II. Definitions
- Impairment (Objective Physiologic Deficit)
- Loss of anatomic, physiologic or psychologic function as defined by medical evaluation
- Examples: loss of range of motion of a specific joint, or Hemiplegia of a limb
- Classifications (e.g. intellectual, language, psychological, ocular, visceral, skeletal, generalized, sensory)
- See Impairment Evaluation
- Disability (Subjective Functional Deficit)
- Activities limited by Impairment, and requiring participation restrictions (esp. occupation specific)
- Example: Difficulty waiting tables
- Classifications (e.g. behavior, communication, personal care, locomotion, dexterity, skill)
- See Disability Evaluation
- Activity Limitation
- Difficulty perfoming a specific action or activity (e.g. holding a hammer, Transferring out of bed)
- Participation Restriction
- Person is unable to fully participate in a life situation (e.g. perform work duties, Activities of Daily Living, independent living)
- Handicap (Social or Environmental Consequences)
- Impairment limits role fulfillment
- Example: Wheelchair, van or Handicapped access required
- Classifications (e.g. Physical independence, mobility, occupation, social integration)
III. Epidemiology
- Americans with ongoing disabling condition: 56.7 million (2013) and >25% of population
- Severe Disability in 38.3 Million adults and 2.6 Million children
- Social security administration Disability benefits
- New applications per year: 2.5 Million
- Disabled workers with benefits in 2012: 8.8 million
- Most common disabilities
- Back or spine conditions
- Arthritis
- Heart conditions
- Most common limitations
- Inability to walk three city blocks
- Inability to climb a flight of stairs
IV. Risk Factors: Groups with disproportionately greater Disability
- Minority ethnic group
- Non-hispanic Black
- Native American
- Alaska Native
- Elderly
- Low socioeconomic group
- Children living in poverty
- Female headed households
- High risk occupation for injury
- Laborer
- Truck Driver
- Custodians, Cleaners and Janitors
- Nursing Assistants
V. Risk Factors: Predictors of prolonged recovery
- Behaviors
- Disability out of proportion to diagnosis
- Exaggerated pain behavior or history of Somatization
- Family factors
- Dysfunctional family
- Family History of prolonged Disability
- Comorbid conditions
- Workplace Difficulties
- Occupational dissatisfaction
- Difficulties with coworkers
- Financial or legal hardships
VI. Evaluation
VII. Precautions: Implicit Bias Related to Disability
- Avoid combining or confusing physical Disability with Intellectual Disability
- Start with the assumption that the patient can make decisions and communicate
- Avoid attributing acute complaints to the underlying Disability
- Evaluate with a complete differential diagnosis
- Evaluation is informed by the underlying conditions as with any patient with comorbidities
- Recognize that physical barriers may be much less restrictive for patients than societal barriers
- For example, deaf patients can communicate fully, as long as they have Deafness accommodations
- Choose a patient's preferred term
- Avoid "Handicapped" and prefer "acessible" to describe accommodations
- Use "Wheelchair User" instead of "Wheelchair bound"
- Avoid terms "suffering from" and "afflicted with"
- Ask how a patient wishes to transfer
- Do they wish to have assistance or to do this on their own
VIII. Management
IX. References
- (1997) Can Med Assoc J 156:680A-C [PubMed]
- Barron (2001) Am Fam Physician 64(9): 1579-86 [PubMed]
- Derebry (1983) J Occup Med 25:829-35 [PubMed]
- Evensen (2023) Am Fam Physician 107(5): 490-8 [PubMed]
- Maness (2015) Am Fam Physician 91(2): 102-9 [PubMed]
- McGrail (2001) Am Fam Physician 63(4):679-84 [PubMed]