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PubMed2001

A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale.

BACKGROUND AND PURPOSE: The quality of a disability scale should dictate when it is used. The purposes of this study were to examine the validity of a global rating of change as a reflection of meaningful change in patient status and to compare the measurement properties of a modified Oswestry Low Back Pain Disability Questionnaire (OSW) and the Quebec Back Pain Disability Scale (QUE). SUBJECTS: Sixty-seven patients with acute, work-related low back pain referred for physical therapy participated in the study. METHODS: The 2 scales were administered initially and after 4 weeks of physical therapy. The Physical Impairment Index, a measure of physical impairment due to low back pain, was measured initially and after 2 and 4 weeks. A global rating of change survey instrument was completed by each subject after 4 weeks. RESULTS: An interaction existed between patients defined as improved or stable based on the global rating using a 2-way analysis of variance for repeated measures on the impairment index. The modified OSW showed higher levels of test-retest reliability and responsiveness compared with the QUE. The minimum clinically important difference, defined as the amount of change that best distinguishes between patients who have improved and those remaining stable, was approximately 6 points for the modified OSW and approximately 15 points for the QUE. CONCLUSION AND DISCUSSION: The construct validity of the global rating of change was supported by the stability of the Physical Impairment Index across the study period in patients defined as stable by the global rating and by the decrease in physical impairment across the study period in patients defined as improved by the global rating. The modified OSW demonstrated superior measurement properties compared with the QUE.

Activities of Daily Living↗

PubMed1999

Management of chronic disabling low back pain with 360 degrees fusion. Results from pain provocation test and concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation in patients with chronic disabling low back pain.

STUDY DESIGN: A follow-up study conducted by an independent observer was performed on the authors' first 29 consecutive patients treated with concurrent posterior lumbar interbody fusion, posterolateral fusion, and pedicle screw instrumentation, for whom at least 2 years had transpired since the operation. OBJECTIVE: To evaluate the results of concurrent instrumented posterior lumbar interbody fusion and posterolateral fusion used to manage chronic disabling low back pain. SUMMARY OF BACKGROUND DATA: Patients chosen for surgery all had a history of chronic disabling low back pain exceeding 2 years and a sick leave period in excess of 6 months (average, 3.4 years). METHODS: From 1989 to 1993, 29 consecutive patients were surgically treated with fusion. The level of fusion was chosen depending on radiologic changes and results from a intradiscal injection provocation test. Bone union was verified by computed tomography scan with 1-mm-thin slices and sagittal reformation, and by a "second look" in all but three patients. All patients were evaluated subsequently by an independent observer in November 1995, 4.7 years after surgery on the average. RESULTS: Bone fusion was obtained in 27 of the 29 patients (93%). There was a highly significant reduction in back and leg pain measurements. Of the 29 patients, the results were excellent in 9 patients (31%), good in 6 patients (21%), fair in 6 patients (21%), and poor in 8 patients (27%). A total of 18 patients (62%) had returned to work. CONCLUSION: The authors consider posterior lumbar interbody fusion with concurrent posterolateral fusion and pedicle screw instrumentation a possible method for managing chronic disabling low back pain.

Adult↗

PubMedDate not supplied

Disability care coordination organizations: improving health and function in people with disabilities.

Disability care coordination organizations (DCCOs) combine attributes of the medical home model and community nursing. Teams of nurses and social workers collaborate with the client to arrange disability-competent medical and social services. This article synthesizes observational findings from site visits to approximately half of the DCCOs operating in 2004. DCCOs have 6 core clinical activities: comprehensive assessment; self-directed, person-centered planning; health visit support; centralized medical-social record; community resource engagement; and constant communication. We also identified 3 core business competencies: service coordination, patient education/behavioral modification, and continuous enhancement of disability competency. Each DCCO started as a new company rather than as a product line of an existing business, and each included the target population in the design stage. Most DCCOs contract with state Medicaid agencies under a prepaid capitation arrangement, and some also enroll Medicare beneficiaries. Capitated DCCOs retain cost savings and may be financially stronger than fee-for-service DCCOs. Although studies suggest that DCCOs improve coordination and clinical outcomes while reducing costs, the current evidence has not been peer reviewed.

Activities of Daily Living↗

PubMed2005

Assessment of patients with intellectual disability using the International Classification of Functioning, Disability and Health to evaluate dental treatment tolerability.

