The Work Disability Functional Assessment Battery (WD-FAB): Development and validation review
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Background The US Social Security Administration (SSA) supports millions of individuals with disabilities and provides billions of dollars in benefits each year.1 A rise in applications has strained SSA’s resources leading to longer wait times and backlogs for claimants.2 Since the 1990s, SSA has made several efforts, both internally and with recommendations from external groups, to improve the efficiency of their disability determination process without sacrificing the consistency or accuracy of their decisions.3 Reviews of SSA’s processes revealed two key issues – the ‘gap between contemporary notions of disability and how SSA defines and operationalises disability,’ and the ‘variability in the timing, quantity, and quality of the functional information obtained about the applicants’.3 Addressing these critical concerns led to a collaborative effort among the SSA, the National Institutes of Health, and Boston Univer Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
1
Department of Occupational Therapy, Tufts University, Medford, MA, USA
2
Boston University School of Public Health, Boston, MA, USA
3
Author for correspondence: [email protected]
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sity’s School of Public Health to develop a standardised, self-reported assessment of function – the Work Disability Functional Assessment Battery (WD-FAB). The WD-FAB was developed to supplement SSA’s disability determination processes by collecting standardised information on claimants’ functioning without increasing the burden on SSA’s resources. The WD-FAB implements contemporary methods of test theory, item response theory and computer adaptive testing (IRT-CAT). Assessments that use IRT-CAT methods are tailored to the respondent’s abil ity level, allowing for more efficient administration while covering a larger breadth of material than most traditional tests. IRT-CAT instruments also allow for continual improvement through the addition of new items. As long as the underlying domains remain the same, these assessments can be simultaneously administered and expanded. The WD-FAB is grounded in the concept that work disability reflects the gap between a person’s ability and the demands of work. For this reason, the WD-FAB’s development was founded on the International Classification of Functioning, Disability and Health (ICF) framework.4 Within the ICF framework, the WD-FAB measures whole-person functioning at the activity level with a focus on activities necessary for work. We review the WD-FAB’s development, validation, and next steps in order to understand its status on the continuum of instrument development. We introduce the two-phased approach used in development along with the corresponding psychometric evaluations. The first phase of development focused on the fundamental dimensions of Physical Function and Mental Health Functioning. Subsequent work aimed to expand the content breadth and depth to include key dimensions such as Communication Function and Community Mobility. Methods Item development Item dev
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