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PubMed2005

Functional disability, disability transitions, and depressive symptoms in late life.

OBJECTIVE: This article addresses how stable functional disability statuses and disability transitions are related to change in depressive symptoms in the elderly. METHOD: The authors estimate longitudinal residual change models using two waves of data, 1986 and 1992, from the National Institute of Aging Established Populations for Epidemiologic Studies of the Elderly, Duke University. RESULTS: Both stable disability statuses and transitions in disability statuses are significantly related to change in depressive symptoms (Center for Epidemiologic Studies depression scale [CES D]). Stable disability statuses in strength and mobility, instrumental activities of daily living (IADL) items and activities of daily living (ADL) items have increasing effects on increment in CES-D scores by the follow-up. The onset of disability has stronger effects on change in CES-D scores than recovery. These effects also differ by types of transitions in disability statuses. DISCUSSION: The authors discuss alternative interpretations of the findings and methodological concerns and also suggest avenues for future research.

Activities of Daily Living↗

PubMed2000

Long-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation.

BACKGROUND: Low-back problems are one of the most frequent reasons for disability compensation claims by workers. However, the effect of Workers' Compensation status on the long-term outcome for workers with sciatica has not been studied in detail, to our knowledge. Therefore, we believe that it is important to describe the long-term outcomes for patients who have herniation of a lumbar disc and sciatica according to the Workers' Compensation status at the time of the preoperative consultation. METHODS: We conducted a prospective, observational study of patients who had sciatica and were seeking care from specialist physicians in community-based practices throughout Maine. Among 440 eligible patients, 199 were receiving Workers' Compensation at the time of entry into the study (baseline) and 241 were not. Three hundred and twenty-six patients (74 percent) completed questionnaires at the time of a four-year follow-up. The outcomes that we assessed included disability compensation and work status as well as relief from symptoms, functional status, and quality of life. RESULTS: Patients who were receiving Workers' Compensation at baseline were more likely to be young, male, and employed as laborers. They reported worse functional status; however, the clinical findings for these patients were similar to those for patients who were not receiving Workers' Compensation. Patients who had been receiving Workers' Compensation at baseline were more likely to be receiving disability benefits at the time of the four-year follow-up compared with those who had not (27 percent of 133 compared with 7 percent of 189; p<0.001); however, they were only slightly less likely to be working at the time of the four-year follow-up (80 percent of 133 compared with 87 percent of 190; p = 0.09). Operative management did not influence these comparisons, but it decreased symptoms and improved functional status. Patients who had been receiving Workers' Compensation at baseline also had significantly less relief from symptoms and improvement in quality of life than patients who had not been receiving Workers' Compensation (all p<0.001). In multivariate models, Workers' Compensation status at baseline was an independent predictor of whether the patient would be receiving disability benefits after four years (odds ratio, 3.5; 95 percent confidence interval, 1.7 to 7.6) but was not an independent predictor of whether the patient would be working on a job for pay at the time of the four-year follow-up (odds ratio, 0.6; 95 percent confidence interval, 0.3 to 1.2). CONCLUSIONS: Even after adjustment for the initial treatment of the sciatica and for other clinical factors, patients who had been receiving Workers' Compensation at baseline were more likely to be receiving disability benefits and were less likely to report relief from symptoms and improvement in quality of life at the time of the four-year follow-up than patients who had not been receiving Workers' Compensation at baseline. Nonetheless, most patients returned to work regardless of their initial disability status, and those who had been receiving Workers' Compensation at baseline were only slightly less likely to be working after four years. Whether or not they had been receiving Workers' Compensation at baseline, patients who had been managed with an operation reported greater relief from symptoms and improvement in functional status at the time of the four-year follow-up compared with patients who had been managed nonoperatively, even though the outcomes with regard to disability and work status in these two groups were comparable.

Adult↗

PubMed1977

Perceived maternal child-rearing behavior among disabled and non-disabled adolescents.