BACKGROUND: Patients with serious intellectual disability (ID) are occasionally unable to tolerate dental treatment when intravenous sedation or general anaesthesia (IVS/GA) is involved. In order to make a decision regarding the application of IVS/GA, the International Classification of Functioning, Disability and Health (ICF) is useful. Therefore, in this study, a set of codes involved in dental problems were chosen from the ICF, and patients with ID who could tolerate dental treatments were compared with those who could not. METHODS: From preliminary interviews of six patients with ID, 16 codes were chosen, and an objective five-rank scale was then constructed for use with all chosen codes. Forty-nine ID patients who visited the Okayama University Hospital for dental treatment between January and April 2003 were evaluated. Facility workers were interviewed according to the code set chosen. The participants were then divided into two subgroups depending on their tolerability of dental treatment. The results of these groups for all 16 codes were then compared. RESULTS: Of the 49 patients interviewed, 23 were able to tolerate the dental treatment. In the 'Activities & Participation' section of the ICF, the tolerable group showed lower disability levels with regard to d110 Watching, d540 Dressing and d550 Eating. In other sections, there were no significant differences between the groups. The code set chosen in this study and the five-rank scales in each code were useful as they enabled easy interviewing. CONCLUSIONS: The ICF was raised as a possibility for considering the application of IVS/GA for dental treatment on patients with ID. For clinical use of the ICF, it is recommended that significant codes should be selected and that the five-rank scale is used so that more objective results are obtained from interviews.

Adult↗

PubMed2005

Functional disabilities profile of chinese elderly people with Alzheimer's disease - a validation study on the chinese version of the disability assessment for dementia.

This study aimed to determine the validity and applicability of the Chinese version of the Disability Assessment for Dementia (CDAD) in the Chinese elderly population. The original English version was translated and modified to a 47-item scale to suit the societal and cultural background of the Chinese population. The CDAD was administered to 169 community-residing Chinese elderly people with Alzheimer's disease (AD) and demonstrated high internal consistency (Cronbach's alpha=0.91), excellent test-retest reliability (intraclass correlation, ICC=0.99) and excellent interrater reliability (ICC=0.98). The functional disabilities profile of the same sample was examined. The CDAD had a high negative correlation with the Global Deterioration Scale (GDS; Spearman's rho=-0.89, p<0.001). ANOVA and post hoc comparisons showed there were significant differences in the mean CDAD scores across different GDS stages. To study the construct validity, the CDAD was administered concurrently with several instruments. The Instrumental Activities of Daily Living subscore of the CDAD had a high correlation with the Instrumental Activities of Daily Living Scale (r=0.94,p<0.001), and the Activities of Daily Living subscore of the CDAD had a high correlation with the Modified Barthel Index (r=0.82, p<0.001). A moderate correlation (r=0.60, p<0.001) with the Cantonese version of the Mini Mental State Examination was also found. Analysis of the relationship with sociodemographic factors indicated that the CDAD was not correlated with gender and education, and that the correlation with age was low. The CDAD was shown to be a reliable and valid instrument in assessing the functional disabilities of community-residing elderly subjects with AD in the Chinese population.

Activities of Daily Living↗

PubMed2005

Dispelling the disability stereotype: embracing a universalistic perspective of disablement.

BACKGROUND: The notion of universalism was introduced to me during my first year of PhD studies in Rehabilitation Science. During a class discussion, we debated the merits of two theoretical perspectives that offered contradicting views as to the most effective means to facilitating a shift in societal perceptions of disability. As exemplified by the World Health Organization's current model of health, the International Classification of Functioning, Disability and Health (ICF), there has been a shift from a minority group analysis towards a universalistic perspective of disablement. PURPOSE: This paper introduces readers to the underlying concepts of both minority group analysis and universalism and, in doing so, proposes that universalism is closely aligned with the underlying constructs of occupational therapy. Universalism provides a comprehensive framework that can be utilized by occupational therapists to encourage the development of health and social-related policies that promote inclusiveness, yet still the respect the differences that exist among individuals. PRACTICE IMPLICATIONS By improving their familiarity with such theories, occupational therapists may be better positioned to contribute to policy development within their respective treatment and/or community settings.

Persons with Disabilities↗

PubMed1989

A homogeneous group of persons with learning disabilities: adults with severe learning disabilities in vocational rehabilitation.

The results of a comprehensive psychoeducational assessment of adults having learning disabilities (LD) and participating in vocational rehabilitation are presented. The subjects were found to have low-average general intelligence; lower verbal than performance IQs; attention, reasoning, and auditory memory deficits; academic achievement at the fourth-/fifth-grade level; language problems; and low self-esteem. These results were contrasted with other studies of adults with LD in vocational rehabilitation, and all studies on this population reported similar findings. A comparison of studies of adults with LD who were clients of vocational rehabilitation with those in college or employed and with those who had been labeled as learning disabled in childhood indicated that the adults with LD in vocational rehabilitation seem to constitute a homogeneous group of persons with severe deficits. The need to subtype learning disabilities by severity and criteria for making such determinations are proposed.

