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PubMed2002

Sexual behaviors of physically disabled adolescents in the United States.

PURPOSE: To examine differences in some aspects of sexual behavior between physically disabled and nondisabled adolescents in the United States. METHODS: The 1994-1995 Wave I data from the National Longitudinal Study of Adolescent Health (Add Health), a stratified, multistage cluster, school-based sample of 7th to 12th graders, were used. Physical disabilities were measured in terms of functional limitation and activity restriction. A total of 1153 adolescents were identified as physically disabled, mainly with limb difficulties. We studied their exposure on school sex education, contraceptive knowledge, sex attitudes, and popularity. Their experiences in romantic attraction and sex were analyzed by multinomial logistic regression methods, controlling for age, pubertal development, and other sociodemographic variables. RESULTS: Although disabled adolescents are slower in pubertal development and more socially isolated, they are as sexually experienced as their nondisabled counterparts. Their exposure to school sex education is largely similar to that of the nondisabled, yet disabled boys are somewhat less knowledgeable about birth control. Severely disabled boys who are sexually active are popular among their same-sex peers, much like nondisabled boys. Although disabled adolescents are as sexually experienced, severely disabled boys and girls have less opposite-sex romantic attraction and are less sure about their sexual preference. Adolescents with mild disabilities have a higher tendency for same-sex attraction than do the nondisabled. Adolescent girls with physical disabilities consistently have higher odds of experiencing forced sex. CONCLUSIONS: Physically disabled adolescents' sexual development and their specific needs for sex education and guidance should not be overlooked. More attention should be paid to protect physically disabled girls from sexual abuses and exploitations.

Adolescent↗

PubMed2006

Disability life expectancy for the elderly, city of Sao Paulo, Brazil, 2000: gender and educational differences.

There is evidence that 'health life expectancy' (expected number of years to be lived in health) differs by socioeconomic status. Time spent in health or disability plays a critical role in the use of health care services. The objective of this study was to estimate 'disability life expectancy' by age, gender and education attainment for the elderly of the city of São Paulo, Brazil, in the year 2000. Data came from the SABE database, population censuses and mortality statistics (SEADE Foundation). Life expectancy with disability was calculated using Sullivan's method on the basis of the current probability of death and prevalence of disability by educational level. The prevalence of disability increased with age, for both sexes and both levels of educational attainment studied. Men showed a lower prevalence of disability, in general, and persons with lower educational attainment showed a higher prevalence of disability. Regarding life expectancy, women could expect to live longer than men, with and without disability. For both sexes, the percentage of life expectancy lived with disability decreased with increasing educational attainment. With increasing educational attainment, the sex differences in the percentage of remaining years to be lived with disability increased for most ages. Finally, the percentage of remaining years to be lived with disability increased with age for males and females, except for males with high educational attainment between the ages 70-75 and 75-80. The results may serve as a guide for public policies in the country, since health problems faced by older persons, such as disability, are the result of a number of past experiences during their life-times, such as health care, housing conditions, hygiene practices and education. Education influences health behaviours and is related, to some extent, to all these factors. Therefore, improvements in education for the disadvantaged may improve health.

Activities of Daily Living↗

PubMed1999

The nutritional status of disabled children in Nigeria: a cross-sectional survey.

