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PubMed1996

A comparison of measures of disability and health status in people with physical disabilities undergoing vocational rehabilitation.

BACKGROUND: The aim of the study was to test among people undergoing vocational rehabilitation six measures of disability and health status commonly used in medical rehabilitation. METHOD: A cross-sectional survey was carried out on 30 people with disabilities on an occupational programme at a non-medical rehabilitation facility in England. Measures used were the Barthel index, Extended Activity of Daily Living (EADL) scale, the Office of Population Censuses and Surveys (OPCS) disability questionnaire, the Functional Independence Measure (FIM), the Nottingham Health Profile (NHP) and the Medical Outcome Study Short Form 36 (SF36). The main outcome measures were item non-response and time for completion of each measure, profile of disability and health status described by each measure, including pertinent domains detected or missed, and floor and ceiling effects. RESULTS: Item non-response was very low with all the instruments; the Barthel index was on average the quickest to complete (mean time 2.2 minutes) and the SF36 the longest (mean time 9.1 minutes). The study group were characterized as having problems in mobility or locomotion and bladder or bowel control, but some of the instruments were insensitive, detecting no disability in many subjects (e.g. 33 per cent showed no disability on the Barthel index). The SF36 scores were the least affected by floor and ceiling effects; mean SF36 scores on all scales except physical functioning were similar to those for the general population of similar age. Some problems were detected by only one of the instruments (e.g. pain and sleep by the NHP, problems with intellectual functioning by the OPCS scale). CONCLUSION: Disability measures commonly used in medical rehabilitation, such as the Barthel score and FIM, may be less useful in vocational rehabilitation where disabilities are less severe. Other measures show more promise but further testing is needed.

Activities of Daily Living↗

PubMed1997

Incentives to disability in federal disability insurance and supplemental security income.

Between 1989 and 1994, Disability Insurance and Supplemental Security Income, the 2 federal programs that provide disability benefits, expanded rapidly. The largest growth has been among recipients with mental disorders in the Disability Insurance program and among children with learning disabilities in the Supplemental Security Income program. The expansion was partly due to changes in eligibility rules and partly to other factors including outreach efforts by the Social Security Administration and a lack of funds to review and terminate cases. Factors that keep many of the disabled from seeking work include a fear of being unable to obtain health insurance, which is provided to beneficiaries under Disability Insurance and Social Security Insurance, and the fear of being unable to obtain and keep stable employment. Although children's Supplemental Security Income benefits have reduced poverty in families with disabled children, there is some evidence that parents are encouraging their children to behave poorly so they can qualify. Replacing present welfare and disability programs with national health insurance and a guaranteed annual income would eliminate the work disincentives, but such dramatic restructuring is unlikely in the context of present political debates.

Eligibility Determination↗

PubMed1986

Disabilities, benefits, and disability benefits.

The purpose of this paper is to relate the patterns of disabilities in a sample of young adults to the amounts they received in social security benefits towards extra arising from disablement. Data on 248 young people aged 18 to 22 who lived in England were obtained by means of interviews with their parents. There was wide variation in weekly amounts received in benefits for the extra costs of disablement. The most severely disabled did not receive invariably the highest levels of support and some disabilities were not associated with amounts received in benefits. The findings indicate that the United Kingdom social security system is biased towards meeting the extra costs which arise from physical disablement; costs which arise because of mental disablement attract less recognition. It is concluded that help with extra costs should be based on a comprehensive assessment of disablement and its financial consequences.

Adolescent↗

PubMed2006

Does the disabilities of the arm, shoulder and hand (DASH) scoring system only measure disability due to injuries to the upper limb?

Although the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was designed, and has been validated, as a measure of disability in patients with disorders of the upper limb, the influence of those of the lower limb on disability as measured by the DASH score has not been assessed. The aim of this study was to investigate whether it exclusively measures disability associated with injuries to the upper limb. The Short Musculoskeletal Functional Assessment, a general musculoskeletal assessment instrument, was also completed by participants. Disability was compared in 206 participants, 84 with an injury to the upper limb, 73 with injury to the lower limb and 49 controls. We found that the DASH score also measured disability in patients with injuries to the lower limb. Care must therefore be taken when attributing disability measured by the DASH score to injuries of the upper limb when problems are also present in the lower limb. Its inability to discriminate clearly between disability due to problems at these separate sites must be taken into account when using this instrument in clinical practice or research.

Adult↗

PubMed1990

The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community.

