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PubMed2006

Health-related quality of life in multiple sclerosis: The impact of disability, gender and employment status.

OBJECTIVES: (1) Evaluate the impact of the patient characteristics of disability, gender and employment status on health-related quality of life (HRQOL) in multiple sclerosis (MS) and (2) Characterize the functional relationship between HRQOL and disability overall, and by gender and employment status. METHODS: We assessed the HRQOL of 215 MS outpatients in our clinic using the MSQOL-54 and Fatigue Severity Scale (FSS), and that of 172 healthy controls, using the SF-36 (a subset of MSQOL-54). We compared QOL between MS subgroups defined by disability, gender and employment, and computed the linear and non-linear relationships between disability level measured by the Expanded Disability Status Scale (EDSS) and MSQOL-54 dimensions. RESULTS: QOL of MS patients measured by SF-36 is lower than controls, varying by QOL dimension with the greatest difference emerging for physical aspects of the disease. The relationship of physical disability, measured by EDSS, and all 14 MSQOL-54 dimensions and FSS is negative; for 12 of the 14 dimensions and FSS it is also non-linear. Non-linearity is most pronounced among women, who show a weak EDSS/QOL relationship at higher levels of physical disability, suggesting women better able to "psychologically buffer" the debilitating aspects of MS. While employed have higher QOL than unemployed, the former are more affected by physical disability. CONCLUSIONS: Multiple attributes, including disability, gender and employment status, affect QOL. QOL's relationship with disability is complex, displaying non-linearity and interacting with patient characteristics. This has implication for QOL research methodology and provides insight into factors affecting patients' perceptions of well-being.

Adolescent↗

PubMed1995

Gender differences in disability: a comparison of married patients with schizophrenia.

Gender differences in disability constitute a fertile area of research, as disabilities need to be measured and evaluated in the social context which defines role expectations and consequently the role performance. This paper reports on the differences in disability in married patients with schizophrenia, as marital status is an important determinant of role expectation. The study sample constituted 30 married patients, of both sexes, who satisfied DSM-III criteria for schizophrenia, and were living with their spouse at the time of assessment. Disability was evaluated using the DAS (modified version). The findings indicated that women were more disabled than men on many of the evaluation parameters (p < 0.05); there was also a strong correlation between negative symptoms and disability variables in both the sexes. While a correlation between PSE syndromes and disability variables was seen in the case of males, the relationship was not seen in females. Stepwise regression also revealed that negative symptoms predominated among the factors associated with global disability in both sexes. Most of the reports in the literature reveal that women are less disabled than men. The findings of this study, that women are more disabled than men, is discussed in the context of the social conditions prevailing in India.

Adult↗

PubMed1994

Predictors of physical disability after age 50. Six-year longitudinal study in a runners club and a university population.

Predictors of disability were studied over 6 years among 50- to 80-year-old members of a runners club (N = 407) and a university population (N = 299). Data have been collected annually since 1984 on sociodemographic characteristics, health habits, medical history, medication use, family history, psychological parameters, and physical disability as measured by the Health Assessment Questionnaire. Members of the runners club, compared to university participants, had better overall health and less disability at baseline (0.03 versus 0.08) and at 6-year follow-up (0.04 versus 0.24). Predictors of greater subsequent disability among university participants were greater baseline disability, greater medication use, greater number of pack-years of cigarette smoking, older age, being unmarried, higher blood pressure, history of arthritis, and less physical activity compared to one's peers. In addition, changes in characteristics during follow-up that were independently associated with greater disability were development of joint pain, arthritis, or bone fracture and increased body mass index. Predictors of greater disability in the runners group included greater baseline disability, being a nonrunner at baseline, greater dietary salt intake, more years of running at baseline, and greater frequency of physician visits for running injuries. Greater disability in this group also was associated with increases in medication use, declining alcohol consumption, and development of joint pain over 6 years. Results of this study suggest that physical disability is linked to a constellation of characteristics, health habits, medical history, comorbidities, and marital status. While self-selection bias cannot be ruled out entirely, these data are consistent with the hypothesis that those who engage in high levels of physical activity beyond middle age will continue to maintain better functional abilities.

Aged↗

PubMed2004

The Cheshire Foot Pain and Disability Survey: a population survey assessing prevalence and associations.