Adult↗

PubMed2000

Disability evaluation in children with hemidecorticectomy: use of the activity scales for kids and the pediatric evaluation disability inventory.

The purpose of this study is to investigate the level of disability of children who are either candidates for or have undergone a hemidecorticectomy. The Activity Scales for Kids and the Pediatric Evaluation Disability Inventory were demonstrated to be useful measurement tools yielding comparative results between subgroups. Overall, children with congenital disease seemed less autonomous postoperatively than were preoperative patients or children with acquired disease. Age at surgery and the interval between seizure onset and surgery are potentially important predictors of disability. This could reflect the importance of timing of surgery, development, environment, and possibly brain plasticity processes in this population.

Adolescent↗

PubMed2006

Storying disability and impairment: retrospective accounts of disabled family life.

Much previous British research on disability and its effects on family life has seen impairment as a personal or family tragedy. In this article, the authors describe current English research that is asking families about their experiences of professional health and social care support since the birth of their disabled child. Interviews with the families uncovered a range of themes that challenged the personal tragedy approach. Far from being passive recipients of care, these are ordinary families seeking appropriate information from professionals to support them in their ordinary parenting role. For them, the professionalized care service should be based on negotiated relationships of equality that give respect to parental perspectives on what is right for their child. The authors conclude that these data are useful in describing ongoing barriers to enabling care provision and in offering a positive view of disabled family life.

Caregivers↗

PubMed2001

Impact of neurorehabilitation on disability in patients with acutely and chronically disabling diseases of the nervous system measured by the Extended Barthel Index.

To study the impact of rehabilitation on disability in an unselected patient group with acutely and chronically disabling neurologic diseases, the Extended Barthel Index (EBI) was determined at the beginning and at the end of the rehabilitation stay in all patients admitted to our Neurorehabilitation Centre in Valens, Switzerland. Patients who reached the highest possible EBI score at entry ("ceiling effect"), with a short stay (<1 week), or with a deterioration due to other medical complications were excluded. Finally EBI data of 743 patients could be analyzed. The mean EBI at entry was 45 and 51 at discharge. The mean increase of the EBI score per week was 1.1 (SD, 1.7). The change of the EBI score was analyzed independently in patients with acute neurologic diseases admitted in the postacute phase (acute group) and patients with chronically disabling neurologic diseases (chronic group). As expected, the increase of the EBI score was higher in the acute group than in the chronic group; 80.8% of the acute group patients and 42.5% of the chronic group patients showed an increase of the EBI score at discharge. Both groups showed a significant EBI gain with a marked shift to higher EBI scores at discharge. The mean gain per week was 1.6 in the acute group and 0.5 in the chronic group, respectively. Analysis of EBI changes considering the different underlying diseases showed the highest increase in patients with stroke and traumatic brain injury.

Activities of Daily Living↗

PubMed2005

Suspects who have a learning disability: police perceptions toward the client group and their knowledge about learning disabilities.

More than a million people in the UK have a learning disability. A small but significant proportion of these people will come into contact with the criminal justice system because they have offended or have been accused of an offence. This article reports on the perceptions of police officers toward this potentially vulnerable group and their knowledge of issues related to learning disabilities. Interview data were collected from eight police sergeants employed by Humberside Police and analysed using qualitative techniques. The article concludes that further training in the subject area is required. This is likely to be successful in the force under study due to their promotion of positive perceptions toward people with learning disabilities.

Cognition↗

PubMed2000

How children with neurofibromatosis type 1 differ from "typical" learning disabled clinic attenders: nonverbal learning disabilities revisited.

To further investigate cognitive deficits in children with Neurofibromatosis Type 1 (NF-1), children with NF-1 were compared to typical learning disabled clinic attenders (LD-clinic), all of whom had reading disabilities, as well as to a group with no disabilities (NoDx). Results indicated that both the NF-1 group and LD-clinic group had reading and reading-related deficits when compared to the NoDx group; however, the NF-1 group was more globally language impaired than the LD-clinic group. In addition, the NF-1 group scored significantly lower than the LD-clinic group, but not the NoDx group, on the visuospatial measures, thus confirming that children with NF-1 have visuospatial deficits not typical of a general LD-clinic population. The NF-1 group was not impaired in comparison to the NoDx group on certain language and visuospatial tasks that were previously found to be deficits in sibling pairwise matched designs; thus, the importance of considering genetic and familial context when studying the impact of genetic disorders on cognition was demonstrated.

Attention Deficit Disorder with Hyperactivity↗

PubMed2001

Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability.

