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PubMed1984

Intervention in work-related disability: the need for an integrated approach.

This paper looks at work-related disability in the United States as it is currently addressed according to the policies and procedures of the Social Security Disability Administration and the Workers' Compensation system. These policies and procedures proceed from a medical model that emphasizes health impairment as the fundamental cause of work-related disability. Thus physicians' evaluations of work-related impairment are the primary basis for administrative disability determinations. Increasing litigation regarding disability determinations and experience with long-term work-related disability suggest that the guiding policies are flawed. Work-related disability is as much a problem of manpower policy as it is one of personal health, but most employers and compensation programs in the United States do not yet respond to it as such. Recommended is a shift from a medical to a socioeconomic frame of reference for work-related disability that would overtly recognize regional variations in the static and dynamic factors of the economy and that would promote return to work and rehabilitation. Political intervention will be necessary. Because cultural values and social relationships are part of the problem, new research is needed in correlates of work-related disability.

Disability Evaluation↗

PubMed1994

How measurement techniques influence estimates of disability in older populations.

Measures of disability in activities of daily living (ADL) have become important indicators of the health of older persons. One fundamental decision in disability research is constructing or choosing a rating scale to measure ADL disability. Although there is growing consensus in the field on what ADLs to measure, there is little agreement on how to measure ADL disability. This study compares the effect of scales that rate the presence of difficulty, use or human assistance and use of any type of assistance to perform seven different ADLs on prevalence estimates of disability in a probability sample of 1818 adults 70 years of age and older living in the six New England states. Results reveal that different disability rating scales can have a dramatic impact on prevalence estimates of disability in older populations. Measures that used the 'difficulty' scale produced disability estimates from 1.2 to 5 times greater than estimates from the 'human assistance' scale. The effect of rating scales was associated with respondents' age, social factors, and health status. Effects also varied substantially across different ADLs. Researchers need to make careful choices of the disability ratings scales and use caution in drawing inter-study comparisons where different scaling methods were employed.

Activities of Daily Living↗

PubMed1996

A cross-national study of quality of life factors associated with patterns of elderly disablement.

This study examines individual-level data of non-institutionalized elderly from Bahrain, Burma, DPR Korea, Egypt, Indonesia, Jordan, Sri Lanka, Thailand and Tunisia. The Grade of Membership multivariate procedure is used to determine profiles of disablement, based upon functional disability and depression items, and to examine socio-demographic and quality of life covariates associated with such profiles. The analysis yielded six profiles or types of disablement: functionally and emotionally healthy, functionally healthy with some depressive symptoms, some strength problems, severely depressed, mobility problems and functionally frail. The healthy profile had higher probabilities associated with males, whereas the very depressed, and those with physical strength limitations, and mobility problems were more likely to be female. There is a strong positive association between age and functional disabilities. The more depressed profiles, however, tended to be among the younger age categories, and the depressed had higher probabilities associated with being not married. The examination of quality of life covariates indicates that the functional and emotional limitations generally are correlated with a lower quality of life. The more functionally disabled and the depressed profiles had more negative self-assessments of health and lower morale scores. The very depressed had less instrumental social support in terms of available kin. Also, the functionally and emotionally disabled profiles expressed less satisfaction of visits with family and friends. Country-specific patterns of elderly disablement indicate a possible disability transition such that as countries become more developed there may be an increase in the prevalence of disabled elderly. However, there are exceptions to this trend, and these may be due to both cultural factors and data limitations.

Activities of Daily Living↗

PubMed1988

Medical disability assessment of the back pain patient for the Social Security Administration: the weighting of presenting clinical features.

We investigated how physicians use history and physical findings when assessing disability for low back pain. Thirty-six North Carolina physicians, either practitioners experienced in disability determinations (26) or employees of the Social Security disability agency (10), responded to 48 clinical vignettes. They rated each case on a scale of 0 to 1.0, according to their degree of certainty that the patient was disabled. All combinations of five patient variables were presented in the vignettes: pain (mild or severe), physical examination (normal, reflex loss or muscular weakness), mobility (normal or restricted), X-rays (normal or osteoarthritis), and occupational history (normal or light work). The mean certainties for the individual vignettes ranged from 0.08 to 0.43. Mean certainty estimates across physicians ranged from 0 to 0.61, indicating substantial variability in how physicians assess disability. Practicing physicians had higher certainty of patients' disability than did physicians employed by Social Security, 0.37 vs 0.07 (p less than 0.01). Degree of pain was not associated with certainty of disability. All other clinical factors were highly significant predictors of physician assessment of certainty of disability. The emphasis on physical and radiographic findings over history places disability evaluation distinctly apart from other medical assessments.

