Conceptual Foundation for Measures of Physical Function and Behavioral Health Function for Social Security Work Disability Evaluation

Published:April 01, 2013DOI:


      Physical and mental impairments represent the 2 largest health condition categories for which workers receive Social Security disability benefits. Comprehensive assessment of physical and mental impairments should include aspects beyond medical conditions such as a person's underlying capabilities as well as activity demands relevant to the context of work. The objective of this article is to describe the initial conceptual stages of developing new measurement instruments of behavioral health and physical functioning relevant for Social Security work disability evaluation purposes. To outline a clear conceptualization of the constructs to be measured, 2 content models were developed using structured and informal qualitative approaches. We performed a structured literature review focusing on work disability and incorporating aspects of the International Classification of Functioning, Disability and Health as a unifying taxonomy for framework development. Expert interviews provided advice and consultation to enhance face validity of the resulting content models. The content model for work-related behavioral health function identifies 5 major domains: (1) behavior control, (2) basic interactions, (3) temperament and personality, (4) adaptability, and (5) workplace behaviors. The content model describing physical functioning includes 3 domains: (1) changing and maintaining body position, (2) whole-body mobility, and (3) carrying, moving, and handling objects. These content models informed subsequent measurement properties including item development and measurement scale construction, and provided conceptual coherence guiding future empirical inquiry. The proposed measurement approaches show promise to comprehensively and systematically assess physical and behavioral health functioning relevant to work.


      List of abbreviations:

      FAT (Functional Assessment Taxonomy), FFM (5-factor model), ICF (International Classification of Functioning, Disability and Health), PROMIS (Patient-Reported Outcome Measurement Instrument System), RFC (residual functional capacity), SSA (Social Security Administration), SSDI (Social Security Disability Insurance), WHO (World Health Organization)
      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


        • Okpaku S.O.
        • Sibulkin A.E.
        • Schenzler C.
        Disability determinations for adults with mental disorders: Social Security Administration vs independent judgments.
        Am J Public Health. 1994; 84: 1791-1795
        • Okpaku S.
        A profile of clients referred for psychiatric evaluation for Social Security Disability Income and Supplemental Security Income: implications for psychiatry.
        Am J Psychiatry. 1985; 142: 1037-1043
        • Ganellen R.J.
        Assessing normal and abnormal personality functioning: strengths and weaknesses of self-report, observer, and performance-based methods.
        J Pers Assess. 2007; 89: 30-40
        • Verboom C.E.
        • Sentse M.
        • Sijtsema J.J.
        • Nolen W.A.
        • Ormel J.
        • Penninx B.W.
        Explaining heterogeneity in disability with major depressive disorder: effects of personal and environmental characteristics.
        J Affect Disord. 2011; 132: 71-81
        • Wideman T.H.
        • Sullivan M.J.
        Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers' compensation claimants.
        Pain. 2011; 152: 376-383
        • Engebretsen K.
        • Grotle M.
        • Bautz-Holter E.
        • Ekeberg O.M.
        • Brox J.I.
        Predictors of Shoulder Pain and Disability Index (SPADI) and work status after 1 year in patients with subacromial shoulder pain.
        BMC Musculoskelet Disord. 2010; 11: 218
        • Sullivan M.J.
        • Thibault P.
        • Andrikonyte J.
        • Butler H.
        • Catchlove R.
        • Lariviere C.
        Psychological influences on repetition-induced summation of activity-related pain in patients with chronic low back pain.
        Pain. 2009; 141: 70-78
        • D'Amato A.
        • Zijlstra F.
        Toward a climate for work resumption: the nonmedical determinants of return to work.
        J Occup Environ Med. 2010; 52: 67-80
        • Brandt D.E.
        • Houtenville A.J.
        • Huynh M.
        • Chan L.
        • Rasch E.K.
        Connecting contemporary paradigms to Social Security Administration's disability evaluation process.
        J Disabil Policy Stud. 2011; 20: 1-13
        • Social Security Administration
        Annual statistical report on the Social Security Disability Insurance program, 2011.
        Social Security Administration, Washington (DC)2012 (No. 13-11827)
      1. Social Security Administration. Annual statistical report on the Social Security Disability Insurance program. Available at: Accessed October 10, 2011.

