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PubMed2001

[Utilization of health care system by patients with chronic pain who apply for disability pensions. A registry study].

INTRODUCTION: Patients with chronic pain may be awarded a disability pension if their working capacity is reduced as a result of an illness. Patients with chronic pain very often consult several specialists in order to obtain proof of their illness. The aim of this study was to investigate how an application for disability pension affected the utilization of health care services by patients with chronic pain. METHOD: Patients with chronic pain who applied for a disability pension in 1989 and 1990 were entered. The study period was divided into three: the year preceding the submission of the application for a disability pension, the time from submission of the application to the making of the decision, and the year following the decision of the health authorities. The patients were divided into four subgroups according to whether the disability pension was awarded or rejected, and whether the patients accepted or appealed the decision. The total costs of care in the primary sector were calculated on the number of and charges for visits to GPs and the total costs of hospital care were calculated on the number of bed days, visits to outpatients clinics, operations, and investigations. RESULTS: Patients with chronic pain had a significantly lower health care utilisation after the case has been closed. Those who did not get a disability pension and those who were not satisfied with the level of the disability pension, continued their utilisation of health care after the decision. The mean health care used by patients who appealed the level of the disability pension was three times higher than that used by patients who accepted the level of the disability pension. CONCLUSION: The study indicates that lack of or insufficient economic compensation from the social system in patients with chronic pain may contribute to inexpedient behaviour leading to increased costs to the health care sector.

Chronic Disease↗

PubMed2001

Disability certifications in adult workers: a practical approach.

Family physicians are frequently asked to complete disability certification forms for workers. The certification process can be contentious because of the number of stakeholders, the varying definitions of disability and the nature of the administrative systems. Insufficient training on disability during medical school and residency complicates this process. Disability systems discussed include workers' compensation, private disability insurance, the Americans with Disabilities Act and the Family and Medical Leave Act. Strategies that help the physician complete disability certification forms effectively include identification of disability type, ascertainment of the definition of disability being applied, evaluation of workplace demands and essential job functions, assessment of worker capacity, and accurate and timely completion of the forms in their entirety.

Adult↗

PubMed2002

Prevalence of childhood disability in rural KwaZulu-Natal.

OBJECTIVE: To determine the prevalence of disability in children under 10 years of age in the Manguzi subdistrict, in order to inform the development of an appropriate rehabilitation service. SETTING: Twelve areas within the rural Manguzi subdistrict of the Jozini-Uthungulu district in the far north-east of KwaZulu-Natal. DESIGN: A descriptive study in two stages. The first stage identified children under the age of 10 years reported with a disability. For this stage, 12 community health workers (CHWs) were trained to use a validated '10-question' screening tool with probes, adapted to include the under-2-year age group. The second stage involved confirmation of actual disability by the Manguzi rehabilitation team. RESULTS: A total of 2,036 children were screened. Of these children, 168 were reported with a disability giving an overall rate of 83/1,000 (95% confidence interval (CI): 71-95). The overall confirmed prevalence rate for children with disabilities under 10 years was 60/1,000 (95% CI: 50-71). The most prevalent disabilities were mild perceptual or learning disability (17/1,000), followed by cerebral palsy (10/1,000), hearing loss (10/1,000), moderate to severe perceptual disability (6/1,000) and seizure disorders (4/1,000). CONCLUSION: The prevalence of disabilities among children aged under 10 years is high. This has major implications for health, rehabilitation, welfare and educational services in rural areas. These implications must be addressed in order to develop appropriate rehabilitation services for children in rural areas.

Age Distribution↗

PubMed2006

Exemption of work activity as a basis for a continuing disability review. Final rules.

We are publishing these final rules to amend our regulations to carry out section 221(m) of the Social Security Act (the Act). Section 221(m) affects our rules for when we will conduct a continuing disability review if you work and receive benefits under title II of the Act based on disability. (We interpret this section to include you if you receive both title II disability benefits and title XVI (Supplemental Security Income (SSI)) payments based on disability.) It also affects our rules on how we evaluate work activity when we decide if you have engaged in substantial gainful activity for purposes of determining whether your disability has ended. In addition, section 221(m) of the Act affects certain other standards we use when we determine whether your disability continues or ends. We are also amending our regulations concerning how we determine whether your disability continues or ends. These revisions will codify our existing operating instructions for how we consider certain work at the last two steps of our continuing disability review process. We are also revising our disability regulations to incorporate some rules which are contained in another part of our regulations and which apply if you are using a ticket under the Ticket to Work and Self-Sufficiency program (the Ticket to Work program). In addition, we are amending our regulations to eliminate the secondary substantial gainful activity amount that we currently use to evaluate work you did as an employee before January 2001.