Adult↗

PubMed1992

Identification of work disability in rheumatoid arthritis: physical, radiographic and laboratory variables do not add explanatory power to demographic and functional variables.

Work disability, a common problem in rheumatoid arthritis (RA), is known to be associated with demographic variables such as occupation, age, and formal education, as well as with disease duration. However, physical, radiographic and laboratory variables, which are included in the traditional "medical model" of work disability and collected routinely in the application process, have not been studied for their capacity to explain whether patients are working or receiving work disability payments. A cross-sectional database which included an extensively characterized group of patients with RA was examined to determine possible associations of demographic, functional, physical, radiographic and laboratory variables with work disability status. All these variables differed in patients who were receiving work disability payments and those who were working full time, but in multivariate analyses, work or disability status was best identified by demographic and functional variables. Physical, radiographic, and laboratory data did not add significantly to explanation of work disability status beyond the demographic and functional variables and disease duration, despite the fact that receipt of disability payments was used as the criterion for work disability status.

Activities of Daily Living↗

PubMed1996

Self-report disability in an international primary care study of psychological illness.

We assessed the replicability of reliability and validity of a brief self-report disability scale, adapted from the Medical Outcomes Survey (short form), in a 15-center, cross-national, multilingual study of psychological illness among primary care patients (n = 5438). Across all 15 centers in the World Health Organization Collaborative Study of Psychological Problems in General Health Care, the reliability of the disability scale was high and individual items were responsive at similar levels of disability. Self-report disability was consistently correlated with disability in work role (including housework) as rated by interviewers according to the Groningen Social Disability Schedule, a semistructured method taking local norms into account. Disability as measured by the self-report questionnaire was also consistently correlated with depressive symptoms as measured by the General Health Questionnaire. At each center, the disability items formed a moderately to strongly hierarchical (Guttman-like) scale. These findings support the feasibility of using self-report disability scales in cross-national primary care research.

Depression↗

PubMed2006

Risk of vehicle-pedestrian and vehicle-bicyclist collisions among children with disabilities.

OBJECTIVES: To examine the potential association between disability and risk of vehicle-pedestrian and vehicle-bicyclist collisions among children. METHODS: Data from the 2002 National Transportation Availability and Use Survey for Persons with Disabilities (NTAUSPD) were analyzed. RESULTS: Among 5019 persons who completed the survey, there were a total of 687 children between 5-17 years of age, including 299 respondents with and 388 without disabilities. After controlling for potential confounding variables, children with disabilities were more than five times more likely to have been hit by a motor vehicle as a pedestrian or bicyclist than children without disabilities (adjusted OR = 5.53, 95% confidence interval (CI): 1.43-21.41). For all children, regardless of their disability status, children who reported having some difficulty with traffic had a significantly higher risk of collisions (adjusted OR = 50.71, 95% CI: 7.35-349.86). The most commonly reported traffic difficulties for all children with and without disabilities were "Too few or missing sidewalks/paths," "Do not know when it's safe to cross," and "Insensitive/unaware drivers." CONCLUSIONS: Existing effective transportation safety interventions should be effective in reducing the risk of vehicle-pedestrian and vehicle-bicyclist collisions in children with disabilities. Future research and safety interventions should focus on how to promote the use of existing effective transportation safety interventions among children with disabilities and their families.

Accidents, Traffic↗

PubMed2006

Risk factors for work disability in severe adult asthma.

PURPOSE: We aimed to elucidate the prevalence of and risk factors for work disability in severe adult asthma and to evaluate the impact of work disability on downstream health outcomes. METHODS: We used data from a prospective cohort study of 465 adults with severe asthma. Structured telephone interviews ascertained asthma status and employment history. A job exposure matrix (JEM) was used to characterize the likelihood of workplace exposure to "asthmagens." RESULTS: The prevalence of asthma-related complete work disability was 14% among working-age adults with severe asthma (95% confidence interval, 11%-18%). Among those who were currently employed, the prevalence of partial work disability was 38% (95% confidence interval, 31%-45%). Sociodemographic (P = .027) and medical factors (P = .020) were related to the risk of complete work disability. Both sociodemographic characteristics (P = .06) and work exposures based on the JEM (P = .012) were related to partial work disability. In additional models, poorer asthma severity, physical health status, and mental health status were all associated with a higher risk of complete and partial work disability. CONCLUSIONS: Work disability is common among adults with severe asthma. There are three sets of risk factors for work disability that are potentially modifiable: smoking, workplace exposures, and asthma severity.

