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PubMed2006

Development and psychometric testing of Korean language versions of 4 neck pain and disability questionnaires.

STUDY DESIGN: Cohort study. OBJECTIVES: To develop and establish the psychometric properties of Korean versions of 4 neck pain and disability questionnaires: the Neck Disability Index, Neck Pain and Disability Scale, Functional Rating Index, and Short Form McGill Pain Questionnaire (SFMPQ). SUMMARY OF BACKGROUND DATA: To our knowledge, there are no published Korean language neck pain and disability measures. METHODS: Versions of each questionnaire in idiomatic modern Korean were developed with a process involving initial independent translation, synthesis of the translations, independent back translation, and review by an expert committee to achieve equivalence with the original English. Psychometric testing of the questionnaires with 261 subjects was undertaken to examine test-retest reliability, internal consistency, discriminative validity, and longitudinal construct validity. RESULTS: Test-retest reliability of the translated versions of the 3 disability questionnaires was excellent (intraclass correlation coefficient[2,1] = 0.86-0.90). High internal consistency was found in the 3 disability questionnaires (Cronbach-alpha ranged from alpha = 0.88 for the Functional Rating Index to alpha = 0.96 for the Neck Pain and Disability Scale, and 0.82 for the SFMPQ). The visual analog scale subscale of the SFMPQ was the most responsive of the subscales (effect size = 1.44, standardized response mean = 1.37). The visual analog scale was also the most responsive pain and disability index in internal responsiveness analysis, although disability indexes showed marginally better responsiveness when compared with external standards. No floor or ceiling effects were observed. CONCLUSIONS: We conclude that the questionnaires were successfully translated and show acceptable measurement properties, and, as such, are suitable for use in clinical and research applications.

Adolescent↗

PubMed2007

Emotional distress as a predictor for low back disability: a prospective 12-year population-based study.

STUDY DESIGN: A population-based, prospective cohort. OBJECTIVE: To study associations between emotional distress and long-term low back disability in a general population. SUMMARY OF BACKGROUND DATA: In primary and hospital care studies, emotional, cognitive, and personality factors have been associated with low back disability, while the association between distress and novel back pain episodes has been uncertain. METHODS: A randomly drawn cohort of 1152 occupationally active persons aged 20-55 years was interviewed with a comprehensive psychosocial questionnaire in 1990, and was followed for 12 years in national registers over sickness, rehabilitation, and disability benefits. Data on emotional distress, earlier low back pain (LBP), education, life style, psychosocial, and work-related factors were collected at baseline. RESULTS: Long-term benefits due to low back disability were granted to 131 persons (11.4%) in the follow-up period. In multivariate analysis, earlier LBP, emotional distress, low grade of education, and high physical job stress were associated with low back disability. Persons with both emotional distress and earlier back pain were most at risk for disability (hazard ratio 2.91, 95% confidence interval 1.60-5.29). Persons with emotional distress but no earlier episodes of LBP had no increased risk for low back disability (hazard ratio 0.71, 95% confidence interval 0.34-1.45). CONCLUSIONS: Emotional distress is a predictor for low back disability in persons with earlier LBP, but not in persons without. To prevent low back disability, emotional distress should be considered and treated in persons with LBP.

Adult↗

PubMed2006

Age-dependent relationships among pain, depressive symptoms, and functional disability in youth with recurrent headaches.

OBJECTIVE: To assess age differences associated with depressive symptoms and functional disability in children and adolescents with recurrent headache. BACKGROUND: Research has indicated that psychological factors, especially depression, are related to the extent and nature of functional disability experienced from headaches. There is a lack of research examining how age impacts the relationship between pain, psychological factors, and activity restriction in children and adolescents with recurrent headache. METHODS: Seventy-seven participants from a pediatric neurology clinic completed self-report measures of pain intensity, depressive symptoms, and functional disability. RESULTS: Findings demonstrated a significant positive correlation between pain and functional disability, and depressive symptoms and functional disability for children. Correlations for adolescents failed to reach significance. Functional disability emerged as a mediator between headache pain and depressive symptoms for children but not for adolescents. CONCLUSIONS: Results indicate potentially important age differences when examining the impact of functional disability on depressive symptoms in this sample. Findings suggest that functional disability may contribute to depressive symptoms differently for children versus adolescents with recurrent headache. Age-specific interventions that differentially focus on the specific roles that pain, depressive symptoms, and disability have for children and adolescents with recurrent headache may be warranted.