OBJECTIVE: To compare the nutritional status of disabled children in Nigeria with their non-disabled siblings and neighbours. A second aim was to investigate anthropometric techniques appropriate for disabled children in this situation. DESIGN: A cross-sectional survey. SETTING: Nasarawa and Plateau States and the Federal Capital Territory in Central Nigeria. SUBJECTS: 311 children under 10 years of age were studied: 112 with various disabilities, 87 siblings and 112 neighbours. METHODS: Selected anthropometric measurements, (height, weight, mid-upper arm circumference (MUAC), demispan and halfspan), and blood haemoglobin levels were assessed by trained personnel. All measurements of disabled subjects were compared to the non-disabled controls. RESULTS: The disabled subjects had mean height for age (ht/age) and weight for age (wt/age) significantly lower than the control group (P<0.05). These differences were due largely to the very low Z scores in children with neurological impairments, (ht/age= 3.07 (s.d.=1.6); wt/age= 2.0 (s.d.=1.2)). Measurement difficulties contributed to low height values in disabled children and halfspan was found to be a useful proxy for height in these children. MUAC results were higher for the children with disabilities due to polio than for controls. The mean haemoglobin levels were slightly but significantly higher (P<0.05) in the disabled and sibling groups compared to the neighbourhood group. CONCLUSION: Disabled children with neurological impairments and consequent feeding difficulties are nutritionally at risk, but others are no worse off than their non-disabled peers in this area. Halfspans may serve as a useful proxy indicator for estimating height in some children with physical impairments. SPONSORSHIP: The study was funded by a TEAR fund grant to JT for her MSc studies.

Anthropometry↗

PubMed2004

Pain assessment in intellectually disabled people: non-verbal indicators.

BACKGROUND: Although important progress has been made during the past decade, research on pain in people with intellectual disabilities is still scarce. Pain assessment in people with intellectual disabilities is a frequent and difficult problem, especially for nurses working with people with intellectual disabilities on a daily basis. Gathering more information about pain in people with intellectual disabilities is of major importance and relevance for nursing, and adds to the developing body of knowledge. OBJECTIVE: To investigate the nature and relative importance of non-verbal indicators used by nurses to assess pain in people with a severe or profound intellectual disability. METHODS: A questionnaire consisting of 158 indicators of pain was used. A total of 135 nurses from nine institutions specializing in the care of people with intellectual disability were asked to rate each indicator on a scale of 1-10 to show which non-verbal expressions they considered important in diagnosing pain. RESULTS: A total of 109 nurses responded. All 158 indicators were mentioned as being important to indicate pain. All except four had a range of 9. Seven (moaning during manipulation, crying during manipulation, painful facial expression during manipulation, swelling, screaming during manipulation, not using (affected) body part, and moving the body in a specific way of behaving) were reported as 'very important' by more than 50% of nurses. The lowest score (median 5.5; minimum 1, maximum 10) was given to the indicator 'waving arm movements'. The pain of people with severe intellectual disability appeared to be assessed differently from that of people with profound intellectual disability. Indicators belonging to the 'physiological' category scored relatively higher in the group of nurses specializing in profound disability. In contrast, indicators belonging to the 'social-emotional' category were scored relatively higher by nurses specializing in severe disability. CONCLUSION: Nurses used a wide range of indicators to assess pain in people with intellectual disability. Functional abilities and level of disability seem to influence the indicators used.

Attitude of Health Personnel↗

PubMed1998

Acceptance of disability and its correlates.

In a sample of 1,266 U.S. adults with disabilities, relationships were examined between acceptance of disability and (a) demographic characteristics (age, gender, race, education, marital status, and income); (b) disability conditions (disability onset, multiple disabilities, and chronic pain); and (c) other psychosocial factors (self-esteem, emotional support, perceived discrimination, and hostility). Self-esteem and emotional support from family and friends played important roles in the participants' adjustment to disability. Furthermore, perceived social discrimination against people with disabilities had a significant impact on acceptance of disability. Disability conditions such as acquired disability, multiple disabilities, and chronic pain were also important variables related to disability acceptance.

Adaptation, Psychological↗

PubMed2005

HIV/AIDS information and services: the situation experienced by adolescents with disabilities in Rwanda and Uganda.