The relation between coronary heart disease and disability was examined in 2,576 community-dwelling women and men ages 55-88 years. These Framingham Study participants were originally recruited in 1948-51 for an examination of cardiovascular disease. Twenty-seven years later, remaining members of the cohort were interviewed to ascertain physical abilities, and a score on a disability scale was assigned. Multivariate logistic analyses examined disability in relation to uncomplicated angina pectoris (AP), complicated AP, and coronary heart disease other than AP, controlling for possible confounders. In younger and older women and men, uncomplicated and complicated AP were associated with disability. Coronary heart disease other than AP was associated with disability only in the younger men. Congestive heart failure predicted disability only in the women. These results suggest that onset of AP should be recognized as a critical point in the development of disability and that AP is a better predictor of disability than is myocardial infarction or coronary insufficiency.

Aged↗

PubMedDate not supplied

A global perspective on disability: a review of efforts to increase access and advance social integration for disabled persons.

Disability has emerged as a major public health problem worldwide, common to nations presenting disparate levels of socioeconomic development. Failure to integrate social welfare programmes within national development planning exacerbates difficulties arising from limited resources, with a disproportionate impact on disabled persons and other vulnerable groups. Such policy failure allows flagrant inequalities and social injustice to persist. Strategies are emerging, however, that are useful for solving common international problems. Community-based disability prevention and rehabilitation is one emerging solution that has attracted considerable attention worldwide, including in the United States. Following a review of global estimates of disability, which reveal the magnitude of the problem and provide background information for this report, I will summarize major international initiatives designed to prevent disability and ensure comprehensive rehabilitation for disabled persons. I will also analyse the relationships between health, socioeconomic development, and disability. Finally, I will describe community-based rehabilitation, an innovative approach evolving from the World Health Organization's Global Strategy for Health for All by the Year 2000, an approach with potential to eliminate barriers to equal opportunities and social integration for disabled persons.

Community Health Services↗

PubMed1996

Disablement observed, addressed, and experienced: integrating subjective experience into disablement models.

Although subjective experience is critical to full comprehension of disablement, it has yet to be integrated into models in a systematic and theoretically grounded way. This article presents a framework for modelling disablement that includes both objective and subjective features. The framework is based on a novel integration of: (1) perspectives on disablement; (2) the contexts within which disablement occurs; and (3) interaction among these perspectives and contexts. The framework is developed using nomenclature derived from the WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Although ICIDH terminology is used, the article's integration of ideas can as well be applied to other disablement nomenclatures and models. The framework offers a conceptual background for innovative clinical, policy, and research responses to disablement, as well as for further development of disablement theory and models.

Activities of Daily Living↗

PubMed2001

Widespread musculoskeletal pain and the progression of disability in older disabled women.

BACKGROUND: Widespread musculoskeletal pain is a poorly understood but common problem in older adults. Little is known about the progression of disability related to this condition. OBJECTIVE: To determine whether widespread musculoskeletal pain increases the risk for worsening disability in older women with disabilities. DESIGN: Prospective cohort study. SETTING: The Women's Health and Aging Study. PARTICIPANTS: 1002 community-dwelling women 65 years of age or older with disability. MEASUREMENTS: Widespread musculoskeletal pain was defined as pain in the upper and lower extremities and axial pain with moderate or severe pain in at least one of the three regions. Worsening disability was defined as progression from no or mild difficulty to severe difficulty or inability to perform activities of daily living (ADLs), walk one-quarter mile, or lift 10 lbs. RESULTS: At baseline, 24% of participants had widespread pain and 25% had no pain or only mild pain in a single site. Women with widespread pain were 2.5 to 3.5 times more likely to have severe difficulty with ADLs, walking, or lifting at baseline compared with women who had no or mild pain. In women without severe difficulty initially, widespread pain nearly doubled the risk for progression to severe difficulty in each of the tasks, after adjustment for age, body mass index, comorbid illness, and other confounders. CONCLUSION: Widespread musculoskeletal pain is frequent among community-dwelling older women with disability and appears to predict the progression of disability. Efforts to better understand the cause of this pain and its treatment might reduce the overall burden of disability.

Activities of Daily Living↗

PubMed1998

Delay in presentation and start of treatment in leprosy patients: a case-control study of disabled and non-disabled patients in three different settings in Ethiopia.