Adolescent↗

PubMedDate not supplied

Disparities in occupational low back injuries: predicting pain-related disability from satisfaction with case management in African Americans and Caucasians.

OBJECTIVE: To predict post-settlement pain-related disability from claimant race and satisfaction with Workers' Compensation case management. DESIGN: Population-based survey with telephone interviewing. SETTING: St. Louis City, St. Louis County, and Jackson County, Missouri. PARTICIPANTS: African American and Caucasian Workers' Compensation claimants (1,475) with single incident low back injuries whose claims were settled between January 1, 2001 and June 1, 2002. MEASURES: Workers' Compensation variables were obtained from the State of Missouri comprising treatment cost, temporary disability payment, disability rating, and settlement award. Satisfaction with Workers' Compensation case management was evaluated across five Likert-type rating scales. Pain-related disability was measured using the Pain Disability Index. Injury variables included diagnosis of disc injury or regional backache. Socioeconomic status included education and income. Demographic variables were race, age, and gender. RESULTS: Path analysis indicated direct negative associations between satisfaction and disability. Race had a direct association with disability but was also mediated through other variables: African Americans received less treatment/compensation across the Workers' Compensation variables (relative to Caucasians), which predicted lower satisfaction. This pattern also held true for lower socioeconomic status claimants and those with regional backache. CONCLUSIONS: For African Americans and lower socioeconomic status persons in the Workers' Compensation system, less treatment/compensation was associated with lower satisfaction with the process, which in turn predicted higher levels of post-settlement disability. Given that the function of Workers' Compensation is to reduce disability from work-related injuries, the current results suggest that the system produces inequitable outcomes for these groups.

Adolescent↗

PubMed2005

Relationship between self-assessed masticatory disability and 9-year mortality in a cohort of community-residing elderly people.

OBJECTIVES: To examine the relationship between self-assessed masticatory disability and mortality. DESIGN: Prospective. SETTING: Community based. PARTICIPANTS: Total of 1,405 randomly selected people aged 65 and older living in Settsu, Osaka Prefecture, in October 1992. MEASUREMENTS: Data on health status as indicated by disability scores, history of health management, self-assessed masticatory ability, and psychosocial conditions were collected by means of interviews during home visits at the time of enrollment. Nine-year follow-up was completed for 1,245 (88.6%; 398 deceased and 847 alive). RESULTS: Self-assessed masticatory disability was significantly associated with being 75 and older, having overall disability, not using dental health checks or general health checks, not participating in social activities, not feeling that life is worth living (no ikigai), and finding relationships with people difficult. As for the association between self-assessed masticatory disability and mortality, the estimated survival rate for those with self-assessed masticatory disability was lower than that for those without for each group stratified by sex and age (65-74 and >or=75), and the equality of survival curves according to self-assessed masticatory disability was significant for each group. After controlling for potential predictors of mortality, self-assessed masticatory disability remained as a significant predictor of mortality (adjusted hazard ratio=1.63, 95% confidence interval=1.30-2.03, P<.001). CONCLUSION: These results indicate that self-assessed masticatory disability may be associated with a greater risk of mortality in community-residing elderly people.

Aged↗

PubMed1990

Age, pattern of consultation, and functional disability in elderly patients in one general practice.