PURPOSE: The study had two aims: (2) To explore whether knowledge about HIV and AIDS was similar among adolescents with disabilities compared with their non-disabled peers; and (2) To determine factors which may increase vulnerability of disabled adolescents to HIV infection and/or inappropriate access to HIV-related services. METHOD: A qualitative study using focus group discussions and sem-structured interviews was conducted with purposefully selected participants in Rwanda and Uganda. The participants included disabled adolescents, non-disabled adolescents, parents, teachers, members of disabled people's organisations and representatives of HIV/AIDS organisations. Interviews explored issues of HIV/AIDS knowledge, access to HIV/AIDS services and perceptions of personal risk. RESULTS: Barriers preventing adequate access to information about HIV and AIDS experienced by adolescents with disabilities depended on the nature and severity of the impairment. For example, parents and health workers were unable to communicate with deaf adolescents using sign language, adolescents with physical impairments were often unable to access community meetings about HIV and print material was not adapted for those with visual impairments. Further, assumptions by health workers and community members that people with disabilities were not sexually active led to the marginalisation of disabled people from HIV services. Adolescents with disability described low self-esteem and issues of self-efficacy affecting control of safer sexual relationships. A high level of targeted abuse, rape and exploitation was reported leading to vulnerability among this population. CONCLUSION: The impact of the HIV epidemic among people with disabilities is a neglected area. This study supports the need to develop strategies in HIV prevention programmes that include people with disabilities.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Disability in Te Rau Hinengaro: the New Zealand Mental Health Survey.

OBJECTIVE: To show the disability associated with 1 month mental disorders and chronic physical conditions for the New Zealand population, controlling for comorbidity, age and sex. METHOD: A nationally representative face-to-face household survey was carried out from October 2003 to December 2004 with 12,992 participants aged 16 years and over, achieving a response rate of 73.3%. Mental disorders were measured with the World Mental Health (WMH) Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Disability was measured with the WMH Survey Initiative version of the World Health Organization Disability Assessment Schedule (WMH WHO-DAS) in the long-form subsample (n = 7435). Outcomes include five WMH WHO-DAS domain scores for those with 1 month mental disorders and with chronic physical conditions. RESULTS: Mood disorders were associated with more disability than anxiety or substance use disorders. Experiencing multiple mental disorders was associated with substantial role impairment. Mental disorders and chronic physical conditions were associated with similar degrees of disability on average. The combination of mental and physical disorders had additive effects on associated disability. CONCLUSIONS: Mood disorders are disabling. The investigation of disability in relation to 1 month rather than 12 month disorders is likely to provide a clearer indication of the disability associated with mood disorders. Although some researchers have queried whether negative mood can lead to 'over-reporting' of disability, recent conceptualizations of disability provide a perspective which may ease such concerns. Comorbidity, of mental disorders or of mental and physical disorders, is disabling.

Adolescent↗

PubMed2003

Disability-free life expectancy of elderly people in a population undergoing demographic and epidemiologic transition.

BACKGROUND: the major purpose of health and social policy in old age is to increase quality of life of elderly people. In many demographically developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability. OBJECTIVES: to determine prevalence and severity of disability among the elderly population and to compare disability-free life expectancy and self-care life expectancy among different age groups and between men and women. DESIGN: a cross-sectional multi-stage random sample survey and routine life tables for Thailand. SETTING: national population of Thailand. SUBJECTS: 4,048 elderly subjects aged 60+ years. RESULTS: prevalence rates (95% CI) of long-term disability and dependency in self-care activities of daily living were 19% (95% CI 17.8, 20.2) and 6.9% (6.1, 7.7) respectively. Rates of disabilities increased with age and women were more disabled than men. The life expectancy and disability-free life expectancy at age 60 for men were 20.3 years and 16.4 years, and for women were 23.9 years and 18.2 years respectively. Self-care life expectancies at age 60, calculated from the prevalence of needing help with basic self-care activities, were 18.6 years and 21.3 years for men and women respectively. Women spent proportionately more of their longer life expectancy in a disabled state than men. Men and women can, respectively, expect that 19% and 24% of their life expectancy at age 60 will be spent in a disabled state, but may expect only about 10% of their life expectancy to be spent unable to manage basic self-care activities of daily living. CONCLUSION: long-term disability is common in old age, affecting a quarter of people over 60 years. However, self-care problems are much less common and suggest that the social and health care consequences of demographic transitions are over-estimated by use of simple questions about limiting long-standing disability. Self-care life expectancy provides a useful monitoring tool for censuses and national disability surveys.

