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PubMed2006

Fear-avoidance beliefs, disability, and participation in workers and non-workers with acute low back pain.

OBJECTIVES: Fear-avoidance beliefs have been shown to be associated with disability and work status in patients with low back pain. Especially in acute low back pain, much research is needed to increase the knowledge concerning the role of fear-avoidance beliefs and its associated avoidance behavior in the influence on disability and the participation in daily and social life activities. The Fear-Avoidance Beliefs Questionnaire is developed to measure such beliefs and has become increasingly popular for use in primary care practice. The aim of the current study was: 1) to investigate the factor structure of the Fear-Avoidance Beliefs Questionnaire in a population of patients with acute low back pain by means of confirmatory factor analysis; 2) to examine the relationship between fear-avoidance beliefs and perceived disability, as well as participation in daily and social life; and 3) to investigate whether perceived disability mediates the association between pain and participation and between fear-avoidance beliefs and participation. METHODS: The study has a cross-sectional design and was performed on a sample of 615 patients with acute low back pain in primary care settings in The Netherlands. Patients completed a visual analogue scale for pain, the Roland Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire, a sociodemographic questionnaire, and 5 participation items. RESULTS: Confirmatory factor analysis corroborated the 2-factor structure of the Fear-Avoidance Beliefs Questionnaire as found by Waddell et al. Investigation of the association between fear-avoidance beliefs and perceived disability or participation was performed for workers and non-workers separately. The 2 subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with perceived disability and participation, although there were differences between the samples. Perceived disability was significantly predicted by pain intensity and fear-avoidance beliefs. Perceived disability significantly predicted participation, and finally, the mediational role of perceived disability was supported. DISCUSSION: In the early stage of low back pain, the reduction of pain and fear-avoidance beliefs might increase the level of activity, which might foster increased participation in daily and social life activities.

Activities of Daily Living↗

PubMed2001

Epidemiology of psychiatric disability in childhood and adolescence.

The goal of the study was to ascertain the factor structure and prevalence of psychiatric disability in children and adolescents in relation to demographic variables and diagnosis. A representative sample of 1,420 children (9-13 years) from 11 countries in North Carolina was followed for up to 6 years. Children and caretakers were interviewed with the Child and Adolescent Psychiatric Assessment, which generates DSM-IV diagnoses and includes a measure of disability secondary to psychological symptoms. Three broad areas of disability were identified (relating to family, school, and peers). School disabilities were more common in boys than girls. while the reverse was true of family disability. Effects of age were complex, and partially gender-differentiated. Children from minority ethnic groups had a higher overall prevalence of school disabilities, and were more prone than Whites to the disabling effects of disruptive behavior disorders. Anxiety disorders were as likely to result in disability as depressive disorders, and oppositional defiant disorders were more strongly associated with disability in some areas than was conduct disorder. The areas where disability is manifested are different depending on race, gender, age, and the type of disorder suffered. The implications of these findings for nosology and prevention are discussed.

Adolescent↗

PubMed2003

Mental health services use among school-aged children with disabilities: the role of sociodemographics, functional limitations, family burdens, and care coordination.

OBJECTIVE: To examine the use of mental health services and correlates of receiving services among community-dwelling children with disabilities, ages 6 to 17 years. STUDY DESIGN: Data are from the 1994 and 1995 National Health Interview Survey Disability Supplements (NHIS-D), conducted by the National Center for Health Statistics. The study sample is 4,939 children with disabilities, representing an estimated eight million children with disabilities nationwide. Parents of children under 16 years of age reported (17-year-olds self-reported) on health, emotional and behavioral problems, mental health services use, and who, if anyone, coordinated the child's health care. PRINCIPAL FINDINGS: Among disabled children with poor psychosocial adjustment (11.5 percent), only 11.8 percent received mental health services in the past year. Multivariate logistic regression analysis showed service use was associated with poor psychosocial adjustment; communication, social, and learning-related functional impairments; public health insurance; and financial family burdens. Younger and black disabled children were less likely to receive mental health services. The odds of service use were greater with the involvement of a health professional in coordinating care, in contrast to no one or family only. Moreover, children with disabilities were more likely to use outpatient mental health services if their care was jointly coordinated by a family member and a health professional, compared to a health professional working alone. In contrast to inpatient and outpatient care, race and family burden were not associated with the likelihood of mental health counseling in special education school settings. CONCLUSIONS: Findings indicate that only two in five disabled children with poor psychosocial adjustment receive mental health services. Differences by age, race, and insurance coverage suggest that inequalities to access exist. However, the school setting may be one in which some barriers to mental health services for disabled children are reduced. The study also shows that the involvement of health professionals in care coordination is associated with greater access to mental health care for disabled children. These findings underscore the importance of engaging both health care professionals and the family in the care process.

