Development of a Novel Assessment Instrument: the Work Disability Functional Assessment Battery (WD-FAB) Diane Brandt, PT, MS, PhD Alan Jette, PT, PhD Leighton Chan, MD, MPH Collaboration to Improve the US Disability Determination Process

Disclosure I have no potential conflicts of interest to report

5 Step Initial Determination Process  Adults Step 1: Substantial Gainful Activity? Not disabled Step 2: Impairment severity? Not disabled Seeks evidence from the claimant's own medical sources*. If unavailable or insufficient, the DDS will arrange for a consultative examination (CE) to obtain the additional information needed. *Acceptable sources include: Physicians; Psychologists; Speech- Language Pathologist

Initial Determination Process  Adults continued... Step 3: Meets/equals listing? Disabled 1.00 Musculoskeletal System 2.00 Special Senses and Speech 3.00 Respiratory System 4.00 Cardiovascular System 5.00 Digestive System 6.00 Genitourinary Disorders 7.00 Hematological Disorders 8.00 Skin Disorders 9.00 Endocrine Disorders Congenital Disorders that Affect Multiple Body Systems Neurological Mental Disorders Cancer (malignant neoplastic diseases) Immune System Disorders

Initial Determination Process  Adults continued... Prior to step 4 Residual Functional Capacity Assessment – The RFC Assessment Process: evaluates and interprets medical and other evidence makes findings of fact about work-related functional capacities documents the findings of fact and the supporting evidence The medical consultant (MC) or psychological consultant (PC) has overall responsibility for completion of the RFC

Initial Determination Process  Adults continued... Physical Residual Functional Capacity Assessment Occasionally lift and/or carry Frequently lift and/or carry Stand and/or walk (with normal breaks) Sit (with normal breaks) Push and/or pull (including operation of hand and/or foot controls) Postural limitations Manipulative limitations Visual limitations Communicative limitations Environmental limitations, heat, cold, vibration, noise

Initial Determination Process  Adults continued... Mental Residual Functional Capacity Assessment UNDERSTANDING AND MEMORY SUSTAINED CONCENTRATION AND PERSISTENCE SOCIAL INTERACTION ADAPTATION

Initial Determination Process  Adults continued... Step 4: Past work Not disabled – Perform any prior job ? Step 5: Not disabled Disabled Other work – Any job in the national economy ? Appreciating age, education, and work experience Regional availability

The Work Disability Functional Assessment Batteries (WD-FAB) using Item Response Theory (IRT) and computer adaptive testing (CAT) Developed by the National Institutes of Health and Boston University

IRT-based Test Development & Scoring… Does not require everyone to respond to all the items or the same items Can tailor a scale to every individual Items chosen from a large ‘item bank’ Provides the foundation for computer adaptive testing administration

Upper Body Function Community Mobility Basic Mobility Fine Motor Function Whole Body Mobility Changing and Maintaining Body Position Pushing, Pulling, Reaching Unilateral lift Unilateral Carry Bilateral lift Bilateral carry Pushing, Pulling, Reaching Unilateral lift Unilateral Carry Bilateral lift Bilateral carry Walking Short Distances Walking Long Distances Walking on Different Surfaces Running Device Aided Mobility Walking Short Distances Walking Long Distances Walking on Different Surfaces Running Device Aided Mobility Kneeling Sitting Standing Squatting Lying down Bending Crawling Climbing Kneeling Sitting Standing Squatting Lying down Bending Crawling Climbing Picking up Gripping Holding Turning Pinching Picking up Gripping Holding Turning Pinching Public Transportation Driving WD-FAB Physical Function Domains

Communication and Cognition Resilience Interpersonal Interactions Comprehending spoken messages Comprehending non- verbal messages Comprehending written messages Speaking Producing Nonverbal messages Producing Non-verbal sign language Producing written messages Conversation with one person; with many persons Discussions with one person; with many persons Comprehending spoken messages Comprehending non- verbal messages Comprehending written messages Speaking Producing Nonverbal messages Producing Non-verbal sign language Producing written messages Conversation with one person; with many persons Discussions with one person; with many persons Orientation Watching Listening Copying Learn to Read Learn to Write Learn to Calculate Ability to recall Thinking Reading Writing Calculating Solving problems Making decisions Carrying out single task Carrying out multiple tasks Orientation Watching Listening Copying Learn to Read Learn to Write Learn to Calculate Ability to recall Thinking Reading Writing Calculating Solving problems Making decisions Carrying out single task Carrying out multiple tasks Adaptability Handling stress Openness to experience Trust others Respect & warmth Extraversion Conscientiousness Trustworthiness Ethical behavior Cooperation Social cues Control on internal distracters Family & community relations Response to change Optimism Coping with time pressure Managing daily task demands Adaptability Handling stress Openness to experience Trust others Respect & warmth Extraversion Conscientiousness Trustworthiness Ethical behavior Cooperation Social cues Control on internal distracters Family & community relations Response to change Optimism Coping with time pressure Managing daily task demands Agreeableness Aggression regulation Impulse control Tolerance Criticism Adjust to supervisors Social rules Family & community relations Ethical behavior Cooperation Social cues Accepts direction Relating to others in authority Respect other property and space Agreeableness Aggression regulation Impulse control Tolerance Criticism Adjust to supervisors Social rules Family & community relations Ethical behavior Cooperation Social cues Accepts direction Relating to others in authority Respect other property and space Optimism Confidence Energy & Drive Cooperation Control of internal distracters Coping skills: stress Criticism Psychic stability Response to change Conscientiousness Tolerance Family & community relations Optimism Confidence Energy & Drive Cooperation Control of internal distracters Coping skills: stress Criticism Psychic stability Response to change Conscientiousness Tolerance Family & community relations WD-FAB Mental Health Function Domains Mood & Emotions

Potential value of WD-FAB for SSA  Improve program efficiency & effectiveness  Low respondent burden  Improve standardization & completeness of claimant function  Can collect functional data at any point in the process  May be able to track changes over time  Protection against gaming  Anomalous response patterns, effort measures, etc.

Additional studies to further enhance FAB … Response Pattern recognition Proxy respondent study Translation to other languages Replenishment Administer FAB to applicants and obtain qualitative feedback to inform integration into established processes Optimize reporting for users

Potential Applications of the WD-FAB Research- –Monitor function over time as an indicator of population health –Track the influence of intervention strategies on functioning over time Claimant support- –Who need help? Identify functional profile thresholds. –Examine functional profiles relative to occupational demand to allow assessment of “fit” –Identify functional thresholds relative to inability to sustain work

WD-FAB accomplishments Completion of WD-FAB prototype in 2016 Scientific validation- 14 publications in peer reviewed journals Now ready for testing/further development International collaborations?

Thank you! Diane Brandt