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PubMed2001

Explaining the role of sex on disability: a population-based study.

PURPOSE: There is no clear consensus about how sex influences prevalent disability and through what mechanisms. We investigated whether sex had a direct independent effect on disability or whether sex had an interactive effect on the relationship between chronic diseases/conditions and disability, and whether these effects differed in middle-aged versus older adults. DESIGN AND METHODS: We used baseline data from two nationally representative health interview surveys, the Health and Retirement Study (HRS) and the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD), and disability and covariate measures that were nearly identical in both surveys. Logistic regression models tested the contributions of diseases, impairments, and demographic and social characteristics on difficulties with prevalent activities of daily living (ADLs), mobility, and strength. RESULTS: Models demonstrated no direct sex effect for ADL disability in either age group after adjusting for key covariates. However, sex did exert an indirect effect on ADL disability in older adults via musculoskeletal conditions and depressive symptoms. In contrast, female sex remained strongly associated with mobility and strength disability in both age groups, net of covariates. Major interactions were also significant, including a female sex/body mass index (BMI) interaction for mobility difficulty and several sex-disease interactions for strength disability in the middle-aged group. IMPLICATIONS: The effect of sex on ADL difficulty is largely explained by social and health-related covariates in middle-aged and older adults. In contrast, the independent association of female sex with decreased strength and mobility in both groups cannot be explained by our models' social or health-related variables. In addition, the positive association of BMI with mobility difficulty is significantly worse for women than for men.

Activities of Daily Living↗

PubMed1995

Predicting subsequent employment status of SSA disability applicants with chronic pain.

OBJECTIVE: The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts. DESIGN: National randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision. SETTING: Six clinical sites were ambulatory referral centers, both public and private. PARTICIPANTS: Population-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused. INTERVENTIONS: No interventions were continued or initiated by the research team between assessment and follow-up. MAIN OUTCOME MEASURES: Claimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation. RESULTS: The MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical examination results, psychological status, functional limitations, and physician's subjective appraisal predict future employment. CONCLUSIONS: The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.

Chronic Disease↗

PubMed1992

Identification of childhood disability in Jamaica: the ten question screen.

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiologic Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8% of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria based on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varied in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all group except boys over 5 years with cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74%. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurements of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collecting disability data or for identifying people in need of rehabilitation help, if a way of reducing false positives could be found.

Child↗

PubMed1998

Health care and indemnity costs across the natural history of disability in occupational low back pain.

STUDY DESIGN: The administrative database maintained by the National Council on Compensation Insurance (United States) was used to compare health care use and indemnity costs within the natural history of work-related low back pain disability. OBJECTIVES: To determine the relative costs of health care services and indemnity at different phases of work disability. SUMMARY OF BACKGROUND DATA: Existing studies have compared total costs along the work disability continuum. This study replicates and extends these earlier studies by providing detailed evaluations of costs by service categories along this continuum. METHODS: Total health care and indemnity costs accrued along the disability curve were examined. Based on the number of days workers were absent from work and receiving indemnity payments (disability days), detailed mean health care costs by type of medial service were computed and compared across four time intervals for the sample. RESULTS: Health care costs were disproportionately distributed along the disability curve, with 20% of claimants disabled 4 months or more, accounting for 60% of health care costs. The most costly service category was diagnostic procedures (25% of total medical costs), with surgical costs (21%) and physical therapy (20%) representing the next two most costly categories. Mental health and chiropractic care represented a small percentage of overall costs (0.4% and 2.9%, respectively). CONCLUSIONS: These data provide policy-makers, program development, and health care industry groups with cost information from which to establish benchmarks for future decisions that facilitate the allocation of resources for more cost-effective management and prevention of work disability.

Absenteeism↗

PubMed2001

Effect of age on outcomes of tertiary rehabilitation for chronic disabling spinal disorders.

