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PubMed1997

Rethinking the relationships between disability, rehabilitation, and society.

This paper provides a critical review of contrasting ways of thinking about the nature of disability in society. It highlights the dominance of the medical model of disability whereby medical and rehabilitative professionals and practitioners tend to conceive of disability as an individual physiological and/or medical condition requiring the afflicted individual to be given appropriate medical and/or rehabilitative support. As the paper suggests, such perspectives are problematical because they reduce the understanding of disability to the conditions of the individual 'patient' and ignore wider social and environmental influences in engendering a state of disability. Thus, the paper highlights other perspectives on disability and society which suggest that social, attitudinal, and environmental barriers in society are an important component in disabling people with physical and/or mental impairments. In this sense, breaking down disabling social practices against people with disabilities might be as important, if not more so, than seeking to cure physical and/or mental impairments.

Attitude of Health Personnel↗

PubMed2005

[Incidence of disability in housebound elderly people living in a rural community].

This study aimed to explore whether being housebound is a risk factor for disabilities and whether low social communication increases incidence of disability in elderly people. A self-reported questionnaire regarding demographic characteristics was administered to 2,046 community-dwelling elderly people (aged 65 and older) in October 2000, and subjects were followed up until March 2003. All subjects were independent in activities of daily living. In this study, being housebound was defined on frequency of going out, with those who left the house once or less per week being classified as housebound. We further classified the housebound into four groups: I, going out alone is difficult but social communication occurs; II going out alone is difficult and no social communication occurs; III, going out alone is possible but not undertaken often, and some social communication occurs; and IV, going out alone is possible but seldom undertaken and no social communication occurs. In this population, overall prevalence of being housebound was 8.5%, and about half of those who were housebound fit the third classification. At the end of the follow-up period, 12.7% of subjects reported disabilities. The incidence of disability was higher in the housebound compared with the non-housebound. The incidence of disability by age was higher in housebound groups than in the non-housebound in elderly individuals aged under 85, but no significant differences were recognized in those aged over 85. In terms of housebound status, all housebound groups had higher levels of disability than the non-housebound. However, the groups without social communication (H and IV) exhibited higher incidence of disability than those with social communication (I and II). From the results obtained, we conclude that being housebound is a risk factor for disability in elderly individuals aged 65 to 85 years who are living independently, and that lower social communication also represents a risk factor for disability. This study appears to indicate that a frequency of going out of once or less a week is a valid guide for determination of housebound status.

Activities of Daily Living↗

PubMed2001

Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors.

OBJECT: The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors. METHODS: Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surgery after failed embolization: and 16 underwent embolization alone. The outcomes of gait and micturition disability, were analyzed. Follow up averaged 3.4 years (range 1 month-11.8 years). Age, duration of symptoms, pre- and postintervention magnetic resonance (MR) imaging findings, and preintervention disability were correlated with outcome. Seventeen patients (57%) experienced improved gait, 12 (40%) were unchanged, and one (3%) was worse. In 11 patients (37%) micturition function was improved, in 15 (50%) it was unchanged, and in four (13%) it was worse. Gait disability, as measured by the Aminoff-Logue Scale, was significantly improved after treatment, from 3.4+/-1.4 (average +/- standard deviation) to 2.7+/-1.5 (p = 0.007). Mean micturition disability scores decreased, but not significantly, from 1.9+/-1 to 1.6+/-1.1 (p = 0.20). Preintervention gait disability was not associated with improvement except for patients with Aminoff-Logue Scale Grade 4 disability (eight of nine improved; p = 0.024). For patients treated within 13 months of symptom onset, mean micturition disability decreased (p = 0.035). No association was found between clinical improvement and age, a symptom duration less than 30 months, or pre- and postintervention MR imaging-documented spinal cord edema. CONCLUSIONS: Spinal DAVF treatment significantly improved patients' mean gait disability score by almost one grade at last follow up. The mean micturition disability score was not significantly improved, unless treatment was performed within 13 months of symptom onset. Longer and more uniform follow-up study is needed to determine if improved and stabilized clinical outcomes are sustained.

