Functional Limitations and Employment Among Disability Benefit Recipients with Musculoskeletal Conditions

A Mediation Analysis

Published in: Journal of Vocational Rehabilitation, Volume 50, Issue 1 (2019), pages 49-59. doi: 10.3233/JVR-180987

Posted on on February 19, 2019

by Zachary A. Morris, Stephanie Rennane

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There is a growing interest among policymakers in improving the delivery of vocational rehabilitation programs to Social Security Disability (SSD) beneficiaries. To advance these efforts, policy makers must understand what prevents beneficiaries from returning to work.


This paper investigates the relationship between functional limitations and employment among SSD beneficiaries with musculoskeletal (MSK) conditions. Drawing from the ICF model of disability, we hypothesize that functional limitations mediate the pathway between the musculoskeletal condition and employment.


We use a nationally representative sample of SSD beneficiaries from the National Beneficiary Survey. We explore the relationships between health conditions, functional limitations, and employment in a multivariate mediation analysis.


Mediation effects are statistically significant at the 5 percent level. We estimate that pain mediates over 50 percent of the direct effect of an MSK condition. Lower body, mobility, and upper body limitations mediate 22, 18, and 10 percent of the direct effect of an MSK condition, respectively.


Functional limitations, in particular experiencing moderate to severe pain, mediate the relationship between the MSK condition and employment among SSD beneficiaries. Addressing these functional limitations may be of first order importance in enabling employment for the MSK population.

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