The delay incurred by leprosy patients between the onset of symptoms and the start of treatment has not been well characterized. Because reducing this delay is likely to be the most productive of all activities aimed at preventing disability, we compared the various components of delay in disabled and nondisabled new leprosy cases in a case-control study. Disabled patients had a median overall delay of 26 months, while nondisabled patients incurred a delay of only 12 months. The total delay was divided into three components: a) the delay between the onset of symptoms and the first act of health-seeking behavior, which was significantly longer for disabled patients; b) the delay between the first action and the first visit to a recognized clinic, which was also significantly longer for disabled patients; and c) the delay between the first clinic visit and the start of treatment, which was important in some cases: in those patients whose delay was due to problems within the health services, disabled patients again had a significantly longer delay. The study also compared two rural areas of Ethiopia, one with high and one with low rates of disability in new cases. High rates of disability (and greater delay in starting treatment) were thus associated with high levels of stigma, being from the Christian rather than the Muslim community, and the use of traditional medicine. There was, surprisingly, no association with knowledge about the transmission, symptoms and curability of leprosy. Implications for health promotion activities are discussed.

Adolescent↗

PubMed2002

Disability part 2: access to dental services for disabled people. A questionnaire survey of dental practices in Merseyside.

This article aims to identify how accessible general dental practitioners thought that their services were and to identify the barriers they face in providing care for disabled people. A postal questionnaire survey was undertaken of all general dental practices in the Liverpool, Sefton, St Helens and Knowsley Health Authorities. Only one quarter of practices described themselves as having full physical access for disabled patients. However, despite this, over 90% of practices reported treating disabled patients and most were willing to treat more disabled patients. Dentists identified physical barriers, lack of time and the lack of domiciliary equipment as the main barriers to providing care for disabled people. Although dentists were willing to treat disabled patients few dental practices were accessible at the time of the survey. Further work is needed to ensure that dental practices comply with the Disability Discrimination Act.

Architectural Accessibility↗

PubMed2006

Prevalence of four developmental disabilities among children aged 8 years--Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1996 and 2000.

PROBLEM/CONDITION: In the United States, developmental disabilities affect approximately 17% of children aged <18 years, resulting in substantial financial and social costs. REPORTING PERIOD: 1996 and 2000. DESCRIPTION OF SYSTEM: The Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) monitors the occurrence of mental retardation, cerebral palsy, hearing loss, vision impairment, and autism spectrum disorders among children aged 8 years in the five-county metropolitan Atlanta area (Clayton, Cobb, DeKalb, Fulton, and Gwinnett). MADDSP uses a multiple source ascertainment methodology. RESULTS: During 1996, the prevalence of mental retardation was 15.5 per 1,000 children aged 8 years; it decreased to 12.0 per 1,000 in 2000. The overall prevalence of cerebral palsy was 3.6 per 1,000 in 1996 and 3.1 per 1,000 in 2000. The prevalence of mental retardation and cerebral palsy was highest among males and black children. The prevalence of hearing loss was 1.4 per 1,000 in 1996 and 1.2 per 1,000 in 2000; the prevalence of vision impairment during 1996 was 1.4 per 1,000 and 1.2 per 1,000 in 2000. Minimal differences by study year were observed in the prevalence of all four disabilities when examined by sex, race, and severity. INTERPRETATION: The prevalence of these four select developmental disabilities in MADDSP was higher in 1996 than the annual average prevalence estimates for these disabilities during previous MADDSP study years (1991-1994) study years; the highest increase was observed among children with mental retardation. However, prevalence estimates during 2000 were more consistent with the estimates from the early 1990s. Data from additional surveillance years (2002 and beyond) are needed to determine if the prevalence for 1996 was an anomaly and to continue to monitor trends in the prevalence of developmental disabilities over time. PUBLIC HEALTH ACTIONS: MADDSP data will continue to be used to examine trends in the occurrence of these disabilities over time, facilitate the development and implementation of appropriate intervention programs, and provide a framework for conducting population-based etiologic studies.

Autistic Disorder↗

PubMed1993

Development of a scoring system to assess disability in an Italian elderly population. Evaluation of a disability questionnaire.