STUDY DESIGN: A prospective cohort study evaluating age as a factor in treatment outcomes for chronic disabling work-related spinal disorders undergoing tertiary rehabilitation. OBJECTIVE: To assess the association between age and objective psychosocioeconomic treatment outcomes for work-related spinal disorders undergoing functional restoration. SUMMARY OF BACKGROUND DATA: As early as the 1950s, a link between age and low back symptoms has been identified in the literature. Several studies have demonstrated that the occurrence of low back pain is positively correlated with age up to about 50-60 years, after which prevalence declines. It has been argued that this pattern is stronger for more severe, chronic back pain cases. Little research attention has been given to age as a factor in treatment outcomes for work-related spinal disorders. METHODS: A cohort of 1052 chronically disabled (none working full-time when starting the rehabilitation program) spinal disorder (CDSD) patients were placed into five groups based on age: Group 1, <25 years (22 +/- 2 years, n = 59); Group 2, 25-34 years (30 +/- 3 years, n = 301); Group 3, 35-44 years (39 +/- 3 years, n = 381); Group 4, 45-54 (49 +/- 3 years, n = 237); and Group 5, > or =55 years (59 +/- 4 years, n = 74). All patients completed a functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach using psychological and case management techniques. Before the start of the program, and again on completion of the program, all patients received a psychosocial evaluation and were also assessed on a variety of physical motion, strength, aerobic, and functional factors, and a cumulative score was calculated, which aggregates and averages these physical measures. A structured clinical interview examining socioeconomic outcomes (work return, health utilization, recurrent injury, and resolution of financial disputes) was conducted at 1 year after program completion, and at least partial information was obtained from this interview on all consecutive patients in the study. RESULTS: The length of pretreatment disability increased with age (P < 0.001), as well as pretreatment surgery rates (P < 0.002). A Mantel-Haenzel chi2 test for linear trend across age groups revealed that the percentage of patients who returned to work declined progressively from 100% in Group 1 to 69% in Group 5 (P < 0.001). The same linear trend was revealed for the percentage of patients retaining work at the end of 1 year (98-62%, P < 0.001). Older workers returned to the same job and/or the same employer (P < 0.005). Younger workers found different jobs with new employers (48-11%, P < 0.0001). Analysis of variance for the disability questionnaire revealed that after treatment subjective disability progressively increased (while improvements decreased) from Group 1 to Group 5 (P < 0.01). The cumulative physical score variable, even normalized for age, was progressively lower from Group 1 to Group 5, both at pretreatment (P < 0.03) and post-treatment (P < 0.02). CONCLUSIONS: The present study represents the first large-scale examination of the association between age and treatment outcomes for a work-related CDSD population. Age is significantly and linearly related to pretreatment duration of disability and frequency of pretreatment surgeries. After rehabilitation treatment there is a linear decrement in both work return and work retention, so that younger patients are far more likely to return and hold work after functional restoration. Older workers who go back to work are much more likely to return to the same employer and do the same job, or to become self-employed. Calculation of odds ratios revealed that patients >55 years are 5.68 times more likely to return to the same job and employer, relative to those <25 years; those >55 years were also approximately three times more likely than those <25 years to return to the same employer, compared with those <25 years. Younger workers are far more likely to take a different job and/or seek a new employer. Older patients are also somewhat more likely to seek a new health provider to deal with perceived residual pain/disability. This trend coincides with their higher post-treatment subjective disability levels, and their lower cumulative physical scores both prerehabilitation and postrehabilitation. However, age does not affect additional surgery rates, subsequent injuries, or delays in settling financial disputes.

Absenteeism↗

PubMedDate not supplied

Issues in the definition and diagnosis of learning disabilities: a perspective on Guckenberger v. Boston University.

This article reviews issues related to the definition of learning disabilities in the context of the Guckenberger v. Boston University case. Four major questions are addressed: (a) Who is learning disabled? (b) How should learning disabilities be assessed? (c) Who is qualified to make a decision about whether or not an individual has a learning disability? and (d) What accommodations should be provided by a postsecondary institution and how should they be selected? Although these are complicated and difficult questions, it is possible to develop a simple, reasonable classification system for learning disabilities, and to conduct assessments based on a coherent and relevant set of achievement tests in which individuals who score below a cutoff are considered learning disabled. Scores on IQ tests are irrelevant and not useful and may even be discriminatory. The issues of decision making regarding learning disabilities and appropriate accommodations remain significant dilemmas for the field; resolution of these issues seems virtually impossible without agreement on appropriate procedures for the definition, identification, and assessment of learning disabilities.

Adult↗

PubMed2002

Body mass index and disability in adulthood: a 20-year panel study.

OBJECTIVES: This study examined whether body mass index (BMI) or change in BMI raises the risk of disability in adulthood. METHODS: The relation between BMI and upper- and lower-body disability was examined among adult subjects from a national longitudinal survey (n = 6833). Tobit regression models were used to examine the effect of BMI on disability 10 and 20 years later. RESULTS: Obesity (BMI > or = 30) at baseline or becoming obese during the study was associated with higher levels of upper- and, especially, lower-body disability. In persons who began the study with a BMI of 30 or more and became normal weight, disability was not reduced. Underweight persons (BMI < 18.5) also manifested higher disability in most instances. CONCLUSIONS: Disability risk was higher for obese persons, but overweight was not consistently associated with higher disability.