OBJECTIVE: To examine how functional disability varies with sex, age, and other variables in patients aged 75 and over living in the community and to ascertain whether a statistical model derived from the variables in this population usefully predicted functional disability in another of similar age. DESIGN: Retrospective study of data collected by interview and by examination of medical records. SETTING: An urban general practice with five partners and a list of 15,000 patients, very few of whom belonged to ethnic minorities. PATIENTS: 775 Patients (252 men, 523 women) aged 75 and over living in the community between September 1985 and August 1986; 13 other patients considered to be unsuitable and 14 who declined an interview were excluded. Also 94 patients who became 75 or joined the practice after August 1986. MAIN OUTCOME MEASURE: The proportions of fit, partially disabled, and severely disabled (housebound) patients. RESULTS: 90 Men (35.7%) and 128 women (24.5%) were fit, and 27 men (10.7%) and 116 women (22.2%) were housebound; in all age groups women were significantly more likely to be disabled than men. A significant trend towards greater disability was shown with increasing age and, more noticeably, with pattern of consultation when patients were divided into three categories based on the number of times they had attended the surgery and been visited at home over about two years. Statistical models gave the forecast percentage of fit and severely disabled patients for each sex, age group, and pattern of consultation, and a simple scheme was derived to identify from information wholly contained in medical records most of those patients most prone to severe disability. The scheme was verified applying it to a population of 94 elderly patients in 1988-9. CONCLUSION: Sex, age, and pattern of consultation together provide a quick indication of elderly patients' tendency to severe disability, which can help in screening and in day to day consultations.

Age Factors↗

PubMed1996

Cost of care for a geographically determined population of low birthweight infants to age 8-9 years. II. Children with disability.

AIM: To determine the cost of health and educational service provision for low birthweight children with a clinical disability. METHODS: Cohort study of a geographically defined population in five health districts that comprise the County of Merseyside was undertaken. All children with a clinical disability born in 1980 and 1981 to mothers resident in the County of Merseyside were followed up to age 8-9 years. The cost of care associated with the initial admission to the neonatal special/intensive care unit and subsequent use of hospital, family practitioner, and special education services was assessed. RESULTS: There were 52 children with a disability; the disability rate in children of birthweight < or = 2000 g was estimated at 7.7%. Of the total expenditure to age 8-9 years, special education was the largest category (52%) and neonatal care accounted for 35%. The disabled children accounted for 38% of the cost of the whole cohort of 693 disabled and non-disabled children who weighed < or = 2000 g at birth. CONCLUSION: In a cohort of low birthweight children, those who are disabled account for a disproportionate amount of the total expenditure to age 8-9. The cost of long term care for disabled young persons and adults will increasingly dominate the cost of care for the whole cohort of low birthweight children.

Child Care↗

PubMed1998

Psychiatric morbidity in epilepsy: a case controlled study of adults receiving disability benefits.

OBJECTIVE: To compare the prevalence of non-organic psychiatric disorders among disabled patients of normal intelligence with epilepsy with the prevalence of similar psychiatric disorders among age and sex matched disabled patients with other somatic diseases. METHODS: A case-control study was carried out in Iceland among people receiving disability benefits using information available at the State Social Security Institute. There were 344 patients with epilepsy in Iceland 16 to 66 years of age (inclusive) receiving disability benefits in 1995. By excluding mentally retarded patients, autistic patients, and patients with organic psychoses, 241 index cases with epilepsy qualified for the study. For each case two age and sex matched controls were selected from all patients receiving disability benefits who had cardiovascular diseases, respiratory diseases, or arthropathies. The same exclusion criteria were applied to the controls as the index cases. In both patient groups psychiatric diagnoses were classified into one of the four following categories: (1) psychotic illness; (2) neurotic illness or personality disorders; (3) alcohol or drug dependence or misuse; and (4) other mental disorders. RESULTS: Psychiatric diagnosis was present among 35% (85/241) of the cases compared with 30% (143/482) of the controls (p=0.15). There was a difference in the distribution of the two groups into different psychiatric categories (p=0.02). This was mainly due to an excess of men in the index group with psychosis, particularly schizophrenia or paranoid states. CONCLUSION: The results suggest that there is not a difference in the prevalence of non-organic psychiatric disorders among disabled patients of normal intelligence with epilepsy compared with patients with other disabling somatic diseases. However, the data indicate that when psychopathology is present disabled patients with epilepsy are more likely to have psychotic illness than the other disabled patients.

Adolescent↗

PubMed2003

One year changes in disability in multiple sclerosis: neurological examination compared with patient self report.

