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PubMed1999

Serum IL-6 level and the development of disability in older persons.

BACKGROUND: The serum concentration of interleukin 6 (IL-6), a cytokine that plays a central role in inflammation, increases with age. Because inflammation is a component of many age-associated chronic diseases, which often cause disability, high circulating levels of IL-6 may contribute to functional decline in old age. We tested the hypothesis that high levels of IL-6 predict future disability in older persons who are not disabled. METHODS: Participants at the sixth annual follow-up of the Iowa site of the Established Populations for Epidemiologic Studies of the Elderly aged 71 years or older were considered eligible for this study if they had no disability in regard to mobility or in selected activities of daily living (ADL), and they were re-interviewed 4 years later. Incident cases of mobility-disability and of ADL-disability were identified based on responses at the follow-up interview. Measures of IL-6 were obtained from specimens collected at baseline from the 283 participants who developed any disability and from 350 participants selected randomly (46.9%) from those who continued to be non-disabled. FINDINGS: Participants in the highest IL-6 tertile were 1.76 (95% CI, 1.17-2.64) times more likely to develop at least mobility-disability and 1.62 (95% CI, 1.02-2.60) times more likely to develop mobility plus ADL-disability compared with to the lowest IL-6 tertile. The strength of this association was almost unchanged after adjusting for multiple confounders. The increased risk of mobility-disability over the full spectrum of IL-6 concentration was nonlinear, with the risk rising rapidly beyond plasma levels of 2.5 pg/mL. INTERPRETATION: Higher circulating levels of IL-6 predict disability onset in older persons. This may be attributable to a direct effect of IL-6 on muscle atrophy and/or to the pathophysiologic role played by IL-6 in specific diseases.

Activities of Daily Living↗

PubMed2004

Bathing disability in community-living older persons: common, consequential, and complex.

OBJECTIVES: To identify the specific bathing subtasks that are affected in community-living-older persons with bathing disability and to determine the self-reported reasons for bathing disability. DESIGN: Cross-sectional study. SETTING: General community of greater New Haven, Connecticut. PARTICIPANTS: A total of 626 community-living persons, aged 73 and older, who completed a comprehensive assessment, including a detailed evaluation of bathing disability. MEASUREMENTS: Trained research nurses assessed bathing disability (defined as requiring personal assistance or having difficulty washing and drying the whole body), the specific bathing subtasks that were affected, and the main reasons (up to three) for bathing disability. RESULTS: Disability in bathing was present in 195 (31%) participants; of these, 97 required personal assistance (i.e., dependence), and 98 had difficulty bathing. Participants with bathing disability reported a mean+/-standard deviation of 4.0+/-2.4 affected subtasks. The prevalence rate of disability for the eight prespecified bathing subtasks ranged from 25% for taking off clothes to 75% for leaving the bathing position. The majority of participants (59%) provided more than one reason for bathing disability. The most common reasons cited by participants for their bathing disability were balance problems (28%), arthritic complaints (26%), and fall or fear of falling (23%). CONCLUSION: For community-living older persons, disability in bathing is common, involves multiple subtasks, and is attributable to an array of physical and psychological problems. Preventive and restorative interventions for bathing disability will need to account for the inherent complexity of this essential activity of daily living.

Activities of Daily Living↗

PubMed1996

Injuries and the risk of disability in teenagers and young adults.

