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PubMed2005

Socio-economic differences in the prevalence of acute, chronic and disabling chronic pain among ageing employees.

Pain is a strong predictor of reduced work ability and well-being, but there is little information on the prevalence of and socio-economic differences in acute, chronic and disabling chronic pain among employees. A questionnaire survey conducted in 2000-2002 among employees aged 40, 45, 50, 55 and 60 of the City of Helsinki (N=8970, response rate 67%) included socio-demographic and socio-economic factors and measures of current pain, pain duration and pain-related disability. Pain was acute when lasting a maximum of 3 months and chronic when persisting for more than 3 months. Disabling chronic pain was determined using the disability subscale of Von Korff's Chronic Pain Grade questionnaire. Acute pain was reported by 15% of women, chronic pain by 29% and disabling chronic pain by 7%. The corresponding figures for men were 12, 24 and 5%. Chronic and disabling chronic pain were more common in older age groups among both genders. Among women, those with secondary or basic education were more likely to report chronic or disabling chronic pain than those with higher education, and semi-professionals, routine non-manual employees and manual workers were more likely to report disabling chronic pain than managers. Among men, separated/divorced or widowed men were more likely to report acute pain than married men, and manual workers were more likely to report chronic pain than managers. Chronic pain was relatively common in this population, and those with older age, lower education and occupational class appear to be at excess risk for chronic pain, especially for disabling chronic pain.

Acute Disease↗

PubMed2002

Exercise to prevent and treat functional disability.

There are myriad ways in which optimal levels of physical activity over the course of the life span could potentially contribute to the prevention of functional disability in old age. These include direct effects of exercise to maximize physiologic capacity and prevent or delay the onset of disability-related conditions and more indirect effects, such as the modulation of psychosocial factors important in the expression of disability. Epidemiologic studies strongly suggest that functional disability is inversely related to physical activity level or physical fitness in various domains. Experimental studies confirm the benefits of exercise on correlates of disability, such as impairments of muscle strength or performance-based tests of functional limitations. However, the evidence that exercise can actually prevent disability in the long-term is not yet established by data from randomized clinical trials in the general population. Secondary prevention of disability in frail elders has been shown in a few trials. The available evidence, however, suggests that a rational exercise prescription for the prevention and treatment of disability at this time should include promotion of a physically active lifestyle and specific exercises targeting aerobic capacity, strength, and balance. Differential emphasis on specific elements of this prescription may be necessary and appropriate, depending on the etiology of the disability in specific cohorts, severity of physical impairments and functional limitations, and other individual characteristics relevant to exercise feasibility, safety, and efficacy.

Aged↗

PubMed1996

Toward a new psychometric definition of social disability in children with attention-deficit hyperactivity disorder.

OBJECTIVE: To investigate a new mechanism for identifying social disability in children with attention-deficit hyperactivity disorder (ADHD), employing psychometric methodology used in defining learning disabilities. METHOD: Two groups of index children were examined: 140 children with ADHD (referred from both psychiatric and pediatric sources) and 120 non-ADHD comparison children. Subjects were defined as socially disabled if they had a value greater than 1.65 on a standardized discrepancy score between observed and expected scores on a measure of social functioning (with expected scores derived as a function of the child's estimated Full Scale IQ). Children identified as socially disabled were compared with non-socially disabled probands on psychopathology, familiality, cognitive functioning, school history, and treatment history. RESULTS: Using this psychometric approach, 22% of the ADHD probands qualified as socially disabled, whereas none of the comparison probands qualified (p < or = .001). Socially disabled ADHD probands were significantly more impaired than were non-socially disabled ADHD probands in global and specific measures of social functioning and patterns of psychiatric comorbidity. CONCLUSIONS: The psychometrically defined construct of social disability may identify children with ADHD who are at very high risk for severe social dysfunction and whose course and prognosis may vary from those of other children with ADHD. This subgroup of children with ADHD may be at heightened risk for poor outcome, and their identification may facilitate the development of clinical interventions aimed at ameliorating their specific difficulties.

Adolescent↗

PubMed1997

Length of disability and cost of workers' compensation low back pain claims.