Previous foot studies have consistently reported high prevalence estimates in self-reported foot disorders. Few population studies, however, have attempted to assess the impact of foot problems in terms of pain and disability so that the burden associated with foot pain is unknown. A cross-sectional postal survey was conducted on a random community sample of 4780 individuals with 3417 (84%) responding. Subjects reporting foot pain in the past month, current pain and marking one item on the Manchester Foot Pain and Disability Index were classified as having disabling foot pain. Those with disabling foot pain and a random sample with no symptoms (matched for age and gender) received a follow-up interview and standardised foot examination. Self-reported nail problems, corns and callosities, swollen feet, foot deformities and recent foot injuries were found to be associated with disabling foot pain. Foot disability was also associated with pain in the shoulder, axial skeleton, hip/upper leg and knee along with other indicators of poor general health. Clinician diagnosed foot problems associated with disabling foot pain were swollen feet, knee and foot joint tenderness. Only 36% of persons with disabling foot pain received professional foot treatment in the 6 months preceding the survey. The results showed that 323/3417 (9.5%) reported symptoms of disabling foot pain and that this condition is likely to be multi-factorial in origin. Further work is necessary to understand more about the extent and type of unmet need and on how patients presenting with symptoms of disabling foot pain should best be managed.

Adolescent↗

PubMed2006

Predictive factors for 1-year and 5-year outcome for disability in a working population of patients with low back pain treated in primary care.

Many patients seeking primary care for low back pain continue to report disability several years after their initial visit. The aims of this study were to assess the independent predictive value of a number of potential predictive factors for disability at the 1-year and 5-year follow-ups, and to examine whether prediction models were improved by replacing baseline health-state-related variables with corresponding variables after treatment. A further aim was to describe possible differences between those on sick leave, early retirement or disability pension, and those who were not. Baseline factors were age, gender, self-reported physical-activity-related and work-related factors, expectations of treatment, similar problems previously, duration of episode, more than one localization, sick leave, pain frequency, disability, and well-being. The study sample comprised 148 participants in a previous randomized trial who were eligible for sick-leave benefits. Multiple logistic regression was used to identify predictive factors. At the 5-year follow-up, 37% (n=19/52) of the patients with disability were on sick leave or were receiving early retirement or disability pension. For those without disability the corresponding figure was 9% (n=8/92). Being a woman, duration of the current episode, similar problems during the previous 5 years, exercise level before the current episode, pain frequency at baseline, and disability after treatment emerged as predictive factors for disability at the 5-year follow-up. Replacing baseline health-state-related measures with corresponding measures after the treatment period, and adding physical-activity-related and possibly work-related factors might improve the likelihood of predicting future disability.

Adolescent↗

PubMed2004

The Israeli kibbutz as a venue for reduced disability in old age: lessons from the Cross-sectional and Longitudinal Aging Study (CALAS).

It is important to identify ways to moderate disability in old age. We assessed whether the kibbutz way of life results in reduced disability by examining risk factors for disability in three comparable populations: kibbutz members (lifetime kibbutz exposure); parents of kibbutz members who came to live on the kibbutz in old age due to health and social needs (old age exposure); and comparable Israelis in the general population (no exposure). Kibbutz members were less disabled, defined as needing help with at least one of five activities of daily living, than the other groups. Kibbutz members had 30% lower risk of disability, after controlling for sociodemographics and social networks, health and health behaviors, and life history and background. Introducing length of residence in current home and death of a child to the analysis reduced this finding to non-significance. Overall, risk of disability was significantly higher for older age groups, women, homemakers, people with more comorbid conditions, those with more children, and those with a child that had died, while risk of disability was significantly lower for those with larger social networks, those who had engaged in physical activity at midlife, and those who had lived in their homes longer. Since occupations on the kibbutz (primarily agricultural and blue collar) have equal pay, and kibbutz members have complete economic security, our results suggest that it is not such occupations themselves but their association with low incomes that have contributed to previous associations of blue collar and agricultural occupations with poor health and high disability. Lower disability among kibbutz members may be due to the social, economic, and instrumental support provided on the kibbutz, as well as to an active life style, suggesting features of kibbutz life that can be replicated elsewhere to reduce disability.

Activities of Daily Living↗

PubMed2003

Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998:a longitudinal study of 3035 patients.

