Disability

1. Definitions
   1. Impairment (Objective Physiologic Deficit)
      1. Loss of anatomic, physiologic or psychologic function as defined by medical evaluation
      2. Example: Lumbar Disc Herniation
   2. Disability (Subjective Functional Deficit)
      1. Activities limited by Impairment
      2. Example: Difficulty waiting tables
2. Epidemiology
   1. Americans with ongoing disabling condition: 49 million
   2. Disability preventing work or school in U.S.: 9 million
3. 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
4. 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
5. Evaluation
   1. See Disability Evaluation
6. Management
   1. See Disability Management
   2. See Assistive Technology
   3. See Letter of Medical Necessity
   4. See Disability Referral
7. References
   1. (1997) Can Med Assoc J 156:680A-C
   2. Barron (2001) Am Fam Physician 64(9): 1579-86
   3. Derebry (1983) J Occup Med 25:829-35
   4. McGrail (2001) Am Fam Physician 63(4):679-84