Chapter 14: Disability Evaluation in Painful Conditions (Robinson, 2001)

Robinson, J. P. (2001). Disability Evaluation in Painful Conditions. In D. C. Turk & R. Melzack (Eds.), Handbook of Pain Assessment. New York: The Guilford Press.

1. Disability: "Disability refers to an inability to carry out necessary tasks in any important domain of life because of a medical condition.
2. Impairment: impairment is "a deviation from normal in a body part or organ system and its functioning."

Issues addressed in disability evaluation

1. Diagnosis
2. Causation
3. Maximal medical improvement
4. Impairment rating
5. Ability to work

Problems associated with the evaluation of disability in painful condition:

1. How do you measure impairment publically and objectively?
2. How well does the mechanical failure model of impairment explain activity limitations?
3. How do you resolve the dilemma between mechanical failure model and patients' appraisal about their condition?

Practical strategies for disability evaluation

The author is a physician and also serves as an IME. The information provided in this section is based on his own experiences since data on the reliability of disability evaluations are scanty (Clark et al., 1988; Clark & Halderman, 1993) and there is also a lack of validity for the evaluations. The author also cautioned practitioners to not fall into believing their judgments are absolutely valid while the act of making an evaluation actually is based on a whole bunch of biases.

The ethics of disability evaluation

The practitioners need to ask themselves the following questions:
What are your attitudes towards disability? Do you empathize with these people or to you think they are con artists?

1. In addition, research have found that regardless the level of medical condition, it is better to keep people at work for when people are separated from their workplace, they and their families are at a higher risk of suffering from outcomes such as depression, anxiety, substance abuse, social isolation, family dissolution… etc (Atkinson, Liem, & Liem, 1986; Hammarstrom & Janlert, 1997; Kaplan et al., 1987; Mrazek & Haggerty, 1994; Rahmqvist & Carstensen, 1998).
2. In addition, when one is out of work, they also suffer severe economic loss… tell me about it…
3. Studies have also shown that people often develop "dysfunctional beliefs and attitudes" as time goes by as they adapt the role of someone disabled. For instance, people who were more upbeat about their condition soon after the injuries have been found to be more resistant to rehabilitation efforts. This is what they call as the disability syndrome, which is a concept that is really hard to validate (Krause & Ragland, 1994; Robinson et al; 1997).

How do you know about the disability agencies with which you interact? Please be knowledgeable about the policy of the disability agencies.

How do you integrate disability evaluation into an overall strategy of disability management?

How much importance do you give to the subjective appraisals that patients make regarding their ability to work? Essentially, believe them and not believe them…. People with chronic pain often have distorted views of their capabilities and these views are modifiable (Alaranta et al., 1994; Estlander et al., 1991; Jensen, Turner, & Romano, 1994; Lipchik, Milles, & Covington, 1993)--- I will have to read up this line of research.. Didn't they read the article….

Mechanics

In this section, the author provides an overview about how Disability evaluations could be conducted systematically.

In this chapter, they also provided a sample list of risk factors for prolonged disability issued by the Washington State Department of Labor and Industries (1999).

A sample list of "characteristics Associated with High Patient Credibility:

Psychogenic pain: every time I read about psychogenic pain, I feel like to scream and I know it is my bias…

People who report chronic pain and restriction in their activities sometimes have no biomedical abnormality to support their complaint.

1. Studies have found high level of psychopathology and psychological distress in patients with chronic pain… (Hey, remember, correlation is no causation.)

After finish reading this, if you ask me why anyone who is non-medical professional shall learn about anything written in this chapter, I would say that... at least now you have a better idea how the system work... for instance, how do we represent ourselves as a patient with high credibility... Too late for me... 8-O lol

In addition, although this chapter doesn't really tell me much about the psychometric properties of anything specific... At least, one thing I learned is that there ain't too much of them evidence about the validity if not reliability of them disability evaluations.... 8-O lol sigh