Adaptation, Psychological↗

PubMed1993

Self report functional disability scores and the use of devices: two distinct aspects of physical function in rheumatoid arthritis.

OBJECTIVES: Self report scores of physical disability and the use of devices or assistance in performing activities are sometimes integrated in one index of physical function, although they are aimed at measuring different dimensions of physical disability. The properties of both parameters were evaluated in two groups of patients with rheumatoid arthritis (RA). METHODS: A group of patients with RA of recent onset was compared with a group with established disease on four parameters of disability: use of devices, use of personal assistance, and scores on a validated Dutch version of the Health Assessment Questionnaire Disability Index, with and without integrating the use of devices or assistance. Correlation coefficients among disability parameters were calculated. In multiple regression analysis the influence of disease duration on the disability parameters was determined after disease activity, psychological wellbeing, and demographical characteristics had been controlled. RESULTS: Functional disability scores were mainly related to inflammatory activity and psychological wellbeing, whereas the uses of devices had a strong relation with disease duration, independent of current disease activity. Integrating these parameters of disability yielded a parameter that was still mainly associated with disease activity. CONCLUSION: Self report scores of functional disability and the use of devices represent distinct dimensions of physical function in RA. Integrating both parameters into one measure of physical disability does not provide an index adequately reflecting both dimensions. The use of both parameters to measure outcome in long term clinical studies is recommended.

Activities of Daily Living↗

PubMed1998

An instrument for assessment of subjective visual disability in cataract patients.

AIMS/BACKGROUND: The construction and validation of an instrument for the assessment of subjective visual disability in the cataract patient is described. This instrument is specifically designed for measuring the outcome of cataract surgery with respect to visual disability. METHODS: Visually related activities thought to be affected by cataract were considered for the questionnaire. These were reduced by pilot study and principal components analysis to 18 items. A patient's assessment of his/her ability to perform each task was scored on a four point scale. Scores were averaged to create an overall index of visual disability, as well as subscale indices for mobility related disability, distance/lighting/reading related disability, and near and related tasks visual disability. The questionnaire, administered verbally is entitled "The Visual Disability Assessment (VDA)". Reliability testing included test-retest reliability, interobserver reliability (p, the intraclass correlation coefficient), and internal consistency reliability (Cronbach's alpha). Construct validation, the process for proving that a test measures what it is supposed to measure, included consideration of content validity, comparison with the established Activities of Daily Vision Scale (ADVS) and empirical support with factor analysis. RESULTS: For the four indices, interobserver reliability varied from 0.92 to 0.94, test-retest reliability varied from 0.96 to 0.98, and internal consistency reliability varied from 0.80 to 0.93. The VDA compared favourably with the ADVS by correlation, but Bland-Altman analysis demonstrated that the two instruments were not clinically interchangeable. Factor analysis suggests that all test items measure a common theme, and the subgroupings reflect common themes. CONCLUSIONS: The VDA is easy to administer because it has a short test time and scoring is straightforward. It has excellent interobserver, test-retest, and internal consistency reliability, and compares favourably with the ADVS, another test of visual disability. Factor analysis demonstrated that the 18 items measure a related theme, which can be assumed to be visual disability. The VDA is a valid instrument which provides a comprehensive assessment of visual disability in cataract patients and is designed to detect changes within a patient over time.

Activities of Daily Living↗

PubMed2000

Disability, gene therapy and eugenics--a challenge to John Harris.