Age Factors↗

PubMed2005

Transitions between states of disability and independence among older persons.

The objectives of this prospective cohort study, conducted in New Haven, Connecticut, from 1998 to 2004, were to describe disability states experienced by older persons, to evaluate the rate of transitions between states and the duration of disability episodes, and to determine whether these findings differ on the basis of physical frailty--a condition of low physical capacity and vulnerability to adverse functional outcomes. Participants included 754 persons aged 70 years or older who were initially independent in four key activities of daily living: bathing, dressing, walking, or transferring. Disability was assessed during monthly telephone interviews for a median of 60 months, and participants were classified each month according to the following four states: no disability, mild disability (one or two activities), severe disability (three or four activities), and death. Transitions between states of disability and independence were common, with a majority of both frail and nonfrail participants experiencing at least one transition. The rate of transitions varied greatly among individuals. Nonfrail participants had lower rates of transition from less to more disability, higher rates of transition from more to less disability, and slightly shorter durations of disability. To fully understand the disabling process, investigators and clinicians must consider the episodic and recurrent nature of disability.

Activities of Daily Living↗

PubMed2002

Functional brain reorganization for hand movement in patients with multiple sclerosis: defining distinct effects of injury and disability.

Previous work has demonstrated potentially adaptive cortical plasticity that increases with brain injury in patients with multiple sclerosis. However, animal studies showing use-dependent changes in motor cortex organization suggest that functional changes also may occur in response to disability. We therefore wished to test whether brain injury and disability lead to distinguishable patterns of activation with hand movement in patients with multiple sclerosis. By employing a passive as well as an active movement task, we also wished to test whether these changes were independent of voluntary recruitment and thus more likely to reflect true functional reorganization. Fourteen patients [Extended Disability Status Score (EDSS) 0-7.5] with relapsing-remitting multiple sclerosis were selected on the basis of pathology load and hand functional impairment for three study groups: group 1, low diffuse central brain injury (DCBI) as assessed from relative N-acetylaspartate concentration (a marker of axonal integrity) and normal hand function (n = 6); group 2, greater DCBI and normal hand function (n = 4); and group 3, greater DCBI and impaired hand function (n = 4). Functional MRI (fMRI) was used to map brain activation with a four-finger and both one-finger passive and active flexion-extension movement tasks for the three groups. Considering all the patients, we found increased activity in ipsilateral premotor and ipsilateral motor cortex (IMC) and in the ipsilateral inferior parietal lobule with increasing global disability (as assessed from the EDSS score). These changes appear to define true functional reorganization, as fMRI activations in IMC (r = 0.87, P < 0.001) and in the contralateral motor cortex (r = 0.67, P < 0.007) were highly correlated between active and passive single finger movements. We attempted to disambiguate any distinct effects of disability and brain injury by direct contrasts between patients differing predominantly in one or the other. To make these contrasts as powerful as possible, we used impairment of finger tapping as a measure of disability specific to the hand tested. A direct contrast of patients matched for DCBI, but differing in hand disability (group 3 - group 2) showed greater bilateral primary and secondary somatosensory cortex activation with greater disability alone. A contrast matched for hand disability, but differing in DCBI (group 2 - group 1) showed a different pattern of changes with relative ipsilateral premotor cortex and bilateral supplementary motor area activity. We conclude that the pattern of brain activity with finger movements changes both with increasing DCBI and with hand disability in patients with multiple sclerosis, and that these changes are distinct. Those related directly to disability may reflect responses to altered patterns of use. As injury- and disability-related activation changes are found even with passive finger movements, they may reflect true brain reorganization.

Analysis of Variance↗

PubMed1999

Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE.

