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PubMed2004

The utility of anthropometric assessment at institutions and schools for individuals with intellectual disabilities and/or motor disabilities: a nation-wide survey in Japan.

OBJECTIVES: To obtain information regarding the actual methods used for nutritional assessment at institutions and schools in order to establish a nutritional assessment method for individuals with disabilities. METHODS: Questionnaires were sent to 1,080 selected institutions and schools for individuals with intellectual disabilities (ID) and/or motor disabilities (MD). The response rate was 76.5%. RESULTS: The implementation rates for height and weight measurements were generally very high at both institutions and schools for individuals with ID and/or MD (85.5-100%), but those for other items were very low and varied among different disability types. The implementation rate for BMI was 17.9-71.9%, demonstrating that BMI was not widely used among institutions and schools for individuals with ID and/or MD. As for the methods for calculating percent body fat, a high percentage of institutions and schools for individuals with ID and/or MD indicated the use of bioelectrical impedance analysis for most disability types (60 - 77.9%). CONCLUSIONS: The percentages of institutions for individuals with ID and/or MD and of schools for individuals with ID and/or MD that implement nutritional assessment are very low, with variations among different disability types.

Adipose Tissue↗

PubMed2001

Public plans--Americans with Disabilities Act--discrimination-disparate treatment of mental disabilities. Rogers v. Department of Health and Environmental Control, 174 F.3d 431 (4th Cir.1999).

Title II of the Americans with Disabilities Act of 1990 (ADA), which prohibits discrimination in the services, programs or activities of public entities, does not require a state's long-term disability plan to provide the same level of benefits for mental and physical disabilities. By placing mental disabilities in different risk classifications from physical disabilities, South Carolina's long-term disability plan did not violate a South Carolina statute that prohibits discrimination "between insureds of the same class and risk involving the same hazards."

Persons with Disabilities↗

PubMedDate not supplied

Measuring functional disability in early rheumatoid arthritis: the validity, reliability and responsiveness of the Recent-Onset Arthritis Disability (ROAD) index.

OBJECTIVE: Disability has been identified as a core outcome measure in rheumatoid arthritis (RA). The aim of this study was to test the Recent-Onset Arthritis Disability (ROAD) questionnaire for validity, reliability and responsiveness in Italian patients with early RA. METHODS: The psychometric properties of ROAD were tested in 159 patients with early RA, mean age 54.7 (+/- 8.8), 74.3% women, mean disease duration 14.5 months (+/- 1.9 months). All completed the ROAD, the Medical Outcomes Study SF-36 Health Survey (SF-36), the Health Assessment Questionnaire (HAQ) and the patient global assessment (PGA) of functional disability twice, in order to test for validity and responsiveness. Of the 159 patients who completed the health status instruments on two occasions, 121 were included in the responsiveness analyses. The test-retest reliability of the ROAD questionnaire was calculated using intraclass correlation coefficients (ICCs) and the Bland and Altman method on 77 patients who completed the questionnaire twice over an interval of one week. Construct validity was assessed using Spearman's correlations, while responsiveness was evaluated by 3 different methods: (1) effect size (the mean difference between the baseline scores and thefollow-up scores divided by the standard deviation of the baseline scores); (2) standardized response mean (the mean change in scores divided by the standard deviation of the change in scores); (3) receiver operating characteristics (ROC) curve analysis. RESULTS: ROAD fulfilled the established criteria for validity, reliability and responsiveness. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, thus supporting the convergent construct validity. Significant correlations were seen between ROAD scores and HAQ scores (rho = 0.372), SF-36 physical component summary (PCS) (rho = -0.413), PGA functional disability (rho = 0.417), pain (rho = 0.639), Ritchie index (rho = 0.357), number of swollen joints (rho = 0.387), patient and physician assessment of disease activity (rho = 0.467 and 0.323, respectively), and Disease Activity Score (rho = 0.476). Test-retest reliability was satisfactory, with ICCs of 0.927 (upper extremity function), 0.892 (lower extremity function), and 0.851 (activity of daily living/work). Bland-Altman plots confirmed this finding. The results of responsiveness analysis indicate that the ROAD subscales were slightly more sensitive to perceived change in functional disability than those of HAQ, SF-36 PCS, and PGA offunctional disability. CONCLUSION: Our data suggest that the ROAD index is a reliable, valid and responsive tool for measuring physical functioning in patients with early RA, and is suitable for use in clinical trials and daily clinical practice. Its generalizability and utility for assessing aggressive treatment and functional outcomes must now be evaluated in broader settings.

