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JAMA Patient Page
November 7, 2007

Assessing Disability

JAMA. 2007;298(17):2096. doi:10.1001/jama.298.17.2096

More than 40 million people in the United States have a physical or mental impairment that significantly affects life activities and work performance. The total annual costs of disability are currently estimated at $300 billion. Impairment is evaluated as a measured change in an individual's health status. Disability is an individual's inability to perform a task successfully. Disability is not necessarily related to any health impairment or medical condition, although a medical condition or impairment may cause or contribute to an ongoing disability. The November 7, 2007, issue of JAMA includes an article that identifies an association between obesity and disability. Obesity-associated disability may contribute to an increased burden in both quality of life and health care costs.

Evaluation of impairment

Impairment is defined as "a loss, loss of use, or derangement of any body part, organ system, or organ function." Assessment of an abnormal anatomic structure, physiological function, intellectual capability, or emotional status is based on examinations and diagnostic tests. Such impairment can be classified as partial or complete, temporary or permanent.

Ratings of impairment may include

  • Pain

  • Mobility and joint motion limitations

  • Instrumental Activities of Daily Living (IADLs)—activities related to independent living including preparing meals, managing money, shopping for groceries or personal items, performing housework, and using a telephone

  • Activities of Daily Living (ADLs)—activities related to personal care including bathing or showering, dressing, getting in or out of bed or a chair, using the toilet, and eating

  • Abnormalities identified by diagnostic tests such as blood tests, x-rays, CT or MRI imaging, electrodiagnostic studies, and psychological examinations

Disability at work

Physicians are often asked by patients, employers, and insurance companies to complete forms that describe a patient's work abilities or work restrictions. In the United States, the American Medical Association's Guides to the Evaluation of Permanent Impairment is the most commonly used source for assessing and rating an individual's permanent impairments. Ultimately, in deciding on an appropriate level of work restrictions, the physician must evaluate the situation of each patient by considering 3 concepts:

  • Capacity (work training, strength, endurance)

  • Tolerance (ability to perform sustained work at a given level)

  • Risk (probability of substantial harm upon return to previous work duties)

If an individual is not capable of returning to his or her previous employment, consideration may be given to increasing physical fitness and stamina, recognizing other abilities and talents, and perhaps vocational retraining.

Disability at older ages

Disability increases with age, and a variety of resources are available to older persons with disabilities. Older persons should discuss difficulties managing independent living with their physician and contact their local senior center to learn more about available programs, such as physical activity programs and home modifications.

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish.

Sources: National Council on Disability, Centers for Disease Control and Prevention, National Center for Health Statistics, Workers' Compensation Research Institute

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724.