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PubMed2000

Range of joint motion and disability in patients with osteoarthritis of the knee or hip.

OBJECTIVE: To establish the relationships between the range of joint motion (ROM) and disability in patients with osteoarthritis (OA) of the knee or hip. Two related issues were addressed: (1) the inter-relationships between ROMs of joint actions, and (2) the relationship between ROM and disability. METHODS: Data on 198 patients with OA of the knee or hip were used. The ROM was assessed bilaterally for the hip and knee, using a goniometer. Disability was assessed using a self-reporting method (questionnaire) and an observational method. Correlation and factor analysis were used to establish the inter-relationships between the ROMs of joint actions. Correlation and multiple regression analyses were carried out to establish the relationships between ROM and disability. RESULTS: Close inter-relationships were found between the ROMs of the same joint action of the lateral and contralateral joints; inter-relationships between ROMs of different joint actions were substantially weaker. Low ROMs were associated with high levels of disability, both self-reported and observed. Some 25% of the variation in disability levels could be accounted for by differences in ROM. In both knee and hip OA patients, flexion of the knee and extension and external rotation of the hip were found to be most closely associated with disability. CONCLUSION: Restricted joint mobility, especially in flexion of the knee and extension and external rotation of the hip, appears to be an important determinant of disability in patients with OA.

Adult↗

PubMed1991

A comparison of models describing reports of disability associated with chronic pain.

We examined pain-related disability from two perspectives. A disability model, suggesting that disability is a direct consequence of pain, is compared with a symptom perception model emphasizing individual differences in perception and report of physical symptoms. Disability estimates (reported activity interference and employment status) were obtained from a sample of 179 patients with chronic pain. Using multiple regression analyses, we showed that distress, symptom reporting, and pain intensity accounted for comparable levels of variance in reports of activity interference. When we controlled for distress, the frequency of reporting physical symptoms made the largest contribution to prediction of this kind of disability (14%). Neither symptom report or pain intensity was useful in predicting the more objective disability criterion of employment status. Results were interpreted as probable evidence against a disability model of pain-related disability and suggest the relative importance of individual cognitive differences in symptom responsivity.

Activities of Daily Living↗

PubMedDate not supplied

Disability rites: the cultural shift following impairment.

Persons with disabilities experience barriers to health within a culture. The local culture assigns meanings to those with impairments and their activities. In order to understand the experience of disability as influenced by culture, anthropological models of rites of passage and liminality have been used, but these can be extended further. The authors posit that local cultures should be the context for studying disability, and thus extend on previous work by Murphy on the rites of passage for persons with disabilities. This article will: (1) review how disability has been culturally created and defined, (2) provide additional evidence for the argument regarding the existence of disability culture, and (3) extend the work on rites of passage for persons with disabilities. A brief discussion of how this expanded model might guide the understanding of disability and the understanding of barriers to health follows.

Cultural Characteristics↗

PubMedDate not supplied

Preventive health screening for breast and cervical cancer and osteoporosis in women with physical disabilities.

Although the Americans With Disabilities Act was enacted 15 years ago in an effort to improve access of people with disabilities to a broad range of services, women with physical disabilities continue to receive less preventive health screening than women without disabilities and less than is recommended. Furthermore, women with more severe disabilities undergo less screening than those with mild or moderate severity of disability. This article reviews findings of studies on health screening for breast and cervical cancer and osteoporosis in women with physical disabilities and identifies practice and research implications on the basis of those findings to improve the health status of women with physical disabilities.

Breast Neoplasms↗

PubMed1982

The economics of disabilities: international perspectives.

The impact of disability within a nation is mediated by the provisions which exist for impairment prevention, for rehabilitation of people who are disabled and for coordination of the various social benefit and labor market actions taken with regard to disabled people and their families. The paper reviews available international research on the socio-economic impact of disability prevention and rehabilitation measures based upon a Rehabilitation International analysis of literature in this field from 40 countries and studies of the United Nations. Key issues include: the cost of disability, the family impacts, displacement from the labor force, social benefit and disability policies, and the application of cost/benefit analysis to these processes-the tool and its limitations. Available research confirms the United Nation study finding that while disability will create a cost in every society regardless of whether or not rehabilitation services exist, "the more a society recognizes these costs, and the more it attempts to ameliorate them through provision of adequate disability prevention and rehabilitation services, the greater is the overall economic return that may be expected."

