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PubMed1996

Early prediction of chronic disability after occupational low back injury.

STUDY DESIGN: An inception cohort design was used to study a consecutive sample of back-injured workers. OBJECTIVE: To refine and to test the Vermont Disability Prediction Questionnaire's ability to indicate an individual's relative risk for chronic disability after occupational low back injury. SUMMARY OF BACKGROUND DATA: Although most back-injured workers return to work quickly, the minority who do not account for the majority of associated costs and health care. Early identification of workers at high risk for disability would facilitate intervention strategies. METHODS: During the study recruitment period, people aged 18-60 years reporting occupational low back injury to the Vermont Department of Labor and Industry within 11 days of onset were eligible. A Vermont Disability Prediction Questionnaire was mailed to the 442 subjects who could be contacted and who gave informed consent. One hundred sixty-three of the 166 subjects who completed and returned the questionnaire within 15 days of initial injury were telephoned 3 months later to determine work status. Those who returned the questionnaire were compared with those who would not consent or did not return the questionnaire in time according to age, sex, residence, wages, work hours per week, and length of employment. Employment status (inability to work because of low back pain) was evaluated by telephone interview 3 months after initial injury. RESULTS: The follow-up interviewer was blinded to the Vermont Disability Prediction Questionnaire scores. of the 163 subjects, 16 (10%) were not working because of low back pain. Using a simple dichotomous scoring system for 11 questionnaire items, a cut-off score of 0.48 identified 3-month postinjury work status, with 0.94 sensitivity and 0.84 specificity. CONCLUSIONS: The Vermont Disability Prediction Questionnaire is a brief, easily administered and scored tool for identifying back-injured workers at relative risk for chronic disability. Such early identification should increase the efficiency of disability prevention strategies by directing them toward people who need them most. The accuracy of the questionnaire needs to be tested in a variety of different clinical and socioeconomic settings.

Adult↗

PubMed1997

The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain.

STUDY DESIGN: In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared. OBJECTIVES: To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts. BACKGROUND: Previous studies have produced conflicting results concerning this issue. METHODS: Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota-based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables. RESULTS: The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group. CONCLUSIONS: In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions.

Adult↗

PubMed1999

Posterior lumbar interbody fusion. Association between disability and psychological disturbance in noncompensation patients.

STUDY DESIGN: An observational study of the relation between disability and psychological distress in patients with no on-going compensation claim who underwent posterior lumbar interbody fusion for chronic low back pain. OBJECTIVES: To study the change in the relation between disability and psychological distress after surgical management for low back pain. SUMMARY OF BACKGROUND DATA: Patient-related factors such as an on-going compensation claim and patient psychology are thought to influence the outcome of low back pain management. METHODS: Of the 58 patients who underwent posterior lumbar interbody fusion for low back pain between 1990 and 1995, 53 were observed for a mean duration of 2.7 years after surgery. Oswestry Disability scores and Distress and Risk Assessment Method scores were collected before surgery and at the follow-up examination. RESULTS: Improvement of 10 points on the Oswestry Disability Score was observed in 52.8% of the patients. However, the results in patients who were distressed before surgery were similar to the results observed in healthy patients. The difference in the Oswestry Disability Scores was 3.1 (95% confidence intervals [-9.9, 16.2], P = 0.297). The change in Distress and Risk Assessment Method scores showed a significant relation to change in the Oswestry Disability Scores (P = 0.033). CONCLUSIONS: Postoperative improvement in disability was not found to be related to preoperative psychology as measured by the Distress and Risk Assessment Method score. Change in disability is significantly related to change in distress.

Adult↗

PubMed2005

Comparison of the functional rating index and the 18-item Roland-Morris Disability Questionnaire: responsiveness and reliability.