PURPOSE: If newer, more aggressive treatment strategies in rheumatoid arthritis are more effective, long-term outcomes in rheumatoid arthritis should be improving substantially. We therefore assessed trends in disability over time in a large cohort of patients with rheumatoid arthritis. METHODS: We examined functional disability data from 3035 patients with rheumatoid arthritis whose disease onset was from 1977 to 1998. Disability data were collected semiannually with the Health Assessment Questionnaire disability index. We then estimated average disability for each patient. We also computed mean disability for each calendar year by averaging the values from all patients in that year. We examined the relation of successive annual cohorts and subsequent disability, adjusting for age, sex, race, education, clinical center, disease duration, follow-up, and attrition. We used two regression approaches: ordinary and generalized least squares. RESULTS: Average disability declined by about 2% to 3% per calendar year of disease onset (2.7% to 2.8% per year [P <0.001] in univariable models and 2.0% to 2.1% per year [P <0.001] in multivariable models). This trend was consistent by age, sex, race, disease duration, clinical center, and baseline disability. CONCLUSION: After accounting for potential confounders, average disability levels in rheumatoid arthritis have declined by approximately 40% in the 20+ years since 1977. This decline is consistent with a beneficial effect of the associated changes in treatment strategies.

Activities of Daily Living↗

PubMed1999

Disability, physical activity, and muscle strength in older women: the Women's Health and Aging Study.

OBJECTIVE: To study associations of motor disability, physical activity, and muscle strength in older women, in particular to investigate whether model of spiraling decrease is expressed in the data. DESIGN: Cross-sectional analysis using data from the baseline measurements of The Women's Health and Aging Study (WHAS). SETTING: Participants' homes. PARTICIPANTS: A total of 1,002 disabled women aged 65 years and older living in the community. OUTCOME MEASURES: Motor disability was measured by the number of self-reported difficulties in grasping, lifting 101b, walking across a small room, walking 1/4 mile, climbing 10 steps, and doing heavy housework. Level of physical activity was determined from response to a series of questions on the frequency and amount of common activities and physical exercise. Hand grip and knee extension forces were measured using portable hand-held dynamometers. RESULTS: Disability and physical activity were inversely associated, with inactivity being most common among the most disabled women. Those with poorer strength reported more difficulties in motor activities. Greater strength was found among the physically more active. In stratified analyses, the positive association of physical activity on knee extension strength was consistent across disability levels. Multiple regression analysis showed that both physical activity and muscle strength were significant predictors for severity of disability. Structural equation model (LISREL) showed that muscle strength had a mediating role between physical activity and disability; disability was associated with physical inactivity, which correlated with lower muscle strength, which was associated with greater degree of disability. CONCLUSION: Even though causality cannot be confirmed in this cross-sectional analysis, our findings suggested a spiraling model of decline in which muscle strength has a significant role.

Activities of Daily Living↗

PubMed1997

Gender differences in abused children with and without disabilities.

OBJECTIVE: Two questions were posed: (1) What are the proportions of boys and girls in various categories of substantiated child abuse? (2) Do the gender proportions differ for children with and without disabilities? METHOD: Data collected by previous researchers from a demographically representative sample of U.S. child abuse reporting districts was analyzed. This included 1,249 case files involving 1,834 children. The number of girls and boys who did and did not have disabilities was identified for three age categories and for several categories of abuse. Chi-square analyses were used to determine whether there was a relationship between disability and gender for the various age and abuse categories. RESULTS: More boys were physically abused and neglected, but more girls were sexually abused. Boys with disabilities, however, were over-represented in all categories of abuse. Moreover, gender proportions among abused children with disabilities differed significantly from those found among other abused children. Although slightly more than half of abused children without disabilities were girls, 65% of abused children with disabilities were boys. CONCLUSIONS: Boys represented a significantly larger proportion of physically abused, sexually abused, and neglected children with disabilities than would be expected from their respective proportion of abused and neglected children without disabilities. Several possible explanations for the observed gender and disability status interaction are discussed.

Adolescent↗

PubMed2003

Self-esteem and women with disabilities.

