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PubMed2003

Adults with self-reported learning disabilities in Slovenia: findings from the international adult literacy survey on the incidence and correlates of learning disabilities in Slovenia.

This study of adults with self-reported learning disabilities (SRLD) in Slovenia is part of a larger secondary analysis of the data from the International Literacy Survey project (IALS). The purpose of the study was to examine the characteristics of 79 (2.68%) individuals who reported experiencing learning disabilities and compare them to the general population on a variety of indicators of educational background, employment status, and reading and writing activities at work and at home. The proficiency scores of the SRLD individuals were lower in all three literacy domains (prose, document and quantitative literacy). In prose literacy 77.9% of SRLD adults performed at Level 1 and only 7.8% reached the level necessary for a modern technological society. Experiencing learning disabilities was not related to gender or age, however, results showed significant differences between the levels achieved by older and younger people with SRLD. In SRLD groups aged 40 years and above, no one achieved more than the second level of literacy in any domain. Learning disabilities were reported more frequently in rural areas. SRLD groups achieve significantly lower educational attainment, and lower employment status, with a preference for manual labour or craft. These findings are of critical importance. SRLD people report that poorer literacy skills are an obstacle to their progression in employment. In the Slovene sample, the SRLD group stands out for low scores in quantitative literacy. Results show that they are less active, pick up information only auditorily or in short written form. They need more frequent help from relatives in literacy activities. Interpretation of the IALS data on SRLD presents many problems. These include amongst others, problems in terminology, different background factors, and the validity of self-report measures. However, the study also raises many interesting challenges for future research and policy. Increasing the availability of support, assistance and counselling for adolescents and adults with learning disabilities remains a very important goal for dyslexia and LD policies in Slovenia.

Adolescent↗

PubMed1998

People with learning disabilities who also have mental health problems: practice issues and directions for learning disability nursing.

The plight of people with learning disabilities who have mental health problems has become an issue of contemporary importance in the provision of health services to this section of the population. This paper will argue that learning disability nursing has a central role to play in the promotion of mental health for this client group (Department of Health 1995a). However, learning disability nursing presently operates without a clear model of mental health. Therefore, before this potential can be realized there is a need to establish the common ground between the discourses of learning disability nursing and those of psychiatric nursing which might be related to this client group. This paper begins by identifying the background issues relating to the problems of meeting the mental health needs of people with learning disabilities. It then proposes that an applied behavioural approach has the potential to provide a coherent theory that can link the discourses of normalization, developmental psychiatry and mental health nursing, whilst also establishing the applied behavioural approach as a powerful technology upon which meaningful interventions can be designed.

Behavior Therapy↗

PubMed1998

A five-year follow-up study of older long-stay clients with intellectual disability using the Disability Assessment Schedule.

The emphasis on community care means closure of the long-stay institutions for people with intellectual disability. Studies have indicated that older people with intellectual disability in particular may not be adequately cared for because of poor monitoring of their changing needs and inadequate provision of services. The use of rating instruments to monitor changes, and to predict outcome or needs in this population may help to improve care by assisting with planning and projection of service requirements. In 1991, all residents of a long-stay hospital for people with intellectual disability were assessed using the Disability Assessment Schedule (DAS). Five years later, the 1991 scores of the older residents (aged > 50 years) were reviewed and compared under three outcome groups: in-patients, discharged and deceased. Furthermore, all older people resident in the hospital in 1996 were reassessed using the DAS. Out of the 144 older clients resident in 1991, five years later, 78 were still in-patients, 38 had been discharged into the community and 28 were deceased. In 1991, the decreased group had the greatest problems with continence and symbolic behaviour, while the discharged group had the greatest problems with self-help, vision, hearing, communication, social interaction, echolalia and repetitive speech. In comparison with 1991, the 1996 DAS scores of older residents showed that there were increasing problems with vision, hearing, communication, behaviour and symbolic activities. The present study suggested that the DAS is a useful instrument for monitoring change and predicting outcome in older people with intellectual disability.

Activities of Daily Living↗

PubMed2001

Defining disability in psychosis: performance of the diagnostic interview for psychosis-disability module (DIP-DIS) in the Australian National Survey of Psychotic Disorders.