Functional disability was evaluated in a cross-section sample of 671 persons, aged > or = 60 years attending the Local Health Care Unit of Borgo San Dalmazzo, Cuneo, Italy, by the OECD (Organization for Economic Co-operation and Development) questionnaire. The unidimensionality of the item set and grading order of severity were studied by Multiple Correspondence Analysis; cumulativeness was examined by Guttman scale-analysis. The OECD set measured two dimensions of disability, physical and sensorial. By excluding the six items that caused the greatest loss of homogeneity, a reduced set of ten items was obtained that was cumulative (Reproducibility coefficient = 0.934 and Scalability coefficient = 0.778) and also produced a simpler score (0-10 points scale). Based on this score, 40% of the subjects presented no disability in running 100 metres (the most difficult task), and males were less disabled than females (p = 0.001). The level of functional disability was slightly decreased in males, and nearly uniform in females up to 70-74 years, after which a clear decrease appeared (p = 0.001). The more disabled aged state a need for a higher number of health services (injection and physical therapy, nursing hospital, nursing home, physician), but knowledge and use of these services are not clearly related to physical function. Based on our results, the choice of scaling appears irrelevant if the homogeneity of the item set is checked; if the cumulative criterion is identified, the use of a simplified cumulative score can be proposed as a sensitive measure of disability, and indirectly, the amount of personal assistance needed.

Activities of Daily Living↗

PubMedDate not supplied

Construction and psychometric properties of sexuality scales: sex knowledge, experience, and needs scales for people with intellectual disabilities (SexKen-ID), people with physical disabilities (SexKen-PD), and the general population (SexKen-GP).

This study reports on the development and assessment of the psychometric properties of three measures to assess sexual knowledge, experience, feelings, and needs. The first was designed to assess the Sexual Knowledge, Experience, Feelings, and Needs of people with mild intellectual disabilities (SexKen-ID). The two parallel measures were designed to assess the same areas of sexuality among people with physical disabilities (SexKen-PD) and among the general population (SexKen-GP). The areas of sexuality included in the scales were Friendship, Dating and Intimacy, Marriage, Body Part Identification, Sex and Sex Education, Menstruation, Sexual Interaction, Contraception, Pregnancy, Abortion and Child-birth, Sexually Transmitted Diseases, Masturbation, and Homosexuality. Generation of the items in these scales is described in Studies 1-3. Study 4 describes the evaluation of the psychometric properties of the scales. Sixty-six people with intellectual disabilities, 54 people with physical disabilities, and 100 people from the general population completed the scales. Test-retest reliabilities were also calculated with 30 people with intellectual disabilities, 30 people with physical disabilities, and 30 people from the general population. These data demonstrate the good psychometric properties of the scales and so their simitability for assessing the sexual knowledge, experience, feelings, and needs of people with disability.

Adult↗

PubMed2002

Children with intellectual disability in rural South Africa: prevalence and associated disability.

The objective of the present study was to determine the prevalence of intellectual disability (ID) and its associated disabilities in rural South African children aged 2-9 years. It was undertaken in eight villages in the district of Bushbuckridge, Northern Province, South Africa. A two-phase design was utilized. The first phase involved screening children on a house-to-house basis by interviewing mothers or caregivers using an internationally validated questionnaire for detecting childhood disability in developing countries. The second phase consisted of a paediatric/neurodevelopmental assessment of the children who screened positive. A total of 6692 children were screened; 722 (10.8%) had a paediatric evaluation and 238 children were diagnosed with ID, giving a minimum observed prevalence of 35.6 per 1000 children in this population. The prevalence of severe and mild ID was 0.64 per 1000 and 29.1 per 1000 children, respectively. The male:female ratio of children with ID was 3:2. In the affected children, a congenital aetiology for the ID was determined in 49 subjects (20.6%), an acquired aetiology in 15 (6.3%) and the aetiology was undetermined in 174 children (73.1%). Epilepsy (15.5%) and cerebral palsy (8.4%) were the commonest associated disabilities. The present study represents the first data on the prevalence of ID and associated disabilities in rural South African children. The prevalence of ID was comparable with results from a study performed in one other African country (Zambia) as well as those from other developing countries. The data provide an initial factual insight into ID and its associated disabilities for healthcare, social service and educational policy planners. This study provides a basis for the initiation and development of appropriate and integrated services for the best possible care of individuals affected with these disabilities, and for their possible prevention.

Child↗

PubMedDate not supplied

Applying the International Classification of Functioning, Disability and Health (ICF) to measure childhood disability.