The MIDAS Questionnaire was developed to assess headache-related disability with the aim of improving migraine care. Headache sufferers answer five questions, scoring the number of days, in the past 3 months, of activity limitations due to migraine. The internal consistency, test-retest reliability, and validity (accuracy) of the questionnaire were assessed in separate population-based studies of migraine sufferers. In addition, the face validity, ease of use, and clinical utility of the questionnaire were evaluated in a group of 49 physicians who independently rated disease severity and need for care in a diverse sample of migraine case histories. The test-retest Pearson correlation coefficient for the total MIDAS score was approximately 0.8. The MIDAS score was valid when compared with a reference diary-based measure of disability; the overall correlation between MIDAS and the diary-based measure was 0.63. The MIDAS score was also correlated with physicians' assessments of need for medical care (r = 0.69). From studies completed to date, the MIDAS Questionnaire has been shown to be internally consistent, highly reliable, valid, and correlates with physicians' clinical judgment. These features support its suitability for use in clinical practice. Use of the MIDAS Questionnaire may improve physician-patient communication about headache-related disability and may favorably influence health-care delivery for migraine patients.

Disability Evaluation↗

PubMed2004

Facilitating participation of students with severe disabilities: aligning school based occupational therapy practice with best practices in severe disabilities.

School-based occupational therapy is the largest employer of occupational therapists. School-based occupational therapists work extensively with students with severe disabilities. Over the past decade, one significant change in the field of severe disabilities has been the advocacy of best practices. This paper discusses the implications of best practices for school-based occupational therapy practice and examines strategies that occupational therapists use to tackle such challenges. Focuses of the discussions are centered on the issues relative to curriculum, educational setting and instructional strategies. The theme of Activity and Participation proposed in International Classification of Functioning (WHO, 2001) guides our discussions. Specific strategies in aligning school-based occupational therapy practice with best practices in severe disabilities are proposed and highlighted.

Adolescent↗

PubMed1992

Medical expenditures for disability and disabling comorbidity.

Disability and disabling comorbidity place a disproportionately large burden on the health care system. National Medical Care Utilization and Expenditure Survey data show that medical care expenditures for noninstitutionalized persons amounted to $154 billion ($691 per capita) in 1980. The medical expenditure per capita for people reporting two or more disabling chronic conditions ($2456) was 5 times the amount incurred by those with no limiting conditions ($486) and more than 1.5 times the amount incurred by those with one limiting condition.

Adolescent↗

PubMed1999

The Missouri Developmental Disability Resource Center: a Web site responding to the critical need for information of parents with a child with a disability.

One of the greatest problems for parents who have a child with a developmental disability is a lack of access to information. Parents have a critical need to learn the specifics of their child's disability, the best treatment practices, and how the broader service delivery system works (Bradley, 1992; Rinck, Calkins, Green, & Stadler, 1986). The Missouri Developmental Disabilities Resource Center Web site [http:/(/)www.moddrc.com] was created as an innovative method of meeting the information needs of this underserved population. Challenges to the adoption of this innovative model are highlighted, and some options for addressing these issues are discussed.

Child, Preschool↗

PubMed1991

Play deprivation in children with physical disabilities: the role of the occupational therapist in preventing secondary disability.

Self-initiated free play experiences are vital for the normal growth and development of all children. In this paper, children with physical disabilities who are deprived of normal play opportunities are viewed as having a second disability that hinders their potential for independent behavior and performance. Physical, social, personal, and environmental barriers that may limit the play experiences of children with physical disabilities are delineated. Studies of the interactions of these children during play are discussed, and a case is made for the promotion of active, free play in the home, the school, and the community. As facilitators of this process, occupational therapists must consider a variety of factors, including the unique capabilities of the child, the influence of parent-child and peer relationships, the role of other caregiving adults, the adaptation of toys and materials, and the impact of the environment and setting.

Caregivers↗

PubMed1999

Old-age, survivors, and disability insurance and supplemental security income for the aged, blind, and disabled; substantial gainful activity amounts. Social Security Administration. Final rules.

We are revising the rules for determining when earnings demonstrate the ability to engage in substantial gainful activity (SGA). This rule change applies to Social Security disability benefits provided under title II of the Social Security Act (the Act) and Supplemental Security Income (SSI) benefits based on disability under title XVI of the Act. (Eligibility for benefits under titles II and XVI also confers eligibility for related Medicare and Medicaid benefits under titles XVIII and XIX of the Act.) Specifically, we are raising from $500 to $700 the average monthly earning guidelines used to determine whether work done by persons with impairments other than blindness is SGA. We are raising this level as part of efforts to encourage individuals with disabilities to attempt to work, and to provide an updated indicator of when earnings demonstrate the ability to engage in SGA. This increase reflects our assessment of the amount that roughly corresponds to wage growth since the last increase in 1990.

Eligibility Determination↗