Disability

Aka: Disability, Impairment, Sick Leave, Handicap, Handicapping Condition

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II. Definitions

  1. Impairment (Objective Physiologic Deficit)
    1. Loss of anatomic, physiologic or psychologic function as defined by medical evaluation
    2. Examples: loss of range of motion of a specific joint, or Hemiplegia of a limb
    3. Classifications (e.g. intellectual, language, psychological, ocular, visceral, skeletal, generalized, sensory)
    4. See Impairment Evaluation
  2. Disability (Subjective Functional Deficit)
    1. Activities limited by Impairment, and requiring participation restrictions (esp. occupation specific)
    2. Example: Difficulty waiting tables
    3. Classifications (e.g. behavior, communication, personal care, locomotion, dexterity, skill)
    4. See Disability Evaluation
  3. Activity Limitation
    1. Difficulty perfoming a specific action or activity (e.g. holding a hammer, Transferring out of bed)
  4. Participation Restriction
    1. Person is unable to fully participate in a life situation (e.g. perform work duties, Activities of Daily Living, independent living)
  5. Handicap (Social or Environmental Consequences)
    1. Impairment limits role fulfillment
    2. Example: Wheelchair, van or Handicapped access required
    3. Classifications (e.g. Physical independence, mobility, occupation, social integration)

III. Epidemiology

  1. Americans with ongoing disabling condition: 56.7 million (2013) and >25% of population
    1. Severe Disability in 38.3 Million adults and 2.6 Million children
  2. Social security administration Disability benefits
    1. New applications per year: 2.5 Million
    2. Disabled workers with benefits in 2012: 8.8 million
    3. Most common disabilities
      1. Back or spine conditions
      2. Arthritis
      3. Heart conditions
    4. Most common limitations
      1. Inability to walk three city blocks
      2. Inability to climb a flight of stairs

IV. Risk Factors: Groups with disproportionately greater Disability

  1. Minority ethnic group
    1. Non-hispanic Black
    2. Native American
    3. Alaska Native
  2. Elderly
  3. Low socioeconomic group
  4. Children living in poverty
  5. Female headed households
  6. High risk occupation for injury
    1. Laborer
    2. Truck Driver
    3. Custodians, Cleaners and Janitors
    4. Nursing Assistants

V. Risk Factors: Predictors of prolonged recovery

  1. Behaviors
    1. Disability out of proportion to diagnosis
    2. Exaggerated pain behavior or history of Somatization
  2. Family factors
    1. Dysfunctional family
    2. Family History of prolonged Disability
  3. Comorbid conditions
    1. Substance Abuse
    2. Major Depression
  4. Workplace Difficulties
    1. Occupational dissatisfaction
    2. Difficulties with coworkers
    3. Financial or legal hardships

VI. Evaluation

  1. See Disability Evaluation
  2. See Functional Capacity Evaluation

VII. Precautions: Implicit Bias Related to Disability

  1. Avoid combining or confusing physical Disability with Intellectual Disability
    1. Start with the assumption that the patient can make decisions and communicate
  2. Avoid attributing acute complaints to the underlying Disability
    1. Evaluate with a complete differential diagnosis
    2. Evaluation is informed by the underlying conditions as with any patient with comorbidities
  3. Recognize that physical barriers may be much less restrictive for patients than societal barriers
    1. For example, deaf patients can communicate fully, as long as they have Deafness accommodations
  4. Choose a patient's preferred term
    1. Avoid "Handicapped" and prefer "acessible" to describe accommodations
    2. Use "Wheelchair User" instead of "Wheelchair bound"
    3. Avoid terms "suffering from" and "afflicted with"
  5. Ask how a patient wishes to transfer
    1. Do they wish to have assistance or to do this on their own

VIII. Management

  1. See Disability Management
  2. See Assistive Technology
  3. See Letter of Medical Necessity
  4. See Disability Referral

IX. References

  1. (1997) Can Med Assoc J 156:680A-C [PubMed]
  2. Barron (2001) Am Fam Physician 64(9): 1579-86 [PubMed]
  3. Derebry (1983) J Occup Med 25:829-35 [PubMed]
  4. Evensen (2023) Am Fam Physician 107(5): 490-8 [PubMed]
  5. Maness (2015) Am Fam Physician 91(2): 102-9 [PubMed]
  6. McGrail (2001) Am Fam Physician 63(4):679-84 [PubMed]

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