STUDY DESIGN: Retrospective design. OBJECTIVES: To compare the responsiveness and test-retest reliability of the Functional Rating Index and the 18-item version of the Roland-Morris Disability Questionnaire in detecting change in disability in patients with work-related low back pain. SUMMARY OF BACKGROUND DATA: Many low back pain-specific disability questionnaires are available, including the Functional Rating Index and the 18-item version of the Roland-Morris Disability Questionnaire. No previous study has compared the responsiveness and reliability of these questionnaires. METHODS: Files of patients who had been treated for work-related low back pain at a physical therapy clinic were reviewed, and those containing initial and follow-up Functional Rating Index and 18-item Roland-Morris Disability Questionnaires were selected. The responsiveness of both questionnaires was compared using two different methods. First, using the assumption that patients receiving treatment improve over time, various responsiveness coefficients were calculated. Second, using change in work status as an external criterion to identify improved and nonimproved patients, Spearman's rho and receiver operating characteristic curves were calculated. Reliability was estimated from the subset of patients who reported no change in their condition over this period and expressed with the intraclass correlation coefficient and the minimal detectable change. RESULTS: One hundred and forty-three patient files were retrieved. The responsiveness coefficients for the Functional Rating Index were greater than for the 18-item Roland-Morris Disability Questionnaire. The intraclass correlation coefficient values for both questionnaires calculated from 96 patient files were similar, but the minimal detectable change for the Functional Rating Index was less than for the 18-item Roland-Morris Disability Questionnaire. CONCLUSION: The Functional Rating Index seems preferable to the 18-item Roland-Morris Disability Questionnaire for use in clinical trials and clinical practice.

Adult↗

PubMed2002

Depression-related short-term disability in an employed population.

There has been a growing realization that the number of workplace disability claims for mental and nervous disorders is increasing. Yet, little is known about the working population disabled by these disorders. Absence of basic information describing this population makes it virtually impossible to plan effective workplace programs. Using administrative data collected from three major Canadian financial/insurance sector employers, we focus on one group of disorders--depression. In this study, we report the prevalence of short-term disability due to depression and describe the characteristics of workers affected and their disability outcomes. We observed that compared with other nervous and mental disorders, depression-related short-term disability generally affected more employees, lasted longer, and had a higher rate of recurrence. In addition, at the end of their episodes more than three quarters of workers returned to work. These estimates suggest that the potential magnitude of the impact of short-term disability should be a concern for employers. This study helps identify the main characteristics of workers who develop depression-related disability. It also helps clarify what happens to those on short-term disability.

Adult↗

PubMed2002

Disabling occupational injury in the US construction industry, 1996.

In 1996 the US construction industry comprised 5.4% of the annual US employment but accounted for 7.8% of nonfatal occupational injuries and illness and 9.7% of cases involving at least a day away from work. Information in the published literature on the disability arising from construction injuries is limited. The construction claims experience (n = 35,790) of a large workers' compensation insurer with national coverage was examined. The leading types and sources of disabling occupational morbidity in 1996 in the US construction industry were identified. Disability duration was calculated from indemnity payments data using previously published methods. The average disability duration for an injured construction worker was 46 days with a median of 0 days. The most frequently occurring conditions were low back pain (14.8%), foreign body eye injuries (8.5%), and finger lacerations (4.8%). Back pain also accounted for the greatest percentage of construction claim costs (21.3%) and disability days (25.5%). However, the conditions with the longest disability durations were sudden-onset injuries, including fractures of the ankle (median = 55 days), foot (42 days), and wrist (38 days). Same-level and elevated falls were the principal exposures for fractures of the wrist and ankle, whereas elevated falls and struck by incidents accounted for the majority of foot fractures. Manual materials handling activities were most often associated with low back pain disability. The results suggest that these most disabling injuries can be addressed by increasing primary prevention resources in slips and falls and exposures related to injuries of sudden-onset as well as in reducing manual materials handling and other exposures associated with more gradual-onset injuries.

Absenteeism↗

PubMed2006

Electronic momentary assessment in chronic pain II: pain and psychological pain responses as predictors of pain disability.

OBJECTIVES AND METHODS: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between pre-chronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). RESULTS: Pain intensity explained 8% to 19% of the disability variance. Beyond this psychological functioning explained 7% to 16%: particularly fear-avoidance and cognitive pain responses predicted chronic pain disorder disability; spousal responses predicted immobility better than other aspects of disability. Immobility due to actual pain occurred infrequently. When it did, however, it was better predicted by avoidance behavior in the patient and by spousal discouragement of movement than by actual pain intensity. The prediction of immobility due to pain by, respectively, avoidance behavior and catastrophizing was better in chronic pain (>6 months) and that of physical impairment by catastrophizing better in persistently chronic pain (>12 months) than in pain of shorter duration. DISCUSSION: The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.

Adult↗

PubMed2005

Understanding functioning, disability, and health in rheumatoid arthritis: the basis for rehabilitation care.