This study examines the sense of self of women with physical disabilities in terms of self-esteem, self-cognition (perceptions of how others see them), and social isolation. It was hypothesized that these variables mediate the relation of precursor variables (age, education, severity of disability, and childhood experiences, including overprotection, familial affection, and school environment) and outcomes (intimacy, employment, and health promoting behaviors). Data were gathered from a sample of 881 community-dwelling women in the USA, 475 with a variety of mild to severe physical disabilities, and 406 without disabilities. Correlation analyses indicated that the women with disabilities had significantly lower self-cognition and self-esteem, and greater social isolation than the women without disabilities, as well as significantly less education, more overprotection during childhood, poorer quality of intimate relationships, and lower rates of salaried employment. Path analysis indicated that each of the sense of self mediators was significantly related to the outcome of intimacy, that both social isolation and self-esteem were significantly related to health promoting behaviors, and that only self-esteem was significantly related to employment. Respondents who were older, less disabled, less educated, less over-protected, and had more affection shown in the home tended to feel that others saw them more positively. Women with positive school environments, less over-protection, and more affection in the home experienced less social isolation; age, education, and disability severity were not significantly related to social isolation. Older respondents with less disability, a more positive school environment, less over-protection, and more affection in the home tended to have greater self-esteem; education was not significantly related to self-esteem. Older respondents tended to report less intimacy. Younger, more educated, and less disabled respondents were significantly more likely to be employed. More highly educated respondents reported engaging in more health promoting behaviors.

Activities of Daily Living↗

PubMed2003

Neonatal behavioral assessment scale as a predictor of later developmental disabilities of low birth-weight and/or premature infants.

The purpose of this study was to evaluate the usefulness of the Neonatal Behavioral Assessment Scale (NBAS) as a tool to assess the risk of later developmental disabilities. The study subjects were 209 low birth-weight and/or premature infants admitted to the NICU at the Nagasaki University Hospital, Nagasaki, Japan. These infants were examined using the NBAS at 36-38 (NBAS36), 40-42 (NBAS40) and 44-46 weeks (NBAS44) of postmenstrual age, and their developmental outcome was measured using standardized assessments at 5 years of age. Based on the results of diagnosis at 5 years of age, subjects were classified into three groups: Normal, Mild Disability and Severe Disability groups. Multinomial logistic regression analysis showed that lower Motor cluster scores for all assessment periods and lower Orientation cluster scores in the NBAS40 and NBAS44 were significantly associated with an increased risk of both Mild and Severe Disability. Also, the Range of State cluster scores for the NBAS44 were significantly related to the risk of Mild Disability, and the Reflexes cluster scores in the NBAS40 and NBAS44 were the best predictor of Severe Disability. In outcome prediction using the estimated regression coefficients, 94-97% of the subjects in the Normal group, 50-78% in the Mild Disability group and 71-85% in the Severe Disability group were correctly classified. The NBAS could help clinicians to develop a management protocol for infants at risk for developmental disabilities as well as to identify neonates at risk of developmental disabilities.

Aging↗

PubMed2002

Injury prevention for children with disabilities.

Little injury data exists for children who have disabilities. There is an urgent need to address injury prevention and to improve safety standards for this group. Understanding the epidemiology of injuries will allow clinicians to accurately advise patients and their families on individual risks and counsel them in steps to take to reduce those risks. Safety information must be tailored to consider each child's functional impairments. All children who have disabilities are at risk for maltreatment. Open discussion of this problem is warranted given the immensity of the problem. Identifying parental concerns and supporting parents in the use of respite resources are appropriate. For children who have problems in mobility, falls are the number one concern. Collaboration with reliable vendors and therapists that adhere to standards for safe seating is essential for reducing the risk of wheelchair tips and falls. In addition, therapists should be directed to provide mobility training for activities from safe transfers to street crossing in a community setting. Parents should be counseled to approach their child's injury risk based on the child's cognitive and behavioral level rather than their chronological level. Knowledge of the child's developmental quotient or intelligence quotient will also allow the clinician to accurately formulate an injury prevention plan. Many children will always need supervision for tasks that put them in situations of injury risk (i.e., swimming, street crossing, bathing). Sensorineural deficits such as blindness or deafness create significant alterations in negotiating the environment and an increased risk of injury. Awareness of the special needs for fire risk reduction and street safety are critical in this population. The collection of injury data is critical to define the scope of the problem and to influence changes in policy and the development of technical standards. Educational efforts focused on safety should include pediatricians, rehabilitative therapists, social workers, teachers, parents, and--most importantly--the empowerment of children as they age injury-free into adults. SUGGESTED STRATEGIES: A national injury surveillance system for children who have disabilities should be developed to identify injury risk factors for children with disabilities. Children with disabilities should be monitored as a separate risk group in data collection regarding injuries. Parents should be aware of the cognitive level of their child and its influence on their injury risk. Crash testing on passenger restraints should include crash dummies whose physical characteristics resemble those of children who have disabilities. Families should have an emergency evacuation plan with specific consideration of their disabled child in the event of an emergency. Risk of burns to insensate skin and risks of thermal and friction trauma should be discussed when appropriate. The fire department and the police department should be notified of the presence of a child who has a disability in the home. Parents must be aware of the risk of falls to children who are mobile but cognitively impaired and to those in wheelchairs regardless of cognitive ability. Hospitals must have Child Protective Services teams with specific training in abuse to children with disabilities. Discussion of maltreatment risk should be addressed during routine office visits and appropriate resources should be made available to provide support to families. Educational programs should be developed to alert providers to the risks of abuse of children who have disabilities.