      2. Social Security Administration. Annual statistical report on the Social Security Disability Insurance program, 2010. 2011; SSA Publication No. 13-11827. Available at: Accessed June 8, 2012.

        • Committee on Improving the Disability Decision Process
        SSA's listing of impairments and agency access to medical expertise. Summary.
        in: Stobo J.D. McGeary M. Barnes D.K. Improving the Social Security disability decision process. The National Academies Pr, Washington (DC)2007: 1-12
        • Committee on Improving the Disability Decision Process
        SSA's listing of impairments and agency access to medical expertise. 7 findings and recommendations.
        in: Stobo J.D. McGeary M. Barnes D.K. Improving the Social Security disability decision process. National Academies Pr, Washington (DC)2007: 89-112
      3. Social Security Advisory Board disability roundtable. A disability system for the 21st century. Available at: Accessed October 15, 2010.

      4. Social Security Administration. Social Security handbook. Available at: Accessed December 22, 2012.

        • Bufka L.F.
        • Stewart D.
        • Stark S.
        The International Classification of Functioning, Disability and Health (ICF) is emerging as the principal framework for the description of health and health related status.
        Can J Occup Ther. 2008; 75: 134
        • Giannangelo K.
        • Bowman S.
        • Dougherty M.
        • Fenton S.
        ICF: representing the patient beyond a medical classification of diagnoses.
        Perspect Health Inf Manag. 2005; 2: 7
        • Amato M.P.
        • Portaccio E.
        Clinical outcome measures in multiple sclerosis.
        J Neurol Sci. 2007; 259: 118-122
        • Lacaille D.
        • White M.A.
        • Backman C.L.
        • Gignac M.A.
        Problems faced at work due to inflammatory arthritis: new insights gained from understanding patients' perspective.
        Arthritis Rheum. 2007; 57: 1269-1279
        • Masala C.
        • Petretto D.R.
        From disablement to enablement: conceptual models of disability in the 20th century.
        Disabil Rehabil. 2008; 30: 1233-1244
        • Cieza A.
        • Bickenbach J.
        • Chatterji S.
        The ICF as a conceptual platform to specify and discuss health and health-related concepts.
        Gesundheitswesen. 2008; 70: e47-e56
      5. World Health Organization. International classification of functioning, disability and health (ICF). 2001. Available at: Accessed November 19, 2009.

        • Escorpizo R.
        • Gmunder H.P.
        • Stucki G.
        Introduction to special section: advancing the field of vocational rehabilitation with the International Classification of Functioning, Disability and Health (ICF).
        J Occup Rehabil. 2011; 21: 121-125
        • Escorpizo R.
        • Reneman M.F.
        • Ekholm J.
        • et al.
        A conceptual definition of vocational rehabilitation based on the ICF: building a shared global model.
        J Occup Rehabil. 2011; 21: 126-133
        • Anthony W.A.
        • Rogers E.S.
        • Cohen M.
        • Davies R.R.
        Relationships between psychiatric symptomatology, work skills, and future vocational performance.
        Psychiatr Serv. 1995; 46: 353-358
        • MacDonald-Wilson K.L.
        • Rogers E.S.
        • Anthony W.A.
        Unique issues in assessing work function among individuals with psychiatric disabilities.
        J Occup Rehabil. 2001; 11: 217-232
        • Cooper C.P.
        • Jorgensen C.M.
        • Merritt T.L.
        Report from the CDC. Telephone focus groups: an emerging method in public health research.
        J Womens Health (Larchmt). 2003; 12: 945-951
        • Appelberg K.
        • Romanov K.
        • Heikkila K.
        • Honkasalo M.L.
        • Koskenvuo M.
        Interpersonal conflict as a predictor of work disability: a follow-up study of 15,348 Finnish employees.
        J Psychosom Res. 1996; 40: 157-167
        • Tett R.P.
        • Burnett D.D.
        A personality trait-based interactionist model of job performance.
        J Appl Psychol. 2003; 88: 500-517
        • Turiano N.A.
        • Pitzer L.
        • Armour C.
        • Karlamangla A.
        • Ryff C.D.
        • Mroczek D.K.
        Personality trait level and change as predictors of health outcomes: findings from a national study of Americans (MIDUS).
        J Gerontol B Psychol Sci Soc Sci. 2012; 67: 4-12
      6. John OP, Pervin LA, editors. The big five trait taxonomy. In: Handbook of personality: theory and research. 2nd ed. New York/London: The Guilford Press; 2001. p 102-38.

