity and cognitive skills. Because of the expected developmental trajectory in childhood, instruments that assess functioning need to take into account the expected developmental stage for norming purposes.
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. Similarly, many adult functional assessment tools are not appropriate for children and have not been validated for use in children.
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2017. Construct validity of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)
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2005. A com parison of developmental versus functional assessment in the rehabilitation of young children.
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2010. Include a social determinants of health approach to reduce health inequities.
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From page 47... ...
to the International Classification of Function. Pediatric Physical Therapy 30(2)
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