Cost-Benefit Analysis↗

PubMed1992

Creating a disability mythology.

People with disabilities have, for the most part, failed to identify with each other as a group. This has been detrimental because it has built a sense of isolation when a camaraderie based upon existing commonalities could have been developed. During the past ten to twenty years, there has been a great deal of discussion about appropriate language to use when discussing disability issues. This discussion has been a part of a larger debate concerning the existence of a disability culture. I believe that there is indeed a disability culture and I am a proponent of identifying and passing on stories which contribute to that culture. I have chosen to use mythology to convey this message and have begun with a focus on heroes - people who do something out of the ordinary. It is contended that almost all people with disabilities have performed heroic activities because of the pervasive discrimination encountered by each individual with a disability. Creating a disability mythology is an attempt to recognize and promote heroes within the disabled community and to advocate the importance of telling other people how positive change has occurred through instances of individual heroism.

Activities of Daily Living↗

PubMed2003

Beliefs about feeding practices and nutrition for children with disabilities among families in Dharavi, Mumbai.

Attitudes arise from specific experiences and emotions driven by cultural beliefs. An understanding of societal constructs regarding disability in a given culture contributes to developing strategies to meet the needs of children with disabilities by providing culturally competent services. In 1999, a series of focus-group discussions were conducted with families in a low-income community in Mumbai, India to collect qualitative information on the knowledge, skills and attitudes (KSA) regarding disability, feeding and nutrition to facilitate the development of an intervention to improve the nutritional well-being of children with disabilities. The KSA of this population of poor families has seldom been directly examined. The specific objectives of this study were (i) to describe the experiences of families with young disabled children in the local community; (ii) to identify the nutritional and feeding needs of children with disabilities; and (iii) to identify any service, environmental or attitudinal barriers to acquiring an adequate nutritional status. Content analysis of concepts in the focus groups identified four emerging themes: (i) acceptance of disability; (ii) services and needs; (iii) future; and (iv) food and nutrition. The focus-group findings enabled a broader understanding of attitudes towards disability within this population, which can have an impact on the care of the child. The findings provided insights into the content of the intervention to be helpful for local families incorporating an understanding of the cultural background of the local community that must be included alongside our understanding of the feeding impairment.

Adaptation, Psychological↗

PubMed2005

Disability pension despite vocational rehabilitation? A study from six social insurance offices of a county.

Many long-term sick-listed individuals move from vocational rehabilitation to pension, rather than reaching the goal of return to work. There is thus reason to consider whether rehabilitation resources are being used optimally. Individuals receiving disability pensions are consuming financial and personnel resources at the insurance offices and also consume a large amount of health care. The general objective of the study was to evaluate the proportion of individuals granted vocational rehabilitation but then obtaining temporary or permanent disability pensions. All persons receiving any kind of rehabilitation and attending one of six local national insurance offices in a county in Sweden in 1998 and 1999 were studied. A 2-year follow-up was carried out to assess changes in status among those who had received temporary disability pensions. Of all individuals receiving rehabilitation, 46.2% ended up with a disability pension allowance. In addition, a large portion of the temporary disability pensions was transformed to permanent disability pensions within 2 years. For clients with a temporary disability pension, the rate of resuming work was close to nil. Among rehabilitation measures, investigation showed the lowest figures of work resumption while job training showed the best outcome in this respect. The study concluded that a large portion of the financial and personnel resources allocated by the national insurance offices to rehabilitation resulted in disability pensions.

Adult↗

PubMed1999

Posttraumatic carotid cavernous fistula: frequency analysis of signs, symptoms, and disability outcomes after angiographic embolization.