Activities of Daily Living↗

PubMed1995

People with physical disabilities admitted to a residential addiction treatment program.

This exploratory study used data on admissions to a 28-day residential addiction treatment program to explore differences between disabled and nondisabled cases with respect to patterns of substance use and other characteristics. Relationships between length and type of disability, substance use, and other characteristics were also explored. The focus was on cases aged 18 to 65 identified as having physical disabilities that limit participation in the work force. The results showed that 5.3% of the sample reported disabilities which prevented them from working, and a further 8.6% reported that physical disabilities limited their participation in the work force. The results also showed that self-identified problems with tranquilizers were more common among the disabled than the nondisabled and that more severely disabled people are more likely to report attempting suicide and to express the need for mental health counseling. Having prescriptions as a main source of drugs was also more common among females with major disabilities than among other groups. Priorities for further research are suggested.

Adult↗

PubMed1995

Description of the US working age disabled populations living in institutions and in the community.

This study provides national estimates of the size of the US working age disabled populations in institutions and in the community, and describes these populations along a number of dimensions. By using data from the Institutional Population and Household Survey Components of the 1987 National Medical Expenditure Survey, the study represents the first time that these populations have been studied using comparable data. The working age disabled population was identified as persons between the ages of 21 and 64 who experienced difficulty with at least one of the activities of daily living (ADLs). Using this definition, approximately 1% of the total US population was found to be working age disabled (n = 2.6 million). Of these, 11% (n = 282,000) resided in long-term care facilities. Significant differences were observed between the institutionalized population having mental retardation (MR) and those with physical disabilities only. Relative to the MR population, members of the physically disabled population had more severe limitations in ADLs, entered the facility at a later age, had much shorter stays, and were more likely to have a spouse and children who might provide support for community-based living. However, some physically disabled persons were admitted early in life for very long stays, similar to the situation for most persons with MR. Comparisons of the working age disabled populations in institutions and in the community showed that those in the community had fewer ADL limitations than their institutionalized counterparts and were much more likely to be married. Although a surprisingly large proportion of the community-based disabled population lived alone (23%), 70% lived with at least one relative.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed2000

Disability and handicap in rheumatoid arthritis and ankylosing spondylitis--results from the German rheumatological database. German Collaborative Arthritis Centers.

OBJECTIVE: To describe indicators of disability and handicap in the 2 major inflammatory rheumatic diseases rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and to estimate the burden of illness in terms of functional status, pain, and global well being, as well as with regard to unemployment and early retirement. METHODS: Data from the German rheumatological database on 52,444 patients with RA and 8,776 patients with AS seen at 21 collaborative arthritis centers in Germany between 1993 and 1997 were analyzed. To estimate the burden of the 2 diseases at different biographical phases, age and sex matched groups of patients were compared for functional disability, pain, global assessment of health status, education level, and employment status. RESULTS: For comparable ages, disability in female patients with AS or RA was rated similarly by the physicians (e.g., 61-70 years: 42% severe disability in RA and 44% in AS), whereas men with AS were rated more disabled than men with RA (61-70 years: 35% in RA and 48% in AS). Patients' self-ratings of disability were generally worse for women than for men (age 61-70: women 37% severe disability in RA and 35% in AS, men: 24% in RA and 19% in AS). Pain intensity was rated similarly by women and men with RA and AS at ages < 51 years (33% severe pain at ages 41-50 in men and 34% in women in both diseases). It increased with age in women (> 70 years: 41% severe pain in RA and 44% in AS) and remained stable in men (27% RA and 29% AS > 70 years). At 71.3% the employment rate in AS was clearly higher than in RA (49.5%). There was significant influence of the education level (men 51-60 years with AS: low education 56% employment rate, high education 79%) and the labor market (men 51-55 years with AS: 80% employment rate under good, 59% under bad overall labor market conditions). CONCLUSION: Age and sex matched groups of patients with RA and AS in tertiary rheumatological care show similar amounts of disability, pain, and reduction in well being. Therefore, the offer of comprehensive care and pain management to both groups should be comparable.

Activities of Daily Living↗

PubMed2000

Are insurance companies liable under the Americans with Disabilities Act?