Although information exists on the cost of workers' compensation low back pain (LBP), there is limited information on the duration of lost work time as well as the association between cost and duration. For this study, cost and duration of lost work time information were derived from a large workers' compensation company's database for 1992 LBP claims (n = 106,961). The distribution of cost was skewed, with an average cost of a claim being 20 times higher than its median. A disproportionately small percentage of the costliest LBP claims (10%) were responsible for a large percentage of the total cost (86%). The distribution of length of disability (LOD) was also skewed, with an average of 102 days and a median of zero. The average and median LOD for those claims with at least one day of compensable disability was 303 and 39 days, respectively. As a "rule of thumb," it was found that of those claimants who remain on disability at the end of n weeks, approximately 50% will be off disability at the end of 6.n weeks. Additionally, the 7% of the claims with an LOD greater than one year accounted for 75.1% of the cost and 84.2% of the total disability days. Disability days that were accrued after one year of disability accounted for 59.3% of the total number of disability days. This result suggests that other LOD estimation techniques, which may not account for disability days beyond one calendar year (e.g., the Bureau of Labor Statistics Annual Survey of Occupational Injuries and Illnesses), may result in a marked underestimation of LOD.

Absenteeism↗

PubMed2006

Work disability and costs caused by recurrence of low back pain: longer and more costly than in first episodes.

STUDY DESIGN: Retrospective analysis of workers' compensation (WC) claims data for nonspecific low back injuries (LBI) in a single jurisdiction. OBJECTIVE: To examine whether recurrences, defined as post-initial episodes of work disability or medical care, substantially contribute to total medical and indemnity costs, and total duration of work disability. SUMMARY OF BACKGROUND DATA: Previous studies have not measured the proportion of care seeking and work disability that are associated with recurrences in claims for work-related LBI. METHODS: All persons with new lost-time claims for nonspecific LBI reported in New Hampshire to a large WC provider from 1996 to 1999 were selected (N = 1867). Three years of follow-up data, starting at the beginning of the first episode, were collected. Previously validated definitions of recurrence were used identify new episodes of care and new episodes of lost work time (work disability). Total duration of work disability, total medical costs, and total indemnity costs were investigated. For individuals with recurrences, these variables were separated into first-episode and recurrent period duration and costs. RESULTS: The rate of recurrent work disability was 17.2%, and the rate of recurrent care seeking was 33.9%. Individuals with recurrence had significantly higher total length of work disability, and higher medical and indemnity costs. For those with recurrent work disability, 69% of total lost time from work, 71% of associated indemnity costs, and 84% of total medical costs occurred during the recurrent period. For those with recurrence of care, the respective values were 48%, 47%, and 42%. CONCLUSIONS: Recurrences contributed disproportionately to the total burden of work-related nonspecific LBI, through both additional care seeking and work disability. Results imply that those who have recurrences may be an especially important target for secondary prevention efforts.

Adult↗

PubMed1997

Occupational factors related to shoulder pain and disability.

OBJECTIVES: To determine, in a population based study, the influence of occupational factors on the occurrence of shoulder pain and disability. METHODS: A random sample of patients was selected from the register of a general practice in the Greater Manchester area of the United Kingdom. Information was collected by a posted questionnaire with specific enquiries about symptoms in the shoulder region and related disability. A lifetime occupational history was obtained including physical exposures, working conditions, and psychosocial aspects of each workplace. Analysis has been conducted as a case-control study, comparing occupational exposures at the time of onset of symptoms in those with shoulder pain and disability with corresponding occupational exposures in those without shoulder pain and disability. RESULTS: An increased risk of shoulder pain and disability in men was associated with carrying weights on one shoulder (relative risk (RR) 5.5, 95% confidence interval (95% CI) 1.8 to 17), whereas those who reported working with hands above shoulder level, using wrists or arms in a repetitive way, or stretching down to reach below knee level had about twice the risk of shoulder pain and disability. Men working frequently in very cold or damp conditions had a fourfold and sixfold risk respectively of shoulder pain and disability. Reporting of shoulder pain and disability was also more common among men and women who reported that their work caused a lot of stress (RR 1.9, 95% CI 0.9 to 4.1) or was very monotonous (RR 2.7, 95% CI 1.3 to 5.4). The relations between physical exposures, working conditions, and psychosocial factors were independent. CONCLUSIONS: This population based study has shown that physical activities carried out at work, the physical conditions under which the work is conducted, psychosocial aspects of work, or the working environment are all independently related to the occurrence of shoulder symptoms and disability, emphasising the multifactorial nature of this condition.