OBJECTIVE: To increase awareness and understanding of posttraumatic carotid cavernous fistula (PTCCF) with the intent to expedite diagnosis and treatment of this disabling injury, a 14-year retrospective review of patients with angiographically identified PTCCF was conducted at this Level I trauma center. A frequency analysis of signs, symptoms, and disability was performed. The impact on disability of demographics, number of embolization attempts required for closure of the PTCCF, and time from injury to diagnosis was assessed by t test for independent samples. RESULTS: Nine patients were diagnosed with 10 PTCCFs. Mean patient age was 41.5 years. All patients with PTCCF had basilar skull fracture, loss of consciousness, bruit, and chemosis; 90% had exophthalmos; 70% had visual changes; 50% complained of headache; and 80% had some lasting disability. Mean age of patients with partial to total disability was 47 years, while the mean age of patients without lasting disability was 19.5 years (p = 0.013). No statistical correlation could be found between disability and sex, blunt versus penetrating injury, days to diagnosis, or number of embolization attempts. CONCLUSION: Patients sustaining head trauma with basilar skull fractures and presenting with the described signs and symptoms should be evaluated for PTCCF. Risk of disability does not appear to be influenced by number of attempts at embolization or time to diagnosis. However, age may have a significant impact on outcome.

Adolescent↗

PubMed1998

A profile of health care utilization of the disabled population in Manitoba.

OBJECTIVES: This study profiled health care utilization by disabled and nondisabled individuals in the Canadian province of Manitoba to evaluate the association between health care utilization and disability. METHODS: Age-standardized annualized utilization rates were calculated according to sex using longitudinal data on individual encounters with the Manitoba health care system from 1983 to 1990. Associations between severity of disability, number of prior chronic conditions, and prospective utilization were examined using multivariate regressions. RESULTS: Utilization patterns of the mildly disabled and the nondisabled differed only slightly. Severely disabled individuals had much higher rates of contact and consumed more resources, even after controlling for chronic conditions. The severely disabled accounted for 3% of the population and consumed 16% of hospital days and 7% of physician costs annually. CONCLUSIONS: The findings emphasize the importance of incorporating measures of disability in health services research. Both the severity of disability and the number of chronic conditions had independent value in predicting health care utilization. This has important implications for data collection and for the allocation of health care resources for research, which has traditionally been targeted toward fatal chronic conditions.

Adolescent↗

PubMed2001

Current injury or disability as a barrier to being more physically active.

PURPOSE: To assess the extent to which a current injury or disability is a significant barrier to being more active. METHODS: Data on current injury or disability as a reported barrier to being more physically active were extracted from an urban-representative population survey. Multivariate logistic regression analyses assessed the association between gender, educational attainment, age, body mass index, and current physical activity levels with injury or disability as a barrier. RESULTS: Twenty percent of the survey respondents gave current injury or disability as a reason for not being more active. There were no significant differences between male and female subjects. There was a significant trend toward a higher reporting of current injury or disability as a barrier, with increasing age (P < 0.001). High body mass index (P < 0.001) and current physical activity levels (P < 0.05) were significantly related to the injury or disability barrier. The only variables significantly independently associated in multivariate logistic regression analyses were age and body mass index. CONCLUSIONS: Current injury or disability as a barrier to increased physical activity was independently, and significantly, associated with both age and body mass index, after adjusting for other variables. The promotion of increased physical activity to older and overweight groups should focus on safe activities that do not aggravate previous injuries or disabilities.

Activities of Daily Living↗

PubMed2002

The measurement of vision disability.

The American Medical Association's (AMA) visual efficiency scale, a vision disability metric based on visual impairment measurements, was adopted in 1925. That scale was based on a 30-year history of theoretical models in vision economics, a misinterpretation of Snellen notation for visual acuity, and an erroneous application of Weber's psychophysical law. The AMA visual efficiency scale survived uncontested for 75 years. In 2001, the AMA adopted a new vision disability scale based on logarithmic transformations of visual acuity and visual field diameter. Like the earlier visual efficiency scale, the new scale is theoretical-it is not supported by any data that speak to the relationship between vision disability and visual impairments. Attempts to measure vision disability date to the early 1980s with the development of self-assessment visual function rating scale questionnaires. Nearly all of the questionnaires developed over the last 20 years use Likert scales, but use them incorrectly. The development of a vision disability metric based on Likert scaling parallels the historical development of other forms of measurement. A tutorial review of psychometrics-classical test theory, item response theory, and Rasch analysis-shows how vision disability measurement scales can be estimated from Likert-type visual function rating scales. We conclude that preliminary data relating measures of vision disability to measures of visual acuity and visual fields support the new AMA vision disability scale.

Algorithms↗

PubMedDate not supplied

Usefulness of the SCORE index as a predictor of osteoporosis in women with disabilities.

