[Structural changes in disability evaluation].
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The physician performing a disability evaluation needs to document the stroke patient's impairments carefully. This is achieved through a thorough history, physical examination, and if necessary, neuropsychologic assessment. Most often, the clinician will deal with the Social Security Administration system; however, the physician may occasionally need to provide this information for private disability insurance.
During the working years, rheumatic conditions are the foremost cause of disability in the United States. Disability evaluation for Social Security applicants and Workers' Compensation patients is commonplace in orthopedic practices. Yet, formal education in this aspect of patient care is rare both during and after residency. Because of a lack of understanding and sophistication the physician who knows the patient better than any other evaluator often play a minor role in the determination of disability. Disability Evaluation Under Social Security--A Handbook for Physicians lists the medical criteria necessary for qualification. Severely disabled arthritis patients will not always fit into these various categories and may have to be considered under the rule of medical equivalency. Workers' Compensation statutes vary somewhat from state to state but generally include disability criteria. Familiarity with these criteria and the process involved will allow the orthopedist to communicate more meaningfully with administrators and will reduce much of the frustration and some of the cost inherent in this system. When subjective complaint (illness) is in excess of apparent organic pathology (disease), team evaluation under the direction of the treating physician will help sort out the dilemma and develop a treatment plan. One hopes that this will bring the illness more in line with the disease, and thus reduce the disability.
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BACKGROUND: Few studies have reported on the functional disability due to vertebral compression factors in osteoporosis. The Osteoporosis Functional Disability Questionnaire (OFDQ) was developed to assess disability in patients with osteoporosis and back pain due to vertebral fractures. The domains of the OFDQ include: quantitative indices of pain, a standard 20-item depression scale, 26 items relating to functional abilities, a scale of social activities, and confidence in the ability of prescribed osteoporosis treatment to reverse disability. METHODS: Reliability of the OFDQ was assessed using test-retest and internal consistency methods. Criterion validity was demonstrated by correlating disability against radiographic evidence of vertebral fractures. Construct validity was demonstrated through comparisons of 81 patients with osteoporosis and fractures to 37 healthy age-matched controls. Additional evidence was found in comparing 45 of the 81 cases who were actively engaged in an exercise program with 36 cases who were sedentary. RESULTS: The test-retest reliabilities ranged from .76 to .93, with internal consistencies from .57 to .96. The OFDQ correlated significantly with relevant spinal pathology, and showed significant improvements in activities of daily living and socialization when active exercisers were compared to inactive patients with osteoporosis. CONCLUSIONS: The OFDQ is a reliable instrument which correlates well with objective measures of osteoporotic spinal damage. It is also sensitive to changes in disability brought about by participation in our aerobic exercise program. The OFDQ may be a useful adjunct to measuring outcomes in other osteoporotic treatment protocols.
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To properly evaluate residual permanent disability arising from impairment of the spine, it is essential to conduct a careful and complete examination in order to arrive at a diagnosis and a determination that present findings are unlikely to change. A formula for computation of permanent disability as developed by McBride includes functional deficiency and physical disorders, taking into account 12 variables. This formula can be simplified to seven components if the physical disorders are mentally computed into the factors of quickness of action, coordination, strength, security, endurance, safety, and adverse employability, which are given weighted values. This method can provide a valid determination of percentage of disability. Some situations only require a delineation of the impairment present and defer disability determination to an agency or board. Currently, there is a trend toward equating the amount of disability with the loss of earnings, which is quite contrary to the longstanding, traditional view.
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A new system for comprehensive disability evaluation has been developed in the framework of our Hospital. This system is based on multidisciplinary evaluation during one day of tests and the summarization of the data collected. The process takes place at the Institute for Functional Evaluation, a joint project of the National Insurance Institute and the Loewenstein Hospital in Israel. The process was designed to provide the basis for the determination of the degree of disability according to the requirements of the General Disability Law. In order to carry out the experimental program a computerized system of recording was created. The method of recording is based upon the "Key-form" where the different systems of the body appear one after the other and next to them the term "normal" or "abnormal". In the case of an abnormal mark, the tester goes on to the next stage which involves completion of a detailed form for that system. The forms are coded for the transfer of information to the computer without intermediary stages and this enables processing of a vast amount of data with relative ease. The system enables compilation of individual profiles and statistical tables and analysis. Theoretical and practical applications of the system are discussed on the basis of the pilot study.
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Fibromyalgia syndrome (FMS) is a common and costly cause of work disability. Patients with FMS, nevertheless, encounter considerable difficulties in their assessment of claims for disability payments. Factors that contribute to FMS as an important cause of disability are its high prevalence, the patients' perception of severe discomfort, and poor function. Disability evaluation in FMS is controversial for several reasons including lack of acceptance of the diagnosis, concurrent psychological abnormalities, difficulties in objectifying disability, deficiencies in instruments of evaluation, the uncertain efficacy of treatment, and physician attitudes. Third parties appear to have inappropriate expectations of the physician's role in determining disability. We suggest that the process of disability evaluation be improved by more objective assessments and by the inclusion of other health professionals in assessing disability and necessary retraining. Further research is needed to develop better instruments for measuring disability, to assess the long-term effects of various treatments, and to clarify the contributions of the work place and of compensation in causing or aggravating FMS.
In recent years, mental disability estimation are more than ever in the practice of forensic psychiatric expertise. The standards about mental disability estimation in the Disability Evaluation Criteria of Traffic Accident Injury are ambiguous and difficult to operate, it cause to different understanding in one case. This article discuss some common questions through 3 aspects in mental disability expertise according to some typical cases, there are the first, we should compare the IQ score before and after injurious in intelligence estimate. The second, the mental disability estimation should be done at least one year after the end of medicine treatment. The third, mental estimate scale should be used in mental disability estimation.
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