Abstract
Disability has traditionally been defined in terms of a largely biomedical model, where an individual’s limitations were seen as being the product of objectively verifiable physical problems. More recently though, disability has been redefined in terms of functionality within a social context. Thus, disability is best understood as a biopsychosocial phenomenon that combines biological, psychological, and social elements. Biopsychosocial assessment has inherent difficulties. Patients may lack insight into their psychological status and thus be unable to answer certain questions. Further, even if patients do have adequate insight, they may be motivated somehow to bias their reports of information. One method to overcome these challenges is the use of standardized psychometric measures that include validity assessment. Disability has traditionally been defined in biomedical terms and closely associated with objective physical impairment (Pledger, Am Psychol 58:279–284, 2003). More recent conceptualizations though hold that a comprehensive evaluation of disability requires not only the assessment of objective physical impairment but also an assessment of the psychosocial context in which the disability occurs. This conceptualization changed due to findings such as Ormel’s global study of 26,000 patients in 14 countries, which examined the origins of disability. The study determined that psychological factors were more predictive of physical disability than was disease severity (Ormel et al., JAMA 272:1741–1748, 1994).
Even when medical disorders are not present, psychological disorders can be disabling. According to the World Health Organization, mental health disorders are the most disabling of all conditions, accounting for 31% of the world’s disability (Mnookin, World Bank Group, & World Health Organization, Out of the shadows: Making mental health a global development priority. Geneva: World Health Organization, 2016; World Health Organization, Global Health Estimates 2015: Disease burden by Cause, Age, Sex, by Country and by Region, 2000–2015. Retrieved from Geneva: http://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html, 2016). Among mental health disorders, depression is the most disabling single condition in the world, accounting for 7.5% of the world’s disability, while anxiety accounts for an additional 3.4% (World Health Organization, Global Health Estimates 2015: Disease burden by Cause, Age, Sex, by Country and by Region, 2000–2015. Retrieved from Geneva: http://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html, 2016).
Among SSDI recipients in the United States, more than half have a disability involving psychological or subjective symptoms (especially pain, as pain disorders are a psychological condition), with 33% of SSDI recipients in 2010 having psychological disorders (up from 22% in 1986) and 28% suffering from painful musculoskeletal disorders (Congressional Budget Office, Policy Options for the Social Security Disability Insurance Program. Retrieved from http://www.cbo.gov/sites/default/files/cbofiles/attachments/43421-DisabilityInsurance_screen.pdf, 2012). These patients tend to gain disability status earlier in life, and stay on SSDI longer, because psychological and musculoskeletal conditions are less likely to be fatal.
Some psychosocial risk factors for disability such as socioeconomic status are objective in nature. In contrast, other psychosocial risk factors, such as depression, are determined to a large extent by the report of subjective states. To assess these subjective states, standardized psychological tests can play a valuable role. The defining characteristics of standardized psychological tests are discussed, as are their uses. Commonly used psychological tests are reviewed. Practical questions are also addressed, such as when to administer psychological tests, what psychosocial risk factors need to be assessed, what tests to use, methods of quantifying the level of psychosocial risk, and the detection of faking.
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Appendix: Psychometric Assessment Tools
Appendix: Psychometric Assessment Tools
The tests listed below are for informational purposes only, and this is not an exhaustive list. The final decision about which tests to use must be left to the evaluator. Within each section, tests are listed in alphabetical order.