The International Classification of Functioning, Disability and Health-ICF addresses the broad need for a common language and classification of functioning and disability. A parallel need is appropriate measures compatible with the content of the ICF to document the nature and impact of limitations of function, activities and participation. The interaction of developmental characteristics and disability among children represent special challenges for classification as well as measurement. Demographic trends emphasize the need for universal measures that encompass the components of the ICF and can be used in surveillance, screening and evaluation. This paper identifies issues related to application of the ICF to measure disability in childhood; reviews approaches and tools to assess childhood disability and identifies priorities for the development of measures of functioning and disability in children based on the ICF. The development of measures should be framed within a framework of children's rights and application of the biopsychosocial model to document profiles of functioning and disability of children.

Activities of Daily Living↗

PubMed2005

The disablement process: factors associated with progression of disability and recovery in French elderly people.

PURPOSE: To study the factors associated with progression, recovery and death from different grades of disability in elderly people. METHOD: The sample included 3198 participants of the PAQUID ('Personnes Agées QUID') cohort, aged 65 and over and community-dwellers at baseline. Subjects were re-interviewed 1, 3, 5, 8 and 10 years after baseline. A five-state Markov model was used to estimate transition intensities between four grades of disability and toward death. We used a hierarchic scale of disability, which combines basic and instrumental activities of daily living and mobility. Several explanatory variables were investigated: medical, personal and environmental factors. RESULTS: The factors associated with progression and/or no recovery of disability were cardiovascular diseases, stroke and diabetes, low cognition, visual impairment and dyspnoea (for pathologies and impairments), older age, female gender, low educational level (for risk factors), depression (for intra-individual factor) and being married, recent hospitalization and number of drugs (for extra-individual factors). Older age, male gender, tobacco consumption and living in an urban area were associated with mortality. CONCLUSIONS: These findings confirm the independent contribution of each group of variables in the disablement process and stress their different impact on progression of disability or on recovery from different grades of disability.

Age Factors↗

PubMed2004

Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale.

PURPOSE: We evaluated the Late-Life Function and Disability Instrument's (LLFDI) concurrent validity, comprehensiveness and precision by comparing it with the Short-Form-36 physical functioning (PF-10) and the London Handicap Scale (LHS). METHODS: We administered the LLFDI, PF-10 and LHS to 75 community-dwelling adults (> 60 years of age). We used Pearson correlation coefficients to examine concurrent validity and Rasch analysis to compare the item hierarchies, content ranges and precision of the PF-10 and LLFDI function domains, and the LHS and the LLFDI disability domains. RESULTS: LLFDI Function (lower extremity scales) and PF-10 scores were highly correlated (r = 0.74 - 0.86, p > 0.001); moderate correlations were found between the LHS and the LLFDI Disability limitation (r = 0.66, p < 0.0001) and Disability frequency (r = 0.47, p < 0.001) scores. The LLFDI had a wider range of content coverage, less ceiling effects and better relative precision across the spectrum of function and disability than the PF-10 and the LHS. The LHS had slightly more content range and precision in the lower end of the disability scale than the LLFDI. CONCLUSIONS: The LLFDI is a more comprehensive and precise instrument compared to the PF-10 and LHS for assessing function and disability in community-dwelling older adults.

Activities of Daily Living↗

PubMed2003

Cross-cultural adaptation of the Norwegian versions of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index.

OBJECTIVE: To evaluate reliability and construct validity of the Norwegian versions of the Roland Morris Disability Questionnaire and the modified Oswestry Disability Index. DESIGN: Translation of two functional status questionnaires and a cross-sectional study of measurement properties. METHODS: The questionnaires were translated and back-translated following the Guillemin criteria. The Norwegian versions were tested for 55 patients with acute low back pain and 50 patients with chronic low back pain. Test-retest with a 2-day interval was performed in a subsample of 28 patients from the chronic sample. Reliability was assessed by repeatability according to Bland and Altman, intraclass coefficient and coefficient of variation. Internal consistency was assessed by Cronbach's alpha. Concurrent construct validity was assessed with correlations between the questionnaires and the SF-36, Disability Rating Index and pain intensity. RESULTS: Repeatability of the Roland Morris Disability Questionnaire was 4 points, coefficient of variation 15% and intraclass correlation coefficient 0.89, and of the modified Oswestry Disability Index 11, 12% and 0.88, respectively. Internal consistency was 0.94 for both questionnaires. The questionnaires correlated highly with the physical functioning scale of SF-36, moderately with pain, and low with mental scales of the SF-36. CONCLUSION: The reliability and construct validity of the Norwegian versions of the Roland Morris Disability Questionnaire and the modified Oswestry Disability Index are acceptable for assessing functional status of Norwegian-speaking patients with low back pain.

Acute Disease↗