Federal courts have split on the question of the applicability of the Americans with Disabilities Act to insurance coverage decisions that insurance companies make on the basis of disability; they have similarly split on other issues pertaining to the scope of that Act's application. In deciding whether to read the Act as prohibiting discrimination in insurance decisions that are often crucial in the lives of people with disabilities, courts have faced two problems. First, where it prohibits discrimination in the equal enjoyment of the goods and services of places of public accommodation, the Act's area of concern may be limited to the ability of people with disabilities to gain physical access to facilities; or that area may extend to all forms of disability-based discrimination in the provision of goods and services. This Comment argues that the language and legislative history of the Act are consistent only with the latter view. Second, the provision limiting the Act's applicability to insurance may create an exemption for all insurance decisions; or it may protect only the ability of an insurance company to make an insurance decision to the disadvantage of an insured with a disability where actuarial data support the decision. This comment argues that the ambiguous language of the limiting provision should be resolved in favor of the latter view. Legislative history and the broader background of the history of insurance discrimination law support this resolution. Consequently, the Act should be interpreted as prohibiting disability-based discrimination by insurance companies in selling insurance policies and as defining discrimination as making disability-based insurance decisions without the support of actuarial data. By accepting this interpretation, courts can help stop the pattern of judicial narrowing of the Act's application through inappropriately restrictive statutory construction.

Activities of Daily Living↗

PubMed2003

[Evaluation on the disability weight of Alzheimer's disease and Parkinson's disease in Beijing].

OBJECTIVE: To formulate the classification criteria of disability weight for Alzheimer's disease (AD) and Parkinson's disease (PD) in China and to evaluate the disability weight of AD and PD in population over 60 years old in Beijing. METHODS: Based on the criteria of Global Burden of Disease (GBD), a seven-grade disability classification was used to develop a new disability classification criteria for AD and PD in terms of Delphi method in China. Using the data from epidemiological survey for AD and PD in Beijing in 1997 and new criteria, mean disability weights of AD and PD in population over 60 years old in Beijing were obtained. RESULTS: The mean disability weights of Alzheimer's disease was 0.40 in population over 60 years old who received treatment in Beijing and 0.52 in those without treatment while the mean disability weights of Parkinson's disease were 0.30 in the patient receiving treatment and 0.23 in those without treatment. CONCLUSION: Difference between the result of this study and the data of GBD study in the mean disability weight for AD and PD was noticed.

Activities of Daily Living↗

PubMed1992

Object play and exploration in children with and without disabilities: a longitudinal study.

The development of object play was examined in 40 children (20 with and 20 without disabilities). The children with disabilities were assessed at ages 11, 15, 19, and 27 months; the children without disabilities, at 6, 11, 15, and 27 months. At each assessment, the children were videotaped during 20 minutes of play with their mothers in a controlled environment. Child's play level was positively related to developmental age for the disabled group at each assessment and for the nondisabled group at 6, 11, and 15 months of age. The types of object play observed in children with no disabilities were observed in the children with disabilities at comparable developmental ages. In a subsample matched for developmental age, the duration and frequency of active involvement with objects were greater for the children without disabilities than for the children with disabilities.

Child Development↗

PubMed1992

Expanding the definition of disability: implications for planning, policy, and research.

Disability remains an area that is difficult to define and measure. Rheumatoid arthritis (RA), with its greater impact on women than on men, is one example of this. People with RA are limited in many areas besides paid work, so to measure this disability only in terms of paid work greatly underestimates its impact on people's lives, particularly those of women. This article reviews the major definitions of disability and reports the results of a national study assessing disability in both family and paid work roles. Both areas reveal high rates of disability among RA patients. The study concludes that measuring disability only in terms of paid work seriously underestimates its prevalence among women. These results have important implications for health policy because the greatest needs of the disabled may be, not in income replacement programs, such as Social Security disability programs, but rather in fortifying family and other care services that would enable people with RA to maintain higher levels of function in all domains of life.

Arthritis, Rheumatoid↗

PubMed2005

The efficacy and benefits of environmental control systems for the severely disabled.