Assessment task | Test | Notesa | Description |
---|---|---|---|
Brief assessments of emotion | These tests are useful when the assessment of a patient’s emotional status is desired | ||
BDI II | S J B G | Beck Depression Inventory II: Well-researched measure of depression, widely used clinically and in research. A brief measure that assesses a broad range of cognitive, affective, and physical depressive symptoms. 21 items, 1 scale, no validity measures. 5 min, hand scoring, computerized scoring and report | |
BSI 18 | S J B G N | Brief Symptom Inventory 18: Brief measure of depression, anxiety, and somatization. Community and cancer patient norms. 18 items, 3 scales, no validity measures, computerized scoring and report, and hand scoring. 2–3 min | |
CES-D | J G | Center for Epidemiological Studies Depression Scale: Brief measure of depression that has been widely used in research. Assesses depression without reliance on physical symptoms, reducing the risk of false positive findings. No norms. 20 items, 1 scale, no validity measures, 3 min, hand scoring | |
HDI | J G | Hamilton Depression Inventory: Brief measure of depression, widely used in research. Assesses a broad range of cognitive, affective, and physical depressive symptoms. Uses community norms. 23 items, 1 scale, fifth grade reading level, no validity measures, 5 min. A variation of this is the Hamilton Rating Scale, which is a 17 or 21 item measure filled out by the professional | |
STAI | S J B G N | State-Trait Anxiety Inventory: Well-researched measure of both anxious states and anxious tendencies. A brief measure that assesses a broad range of cognitive, affective, and physical anxiety symptoms. Community norms. 40 items, 2 scales, no validity measures, 8–10 min | |
Zung | J G | Zung Depression Scale: Brief measure of depression that has been widely used in research. A brief measure that assesses a broad range of cognitive, affective, and physical depressive symptoms. Uses cutoff scores, not norms. 20 items, 1 scale, no validity measures, 5 min, hand scoring | |
Brief assessment of pain and functioning | These tests are useful when the assessment of a patient’s ability to function is desired | ||
BPI-SF | S J G | Brief Pain Inventory Short Form: Assesses pain, pain variation, and pain distribution through drawing. Also assesses degree to which pain interferes with functioning. Used in pain research, no norms. 20 items, multiple measures, no validity measures, 4–6 min | |
Oswestry | J G | Oswestry Low Back Pain Disability Questionnaire: Commonly used measure of functioning in research studies is known to be sensitive to assess change. Original version has been shown to be an effective research outcome measure, multiple modified versions, and no norms. 20 Items, 1 scale, no validity measures, 4–5 min | |
PROMIS PDQ | S J N J G | Patient-Reported Outcomes Measurement Information System: A set of measures developed by US Department of Health and Human Services that assesses physical, mental, and social health in adults and children across all conditions Pain Disability Questionnaire: Brief tool that appears to be a sensitive measure of disability associated with pain. 15 items, 1 scale, no norms, no validity measures, 3–4 min | |
Roland and Morris | J G | Roland and Morris Disability Questionnaire: Commonly used measure of functioning in research studies is known to be able to assess change in functioning. Original version is a frequently used research outcome measure. | |
24 items, 1 scale, no norms, no validity measures, 4–5 min | |||
Translated into Arabic, Chinese, Croatian, Czech, Danish, Dutch, English, Flemish, French, German, Greek, Hindi, Hungarian, Iranian, Italian, Japanese, Kannada, Korean, Marathi, Norwegian, Polish, Portuguese, Romanian, Russian, Spanish, Swedish, Tamil, Telugu, Thai, Tunisian, Turkish, and Urdu, 3–4 min | |||
SF 36-V2 | S J G N | Short Form 36 Questionnaire Version 2: Overall assessments of physical and mental health. Function scale is the strongest and it assesses subjective reports of impairment. Has scoring software. Original SF 36 is less well standardized. SF 36-V2 has an improved administration format, norms, and standardized scores. 36 items, 8 scales, no validity measures, 6–8 min | |