Arthritis, Rheumatoid↗

PubMed1978

Work and disability at the age of 30 years. A sociomedical study of a birth-cohort from Bergen. III. Disability as related to medical, psychological and educational background.

This article deals with occupational disability at the age of 30 years, seen the light of medical, psychological and educational background. The study is based on a cohort of 1570 persons, all live births in 1940 of mothers then residing in Bergen. This birth-cohort was followed-up in the compulsory school system at age 14 years, and again at age 30 years, concluding at 1st June 1971. Only those of the cohort residing in Norway on 1st June 1971, a total of 1331 persons, are included in the present analysis. The diagnoses discussed are based on data obtained from disability pension case records, from the National Insurance Institution files and from the Public Welfare office files. Results of medical and psychological examinations made on a stratified random sample of the cohort are also used. Thirty-seven persons (2.8%) of the total of 1331 were found to be disabled according to the criteria set for this study. The prevailing primary diagnosis was mental disorder, as 25 of the disabled had this diagnosis, oligophrenia being dominant. The former pupils in the different types of compulsory school attended at age 14 years show a frequency of disability at age 30 years as follows: junior high school 0.8%, continuation school 1.3%, elementary school classes for slow learners 10.7%, special schools for the educable mentally retarded 32.7%, and receiving services for the mentally retarded, 97.0%.

Adult↗

PubMed1991

Comparison of the old and new W.H.O. leprosy disability grading scheme for ocular disabilities.

We compared the old (1970) and new (1988) World Health Organization schemes for classifying the ocular disabilities in leprosy patients. 509 leprosy patients from eight resettlement villages in central South Korea were examined and graded by eye according to both of the schemes. A more liberal definition of severely disabled in 1988 resulted in a 119% increase in eyes graded as severely disabled in this population. 59 eyes were graded as severely disabled by the old scheme and 129 eyes were so graded according to the new scheme. Keratitis, one of three measures of moderate disability in the old scheme, was replaced by corneal anaesthesia in the new scheme, but this change did not make a substantial difference in the number of patients in the moderately impaired category. In the absence of longitudinal studies documenting the significance of keratitis, it is unclear whether the change in an improvement. The new disability scheme improved upon the old by removing the criteria for mild impairment.

Adult↗

PubMed2005

Higher education and psychiatric disabilities: national survey of campus disability services.

Students with psychiatric disabilities are an increasing presence on college and university campuses. However, there is little factual information about the services available to these students in campus disability services offices or the extent to which they use these services. This article reports the results of a survey of disability services offices at colleges and universities in 10 states. Data from 275 schools revealed the number of students with psychiatric disabilities seeking assistance from disability services offices, characteristics of these offices, and the types of services they provide. Survey data also identified barriers to full participation of these students in academic settings. Implications of the study are discussed to inform policy and postsecondary institutional practices with the goal of better serving psychiatrically disabled students to maximize their talents and potential.

Adult↗

PubMed2003

Cross-national agreement on disability weights: the European Disability Weights Project.

BACKGROUND: Disability weights represent the relative severity of disease stages to be incorporated in summary measures of population health. The level of agreement on disability weights in Western European countries was investigated with different valuation methods. METHODS: Disability weights for fifteen disease stages were elicited empirically in panels of health care professionals or non-health care professionals with an academic background following a strictly standardised procedure. Three valuation methods were used: a visual analogue scale (VAS); the time trade-off technique (TTO); and the person trade-off technique (PTO). Agreement among England, France, the Netherlands, Spain, and Sweden on the three disability weight sets was analysed by means of an intraclass correlation coefficient (ICC) in the framework of generalisability theory. Agreement among the two types of panels was similarly assessed. RESULTS: A total of 232 participants were included. Similar rankings of disease stages across countries were found with all valuation methods. The ICC of country agreement on disability weights ranged from 0.56 [95% CI, 0.52-0.62] with PTO to 0.72 [0.70-0.74] with VAS and 0.72 [0.69-0.75] with TTO. The ICC of agreement between health care professionals and non-health care professionals ranged from 0.64 [0.58-0.68] with PTO to 0.73 [0.71-0.75] with VAS and 0.74 [0.72-0.77] with TTO. CONCLUSIONS: Overall, the study supports a reasonably high level of agreement on disability weights in Western European countries with VAS and TTO methods, which focus on individual preferences, but a lower level of agreement with the PTO method, which focuses more on societal values in resource allocation.