        • Hampson S.E.
        Mechanisms by which childhood personality traits influence adult well-being.
        Curr Dir Psychol Sci. 2008; 17: 264-268
        • Hudek-Knezevic J.
        • Kardum I.
        Five-factor personality dimensions and 3 health-related personality constructs as predictors of health.
        Croat Med J. 2009; 50: 394-402
        • Matheson L.N.
        • Kaskutas V.
        • McCowan S.
        • Shaw H.
        • Webb C.
        Development of a database of functional assessment measures related to work disability.
        J Occup Rehabil. 2001; 11: 177-199
        • Tackett J.L.
        • Balsis S.
        • Oltmanns T.F.
        • Krueger R.F.
        A unifying perspective on personality pathology across the life span: developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
        Dev Psychopathol. 2009; 21: 687-713
        • Mount M.K.
        • Barrick M.R.
        • Stewart G.L.
        Five-factor model of personality and performance in jobs involving interpersonal interactions.
        Hum Perf. 1998; 11: 145
        • Barrick M.R.
        • Mount M.K.
        • Judge T.A.
        Personality and performance at the beginning of the new millennium: what do we know and where do we go next.
        Int J Selection Assess. 2001; 9: 9
        • Reed G.M.
        • Leonardi M.
        • Ayuso-Mateos J.L.
        • et al.
        Implementing the ICF in a psychiatric rehabilitation setting for people with serious mental illness in the Lombardy region of Italy.
        Disabil Rehabil. 2009; 31: S170-S173
        • Baron S.
        • Linden M.
        The role of the “International Classification of Functioning, Disability and Health, ICF” in the description and classification of mental disorders.
        Eur Arch Psychiatry Clin Neurosci. 2008; 258: 81-85
        • Sanderson K.
        • Nicholson J.
        • Graves N.
        • Tilse E.
        • Oldenburg B.
        Mental health in the workplace: using the ICF to model the prospective associations between symptoms, activities, participation and environmental factors.
        Disabil Rehabil. 2008; 30: 1289-1297
        • Stucki G.
        • Kostanjsek N.
        • Ustun B.
        • Cieza A.
        ICF-based classification and measurement of functioning.
        Eur J Phys Rehabil Med. 2008; 44: 315-328
        • Akiskal H.S.
        • Hirschfeld R.M.
        • Yerevanian B.I.
        The relationship of personality to affective disorders.
        Arch Gen Psychiatry. 1983; 40: 801-810
        • Gaudino E.
        • Matheson L.N.
        • Mael F.A.
        Development of the Functional Assessment Taxonomy.
        J Occup Rehabil. 2001; 11: 155-175
        • Wang J.L.
        Perceived work stress, imbalance between work and family/personal lives, and mental disorders.
        Soc Psychiatry Psychiatr Epidemiol. 2006; 41: 541-548
        • Gomez-Garcia P.
        • von Gaudecker H.M.
        • Lindeboom M.
        Health, disability, and work: patterns for the working age population.
        Int Tax Public Finance. 2010; 18: 146-165
        • Kuhlow H.
        • Fransen J.
        • Ewert T.
        • et al.
        Factors explaining limitations in activities and restrictions in participation in rheumatoid arthritis.
        Eur J Phys Rehabil Med. 2010; 46: 169-177
      7. OECD. Sickness, disability and work: breaking the barriers: a synthesis of findings across OECD countries. 2010. OECD Publishing. Available at: Accessed December 4, 2011.