OBJECTIVE: To examine the risk of disability from unintentional injury in teenagers and young adults. METHODS: Analyses of data from the National Child Development Study, a follow up study of 98% of all children born in England, Scotland, and Wales in one week in March, 1958. In 1981, 12,537 study participants, 76% of the original cohort, were asked about unintentional injuries since age 16 years requiring hospital treatment, and whether these injuries resulted in permanent disability. RESULTS: 62% of men and 26% of women reported at least one accident since age 16 resulting in injury that required hospital treatment. Of these accidents, 3.2% caused permanent disability. The risk of disability increased with accident frequency. Injuries requiring hospital admission carried the highest risk of disability (9.7%). However, 54% of permanent disability reported by men and 74% reported by women resulted from injuries treated as outpatients. Road traffic accidents caused 42% of admissions and 31% of disability. Fractures constituted 21% of all injuries but were responsible for 32% of permanent disabilities. Of the permanent disabilities resulting from work related accidents, 82% involved the hand. Of the permanent disabilities resulting from accidents in the home, 32% involved the hand. CONCLUSIONS: The targeting of prevention strategies towards the major causes of injury mortality may have a smaller impact on population levels of injury related disability. Non-life threatening injuries, in particular injuries to the hand and limb fractures, resulting from accidents in the workplace, the home, and during sports, make a significant contribution to the prevalence of permanent injury related disability in young adults.

Accidents↗

PubMed2000

Effect of severity of disability on survival in north east England cerebral palsy cohort.

AIMS: To investigate the effect of motor and cognitive disabilities on the survival of people on the North of England Collaborative Cerebral Palsy Survey, and compare this with other published results. METHODS: The cerebral palsy cohort consists of 1960-1990 births in Northumberland, Newcastle, and North Tyneside health districts. Survival and cause of death were analysed in relation to data on birth, disabilities, and a unique measure of the impact of disability. RESULTS: Disability strongly influences survival. More than a third of those with a severe disability die before age 30. Fewer than a third of deaths are attributed to cerebral palsy on death certificates. Of those with severe cognitive disability, 63% live to age 35 (58% with severe ambulatory disability and 53% with severe manual disability), whereas at least 98% without severe disabilities live to age 35. The Lifestyle Assessment Score (LAS) allows a finer categorisation of impact of disability, and is strongly associated with survival: a ten point increase in LAS is associated with a doubling of the hazard rate. People who had LAS of at least 70, and had survived to age 5 have a 39% chance of dying before age 35. CONCLUSIONS: The majority of people with cerebral palsy attain adulthood. There appears to be more variation in survival rates associated with severe disability between regions of England, than between north east England, British Columbia, and California. Instantaneous risks of dying vary widely between England and California. This variation is not obviously attributable to differing rates of severe disability.

Birth Weight↗

PubMed2002

Measuring the meaning of disability in rheumatoid arthritis: the Personal Impact Health Assessment Questionnaire (PI HAQ).

BACKGROUND: Measurement of disability in rheumatoid arthritis is often used to support treatment decisions and outcome assessments, but is used without reference to the impact of disability on individual patients. OBJECTIVE: To develop and validate a scale to measure individual values for functions, which is used to weight the level of an individual patient's functional loss and thus calculate the personal impact of disability. METHODS: In four linked studies, first the phraseology for values was explored to develop a stem question for the value scale couched in terms patients understand (face validity). Then short and long versions of the value scale were compared (content validity) and tests of internal consistency and short term reliability undertaken (criterion validity). Finally, the value scale was examined for long term reliability and agreement with expected variables (criterion and construct validity), after which personal impact scores were calculated and their construct validity examined. RESULTS: Patients understand the concept of values, and a positively phrased stem question was developed for the value scale, for which a short version was reasonably equivalent to a long version. The value scale was reliable over one week (96% changed by <1 point) with positive interitem correlation. Reasonable six and 12 month reliability was shown (52% changed by <0.5 points), and the value scale was independent of disability and clinical, psychological, personality, and social support variables. Personal impact scores were then calculated by using the value scores to weight disability scores. Impact scores varied widely between patients of similar disability. Personal impact for disability showed convergent validity with dissatisfaction with disability, perceived increase in disability, increased disease activity, worse psychological status, low social support, and time trade off for disability. It discriminated between patients with low and high dissatisfaction with disability, life satisfaction, depression, pain, and helplessness. CONCLUSION: This individualised personal impact scale should lend meaning to disability scores, improving the interpretation of clinical and research data.