OBJECTIVE: We aimed to use data from the Australian Survey of Mental Health and Wellbeing to examine the psychometric properties of the Diagnostic Interview for Psychosis-Disability Module (DIP-DIS). The DIP-DIS is a semi-structured questionnaire specially designed to assess disability associated with psychotic disorders. METHOD: The psychometric properties of the instrument were determined by examining its inter-rater reliability, internal structure, as well as its criterion and discriminant validities. RESULTS: Analysis shows: (1) that it can be rated reliably by trained interviewers, (2) that the items are complementary but tap a number of different domains, (3) that four factors account for over 66% of the variance, and (4) that it is sensitive to differing clinical populations with expected differences in level of disability. Ratings on the DIP-DIS bore significant relationships with a criterion measure of quality of life. CONCLUSIONS: The DIP-DIS has encouraging psychometric properties for cross-sectional assessment of disability and may be useful in future studies of disablement associated with psychosis. Future work should examine its sensitivity to change.

Adult↗

PubMed1999

Women, disability, and sport and physical fitness activity: the intersection of gender and disability dynamics.

This study explores the often overlooked experiences of women with physical disabilities in the sport and physical fitness activity domain. Interviews with 16 women with a physical disability (age range of 19-54 years) revealed the following major themes: (a) participation in fitness-related as opposed to sport-related activities, (b) participation to maintain the functional level of the body and preserve existing capabilities, (c) intrinsic nature of gains derived from participation (perceived competence, enhanced view of body, motivational outlet, control in life), and (d) perceived differences in the sport and physical fitness activity experiences of men and women with disabilities. Findings support the notion that gender and disability interact in the sport and physical fitness context for women with physical disabilities.

Adult↗

PubMed2005

Factors determining job retention and return to work for disabled employees: a questionnaire study of opinions of disabled people's organizations in the UK.

OBJECTIVES: To determine the views of organizations of and for disabled people in order to inform the writing of the British Society of Research Medicines policy document "Vocational Rehabilitation--The Way Forward". PATIENTS/ORGANIZATIONS: A single mailing was sent to 98 disability organizations within the UK. DESIGN: A semi-structured postal questionnaire focused on factors (i) within the National Health Service; (ii) external to it, mainly in the workplace, making it difficult for people to stay in work in the presence of disease/disability, or to find work after losing their job (within the last 6 months). RESULTS: A 30% response rate, with many incomplete questionnaires, was obtained so that 24 complete questionnaires were analysed. The dominant findings concerning the National Health Service were, overwhelmingly, that it was perceived as impacting deleteriously on the work of disabled people with delays to consultation, investigation and rehabilitation and a lack of appreciation of workplace issues. Employers were seen as unresponsive to the needs of workers, with negative attitudes to disability. The changes required in both areas were closely related to these findings. CONCLUSION: Though the organizations surveyed were not representative, nevertheless there was considerable agreement about the need for both the National Health Service and employers to be more responsive to the workplace needs of disabled people.

Persons with Disabilities↗

PubMed1996

The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system.

BACKGROUND AND PURPOSE: Disorders of the facial neuromuscular system can result in marked disfigurement of the face and difficulties in activities of daily living such as eating, drinking, and communicating. No systematic means of measuring the disability associated with facial nerve disorders exists. The purpose of this investigation was to examine the reliability and construct validity of the Facial Disability Index (FDI), a disease-specific, self-report instrument for the assessment of disabilities of patients with facial nerve disorders. SUBJECTS AND METHODS: The FDI was administered to 46 ambulatory patients of the University of Pittsburgh Medical Center's Facial Nerve Center. The relationship of the FDI subscale and total scores with clinical impairment measures was determined, and a comparison of the use of the FDI and subscales of the more general SF-36 was made. RESULTS: The FDI subscales produced reliable scores (theta reliability: physical function = .88; social/well-being function = .83). Construct validity of the FDI physical function subscale was demonstrated by a correlation with the clinician's physical examination of facial movement. The FDI social/well-being subscale was associated with the FDI physical function subscale and with a clinical assessment of psychosocial status within a subset of the sample (n = 14). The FDI represented the relationship between impairments, disability, and psychosocial status better than the generic SF-36 did. CONCLUSION AND DISCUSSION: The FDI subscales produce reliable measurements, with construct validity for measuring patient-focused focused disability of individuals with disorders of the facial motor system.