OBJECTIVE: To characterise prospectively the relation between one year changes in neurologist rating of neurological exam abnormalities as measured by the Expanded Disability Status Scale (EDSS) and changes in patient perceived disability as measured by the Guy's Neurological Disability Scale (GNDS) in patients with multiple sclerosis. METHODS: Two hundred and fifty patients with MS were recruited at an outpatient clinic. Disability at baseline and one year follow-up was assessed using the EDSS and GNDS. Correlations between change in EDSS, GNDS-sum score, Functional Systems and GNDS subcategories were studied as well as the significance of changes in EDSS associated with changes in perceived disability. RESULTS: The correlation between one year changes in EDSS versus GNDS was substantially lower (0.19) than cross-sectional correlations between EDSS and GNDS either at baseline (0.62) or at follow-up (0.77). Notably, changes in functional system scores that are based on neurological examination are poorly or not at all correlated with changes in disability as perceived by the patient. Analysing the impact of a significant worsening in EDSS-score, a commonly applied outcome criterion in clinical trials, we found that this was associated with significant worsening, insignificant change, and significant improvement in the patients' perceived disability in 45%, 39% and 15% of patients, respectively. CONCLUSION: Patients' perception of change in disability differs not only quantitatively but also qualitatively from that of an examining physician. This seems to be due both to the fact that there are true differences in change as perceived by the patient and that measured by the physician and to the fact that changes in many dimensions of disability that are relevant to the patient have no measurable impact on the EDSS.

Adult↗

PubMedDate not supplied

Excess functional disability among demented subjects? Findings from the Canadian Study of Health and Aging.

Dementia has been recognized as the strongest determinant for developing functional disability. However, dementia patients typically present with concomitant illness, thereby making difficult a determination of the fraction of disability due to dementia. The objective of this study was to estimate the prevalence of functional disability among demented and nondemented people and to estimate the excess disability in demented subjects net of conditions independently associated with disability in older people, using data on nearly 2,900 subjects from the clinical examination of the 1991 Canadian Study of Health and Aging. Unadjusted specific disability prevalence (in bathing, dressing, grooming, toileting and stool and urinary incontinence) is considerably greater among demented subjects than among cognitively normal or cognitively impaired but not demented subjects. After adjustments, specific disability in demented subjects is somewhat reduced in comparison to nondemented and cognitively impaired but not demented subjects. Thus, even when one considers the influence of a history of physical illnesses that typically result in disability, the link between disability and dementia is only marginally attenuated.

Activities of Daily Living↗

PubMed2004

Function, disability, and psychological well-being.

Disability research in arthritis, as in disability research in general, has focused on functional limitations and activities of daily living/instrumental activities of daily living (ADL/IADL) disability, and has thus ignored a great deal of daily life. Unfortunately, the areas of life that have been ignored may be those that are most important to individuals, and may also be the most sensitive to the first signs of developing disability. The ability to perform valued life activities, the wide range of activities that individuals find meaningful or pleasurable above and beyond activities that are necessary for survival or self-sufficiency, has strong links to psychological well-being--in some cases, stronger links than functional limitations and disability in basic activities of daily living. A broader assessment of disability has great potential for interrupting the disablement and distress process, thereby improving the quality of life of individuals with arthritis. Assessment of the effects of arthritis, pain, or other chronic health conditions should expand beyond assessment of functional limitations and disability in basic activities to include assessment of disability in advanced, valued activities.

Activities of Daily Living↗

PubMedDate not supplied

Modifiable factors for the length of life with disability before death: mortality retrospective study in Japan.

BACKGROUND: Past studies have measured and described the length of life with disability before death, but there has been no study of the relationship between modifiable lifestyle factors and duration of disability. OBJECTIVE: To examine whether there are modifiable factors influencing the length of life with disability before death. METHODS: The study was designed as a retrospective observation of the deceased who had earlier been enrolled in a prospective cohort study. During the follow-up period (1996-1999), we documented 781 deaths among those who were 70-79 years of age at the baseline survey in 1994 (n=10,216). In 2000, we interviewed family members of the deceased about the duration of the subjects' disability before death (n=655). RESULTS: The median duration of disability before death was approximately 6 months. Both higher Body Mass Index (BMI) and shorter time spent walking were significantly associated with an increased risk of long-term disability (more than 6 months). The odds ratios of long-term disability were 1.3 in those with BMI 20-25 and 2.1 in those with BMI>25, compared with BMI<20. The odds ratios of long-term disability were 1.3 in those walking for 0.5-0.9 h/day and 1.7 in those walking for <0.5 h/day, compared with those walking for >1.0 h/day. These relationships were unchanged after stratification for causes of death. CONCLUSION: Weight control and walking in later life may shorten the length of life with disability before death.