Activities of Daily Living↗

PubMed2003

Longitudinal disability curves for predicting the course of relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a lifelong disease affecting young adults that ultimately can lead to significant neurological disability. Identifying the rate of progression of disability for an individual patient early in the disease process can influence treatment decisions as well as enable monitoring of the disease overtime. OBJECTIVE: The aims of the present study were to develop longitudinal disability curves to assess disease progression in patients with relapsing remitting MS. The construction of these disability curves was based on the mean yearly Expanded Disability Status Scale (EDSS) scores, represented as a major percentile group. To determine their predictive ability, validation of the percentile curves was performed. METHODS: Using the Multiple Sclerosis Center computerized database of 1540 patients' records, we identified 1317 subjects with a definite MS and a relapsing-remitting disease course. Longitudinal disability curves were constructed for a subgroup of relapsing-remitting patients (n = 1001) with consecutive (3-6 months) EDSS assessments for a period of up to 10 years since onset. The constructed disability curves were then validated in an additional subgroup of relapsing-remitting MS patients (n = 268) with continuous follow-up visits for a period of 10 years. RESULTS: Statistical procedures using parametric and nonparametric regression procedures were applied to the data in two stages. In the first stage, selected major percentiles were generated for up to 10 years from disease onset with a variety of parametric procedures including moving averages. In the second stage, the empirical percentiles were smoothed to obtain the final disability progression curves. The log-rank test for equality demonstrated a significant adjustment between the initial percentile assignment and disability progression (P < 0.001). Life table analysis demonstrated that the probability of deviating from the initially assigned percentile to a higher percentile over time, representing more severe disability than expected, is in the range of 6.5% for the 50th percentile to 10.4% for the 75th percentile. CONCLUSION: Longitudinal disability curves can be used in MS to assess individual patient disability, can contribute to the overall clinical impression of disease progression and can add to the evaluation of immunomodulating treatment effects overtime.

Adult↗

PubMed2005

Inclusion of people with disabilities in telephone health surveillance surveys.

OBJECTIVES: Telephone survey data are widely used to describe population health, but some fear that people with disabilities cannot participate. We tested the hypothesis that a telephone survey would underrepresent adults with disabilities, and that the adults with disabilities who responded would report lower prevalences of sensory, mental, self-care, and multiple limitations than those observed in people with disabilities in the general population. METHODS: We compared characteristics of adults with disabilities identified by the 2001 Washington State Behavioral Risk Factor Surveillance Survey (BRFSS) to Washington adults with disabilities in the Census 2000 Supplementary Survey (C2SS), to 2 BRFSS Disability Supplements, and to the Washington State Population Survey. All except the C2SS are telephone surveys. RESULTS: Contrary to expectations, post hoc analyses of all telephone surveys found significantly higher prevalence of disability in the Washington adult population than did the C2SS. The hypothesis of more sensory, mental, and self-care limitation in telephone disability samples was supported in only 2 of 11 instances in which a disability sample was asked about 1 of these limitations. Findings were not explained by differences in disability definition or type of informant. CONCLUSIONS: These results suggest that population telephone surveys do not underrepresent adults with disabilities. The counterintuitive finding of their higher survey participation raises further questions.

Activities of Daily Living↗

PubMed1995

What does morbidity have to do with disability?

This study compares and contrasts survey data on disablement from six countries according to their distributions and prevalence of causes and underlying medical conditions, using a framework proposed by the author that includes morbidity as one important determinant of disablement. The main thesis of this paper is that the study of disablement (that is impairments, disabilities and handicaps) should be conceptualized and classified independently of illness and poor health. Disablement, by definition, is not an illness. Using the World Health Organization global definitions of health it is possible to be both healthy and disabled. The assertion, however, that disability is not an illness does not preclude the joint study of morbidity and disablement; nor does it diminish the significance of disease and injury in the explanation of rates of disablement. Disablement is classified through the use of the WHO International Classification of Impairments, Disabilities, and Handicaps (ICIDH). The WHO International Statistical Classification of Diseases and Related Health Problems (ICD-10) is the primary classification used for the study of morbidity. This paper demonstrates that statistical guidelines and instructions on the use of the ICD and the ICIDH, including the development of appropriate short-listings of codes, are needed in order to increase data comparability and to further encourage sound research. National survey data examined are from the United Nations International Disability Statistics Data Base, DISTAT.