This article challenges the view of disability presented by Harris in his article, "Is gene therapy a form of eugenics?" It is argued that his definition of disability rests on an individual model of disability, where disability is regarded as a product of biological determinism or "personal tragedy" in the individual. Within disability theory this view is often called "the medical model" and it has been criticised for not being able to deal with the term "disability", but only with impairment. The individual model of disability presupposes a necessary causal link between a certain condition in the individual and disablement. The shortcomings of such a view of disability are stated and it is argued that in order to have an adequate ethical discourse on gene therapy perspectives from disability research need to be taken into consideration.

Achondroplasia↗

PubMed2005

Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers.

AIMS: Most industrialised countries have public income maintenance programmes to protect workers in case of disability but studies addressing disability risk of specific professional groups are rare. The objective of this study was to establish a detailed pattern of the nature and extent of occupational disability among construction workers. METHODS: A cohort study was set up including 14,474 male workers from the construction industry in Württemberg (Germany) aged 25-64 years who underwent occupational health exams between 1986 and 1992. The cohort was linked to the regional pension register of the manual workers' pension insurance institution to identify workers who were granted a disability pension during the 10 year follow up. All-cause and cause specific standardised incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using disability rates from the general workforce and from all blue collar workers in Germany as references. RESULTS: In total, 2247 (16%) members of the cohort were granted a disability pension. Major causes of disability were musculoskeletal (45%) and cardiovascular diseases (19%). In comparison with the general workforce, construction workers experienced a higher risk of disability from cancer (SIR = 1.26; 95% CI 1.08 to 1.47), respiratory diseases (SIR = 1.27; 95% CI 1.03 to 1.55), musculoskeletal diseases (SIR = 2.16; 95% CI 2.03 to 2.30), injuries/poisoning (SIR = 2.52; 95% CI 2.06 to 3.05), and all causes combined (SIR = 1.47; 95% CI 1.41 to 1.53). When compared with the blue collar reference group, increased risks of disability among construction workers were found for musculoskeletal diseases (SIR = 1.53; 95% CI 1.44 to 1.63), injury/poisoning (SIR = 1.83; 95% CI 1.50 to 2.21), and all causes combined (SIR = 1.11; 95% CI 1.07 to 1.16). CONCLUSIONS: Musculoskeletal diseases and external causes are major factors limiting the work capability of construction workers and lead to an increased proportion of occupational disability.

Adult↗

PubMed2002

Mediation of employment discrimination disputes involving persons with psychiatric disabilities.

OBJECTIVE: This study sought to determine whether persons with psychiatric disabilities who filed employment discrimination complaints with the Equal Employment Opportunity Commission (EEOC) under the Americans With Disabilities Act (ADA) were referred to the EEOC's mediation program with the same frequency as ADA claimants with other disabilities. The extent to which employers agreed to engage in mediation with claimants and the extent to which claimants benefited from participating in the mediation program were also examined. METHODS: The data included all 23,759 ADA charges filed with the EEOC from January 1, 1999, through June 30, 2000, and closed as of September 30, 2000. Percentages of mediation rates were computed, and chi square tests were conducted to test for differences between categories. RESULTS: Individuals with employment discrimination complaints based on psychiatric disabilities were slightly but significantly less likely to be referred by the EEOC to mediation than were individuals with other types of disabilities. Moreover, employers were significantly less willing to mediate with claimants who had psychiatric disabilities than with those who had nonpsychiatric disabilities. Once employers agreed to participate in mediation, however, the majority of cases were settled. No significant differences in settlement rates were found between cases with claimants who had psychiatric disabilities and cases with claimants who had other types of disabilities. CONCLUSIONS: The EEOC's mediation program has been a remarkably successful development and has the potential to provide effective case resolution services to thousands of EEOC claimants. However, the agency should educate employers and EEOC investigators alike that many people with psychiatric disabilities can work productively and participate in mediation successfully.

Disability Evaluation↗

PubMedDate not supplied

Intraindividual differences in motivation and cognition in students with and without learning disabilities.

