Acute and Chronic Conditions

This entry discusses acute and chronic conditions in the context of ability and disability. The focus of the discussion is the nature of different conditions and how they affect function. Clinical or case examples illustrate acute and chronic conditions that affect people and how they interact with their environment. Other entries in this encyclopedia elucidate many issues that directly relate to specific conditions and their functional impact; therefore, the examples found herein are for illustration only.

A condition in the context of ability and disability can be described in terms of physical, cognitive, or behavioral changes that affect one's ability to participate in functional activities. For example, osteoarthritis of the knee results in anatomic and physiological changes to the joint that render it less capable of bearing an axial load such as when bearing weight. The resultant loss of mobility renders the person less able to walk long distances or remain standing. The functional outcome of this limitation is less mobility independence. If this limitation is concurrent with other limitations (such as shortness of breath due to cardiovascular disease), then the person's independence might be impaired such that he or she would be considered disabled using standard societal definitions.

Using this definition, an acute condition is one that has an immediate effect on the individual. The type, degree, and severity of the condition may then produce functional limitations. The time course for an acute condition is generally short in duration, with most authorities such as the Centers for Disease Control and Prevention in the United States considering an acute medical condition as one lasting three months or less. Such definitions are predicated, however, on the immediate and accurate identification of the condition. For example, an individual with buttock pain present for 11 months that multiple physicians have failed to identify and treat adequately is evaluated by a consulting expert and found to have specific pathology affecting the piriformis muscle in the buttock. Shortly after the initiation of a treatment program for the specific problem, the condition completely resolved, rendering her fully functional. The condition cannot therefore be [Page 32]considered chronic in nature, but rather the result of inadequate identification of the acute condition.

It is for this reason that purely time-based considerations relating to acute conditions must be considered in their context. Some conditions will present themselves immediately or, with rapid progression, affect the individual, then abate, leaving the person fully functional at the conclusion of the condition. Others will affect the individual at the outset, with residual impairments that extend beyond the period of illness or injury. Polio would serve as an example of an acute illness that produces limitations that persist beyond the period of the infection.

In the United States, disability resulting from an acute condition can be measured in terms using temporary partial disability, temporary total disability, permanent partial disability, or permanent total disability based on the degree and severity of the impairment and its affect on the person's employability during the period of acute illness or injury. European systems offer a similar approach to temporary incapacity, with most systems considering the transition from acute to chronic disability occurring on or around the first anniversary of the onset of the disabling condition. Differing systems exist for the determination of income replacement when substantive improvement cannot be expected beyond the 360-day period of temporary disability. Most programs will use some formula for the determination of benefits at the determination of maximum improvement but may differ widely from state to state (as in the United States) or from country to country (as in the European Union).

...