Data Collection↗

PubMed2006

Environmental barriers to health care among persons with disabilities--Los Angeles County, California, 2002-2003.

In 2002, an estimated 51.2 million persons in the United States (approximately 18.1% of the population) had a disability. Recent data suggest that substantial disparities in health behaviors and overall health status exist between persons with and without disabilities. Nonetheless, when they have access to adequate health care, persons with disabilities can lead healthy lives. The World Health Organization's International Classification of Functioning, Disability, and Health stresses the importance of environment (e.g., physical environment, attitudes of others, or policies) as either a barrier or facilitator in the daily activities of persons with disabilities. In addition, increasing access to health and wellness treatment programs for persons with disabilities and reducing the proportion of persons with disabilities who report environmental barriers to participation in daily activities are goals of Healthy People 2010 (objectives 6-10 and 6-12). However, few population-based studies have explored how environment affects the lives of those with disabilities. To determine the prevalence of disability among persons in Los Angeles County, California, and assess the effects of environmental barriers on these persons, residents were surveyed during 2002-2003. The results of that survey suggested that persons with physical or sensory disabilities experienced several environmental barriers and that the prevalence of barriers varied by demographic characteristics, household income, and severity of disability. To improve quality of life among persons with disabilities, public and private health agencies should implement measures to remove environmental barriers to health care and other services.

Adolescent↗

PubMed1990

The role of non-auditory factors in measured and self-reported disability.

The effect of age per se on auditory disability in relation to other non-auditory factors, including personality and IQ, is unclear because of the close link with hearing threshold level. Auditory disability may be assessed in terms of either performance or self-report. It was measured using two tasks identifying words in sentences: (1) sentence identification in noise for spatially separated signal sources, and (2) identification of sensible and nonsensical sentences given at normal and artificially accelerated rates. Self-reported disability was assessed using the MRC Institute of Hearing Research's Hearing Disability Questionnaire and the American Hearing Performance Inventory. The sample of 240 individuals aged 50-75 years was constructed to provide a balance across the major stratification parameters of hearing level and age. In accordance with much of the published literature, the performance indices exhibited significant age effects: for a given hearing threshold level, older individuals are more disabled. Conversely, the indices of self-reported disability exhibit a trend whereby individuals with a given hearing threshold level, report a lower degree of disability with increasing age. There were no significant effects of personality, verbal or non-verbal IQ on the performance indices. However, these variables had large effects on reported disability, increasing the explained variance by approximately 20% more than the variance explained by hearing threshold level and age. Thus, the effect of age has the expected direction for performance-based disability, but for reported disability has the counter-intuitive direction. This finding, together with the additional large significant effects of other nonauditory variables, implies that indices of self-reported disability have to be controlled for these other major determinants if they are to be useful in an overall assessment of auditory disability.

Aged↗

PubMed1985

[The right work for every disabled person: the ERTOMIS ability and requirement profiles for the appropriate determination of a workplace].