Activities of Daily Living↗

PubMed2001

Neuropathology in vegetative and severely disabled patients after head injury.

OBJECTIVE: To discover if the neuropathology differs in head-injured patients who were in a vegetative state (VS) or were severely disabled at time of death. METHODS: Review of 35 VS cases and 30 severely disabled cases treated in this institute in the acute stage, surviving at least a month; all brains were fixed for 3 weeks before full neuropathologic examination. RESULTS: The severely disabled cases were older, had a higher incidence of skull fracture and of evacuated intracranial hematoma, and they had more cortical contusions. Diffuse axonal injury (DAI) was less common in the severely disabled cases, particularly its most severe grade. Structural damage in the thalamus was much less common in severely disabled cases. Half of the severely disabled patients had neither grade 2 or 3 DAI nor thalamic damage and 10 of these 15 cases did not have ischemic brain damage either. These combinations did not occur in a single VS case. However, some severely disabled cases had similar lesions to VS cases, and this included some patients who were in a minimally conscious state as well as some who were out of bed and mobile. CONCLUSIONS: Half the severely disabled cases had only focal brain damage, a feature not found in any VS cases. In the severely disabled patients with lesions similar to those of VS cases it is likely that a greater quantitative amount of damage occurred in the VS cases.

Adolescent↗

PubMed2001

Self-efficacy and goal importance in the prediction of physical disability in people following hospitalization: a prospective study.

OBJECTIVES: This prospective study evaluates the role of self-efficacy and goal importance in predicting decreases in disability in activities of everyday living. METHOD: Disability, self-efficacy and goal importance were each assessed before and at 3 and 9 months after participants underwent joint replacement surgery. RESULTS: Disability had decreased at 3 and 9 months post-surgery assessments. Self-efficacy beliefs were higher at 3 and 9 months following surgery while goal importance was increased at 9 months but not at 3 months. Medical variables and prior disability predicted disability at 3 months. Social-cognitive variables did not contribute to the prediction of 3 months disability. Pre-surgery goal importance and self-efficacy at 3 months were independent predictors of disability at 9 months after controlling for pre-surgery and 3 months disability. Evidence also suggested that goal importance and self-efficacy interacted to predict levels of disability at 9 months following surgery. CONCLUSIONS: The findings demonstrate that recovery is governed not solely by medical phenomena but also by psychological variables and suggest that modification of these variables may have an impact on recovery outcomes. Moreover, attention should be paid to the timing of such intervention and to the length of follow-up.

Journal Article↗

PubMed1990

The contribution of central auditory factors to auditory disability.

Auditory disability increases with both hearing threshold level and age. It is often suggested that some or most of the age effect in auditory disability is underpinned by deficits in central auditory function. A sample of 240 individuals aged between 50 and 75 years was examined to provide a balance across the major variables of hearing level and age. The central auditory indices investigated were: the binaural masking difference, the effects of dichotic competition on the staggered spondaic word tests, the binaural advantage for dichotically presented words, the binaural advantage for dichotically presented sentences, the effect of increasing the rate of presentation of speech, and the effect of nonsense as opposed to sensible sentences. In addition, the non-auditory variables of verbal and non-verbal IQ and the peripheral auditory factors of frequency and temporal resolution were assessed. Auditory disability was assessed using a performance index derived from a sentence identification-in-noise procedure and a procedure containing sense or nonsense sentences. Aspects of self-reported disability were determined using the MRC Institute of Hearing Research's Hearing Disability Questionnaire and the American Hearing Performance Inventory. There were significant correlations between the derived central variables and measured disability after control for hearing threshold levels and age. Central variables were correlated with self-reported disability for only the specific sub-score reflecting disability in localisation. On a multiple regression, the central variables explained 11.1% of the variance in performance index of disability above the 21.1% explained by hearing threshold levels and age.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2006

The functional IME: A linkage of expertise across the disability continuum.