BACKGROUND: People living with a severe disability suffer substantial personal and social consequences that reduce quality of life (QOL). One potential negative impact on the QOL of a disabled person is the loss of the ability to control devices in their immediate environment (such as the television, computer, telephones, lights, doors, etc.). Consequently, research and development has been conducted on technology designed to restore independence by providing some means of control over these devices. Technology that allows a severely disabled person to gain this type of control has been called an environmental control system (ECS). The aim of this review was to evaluate critically the status and efficacy of ECS technology for the severely disabled. MATERIALS/METHODS: To achieve this, a comprehensive database search was conducted for relevant material on technical and clinical aspects of ECS control. RESULTS: The review demonstrated that there is an abundance of work conducted on ECS technology, resulting in a number of creative control systems that are designed to be used by the severely disabled. These include switching systems that utilize voice, muscle, brain activity, head motion, eye blink, breath, chin, and so on. However, the review also established that rarely has the efficacy of these systems been scientifically established. CONCLUSIONS: Severely disabled persons need access to ECS technology that has been shown to be efficacious. While the severely disabled gain benefits from using ECS technology, challenges still exist before ECS technology for the severely disabled can provide highly reliable and user-friendly device control.

Communication Devices for People with Disabilities↗

PubMed2004

Evaluation of psychiatric disability in PTSD of military origin.

BACKGROUND: Israeli veterans suffering from post-traumatic stress disorder (PTSD) filed claims for recognition of their mental disability and for compensation underwent thorough psychiatric evaluations conducted by an interdisciplinary team. OBJECTIVE: To study the clinical features and functional impairment of PTSD veterans who filed claims for psychiatric disability. To evaluate possible relationships among severity of PTSD, psychiatric comorbidity and level of disability. METHOD: Subjects were 294 veterans with PTSD. Evaluation included a semi-structured psychiatric interview; self report questionnaires of PTSD, psychiatric symptoms and assessment of functional impairments (in self-care in daily living, interpersonal--familial and social, and occupational functioning). Upon completion of the various assessments the psychiatrist determined a global disability score. RESULTS: 156/294 (53%) of the PTSD subjects had psychiatric comorbidity, mainly depression (31%) and anxiety (15%). PTSD casualties suffered significant functional impairments, more in occupational functioning than interpersonal and activities of daily living, respectively. A number of PTSD symptoms were positively correlated with functional impairments in the occupational and interpersonal areas and with the global disability score, while psychiatric comorbidity was not. CONCLUSION: PTSD veterans who file for psychiatric disability report severe mental distress and functional impairment, and probably constitute the more severe PTSD casualties. Systematic assessment of functional impairment in addition to clinical examination is needed for valid evaluation of disability and for determining disability score.

Activities of Daily Living↗

PubMed1989

[The significance of childhood conditions with regard to disability pensions. A case-controlled study among unskilled workers].

The significance of the conditions in childhood and adolescence for awarding of disability pension is illustrated by means of a case-control design with persons matched according to age, sex and type of work. The group investigated consisted of 581 general male workers who received middle or highest disability pension and 1,550 control persons. No significant differences were found between the case and control group as regards the occupation of the father, unemployment of the father, illness or disability pension in the parents, economical problems during childhood, growing up in the parental home and growing up in rural or urban surroundings. Disability pensioners had more frequently had schooling for less than seven years. These results cannot confirm the conclusions from previous investigations which are associated with bias in the form of socioeconomical differences between the group investigated and the control group. Unskilled work results in confounding as it is associated not only with poor childhood conditions and also with a high incidence of disability pension. Poor childhood conditions are not found more frequently within the group of general workers among the disability pensioners and can thus not be regarded per se as a risk factor for awarding disability pensioning. However, the childhood condition may influence the choise of occupation and then indirectly act as a risk factor for disability pension.

Adult↗

PubMed1989

Survey design strategies for the study of disability.

This article examines international statistical guidelines and recommendations relevant to the collection and analysis of disability data in population census, household survey and civil registration programmes. It also gives examples of survey design methods and their influence on findings of disability surveys. These examples are taken from the results of population censuses, household surveys and registration systems of 55 countries, as compiled in the United Nations Disability Statistics Data Base (DISTAT, 1988). Comparisons of crude disability rates, defined as the percentage of the total population that is disabled, indicate considerable variation in the rates both within and across the major data-collection types. Cross-national variations in disability rates are not only due to actual differences in disability rates, but are also the result of differences in survey design, the statistical concepts and definitions and the survey screening devices used. This article provides the reader with specific examples of screening devices tried and topics covered in survey programmes, and reviews the potential for using the ICIDH as one way of standardizing survey results. Short lists of impairments and disabilities for survey research are proposed. Survey implementation of the study of handicap is also discussed, and a list of possible survey topics for the study of handicap is outlined.

Activities of Daily Living↗