Disability Evaluation↗

PubMed1986

Physical disability in 1986 and beyond. A report of the Royal College of Physicians.

This Report puts forward a plan for the management of physical disability. It recognises that the subject is administratively complex and that many different organisations, including Social Services, are involved. The Report concentrates upon the role of the NHS in general, and upon the position of physicians in particular. The Report starts by reviewing some of the evidence that services for the physically disabled are in many respects deficient. The evidence includes accounts given by disabled people themselves, the fact that many patients are 'follow-up' by inexperienced junior hospital staff, and the lack of agreed standards of provision in many areas (see Section 3) such as pressure sores, incontinence, wheelchairs, and the care of head injured patients. Disabled people between the ages of 15 and 65 are identified as requiring particular attention (Paediatric and Geriatric Services probably cater reasonably well for the young and the old). The 'size' of the problem of physical disability is examined. For instance, the average Health District (of 250,000 persons) will contain 25,000 physically disabled people, of whom 6,250 will be severely, or very severely disabled; and 1,800 will have a wheelchair; 40 per cent of disabled people are under the age of 65. The Working Party on Rehabilitation Medicine of the Royal College of Physicians (1978) was of the opinion that rehabilitation is an integral part of total patient care, and is therefore the concern of all clinicians. The implication of this view is that Medical Disability Services should be developed without a major specialty of Rehabilitation or its equivalent, such as exists in most western countries. The Report explores the practical implications of this principle in the light of evidence discussed above.

Adolescent↗

PubMed1993

Self reported disability in six electoral districts in Grampian.

Following the Office of Population Censuses and Surveys (1988) Survey on disability, a survey was carried out in Grampian in 1989, initiated by the Social Work Department of Grampian Regional Council. From 5,042 mail questionnaires a response rate of 83.6% was obtained. Twelve and 88% of those with health disorders were considered as having impairments and disabilities respectively, when the categories of the World Health Organisation's International Classification of Impairments, Disabilities and Handicaps (1980) were applied. Thirty-two per cent of survey households considered that they had at least one person with a disability. Of the 1,289 households with disability 23% and 3% had two, and three or more people with a disability. Six disorders accounted for 86.9% of all disability, and asthma accounted for nearly half of all reported disability among Grampian's population under 16 years of age. The nature and extent of disability was found to vary considerably within Grampian.

Adolescent↗

PubMed1995

Detection and prevention of childhood disability with the help of Anganwadi workers.

OBJECTIVES: To evaluate the role of Anganwadi Workers (AWW) for detection and prevention of disability in children below 6 years of age. DESIGN: Cross sectional and longitudinal follow up. SETTING: Ten Anganwadi Centers in ICDS Urban Project. METHODS: Trained AWWs identified disabilities and instituted preventive measures like immunization and supplementary nutrition. Simultaneous independent verification by pediatricians. Repeat survey after 6 mo of follow-up. RESULTS: Amongst the 1545 children, AWW identified disability in 126 subjects which were verified in 118 cases by pediatricians. The disability rate was 7638 per 100,000 population. Visual, mental, orthopedic, speech and hearing disabilities rates were 4790, 2654, 583, 518 and 453 per 100,000 population, respectively. In the repeat survey, 35 of the 74 children with visual disability (mostly xerophthalmia), 4 of the 9 with orthopedic disability and 3 of the 7 with hearing disability could be managed satisfactorily. CONCLUSIONS: AWW can help in early detection and appropriate management of incipient and preventable childhood disabilities.

Child Health Services↗

PubMed1996

[International Classification of Impairments, Disabilities and Handicaps ICIDH--results and problems].