Disability assessment remains a significant challenge especially in welfare systems like workers' compensation and disability insurance. Many of today's managed care strategies do not impact on the seminal issue of return to gainful employment. Employers, insurers, attorneys and case managers routinely request independent medical examinations (IMEs) as a means of determining degree of disability, functional limitations, work restrictions and "estimated" physical capacities. However, this approach is limited because physicians are not trained in the functional model of disability assessment. IMEs address pathology and impairments which represent a portion of the disability continuum described by the World Health Organization, Nagi, Guccione and others [e.g. pathology-impairment-disability-handicap]. Functional capacity evaluations or FCEs are often performed by physical and occupational therapists who are trained in a function-based model of disability assessment. Unlike an IME physician who completes "Estimated Physical Capacities", therapists measure actual physical functioning. The value of both IMEs and FCEs can be enhanced through a "functional IME" that combines both models; medical-based examination and a function-based disability evaluation. This combination enhances the assessment of the relationship of pathology to impairment and impairment to disability status especially, in musculoskeletal disorders which tend to drive costs in workers' compensation.

Humans↗

PubMedDate not supplied

Disability and work: fitness for work judgement.

BACKGROUND: The role of physicians, in particular those dealing with health promotion in the workplace, takes on a specific meaning in relation to the difficulties that disabled people encounter both in order to reach the workplace and to reconcile their working activity with the difficulties that result from their condition. Observing the data concerning employment of disabled persons in Italy, it becomes dramatically evident that among the disabled subjects of working age only 17% are employed. OBJECTIVE: The objective of the occupational health physician is to recognise the impairment, study the disability and, possibly, eliminate or reduce the handicap. Achieving this target is difficult, and there is often a lack in understanding the discomforts experienced by disabled people in their working activity. Expression of a judgement of work fitness for a specific task is a particularly delicate matter, all the more so if the worker is a disabled person. A judgement of work fitness of a disabled person should include evaluation of the person's ability and an analysis of the working task and the workplace. CONCLUSIONS: Based on our experience, one can safely say that working inclusion and integration in work is possible, without any decrease in productivity, if an appropriate position is found for disabled workers. The occupational health physician has a primary role in the entire process of inclusion of disabled people at work, since he/she knows the company, the tasks, and the associated risks, and furthermore is able to assess the capabilities and abilities of the worker and can thus identify the most suitable and safe working situation.

Humans↗

PubMed1987

A developmental approach to reading disability: accuracy and speed criteria of normal and deficient reading skill.

The constructs of accuracy and speed were adopted as performance criteria against which to define 2 clinical samples of disabled readers. Accuracy-disabled subjects had failed to achieve reliable age-appropriate word recognition skills. Rate-disabled readers were age-appropriate in word recognition accuracy but deficient in reading speed. These disabled readers were compared to fluent normal children selected to be reading at the same level of accuracy as the rate-disabled subjects but at a significantly faster rate. All aspects of the accuracy-disabled subjects' reading systems proved deficient, and these children were less able to learn new sound-symbol associations in a task simulating initial reading acquisition. The rate-disabled subjects exhibited a basic deficit in word recognition speed, compromised accuracy when reading in context, and compromised spelling when competing visual patterns were available. A multidimensional oral language impairment was found to accompany the accuracy disability, while the rate disability appeared restricted to language in its visible form and the naming of visual representations. A visual naming speed impairment was associated with both profiles of deficient reading skill.

Adolescent↗

PubMed1983

Culture and disability behavior.