The purposes of this study were (a) to contrast the reported perceptions of maternal rearing using the Child's Report of Parental Behavior Inventory of 70 disabled (cerebral palsied) and 70 non-disabled adolescents of similar sex, age, intelligence, and socioeconomic status and (b) to evaluate the impact of severity of physical impairment within the disabled group. Analyses of variance were completed using group (disabled/controls) as one dimension and sex as the within-groups source. Partial correlations were used to assess the relationship between severity of incapacitation and perceived maternal behavior. Of the 18 main effects, two were significant, suggesting that the non-disabled perceived their mothers as more possessive and intrusive than did the disabled. Males perceived their mothers as significantly more lax in discipline and allowing more autonomy than did females. Severity of disability was only modestly related to perceived maternal behavior. With this sample of disabled adolescents it was suggested that a physically handicapping condition and its severity may be of more limited influence in the maternal rearing process than assumed.

Adolescent↗

PubMed1995

Rethinking disability policy: equity in the ADA era and the meaning of specialized services for people with disabilities.

An analysis of disability policy suggests that policy-makers have pursued two strategies to treat people with disabilities equally. In one approach, categories of people with disabilities were identified and provided with specialized services. In the second, categories of services were provided to people with disabilities on a specialized basis. In both cases, the implication is that people with disabilities are so different a class of people that society should not be required to adapt to their presence. In this article, the authors suggest that the new equity standard established by the Americans with Disabilities Act makes such specialized services inappropriate and suggests a general three-prong strategy for including the needs of people with disabilities in mainstream policy-making. This strategy addresses education and training needs, health care reform, and civil rights enforcement.

Persons with Disabilities↗

PubMed2001

Clinical utility of an instrument assessing migraine disability: the Migraine Disability Assessment (MIDAS) questionnaire.

OBJECTIVE: We evaluated the agreement between Migraine Disability Assessment (MIDAS) scores and independent physician judgments about pain, disability, and treatment needs based on patient medical histories. BACKGROUND: The MIDAS questionnaire measures headache-related disability as lost time due to headache from paid work or school, household work, and nonwork activities. METHODS: Twelve histories from patients with migraine were presented to 49 primary and specialty care physicians unaware of the MIDAS scores. Physicians graded each patient for pain level (mild, moderate, or severe), level of disability (none, mild, moderate, or severe), and need for medical care (from 0 [lowest] to 100 [highest]). Physicians also identified MIDAS scores they associated with different degrees of disability and with the urgency to prescribe an effective treatment during the first consultation. RESULTS: The physicians' perceptions of the need for medical care based on medical histories correlated with the MIDAS score (r =.69). Estimates of pain and disability by physicians were directly correlated with increasing MIDAS scores. Using the physicians' clinical judgments, the overall MIDAS score was categorized into four grades of increasing severity. CONCLUSIONS: Scores on the MIDAS are highly correlated with physician judgments regarding patients' pain, disability, and need for medical care. These findings support the potential utility of the MIDAS questionnaire in clinical practice.

Disability Evaluation↗

PubMed2006

Prognosis in soft tissue disorders of the shoulder: predicting both change in disability and level of disability after treatment.

BACKGROUND AND PURPOSE: Clinicians often are faced with questions about prognosis and outcome of shoulder disorders. The purpose of this study was to identify predictors of both change in disability and level of disability following physical therapy treatment. SUBJECTS: The subjects were consecutive patients (n=361) who were receiving physical therapy for soft tissue shoulder disorders. METHODS: Clinical response to physical therapy, which was measured using the Disabilities of the Arm, Shoulder, and Hand (DASH) measure, was assessed over 12 weeks. The 28 independent baseline predictors included demographics, disorder-related and disability measures, medication use, clinical findings, and expectations for recovery. Multiple linear regression techniques were used. RESULTS: Predictors of greater disability at discharge were: higher initial disability, therapist prediction of restricted activities at discharge, workers' compensation claim, older age, and being female. Predictors of greater improvement in disability were: shoulder surgery, higher pain intensity, shorter duration of symptoms, younger age, and poorer general physical health (measured using the 36-Item Short-Form Health Survey [SF-36]). DISCUSSION AND CONCLUSIONS: Prognostic factors differ depending on the format of the outcome. Only age was significant in both models.