OBJECTIVES: There is considerable evidence that social networks are strongly related to survival and other health outcomes. However, findings regarding the effect of social networks on disability outcomes have been inconsistent. This study examines this relationship with respect to the risk of developing disability and recovering from disability. METHODS: Data come from a community-based sample of the New Haven population aged 65 years and older, with nine annual interviews conducted between 1982 and 1991. Disability was measured by a 6-item index of activities of daily living (ADL), and a 3-item Rosow-Breslau index, with disability defined as impairment in one or more tasks on each measure. Social network variables were constructed for each of four domains of ties: children, relatives, friends, and a confidant, and a summary measure of total social networks. A Markov model was used to estimate one-year disability transitions averaged across all 8 intervals, after controlling for sociodemographic and health-related variables. RESULTS: Total social networks was associated with a significantly reduced risk of developing ADL disability (beta = -0.009, p < .01), and a significantly increased likelihood of ADL recovery (beta = 0.017, p < .01). Emotional and instrumental support did not affect the protective effect of social networks against disability, but partially accounted for their effect on enhanced recovery. Network variables related to relatives and friends were significantly associated with disability and recovery risks, but those related to children or a confidant were not. The associations with disability transitions as measured by the Rosow-Breslau index were generally smaller and nonsignificant. DISCUSSION: The findings lend further support for the role of social relationships in important health outcomes in old age. They suggest that being "embedded" in a social network of relatives and friends reduces risk for ADL disability, and enhances recovery from ADL disability.

Activities of Daily Living↗

PubMed2000

Sex differences in the prevalence of mobility disability in old age: the dynamics of incidence, recovery, and mortality.

OBJECTIVES: This study examined sex differences in the prevalence of mobility disability in older adults according to the influences of three components of prevalence: disability incidence, recovery from disability, and mortality. METHODS: Participants in a population-based study of older adults from three communities in the United States (N = 10,263) were studied for up to 7 years. Life table methods were used to estimate the influence of each of the three components of disability prevalence in women and men. Sex differences in probabilities for transition states were measured by relative risks derived from a single model using a Markov chain approach. RESULTS: The proportion of disabled women increased from 22% of women aged 70 years to 81% of those aged 90 years. In men, comparable figures were 15% and 57%. Incidence had the greatest impact on the sex differences in disability prevalence until age 90 and older when recovery rates had a greater impact on differences in prevalence. Mortality differences in men and women had only a modest impact on sex differences in disability prevalence. These findings initially seemed to contradict striking sex differences observed in the relative risks for mortality in men compared with women. Subsequent graphical analyses showed that incidence rather than recovery or mortality largely accounted for sex differences in disability prevalence in old age. CONCLUSION: Disability incidence, recovery from disability, and mortality dynamically influence the sex differences in the prevalence of mobility disability. However, incidence has the greatest impact overall on the higher prevalence of disability in women compared with men.

Adult↗

PubMed2003

Physical activity and disablement in the idiopathic inflammatory myopathies.

PURPOSE OF REVIEW: The sequelae associated with idiopathic inflammatory myopathy (IIM) often result in disability and decreased quality of life. Our understanding of how exercise mitigates disability may be facilitated through the use of a conceptual model. This review describes the enablement-disablement model applied to myositis and explores the role of physical activity in the enablement process. RECENT FINDINGS: National and international organizations have revised their disablement models by acknowledging disability as a relational concept, refining the relationship of disability to quality of life, and incorporating the role of intervention through the enablement process. Disability associated with IIM may be complicated by aging-related comorbidities and decreased physical activity. However, data indicate that both short-term and long-term aerobic training results in improved aerobic capacity and decreased disability in adults with IIM. Strengthening regimens have also resulted in decreased functional limitations and disability for adults with polymyositis and dermatomyositis. While comprehensive exercise programs have not been shown to exacerbate disease activity or damage in people with IIM, their effectiveness for individuals with inclusion body myositis (IBM) remains uncertain. SUMMARY: Physical activity constitutes a valuable enablement strategy that can reduce disability in adults with IIM. Use of the disablement-enablement model and ICF taxonomy in conjunction with outcomes across disablement domains may augment further investigation of the effectiveness of exercise interventions. Additional research is needed to better understand the relationship between disease severity and optimal exercise dosage, the effects of long-term exercise in children with IIM, and the physiologic response to exercise in people with IBM.

