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PubMed2005

Impact of age-related cerebral white matter changes on the transition to disability -- the LADIS study: rationale, design and methodology.

Age-related white matter changes (ARWMC) on brain MRI have been associated with cognitive, motor, mood and urinary disturbances. These factors are known to contribute to disability in elderly people, but the impact of ARWMC and of their progression on the transition to disability is not determined. The LADIS (Leukoaraiosis and Disability in the Elderly) study aims at assessing the role of ARWMC as an independent predictor of the transition to disability in initially nondisabled elderly (65-84 years). Subjects who are not impaired or impaired on only 1 item of the Instrumental Activity of Daily Living (IADL) scale, presenting with different grades of ARWMC severity, were enrolled. Eleven European centers are involved. All the patients were assessed at baseline using an extensive set of clinical and functional tests including global functioning, cognitive, motor, psychiatric and quality of life measures. MRI studies were performed at baseline and will be repeated at the end of the follow-up period to evaluate changes of ARWMC and other lesions. ARWMC were categorized into mild, moderate or severe using the scale of Fazekas et al. For each ARWMC severity class, the primary study outcome is the transition to disability defined as an impairment on 2 or more IADL scale items. Secondary outcomes are the occurrence of dementia, depression, vascular events or death. Six-hundred and thirty-nine subjects (mean age 74.13 +/- 5.0 years, M/F: 288/351) were enrolled in a hospital-based setting and are being followed up for up to 3 years. The large and comprehensive set of measures in LADIS enables a comprehensive description of their functional and clinical features to be examined in relation to different morphological patterns and severity of ARWMC. The longitudinal design will give insight into the possible role of ARWMC and their progression as an independent contributor to disability in the elderly, eventually helping to develop preventive strategies to reduce the burden of disability in late life. The study results may also help to standardize, on an international basis, tools and criteria to identify early stages of disability.

Activities of Daily Living↗

PubMed1991

Evaluation of Parkinson's disease: a new approach to disability.

Testing the reliability and usefulness of disability scales in Parkinson's disease has been the object of a study carried out by 4 neurologists on 48 patients using 2 rating scales--Hoehn and Yahr staging and Columbia University Rating Scale--and 2 disability scales--Northwestern University Disability Scale and Extensive Disability Scale, a new scale conceived for this purpose, which is more accurate in examining in a different way the physical incapacity and handicap of parkinsonian patients in their daily living. The examiners worked in pairs and did not discuss their rating scores before the end of the study. As far as interobserver agreement is concerned, the results of the disability scales are better than those of the rating scales. The Northwestern Disability Scale and the new scale are similar in reliability and consistency; however, the Extensive Disability Scale has proved to be a better indicator of the functional status. We suggest a more extensive employment of disability scales in clinical studies.

Activities of Daily Living↗

PubMed2004

Disability measures in stroke: relationship among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale.

BACKGROUND AND PURPOSE: Residual disability after stroke presents a major economic and humanistic burden. To quantify disability in patients, activities of daily living (ADL; Barthel Index [BI], and motor component of Functional Independence Measure [M-FIM]) and categorical disability measures (Modified Rankin Scale [MRS]) are used. The purpose of this study is to examine the predicting ability of ADL measures to global disability scale. METHODS: Kansas City Stroke Study data were used for the present study. Correlation coefficient, Kruskal-Wallis test, and polytomous logistic regression analysis were applied to examine the relationship between the ADL measure and global disability scale. Model fit statistics were examined to verify logistic regression appropriateness. A categorization scheme, which minimized the false-positive response rate, was selected as the optimal categorizing system. RESULTS: The 3 measures were highly correlated. Both BI and M-FIM differentiated disability better in lower than higher disability. In logistic regression, BI differentiated 4 disability levels; M-FIM differentiated 3 levels in MRS. However, on the basis of results of the Kruskal-Wallis and multiple comparison tests, we suspect that M-FIM may have the potential to predict MRS categories better with a different model. CONCLUSIONS: The proposed categorization scheme can serve as a translation between measures. However, because of the ceiling effect of BI and M-FIM, the translation could not be completed for all 6 levels of MRS. No apparent variation over time in the categorization scheme was observed. Further research needs to be conducted to develop better prediction models explaining the relationship between M-FIM and MRS.

Activities of Daily Living↗

PubMed1999

Asthma-related work disability in Sweden. The impact of workplace exposures.