PURPOSE OF REVIEW: To examine the recent literature on rheumatoid arthritis in relation to functioning and disability, highlighting it from the perspective of the biopsychosocial model of functioning, disability, and health of the World Health Organization. This review focuses on longitudinal studies because they clarify associations found in cross-sectional studies and are useful in shedding light on the mechanisms that explain functioning and disability. RECENT FINDINGS: The studies that contribute best to understanding of functioning and disability in patients with rheumatoid arthritis are studies that (1) incorporate a comprehensive model to integrate different variables of interest, (2) use a longitudinal design to examine the potential casual relationships among the variables, and (3) use hierarchical regression analyses or path analysis to study the relation among variables. SUMMARY: It is time to rethink and redefine what should be measured when addressing functioning and disability of patients with rheumatoid arthritis. The use of a universally agreed framework and classification, such as the International Classification of Functioning, Disability and Health, a universally agreed-on comprehensive list of variables potentially relevant to functioning and disability in rheumatoid arthritis, and a greater focus on functioning-oriented versus disability-oriented perspectives constitute a solid foundation for such a rethinking process.

Activities of Daily Living↗

PubMedDate not supplied

Unemployment and disability in patients with moderately to severely active Crohn's disease.

GOALS: Unemployment and disability rates in Crohn's disease patients from the ACCENT I trial were assessed. Factors associated with employment and disability status were explored. BACKGROUND: Limited data regarding unemployment and disability status in patients with active Crohn's disease are available. STUDY: Baseline data were used to assess unemployment and disability rates. Logistic regression analysis examined factors that were associated with employment and disability status. Analysis of variance was used to compare quality of life. RESULTS: The baseline full-and part-time employment rates were 48% and 13%, respectively, with 39% of patients unemployed and 25% receiving disability compensation. Only 14% of 225 unemployed patients felt well enough to work if a job were available. Younger age, female gender, shorter disease duration, and prior bowel resection predicted a higher likelihood of unemployment. Younger age and female gender also predicted a higher likelihood of not being employed full-time. Prior bowel resection predicted a higher likelihood of receiving disability compensation. Quality of life (Inflammatory Bowel Disease Questionnaire, Short Form-36) scores were significantly higher in employed patients. CONCLUSIONS: Patients with moderately to severely active Crohn's disease had low employment and high disability rates. Given their economic importance, assessment of these outcomes should be integrated into future evaluations of therapy, including clinical trials.

Adrenal Cortex Hormones↗

PubMed2006

Attitudes toward people with disabilities: a comparison between health care professionals and students.

The objective of this study was to explore the attitudes of health care professionals and their students towards people in Hong Kong with disabilities. The attitudes of four groups of professionals and students (physiotherapists, occupational therapists, social workers and nurses) were assessed using the well-documented Attitude Toward Disabled Persons scale through the methodology of mailed questionnaires. Comparisons were made among different groups of students and professionals in order to gain insight into factors affecting their behavior. In this study, 511 students and 489 professionals were selected randomly. The results indicated that the overall mean Attitude Toward Disabled Persons scale score of the respondents was comparatively lower than that of their counterparts in foreign countries. The professionals had a significantly higher attitudinal score than the students. Among the four disciplines, nurses held the least favorable attitudes towards people with disabilities. In addition, their attitudes were less positive than those of the student nurses. On the other hand, the social work students had less favorable attitudes than the professional social workers, as well as other types of health care students. The analysis of the data also revealed that the mean Attitude Toward Disabled Persons scale scores for both the occupational therapists and occupational therapy students were above the overall average. Unlike the physiotherapists, the mean Attitude Toward Disabled Persons scale score of the physiotherapy students was below the overall average. In addition, age, year of study, educational level, knowledge and contact with people with disabilities were significant factors in the attitudes held by the students and professional respondents. The quality of the contact was found to be a dominant factor in affecting the scores on attitude. Thus, recommendations were made to modify the current training curriculum and enhance the quality of services to develop more favorable attitudes towards people with disabilities.

Attitude of Health Personnel↗

PubMed2003

Influence of poststroke urinary incontinence on disability: the nursing home setting.

OBJECTIVE: To characterize the association of poststroke urinary incontinence with disability progression in nursing home residents. DESIGN: In this prospective cohort study, the Minimum Data Set from the State of New York between 1994 and 1997 was utilized. From a pool of over 240,000 potential subjects, 500 met inclusion/exclusion criteria. Previously continent, first-time stroke survivors were classified as being continent or incontinent immediately after their stroke and were followed for changes in activities of daily living status (disability) at quarterly intervals for a 1 yr. In addition, a post hoc analysis was performed examining changes in activities of daily living status from the prestroke condition and exploring the relationship between poststroke impairments in continence and limitations in mobility. RESULTS: An almost 2-fold difference in level of disability was noted poststroke among those who were incontinent those who were continent (P < 0.001). This difference in disability level remained unchanged for 1 yr. Through the post hoc analysis, it was determined that, although the onset of stroke produced significant elevations in disability for both continent and incontinent stroke survivors (P < 0.001), the presence of an impairment in urinary continence was associated with a significantly greater increase (94% 13%) in disability (P < 0.001). In addition, incontinence occurred more frequently among those who had a loss in mobility function. CONCLUSION: Incontinence is a clinical factor after stroke that is associated with greater disability among nursing home residents. These findings have clinical implications for physiatrists and nursing home clinicians and provide a context in which future disability research can be conducted.