Aged↗

PubMed2003

Sexual satisfaction and risk of disability in older women.

BACKGROUND: Most studies evaluating sexuality in older adults have focused on men, and relatively little research has evaluated the relationship between sexual satisfaction and health outcomes in older women. The aims of this study were to describe correlates of sexual satisfaction in community-dwelling older women with moderate to severe levels of disability and to examine the association of sexual satisfaction with progression of disability in this population. METHOD: A total of 980 moderately to severely disabled women aged 65 years or older who had participated in The Women's Health and Aging Study entered this study. Baseline evaluations took place from 1992 through 1995. Participants rated their satisfaction with their level of sexual activity on a 0-to-10 scale. Women scoring > or = 8 were considered sexually satisfied. The onset of new severe disability was determined by semiannual assessments, over 3 years, of disability in performing activities of daily living (ADLs) and walking across a room. RESULTS: Of 203 (49.8%) women living with a spouse, 101 were satisfied with their level of sexual activity. In this group, older age, white race, and higher level of physical function were independent predictors of sexual satisfaction. In addition, among women living with a spouse, higher sexual satisfaction was associated with a significantly decreased risk for incident disability in performing ADLs (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.36 to 0.94) and walking across a small room (HR = 0.38, 95% CI = 0.18 to 0.79). Among women not living with a spouse, the response on the sexual satisfaction question showed different determinants and was not associated with disability risk. CONCLUSION: Sexual satisfaction in community-dwelling, older, disabled women living with their spouse is associated with reduced risk for subsequent new severe disabilities.

Activities of Daily Living↗

PubMed1993

From dependency to self-advocacy: redefining disability.

People continually redefine the meaning of disability for themselves through interaction and interpretation. Negative assumptions about disability result in low expectations for persons with disabilities and contribute to policies that keep them in isolation and out of the mainstream of life. Disability rights activists have begun to strip away some of the old stigmas and assumptions by redefining the meaning of disability to themselves and to others, and by organizing themselves into groups for purposes of discussion, education, and protest. Their efforts have resulted in improvements in attitudes about and opportunities for persons with disabilities. They need to remain vigilant to maintain the rights they have won, as well as to address new issues. Those who are interested in equal opportunities for persons with disabilities need to become advocates. Persons with disabilities learn to advocate for themselves through interaction with others who are committed to activist goals. They also learn through trial and error, gaining strength as they experience success, and they learn through formal advocacy training. Occupational therapists can actively contribute to the redefinition of disability through self-reflection and through advocacy training.

Activities of Daily Living↗

PubMed1997

Predictors of disability retirement.

OBJECTIVES: Disability retirement may increase as the work force ages, but there is little information on factors associated with retirement because of disability. This is the first prospective population-based study of predictors of disability retirement including information on workplace, socioeconomic, behavioral, and health-related factors. METHODS: The subjects were 1038 Finnish men who were enrolled in the Kuopio Ischemic Heart Disease Risk Factor Study, who were 42, 48, 54, or 60 years of age at the beginning of the study, and who participated in a 4-year follow-up medical examination. RESULTS: Various job characteristics predicted disability retirement. Heavy work, work in uncomfortable positions, long workhours, noise at work, physical job strain, musculoskeletal strain, repetitive or continuous muscle strain, mental job strain, and job dissatisfaction were all significantly associated with the incidence of disability retirement. The ability to communicate with fellow workers and social support from supervisors tended to reduce the risk of disability retirement. The relationships persisted after control for socioeconomic factors, prevalent disease, and health behavior, which were also associated with disability retirement. CONCLUSIONS: The strong associations found between workplace factors and the incidence of disability retirement link the problem of disability retirement to the problem of poor work conditions.

Adult↗

PubMed2005

A health system program to reduce work disability related to musculoskeletal disorders.