Absenteeism↗

PubMed2005

Gender moderates the association between depression and disability in chronic pain patients.

Pain-related anxiety and depression are important correlates of disability amongst chronic pain patients. Furthermore, women may differ in their experience of pain, anxiety and depression when compared to men. The aim of the current study was to determine the relative contribution of anxiety and depression on disability in male and female chronic pain patients. The sample consisted of 260 patients (101 males, 159 females) referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases in Bath, UK. As part of an initial assessment, all patients completed measures of depression, pain-related anxiety and disability. As predicted, both anxiety and depression were found to be significant positive predictors of pain, number of medications used and disability. Although gender did not significantly predict disability, it did moderate the relationship between depression and disability, in that when depression was high, women report greater disability than men. Gender was also found to moderate the relationship between depression and number of medications used, in that a positive association was found for men, but not women. However, gender did not significantly moderate the relationship between anxiety and disability. Together these results not only suggest that gender is an important moderator of the relationship between emotional responses and disability, but that such associations may be related more to depression than anxiety.

Adult↗

PubMed2004

Psychometric properties of disability measures among patients with social anxiety disorder.

BACKGROUND: Although recognition of the importance of disability as a construct has increased in recent years, there has been little examination of the reliability and validity of disability measures. METHODS: This study examined three disability measures, the Liebowitz Self-Rated Disability Scale (LSRDS), the clinician-rated Disability Profile (DP), and the Sheehan Disability Scale (SDS) among patients with a primary diagnosis of social anxiety disorder. RESULTS: The disability measures correlated strongly with each other, as well as with measures of social anxiety, depressive symptoms, and patients' subjectively-evaluated quality of life. The LSRDS and DP were more internally consistent than the SDS Total Score. All measures discriminated between patients with generalized and non-generalized social anxiety disorder. However, the LSRDS and DP also showed greater sensitivity to ecological indicators of distress than the SDS. Social anxiety symptoms accounted for significant variance in disability, above and beyond that accounted for by depressive symptoms. CONCLUSIONS: Overall, the LSRDS, DP, and SDS appear to be valid tools in the study of disability in social anxiety disorder, although the LSRDS and the DP appear to be somewhat more sensitive to the experiences of socially anxious patients.

Adult↗

PubMedDate not supplied

Risk factors for heart disease and stroke among diabetic persons, by disability status.

OBJECTIVE: To determine whether disabled diabetic persons have a higher prevalence of risk factors for heart disease and stroke than do diabetic persons without disability. RESEARCH, DESIGN, AND METHODS: Data were analyzed for noninstitutionalized adults in 27 states and the District of Columbia that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 and/or 2003. Logistic regression analysis was used to estimate the adjusted prevalence and odds ratios of disabled diabetic persons, by sociodemographic characteristics. The logit form of each model was used to estimate conditional marginal probabilities of risk factors for heart disease and stroke among diabetic persons, by disability status. RESULTS: Diabetic persons with disability were more likely than those without disability to have more risk factors for heart disease and stroke, including insufficient leisure-time physical activity or inactivity (adjusted prevalence: 75.2% vs. 63.3%; P<.001), obesity (58.9% vs. 43.3%; P<.001), hypercholesterolemia (52.6% vs. 48.4%; P=.038), and hypertension (63.9% vs. 56.6%; P<.001). They were also more likely to have one or more, two or more, three or more, and four or more risk factors (97.2% vs. 95.6%, 83.5% vs. 74.0%, 56.5% vs. 41.1%, and 22.2% vs. 13.6%, respectively; P< or =.005). CONCLUSIONS: Diabetic persons with disability are more likely than those without disability to have clusters of risk factors for heart disease and stroke. Health care guidelines specifically targeting diabetic patients with disability may be needed to aid health care providers in addressing these risk factors.

Adult↗

PubMed2006

Neurocognitive performance and negative symptoms: are they equal in explaining disability in schizophrenia outpatients?