Translated into English, Spanish, German, French, Chinese, Japanese, and for persons from the following countries: Armenia, Bangladesh, Brazil, Bulgaria, Cambodia, Croatia, Czech Republic, Finland, Greece, Hungary, Iceland, Israel, Korea, Latvia, Lithuania, Poland, Portugal, Romania, Russia, Singapore, Slovak Republic, Tanzania, Turkey, Wales (UK), and Vietnam | |||
MPQ-SF | J B G | McGill Pain Questionnaire Short Form: Assesses sensory, affective, and evaluative dimensions through the use of verbal descriptors of pain experience as opposed to pure pain intensity, no norms. 15 items, 2 scales, no norms, no validity measures, 3–5 min | |
Translated into Amharic (Ethiopian), Arabic, Chinese, Czech, Danish, Dutch, English, Finnish, Flemish, French, German, Greek, Hungarian, Italian, Japanese, Norwegian, Polish, Portuguese, Slovak, Spanish, and Swedish | |||
NRS | J G | Pain Numerical Rating Scale: Ubiquitous pain rating scale is recommended by JCAHO. Extremely easy to use, usually administered verbally. Unstandardized test, with unknown number of variations. No agreement on scaling (e.g., 0–10 vs. 1–100), location (e.g., rating whole body vs. one body part) or time (e.g., right now vs. typical). No norms. <1 min | |
VAS | J G | Pain Visual Analog Scale: Sensitive measure of pain used extensively in research. Unstandardized test, with unknown number of variations. No agreement on graphic format of test (e.g., length of line; does the line have numbers on it), location (e.g., rating whole body vs. one body part) or time (e.g., right now vs. typical). No norms. <1 min | |
Intermediate length assessments of pain and disability | Intermediate length assessments of pain and disability | ||
BBHI 2 | S J B G N | Brief Battery for Health Improvement 2: Assesses depression, anxiety, somatization, pain, and function. Also has validity measures for minimizing, exaggerating, and random responding. Pain measures include pain intensity, distribution, and tolerability. Normed on both community sample and a rehabilitation sample. Computer scored. Has Spanish version. 63 items, 6 scales, 15 critical items, 1 validity measure, fifth grade reading level, 8–10 min | |
BPI | S J G | Brief Pain Inventory-Long Form: Assesses pain, pain variation, and pain distribution through drawing. Also assesses degree to which pain interferes with functioning. Includes demographic and medication short answer questions. 15–25 min | |
BSI | S J B G N | Brief Symptom Inventory: Brief assessment of a broad range of psychopathology, including somatization, depression, anxiety, hostility obsessive-compulsiveness, paranoid ideation, and psychoticism. 53 items, 12 scales, no validity measures, computerized scoring and report, 7–8 min | |
P3 | S J B G N | Pain Patient Profile: Measure of depression, anxiety, and somatization with chronic pain patient and community norm groups. Validity measure checks for random or bizarre responding. Has Spanish version. 44 items, 3 scales, 1 validity measure, computerized scoring and report, 12–15 min | |
Comprehensive assessment of psychopathology | These tests are useful for the comprehensive assessment of psychopathology and were designed primarily for psychiatric patients | ||
MCMI IV | S J B G N | Millon Clinical Multiaxial Inventory-IV: Scales keyed to the DSM-5. Also has scales for DSM-5 diagnoses of affective and psychotic disorders and for each form of personality disorder. Base rate scoring attempts to adjust test findings to approximate the actual base rates of psychological disorders in the psychiatric population. Has Spanish version. 175 items, 25 scales, 3 validity measures, critical items, computerized scoring and report, eighth grade reading level, 25–30 min | |
MMPI-2 | S J B G N | Minnesota Multiphasic Personality Inventory-2: Most researched psychological test, with well-established strengths and weaknesses. Over 100 scales and indices to assess a wide range of psychological conditions. Extensive validity assessment is valuable to assess conscious or unconscious exaggeration of reports. Has Spanish version. 567 items, 100+ scales and indices, critical items, computerized scoring and report, hand scoring, sixth grade reading level, 70–90 min | |
MMPI-2-RF | S J B G N | Minnesota Multiphasic Personality Inventory 2 – Revised Form: New version of MMPI-2 that has undergone radical revision to correct perceived MMPI-2 deficiencies. Extensive validity assessment is valuable to assess conscious or unconscious exaggeration of reports. May be stronger at psychiatric assessment, but some studies found it to be less capable when assessing somatoform disorders. (Butcher, Hamilton, Rouse, & Cumella, 2006; Thomas & Youngjohn, 2009) 338 items, 50 scales including 8 validity scales, critical items, fifth grade reading level 45–50 min | |