Adolescent↗

PubMed1987

[Physical disabilities in Hansen's disease at the time of diagnosis. I. Disability evaluation].

The evaluation of the physical disabilities at the moment of the hanseniasis diagnosis was carried out through the clinical and epidemiological forms of the 8,915 cases recorded in the State of São Paulo, Brazil, from 1981 to 1983. The records of the physical disabilities were studied by three different methods: the disabilities at their highest grade, the disabilities' grade index achieved from the arithmetic mean of the added values of the different disability grades, and the absolute disabilities frequency. The study suggested that the maximum grade was the best evaluation method of the physical disabilities at the moment of the diagnosis, being an important indicator for the evaluation of prevention efforts and of the hanseniasis control.

Adolescent↗

PubMed1994

[Use of disability pensions. Disability pensions from 1967 to 1992 in a group from Bergen born in 1940].

The authors describe the medical conditions (expressed by ICD-codes) leading to a disability pension in a cohort of 1,570 persons born in the year 1940. Information on disability pensions was extracted from the files of the National Insurance Administration for the years 1967-92. The disability diagnoses varied during the period 1967-92. Diagnoses during the first years reflect conditions that caused disability of young persons. Later on, diagnoses of "traditional" mental and organic diseases were used. Gradually other diagnoses, including alcoholism also appeared. This was a consequence of a broadening in the 1970s of the medical criteria for occupational disability. In recent years, disability diagnoses related to unspecific conditions are seen, particularly diagnoses reflecting symptoms associated with the musculosceletal system. These disability diagnoses were used in the case of about 30% of the women in the cohort who became new pensioners during the period 1988-92.

Cohort Studies↗

PubMed1996

Importance and attainment of life values among disabled and non-disabled people.

How do disabled persons evaluate their life situation? To address this issue, importance and attainment ratings of 82 different life values as well as mood ratings were collected from 325 chronically ill and/or disabled persons and 504 non-disabled persons. Both groups largely agreed on what is important in life. The disabled persons, however, gave lower importance ratings on functions related to health and mobility. The attainment and mood ratings were in general slightly lower for the disabled persons. The attainment ratings for health and mobility were markedly lower. The concordance between rated importance and attainment across different life values was positive in both groups. This measure was also positively related to mood in both samples. It was suggested that disabled persons adjust to their life situation by de-emphasizing the importance of the physical functions affected by the disability and through habituation.

Affect↗

PubMed2001

Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 National Health Interview Survey Disability Supplements.

In 1994 and 1995, the National Health Interview Survey included a Disability Supplement (NHIS-D) to collect extensive information about disabilities among individuals sampled as part of annual census-based household interview surveys. Here we describe the development and application of operational definitions of mental retardation and developmental disabilities to items in the NHIS-D to estimate prevalence. In our analyses, we estimate the prevalence of mental retardation in the noninstitutionalized population of the United States to be 7.8 people per thousand (.78%); of developmental disabilities, 11.3 people per thousand (1.13%); and the combined prevalence of mental retardation and/or developmental disabilities to be 14.9 per thousand (1.49%). Differences in prevalence estimates for mental retardation and developmental disabilities and among people of various ages are explored.

Adolescent↗

PubMed1984

Processing of short vowels, long vowels, and vowel digraphs by disabled and non-disabled readers.

The speed with which disabled and non-disabled readers process short vowels, long vowels, and vowel digraphs was investigated in this study, an exploration of Morrison's 1984 conceptualization of reading disability as the failure to master the complex irregular system of rules governing sound-symbol correspondence in English. 7 disabled and 7 non-disabled readers, all of average intelligence, were presented pseudoword pairs on slides and asked to identify a pronounced target word by identifying its position ("top" or "bottom"). Reaction time was measured with voice-operated relay and digital millisecond clock counter. The pseudoword pairs were formed such that each pseudoword was paired with another that was identical except for one or two vowels in the medial position. No effects of type of reader (disabled or non-disabled) and type of letters in the medial position (long vowel, short vowel, vowel digraph) on reaction time were noted. Analysis of reaction times for individual words gave significant differences. The need for an empirically supported "complexity scale" is discussed.