BACKGROUND: Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product. OBJECTIVE: To evaluate whether a population-based clinical program offered to patients with recent-onset work disability caused by MSDs is cost-effective. DESIGN: Randomized, controlled intervention study. The inclusion and follow-up periods each lasted 12 months. SETTING: Three health districts in Madrid, Spain. PATIENTS: All patients with MSD-related temporary work disability in 1998 and 1999. INTERVENTION: The control group received standard primary care management, with referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties. MEASUREMENTS: Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis. RESULTS: 1,077 patients were included in the study, 7805 in the control group and 5272 in the intervention group, generating 16,297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (mean, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, 6.00 dollars had to be invested in the program. Each dollar invested generated a benefit of 11.00 dollars. The program's net benefit was in excess of 5 million dollars. LIMITATIONS: The study was unblinded. CONCLUSIONS: Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.

Absenteeism↗

PubMed2001

[Visual disability incidence among diabetes patients in Olsztyn province in the years 1990-1999].

UNLABELLED: The aim of the study was to estimate the incidence of visual disability. Long-term studies on visual disability have been conducted in Olsztyn Province since 1989. A standardized register has comprised 292 patients with diabetes type 1 and 2 whose visual disability resulted from diabetes. Visual disability incidence was expressed by means of a standard rate describing the number of newly diagnosed cases of visual disability per 100,000 population per year. Diabetes related visual disability incidence rate ranged from 2.52/100,000 population in 1990 to 3.08/100,000 population in 1999. For diabetes type 1, visual disability incidence rate was 1.20/100,000 population in 1990 and 1.03/100,000 population in 1999. For diabetes type 2, the rate was 1.33/100,000 population in 1990, increased to 4.66/100,000 population in 1995, and decreased to 2.05/100,000 in 1999. The rate was twice as high among women as among men. CONCLUSIONS: 1. The incidence of visual disability in 1990-1999 was 2.52 to 3.08/100,000 population on average. For type 2 diabetes it was significantly higher than for type 1 diabetes. 2. The monitoring of visual disability is a good indicator of diabetological care.

Adult↗

PubMed2001

[Visual disability due to diabetes in Cracow voivodeship].

Visual impairment and blindness are major complications of diabetes and are regarded as the most serious disability by most of patients. The purpose of the study was to determine the incidence and prevalence due to diabetes-induced visual disability in 1991-1999 in the former Cracow voivodeship with population of 1,245,047 inhabitants. A register of visual disability was established using independent sources of information. On the end of 1999 the register had included 122 diabetics with visual disability--66 women (54.1%) and 56 men (45.9%). The patients with type 2 diabetes predominated--92 subjects (75.4%). The remaining 30 patients (24.6%) had type 1 diabetes. Grade 1 visual disability was diagnosed in 82 subjects (67.2%) whereas grade 2 visual disability in 40 patients (32.8%). Grade 1 visual disability was defined as visual acuity in a better eye < 0.05 and visual field narrowing < 20%. The criteria of grade 2 were visual acuity after correction in a better eye 0.05-0.1 and visual field narrowing 20-30%. According to the register of the Cracow Branch of the Polish Association of the Blind diabetics made up 6.2% of all visual disability cases. In 1991-1999 the incidence of visual disability due to diabetes did not increase significantly. The mean incidence rate was 0.9/100,000 population. However, there was a significant increasing trend in prevalence with mean annual increase of 0.24/100,000 population (95% CI 0.17-0.31/100,000).

Adult↗

PubMedDate not supplied

Social support, depression, and functional disability in older adult primary-care patients.