Published by the World Health Organization in 1980, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) provides a conceptual framework for information by enabling classification, and hence description, of the three dimensions of the phenomenon of "disablement" (as a consequence of disease, injury or congenital condition). The ICIDH permits a highly complex issue to be easily grasped to a certain extent, and has gained almost worldwide recognition as a valuable tool in the perception of the problem of disablement, in describing this problem and developing solutions for this problem. With modern definitions in rehabilitation using its basic terms, the ICIDH will before long also be established as a tool for purposes of documentation, evaluation and treatment planning in the field of rehabilitation. Notwithstanding its successes, the ICIDH not only raises practical problems but theoretical ones as well. The points of criticism relate to the consequences of disease model, the definitions of the basic terms, and the overlap of basic term extensions. In order to overcome the definitional and overlap problems it is suggested, for one, to clearly distinguish between the phenomena and their symptoms and, for the other, to eliminate any overlap that may exist in the formulation of the concepts the definitions of the basic terms build on. The ICIDH model of disease consequences may be viewed as a preliminary step towards developing a theory of disablement. Such a theory would in particular be designed to enable explanation and prognosis of disablement creation processes as well as development of causally founded methods of intervention in rehabilitation. It should moreover include a theory of the etiologic processes involved in disablement as well as a theory of rehabilitative intervention. The crucial future tasks of the rehabilitation sciences will include the further development of a theory of disablement enabling provision of assistance to persons with disablement, or at risk of being disabled, in a more purposeful and causally founded manner than has been the case so far.

Activities of Daily Living↗

PubMed2002

Postponed development of disability in elderly runners: a 13-year longitudinal study.

BACKGROUND: The magnitude and duration of the benefit of running and other aerobic exercise on disability and mortality in elderly persons are not well understood. We sought to quantify the benefits of aerobic exercise, including running, on disability and mortality in elderly persons and to examine whether morbidity can be compressed into later years of life by regular exercise. METHODS: A 13-year prospective cohort study of 370 members of a runners' club for persons aged 50 and older and 249 control subjects initially aged 50 to 72 years (mean, 59 years), with annual ascertainment of the Health Assessment Questionnaire disability score, noting any deaths and their causes. Linear mixed models were used to compute postponement in disability, and survival analysis was conducted to determine the time to and causes of death. RESULTS: Significantly (P<.001) lower disability levels in runners' club members vs controls and in ever runners vs never runners were sustained for at least 13 years. Reaching a Health Assessment Questionnaire disability level of 0.075 was postponed by 8.7 (95% confidence interval [CI], 5.5-13.7) years in runners' club members vs controls. Running club membership and participation in other aerobic exercise protected against mortality (rate ratio, 0.36 [95% CI, 0.20-0.65] and 0.88 [95% CI, 0.77-0.99], respectively), while male sex and smoking were detrimental (rate ratio, 2.4 [95% CI, 1.4-4.2] and 2.2 [95% CI, 1.1-4.6], respectively). Controls had a 3.3 times higher rate of death than runners' club members, with higher death rates in every disease category. Accelerated rates of disability and mortality were still not seen in the runners' club members; true compression of morbidity was not yet observable through an average age of 72 years. CONCLUSION: Running and other aerobic exercise in elderly persons protect against disability and early mortality, and are associated with prolongation of a disability-free life.

Age Factors↗

PubMed2004

Psychosocial disability before, during, and after a major depressive episode: a 3-wave population-based study of state, scar, and trait effects.

BACKGROUND: Psychosocial disability after remission from a unipolar major depressive episode (MDE) can be due to (1) residual symptoms (state effect), (2) the continuation of premorbid disability (trait effect), and/or (3) disability that developed during the MDE and persisted beyond recovery (scar effect). METHODS: Data came from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective Dutch psychiatric population-based survey. We obtained psychiatric data (Composite International Diagnostic Interview) and information on psychosocial functioning (work, housekeeping, spouse/partner, and leisure-time domains) from 4796 respondents in 1996 (T1), 1997 (T2), and 1999 (T3). We evaluated trait effects using between-subject comparisons, and state and scar effects using within-subject comparisons. RESULTS: In 216 and 118 respondents, a first and a recurrent MDE developed, respectively, after T1 that remitted before T3. Compared with never-MDE individuals, first-MDE subjects had higher disability scores long before their episode (effect size, 0.42-0.57 U). During the MDE, disability further increased in first- and recurrent-MDE subjects (effect size, 0.44-0.79 U), but returned to its premorbid level after MDE remission, except in subjects who experienced a severe recurrent episode. If the premorbid period (T1 to MDE onset) was longer than the postmorbid period (MDE remission to T3), disability at T3 was higher than at T1, misleadingly suggesting scar effects. The reverse occurred if the premorbid period was shorter than the postmorbid period. CONCLUSIONS: Postmorbid psychosocial disability reflects largely the continuation of premorbid psychosocial disability. Scarring does not occur routinely, but may occur in a severe recurrent episode. Within-subject premorbid-postmorbid comparisons are sensitive to state effects of prodromal and residual symptoms. These findings point at the following 2 independent processes: (1) the ongoing expression of trait vulnerability to depression in mild psychosocial dysfunctioning; and (2) synchrony of change between severity of depressive symptoms and psychosocial disability.