PAI | S J B G N | Personality Assessment Inventory: A comprehensive personality test that is significantly shorter than the MMPI-2. Assesses a broad cross-section of affective, characterological, and psychotic conditions. Multiple validity measures. 340 items, 22 scales, including 4 validity scales, critical items, fourth grade reading level, 50–60 min | |
Comprehensive assessment of medical patients | These are psychological tests designed specifically for the comprehensive assessment of medical patients | ||
BHI 2 and BHI 2 MIR | S J B G N | Battery for Health Improvement 2: Assesses broad range of psychological symptoms, characterological risks, social conflicts, coping, and physical symptoms, such as pain and disability complaints. Pain measures include pain intensity, pain distribution, pain intolerance, and dysfunctional pain cognitions. Normed on both community sample and a rehabilitation sample, plus has eight other reference groups, including chronic pain, head injury, and fake bad. Has three validity measures for minimizing, exaggerating and random responding. Has Spanish version. 217 items, 18 scales, including 3 validity measures, 40 subscales, 25 critical items, computerized scoring and report. Sixth grade reading level, 30–35 min Battery for Health Improvement 2 Medical Intervention Risk report: A separate test based on the BHI 2 items which assesses risk for poor response to surgery, rehabilitation, opioid and other habit forming medications, physical therapy, and other treatments. Has one validity measure for over or under reporting. Has Spanish version. 217 items, 7 scales, computerized scoring and report. Sixth grade reading level, 30–35 min | |
MBMD | S J B G N | Millon Behavioral Medicine Diagnostic: Assesses broad range of psychiatric and problematic behavioral comorbidities that may affect health management and compliance. Offers analysis of health habits, psychiatric indicators, coping styles, and stress moderators. Three validity scales were developed to detect exaggerating or minimizing of symptoms. Two patient norm groups, bariatric and chronic illness (heart disease, diabetes, HIV, neurological, and others). Has Spanish version. 165 items, 38 scales, 3 validity measures, computerized scoring, sixth grade reading level, 20–30 min | |
Assessment of malingering | These tests are used solely to detect malingering | ||
CARB | S J B G N | Computerized Assessment of Response Bias: Used to assess whether an individual is falsifying symptoms of memory impairment. No norms | |
Hare | S J B G N | Hare Psychopathy Checklist – Revised: The assessment can be used to help assess the degree to which an individual exhibits severe antisocial traits, in the form of a prototypical violent psychopath. May be useful if assessing patients who are making threats | |
SIMS | S J B G N | Structured Inventory of Malingered Symptomatology: Used for both malingered psychopathology and neuropsychological symptoms | |
TOMM | S J B G N | Test of Memory Malingering: Used to assess whether an individual is falsifying symptoms of memory impairment. No norms | |
VIP | S J B G N | Validity Indicator Profile: Employs independent verbal and nonverbal subtests to assess the validity of the patient’s reports. Computer scored. No norms | |
WMT | S J B G N | Word Memory Test: Used to assess whether an individual is falsifying symptoms of verbal memory impairment. No norms | |
Assessment of cognitive ability | These tests are measures of intelligence, memory, and cognitive processing ability | ||
GAMA | S J B G N | Global Assessment of Mental Ability: Culture-free measure of general intellectual ability. Based on the scores on four subtest scales: matching, analogies, sequences, and construction. Community norms. 25 min timed test | |
RBANS | S J B G N | Repeatable Battery for the Assessment of Neuropsychological Status: Measures neuropsychological status and cognitive decline in individuals who have experienced stroke, head injury, dementia, or neurological injury or disease. Community norms. Less than 30 min | |
WASI | S J B G N | Wechsler Abbreviated Scale of Intelligence: An abbreviated measurement of adult intelligence in short and very short forms. 15 min for 2 subtests IQ. 30 min for 4 subtest IQ | |