Activities of Daily Living↗

PubMed1993

Intercorrelation and test-retest reliability of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with pain intensity in low back pain patients.

OBJECTIVE: To determine the intercorrelation between subjective disability, as assessed with the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with visual analogue scale (VAS) pain intensity ratings. DESIGN AND SUBJECTS: Questionnaires were administered to 94 patients with chronic low back pain with or without radiation into the legs of at least 3 months' duration. SETTING: Tertiary care center. RESULTS: High correlations were noted between the ODQ and PDI (r = 0.83) and PDI factor 1 (r = 0.84), a subscale of the PDI. Lower correlations were noted between pain intensity (VAS) scores and the ODQ (r = 0.62) and the PDI (r = 0.69). A weaker correlation (r = 0.41) was noted between the ODQ and PDI factor 2. Intraclass correlation coefficients (ICC) for test-retest reliability in 20 patients (time interval 1 week) were for the ODQ ICC = 0.83, PDI ICC = 0.91, PDI percentage score ICC = 0.91, PDI factor 1 ICC = 0.87, and PDI factor 2 ICC = 0.73, respectively. CONCLUSIONS: The present results suggest that either the PDI or the percentage score PDI and also the even shorter-to-administer PDI factor 1 may be useful and reliable tests for the assessment of subjective disability in low back pain patients. As noted by the moderate intercorrelations with pain intensity scores, both the PDI and the ODQ address a broader concept of disability than that directly related to pain intensity.

Adolescent↗

PubMed1994

Relationship of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) with three dynamic physical tests in a group of patients with chronic low-back and leg pain.

OBJECTIVE: To determine the relationship between overall disability in daily activities, assessed with the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ), and impaired performance on three physical tests in patients with chronic low-back pain. DESIGN AND SUBJECTS: The PDI and ODQ were administered in a cross-sectional study, before beginning a back rehabilitation program, to 45 patients with low-back pain of > or = 3 months' duration, with or without radiation to the legs. All patients also performed repetitive sit-up, arch-up, and squatting tests. SETTING: Tertiary care center. RESULTS: Modestly significant (p < 0.05) or significant (p < 0.01) inverse correlations (Pearson's r = 0.30-0.41) were noted between the PDI and the ODQ and all three physical performance tests. When normative data were used, the correlation (Spearman's rs = -0.45) between PDI and the squatting test remained significant (p < 0.01), whereas it was modestly significant (rs = -0.33, p < 0.05) between the ODQ and squatting test and between the PDI and arch-up test (rs = -0.35, p < 0.05). Compared with patients presently working, those on sick leave had significantly higher scores on the PDI and ODQ (Wilcoxon's two-sample test: p < 0.001) and also significantly worse performance on all physical tests (p < 0.001). CONCLUSIONS: The PDI and ODQ, as measures of self-perceived disability, and impaired performance on repetitive squatting, arch-up, and sit-up tests, as measures of physical capability, show some overlap in low-back-pain patients. Both types of disability measures are clearly influenced by the patient's work status.

Adult↗

PubMed1993

Perceiving oneself as 'disabled' or as having a 'disabling condition': a discriminant function analysis.

Using discriminant function analysis, information obtained in telephone interviews with a national, random sample of 1000 Americans with self-ascribed disabling conditions was analysed to cast light on differences between individuals who did and did not consider themselves 'disabled'. Maximum separation between the two groups was attained by an equation of six descriptors. In the order of their importance they were (1) the belief that others who knew them well considered them disabled, (2) self-rated severity of disability, (3) identification with others with disabilities, (4) gender, (5) perceived extent of limitations, and (6) needing equipment to walk. Somewhat different equations were generated for sampled men and women. An appreciation of these results in terms of a person's fit with his or her environment is offered.

Adolescent↗

PubMed2000

Collaboration in disability policies--collaboration between stakeholders of disability policies in the South and in the North.