Activities of Daily Living↗

PubMed2006

Exploring how peak leg power and usual gait speed are linked to late-life disability: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002.

OBJECTIVE: To investigate the relation of both peak leg power and usual gait speed in their association with varying domains of late-life disability. DESIGN: Participants (> or =60 yrs of age, n = 1753) were from the National Health and Nutrition Examination Survey, 1999-2002. Disability in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities was obtained by self-report. Peak muscle power was the product of isokinetic peak leg torque and peak force velocity. Functional limitations were evaluated via usual gait speed, which was obtained from a 20-foot timed walk. RESULTS: Low usual gait speed was associated with disability independent of basic demographics, cognitive performance, co-morbidities, health behaviors, and inflammatory markers. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in walking speed were 0.72 (95% confidence interval [CI], 0.59-0.87), 0.63 (95% CI, 0.52-0.77), 0.57 (95% CI, 0.45-0.72), 0.56 (95% CI, 0.47-0.67), and 0.74 (95% CI, 0.64-0.85), respectively. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in leg power were 0.70 (95% CI, 0.55-0.89), 0.67 (95% CI, 0.53-0.86), 0.62 (95% CI, 0.47-0.83), 0.58 (95% CI, 0.47-0.72), and 0.73 (95% CI, 0.61-0.87), respectively. Supplementary adjustment for walking speed mildly attenuated the relation of leg power to disability. CONCLUSION: Peak leg power and habitual gait speed were associated with varying domains of late-life disability. The association between peak leg power and disability seems to be partially mediated through usual gait speed.

Activities of Daily Living↗

PubMedDate not supplied

Effect on disability outcomes of a depression relapse prevention program.

OBJECTIVE: This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse. MATERIALS AND METHODS: Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription. Patients responding to initial treatment but at high risk for relapse were randomized to usual care or a relapse prevention intervention (N= 386). The 12-month relapse prevention program included systematic patient education, two psycho-educational visits with a depression prevention specialist, shared decision-making regarding maintenance pharmacotherapy, and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail. Disability outcomes were assessed via blinded telephone assessments at 3, 6, 9, and 12 months using SF-36 and Sheehan Disability scales. RESULTS: Usual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy. Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period. One of the three disability measures (the SF-36 Social Function scale) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up, whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls. CONCLUSIONS: Moderate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes. Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients, relatively mild levels of depressive symptoms among both intervention and control patients at baseline, the absence of a specific relapse prevention effect of the intervention, and the resultant modest differences in depressive symptoms between intervention and control patients in this trial.

Adult↗

PubMedDate not supplied

Potentially modifiable factors associated with disability among people with diabetes.

OBJECTIVE: This article seeks to identify potentially modifiable factors associated with disability among people with diabetes. STUDY DESIGN AND SETTING: Among people with diabetes (N = 4357) in a large health maintenance organization, disease severity, psychologic and behavioral risk factors for disability were assessed. Disability was evaluated by the WHO Disability Assessment Scale (WHO-DAS-II), the SF-36 Social Functioning scale, and days of reduced household work. RESULTS: Depression was associated with a tenfold increase in elevated WHO-DAS-II and low SF-36 Social Functioning scores, and a fourfold increase in 20+ days of reduced household work. Minor depression and the presence of three or more diabetic complications were associated with approximately a twofold increase in disability risk. Diabetic symptoms, chronic disease comorbidity, and reduced exercise were also associated with disability. CONCLUSION: Among people with diabetes, depression, diabetic complications, and exercise are potentially modifiable factors associated with disability. This suggests that integrated, biopsychosocial approaches may be needed to understand and to ameliorate disability among people with diabetes.

Activities of Daily Living↗

PubMed2006

A comparison of self-reported and independently observed disability in an orthopedic trauma population.