WAIS-IV | S J B G N | Wechsler Adult Intelligence Scale-IV: Common measure of adult intelligence assesses cognitive strengths and weaknesses. WAIS-IV and WMS-IV are the only conormed ability-memory instruments. 60–90 min | |
WMS-IV | S J B G N | Wechsler Memory Scale-IV: Measures visual and auditory memory, immediate versus delayed memory, and free recall versus cued recall as well as recognition. Normed on older adolescents and adults. 30–35 min | |
WRAT-4 | S J B G N | Wide Range Achievement Test-4: Achievement test assesses basic academic skills of reading, spelling, and math, with norms to age 94. The test has been validated against multiple other cognitive psychological tests. 35–45 min |
Colorado division of workers’ compensation guideline – Approved measures for assessing functional changes improvement in treatment | ||
---|---|---|
Name of test/site link body part description | Body part | Description |
Neck Disability Index http://www.maic.qld.gov.au/forms-publications-stats/pdfs/NDI.pdf | Cervical spine | Ten questions addressing pain, personal care, headaches, and functional deficits |
Simple Shoulder Test http://www.orthop.washington.edu/?q=patient-care/articles/shoulder/simple-shoulder-test.html | Shoulder | Shoulder function only |
Quick DASH (Disabilities of the Arm, Shoulder, and Hand) | Upper extremity | Shoulder, elbow, and hand assessment |
PREE – Patient-Rated Elbow Evaluation http://srs-mcmaster.ca/wp-content/uploads/2015/05/English-PREE.pdf | Elbow | Elbow joint specific |
Hand/Wrist Symptom Severity Scale http://hqlo.biomedcentral.com/articles/10.1186/1477-7525-4-87 | Hand/wrist | Hand and wrist specific |
Oswestry Low Back Pain Disability Questionnaire http://www.rehab.msu.edu/_files/_docs/Oswestry_Low_Back_Disability.pdf | Lumbar spine | Functional questions with sleeping, lifting, walking, sitting, and standing |
Quebec Back Pain Disability Scale https://www.tac.vic.gov.au/files-to-move/media/upload/quebec_scale.pdf | Spine | Functional and emotional questions |
Dallas Pain Questionnaire | Spine | Chronic pain |
Oxford Hip, Knee, Elbow, Shoulder, and Shoulder Instability Score | Hip, knee, shoulder, and elbow | Functional ADLs |
LEFS (Lower Extremity Functional Scale) http://www.emoryhealthcare.org/physical-therapy/pdf/hip-lefs.pdf | Lower extremity | Disorders of one or both lower extremities, standing, walking, running (higher functioning) |
Lower Limb Questionnaire | Lower extremity | Brief seven questions with ability to ambulate addressed (lower functioning) |
Foot and Ankle Outcomes Questionnaire | Foot and ankle | Lower extremity functional ADLs |
SF-36 and SF-12 http://www.rand.org/health/surveys_tools/mos/mos_core_12item.html | Physical health | Assesses ADLs |
FOTO – Focus on Therapeutic Outcomes, Inc. | Various body parts | Functional ADLs specific to body part |
BBHI 2 (Brief Battery for Health Improvement – 2nd Edition) | Behavioral health | Measures pain, functioning, somatization, depression, anxiety; brief measure of risk factors for delayed recovery; two validity measures for exaggerating, minimizing, and random responding |
DRAM (Distress and Risk Assessment Method) | Behavioral health | Measures depression and somatic symptoms of anxiety, risk factors commonly associated with chronic pain |
CES-D (Center for Epidemiological Studies Depression Scale) | Behavioral health | Measures depression, 20 items |
BDI II (Beck Depression Inventory – 2nd edition) | Behavioral health | Measures depression, 21 items |
PRIME-MD (Primary Care Evaluation for Mental Disorders) | Behavioral health | Two components: paper and pencil screen for patient and follow-up interview by physician. Assesses mood, anxiety, somatoform tendencies, alcohol, and eating disorders |
Zung Depression Inventory | Behavioral health | Measures depression, brief measure |
PHQ (Patient Health Questionnaire) and PHQ-9 | Behavioral health | Self-administered version of the PRIME-MD. Assesses mood, anxiety, somatoform tendencies, alcohol, and eating disorders |
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Bruns, D., Warren, P.A. (2018). Assessment of Psychosocial Contributions to Disability. In: Warren, P. (eds) Handbook of Behavioral Health Disability Management. Springer, Cham. https://doi.org/10.1007/978-3-319-89860-5_6
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