Work disability due to respiratory disease, especially asthma, is common and costly among working age adults. The goal of this analysis was to characterize the risk factors for such disability. We analyzed data from the Swedish part of the European Community Respiratory Health Survey (ECRHS), a random population-based sample of adults age 20 to 44, enriched with symptomatic subjects at increased likelihood of having asthma. We analyzed structured interview data available for 2,065 subjects and further analyzed methacholine challenge and skin prick test data for 1,562 of these. We defined respiratory work disability as reported job change or work loss due to breathing affected by a job. We used binary generalized linear modeling with a log link to estimate disability risk. Eighty-four subjects (4%) reported such work disability. This increased to 13% among those with asthma (45 of 350 subjects). Adjusting for covariates, occupations at high risk for asthma were associated with disability (prevalence ratio [PR] 1.8; 95% confidence interval [CI] 1.1 to 3.0), as was self-reported regular exposure to environmental tobacco smoke (ETS) at work (PR 1.8; 95% CI 1.1 to 3.1) and self- reported job exposure to vapors, gases, dust, or fumes (VGDF) (PR 4.3; 95% CI 2.2 to 8.6). Workplace ETS exposure was also associated with methacholine challenge-positive asthma reported to be symptomatic at work among male subjects (PR 4. 2; 95% CI 1.8 to 9.8), whereas high asthma-risk occupations were associated with this outcome among female subjects (PR 2.7; 95% CI 1. 05 to 7.1). Respiratory work disability, defined as breathing-related job change due to work loss, was associated with workplace exposures themselves, even after taking into account other covariates. Better control of workplace exposures, including workplace ETS, may reduce work disability caused by respiratory conditions, especially adult asthma.

Adult↗

PubMed1983

Statistical "biases" in respiratory disability determinations.

The manner in which pulmonary function test results are employed in the assessment of respiratory disability may be affected by 4 statistical choices: (1) choice of prediction equation(s), (2) adjustment factors (such as sex and race), (3) criterion values, and (4) method of comparison of observed to predicted normal test values. The records of 900 respiratory disability applicants were employed to estimate the direction and magnitude of the effect of these choices on the overall number of persons who would be declared "disabled" and upon the manner in which personal characteristics (e.g., sex, race, height, age) affect the likelihood of being declared "disabled." Choice of prediction equation had minor effects, and adjustment for race and sex had more significant effects. Choice of criterion value affected the overall number and, in certain instances (e.g., Social Security Disability Insurance), the distribution of "disability" declarations. Method of comparison (percent of predicted, difference of predicted minus observed or minimal value criterion) had major effects upon the distribution of "disability" declarations between population subgroups. Preliminary analysis therefore suggests that these statistical choices should be carefully manipulated in the design of a disability system to facilitate achievement of the system's goals.

Age Factors↗

PubMed1997

Mental disorders and disability among patients in a primary care group practice.

OBJECTIVE: This article examines social and occupational disability associated with several DSM-IV mental disorders in a group of adult primary care outpatients. METHOD: The subjects were 1,001 primary care patients (aged 18-70 years) in a large health maintenance organization. Data on each patient's sociodemographic characteristics and functional disability, including scores on the Sheehan Disability Scale, were collected at the time of a medical visit. A structured diagnostic interview for current DSM-IV disorders was then completed by a mental health professional over the telephone within 4 days of the visit. RESULTS: The most prevalent disorders were phobias (7.7%), major depressive disorder (7.3%), alcohol use disorders (5.2%), generalized anxiety disorder (3.7%), and panic disorder (3.0%). A total of 8.3% of the patients met the criteria for more than one mental disorder. The proportion of patients with co-occurring mental disorders varied by index disorder from 50.0% (alcohol use disorder) to 89.2% (generalized anxiety disorder). Compared with patients who had a single mental disorder, patients with co-occurring disorders reported significantly more disability in social and occupational functioning. After adjustment for other mental disorders and demographic and general health factors, compared with patients with no mental disorder, only patients with major depressive disorder, bipolar disorder, phobias, and substance use disorders had significantly increased disability, as measured by the Sheehan Disability Scale. CONCLUSIONS: Primary care patients with more than one mental disorder are common and highly disabled. Individual mental disorders have distinct patterns of psychiatric comorbidity and disability.

Persons with Disabilities↗

PubMedDate not supplied

The effects of extended time on algebra test scores for college students with and without learning disabilities.