The present study examines several cognitive and motivational variables that distinguish children with learning disabilities (n = 19) from children without learning disabilities (n = 20). The total sample included 30 males and 9 females and was composed of white, fifth-grade students from a middle-class community in the Midwest. Results showed that although the students with learning disabilities displayed lower levels of metacognitive knowledge and reading comprehension, they did not differ from the students without learning disabilities on self-efficacy, intrinsic orientation, or anxiety. In addition, they did not show any signs of learned helplessness, although they did tend to attribute success and failure to external causes more often than the students without learning disabilities. Using a cluster analysis that grouped individuals, we found that differences in the motivational and cognitive variables cut across a priori categories of children with and without learning disabilities. Three clusters were formed: one with high comprehension, motivation, and metacognition (mostly children without learning disabilities); one with low levels of comprehension and metacognition but high intrinsic motivation (all children with learning disabilities); and one with low intrinsic motivation but average comprehension, metacognition, and attributional style (approximately equal numbers of children with and without learning disabilities). Implications for diagnosis and intervention for students with learning disabilities are discussed.

Anxiety↗

PubMed2006

Managing depression-related occupational disability: a pragmatic approach.

OBJECTIVE: To identify the crucial issues that arise for psychiatrists and other physicians when dealing with occupational disability in their patients with depression and to suggest practical strategies for responding more effectively to the challenges of this aspect of patient functioning. METHOD: We identify fundamental concepts in the occupational disability domain and draw crucial distinctions. The wider context for occupational disability is articulated, involving the workplace environment and the disability insurance industry. Research with direct relevance to clinical decision making in this area is highlighted. We make pragmatic suggestions for effective management of occupational disability in patients with depression. RESULTS: To successfully manage issues of occupational disability, psychiatrists and other physicians must understand the distinction between impairment and disability. To make this decision fairly and accurately, the adjudicator requires particular types of information from the physician, with requirements varying across short-term or long-term disability claims; failing to provide relevant information may cause substantial stress or financial harm to the patient. Balanced and collaborative decision making regarding whether and for how long to take work absence will greatly help to maintain occupational function in the long-term. Realistic expectations and support of the patient's sense of personal competence foster recovery of occupational function. CONCLUSION: Management of depression-related disability is challenging. Thoughtful evaluation of the patient's functional status, careful response to the requirements of disability determination, and a focus on functional recovery yield substantial benefits.

Canada↗

PubMed2005

Disability in everyday life.

The authors explored how persons with disabilities perceived the experience of disability in their everyday lives. The findings suggest that the current models in the literature do not address disability adequately. Instead, disability was described as a multifaceted, complex experience that is integrated into the lives of persons with disabilities. The degree to which integration was possible was influenced by three disability-related factors: (a) the fundamental effects of the disabling condition, (b) others' perceptions of disability, and (c) the need for and use of resources. Important contextual conditions included the environment, time, and experience. Ultimately, it was the match between how these persons perceived themselves and what was important in their lives, and the influence of the three factors that determined how well they were able to integrate disability into their lives. The findings suggest the need for a conceptual model that reflects the personal experience of disability.

Activities of Daily Living↗

PubMed2001

Factors determining participation in young adults with a physical disability: a pilot study.

OBJECTIVES: To evaluate in a pilot study the usefulness of measures of health and psychosocial status for use with young people with physical and complex disability. Also to test empirically a conceptual model of the factors determining key outcomes in young disabled adults, in particular, participation (handicap). DESIGN: A cross-sectional study involving face-to-face interviews with young adults aged 16-28 years (n = 45) with physical and complex disabilities. A group of nondisabled college students completed the same set of questions to provide normative scores for some psychosocial measures. SETTING: Young people with physical disabilities were recruited from the area of North and North East Lincolnshire, and nondisabled young people from the Leeds area. METHODS: Standardized measures of impairment, disability and handicap, together with various psychosocial scales were incorporated into a structured face-to-face interview. Standardized measures included the Nottingham Health Profile (NHP), the Barthel Index, the London Handicap Scale, Rosenberg's Self-esteem Scale and the Proactive Scale. RESULTS: Regression analysis showed the most important predictors of participation were energy and pain (NHP), disability (Barthel) and self-efficacy. Most of the health status measures were able to discriminate between disabled and nondisabled young people, but some measures lacked face validity for the 'nonwalking' disabled group. CONCLUSIONS: Both health status and psychosocial factors were found to impact on the participation of young people. Impairment and disability however, did not impact adversely on self-ratings of health or quality of life and it is clear from these results that having a disability may limit participation, but is not necessarily synonymous with a poorer quality of life.