Four studies have been recently undertaken at the Centre for International Child Health on the collaboration between the stakeholders of disability policies, in Southern and Northern countries. Informed by the literature, the authors have explored the roles disabled people's organizations, non-governmental organizations, government and professionals play in the design, provision and evaluation of services for disabled people. They also highlight the different forms participation can take and their most relevant features. The main factors influencing collaboration processes are then classified in three different categories: social factors, ideology-related factors and project-related factors. They are subsequently analysed. The first group encompasses the societal framework in which collaboration may take place, while the identity of the stakeholders is reflected in the ideology-related factors. The nature of the activities undertaken by stakeholders is characterized by the third group of factors. In the conclusion it is suggested that stakeholders, and especially disabled people's counterparts, should increase their awareness of the social model of disability, adopt participatory practices and promote participation at higher levels. However, they should acknowledge that it implies more trust between partners and an alteration of their structures.

Community Networks↗

PubMed2006

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Neck Disability Index and Neck Pain and Disability Scale.

STUDY DESIGN: This study's design was a cross-cultural validation of the Neck Disability Index and Neck Pain and Disability Scale. OBJECTIVES: This study's objective was to translate, culturally adapt, and validate a Brazilian Portuguese version of the Neck Disability Index (NDI-BR) and the Neck Pain and Disability Scale (NPDS-BR). SUMMARY OF BACKGROUND DATA: Although several valid measures exist for measurement of neck pain and functional impairment, these measures have yet been validated in Brazilian Portuguese. Successful linguistic and cultural translation may allow appropriate cross-cultural comparison for clinical and laboratory research analysis. METHODS: The NDI-BR and NPAD-BR were culturally and linguistically translated from English into Brazilian Portuguese. The translated version of the instrument was administered to 203 patients at a midsize hospital in southern Brazil. Psychometric evaluation included factor analysis, internal reliability measures, test-retest reliability at 1 and 7 days, and criterion validity comparison with the Brazilian version of the SF-36. RESULTS: Factor analyses demonstrated a single-factor subscale for the NDI-BR and three subscales for the NPDS-BR. An item analysis showed a high degree of internal consistency for the NDI-BR (r = 0.74) and the three subscales of the NPDS-BR (subscale 1, r = 0.89; subscale 2, r = 0.81; subscale 3, r = 0.72). Test-retest reliability was also acceptable at for the NDI-BR (0.98 at baseline and 0.48 at 7 days) and subset one (0.96 at baseline and 0.91 at 7 days), subset 2 (0.96 at baseline and 0.62 at 7 days), and subset 3 (0.52 at baseline and 0.45 at 7 days) of the NPDS-BR. Construct validity was established during comparison of the Brazilian version of the SF-36. Only items associated with physical role, bodily pain, and emotional role failed significant correlation. CONCLUSIONS: A reliable and valid Portuguese version of the Neck Disability Index and Neck Pain and DisabilityScale was developed, which will facilitate the examination of functional performance within a large patient population, as well as cross-cultural comparisons.

Adult↗

PubMed2004

Demystifying disability: a review of the International Classification of Functioning, Disability and Health.

The paper describes and evaluates the theoretical underpinnings of the International Classification of Functioning, Disability and Health (ICF), and develops the proposition that its conceptual framework provides a coherent, if uneven, guide through the competing conceptions of disability. To date, however, there has been little evaluation of the theoretical efficacy of the ICF. In seeking to redress this, the paper develops the argument that the ICF fails to specify, in any detail, the content of some of its main claims about the nature of impairment and disability. This has the potential to limit its capacity to educate and influence users about the relational nature of disability. The paper develops the contention that three parts of the ICF require further conceptual clarification and development: (a) (re)defining the nature of impairment; (b) specifying the content of biopsychosocial theory; and (c) clarifying the meaning and implications of universalisation as a principle for guiding the development of disability policies.

Persons with Disabilities↗

PubMed2006

Themes of effective coping in physical disability: an interview study of 26 persons who have learnt to live with their disability.