The purpose of this study was to assess the effects of extended time on the algebra test performance of community college students with and without learning disabilities. Forty-four students with learning disabilities and 44 students without learning disabilities attending five California community colleges participated in the study. The students each took an algebra test under timed conditions and a comparable test under extended-time conditions. The main results were that the students with learning disabilities scored significantly lower than the students without learning disabilities under timed conditions, the scores of the students with learning disabilities increased significantly with extended time, and the scores of the students with learning disabilities under extended-time conditions did not differ significantly from the timed or extended-time scores of the students without learning disabilities.

Adolescent↗

PubMed2005

Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement.

BACKGROUND: Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form-36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported. HYPOTHESIS: Short Form-36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The records of active-duty soldiers who underwent hip arthroscopy at the authors' institution were retrospectively reviewed. Forty consecutive patients who underwent hip arthroscopy for the primary indication of labral tear formed the basis of the study group. Patients completed the modified Harris hip score, the Short Form-36 general health survey, and a subjective overall satisfaction questionnaire. RESULTS: Thirty-three patients, with a mean age of 34.6 years, were available for follow-up at a mean of 25.7 months postoperatively. Fourteen (43%) patients were undergoing medical evaluation boards (military equivalent of workers' compensation or disability claim). Pearson correlation coefficients for comparing the Short Form-36 Bodily Pain, Physical Function, and Physical Component subscale scores to the modified Harris hip score were 0.73, 0.71, and 0.85, respectively (P < .001). The mean modified Harris hip score was significantly lower in patients on disability status than in those who were not (92.4 vs 61.1; P < .0001). The Short Form-36 subscale scores were significantly lower in disability patients (P < .02). Patient-reported satisfaction rates (70% overall) were 50% for those undergoing disability evaluations and 84% for those who were not (P < .04). There was no significant difference in outcomes based on patient age, surgically proven chondromalacia, or gender for military evaluation board status. CONCLUSION: The Short Form-36 demonstrated good correlation with the modified Harris hip score for measuring outcomes after arthroscopic partial limbectomy. Arthroscopic debridement yielded a high percentage of good results when patients undergoing disability evaluations were excluded. Disability status may be a negative predictor of success after hip arthroscopy.

Acetabulum↗

PubMedDate not supplied

Access to breast cancer screening services for women with disabilities.

OBJECTIVE: To identify barriers to breast cancer screening services encountered by women with physical disabilities. DESIGN: Phenomenologic design using a semi-structured interview guide to explore the experiences of women with disabilities seeking breast cancer screening services. SETTING: Face-to face interviews conducted in the homes of women from the urban and rural mid-south. PATIENTS/PARTICIPANTS: A purposive sample of women with motor or sensory disabilities, age 21 to 65, was recruited for this study based on community type and type and severity of disability. Community collaborators working with people with disabilities identified eligible participants. RESULTS: Although the study focused on breast cancer screening services, women also described financial, architectural, environmental, and attitudinal barriers that affected all of their health care services. Women described poor transportation, heavy doors, and inaccessible exam tables and bathrooms. They felt devalued by their providers and believed that their symptoms were often overlooked. Women with disabilities want to be partners in their own health care. CONCLUSIONS: Women with physical disabilities face both financial and nonfinancial barriers to access that may result in delayed detection and increased risk of poorer outcomes from breast cancer. Providers require education about working with women with disabilities.

Adult↗

PubMed1999

People with disabilities--the same, but different: implications for health care practice.

Despite the author's experiences as a nurse and parent of a young adult with physical disabilities, the author had much to learn about the culture surrounding disability. The contemporary "minority-group" model for disability replaces a medical model that views people with disabilities in need of remediation. Disability rights advocates often criticize health professionals, citing erroneous assumptions and failure to understand the perspectives of disabled persons. The author illustrates applications for clinical practice by health professionals with excerpts from a qualitative study that explored the spiritual experiences of adults with physical disabilities and family members as well as their responses to lived experience with disability.

Adaptation, Psychological↗

PubMedDate not supplied

Use of screening and preventive services among women with disabilities.

Roughly 54 million Americans have some disability; at older ages, women are more likely to be disabled than men. Many people with disabilities today live virtually normal life spans, and therefore routine screening and preventive services are essential to their overall quality of care. We used the 1994-1995 National Health Interview Survey (NHIS), with Disability, Family Resources, and Healthy People 2000 supplements, to examine screening and preventive service use for adult women with disabilities living in the community--about 18.4% of women (estimated 18.28 million). Disability was associated with higher age-adjusted rates of: poverty; living alone; low education; inability to work; obesity; and being frequently depressed or anxious. Disabled women generally reported screening and preventive services at rates comparable to all women. Women with major lower extremity mobility difficulties had much lower adjusted odds of Papanicolaou smears (odds ratio, 0.6; 95% confidence interval, 0.4-0.9), mammograms (odds ratio, 0.7; 95% confidence interval, 0.5-0.9), and smoking queries (odds ratio, 0.6; 95% confidence interval, 0.5-0.8). Various approaches exist to improve access for disabled women to health care services.