Adolescent↗

PubMed2000

The Southampton Needs Assessment Questionnaire (SNAQ): a valid tool for assessing the rehabilitation needs of disabled people.

OBJECTIVE: To validate the Southampton Needs Assessment Questionnaire (SNAQ) for use with disabled people during face-to-face interviews. DESIGN: The SNAQ was designed to be used in a cross-sectional survey of disabled people with a physical disability with a follow-up study one year later. Content and criterion validity was examined using 32 disabled people who took part in the pilot study. Construct validity and internal reliability was examined using data from 93 disabled people who took part in the main survey. Responsiveness of the questionnaire was evaluated using the data gathered during a follow-up study of 77 people had taken part in the original study. OUTCOME MEASURES: The OPCS Disability Severity Scales (OPCS) and the Functional Independence Measure (FIM) were used to measure level of disability of participants, the Nottingham Health Profile (NHP) and the UK version of the SF-36 to examine perceived health status. PARTICIPANTS: People with a primary physical disability, aged 16-65, randomly selected from two disability registers in southern England. MAIN RESULTS: Content and criterion validity were established. Construct validity and internal reliability of the SNAQ was good. Inter-rater reliability was not tested since only one researcher conducted the interviews. Test-retest reliability was not formally tested because of the probability that participants would learn from the first needs assessment questionnaire and that different results on a retest occasion could arise from this. The SNAQ was sensitive in picking up changes over time. CONCLUSION: The SNAQ has shown good validity (content, coverage and construct), internal reliability, sensitivity and responsiveness. Further studies are needed to define the consequences of meeting or not meeting the rehabilitation needs of disabled people. Inter-rater reliability remains to be established.

Adolescent↗

PubMed1996

Asthma, employment status, and disability among adults treated by pulmonary and allergy specialists.

STUDY OBJECTIVE: Identify risk factors for work disability among adults with asthma treated by pulmonary and allergy specialists. DESIGN: Cross-sectional survey, including retrospective work history data. PARTICIPANTS: Sixty-eight pulmonary and 16 allergy internal medicine subspecialists maintaining a registry of patient visits for asthma; 698 registered patients aged 18 to 50 years, of whom 601 (86%) were studied. MEASURES: Computer-assisted, telephone-administered structured interview assessing asthma severity, perceived general health status, asthma quality of life, demographics, and work history. Complete work disability defined as total work cessation attributed to asthma; partial work disability defined as change in job, duties, or reduction in work hours attributed to asthma. RESULTS: Complete cessation of work due to asthma was reported by 40 (7%; 95% confidence interval [CI], 5 to 9%) and partial work disability by 53 (10%; 95% CI, 7 to 12%) of 550 subjects with a history of labor force participation. Severity of asthma score predicted both complete disability (odds ratio [OR], 7.9; 95% CI, 4.2 to 15 per 10-point increment) and partial disability (OR 2.6; 95% CI, 1.6 to 4.2). Taking illness severity into account, job conditions, occupation, and work exertion carried a combined disability OR of 3.9 (95% CI, 1.7 to 8.6). CONCLUSIONS: Work disability is common among adults with asthma receiving specialist care. Severity of disease is a powerful predictor, but not the sole predictor of disability in this group. Working conditions, including job-related exposures, are associated with added disability risk even after taking illness severity into account.

Adult↗

PubMed2004

Ethnic differences in disability risk between Dutch and Turkish scaffolders.