OBJECTIVE: The aim of this study is to assess if cognitive variables and symptom dimensions can predict disability in a sample of outpatients with schizophrenia. METHOD: A cross-sectional sample of 113 individuals with a diagnosis of schizophrenia (DSM-IV criteria) was selected from a computerized register of five Community Mental Health Centers. Patients were assessed by two trained psychologists, with a neuropsychological battery comprising measures for verbal memory, attention, operative memory and abstraction and flexibility functions. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); a socio-demographic and clinical questionnaire, comprising the Disability Assessment Scale (DAS), was also completed. Test scores were standardized (t scores) to performance of healthy controls. To assess the relationship between clinical and sociodemographic factors and disability and cognitive functioning Pearson's correlation coefficients were computed. In order to establish the predictive capacity of the cognitive, clinical and symptom variables on disability linear regression models were fitted. RESULTS: Mean age of patients was 41.6 years and 68% were male. Higher ratings in the negative dimension were associated with more cognitive deficits. Association with the positive dimension was present but less strong. All disability areas, except for disability in occupational functioning, were partially explained by the negative dimension. Disability in family functioning was also partially explained by attention and number of admissions since onset. CONCLUSION: Negative symptoms are the major source of disability of our sample and are also associated to cognitive functioning. The present findings suggest that further investigation on the mediators between clinical and social outcomes may help to design specific treatments to reduce disability.

Adult↗

PubMed2004

Social inequalities and disability in older men: prospective findings from the British regional heart study.

The independent association of socio-economic position with self-reported disability was assessed. The effect of home and car ownership as additional indices of socio-economic position within occupational social classes was explored. Data from a prospective study of a cohort of 7735 men aged 40-59 years at recruitment and representative of the occupational social class distribution of middle-aged men in Great Britain were used. Men were selected from one general practice in each of 24 towns in England, Wales and Scotland in 1978-1980. The present study concerns 5773 (88.4% of those able to take part) men aged 52-73 years at follow up in 1992 who completed the disability section of a postal questionnaire. A quarter (1453) of men reported disability. Socio-economic position measured as both occupational class (social class I vs. V: age-adjusted OR 5.0, 95% CI 3.4-7.5) and ownership of home and car (both vs. neither: age-adjusted OR 2.8, 95% CI 2.3-3.4) showed a graded relationship with likelihood of reporting disability in 1992. Within all social class groups, those owning both home and car had a lower risk of disability than those who owned neither, even after adjustment for a wide range of risk factors. Men from manual occupations were more likely than those in non-manual occupations to report disability on developing chronic diseases. The relationship between socio-economic position and severe, but not milder, disability appeared to be independent of disease status. Socio-economic position is a strong predictor of disability in later life independent of a wide range of lifestyle factors and presence of diagnosed disease. The likelihood of reporting disability between and within social class groups is influenced by material wealth.

Activities of Daily Living↗

PubMedDate not supplied

Disability and receipt of clinical preventive services among women.

BACKGROUND: More individuals are surviving catastrophic injuries and living longer with persistent disability; however, their receipt of clinical preventive services is not well understood as compared with those without disabilities given the dual focus of care on both primary prevention and the prevention of secondary complications related to their disabilities. METHODS: Longitudinal analyses of 1999-2002 Medical Expenditure Survey (MEPS). Study sample consisted of 3,183 community-dwelling women aged 51-64 years and followed for 2 full years. Women with disabilities were defined as having reported any limitation in any area of activity of daily living in 2 years. Recommended clinical preventive services were defined as receiving the following at the recommended intervals: colorectal, cervical, and breast cancer; cholesterol screening; and influenza immunization. chi(2) tests and multiple logistic regressions were used to examine variations in use of clinical preventive services. RESULTS: Overall, 23% of the women in the study (n = 835) were disabled. Disabled women, however, were less likely to receive mammography and Pap smears within the recommended intervals. However, disabled women were more likely to receive influenza immunization, cholesterol screening, and colorectal screening within the recommended intervals. Among the disabled, usual source of care and health insurance remained significant predictors of receipt of clinical preventive services across all types, CONCLUSIONS: Disabled women were less likely to receive some of the cancer screening services, suggesting a need for targeted interventions to promote breast cancer and cervical cancer screening. Increased access to health care insurance and health care providers may also help.

Breast Neoplasms↗

PubMed1998

Disabilities resulting from traffic injuries in Barcelona, Spain: 1-year incidence by age, gender and type of user.