A substantial amount of literature suggests that illness behavior in the United States is a product of a patient's core culture; equally credible findings do not support this contention. Most students and graduates in the health care professions believe that illness and disability behavior are affected by a patient's culture, but they are hard put to find convincing examples of that relationship. In experience with medical students studying the social and cultural bases of illness behavior, with patients who are disabled and with persons who claim disability in the absence of physical disease or disabling psychopathology, I observed no deviant disability behavior that was typical for the members of any cultural group, and no behavior was displayed by the members of one cultural group that was not seen in members of other cultural groups. No cultural stereotypes were upheld. I did find evidence that disability behavior is influenced by personality factors, social situations and the gains derived from the disability status. Evolving concepts of "entitlement," which are closely related to socioeconomic status, also have a significant influence. The impact of feedback from others in a person's many social and medical subcultures is a more crucial determinant of illness and disability behavior, except in those for whom illness and disability behavior is determined by the limitations imposed by the disease or by a personality structure resistant to cultural expectations and social feedback.

Culture↗

PubMed1995

[Locomotor disability in the elderly; the ERGO Study (Erasmus Rotterdam Health and the Elderly). ERGO Study Group].

OBJECTIVE: Determination of the prevalence of locomotor disability and its association with signs and symptoms of the hips and knees in a Dutch general population aged 55 years and over. DESIGN: Cross-sectional population-based study. SETTING: Rotterdam-Ommoord, the Netherlands. METHOD: During home interviews of 1,901 men and 3,132 women aged 55 years and over living in the Ommoord district of Rotterdam, locomotor disability was assessed using the Health Assessment Questionnaire (HAQ). Morning stiffness and pain in the hips and knees during the past month were assessed. At the research centre weightbearing radiographs of the hips and knees were taken. Radiological osteoarthritis was defined as Kellgren score 2 or more. A complete physical examination of the hips and knees was performed. RESULTS: The prevalence of locomotor disability was 21.9% for independently living men and 36.0% for independently living women. In homes for the elderly these figures were 84.0% en 96.5%, respectively. There were significantly elevated age-adjusted odds ratios for locomotor disability for women, people in homes for the elderly, independently living men with only primary education, independently living participants with a below-median net annual income and widowed men in homes for the elderly. Taking the associations between the independent variables into account only morning stiffness, pain in the hips and knees and restricted flexion of the hips and knees were independently associated with locomotor disability in men. In women radiological osteoarthritis of the hips and knees, restricted endorotation of the hip, instability and valgus deformity of the knees were also associated with disability. CONCLUSION: The prevalence of locomotor disability in people aged 55 years and over in the general population was high and associated with female sex, low education, low income and living in a home for the elderly. Of the signs and symptoms of the hips and knees only pain in the hips and knees, morning stiffness and restricted flexion of the hip were independently associated with locomotor disability. Radiological osteoarthritis of the hip and knee did not contribute much to the explanation of locomotor disability.

Activities of Daily Living↗

PubMed1993

[Congenital hearing disability among children in Copenhagen].

The survey describes the detection, identification and aetiology of congenital/early acquired (i.e. neonatal period) hearing disability in a well-defined cohort of children, living in the Copenhagen area (Copenhagen City and County). The effect of intervention programmes is also mentioned. The children's age at identification can be considered as an evaluation of the quality of hearing screening aimed towards the detection of children with congenital/early acquired hearing disability, while the results of the aetiological evaluation reflects the quality of the diagnostic evaluations performed within paediatric audiology. The prevalence rate of 1.5/1000 of congenital/early acquired hearing disability for children born during 1980-1990 is unchanged in comparison to the period 1970-1980. An improvement in the detection of children with congenital/early acquired hearing disability is found, the identification is, however, still delayed in both children at risk and not-at-risk of hearing disability. The parents are most frequently the first to raise suspicion of their child's hearing disability, but very seldom apply to the audiological department without a referral from the primary health care sector. A change in the aetiology of congenital/early acquired hearing disability has taken place within 1980-1990, which can be ascribed to the reduced frequency of foetal rubella infection, while the frequency of inherited hearing disability has increased. The outcome of intervention programmes, evaluated by means of type of school, education, and employment situation is briefly described in relation to the social consequences of a hearing disability.

Child, Preschool↗

PubMed2000

Predictors of chronic disability in injured workers: a systematic literature synthesis.

