Survey Measurement of Work Disability: Summary of a Workshop by Nancy A. Mathiowetz

By Nancy A. Mathiowetz

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CONCEPTUAL ISSUES IN THE MEASUREMENT OF WORK DISABILITY 21 Both the Nagi and the ICIDH models cover the spectrum of the consequences of health conditions. As indicated earlier, as well as terminology, a major difference is where these models place the boundaries between the different concepts (see Figure 2-3). In the Nagi model the performance of all activities, except for basic actions or functions of the body, are subsumed into the overall category of disability (Nagi, 1976). In the ICIDH model the concept of activity includes these basic actions as well as ADLs, IADLs, and some other role activities (with the emphasis very much on activity) (WHO, 1980, 1997; Badley, 1993).

These feedback consequences, which may involve pathology, impairments, and further limitations in function or disability, have been explicitly incorporated into the graphic illustrations of more recent disablement formulations. The 1991 IOM report uses the term secondary conditions to describe any type of secondary consequence of a primary disabling condition. Commonly reported secondary conditions include pressure sores, contractures, depression, and urinary tract infections (Marge, 1988); but it should be understood that they can be either a pathology, an impairment, a functional limitation, or an additional disability.

The problem with this impairment-focused approach is that even though these assessments may be made in the context of relating functional requirements with the requirements of certain jobs, one needs empirical evidence to support the contention that the degree of impairment is going to have a direct relationship to work disability. Without such evidence, the validity of such an approach is highly suspect. Functional Limitation Much of the discussion of assessment of work effectively has been at the level of functional disability.

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