Interpreting physical and behavioral health scores from new work disability instruments

The role of physical and cognitive/emotional functioning in the associations between common health conditions and working

The degree to which functional abilities explain the negative associations between chronic disease and employment is not well understood. If functional limitations play an important role, then increasing access to accommodations and rehabilitation could facilitate employment among people with chronic illness. If not, other barriers related to living with chronic illness may be at play, calling for other interventions. The goal of this study was to 1) assess how health conditions were associated with employment for adults ages 30-69, and 2) test how much of these illness-employment associations was explained by physical and cognitive/emotional functioning. We fielded the state-of-the-art Work Disability Functional Assessment Battery (WD-FAB) in the nationally-representative RAND American Life Panel (N = 1774) in 2020, stratifying the sample by age and educational attainment. We found that mental health conditions, nervous system/sensory conditions, and cardiovascular conditions were significantly associated with large reductions in the probability of working, at -8, -10, and -19 percentage points (pp) respectively, while there were no significant associations for other conditions. Functional abilities were positively associated with employment to different degrees depending on education. Among those without college degrees, physical functioning (+16 pp) but not cognitive/emotional functioning was significantly associated with working. Among those with college degrees, both physical (+6 pp) and cognitive/emotional (+4 pp) functioning were associated with working. Older workers (ages 51-69) showed a larger association between physical functioning and work with no association between cognitive/emotional functioning and work. Importantly, accounting for functioning reduced the negative associations with employment for mental health and nervous system/sensory conditions but not for cardiovascular conditions. This implies that, for the former conditions, accommodating functional limitations could promote greater employment. However, broader accommodations, such as paid sick leave, increased control over work schedules, and other improvements to working conditions may be necessary to reduce work exits due to cardiovascular conditions.

Linking job duties, functioning, and employment status using the Work-Disability Functional Assessment Battery (WD-FAB): An expert coding and quantitative analysis

BACKGROUND

An understanding of the link between specific occupational demands and individual worker functioning is limited, although such information could permit an assessment of the fit between the two in a manner that would inform national and state disability programs such as vocational rehabilitation and Social Security disability programs.

OBJECTIVE

Our goal was to examine the utility of assessing physical and mental functioning relative to self-reported job duties to identify the domains of worker functioning most likely to create barriers to fulfilling an occupation's specific requirements.

METHODS

Through primary survey data collection, 1770 participants completed the Work-Disability Functional Assessment Battery (WD-FAB) instrument after reporting details on their occupations (or most recent occupation if not working). Expert coders evaluated the level of function expected to successfully carry out each self-reported job duty with respect to six scales of physical and mental function. Quantitative analysis is used to examine the relationship between functioning and job duties.

RESULTS

Those not working due to disability were more likely to fall short of the threshold of the physical and mental functioning requirements of their last job's three main job duties compared to those currently employed. Mental function scales were most likely to be the area experiencing a shortfall.

CONCLUSIONS

Functional difficulties impede the ability to continue working in particular jobs that require that ability. This points to a need for specific accommodations to be implemented to bridge the gap between job requirements and functional capacity so that workers may remain engaged in their current work.

Identifying Clinically Relevant Functional Strata to Direct Mobility Preservation among Patients Hospitalized with Medical Conditions

OBJECTIVE

To develop a system to guide interpretation of scores generated from the newly developed item response theory (IRT)-based, multi-dimensional computer adaptive test (FAMCAT) which assesses three important domains of function: mobility, daily activities, and applied cognition.

DESIGN

Cross-sectional data used to inform a modified-Delphi approach to establish FAMCAT cut points delineating various functional ability levels.

SETTING

Large Midwestern academic teaching hospital PARTICIPANTS: 2049 patients hospitalized to an inpatient medical service INTERVENTION: Not applicable.

MAIN OUTCOME MEASURES

FAMCAT Basic Mobility, Daily Activity, and Applied Cognition scores RESULTS: IRT-based score estimation data was successfully integrated with expert clinical feedback using a modified-Delphi process to arrive at consensus yielding 4 functional level strata (ranging from bed-based mobility to independent mobility) for both the FAMCAT Mobility and Daily Activity scales; 1 cut-point was supported to delineate two functional strata for Applied Cognition.

