Development of a computer adaptive test to assess physical capabilities for work disability determination

Due to increasing demand on the Social Security Administration (SSA) disability programs, novel assessment methodologies are needed. Through an interagency agreement with the SSA, the National Institutes of Health (NIH) is collaborating with Boston University to apply Item Response Theory (IRT) and Computer Adaptive Testing (CAT) to assess physical capabilities relevant to work. New approaches to comprehensively and systematically assess functioning may improve the precision and efficiency of SSA's disability evaluation process. Project objectives include: 1) assessing the feasibility of CAT within the SSA context; 2) developing a content model for Physical Capabilities sub-domains; and 3) building item pools for physical capabilities relevant to work addressing content in each sub-domain. A comprehensive literature review led to a conceptual framework and content model guiding the structure of the Physical Capabilities domain. Content experts reviewed and revised items in relation to the content map. Where gaps were noted, new items were written. Focus groups were conducted with claimants and clinicians to inform item development. The final item pool consisted of 138 items for SSA claimants and 112 items for claimants' health-care providers. Future work involves administering the item pools to a sample of 1,000 SSA work disability claimants and to a matched sample of 500 primary health care providers. IRT will be used to analyze the responses and to calibrate each item in the item banks. CAT instruments will allow tailored administration of relevant questions about physical capabilities related to work that may enhance the efficiency and accuracy of SSA's disability determinations.