Adult↗

PubMed2004

Impact of demographic and impairment-related variables on disability associated with plantar fasciitis.

BACKGROUND: Plantar fasciitis is a common foot disorder that impacts many functional activities. Research that quantifies the impact that plantar fasciitis has on function is lacking. In addition, little is known about which variables are associated with disability in patients with plantar fasciitis. The first purpose of this study was to determine if age, gender, body mass index, pain intensity, chronicity of symptoms, or ankle dorsiflexion range of motion was associated with disability in patients with plantar fasciitis. The second purpose was to describe the impact that plantar fasciitis has on functional status in the context of five functional domains: household activities of daily living, usual work and hobbies, nonweightbearing activities, walking-related activities, and running-related activities. METHODS: Fifty consecutive patients diagnosed with unilateral plantar fasciitis were recruited. Demographic and impairment data were collected and all patients completed the Lower Extremity Functional Scale (LEFS), a validated self-report measure of disability. Multiple regression analysis was used to describe the association between the variables and disability. Graphs depicting five domains of function derived from the LEFS were generated to describe the extent of disability. RESULTS: Body mass index (BMI) was the only variable that was significantly associated with disability (F = 9.87, p =.003). Measures of pain intensity, ankle dorsiflexion, age, gender, chronicity, and time spent weightbearing were not related to disability. Plantar fasciitis showed distinct patterns of disability depending on the functional domain that was assessed. CONCLUSIONS: With the exception of BMI, impairment and demographic variables do not predict the extent of functional loss in patients with plantar fasciitis. The most likely domains of function to be at least moderately affected in patients with plantar fasciitis are running-related activities and usual work or hobbies.

Adult↗

PubMed2005

Increase of mild disability in Japanese elders: a seven year follow-up cohort study.

BACKGROUND: Japan has the highest life expectancy in the world. In a 2002 census government report, 18.5% of Japanese were 65 years old and over and 7.9% were over 75 years old. In this ageing population, the increase in the number of dependent older persons, especially those with mild levels of disability, has had a significant impact on the insurance budget. This study examines the increase of mild disability and its related factors. METHODS: All community-dwelling residents aged 65 and over and without functional decline (n = 1560), of Omishima town, Japan, were assessed in 1996 using a simple illustrative measure, "the Typology of the Aged with Illustrations" to establish a baseline level of function and were followed annually until 2002. The prevalence and incidence of low to severe disability, and their association with chronic conditions present at the commencement of the study, was analyzed. A polychotomous logistic regression model was constructed to estimate the association of each chronic condition with two levels of disability. RESULTS: An increase in mild functional decline was more prevalent than severe functional decline. The accumulation of mild disability was more prominent in women. The major chronic conditions associated with mild disability were chronic arthritis and diabetes in women, and cerebrovascular accident and malignancy in men. CONCLUSION: This study showed a tendency for mild disability prevalence to increase in Japanese elders, and some risk factors were identified. As mild disability increasingly prevalent, these findings will help determine priorities for its prevention in Japanese elders.

Activities of Daily Living↗

PubMed2006

Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses.

BACKGROUND: Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. DISCUSSION: Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs - equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care - and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. SUMMARY: This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of - or revisions to - a regionalised health care strategy.

Adult↗

PubMed2000

An epidemiological survey of the health needs of disabled people in a rural community.

