"Disability" evaluation and its relation to motivation.
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A review of Social Security Disability Income (SSDI), listed impairments (Section 1.05) for axial pain, the application process, appeals process, and the importance and impact of the treating physician's role in Social Security disability determination is discussed. The authors summarize the major types of disability programs and the present impairment rating systems, and present recent research in the complicated area of chronic pain and illness behavior that may alter the present system. They give recommendations that may aid the treating physician to prepare the patient's application for Social Security Disability Income.
This study involved the validation of the Minnesota Rate of Manipulation Test in assessing permanent disability of the hand. 118 persons with permanent impairments of the hand were given four subtests of the Minnesota Rate of Manipulation Test. The impaired hand was assessed with the traditional measure for permanent impairment and a rating obtained. Scores for the impaired hand on each of four subtests were strongly correlated with the rating of disability.
These cases represent individuals who feel they have a severe impairment and are "disabled." They have been labeled with fibromyalgia. They are truly distressed. Their symptoms, their courses, are more chronic and refractory than those of medically ill patients, and they are high users of medical services, laboratory investigations, and surgical procedures. These patients see multiple providers simultaneously and frequently switch physicians. They are difficult to care for, and they reject psychosocial factors as an influence on their symptoms. Such persons "see themselves as victims worthy of a star appearance on the Oprah Winfrey show. A sense of bitterness emerges...." Shorter, a historian, believes that fibromyalgia is "heaven-sent to doctors as a diagnostic label for pain patients who display an important neurotic component in their illness. Our culture increasingly encourages patients to conceive vague and nonspecific symptoms as evidence of real disease and to seek specialist help for them; and the rising ascendancy of the media and the breakdown of the family encourage patients to acquire the fixed belief that they have a given illness...." Regarding the finding of "disability," this is a social construct, and many authors believe it is society and the judicial system who must decide who can work. To remain objective, the physician should report the objective clinical information. Physicians need not and should not sit in judgment of the veracity of another human being.
A repetitive gripping test for the evaluation of neck and shoulder pain and disability was standardized and validated in a population study. Repeatability of the endurance of gripping was acceptable (correlation coefficient 0.74). Out of 49 women without neck and shoulder pain during the preceding seven days, 18% showed low endurance (endurance time less than 7 min); out of 19 women with disabling pain during the preceding seven days, 58% showed low endurance; and of 10 women with disabling pain at the time of examination, 80% showed low endurance. Low endurance was related to disability especially in some critical functions of the arms as e.g. working with the hands overhead. Endurance was not affected by age. In men, low endurance did not correlate with neck and shoulder pain. The test provides a tool for the evaluation of patients, but the applicability of the test to men needs further research.
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