Aligning metrics with meaning: considerations for measurement selection in disability evaluation

Area of Science:

• Health Services Research
• Rehabilitation Medicine
• Disability Studies

Background:

• Disability evaluation traditionally relies on clinical performance-based assessments, often perceived as objective.
• Patient-reported outcome measures (PROMs) are increasingly recognized for efficiency and patient-centered data collection.
• PROMs capture subjective experiences crucial for understanding functional decline in disabling conditions.

Purpose of the Study:

• To explore the role and value of PROMs in disability evaluation.
• To compare PROMs with performance-based assessments in evaluating mental and physical function.
• To emphasize aligning measurement tools with evaluation purposes (clinical, policy, programmatic).

Main Methods:

• Literature review and conceptual analysis of assessment tools in disability evaluation.
• Case illustration using the Work Disability Functional Assessment Battery (WD-FAB) to compare PROMs and performance measures.
• Analysis of strengths and limitations of each assessment type for different evaluation contexts.

Main Results:

• PROMs, like the WD-FAB, efficiently generate multi-domain functional scores (mood, mobility, cognition) suitable for change detection.
• Performance-based assessments can be resource-intensive and may not reflect real-world functioning accurately.
• PROMs are a valuable, often preferable, alternative or complement to performance measures in many disability evaluations.

Conclusions:

• PROMs should be considered a valuable tool in disability evaluation, not necessarily replacing but complementing performance measures.
• The choice of assessment tool must align with the evaluation's purpose, available resources, and the need for comprehensive, patient-centered data.
• Integrating PROMs enhances the efficiency and patient-centeredness of disability assessments, particularly for tracking functional changes.