In close accordance with the "International Classification of Impairments, Disabilities and Handicaps" issued by the World Health Organisation in 1980, and in cooperation with medical doctors, psychologists, and vocational teachers a reintegration of disabled adults. Instead of only attesting to the rehabilitated person his disabilities this system allows qualified persons to assess by means of a set of 64 evaluation criteria in an "Ability Profile" the abilities available to the disabled after rehabilitation; likewise, using the same 64 criteria it allows one to determine in a "Requirement Profile" those requirements a particular job poses to the corresponding person. The two profiles can be compared, thus providing an easy match between the person's abilities and the abilities necessary to perform the job. The various criteria reflect "elementary abilities" or correspondingly "elementary requirements". By comparison of the two profiles it is possible--in a first rough approach based on correspondingly developed judging abilities of the evaluator--to determine rather accurately whether a certain kind of work, to which a "Requirement Profile" is available, is adequate for a certain disabled person--for whom an "Ability Profile" has also been developed. The question whether the chosen work is fully adequate can thereby be answered with maximum accuracy only at the corresponding workplace by an occupational physician and the other professionals responsible for the employment of the disabled. The ERTOMIS system thus facilitates the job placement of disabled people; it can also help decide on eventual complementary rehabilitation measures directed towards the better adjustment of the disabled to a certain work, or the improved adjustment of that work to the abilities of the disabled. Each disability is unique to each individual; by means of this system system--completed with the personal dossier from which data on the vocational training and experience of the disabled can be taken--it can also be assessed in a way that reflects this important individuality. The criteria describe only abilities and requirements relevant to work performance. If one so chooses, for data protection reasons the "Ability Profile" can be handed out to the disabled person only. No copies of documents may be kept except for the purpose of medical records.

Aptitude↗

PubMed1987

The cost of disability.

Approximately 16.5% of the adult population in the United States is disabled. About half of the disabled are severely limited and unable to work regularly. Musculoskeletal disorders are the most frequent type of disability. In the United States, there are three major types of disability insurance: Social Security Disability Insurance (a federal program), Workers' Compensation Insurance (usually a state-regulated program), and private health insurance. Recent years have seen a greater demand for private long-term disability insurance, as the trend increases toward less than total reliance on public programs to support disabled workers. The most recent statistics available indicate that Social Security Disability Insurance benefits are currently about $16.8 billion per year; workers' compensation benefits, $16.1 billion; and private disability income protection benefits, $5.2 billion. These figures add up to almost $40 billion in insurance costs. However, insurance costs are only part of the total cost because not everyone is covered by insurance, and insurance does not cover all disabilities. Disability can never be totally prevented or eliminated, but disability and its costs can be substantially reduced through more effective treatment and rehabilitation, including patient education and vocational rehabilitation.

Adolescent↗

PubMed1994

Prevalence of disabling conditions in a rural northern Thai community: a survey conducted by village health communicators.

This report presents a survey of disabling conditions conducted by village health communicators (VHCs) in 1989 in a rural northern Thai community. The disabled were first identified by a VHC and then examined clinically and socially by a health care team both to confirm the clinical diagnosis and to formulate an appropriate treatment plan. The overall prevalence rate of disabled persons was 6.3/1,000 population. The prevalence rate was higher for males than females and increased with age. Locomotor disability (48.8%) was the most commonly identified disabling condition, with visual disability (27.8%) the next most common. Communication disorders, mental retardation, and psychosis constituted the remaining 23.4%. Of the locomotor disabilities, the major disabling conditions were poliomyelitis, congenital malformations, traumatic amputations, and cerebral palsy. Unoperated cataract accounted for 72.0% of all cases with visual disabilities. While the true magnitude of the disability problem may be somewhat understated, the data reported in this study clearly reveal that there are many persons with untreated disabling conditions in rural communities, and that a significant number of them can benefit from medical treatment and rehabilitation. A survey utilizing VHCs may be helpful to identify the disabled in rural communities.

Adolescent↗

PubMed1998

Major medical and social needs of disabled rural inhabitants.

