Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
To the Editor.—As director of the National Institute on Disability and Rehabilitation Research, I wish to enlist the medical research community in an effort to develop adequate measures of disability so that future articles will report more balanced findings than the study by Dr Zwerling and colleagues.1
The authors identified an area of vital concern to both the research and the disability communities, namely, the relationship among work, disability, and injury. While I am sure it was not their intent to support a stereotype of disabled workers, nonetheless, this may be the result. The findings of this article are troubling because they do not adequately address significant measurement limitations. In addition, sampling decisions may have been arbitrary, and the sample choice may have had a negative impact on the results.
The authors do not adequately acknowledge the impact of limitations of existing measures of disability on their findings. Current measures do not include important factors, such as level of accommodation, that more accurately portray the experience of disabled workers in the workplace. It would be important to know, for instance, if an employer incorporated accessibility standards in implementing risk management procedures.
The article is based on measurement and sampling decisions that may bias the findings of the study on which it is based. For instance, to identify subjects with blindness and deafness, the authors used sources other than the condition lists to identify cases. Persons with other disabilities were selected only from the condition lists; thus, the authors introduced systematic bias to increase the size of the domain. Use of the condition lists alone would have provided an insufficient sample of persons with vision impairments and resulted in statistical findings of questionable significance for persons with hearing impairments. Further, one of the assumptions results in the exclusion of 3728 cases from the analysis. Without this exclusion, the results are not statistically significant.
The Americans With Disabilities Act (ADA) was enacted with the support of many different constituencies, including representatives from the field of medical rehabilitation. This field is at the early stages in developing the measurement tools to move beyond a focus on condition to a focus on the interaction of impairment, function, and the environment. This change will enable us to form a more complete understanding of how persons with disabilities function in the workplace. The World Health Organization, the Institute of Medicine, and the National Institute on Disability and Rehabilitation Research have addressed these problems. I invite further participation from the JAMA readership so that we move forward together.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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