Child↗

PubMed1989

Occupational differences in disability awards, benefit application, and awareness of the Social Security Administration Disability Program.

Previous studies have identified occupational differences in disabling illness among recipients of Social Security Administration (SSA) disability awards. Interpreting such differences as evidence of excess risk, however, assumes that medical factors are the primary criteria for receipt of benefits. The present study examined the influence of demographic, occupational, and medical factors on awareness, application, and receipt of SSA disability benefits. Bivariate and multiple logistic regression analyses indicated that awareness, benefit application, and receipt of awards were not well predicted by demographic, health-related, or occupation variables. Occupation explained less than 1% of the variance in awareness, benefit application, and disability awards among severely disabled persons. The results suggest that occupational differences in disabling illnesses among SSA disability beneficiaries are not merely reflections of differences in awareness of the SSA benefit program or less frequent application for benefits.

Adult↗

PubMed2000

Occupational disability related to back pain: application of a theoretical model of work disability using prospective cohorts of manual workers.

BACKGROUND: A new model of work disability was developed based on the assumption that four different groups of workers are present at the beginning of a prospective epidemiologic study: one group of workers without back pain, and three groups of workers with back pain and a gradient of work disability. The goal of this research was to verify if these groups comprise workers at different levels of risk of occurrence of complete work disability related to back injury. METHODS: Prospective cohorts of manual workers (n=578) were followed for 1 year to document the risk of occurrence of complete disability related to back injury. RESULTS: The results showed that the workers who presented with back pain without work disability at the beginning of the study were at less risk compared to all the other workers in the cohort. Moreover, an effect modification was found between the workers who initially presented with back pain without work disability and a past history of compensation for back injury, adding credence to the non-similarity of these workers to the others. CONCLUSIONS: Based on these results, further studies should focus on improving the knowledge of the characteristics of these workers leading to a better understanding of how to prevent occupational low-back pain.

Adult↗

PubMed2000

Antipsychotic medication for challenging behaviour in people with learning disability.

BACKGROUND: The term 'challenging behaviour', in the absence of psychiatric disorder, encompasses a wide range of behaviours that may be harmful to people or property, may be difficult to manage and may limit access to community facilities. Antipsychotic medications have been used to modify such behaviours in people with learning disability, but there is little evidence to suggest that the benefits outweigh the risks. OBJECTIVES: To determine the effectiveness of antipsychotic medication for people with learning disability and challenging behaviour. SEARCH STRATEGY: Biological abstracts, the Cochrane Library, the Cochrane Schizophrenia Group's Register, EMBASE, MEDLINE, PsycLIT were searched. Further references were sought from published trials and pharmaceutical companies. Trials were reliably identified and data extracted. SELECTION CRITERIA: All randomised controlled trials of antipsychotic medication versus placebo. DATA COLLECTION AND ANALYSIS: Reviewers independently evaluated and analysed data on an intention to treat basis. Data were evaluated at 4 and 8 weeks as longer follow-up data were not available. Reviewers assumed that those subjects lost to follow-up had a bad outcome. MAIN RESULTS: Only three randomised controlled trials could be included in the analyses. These provided no evidence of whether antipsychotic medication helps or harms adults with learning disability and challenging behaviour. REVIEWER'S CONCLUSIONS: There is limited data on this important issue and more research is urgently needed.

Adult↗

PubMed2006

Assessment of everyday functioning in young children with disabilities: an ICF-based analysis of concepts and content of the Pediatric Evaluation of Disability Inventory (PEDI).