OBJECTIVE: The authors asked whether social support and depression are independently associated with functional disability and examined the potential role of social support as a moderator in the depression-functional disability association. METHODS: Subjects were 305 patients age 60 years and over. Predictor variables were social support, depressive symptoms, and depression diagnosis. Dependent variables were the Instrumental Activities of Daily Living Scale, the Physical Self-Maintenance Scale, and the Physical Functioning subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey. Authors used multiple-regression analyses. RESULTS: Depressive symptoms and all dimensions of social support were independently associated with functional disability: the specifics of these relationships varied among types of social support and functional disability. Depression diagnosis was not independently associated with any functional disability measure. Social support (more instrumental help, more perceived satisfaction) moderated some depression diagnosis-functional disability associations, and one depressive symptom-functional disability association. CONCLUSIONS: The study hypotheses were partially confirmed. Different dimensions of social support have important and varied roles in the depression-functional disability dynamic. Future research is needed to further specify the complex relationships among depression, social support, and functional disability.

Activities of Daily Living↗

PubMed2004

Juvenile idiopathic arthritis: parent-child discrepancy on reports of pain and disability.

OBJECTIVE: To examine the incidence and nature of disagreements about pain and functional disability between parents and their children with juvenile idiopathic arthritis (JIA) and to identify demographic and psychosocial predictors of parent-child disagreement about pain and functional disability. METHODS: Participants comprised 63 children 8-16 years of age (mean 12.36 +/- 2.61) and their parents, followed as part of a longitudinal study of pain in children. During routine rheumatology clinic visits, children and their parents completed validated measures of pain, depressive symptoms, and functional disability. RESULTS: Parents and children often disagreed as to the frequency and intensity of pain and to the degree of disability caused by arthritis. Child depressive symptoms (p < 0.01) and parental perceptions of child limitations (p < 0.02) predicted parent-child disagreement about the frequency of the child's pain. Parental perceptions of child limitations also predicted parent-child disagreement about the child's level of functional disability (p < 0.04). Those children who estimated their level of disability to be different than their parents' rating also were more depressed compared to children who agreed with their parents about their level of disability (p < 0.01). CONCLUSION: Discrepancy between parent and child reports of pain and disability in children with JIA is common. Findings suggest that such disagreements in reporting of pain and functional disability by parents and their children with JIA are associated with underlying depressive symptoms in children.

Activities of Daily Living↗

PubMed2004

Predicting the effect of disability on employment status and income.

Research shows that participation in employment contributes to life satisfaction for persons with disabilities [18]. Title I of the Americans with Disabilities Act (ADA) sought to prohibit discrimination against persons with disabilities in the workplace, however, the ADA's effectiveness remains controversial. This research utilizes data from the disability supplement of the 2000 Behavioral Risk Factor Surveillance System to examine the impact of disability status on predicting employment status and income. Confounding variables such as gender, age, educational level, race and marital/parental status are examined regarding their influence on results. Results from analysis utilizing zero-order correlation, linear and logistic regression analysis techniques revealed that disability status has a significant predictive effect on inability to work. Furthermore, results continue to show that despite legislation, the higher the level of disability, the lower the employment status (those employed for wages) and income. Finally, disability status, coupled with being female or decreased educational level, consistently shows significance in predicting lower employment status and income than men or non-minorities with disabilities. Future research opportunities and policy implications are discussed with regard to the results presented.

Adolescent↗

PubMed2005

[Risk of disability pension among young persons on long-term sick leave].

BACKGROUND: In the late 1990s the incidence of new disability pensioners in Norway increased, especially among young people. This study assessed the risk and possible predictors of a transition to disability among long-term sickness absentees below 40. MATERIAL AND METHODS: The study was carried out in a county with 10 % of Norway's population. All new long-term (i.e. more than 8 weeks) sickness absentees below 40 years over a six-month period in 1994 were included and followed up until year-end 1999. Socio-demographic and medical information were used as independent variables in Cox regression analysis with disability as the outcome variable. RESULTS: The five-year risk of disability was 7.9 % (95 % CI 5.8 % - 10.0 %) for men and 10.3 % (95 % CI 8.5 % - 13.1 %) for women. Among young persons on long-term sickness absence with psychiatric diagnoses the rate of disability was 24 % (95 % CI 15 - 33 %) for men and 11 % (95 % CI 6 - 16 %) for women. In musculoskeletal disorders the risk of disability was 5 % (95 % CI 3 - 7 %) for men and 11 % (95 % CI 8 - 14 %) for women. Women had higher rates of disability among all subgroups of musculoskeletal disorders. Regression analysis showed no gender effect. The following variables increased the risk of disability pension: psychiatric diagnosis (only for men), low income (both genders), increasing age (only women) and previous long-term absence (only for men). INTERPRETATION: A moderate risk of disability pension was found among young people on long-term sick leave. Special interventions targeted at men with psychiatric diagnoses and women with musculoskeletal disorders should be considered.