The purpose of this study was to examine the 1-year incidence of disabilities resulting from traffic injuries among the population of Barcelona (Spain), as well as its distribution by age, gender and type of motor-vehicle user, taking into account different exposure criteria. This is a population-based cross-sectional study; subjects were all cases (n = 4080) having undergone a medical examination for a traffic injury having occurred in 1993 resulting in a disability among residents in the area of Barcelona. Subjects were considered to have suffered a disability as a result of an injury if they were prevented from carrying out their normal activities for a period of 2 days or more. In 1993, the cumulative incidence rate of disability was 237.9 cases per 100,000 inhabitants, higher for men (287.1) than for women (193.9). The 20-24 year age group showed the highest incidence of disability (607.5). The rate of incidence of disability was 95.5 per 100,000 inhabitants among occupants of two wheeled vehicles, 87.7 among car occupants and 39.9 in pedestrians. When length of exposure to traffic was taken into account, the incidence rate of disability for residents aged > 14 years was 1.09 per 100,000 hours per person per year, similar for both sexes. This study represents a first attempt to use population-based health data to evaluate the incidence of disabilities due to traffic injuries. The results allow the identification of the groups with the greatest risk and who contribute the most to disabilities resulting from injuries, especially young users of two-wheeled motor vehicles.

Accidents, Traffic↗

PubMed1995

Dimensionality and hierarchical structure of disability measurement.

Since the D-code of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) in its full form has proven to be impractical, an instrument based on a selection of 28 items is used to measure disability in Dutch patients undergoing rehabilitation. The items are categorized into 5 domains of physical, activities of daily living (ADL), social, psychological, and communicative activity. Measurement is made on a 4-point scale ranging from 0 (not disabled) to 3 (severely disabled). As a result of the ordinal character of the rating, statistical and mathematical manipulations of the scores are complicated. The aim of this study was to obtain more insight in the dimensionality and hierarchical structure of the items, to overcome problems in comparing disability between items, between patients, and within patients between different moments in time. Mokken scale analysis of the disability scores from 1,967 rehabilitation inpatients showed that the 28 items constitute hierarchical scales. However, categorization of the items into the 5 original domains was not replicated. Five other scales or dimensions were investigated, measuring the level of extended ADL, extended psychological, fine motoric, work/leisure, and hearing/seeing activity, respectively. The number of items per dimension ranges from 14 in the extended ADL dimension to 2 each in the work/leisure and hearing/seeing dimensions. Although each disability item may be of importance in clinical case management, a reduced set of extended ADL items suffices to describe the disability level in this dimension for epidemiological research purposes. The other dimensions need further specification to provide reliable and sensitive measuring of disability.

Activities of Daily Living↗

PubMed1995

Work disability evaluation and the fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) is a common and costly cause of work disability. Patients with FMS, nevertheless, encounter considerable difficulties in their assessment of claims for disability payments. Factors that contribute to FMS as an important cause of disability are its high prevalence, the patients' perception of severe discomfort, and poor function. Disability evaluation in FMS is controversial for several reasons including lack of acceptance of the diagnosis, concurrent psychological abnormalities, difficulties in objectifying disability, deficiencies in instruments of evaluation, the uncertain efficacy of treatment, and physician attitudes. Third parties appear to have inappropriate expectations of the physician's role in determining disability. We suggest that the process of disability evaluation be improved by more objective assessments and by the inclusion of other health professionals in assessing disability and necessary retraining. Further research is needed to develop better instruments for measuring disability, to assess the long-term effects of various treatments, and to clarify the contributions of the work place and of compensation in causing or aggravating FMS.

Adult↗

PubMed1996

Psychosocial assessment of organ transplant candidates and the Americans with Disabilities Act.

The use of psychosocial criteria to assess candidates for organ transplantation may violate the Americans with Disabilities Act (ADA). The ADA prohibits discrimination on the basis of disability or on the basis of eligibility criteria that disproportionately affect persons with disabilities. When organ programs deny access to a person because of schizophrenia, they are denying an organ on the basis of disability. When organ programs deny access to a noncompliant person, they are denying an organ on the basis of an eligibility criterion that is more common in persons with coexisting disabilities like mental illness. Accordingly, both of these denials may violate the ADA. However, the ADA recognizes that it often is appropriate to take a person's disability into account when allocating organs for transplantation. There is a legitimate social interest in allocating organs in a way that maximizes medical benefit, and a person's disability may compromise the benefit that the person will receive from a transplant. It is likely that courts will interpret the ADA to permit denials of organs or lower waiting list priorities for persons with disabilities as long as predictions of diminished benefit are based on scientifically valid criteria, the assessment of candidates is individualized and not based entirely on generalized predictors, and the transplant program undertakes reasonable steps like psychological counseling to compensate for an organ candidate's coexisting disability.

Persons with Disabilities↗