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. Example: Lumbar Disc Herniation
    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 (occupation specific)
    2. Example: Difficulty waiting tables
    3. Classifications (e.g. behavior, communication, personal care, locomotion, dexterity, skill)
    4. See Disability Evaluation
  3. 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
  2. Elderly
  3. Low socioeconomic group
  4. Children living in poverty
  5. Female headed households

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. Maness (2015) Am Fam Physician 91(2): 102-9 [PubMed]
  5. McGrail (2001) Am Fam Physician 63(4):679-84 [PubMed]

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Related Studies

Ontology: Disability (C0231170)

Definition (HL7V3.0) <p>A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.</p>
Definition (MEDLINEPLUS)

Disabilities make it harder to do normal daily activities. They may limit what you can do physically or mentally, or they can affect your senses. Disability doesn't mean unable, and it isn't a sickness. Most people with disabilities can - and do - work, play, learn, and enjoy full, healthy lives. Mobility aids and assistive devices can make daily tasks easier.

About one in every five people in the United States has a disability. Some people are born with one. Others have them as a result of an illness or injury. Some people develop them as they age. Almost all of us will have a disability at some point in our lives.

Department of Health and Human Services
Definition (NCI) Any physical or mental impairment that interferes with an individual's ability to perform desired activities.
Concepts Finding (T033)
SnomedCT 138363006, 161049007, 21134002
HL7 DIS
English Disability NOS, disabilities, disability, Disabilities, Disability NOS (finding), DISABILITY, Disability, Disability (finding), Disability, NOS
Italian Disabilità, Disabilità NAS
Dutch invaliditeit NAO, invaliditeit
French Handicap SAI, Incapacité
German Behinderung NNB, Behinderungen
Portuguese Invalidez NE, Incapacidade
Spanish Discapacidad NEOM, discapacidad, SAI, discapacidad, SAI (hallazgo), discapacidad (hallazgo), discapacidad, Discapacidad
Japanese 障害者, 障害者ＮＯＳ, ｼｮｳｶﾞｲｼｬ, ｼｮｳｶﾞｲｼｬNOS
Czech Postižení, Postižení NOS
Hungarian Rokkantság, Rokkantság k.m.n.
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: handicapping condition (C0231172)

Concepts Finding (T033)
SnomedCT 29962006
HL7 0295
Dutch handicap
French Handicap
German Handicap
Italian Handicap
Portuguese Handicap
Spanish Minusvalía, defecto, handicap, incapacidad (hallazgo), incapacidad, minusvalía
Japanese ハンディキャップのある人, ﾊﾝﾃﾞｨｷｬｯﾌﾟﾉｱﾙﾋﾄ
Czech Omezená schopnost
English handicap, handicaps, handicapping, Handicap, Handicap (finding), handicapping condition, Handicaps, Infirmity
Hungarian Fogyatékosság
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Sick Leave (C0242807)

Definition (MSH) An absence from work permitted because of illness or the number of days per year for which an employer agrees to pay employees who are sick. (Webster's New Collegiate Dictionary, 1981)
Concepts Idea or Concept (T078)
MSH D018582
English Leave, Sick, Sick Leave, sick leave, Sick leave
French Arrêt maladie, Congé de maladie, Absence pour maladie, Arrêt de travail, Congé maladie
Swedish Sjukfrånvaro
Czech pracovní neschopnost
Finnish Sairausloma
Russian BOL'NICHNYE DNI, OTPUSK PO BOLEZNI, OTPUSK PO NETRUDOSPOSOBNOSTI, БОЛЬНИЧНЫЕ ДНИ, ОТПУСК ПО БОЛЕЗНИ, ОТПУСК ПО НЕТРУДОСПОСОБНОСТИ
Japanese 休職-病気, 休業-病気, 無気力休業, 病気休業日, 病気欠勤日, 病気休暇, 病気休業
Croatian BOLOVANJE
Polish Zwolnienie chorobowe
Norwegian Sykefravær, Sykepermisjon
German Fehlen wegen Krankheit, Fehlen wegen Arbeitsunfähigkeit
Italian Congedo per malattia
Dutch Ziekteverzuim
Portuguese Licença Médica
Spanish Ausencia por Enfermedad
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Impaired health (C0684336)

Concepts Pathologic Function (T046)
SnomedCT 40226000
LNC MTHU029814
English Impaired health, health impairment, health impaired, impaired health, health impairments, Impairments, Impairment, Impairment (finding), Health Impairments, impairment
Spanish daño, debilitamiento, deterioro (hallazgo), deterioro, injuria física
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Disability

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