Activities of Daily Living↗

PubMed1983

Trend and types of disabled persons in Libyan Arab Jamahiriya.

Libyan Arab Jamahiriya pays special attention to the problem of disability. It truly follows the policy: "Full participation and equality for all persons with disability". In the country, the number and types of disabled persons have been documented thrice since 1964 and priority social services have been extended for them. The prevalence of disabled persons per 1000 population has shown a downward trend from 29.26 in 1964 to 18.65 in 1976. Males were observed to have significantly higher rates than females. The age specific disability rate per 1000 was 7.92 under 15 years, 24.23 between 15 to 49 years and 99.95 for 50 years or more. Blindness and paralysis were the first and second frequent causes of disability in the three counts carried out in 1964, 1973 and 1976. Among all causes of disability mental subnormality and loss of limbs respectively moved up from position five and four in 1964 to three and five in 1973 and 1976; whereas, deafness and dumbness together moved down from position three to four during the same period of time. Compared to the situation in 1964, all categories of disabled persons per 1000 population showed a declining trend over the years except of mentally subnormal who showed an increasing trend. The common causes of disability in the descending order of frequency were acquired diseases (both communicable and non-communicable), accidents, congenital and other disorders. Prevention of disability and services for disabled persons are outlined along with reference to the newly founded National Committee for Care to Disabled Persons.

Adolescent↗

PubMed2005

Perspectives on disability in Afghanistan and their implications for rehabilitation services.

Twenty years of conflict has severely disrupted the infrastructure and economy of Afghanistan. Disability levels are high and much of the population has little access to health facilities. Re-establishing and strengthening rehabilitation services is therefore an important country priority. The aims of this study were to explore perceptions of the nature of disability in Afghanistan and to identify implications for the development of rehabilitation services. Over a 4-week period, interviews and focus groups, supplemented by field observations, were held with a range of service users and other stakeholders (including physiotherapist service providers and representatives of the Afghan Disability Committee) in the districts of Kabul and Herat. Data analysis identified three core themes in discussions with respondents: the nature of disability, causes of disability and rehabilitation priorities for people with disability (PWD). Afghan society distinguishes between traumatic and congenital disability, but disability awareness is much greater for persons with traumatic disability. This group enjoys much greater representation in disabled people's organizations. There is a strong cultural responsibility to care and provide for PWD rather than to encourage independence. Healthcare professionals reflect a medical model in their attitudes towards PWD. A key priority of PWD is economic. There is a low understanding of rehabilitation practice by PWD and medical staff. Training for rehabilitation workers and wider health professionals needs to reflect greater emphasis on a social model of disability. Public awareness and enablement of people with congenital disability needs to be raised.

Afghanistan↗

PubMed1998

Components of initial and residual disability after back injury in nurses.

STUDY DESIGN: A pre- versus postintervention with concurrent control group design was used to investigate the effect of a workplace-based early intervention program on perception of disability in nurses with low back injury. OBJECTIVES: This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Questionnaire in two groups of back-injured nurses-those who received the early intervention program (study) and those who were not offered the program (control). SUMMARY OF BACKGROUND DATA: Early intervention programs can decrease morbidity, time lost from work, and compensation costs. Although perception of disability decreases, some residual disability remains, the nature of which is not clear. METHODS: The Oswestry Low Back Pain and Disability Questionnaire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined. Analysis of variance was used to compare changes in mean overall scores over time. The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Questionnaire at each time period was compared with the results of a chi-square test. RESULTS: Overall Oswestry Low Back Pain and Disability Questionnaire scores were similar between study and control nurses at time of injury, but were significantly lower in study nurses at 6 months after injury. However, scores of individual Oswestry Low Back Pain and Disability Questionnaire components that related to job demands increased over time; this was most apparent in lifting, particularly in study nurses. CONCLUSIONS: Although overall perception of disability decreased 6 months after injury, particularly in study nurses, disability in job-related activities persisted. Residual disability after back injury should be addressed in workplace-based prevention programs.