BACKGROUND: Osteoporosis is widely recognized as a common health problem among older women. It has also recently been identified as common in both pre- and postmenopausal women with disabilities. Although several clinical indices have been developed to identify nondisabled women likely to have low bone mineral density (BMD) when tested, studies that have tested the usefulness of these clinical indices have excluded women with disabilities. Thus, the usefulness of these indices in predicting low BMD and osteoporosis in women with disabilities is unknown. PURPOSE: This study examined the ability of one of these indices, the Simple Calculated Osteoporosis Risk Estimation (SCORE), to identify women with disabilities likely to have low BMD on screening. SAMPLE/DATA COLLECTION: Women with disabilities (N = 307) responded to the six-item SCORE index and underwent peripheral BMD screening. The sensitivity, specificity, and accuracy of the SCORE index in predicting BMD with the criterion of a T-score of </=2.5 were 65.7, 61.1, and 62.2%, respectively. When a T-score of </=2.0 was used as the criterion, the sensitivity, specificity, and accuracy of the SCORE index were 62.6, 63, and 62.9%, respectively. FINDINGS: The low sensitivity, specificity, and accuracy of the SCORE index indicate that it is not a useful predictor of low BMD in women with disabilities, incorrectly categorizing almost 40% of the sample. A clinical index that includes osteoporosis risk factors present in women with disabilities is needed to increase the likelihood that women with disabilities will be referred for testing and receive treatment of osteoporosis when indicated.

Absorptiometry, Photon↗

PubMedDate not supplied

Measuring subclinical disability in older mexican americans.

OBJECTIVE: The purpose of this study was to develop a comprehensive list of adaptive strategies to prevent disability and use this information to devise a preliminary measure of subclinical disability (state of sustained independence in the presence of latent or manifest functional limitations) suitable for older Mexican Americans. METHOD: Semistructured interviews were conducted with 24 community-dwelling Mexican American elders (> or =65 years old) to elicit information about adaptations in performance of daily living tasks (eg, walking, dressing, and shopping) that may indicate presence of subclinical disability. This information was used to construct a quantitative self-report measure of subclinical disability administered to 207 older Mexican Americans. Item and factor analyses were performed to reduce the number of items and establish their underlying structure. Construct and discriminant validity of the reduced instrument was determined. RESULTS: A framework comprised of nine categories of daily living tasks, three functional levels, and five adaptation types was generated from the qualitative data. The initial 133-item measure (named the ADAPT) was reduced to a 44-item scale with three subscales (physical, household, and social). ADAPT scores correlated significantly in the expected direction with standard functional status measures, but the shared variance was modest, indicating that the ADAPT captured substantial, unique variance. Mean ADAPT scores differed significantly and were monotonically lower across subgroups classified as independent, subclinically disabled, and disabled, respectively. CONCLUSIONS: The ADAPT seems to have construct and discriminant validity as a measure of subclinical disability. Additional research is required to determine sensitivity to change and clinically significant cut points for varying risk of frank disability.

Activities of Daily Living↗

PubMed1994

The use of the percentage change in Oswestry Disability Index score as an outcome measure in lumbar spinal surgery.

STUDY DESIGN: A retrospective analysis of the change in the Oswestry Low Back Pain Disability Questionnaire in a heterogeneous group of 144 operatively managed patients was undertaken to examine the change in disability index as an outcome measure. OBJECTIVES: To establish the percent change in disability index as an outcome measure able to identify risk factors for poor results in lumbar spinal surgery. METHODS: Epidemiologic, diagnostic, and surgical variables were examined as risk factors using step-wise multiple linear regression analysis at both follow-up times (6 months and 2 years), with percent change in disability index used as the outcome measure. RESULTS: At 6-months follow-up, previous surgery, female gender, workers' compensation, a lower initial disability index score, increasing age, and spinal fusion alone as an operative procedure were independently and significantly negatively correlated with outcome. Further analysis revealed that for patients with spinal canal stenosis, the magnitude of the initial disability index did not correlate with outcome, whereas patients with low back pain or a prolapsed intervertebral disc fared better if they had high initial disability scores. Data at 2-years follow-up were less adequate. However, previous surgery on the spine and low initial disability score were significant negative predictors of outcome at 6-month and 2-year follow-up. CONCLUSIONS: The findings indicate that the absolute value and change in these scores after surgery vary from patient to patient, but that their percentage change is likely to be the best marker of outcome when such subjective scoring systems are used.