CONCLUSIONS

Meaningful cut-points were established for each FAMCAT domain using a data-informed, modified-Delphi process for achieving consensus. The resulting FAMCAT interpretation guide may be used to develop an ability-matched mobility preservation program and identify patients who may require a higher level of supervision based on the resulting FAMCAT scores.

Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers

The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure developed to assess social participation in adult burn survivors. This study identified numeric score cut-points that define different levels of social participation ability and described each level. An expert panel identified numeric score cut-points that distinguish different levels of social participation for the six LIBRE Profile domains. Methods employed an iterative, modified-Delphi approach, and bookmarking to review calibrated item banks. Analyses (using calibration sample data and repeated in a validation sample) examined means, SDs, and sample distributions for each level. Analyses of variance examined score differences between levels. The panel developed descriptions for each established level. Initial cut-points resulted in four levels for five domains (Social Activities, Social Interactions, Romantic Relationships, Sexual Relationships, and Work & Employment) and five levels for the sixth domain (Relationships with Family & Friends). Comparisons demonstrated significant differences between level mean scores for all domains (P < .05) except Relationships with Family & Friends. Based on follow-up surveys, Relationships with Family & Friends score cut-points were adjusted to identify four levels with significant score differences between all levels. Panelists reached consensus for level descriptions. Score cut-points and descriptions identify different levels of social participation, providing a relevant context for interpreting LIBRE Profile numeric scores. LIBRE Profile Social Participation levels will help clinicians and persons with burn injury interpret LIBRE Profile numeric scores and promote use of this important new assessment.

Development and initial validation of ability levels to interpret pediatric spinal cord injury activity measure and pediatric measure of participation scores

PURPOSE

To develop ability levels and descriptions to interpret Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI AM) and Pediatric Measure of Participation (PMoP) scores.

METHODS

Mixed-methods approach to 1.) create item maps using PEDI-SCI AM and PMoP calibration data; 2.) employ bookmarking methods and an iterative consensus process including semi-structured interviews, focus groups and surveys to establish PEDI-SCI AM and PMoP level score cut-points and descriptions; 3.) use calibration sample data to examine mean score differences across levels [analyses of variance (ANOVAs)] and assess the sample distribution (%) across levels; 4.) repeat in a separate validation sample; 5.) develop level descriptions. Throughout the mixed methods approach, the sample participants include children with spinal cord injury (SCI), parents of children with SCI, and professionals who work with children with SCI.

RESULTS

Four or five ability levels were identified for each PEDI-SCI AM and PMoP domain along with descriptions for each level. ANOVA results revealed significant overall differences for level mean scores and pairwise comparisons (p < 0.05). Consensus (>80%) was achieved for all PEDI-SCI AM and some PMoP level descriptions.

CONCLUSION

PEDI-SCI AM and PMoP score cut-points identify different levels of activity and participation among children with SCI. These levels and descriptions provide clinical relevance for PEDI-SCI and PMoP numeric scores.

Identifying Work Capacity and Promoting Work: A Strategy for Modernizing the SSDI Program

The Social Security Disability Insurance (SSDI) program, which provides income support to individuals who become unable to work because of a disability, has not been substantially reformed since the 1980s, despite sweeping changes in health, medical technology, and the functional requirements of jobs. I review how the SSDI program works, its history in terms of caseloads and reforms, and findings from the research evidence that offer lessons for the future. I then propose two interlocking reforms that would modernize the core functions of the program. The first is to improve SSDI's process for determining whether an applicant has remaining capacity to work by replacing the outdated medical-vocational "grid" with a new system of individual work capacity measurement. Second, I propose the introduction of partial disability benefits, which would make use of the new system for measuring work capacity, and allow beneficiaries to combine benefit receipt with work. Partial benefits could be paired with a generalized benefit offset to further encourage work by beneficiaries, and the Social Security Administration's complex array of work-related rules could be eliminated.