Adult↗

PubMed2002

Reasonable accommodations for medical faculty with disabilities.

An unknown number of medical school faculty have disabilities, and their experiences have generally escaped notice and scrutiny. Although most medical schools offer long-term insurance and extended leaves of absence for disability, relatively few have policies explicitly addressing accommodations for faculty with disabilities as they perform teaching, research, and clinical duties. We discuss accommodating active medical school faculty with disabilities, drawing on University of Pennsylvania School of Medicine initiatives exploring the concerns of faculty with sensory and physical disabilities. Anecdotal reports suggest that many faculty, fearing reprisals, resist seeking job accommodations such as those mandated in the 1990 Americans with Disabilities Act (ADA). Although some faculty with disabilities have found supportive academic mentors, others report that lax institutional enforcement of ADA requirements, including physical access problems, demonstrates a tepid commitment to disabled staff. Potentially useful job accommodations include adjusting timelines for promotion decisions; reassessing promotions requirements that inherently require extensive travel; improving physical access to teaching, research, and clinical sites; and modifying clinical and teaching schedules. Faculty with disabilities bring identical intellectual and collegial benefits to medical schools as their nondisabled counterparts. In addition, they may offer special insights into how chronic illness and impairments affect daily life.

Architectural Accessibility↗

PubMedDate not supplied

Understanding how disability is defined and conceptualized in the literature.

A goal of rehabilitation nursing is to advance the care of persons with chronic disabling conditions by minimizing disability. There are two distinct perpectives in the literature about how to conceptualize disability. Definitions and models of disability that inform rehabilitation nursing practice are based on a functionalist perspective of illness and locate disability as a problem of individual functioning. Alternatively, there are definitions and models that have evolved from the civil rights and social justice perspectives, and that locate the problem of disability within a disabling society. Recent attempts to integrate these two perspectives are based on earlier rehabilitation models and the functionalist assumptions remain. Rehabilitation nursing research and practice based on either of these two perspectives is fragmented and incomplete. To know how to define and approach disability-related issues, it is important to understand how people living with disability perceive its influences on their lives.

Attitude to Health↗

PubMed1996

Physician perspectives on the ethical aspects of disability determination.

OBJECTIVE: To evaluate physician's attitudes and responses to the ethical conflicts involved in certifying patients for welfare disability. DESIGN: A mailed questionnaire survey that used case scenarios and general questions. SETTING: Massachusetts. PARTICIPANTS: A random sample of 347 internists and family practitioners and a convenience sample of 100 neighborhood health center physicians from three large cities (NHC sample). The response was 53% and 76%, respectively. MEASUREMENTS AND MAIN RESULTS: Physician responses to case scenarios representing difficult decisions about patient requests for welfare disability determination and general questions about the welfare disability system. Physicians reported a willingness to exaggerate clinical data to help a patient they thought deserving of welfare disability benefits (39% random sample; 56% NHC sample). Physicians did not report confidence in their ability to determine who was disabled as measured by a visual analog scale (4.4 cm random sample, 4.6 cm NHC sample; 0 = very confident, 10 = very uncertain). They did feel burdened by their participation in welfare disability determinations when compared with other administrative chores as measured on a visual analog scale (2.8 cm random sample, 2.5 cm NHC sample; 0 = more burdensome, 10 = less burdensome). Eighty-two percent of the random sample physicians and 86% of the NHC sample physicians thought that filling out a disability form could adversely affect the physician-patient relationship, and 62% of physicians in each sample thought that it represented a conflict of interest. Eighty percent of physicians in both samples thought that it would be better if an independent group of physicians were designated to determine disability. CONCLUSIONS: Physicians perceive an ethical bind as they try to satisfy the conflicting demands of patients and the welfare disability system. They will frequently decide in favor of their patient's interests. This has implications for welfare policy planners.