Adolescent↗

PubMed2005

[The duration of disability pensions in Iceland].

OBJECTIVE: To analyze the long-term outcome for recipients of disability pension in Iceland. MATERIAL AND METHODS: The study includes all those receiving disability pension for the first time in 1992 in Iceland. Their status in the disability register at the State Social Security Institute of Iceland November 30th 2004 was examined as to whether they were still receiving disability pension, had died, had reached the age of retirement or were not receiving disability pension any more for some other reasons. RESULTS: In 1992 there were 725 new recipients of disability pension in Iceland, 428 females and 297 males. Twelve years later 434 from this group were no longer receiving disability pension, 240 females and 194 males. In most cases this was because they had reached the age of retirement or died (on average 88% of the females and 91% of the males each year). Only 12% of the females and 9% of the males ceased to receive disability pension (and probably went back to work). CONCLUSION: In Iceland few people return to work once they have started receiving disability pension.

Adult↗

PubMedDate not supplied

Integration of disability-related content in nursing curricula.

Despite evidence that health care professionals, including nurses, do not perceive persons with disabilities in a positive light and fail to attend to their health care needs, it is not known how nursing programs address the topic of disability. This descriptive study was conducted to examine the extent to which schools of nursing in the United States address disability-related issues and the strategies used to integrate disability-related content in their curricula. A 27-item investigator-developed survey was sent to a national stratified random sample of 1,000 schools of nursing. Questions pertained to curricular content, specific groups of persons with disabilities, and teaching methods and resources used to teach nursing students about disability. Respondents indicated that they included some content related to disability in their curricula. Nursing textbooks were the most common source of information used. Barriers to including disability-related content were lack of time and lack of faculty interest or expertise. These findings can serve as a stimulus to increase the extent and breadth of disability-related issues in nursing curricula.

Attitude of Health Personnel↗

PubMedDate not supplied

[Malingering among workers seeking disability insurance].

OBJECTIVE: Describe the frequency and characteristics of Mexican Social Security workers with malingering disorder that request disability pension. MATERIAL AND METHODS: Comparative survey made among 136 workers seen during 2001, which were divided into three groups: malingering workers (MW), workers without disability (WOD), and workers with disability (WWD). We administered the Z Test for scaled variables and Z2 Test for nominal variables to identify group differences RESULTS: The incidence ofmalingering was of 2.2/100,000 workers. Mean age was 41.9 +/- 10.1 years, 440 was the average number of days of labor disability; 51 (37%) workers were malingerers. 35 (26%) workers were work disabled and 50 (37%) without disability. Malingerers had higher level of schooling compared with WOD and WWD (p < 0.02); most worked at the Social Security (p < 0.05), with lower number of previous jobs (p < 0.05), presented longer work disability (p < 0.05). Depressive symptoms were not frequently noted (p < 0.025) and all had normal electroencephalogram and brain computed tomography studies. CONCLUSIONS: Malingering workers who request work disability pensions follow a particular pattern that differs from other workers that request disability assessment at the Social Security Institute of Mexico.

Adult↗

PubMed2006

Using participatory rural appraisal (PRA) in the identification of children with disabilities in rural Kilifi, Kenya.