Measuring Work Related Physical and Mental Health Function: Updating the Work Disability Functional Assessment Battery (WD-FAB) Using Item Response Theory

OBJECTIVE

To further improve measurement of work-related physical and mental health by updating the Work Disability Assessment Battery (WD-FAB).

METHODS

Cross-sectional study with 1024 disability claimants and 1000 working age (21 to 66 years) adults in the United States. Developed new items to replenish the WD-FAB and analyzed using factor analysis and item response theory (IRT). Computer adaptive testing (CAT) simulations evaluated the psychometric properties of the original versus updated WD-FAB.

RESULTS

Analyses confirmed the structure of the WD-FAB. Twenty-three new items were added (basic mobility: 7, upper body function: 4, fine motor: 6, self-regulation: 1, resilience & sociability: 5 items).

CONCLUSIONS

Findings support the WD-FAB as a robust, psychometrically sound assessment of work-related function. Extensive content coverage (331 items) represents eight physical and mental health domains. IRT/CAT methods allow administration in under 15 minutes. The WD-FAB may prove valuable for efficiently characterizing work-related function across work rehabilitation settings.

Validation of the Work-Disability Physical Functional Assessment Battery

OBJECTIVE

To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation called the Physical Work Performance Evaluation (PWPE).

DESIGN

Cross-sectional.

SETTING

Outpatient rehabilitation.

PARTICIPANTS

Adults (N=50) participating in physical therapy for musculoskeletal conditions.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Patients completed the PWPE and the WD-FAB physical function scales including Changing and Maintaining Body Position, Whole Body Mobility, Upper Body Function, and Upper Extremity Fine Motor. The physical therapist also answered the WD-FAB questions on the patient's physical functioning. The WD-FAB computer-adaptive test version administered up to 10 items for each scale. The PWPE produces ratings from 0 to 5 indicating overall Level of Work ability: 0 (unable to work); 1 (sedentary); 2 (light); 3 (medium); 4 (heavy); 5 (very heavy). The PWPE also produces Level of Work ability ratings in the Dynamic Strength, Position Tolerance, and Mobility subsections.

RESULTS

Participating in the study were 50 patients with 1 or more conditions (shoulder, n=21; knee, n=16; low back, n=13; ankle/foot, n=10; neck, n=8; hip, n=7). The patient-based WD-FAB scores demonstrated moderate, statistically significant correlations with the provider proxy WD-FAB report (R=.49-.65). The WD-FAB Upper Body Function scale scores demonstrated moderate strength relationships with the PWPE overall ratings. The Whole Body Mobility and Changing and Maintaining Body Position scales did not demonstrate statistically significant relationships with the PWPE overall ratings.

CONCLUSIONS

We found moderate evidence for validity for the WD-FAB Upper Body Function, Whole Body Mobility, and Changing and Maintaining Body Position scales relative to clinician report and varied evidence relative to the PWPE in this clinical sample.

Improving Assessment of Work Related Mental Health Function Using the Work Disability Functional Assessment Battery (WD-FAB)

Purpose To improve the mental health component of the Work Disability Functional Assessment Battery (WD-FAB), developed for the US Social Security Administration's (SSA) disability determination process. Specifically our goal was to expand the WD-FAB scales of mood & emotions, resilience, social interactions, and behavioral control to improve the depth and breadth of the current scales and expand the content coverage to include aspects of cognition & communication function. Methods Data were collected from a random, stratified sample of 1695 claimants applying for the SSA work disability benefits, and a general population sample of 2025 working age adults. 169 new items were developed to replenish the WD-FAB scales and analyzed using factor analysis and item response theory (IRT) analysis to construct unidimensional scales. We conducted computer adaptive test (CAT) simulations to examine the psychometric properties of the WD-FAB. Results Analyses supported the inclusion of four mental health subdomains: Cognition & Communication (68 items), Self-Regulation (34 items), Resilience & Sociability (29 items) and Mood & Emotions (34 items). All scales yielded acceptable psychometric properties. Conclusions IRT methods were effective in expanding the WD-FAB to assess mental health function. The WD-FAB has the potential to enhance work disability assessment both within the context of the SSA disability programs as well as other clinical and vocational rehabilitation settings.