Aged↗

PubMed1994

Predicting the disability of first-time stroke sufferers at 1 year. 12-month follow-up of a population-based cohort in southeast England.

BACKGROUND AND PURPOSE: The purpose of this study was to predict the functional outcome at 1 year of first-time stroke patients aged younger than 75 years in relation to the severity of stroke and demographic characteristics. METHODS: Population registers in three districts of southeast England were established in August 1989, with notification by stroke registry field-workers, general practitioners, and rehabilitation practitioners. Assessments were made using the Barthel index for activities of daily living at the time of maximum impairment and at 3 and 12 months after the stroke. RESULTS: Of 639 registered stroke patients, 392 without previous disability survived and were assessed for disability at 3 months, of whom 34 (9%) were severely disabled and 60 (15%) moderately disabled. Initial incontinence was the best single predictor of disability with a sensitivity of 60% and a specificity of 78%. Two hundred twenty-five patients (35%) were eligible for 12-month follow-up; 11% had moderate or severe disability, for which initial incontinence was the best predictor. CONCLUSIONS: There is no evidence from this study of an association between demographic characteristics and the disability status of stroke survivors in the medium term. Multivariable predictors of disability had little advantage over incontinence within 24 hours of the stroke. The estimates of the prevalence of disability from this large population-based study are relevant when assessing the medium-term needs of stroke patients.

Activities of Daily Living↗

PubMed2001

Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population.

BACKGROUND AND PURPOSE: The goals of the present study were to estimate the prevalence of acute impairments and disability in a multiethnic population of first-ever stroke and to identify differences in impairment and early disability between pathological and Bamford subtypes. Associations between impairments and death and disability at 3 months were identified. METHODS: Impairments that occur at the time of maximum neurological deficit were recorded, and disability according to the Barthel Index (BI) was assessed 1 week and 3 months after stroke in patients in the South London Stroke Register: RESULTS: Of 1259 registered patients, 6% had 1 or 2, 31.1% had 3 to 5, 50.6% had 6 to 10, and 10.6% had >10 impairments. Common impairments were weakness (upper limb, 77.4%), urinary incontinence (48.2%), impaired consciousness (44.7%), dysphagia (44.7%), and impaired cognition (43.9%). Patients with total anterior circulation infarcts had the highest age-adjusted prevalence of weakness, dysphagia, urinary incontinence, cognitive impairment, and disability. Patients with subarachnoid hemorrhage had the highest rates of coma. Patients with lacunar stroke had the high prevalence of weakness but were least affected by disability, incontinence, and cognitive dysfunction. Blacks had higher age- and sex-adjusted rates of disability in ischemic stroke (BI <20, odds ratio 2.76, 95% CI 1.47 to 5.21, P=0.002; BI <15, odds ratio 1.8, 95% CI 1.45 to 2.81, P=0.01) but impairment rates similar to those of whites. On multivariable analysis, incontinence, coma, dysphagia, cognitive impairment, and gaze paresis were independently associated with severe disability (BI <10) and death at 3 months. CONCLUSIONS: The extent of these findings indicates that an acute assessment of impairments and disability is necessary to determine the appropriate nursing and rehabilitation needs of patients with stroke.

Age Distribution↗

PubMed1999

Outcomes of employment discrimination charges filed under the Americans With Disabilities Act.