Accident Prevention↗

PubMed1996

Assessing dissimulation among Social Security disability income claimants.

Social Security disability income programs have been tested by increasingly politicized concerns regarding widespread fraud among claimants. This study was an initial investigation of malingering among claimants in Los Angeles seeking disability income on psychological grounds. After a review of 100 disability income applications, a population-appropriate instrument was developed from established psychometric indices of malingering. The Composite Disability Malingering Index was completed by 167 disability claimants (possible malingerers), a sex, age and IQ cognate group of 63 psychologically disabled individuals without incentive to malinger (disabled nonmalingerers), and 45 disability examiners with instructions to malinger (instructed malingerers). The mean score of instructed malingerers and the score at the 95th percentile of the disabled nonmalingerers converged, indicating 8 as the critical score. This cutting score found 32 (19%) of disability claimants to be malingering. Self-reported substance abuse history was the only participant variable that significantly predicted higher malingering scores.

Adult↗

PubMed2002

Could you hold the door for me? Including disability in diversity.

This article is intended to help those unfamiliar with disability studies by providing a context for disability on which psychologists can build. The 1st part presents data on disability training in graduate clinical programs and on training accessibility for graduate students with disabilities. The 2nd part is an introduction to disability studies and includes 3 core concepts of disability issues in psychology: (a) the framing of disability from 3 models (the moral, medical, and social models); (b) the ways in which disability is like and unlike other minority groups; and (c) the language that is used to describe disability. These 2 parts taken together constitute a brief introduction to disability issues within psychology.

Activities of Daily Living↗

PubMed2001

Perceived disability and observed functional limitations in obese women.

OBJECTIVE: To describe perceived disability in obese women. DESIGN: Comparisons of perceived disability in obese women and in a normal-weight reference group regarding activities of daily life (ADL), mobility, housework and professional work as well as comparisons of perceived disability and observed functional limitations reported in a previous study. SUBJECTS: Fifty-seven consecutively selected obese female outpatients, mean age 44 y (body mass index (BMI) 37 kg/m2) and 22 voluntary referents, mean age 49 y (BMI 22 kg/m2). MAIN OUTCOME MEASURES: A pain questionnaire (for background data) and a disability questionnaire, which is new, detailed and specific with test-retest stability and content- and criterion-referenced validity. Comparisons of results from the questionnaire and a functional test regarding observations of similar functional limitations. RESULTS: The obese women perceived disability to a much higher extent (P<0.003) than did the normal-weight women. The main problems concerned occupational work in strenuous positions, strain and pain, sports, walking outdoors or on stairs, and moderate housework requiring squatting, stooping or lifting. Rising from sofas, pedicure and stress incontinence were problematic. The correlation between perceived disability and functional limitations was fairly good (r(s)=0.56) but ranged widely (r(s)=0.14-0.61). Within the group of obese women the disability neither correlated to BMI nor age, rather to lower-body pain. CONCLUSION: The disability questionnaire conveyed new and detailed information of disability problems in everyday life in obese women. It highlighted the difference between the disability these women may perceive and the functional limitations we can observe and measure. This result is of great clinical relevance in the care of obese women.

Activities of Daily Living↗

PubMed2003

Self-reported disability and its association with performance-based limitation in elderly men: a comparison of three European countries.

