Design and Validation of a Methodology Using the International Classification of Diseases, 9th Revision, to Identify Secondary Conditions in People With Disabilities


      Chan L, Shumway-Cook A, Yorkston KM, Ciol MA, Dudgeon BJ, Hoffman JM. Design and validation of a methodology using the International Classification of Diseases, 9th Revision, to identify secondary conditions in people with disabilities.


      To design and validate a methodology that identifies secondary conditions using International Classification of Disease, 9th Revision (ICD-9) codes.


      Secondary conditions were identified through a literature search and a survey of Washington State physiatrists. These conditions were translated into ICD-9 codes and this list was then validated against a national sample of Medicare survey respondents with differing levels of mobility and activities of daily living (ADL) disability.


      National survey.


      Participants (N=9731) in the 1999 Medicare Current Beneficiary Survey with no, mild, moderate, and severe mobility and ADL disability.


      Not applicable.

      Main outcome measure

      Percentage of survey respondents with a secondary condition. The secondary conditions were grouped into 4 categories: medical, psychosocial, musculoskeletal, and dysphagia related (problems associated with difficulty in swallowing).


      Our literature search and survey of 26 physiatrists identified 64 secondary conditions, including depression, decubitus ulcers, and deconditioning. Overall, 70.4% of all survey respondents were treated for a secondary condition. We found a significant relation between increasing mobility as well as ADL disability and increasing numbers of secondary conditions (χ2 test for trend, P<.001). This relation existed for all categories of secondary conditions: medical (χ2 test for trend, P<.001), psychosocial (χ2 test for trend, P<.001), musculoskeletal (χ2 test for trend, P<.001), and dysphagia related (χ2 test for trend, P<.001).


      We created a valid ICD-9–based methodology that identified secondary conditions in Medicare survey respondents and discriminated between people with different degrees of disability. This methodology will be useful for health services researchers who study the frequency and impact of secondary conditions.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Healthy People 2010. Centers for Disease Control and Prevention, National Institute on Disability and Rehabilitation Research, US Department of Education, Washington (DC)2000 (ch 6. Available at Accessed: December 24, 2004)
        • Marge M.
        Health promotion for persons with disabilities.
        Am J Health Promotion. 1988; 2: 29-44
      2. Pope A. Tarlov A.R. Disability in America toward a national agenda for prevention. Natl Acad Pr, Washington (DC)1991
        • Campbell M.L.
        • Sheets D.
        • Strong P.S.
        Secondary health conditions among middle-aged individuals with chronic physical disabilities.
        Assist Technol. 1999; 11: 105-122
        • Gajdosik C.G.
        • Cicirello N.
        Secondary conditions of the musculoskeletal system in adolescents and adults with cerebral palsy.
        Phys Occup Ther Pediatr. 2001; 21: 49-68
        • Pope A.M.
        Preventing secondary conditions.
        Ment Retard. 1992; 30: 347-354
        • Rimmer J.H.
        Health promotion for people with disabilities.
        Phys Ther. 1999; 79: 495-502
        • Coyle C.P.
        • Santiago M.C.
        • Shank J.W.
        • Ma G.X.
        • Boyd R.
        Secondary conditions and women with physical disabilities.
        Arch Phys Med Rehabil. 2000; 81: 1380-1387
        • Wilber N.
        • Mitra M.
        • Walker D.K.
        • Allen D.
        • Meyers A.R.
        • Tupper P.
        Disability as a public health issue.
        Milbank Q. 2002; 80: 393-421
        • Chan L.
        • Houck P.
        • Prela C.M.
        • MacLehose R.F.
        Using Medicare databases for outcomes research in rehabilitation medicine.
        Am J Phys Med Rehabil. 2001; 80: 474-480
      3. MCBS survey overview. Centers for Medicare & Medicaid Services. Available at: Accessed December 28, 2004.

        • Eppig F.J.
        • Chulis G.S.
        Matching MCBS (Medicare Current Beneficiary Survey) and Medicare data.
        Health Care Financ Rev. 1997; 18: 211-229
        • Dunlop D.D.
        • Hughes S.L.
        • Manheim L.M.
        Disability in activities of daily living.
        Am J Public Health. 1997; 87: 378-383
        • Chan L.
        • Doctor J.N.
        • MacLehose R.F.
        • et al.
        Do Medicare patients with disabilities receive preventive services? A population-based study.
        Arch Phys Med Rehabil. 1999; 80: 642-646
        • Kinsman S.L.
        • Doehring M.C.
        The cost of preventable conditions in adults with spina bifida.
        Eur J Pediatr Surg. 1996; 6: 17-20
        • Marks R.
        • Allegrante J.P.
        Comorbid disease profiles of adults with end-stage hip osteoarthritis.
        Med Sci Monit. 2002; 8: CR305-CR309
        • Verbrugge L.M.
        • Jette A.M.
        The disablement process.
        Soc Sci Med. 1994; 38: 1-14
        • Turk M.A.
        • Scandale J.
        • Rosenbaum P.F.
        • Weber R.J.
        The health of women with cerebral palsy.
        Phys Med Rehabil Clin N Am. 2001; 12: 153-168