The number of native Dutch and Turkish workers receiving a permanent disability pension in the Netherlands is still rising. To assess ethnic differences in disability risk between Dutch and Turkish scaffolders, a retrospective study was conducted within a large scaffolding company. Medical files for the period 1981-2000 were used to gather information on ethnicity, age at entering service, age at becoming disabled, years of employment, the year to receive a disability pension, the disability diagnosis, and the percentage rating of the disability pension. In the past 20 yr, 131 Turkish and 125 Dutch scaffolders have become disabled. Musculoskeletal disorders were the primary reason for the diagnosis. No differences in diagnoses were observed, except for a small difference in cardiovascular disease. Turkish scaffolders started their work at an older age, received the disability pension at an older age, and had a longer duration of employment. Turkish scaffolders faced disability 2.48 (95% confidence interval 1.94-3.18) times more often than their Dutch colleagues, adjusted for age. Explanations for the differences in disability risk between Dutch and Turkish scaffolders are sought in the older age at start of employment, lower mobility in the labour market, and less access to medical and social care. In future, employers, general practitioners, occupational health physicians and social security workers, as stakeholders in reintegration, should sufficiently attune their activities concerning care and cure for Turkish construction workers on long-term sick leave or during reintegration into other work.

Adult↗

PubMed2004

Physical activity for people with a disability: a conceptual model.

The promotion of a physically active lifestyle has become an important issue in health policy in first-world countries. A physically active lifestyle is accompanied by several fitness and health benefits. Individuals with a disability can particularly benefit from an active lifestyle: not only does it reduce the risk for secondary health problems, but all levels of functioning can be influenced positively. The objective of this article is to propose a conceptual model that describes the relationships between physical activity behaviour, its determinants and functioning of people with a disability. The literature was systematically searched for articles considering physical activity and disability, and models relating both topics were looked for in particular. No models were found relating physical activity behaviour, its determinants and functioning in people with a disability. Consequently, a new model, the Physical Activity for people with a Disability (PAD) model, was constructed based on existing models of disability and models of determinants of physical activity behaviour. The starting point was the new WHO Model of Functioning and Disability, part of the International Classification of Functioning, Disability and Health (ICF), which describes the multidimensional aspects of functioning and disability. Physical activity behaviour and its determinants were integrated into the ICF model. The factors determining physical activity were based mainly on those used in the Attitude, Social influence and self-Efficacy (ASE) model. The proposed model can be used as a theoretical framework for future interventions and research on physical activity promotion in the population of people with a disability. The model currently forms the theoretical basis for a large physical activity promotion trial in ten Dutch rehabilitation centres.

Attitude↗

PubMed1998

Disability theory and public policy: implications for critical gerontology.

Current gerontological theories and aging policy often fail to acknowledge the social and economic consequences of disability in later life, while disability theories and policies tend to focus only on the employment impacts of disability in younger populations. This article attempts to apply a critical gerontology framework to aging and disability issues. The authors review theoretical models of the disablement process, and note the primacy of environmental factors. The production and distribution of disability are assessed, using both social epidemiology and political economy insights. The authors examine the linkage of disability and work impedance and the consequences in disability programming, giving special consideration to inherent age, gender, and racial biases. Some of the historical antecedents of disability stigma in aging populations are also identified. The article concludes by suggesting that analysts and policymakers who wish to address the tremendous social and economic inequities that accompany aging and disability should look to the principles put forth by the independent living movement and to recent work on the moral economy of interdependency over the life course.

Age Factors↗

PubMedDate not supplied

Disability and diabetes.

Little work has been carried out on diabetes and disability. A questionnaire survey on the employment of people with diabetes aged 17-65 years was carried out in the UK. Data were also collected from a questionnaire sent to a random sample of employers. A comparison between those diabetic patients registered as disabled and those not so registered showed that men were more likely to be registered than women. The disabled group were also older, lower down the social scale, more likely to rent their house, to have left school before the age of 17 years, and to live in the north of the country. Significantly fewer disabled patients were currently working compared with those not registered as disabled (30% versus 65%, p less than 0.0001). Registered disabled patients who were working were no more likely to report having more than 20 days off sick in the last year compared with those patients not registered as disabled (7% versus 9%). Employers did not report adverse sickness absence rates for their registered disabled diabetic patients. People with diabetes who are registered as disabled can make good employees in a range of different occupations. Registering as disabled may improve employment opportunities for people with diabetes who are finding difficulty in obtaining suitable employment.

Adolescent↗