OBJECTIVES: To compare self-reported disability and performance-based limitation and their association in elderly men from three European countries. DESIGN: Cross-sectional data from a cohort study collected around 1990. SETTING: Three cohorts from Finland, the Netherlands, and Italy. PARTICIPANTS: One thousand one hundred sixty-one men aged 70 and older. MEASUREMENTS: Disability and functional limitation were measured in a standardized way in three countries. Self-reported disability was estimated by questionnaire, assessing three domains of activities of daily living: instrumental activities of daily living, mobility, and activities of daily living (score 0-3). Functional limitation was measured by performance tests (score 0-16), with 0 indicated the healthiest score. RESULTS: Self-reported disability and performance-based limitation scores differed between countries. Mean self-reported disability score was worse in Italy (0.72) and the Netherlands (0.70) than in Finland (0.54). Italian men scored worst on the performance-based tests (mean 4.80 vs 4.04 for Finland and 3.74 for the Netherlands). Differences in self-reported disability remained after adjusting for performance scores: Dutch men reported more disabilities (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.23-2.25) than men in Finland (reference group) and Italy (OR = 1.08, 95% CI = 0.77-1.53). Self-reported disability was positively associated with performance-based score (OR = 1.28, 95% CI = 1.21-1.35) and did not differ between countries. CONCLUSION: Cross-cultural variation was noted in self-reported disability adjusted for performance score. These differences may be due to sociocultural and physical environmental factors. Self-reported disability was consistently associated with performance-based limitation in Finland, the Netherlands, and Italy.

Activities of Daily Living↗

PubMed2001

Ability of fat and fat-free mass percentages to predict functional disability in older men and women.

OBJECTIVES: Previous studies suggest an association between body composition and declining functional ability in older people. This study examined the relation between functional disability and percentage of fat mass (FM) and percentage of fat-free mass (FFM) in older men and women. DESIGN: Cross-sectional and prospective. SETTING: Rancho Bernardo, California. PARTICIPANTS: Subjects consisted of 1,051 ambulatory, community-dwelling Caucasian men and women, age 55 to 92, who attended a clinic visit between 1988 and 1992 and a subsequent clinic visit between 1992 and 1996. MEASUREMENTS: Measured at both visits, percentage of fat mass and percentage of lean body mass were estimated by bioelectric impedance analysis and functional disability was ascertained by self-administered questionnaire. Functional disability was dichotomized into those having any difficulty with a set of tasks versus those having no difficulty with the tasks. Two measures of functional disability were used: "lower body" disability, consisting of two lower motor tasks (walking 2-3 blocks and climbing up 10 stairs) and "overall" disability, consisting of nine tasks representing upper and lower body function and mobility. RESULTS: Compared with men, women were more likely to report both lower body and overall functional disability (P=.001). Cross-sectionally, a significant positive association was shown between fat mass and overall functional disability and a significant negative association was shown between FFM and overall functional disability in both men and women. Prospectively, increased percentage of body fat and decreased percentage of FFM were significantly associated with decreased functional ability in both women and men. All results were adjusted for age, smoking, alcohol use, physical activity, current estrogen use, depression, chronic disease, and education. CONCLUSION: Increased percentage of fat mass and decreased percentage of FFM are associated with greater functional disability in older men and women. Further research is needed to assess the relative importance of decreasing fat percentage or increasing fat-free percentage to preserve or improve functional ability in older people.

Adipose Tissue↗

PubMed2002

Health-related quality of life and disability in young patients with spina bifida.

OBJECTIVES: To assess the health-related quality of life (QOL) and disability in young patients with spina bifida and to correlate them with the clinical examination findings. DESIGN: Prospective multidimensional study by means of (1) clinical assessment, (2) self-administered questionnaire for general health, and (3) standardized disability measurements. Relationships between disability measurement, patient-oriented examination, and conventional clinical assessment were evaluated. SETTING: Pediatric department at a university hospital in Italy. PATIENTS: Twelve consecutive young patients with spina bifida (mean age, 15.2 y; range, 14-18 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Medical Outcomes Study 36-Item Short-Form Health Survey, the FIM trade mark instrument, and the Barthel Index. RESULTS: As expected, disability was inversely related (r=.72, P<.02) to the physical aspect of QOL. Unexpectedly, for the mental aspects of QOL, less disability was associated (r=-.70, P<.05) with higher psychologic distress and severe role disability because of emotional problems. The findings at clinical examination, especially proximal deficit of inferior limbs (r=-.70, P<.05), were usually related to higher disability and lower physical aspects of QOL. CONCLUSION: There was no linear inverse correlation between disability and QOL in patients with spina bifida. Patients with mild disability needed as much psychologic support as patients with severe whole disability.

Activities of Daily Living↗