OBJECTIVE: To describe service use and unmet needs of disabled people in a rural environment, given well-recognized difficulties in providing equitable services to a widely-spread population, availability of transport and the presence of discrepancies in wealth. PARTICIPANTS: Disabled people registered with a single rural general practice, identified by postal questionnaire. METHOD: All 3462 households were screened using the Office of Population, Censuses and Surveys (OPCS) disability screening questionnaire. An 86% response rate was achieved. Seventy-four people aged 16-65 and 69 people aged 66-75 were interviewed by a rehabilitation physician. Fifty-five people aged 76+ were interviewed. Disability was assessed using the OPCS scales of disability, Barthel Index, and Hospital Anxiety and Depression Scale. RESULTS: Thirty per cent (43) of those aged 16-75 received assistance for their personal activities of daily living (ADLs), and 98% (140) required assistance for extended ADLs (taken from the OPCS surveys criteria). There was no difference in either disability or dependency by age group. Fifty-three per cent of this group had domestic adaptations, 75% had disability aids. Those aged 16-75 had significantly fewer aids and adaptations, less home care, care management, respite, district nursing and chiropody services than people over 75. Equipment was provided by statutory services less frequently and fewer carers were salaried. The rehabilitation physician assessed them as needing more occupational therapy, physiotherapy and chiropody. Thirty per cent saw their GP monthly and 45% attended hospital. CONCLUSION: Unmet need was assessed as greater in the younger group. Elderly people are possibly more visible to service providers with better recognition of need. There is no evidence of a relationship between medical surveillance and identification of rehabilitation needs. Those with greater degrees of disability require more interlinked and organized services.

Activities of Daily Living↗

PubMed2003

Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap.

OBJECTIVES: (1) To examine the relationships between measures of impairment and disability for the arm and leg with a measure of handicap and (2) to identify the impairment or disability most strongly related to handicap situations. DESIGN: Prospective cohort study. SETTING: Intensive functional rehabilitation unit and community. PATIENTS: One hundred and two persons who had a stroke. MAIN OUTCOME MEASURES: Arm and leg impairments and disabilities were evaluated with reliable and valid tests at discharge from rehabilitation. Six months later, handicap situations were evaluated with the Assessments of Life Habits (LIFE-H). RESULTS: Arm and leg impairments and disabilities are correlated with handicap situations. Disability of the leg is more strongly associated with handicap than arm disability. Arm and leg disabilities are not statistically more strongly related to handicap than arm and leg impairments. CONCLUSIONS: The high correlations found between handicap situations and the impairment and disability measures of the leg provide new information that support the importance of mobility to promote integration after stroke.

Aged↗

PubMed2004

Rehabilitation outcomes after brain injury: disability measures or goal achievement?

BACKGROUND: The outcome of rehabilitation interventions following brain injury is commonly rated by disability scales. Goal-setting and achievement are important in inpatient rehabilitation, but seldom assessed as outcomes. OBJECTIVE: To compare the information acquired from using disability ratings and goal attainment/variances as outcome measures in brain injury rehabilitation. SETTING: An inpatient regional neurological rehabilitation unit. SUBJECTS: One hundred and seventy-seven patients admitted after single incident brain injury over a three-year period. MAIN MEASURES: (1) Disability outcomes by the Barthel Index and the Functional Independence Measure, (2) goal achievement and variance distribution, and (3) the influence of diagnosis and demographics on these measures. RESULTS: Patients improved significantly on all disability scales employed (p < 0.0001), with the baseline admission scores being inversely correlated with changes in dependency by discharge (rho approximately -0.4). The median attainment rate of long-term goals was 75% per patient. Nonachievement was most frequently due to cognitive problems (38%), followed by behavioural difficulties and physical limitations (18% each). Goal achievement correlated poorly with disability outcome at discharge (rho < 0.3). Patients who accomplished all their goals tended to be less disabled at admission. Diagnostic groups and demographic factors had little influence on either disability or goal achievement outcomes. CONCLUSIONS: The use of a simple goal achievement and variance coding scheme has been relatively straightforward to incorporate into the daily practice of the unit. It provides useful information on rehabilitation process and outcome after brain injury that is complementary to the utilization of disability measures.

Achievement↗

PubMed2000

Health care provision for people with a learning disability. Record-linkage study of epidemiology and factors contributing to hospital care uptake.

BACKGROUND: We know little about how people with a learning disability access secondary health care. AIMS: To describe the epidemiology of learning disability, the influence of deprivation on prevalence and the pattern of secondary care uptake, including the effect of institutionalisation. METHOD: A record-linkage study of secondary care contacts of 434,000 people between 1991 and 1997. A population with learning disability was identified; their secondary care contact was calculated and compared with the general population's. RESULTS: The distribution of people with a learning disability (n = 1595) correlated significantly with deprivation. The presence of a learning disability hospital significantly affected care uptake. Place of residence also affected acute admission to the learning disability hospital. Former institution residents generated 212 admissions per 1000 patients; community patients generated 18 per 1000. The admission rate with any psychiatric diagnosis to any setting was 26.3 per 1000 people with a learning disability; 16.5% of such patients had a dual diagnosis. CONCLUSIONS: Health provision for people with a learning disability is affected by institutional provision.

Adolescent↗