A considerable increase in the number of the disabled has been observed in Poland during the last two decades, especially in rural areas, and constitutes a serious social and economic problem. It is therefore necessary to continue work on the detailed definition of disability and to develop new disability qualification-classification methods (evaluation of the degree of invalidity). The all-Polish study of the state of health of rural population has considerably extended the knowledge of the problems experienced by this population group. The survey covered 1,491 people, including 779 females (52.2%) and 712 males (47.8%). The primary aim of the study was the qualitative and quantitative analysis of the medical and social situation of disabled adult rural inhabitants. The paper presents the basis on which respondents were classified as disabled, an analysis of their health and social situation, and analysis of their medical and social needs. The features were determined which distinguish subpopulations of those with legally ascribed categories of invalidity from those who have no legal decision concerning invalidity, and factors which distinguish farmers from non-farmers. The most frequent causes of disability were cardiovascular diseases, followed by diseases of the musculoskeletal system and connective tissue, diseases of the nervous system and sense organs, and respiratory diseases. As much as 93.7% of the total number of the disabled required diagnostic and treatment procedures. A great demand for specialist treatment was observed among the youngest disabled aged 20-34. It was noted that the provision of orthopaedic and rehabilitation equipment, as well as of auxiliary aids, was highly insufficient from the aspect of both quality and quantity. Only 17% of the total number of disabled who expressed needs (130 out of 765 persons) were provided with such equipment. Only 8 people had a full range of technical adjustments in their dwellings. The disabled mentioned the following problems which significantly disturbed their functioning in everyday life: material difficulties, need for providing care for another disabled member of the family, the lack of independent lodging and proper employment. The study shows that the health, social and economic situation of the disabled rural inhabitants is very difficult. Further studies of this problem are needed, as well as the organization of medical, rehabilitation and social aid in this micro-environment.

Adult↗

PubMed2000

Repeated lumbar or ventricular punctures for preventing disability or shunt dependence in newborn infants with intraventricular hemorrhage.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether repeated CSF tapping, by lumbar puncture or ventricular tap, reduced the risk of permanent shunt dependence, neurodevelopmental disability or death in neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus (PHH). This form of treatment was based on the hypothesis that repeated tapping removed protein and blood from the CSF, thus clearing obstruction from the channels of CSF absorption. SEARCH STRATEGY: Pediatric, Neurosurgical and General Medical Journals were handsearched from 1976, as well as the Medline database. Personal contacts were used. SELECTION CRITERIA: Four controlled trials ( with five published papers) were identified, three being randomised and the fourth using alternative allocation. Two trials evaluated repeated lumbar punctures in neonates with intraventricular hemorrhage (IVH) and two trials evaluated repeated CSF tapping infants with IVH followed by progressive ventricular dilatation. DATA COLLECTION AND ANALYSIS: In addition to details of the patient selection and patient allocation, the interventions were extracted. The end-points examined were: ventriculoperitoneal shunt, death, disability, multiple disability and death or disability. MAIN RESULTS: The studies were sufficiently similar in the question they were asking and the interventions were sufficiently in common that they could be combined when assessing the effect of the intervention. When repeated CSF tapping was compared to conservative treatment, the relative risks for shunt placement, death, disability and multiple disability were very close to 1.0 with no statistically significant effect. There is also evidence that this form of treatment increased the risk of CSF infection. REVIEWER'S CONCLUSIONS: Early repeated CSF tapping cannot be recommended for neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus.

Cerebral Hemorrhage↗

PubMed1985

Spatial-frequency-dependent visible persistence and specific reading disability.