Adult↗

PubMed2000

Socioeconomic factors and disability retirement from back pain: a 1983-1993 population-based prospective study in Norway.

STUDY DESIGN: A prospective observational study with an 11-year follow-up period was performed. OBJECTIVE: To investigate the influence of education and socioeconomic position on the incidence of permanent disability retirement from back pain. SUMMARY OF BACKGROUND DATA: Early retirement because of back pain is the extreme end point of a disabling process that is a great burden to the individual and costly for the society. Groups of employees at particular risk for permanent back pain disability need to be identified. METHODS: All employed men and women in Norway between the ages of 20 and 53 years in 1980 were included (n = 1,333,556). Outcome measures were disability retirement from inflammatory back pain (ICD-9 code 720) and noninflammatory back pain (ICD-9 codes 721 to 724). RESULTS: The 11-year cumulative incidence was 0.15% (n = 1990) for disability retirement from inflammatory back pain and 1. 64% (n = 21,829) for noninflammatory back pain and was somewhat higher in women than in men. Each year of formal education was independently associated with decreased risk for disability retirement from noninflammatory back pain (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.77-0.79) and from inflammatory back pain (OR = 0.83; 95% CI = 0.81-0.86). Whereas disability from inflammatory back pain was moderately associated with socioeconomic status, there was a consistent upward trend in the association between disability retirement from noninflammatory back pain and lower socioeconomic position. The OR for unskilled workers was 3.1 (95% CI = 2.6-3.7) for men and 2.1 (95% CI = 1.7-2.5) for women, as compared with that of higher professionals. Stepwise analyses suggest that the effect of education is not mediated by socioeconomic status. CONCLUSIONS: The consistent upward trend in the relation of disability retirement to lower levels of education and socioeconomic position, even for inflammatory back pain, shows that factors related to the occupational and social environment play an important role in the disabling process. The stepwise, monotonic relation between socioeconomic position and disability retirement from back pain, even at the higher end of the socioeconomic scale, suggests that the relation between social class and back pain disability cannot be explained solely in terms of manual versus nonmanual jobs.

Adult↗

PubMed2006

Discrepancy between disability and the severity of low back pain: demographic, psychologic, and employment-related factors.

STUDY DESIGN: Survey of a random sample of all registered residents of Japan between the ages of 20 and 79 years (n = 2966), focusing on those who had had low back pain (LBP) within the past month (n = 906). OBJECTIVE: To learn more about the characteristics of people in whom the severity of LBP and the disability attributed to that pain are discrepant. SUMMARY OF BACKGROUND DATA: LBP can cause disability, but levels of pain and of disability can be discrepant. Some people with severe pain are only slightly disabled, some with mild pain are very disabled, and others have no such discrepancy. METHODS.: Severity of LBP was measured with a visual analog scale. Disability was measured with the Roland-Morris Disability Questionnaire, which quantifies disability in many daily activities, not necessarily disability related to employment. The respondents also provided demographic information, and completed the SF-36 and questionnaires about perceived stress, employment, and satisfaction with employment. RESULTS: In about 45% of those patients with LBP, the severity of the pain and level of disability attributed to that pain were discrepant. People with a high level of disability despite only mild pain were older, felt more stress, were more depressed, worked more overtime, and were less satisfied with their job content, income, working conditions, and relationships with coworkers. People with little disability despite severe pain were the opposite in all those respects. CONCLUSIONS: A group of patients with LBP can be identified for whom the most appropriate interventions should consider psychosocial factors.

Adult↗