The aim of this study was to gain a deeper understanding of effective coping in physical disability and/or chronic illness. Twenty-six well-adjusted adults with various disabilities were interviewed. The interviews focused on how they perceived they had managed to master problems encountered by their disability and their personal views about how one should act and think to manage a life with a disability. The protocols were content analysed according to grounded theory. Five categories were extracted--self-trust, problem-reducing actions, change of values, social trust and minimization. These categories clustered around two broader bipolar constructs--acknowledgement of reality vs. creation of hope and trust in oneself vs. trust in others. The different themes of coping complemented each other and tended to be used in different contexts in a flexible manner. Both the extracted categories and the core concepts have been extensively described in the coping literature, supporting their validity. The importance of understanding coping processes from the disabled's point of view is discussed.

Activities of Daily Living↗

PubMed2004

Disability identity and attitudes toward cure in a sample of disabled activists.

This study investigates the assumption that disabled people want improvements in their functional abilities, or complete cures. Contrary to this assumption, many disabled activists are found to have attitudes in which they refuse treatment that promises a cure. In order to explain this attitude, different sources of disability identity are isolated as potential predictor variables. A multivariate model reveals that self-identity related to a personal affirmation of disability is a significant predictor of refusal of treatment, as is the age of onset of disability. Implications for interactions with medical professionals and utility-based modeling of medical treatment seeking are discussed.

Adolescent↗

PubMed1996

Students with learning disabilities in education: managing a disability.

The purpose of this study was to examine factors that have contributed to the success of students with learning disabilities (LD) in schools and to explore how these students manage their disabilities from kindergarten through college. The study followed a qualitative research methodology consisting of reviewing academic records and conducting interviews and classroom observations over a 6-month period. The subjects were 9 students with learning disabilities enrolled in a public 4-year university. It was found that the students experienced labeling, stigmatization, and gatekeeping throughout their school years. Furthermore, the students employed a variety of positive and negative coping techniques in an effort to successfully manage their disabilities in school. Positive coping techniques included relying on benefactors, implementing self-improvement techniques, and utilizing particular strategies and management skills to assist with academics. Negative coping techniques were described as "passing" and created tension for the students. Students employed passing techniques to avoid disclosure of their disability and to make it through school. The results of this study have significant implications for school administrators and university educators who provide services for students with LD under current federal laws, and further underscore the need for such students to self-advocate.

Achievement↗

PubMed1999

The Guy's Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis.

A postal survey showed that the majority of 49 leading international neurologists involved with multiple sclerosis research felt that currently existing outcome measures for this illness were inadequate, and that there was a need for a new measure which should be patient orientated, multidimensional, and not biased towards any particular disability. The Guy's Neurological Disability Scale (GNDS) was subsequently devised as a simple and user-friendly clinical disability scale capable of embracing the whole range of disabilities which could be encountered in the course of multiple sclerosis. It has 12 separate categories which include cognition, mood, vision, speech, swallowing, upper limb function, lower limb function, bladder function, bowel function, sexual function, fatigue, and 'others'. The GNDS was found to be acceptable to neurologists and patients, reliable, responsive, and valid as a measure of disability. The scale was also found to be valid when applied by non-neurologists, over the phone, or via a postal questionnaire.

Clinical Trials as Topic↗

PubMed1978

Untreated psychiatric disability. A study of disabled persons with major psychiatric health impairment, having never received psychiatric treatment.

The presented investigation, from a county seemingly representative of the average for Norway, showed that at least 15% of male Disability Pensioners with a psychiatric primary diagnosis, become pensioned without having had any psychiatric treatment. The purpose of the investigation was to describe this group of untreated psychiatric disabled, both numerically and regarding social, personal and nosological factors. It was found that the absence of treatment was due to lack of opportunity, but to the pensioner's own attitude, a stubborn resistance to being defind as a psychiatric patient. This is enhanced by a general tendency in our culture to choose, when possible, the role of a somatic patient rather than that of a psychiatric patient. The untreated group of male Disability Pensioners had a normal distribution of social status and stability, and showed a strong preponderance of neurosis-like conditions, combined with pains and other symptoms from the musculo-skeletal system in 51% of the clients. Among War Pensioners there were also found many untreated psychiatric disabled, especially ex-wartime seamen, showing a surprisingly constant syndrome of mixed anxiety and asthenia. The material comprised 150 males, 101 applicants for Disability Pension and 49 for War Pension, all untreated.

Adolescent↗