Visible persistence duration for sine-wave gratings was measured in 9-year-old normal and specific-reading-disabled children. Experiment 1 investigated the influence of stimulus duration on visible persistence. The results demonstrated a Reading Group X Spatial Frequency interaction with disabled readers showing a smaller increase in persistence duration with increasing spatial frequency than controls. This interaction was greatest with stimulus durations longer than 80 msec. In Experiments 2a and 2b persistence was measured across a range of contrasts from .1 to .5. The stimulus durations employed were 100 msec in Experiment 2a and 300 msec in Experiment 2b. In both experiments, increasing contrast decreased persistence duration at 2 and 12 cycles per degree (c/deg) for the control group. In the specific-reading-disabled group, however, contrast had little effect on the persistence of 2-c/deg gratings in either experiment. In Experiment 2a the persistence of the 12-c/deg grating decreased with increasing contrast for both groups. In Experiment 2b contrast had significantly less effect on persistence duration in the specific-reading-disabled group, however, contrast had little effect on the persistence of 2-c/deg ratings in either experiment. In Experiment 2b contrast had significantly less effect on persistence duration in the specific-reading-disabled group than in the control group at 12 c/deg. Consequently, contrast had less effect on persistence in specific-reading-disabled children than in normal readers, especially at durations longer than the "critical duration" for each spatial frequency. Experiment 3 extended this finding to gratings with spatial frequencies of 4 and 8 c/deg. These results indicate a difference between normal and specific-reading-disabled children in cortical visible persistence. Two scores of visual processing were derived from the above experiments. On these scores the reading-disabled children were divided into Visual Disabled Readers (approximately 70%--eight subjects) and Nonvisual Disabled Readers (approximately 30%--four subjects). The percentages of disabled readers in each category remained constant when the sample size was increased to 61 normal and disabled readers.

Attention↗

PubMed1998

Psychological distress: linking impairment with disability in facial neuromotor disorders.

The relationship between facial neuromotor system impairment, disability, and psychological adjustment is not well understood. This study was designed to explore the relation between impairment and disability and the impact of psychological adjustment on the relation for individuals with disorders of the facial neuromotor system. We studied outpatients (n=48; mean age, 49.0; SD=16.3; range, 18 to 84 years) with a facial neuromotor disorder and acute or chronic facial paralysis. Measures of impairment (Facial Motion Assay, House-Brackmann scale, and Facial Grading System), disability (Facial Disability Index, physical and social well-being subscales), and psychological adjustment (Beck Anxiety Inventory, Beck Depression Inventory) were administered. Bivariate correlations between impairment and disability measures indicated impairment was positively correlated with physical and social disability (r=0.44, p < 0.01; r=0.39, p < 0.05, respectively). Stepwise regression analysis to predict disability indicated physical disability was predicted by impairment and the interaction of impairment and psychological distress (R2=0.425; F=12.57; df=2, 34; p=0.002). Psychological distress, and not impairment and the interaction of impairment and distress, was the single predictor of social disability (R2=0.274; F=13.23; df=1, 35; p=0.001). Psychological distress was a moderator of the relation between impairment and physical disability and a mediator of the relation between impairment and social disability for individuals with facial neuromotor disorders. Assessment and interventions targeted for psychological distress in addition to interventions targeted for impairments appear warranted to effectively reduce the disability associated with facial neuromotor disorders.

Adaptation, Psychological↗

PubMed2003

Validity of clinical and patient ratings of tremor disability among older adults.

OBJECTIVE: To evaluate the validity of the clinical tremor disability interview using a performance-based measure, patient ratings of tremor disability, and bedside tremor severity ratings of upper extremity (UE) action/intention (A/I) and postural (P) tremor. METHOD: Sixteen older adult essential tremor patients (mean age=75.4 years, sd=5.7 years) took part in a study evaluating the validity of clinical and self-rating scales of tremor disability. A neurologist obtained bedside clinical ratings of UE A/I and P tremor of each limb and completed a clinical tremor disability rating. A second investigator, blind to neurological exam results obtained a clinical disability rating using the same measure, patient rated tremor disability ratings and conducted a performance-based disability assessment. RESULTS: Clinical tremor disability ratings were not significantly related to functional performance-based or patient ratings of tremor disability. Bedside clinical ratings of tremor severity also were not associated with clinical or patient-rated tremor disability. Patient ratings were significantly correlated with performance-based ratings. CONCLUSIONS: Further research is needed to validate a brief, sensitive clinical rating scale of tremor disability among older adults. Use of bedside ratings of tremor severity may be problematic and possibly estimate tremor disability. Empirical evaluation of differences in rating methods needs to be directly addressed.

Activities of Daily Living↗