BACKGROUND: Assessment of everyday functioning in children may depend to a considerable extent on the framework used to conceptualise functioning and disability. The Pediatric Evaluation of Disability Inventory (PEDI) has incorporated the mediating role of the environment on disability, using different measurement scales. The construction of the Functional Skills scales, which measure capability, and the Caregiver Assistance scales, which measure performance, was based on the Nagi disablement scheme. The International Classification of Functioning, Disability and Health (ICF) represents a new framework of functioning and disability that could be used to compare the measurement constructs and the content of different outcome measurements. PURPOSE: To examine the conceptual basis and the content of the PEDI using the ICF. METHOD: Phrases that describe the conceptual basis of the PEDI scales and of the ICF classifications were systematically collected and compared. Two researchers classified the item content of the Functional Skills scales independently before consensus was reached. RESULTS: The analyses indicate that the conceptual basis of the PEDI scales to a large extent match the ICF concepts of activity, participation and environmental factors. Both the PEDI and the ICF use the constructs of capacity and performance, but differ in how to operationalise these constructs. The classification of the Functional Skills scales shows that the PEDI primarily is a measure of activities and participation. The frequently use of environmental codes to classify the context of the requested functions demonstrates that the PEDI has incorporated the environment into the assessment. CONCLUSIONS: Our analyses indicate that the ICF could serve as a conceptual framework to clarify the measurement construct of the PEDI scales, and as taxonomy to describe and clarify the item content of the Functional Skills scales. Both as framework and taxonomy the ICF showed limitations in covering functioning in early childhood.

Activities of Daily Living↗

PubMed2001

Unmet and undermet need for activities of daily living and instrumental activities of daily living assistance among adults with disabilities: estimates from the 1994 and 1995 disability follow-back surveys.

BACKGROUND: Accurate assessments of need for disability assistance are essential for effective planning of disability support services, but there is little national data on type and acuity of need. OBJECTIVE: To more fully delineate the type and magnitude of disability assistance needs across the US population, focusing on factors associated with perceived gaps in assistance. RESEARCH DESIGN: Secondary analysis of national household survey. SUBJECTS: Twenty-five thousand eight hundred five adults identified as disabled in the 1994 and 1995 National Health Interview Surveys. MEASURES: Self-reported assistance deficits with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS: An estimated 3.2 million adults with disabilities have at least one assistance deficit, usually involving IADLs like housework. However, approximately 970 thousand adults report one or more assistance deficits with basic ADLs. Compared to adults with met ADL needs, people with ADL assistance deficits are more likely to live alone, to be in poor health, to be a member of a racial or ethnic minority, and to need help with multiple activities. DISCUSSION: These analyses suggest a relatively high rate of unmet and undermet need for disability assistance in the general population. However, only a small number of these adults report assistance deficits with basic ADLs. This group is a logical target for expanded state or federal personal assistance services programming.

Activities of Daily Living↗

PubMed2003

The organization of difference: people with intellectual disabilities and the social model of disability.

In this article I propose that the experience of people categorized as having intellectual disabilities is inadequately represented by current disability theory, premised, as much of it is, on the socially constructed duality between disability and impairment. I argue that representation of intellectual disability within the wider world of disability in general will only be achieved by thinking of disability on a continuum. This should preserve individual identities while reducing categorization and the attendant essentialist versus constructionist conflict. Debate can then move to a consideration of what methodologies are appropriate to the inquiry.

Persons with Disabilities↗

PubMed1998

Functional disabilities of disabled workers in vocational aid facilities and a social welfare factory.

We evaluated functional disabilities of disabled workers at vocational aid facilities and a social welfare factory to reveal whether evaluation of the functional disabilities is useful for occupational health care activities. Subjects were 121 persons with a physical disability working at Fukuoka Colony (FC workers) and 35 persons with mental retardation working at Nanomi Kogei (NK workers). The Self-Rating Barthel Index, Self-Rating Frenchay Activities Index, and Satisfaction in Daily Life (SDL) were used for the evaluation of basic activities of daily living (ADL), lifestyle, and subjective domain of quality of life, respectively. The FC workers were almost independent in basic ADL: had a high capability in self-care activities and moderately disturbed capability in mobility activities, and had a more active lifestyle than the NK workers. The total SDL score indicated that the FC workers were less satisfied with overall daily life, although not significant, and were less satisfied with the SDL items of physical health, gait, house facilities, and having a job than the NK workers. Because these results indicated the features of disabled workers and gave an occupational health physician valuable information about disabilities, the evaluations used in this study can be regarded as useful for occupational health care activities.

Activities of Daily Living↗