        • Spanjer J.
        • Krol B.
        • Brouwer S.
        • Popping R.
        • Groothoff J.W.
        • van der Klink J.J.
        Reliability and validity of the Disability Assessment Structured Interview (DASI): a tool for assessing functional limitations in claimants.
        J Occup Rehabil. 2010; 20: 33-40
        • Finger M.E.
        • Glassel A.
        • Erhart P.
        • et al.
        Identification of relevant ICF categories in vocational rehabilitation: a cross sectional study evaluating the clinical perspective.
        J Occup Rehabil. 2011; 21: 156-166
        • Brage S.
        • Donceel P.
        • Falez F.
        Working Group of the European Union of Medicine in Assurance and Social Security. Development of ICF core set for disability evaluation in social security.
        Disabil Rehabil. 2008; 30: 1392-1396
      8. PROMIS Cooperative Group. Patient-Reported Outcomes Measurement Information System (PROMIS). Domain frameworks–physical health. Available at: Accessed July 17, 2012.

        • Cella D.
        • Young S.
        • Rothrock N.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap Cooperative Group during its first two years.
        Med Care. 2007; 45: S3-11
        • Matheson L.N.
        Disability methodology redesign: considerations for a new approach to disability determination.
        J Occup Rehabil. 2001; 11: 135-142
        • Matheson L.N.
        • Isernhagen S.J.
        • Hart D.L.
        Relationships among lifting ability, grip force, and return to work.
        Phys Ther. 2002; 82: 249-256
        • Matheson L.N.
        • Kaskutas V.K.
        • Mada D.
        Development and construct validation of the hand function sort.
        J Occup Rehabil. 2001; 11: 75-86
        • Escorpizo R.
        • Cieza A.
        • Beaton D.
        • Boonen A.
        Content comparison of worker productivity questionnaires in arthritis and musculoskeletal conditions using the International Classification of Functioning, Disability, and Health framework.
        J Occup Rehabil. 2009; 19: 382-397
        • Jelsma J.
        Use of the International Classification of Functioning, Disability and Health: a literature survey.
        J Rehabil Med. 2009; 41: 1-12
        • Frey W.D.
        • Azrin S.T.
        • Goldman H.H.
        • et al.
        The mental health treatment study.
        Psychiatr Rehabil J. 2008; 31: 306-312
        • Marfeo E.E.
        • Ni P.
        • Haley S.M.
        • et al.
        Development of an instrument to measure behavioral health function for work disability: item pool construction and factor analysis.
        Arch Phys Med Rehabil. 2013; 94: 1670-1678
        • Marfeo E.E.
        • Ni P.
        • Jette A.M.
        • et al.
        Scale refinement and initial evaluation of a behavioral health function measurement tool for work disability evaluation.
        Arch Phys Med Rehabil. 2013; 94: 1679-1686
        • McDonough C.M.
        • Jette A.M.
        • Ni P.
        • et al.
        Development of a self-report physical function instrument for disability assessment: item pool construction and factor analysis.
        Arch Phys Med Rehabil. 2013; 94: 1653-1660
        • Ni P.
        • McDonough C.M.
        • Jette A.M.
        • et al.
        Development of a computer-adaptive physical function instrument for Social Security Administration disability determination.
        Arch Phys Med Rehabil. 2013; 94: 1661-1669

      Linked Article

      • Commentary on Measuring Disability
        Archives of Physical Medicine and RehabilitationVol. 94Issue 9
        • Preview
          This is a commentary on 5 articles in this issue of Archives of Physical Medicine and Rehabilitation that report on several related studies of new approaches to measuring disability. The project was grounded in theory, beginning with the development of a conceptual framework enhanced by a literature review and expert consultation within and outside of the Social Security Administration. The investigators then used item response theory to develop test items, which they organized into computer adaptive testing instruments and tested them for their psychometric properties.
        • Full-Text
        • PDF