BACKGROUND: Although outcome measures that assess disability after isolated orthopedic injuries have been found to be valid and responsive to change, the reliability of self-reported disability has not been studied in these patients. The purpose of this study was to compare self-reported and independently observed disability in patients with isolated orthopedic injuries. METHODS: Items were selected from the Short Musculoskeletal Functional Assessment (SMFA) and Disabilities of the Arm, Shoulder, and Hand (DASH) outcome assessment instruments. Participants had either an isolated upper (n = 61) or lower extremity (n = 55) injury or were noninjured controls (n = 40). Participants completed the SMFA and DASH before being videotaped completing items selected from the outcome assessment instruments. Observers reviewed the video and rated participants' levels of disability in performing the items. RESULTS: Observers consistently rated the disability levels for the items lower than the participants. Overall, agreement in levels of disability between observers and participants varied greatly across the different items (quadratic weighted kappa; range, 0.00-0.82). CONCLUSION: The results emphasize that patients and observers differ in their assessment of an individual's level of disability in performing items related to activities of daily living. Therefore, caution should be used when data collected by a proxy observer is used to substitute self-reported data.

Activities of Daily Living↗

PubMed2005

Quality of life and disability assessment in neuropathy: a multicentre study.

Neuropathy can severely affect patients' quality of life (QoL), causing disability and decreased motor efficiency while modifying their perception of the external environment. We performed a large, multi-perspective, and multi-measurement assessment using validated clinical measurements of disability and QoL. With regard to general disability, more than 10% of patients needed assistance to walk. With regard to arm disability, about 10% of patients had severe disability defined as impairment in carrying out simple tasks. General disability was similar both in polyneuropathic and multi-neuropathic groups, but arm disability appeared more severe in multi-neuropathic patients. QoL profiles were highly deteriorated in our sample with respect to the Italian normative sample. All age brackets were highly impaired except for older patients for whom the QoL picture was only mildly impaired with respect to Italian norms. We believe that our study provides reliable data on QoL in patients with neuropathies and that it may represent a quantitative step forward in understanding the disability of patients with neuropathy.

Adolescent↗

PubMedDate not supplied

Characteristics of social interactions between mothers and their disabled infants: a review.

This paper examines interactional characteristics of disabled infants and young children and their mothers. Interactional characteristics of disabled infants and young children differ from those of non-disabled children in several ways: disabled children provide fewer and less readable cues to the mother; they demonstrate less positive affect, more negative affect, and more muted affect; and they have more difficulties synchronizing turn-taking than non-handicapped children. Maternal interactions with disabled children differ from those of mothers with non-disabled children in dimensions involving maternal activity and positive affect. It is suggested that the social deficits commonly observed in disabled preschoolers and older children may have begun in the altered social interactional patterns observed in infancy. Various intervention strategies are described which assist parents to achieve more pleasurable, reciprocal, child-centered interactions with their disabled infants.

Persons with Disabilities↗

PubMed2005

Ascertaining the prevalence of childhood disability.

OBJECTIVES: To reapply 1985 Office of Population Census and Surveys (OPCS) disability survey methods, modified as necessary, to a sample of children to ascertain presence of disability. To compare OPCS-based prevalence with prevalence based on carer's views and medical records. DESIGN: Analytical study. Setting Community Child Health Department in UK. PARTICIPANTS: Principal carers of 100 children aged 5-15, selected from a district special needs register. Main outcome measures Comparable information about disability from three sources and diagnosis from carers and medical records. RESULTS: Medical records of 46% contained a diagnosis. Carers were always aware of this, although a single question did not always elicit their knowledge. OPCS-derived threshold disability criteria in categories of Hand function, Personal care, Consciousness and Continence gave prevalence results similar to medical records and carers. OPCS criteria yielded higher prevalence of disability in the areas of Locomotion (8%), Communication (14%) and Hearing (18%). Carers, OPCS and medical records disagreed markedly about prevalence of disabilities of Vision, probably because of the use of differing definitions. OPCS learning criteria were judged unsuitable and standard attainment targets (SATs) were substituted. These provided similar prevalence figures to carers and medical records. OPCS behaviour criteria were also unsuitable and were replaced by the General Health and Behaviour Questionnaire (GHBQ). This found an increased prevalence of problems compared with carers and doctors. CONCLUSIONS: Diagnostic labels have limited use when collecting data about disabled children. Doubt is cast on the validity of some of the 1985 OPCS threshold criteria, and reassessment is suggested before their future use. Further work is needed on the use of SATs and GHBQ in the benchmarking of disability. To collect population data it would be easier and at least equally effective (with caution in the case of Vision) to ask carers directly rather than applying descriptive thresholds and external judgements. Similar information could be obtained from medical records, however, they are likely to be out of date.

Adolescent↗