Disability is commonly defined as a decrease in or inability to perform some or all functions related to personal, social, or workplace demands due to a physical or mental impairment. This view is distinct from impairment, defined as a reduction in normal function. Impairment should not necessarily imply that work disability is present, unless there is a functional limitation that precludes the worker from performing some or all of the tasks required in their job, after considering available work accommodations.
The American Medical Association’s (AMA) Guides to the Evaluation of Permanent Impairment states that its impairment ratings are not intended to be used to rate disability because disability reflects a combination of medical and nonmedical factors. Critics point out that the numeric quantification of impairment, the aspect of the guides that encourages its expanding use, is not based on substantial evidence for validity and reliability. State workers’ compensation programs may use the impairment ratings as a proxy for the extent of disability; although there is some relationship between impairment ratings and ability to work, the relationship is variable.
Work disability has not been consistently defined nor measured, and thus population data on incidence, prevalence, and causes are inconsistent. In developed countries, around one in six workers has or develops a significant health-related limitation in ability to work each year, and one-third have a period of work absence as a result—mostly short-term absences due to temporary conditions. A small but important group develops long-term work disability and accounts for the majority of total days lost from work due to health conditions.
Nearly one in four US adults is at least partially disabled from work due to mental and behavioral disorders, musculoskeletal problems, or neurologic conditions. About one-half of the disabled are severely limited and unable to work. Musculoskeletal disorders are the most frequent type of disability, but in some working age groups mental health disorders are now more frequent. The relationships between work, disability, and mental health are interrelated with each one having a potential impact on the other.
Work disability is a complex issue that can involve multiple participants and concerns beyond a particular health-related condition and its treatment. Personal, workplace, medical, and societal issues can affect the extent of a disability and how return to work (RTW) may succeed or fail. Social and environmental factors usually have a greater impact on disability and its prevention than health-related dimensions. The organizational work environment with supervisors, coworkers, unions, and management roles along with insurers, family, and society are recognized as major potentially modifiable influences on disability and RTW; the immediate workplace response to a worker with a potentially disabling condition is especially important. Health care providers must understand and address within and their medical systems (facilities, staff, insurers, administrators, medical records) these influences and be able to collaborate with and at times influence nonmedical personnel, to achieve optimal prevention and ...