BACKGROUND: Loss of productive life among injured workers potentially could be prevented by clearer knowledge of disability risk factors. Despite the number of studies that have examined predictors of disability, there have been no systematic literature reviews integrating multiple risk factor domains. Such a synthesis could help to define important gaps in knowledge, inform future study designs most likely to successfully address these gaps, and highlight the importance of secondary (disability) prevention to public health policy. A systematic synthesis of the literature on risk factors for chronic or recurrent disability in injured workers was performed to meet this need. METHODS: Articles were identified through a MEDLINE search, personal file searches, and requests to experts. Information concerning study methods and results was abstracted from 20 articles that met the inclusion criteria (population-based or prospective cohort studies). RESULTS: The most frequently identified predictors of prolonged disability were older age and greater baseline pain and functional disability. Lumbar symptoms, smaller company size, and construction work were significant predictors in several, but not all, studies. Risk factors did not appear to differ for back versus mixed injuries. CONCLUSIONS: Several risk factors for prolonged disability were identified. Research is needed to develop and test multivariate models of worker, workplace, health care, and administrative risk factors for prolonged and recurrent disability in order to refine and target interventions.

Accidents, Occupational↗

PubMed2003

Development of an instrument to measure disability in parenting activity among women with rheumatoid arthritis.

OBJECTIVE: To develop a method of assessing and summarizing parenting function and disability, and to use that method to describe parenting disability among a group of women with rheumatoid arthritis (RA). METHODS: The study group comprised 231 women with RA who are members of the University of California, San Francisco RA Panel Study. Parenting disability scales were developed by first asking open-ended questions and then, based on the responses, constructing closed-ended questions. Separate sets of questions were asked concerning young (ages 0-5 years) and older (ages 6-18 years) children. Parenting disability indices (PDIs), scored in a manner similar to that for the Health Assessment Questionnaire (HAQ) (range 0-3), were developed (total, and for young and older children). Associations of PDIs with demographic, health, and symptom measures were assessed. RESULTS: Substantial proportions of women with RA experienced disability in parenting activities. Greater disability was reported for activities related to parenting young children. Doing less of parenting functions because of RA was commonly reported. The mean total PDI of women who currently had children under age 18 years, taking into account "doing less" of activities because of RA, was 0.76 (range 0-2.08). Greater parenting disability was associated with poorer general function (HAQ; P < 0.0001), more severe pain (P = 0.002), greater fatigue (P = 0.0005), greater parenting stress (P = 0.005), and greater psychological distress (depressive symptoms; P < 0.0001). DISCUSSION: The PDI appears to be valid. This method can provide the means of assessing parenting disability, its risk factors, and its effects, which may assist in identifying ways of helping individuals with RA cope more effectively with parenting.

Adolescent↗

PubMed1995

A longitudinal study of functional disability in a national cohort of patients with polymyositis/dermatomyositis.

OBJECTIVE: To analyze changes in functional status and the factors contributing to disability in a national inception cohort of 257 patients with polymyositis/dermatomyositis (PM/DM). METHODS: Data were gathered from patients' self-reports on questionnaires: one concerning disease- and treatment-related complications, and the other concerning disability, as reflected by a disability index (DI) derived from the Health Assessment Questionnaire (HAQ). RESULTS: Based on certain characteristics that differentiated disability patterns, 3 groups of patients were identified. Group 1 patients (n = 153) were < or = 60 years old and never had avascular necrosis (AVN) or a vertebral compression fracture (CF), Group 2 patients were > 60 and never had AVN or a vertebral CF, and Group 3 patients reported AVN or a vertebral CF irrespective of age. As measured by the HAQ DI, disability increased very gradually over time in Group 1 patients and more rapidly in Group 2 and Group 3 patients. The increase in disability in patients experiencing AVN was greater than that in patients with similar pre-AVN disease characteristics who did not develop AVN (P = 0.003). CONCLUSION: In this prospective study of disease course and iatrogenic factors related to functional disability in PM/DM, the HAQ DI increased with disease duration. Corticosteroid-related morbidity, as reflected by the development of AVN or CF, significantly contributed to patient-reported functional disability.

Adult↗