Disability Evaluation↗

PubMed1995

The Quebec Back Pain Disability Scale. Measurement properties.

STUDY DESIGN: The Quebec Back Pain Disability Scale is a 20-item self-administered instrument designed to assess the level of functional disability in individuals with back pain. The scale was administered as part of a larger questionnaire to a group of 242 back pain patients. Follow-up data were obtained after several days and after 2 to 6 months. OBJECTIVES: The goal of this study was to determine whether the Quebec scale is a reliable, valid, and responsive measure of disability in back pain, and to compare it with other disability scales. SUMMARY OF BACKGROUND DATA: A number of functional disability scales for back pain are being used, but their conceptual validity is uncertain. Unlike most published instruments, the Quebec scale was constructed using a conceptual approach to disability assessment and empirical methods of item development, analysis, and selection. METHODS: The authors calculated test-retest and internal consistency coefficients, evaluated construct validity of the scale, and tested its responsiveness against a global index of change. Direct comparisons with the Roland, Oswestry, and SF-36 scales were carried out. RESULTS: Test-retest reliability was 0.92, and Cronbach's alpha coefficient was 0.96. The scale correlated as expected with other measures of disability, pain, medical history, and utilization variables, work-related variables, and socio-demographic characteristics. Significant changes in disability over time, and differences in change scores between patients that were expected to differ in the direction of change, were found. CONCLUSIONS: The Quebec scale can be recommended as an outcome measure in clinical trials, and for monitoring the progress of individual patients participating in treatment or rehabilitation programs.

Adolescent↗

PubMed1995

The dominant role of psychosocial risk factors in the development of chronic low back pain disability.

STUDY DESIGN: An inception cohort design was used in which 421 patients were evaluated systematically with a standard battery of psychosocial assessment tests (Structured Interview for DSM-III-R Diagnosis, Minnesota Multiphasic Personality Inventory, and Million Visual Pain Analog Scale) within 6 weeks of acute back pain onset. OBJECTIVES: The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems (as measured by job-work status at 1-year follow-up evaluation). SUMMARY OF BACKGROUND DATA: There has been a relative paucity of prospective research in the United States comprehensively evaluating potential psychosocial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability. Such research has been quite limited because of the time and cost involved in conducting prospective studies. METHODS: All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks. These acute patients were tracked every 3 months, culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status. RESULTS: Logistic regression analyses, conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury, revealed the importance of three psychosocial measures: self-reported pain and disability, scores on Scale 3 of the Minnesota Multiphasic Personality Inventory, and workers' compensation and personal injury insurance status. The model generated correctly classified 90.7% of the cases. Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development chronic pain disability. CONCLUSIONS: These results show the presence of a robust "psychosocial disability factor" that is associated with those injured workers who are likely to develop chronic low back pain disability problems. Based on these data, a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability. The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability, although high rates of psychopathology have been shown in chronic low back pain. Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity.

Adult↗

PubMed1995

Formal education and back-related disability. In search of an explanation.

STUDY DESIGN: The present study is a 2-year prospective study with repeated measurements. OBJECTIVES: To examine the association of education with back-related disability along with four sets of variables that might explain this relationship: clinical, behavioral, and environmental factors; occupational variables; health care use; and interactions between stressful events and coping strategies. SUMMARY OF BACKGROUND DATA: Although education has been found to be associated with back-related disability in previous reports, this relationship remains to be explained. Examination of this association may yield a better understanding of the causes and natural history of disability resulting from back pain. METHODS: Subjects were 1213 enrollees of a Health Maintenance Organization (HMO) who consulted a primary care physician for back pain in 1989-1990, completed a baseline telephone interview, and had a follow-up evaluation after 1 and 2 years, using a modified version of the Roland-Morris Scale to measure disability. RESULTS: Subjects who completed 13 years or more of schooling had less disability and a greater decline in their disability over time than those who completed less schooling. Occupational characteristics and somatization were among the strongest explanatory factors. Cigarette smoking contributed to the explanation of the cross-sectional association. CONCLUSIONS: Education is associated cross-sectionally and longitudinally with disability resulting from back pain. A wide range of variables may mediate the education-back-related disability association, including a propensity to report diffuse physical symptoms (somatization), lifestyle (e.g., cigarette smoking), and occupational factors.

Adult↗