INTRODUCTION: Cross-sectional surveys have been used widely for identifying children with disabilities, but they have several disadvantages. The surveys concentrate on identifying impairments and do not encourage the participation and ownership of the community. Participatory rural appraisal (PRA) provides a cost-effective and efficient method that reflects the local perceptions of disability and involves local people. These factors are important for sustainability in resource-poor countries. PURPOSE: To evaluate the application of PRA to identifying children with disabilities in a rural setting. METHODS: PRA was used to identify children with disabilities in two rural sub-locations in Kilifi, Kenya. Data were collected through 12 focus group discussions and 12 social mapping activities. A purposive convenience sample of teachers, village leaders and women groups participated in the PRA. The perceptions of disability were established before identification of the children. The categories of identification were based on these local perceptions. The qualitative data were analyzed thematically and validation was performed through triangulation. RESULTS: Disability was perceived locally as the existence of impairments, activity limitations and participation restrictions. Disabilities were associated with traditional beliefs including witchcraft, evil spirits and punishments from God. In some cases these categories were mutually exclusive and in others they were concurrent. Children who had lost their parents and were not being cared for by relatives (disadvantaged orphans) were also perceived as disabled children by teachers and local women, but not by community leaders. CONCLUSION: The results suggest that PRA is an efficient and cost-effective method of identifying children with disabilities according to local perceptions, and it may be useful in community-based rehabilitation as an alternative to surveys.

Adolescent↗

PubMed2006

Health problems and disability of elderly individuals in two population groups from same geographical location.

OBJECTIVE: To compare morbidity, disability (ADL-IADL disability) along with behavioral and biological correlates of diseases and disability of two elderly population groups (tea garden workers and urban dwellers) living in same geographical location. METHODS: Two hundred and ninety three and 230 elderly from urban setting and tea garden respectively aged > 60 years were included in the study. Subjects were physical examined and activity of daily living instrumental activity of daily living (ADL-IADL) was assessed. Diagnosis of diseases was made on the basis of clinical evaluation, diagnosis and/or treatment of diseases done earlier elsewhere, available investigation reports, and electrocardiography. Hypertension was defined according to JNC-VI classification. BMI (weight/height2) was calculated. Logistic regression analysis was performed to see the impact of important background characteristics on non-communicable diseases (NCD) and disability. RESULTS: Hypertension (urban--68% and tea garden--81.4%), musculoskeletal diseases (urban--62.5% and tea garden--67.5%), COPD and other respiratory problems (urban--30.4% and tea garden--32.2%), cataract (urban 40.3% and tea garden--33%), gastro-intestinal problems (urban--13% and tea garden--6.5%) were more commonly observed health problems among community dwellings elderly across both the groups. However in contrast to urban group, serious NCDs like Ischaemic Heart Disease (IHD), diabetes were yet to emerge as health problems among tea garden dwellers. Infectious morbidities, undernutrition and disability (ADL-IADL disability) were more pronounced among tea garden dwellers. Utilization of health service by tea garden elderly was very low in comparison to the urban elderly. Both tea garden men and women had very high rates of risk factors like use of non-smoked tobacco and consumption of alcohol. On the other hand, smoking and obesity was more common in urban group. Most morbidities and disabilities were associated with identifiable risk factors, such as obesity, tobacco (smoked and non-smoked) and alcohol consumption. Educational status was also found to be an important determinant of diseases and disability of elderly population. Age showed a J-shaped relationship with disability and morbidity. Sex difference in health status was also detected. CONCLUSION: This study highlights the physical dimension of health problems of elderly individuals. Social circumstances and health risk behaviours play important role in the variation of health and functional status between the two groups. Life-style modification is warranted to prevent onset of chronic diseases. To improve quality of life, rectification of poor health status through affordable health service for disease screening and better management of illness, nutritional improvement and greater health awareness are necessary particularly among low socio-economic group. Low-cost intervention like cataract surgery could make a difference in the quality of life of elderly Indian.

Activities of Daily Living↗