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]
Images: Related links to external sites (from Bing)
Related Studies
| 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. |
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 |
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 |
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 |