Alcoholism↗

PubMed2004

Age- and sex-stratified prevalence of physical disabilities and handicap in the general population.

BACKGROUND AND AIMS: Our aim was to provide age- and sex-stratified prevalence estimates of physical disabilities and handicap in the general Belgian population. METHODS: A cross-sectional and demographically representative health interview survey was conducted nationwide in Belgium in 1997. The 8836 persons aged 15 years and over who answered the health interview were included in this study. Seventeen items from the survey encompassing main activities of daily living (ADL) and confining were analyzed. To provide prevalence estimates as detailed as possible, neither aggregation nor dichotomization were applied. RESULTS: Women consistently reported more disability than men: mobility (p < 0.001), transfer in-out bed (p < 0.001), transfer in-out chair (p < 0.001), dressing (p = 0.004), washing hands and face (p = 0.029), getting to and using toilet (p = 0.003), continence (p < 0.001), seeing (p < 0.001) and mastication (p < 0.001). As expected, there was a marked trend for increased prevalence of disability with increasing age for both sexes. Moderate disability arose mainly from the 25-34 age group for both sexes. For both genders, severe disability appeared mainly at higher ages, particularly for the 65-74 age group. Nevertheless, the data suggest that continence problems for women, mobility and transfer issues for men, as well as mastication problems for both genders, clearly emerge earlier than age 65. Regarding handicap, observed prevalence rates were increasing, in age as was the case for disability, but no differences were found between men or women, except for confinement to house/garden, for which women presented a higher rate in general (p < 0.001) and in the 75-84 age group (p = 0.036) in particular. CONCLUSIONS: This study shows the wide range of disability types in the general population and their association with handicap. While elderly individuals consistently report higher degrees of disability and handicap, attention should also be paid to younger age groups. Disability calls for wide, coherent and relevant medical as well as social responses.

Activities of Daily Living↗

PubMed2006

Decreasing prevalence of disability in activities of daily living, functional limitations and poor self-rated health: a 6-year follow-up study in Spain.

BACKGROUND AND AIMS: Forecasting functional status in elderly populations is uncertain. Our aim is to provide evidence of population trends of Activities of Daily Living (ADL) disability, functional limitations and self-rated health. METHODS: Data come from a longitudinal study of aging in Leganés (Spain), collected in 1993, 1995, 1997 and 1999, on a representative sample of 1560 community dwelling people over 65. Response rate at baseline was 82%. ADL disability was defined as needing help in at least one of the following: walking across a small room, taking a shower, toileting, getting out of bed, getting up from a chair, using the toilet, dressing and eating. Functional limitations were based on questions of difficulty with upper and lower limbs. Self-rated health was assessed with a single question. ADL disability, functional limitations and self-rated health were regressed on age, survey year, sex and education. RESULTS: There are significant declines in ADL disability, functional limitations and poor self-rated health at every age and up to very advanced ages. Over 90, the ADL disability trend may be reversed, with the emergence of a very old and disabled population. Women and people with little education have a higher prevalence of disability, functional limitations and poor health, when compared with men and those with higher education. CONCLUSIONS: Results suggest the postponement of severe disability onset in this Spanish population, leading to longer healthy life expectancy, and support the emergence of a very disabled population over 90 years of age.

Activities of Daily Living↗

PubMed2005

A prospective study of the interrelationship between subjective and objective measures of disability before and 2 months after lumbar decompression surgery for disc herniation.