OBJECTIVE: The outcomes of employment discrimination charges filed under the Americans With Disabilities Act (ADA) by individuals with psychiatric disabilities and those with other disabilities were compared. METHODS: Data obtained from the Equal Employment Opportunity Commission (EEOC) consisted of all ADA employment claims closed as of March 31, 1998. Charges were categorized by whether they were investigated by the EEOC or by a Fair Employment Practice Agency (FEPA). RESULTS: Of the 175,226 charges filed, 83.2 percent were closed by March 31, 1998. Of these, 15.7 percent brought some kind of benefit to charging parties, although only 1.7 percent resulted in new hires or reinstatements. Of charges investigated by FEPAs, 23.3 percent led to some benefit, compared with 11.5 percent of charges investigated by the EEOC. Of charges investigated by the EEOC, the median actual monetary benefit was $5,646, compared with $2,400 for charges investigated by FEPAs. A total of 13.6 percent of charges filed by individuals with psychiatric disabilities resulted in benefits, compared with a benefit rate of 16 percent for persons with other disabilities. The median actual monetary benefit received by persons with psychiatric disabilities was $5,000, compared with $3,500 for those with nonpsychiatric disabilities. Individuals whose charges were investigated in the first three years of ADA implementation were more likely to receive benefits than individuals whose charges were investigated more recently. CONCLUSIONS: Most employment discrimination charges filed under the ADA do not result in benefits or a finding of reasonable cause. Outcomes for people with psychiatric disabilities do not differ substantially from those for people with other disabilities.

Databases as Topic↗

PubMed1993

Social skills in the context of learning disability definitions: a reply to Gresham and Elliott and directions for the future.

In this article we review the evidence on the status of a social skills deficit as a learning disability (LD) by examining social skills deficits in the context of learning disability definitions. For the most part, social skills deficits fall within the terms that are specified in the definitions; that is, when there is evidence of neurological involvement, social skills deficit as a learning disability is consistent with the focus on listening and speaking that is characteristic of most definitions of learning disabilities. We also conclude that the absence of limiting conditions in extant definitions of learning disabilities makes it difficult to exclude any particular skill or type of knowledge from falling within the bounds of the definitions. Furthermore, we argue that the critical issue centers on the reformulation of the definition of learning disabilities. We suggest two directions in future work: First, the term "learning disability" should be limited to intentional learning contexts. Acceptance of this limitation would clarify at least some of the confusion regarding the domain of learning disabilities. Second, learning disability definitions should become more responsive to recent research on the nature of learning.

Brain Damage, Chronic↗

PubMed1993

Dysrationalia: a new specific learning disability.

The concept of selective deficit is the foundation of most conceptual definitions of learning disability. Such definitions have tended to implicate the construct of intelligence in the conceptualization of learning disability and have led to the use of IQ test scores to operationalize the notion of aptitude-achievement discrepancy. The learning disabilities field is only beginning to grapple with the implications of its reliance on the concept of psychometrically defined intelligence. For example, discrepancy-based definitions of learning disabilities guarantee that such disabilities will become more or less prevalent depending on the comprehensiveness of the set of skills assessed on IQ tests. Unlike the vernacular concept of intelligence--which is quite broad--psychometric operationalizations reflect only a thin slice of the mental domain that might be considered cognitive. Thus, it is possible that we have not exhausted the potential set of discrepancy-based disabilities. As a demonstration proof, a new discrepancy-based disability category is proposed and defended in this paper. The disability is one that may force more careful consideration of the role that intelligence plays in conceptual and operational definitions of learning disabilities.

Child↗

PubMed1999

Generic health status measures are unsuitable for measuring health status in severely disabled people.

OBJECTIVES: To assess the perceived health status of disabled people. DESIGN: Perceived health status was evaluated with the Short Form 36 Health Survey (SF-36) and the Nottingham Health Profile as part of a needs assessment project exploring systematic differences in unmet needs for rehabilitation as perceived by disabled people, carers and professional staff. Disabled participants completed these health status questionnaires, as part of a face-to-face interview in participants' own homes. SUBJECTS: Ninety-two disabled people aged 16-65, recruited into the study from two disability registers. OUTCOME MEASURES: The Office of Population Censuses and Surveys (OPCS) Disability Severity Scale, Nottingham Health Profile, SF-36. RESULTS: Ninety-six disabled people took part in this study. Four were later excluded because of overwhelming communication difficulties. Median OPCS category was 8 (interquartile range 6-9.75). The pain and physical mobility domains of the Nottingham Health Profile were not completed by 46/92 participants (50%) because many questions referred to activities that these people could not perform, particularly walking. The physical functioning domain of the SF-36 showed severe floor effects. It was not therefore possible to use these measures to test the effectiveness of services provided to disabled people, particularly in the areas of physical functioning and pain. CONCLUSIONS: There is a continued need to develop and test instruments that can measure the outcomes of rehabilitation in severely disabled populations.

Adolescent↗