The value of range of motion (ROM) as an indicator of impairment associated with spinal problems, and in monitoring changes in response to treatment, is a controversial issue. The aim of this study was to examine the interrelationship between subjective disability (Roland-Morris scores) and objectively measured impairment (ROM), both before and in response to spinal decompression surgery, in an older group of patients with herniated lumbar disc (DH). Seventy-six individuals took part in the study: 33 patients (mean age 57 years, SD 9 years) presenting with DH and for whom decompression surgery was planned, and 43 controls (mean age 57 years, SD 7 years), with no history of back pain requiring medical treatment. In the patient group, pain intensity (leg and back; visual analog score), self-rated disability (Roland-Morris score), certain psychological attributes, and ROM of the spine (Spinal Mouse) were measured before and 2 months after decompression surgery. In addition, the patients rated the success of surgery on a 1-5 Likert scale. The pain-free control group performed only the tests of spinal mobility. Before surgery, compared with matched controls, significantly lower values were observed in the DH patients for standing lumbar lordosis (p=0.01), and for range of flexion of the lumbar spine (ROF(lumbar)) (p=0.0006), but not of the hips (ROF(hip)) (p=0.14). Roland-Morris Disability scores correlated significantly with ROF(lumbar) (r=0.61, p=0.0002), but less well with ROF(hip)(r=0.43, p=0.01). Two months after surgery, there were significant reductions in back pain and leg pain (p=0.0001) and in Roland-Morris Disability scores (p=0.019). There was also a significant decrease in the group mean values for lumbar lordosis angle (i.e., a "flatter" spine after surgery, p=0.002) and ROF(lumbar) (p=0.038). ROF(hip) showed a (nonsignificant) tendency to increase (p=0.08) towards normal control values. As a result of these two opposing changes, the range of total trunk flexion showed no significant changes from pre-surgery to 2 months post-surgery (p=0.60). On an individual basis, there was a highly significant relationship between the change in self-rated disability scores and the change in ROF(lumbar), pre-surgery- to 2 months post-surgery (r= -0.82; p<0.0001). Changes in ROF(hip) showed no such relationship (r= -0.30, p=0.10). The patients in the "poor" outcome group ("surgery didn't help"; 9%) had a significantly greater reduction in ROF(lumbar) post-surgery compared with the "good" outcome group ("surgery helped"; 91%) (p=0.04). In stepwise linear regression, the change in ROF(lumbar) was the only variable accounting for the change in self-rated disability pre-surgery to post-surgery (variables not included: pain intensity, psychological factors). The pivotal role of lumbar mobility in explaining disability emphasizes the importance of measuring lumbar and hip ranges of motion separately, as opposed to "global trunk motion." In the patient group examined, the determination of lumbar spinal mobility provides a valid, objective measure of function, that shows differences from normal matched controls, that correlates well with self-rated disability, and the changes in which correlate extremely well with subjective changes in disability following surgery.

Back Pain↗

PubMed2005

Reconsidering the social location of the medical model: an examination of disability in parenting literature.

This paper challenges the view that there is one medical model of disability monolithically and oppressively imposed on disabled people. Because the presence of disability may be ambiguous in any given case, multiple actors, lay and professional, may invoke particular medical models of disability and advance competing claims about an individual's disabilities and related needs. The literature for parents of disabled children is seen as a resource on which parents can draw in making claims about their children's disabilities and disability-related needs. Particular attention is given to the assumptions that this literature makes about the identity, resources and dispositions of the audience. Ultimately, these assumptions favor disability claims made by white, highly educated, upper-income parents.

Adult↗

PubMed1993

Salivary testosterone in children with and without learning disabilities.

Previous studies have indicated that the sex steroids have organizational effects upon neural tissue and that abnormal secretion during development may lead to functional anomalies. In this study, we explore the possibility of prepubertal steroid hormone involvement in the etiology of learning disabilities. Salivary testosterone levels in 264 children without learning disabilities (133 males, 131 females) were measured and compared to that in 32 children with learning disabilities (25 males, 7 females). The presence of learning disabilities was significantly associated with higher salivary testosterone. Data from equivalent samples of learning-disabled and control subjects also were compared separately because of disparities in sample size and variable distribution in the total group analysis. A 32-member sample of nonlearning-disabled children was created by randomly selecting individuals who exactly matched the age, race, and sex characteristics of the learning-disabled group. The matched analysis further substantiated the association between testosterone secretion and learning disabilities. Thus, it is possible that some learning disabilities may be associated in part with abnormal testosterone levels.

Adolescent↗