Journal Article↗

PubMed2001

Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 national health interview survey disability supplements.

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

Journal Article↗

PubMed1981

The Framingham Disability Study: II. Physical disability among the aging.

The Framingham Disability Study (FDS), a recent component of the Heart Disease Epidemiological Study in Framingham, Massachusetts, was designed to investigate the nature and magnitude of disability among non-institutionalized elderly. From September 1976 through November 1978, 2,654 individuals aged 55 to 84 years from the original Framingham cohort were interviewed in person or by telephone (94 per cent of the potential participant pool). The findings support the well known relationship between physical disability and age. The magnitude of disability, however, is not as great as conventional wisdom might suggest. This paper presents the physical disability prevalence findings and compares these results to earlier epidemiological investigations of disability in the elderly.

Activities of Daily Living↗

PubMed2005

[Chances and successes of vocational training of disabled youth in occupational and vocational school--findings of the BAR-pilot study "Regional Networks for Vocational Rehabilitation of (Learning-) Disabled Juvenile (REGINE)"].

The pilot study "REGINE" was realized on initiative of the Federal Rehabilitation Council (BAR) to test the opportunities of vocational training of learning-disabled youth under "normal" conditions: That means the young people are trained in firms and regular vocational schools, and -- while doing so -- are supported by educational institutions. The project was finished successfully. The results of the evaluation, realized by the Institute for Empirical Sociology at the University of Erlangen-Nürnberg were already published in December 2003. They encourage making use of the opportunities of in-firm vocational training of disabled youth more frequently. More than half of the participants of the first REGINE-cohort successfully finished their vocational training. Nearly 40 % were taken over by the firm that provided vocationally trained, and 12.8 % found a job in another company. The second cohort showed even better results: the corresponding rates are 47.1 and 32.4 %. This success speaks in favour of this place of vocational training, particularly considering the difficult job situation. It seems to be possible, that disabled youth are successfully and cost-effectively trained vocationally, if an individual support of both youth and firms can be provided. Prerequisite for this is a conscientious preparation of the vocational training, which may already begin in the last classes of school. "Achilles heel" of the new place of vocational training for disabled youth is the theoretical training in regular vocational schools which usually can not meet the needs of the learning-disabled. These shortcomings had to be compensated by special educational institutions which are not financed by educational administration but by employment agencies (which actually have no jurisdiction over this kind of duties).

Adolescent↗

PubMed2005

Measuring disability and function in older women: psychometric properties of the late-life function and disability instrument.

BACKGROUND: The recent development of the Late-Life Function and Disability Instrument (LL-FDI) was an important contribution to the measurement of function and disability in older adults. The present study examined the psychometric properties and construct validity of the LL-FDI measure in a sample of older women. METHODS: Older black (n = 81) and white (n = 168) women completed the LL-FDI, several measures of physical function, and physical activity measures, and had their body mass index assessed at baseline of an ongoing prospective study. Confirmatory factor analyses (CFA) and correlational analyses were used to examine factorial and construct validity of the measure. RESULTS: The CFA, using an iterative model modification technique, resulted in an acceptable 15-item solution for the function component and an 8-item solution for the disability component. This abbreviated instrument demonstrated high correlations with the original scales. Construct validity for the LL-FDI was supported. Participants who demonstrated better physical function, reported being more active, and had lower body mass index reported less disability and less difficulty with function on the LL-FDI. CONCLUSIONS: The LL-FDI appears to be an effective instrument for assessing function and disability in older women, and the abbreviated version reported here may prove useful in certain circumstances due to its brevity. However, continued determination of the construct validity of the complete and abbreviated scales is recommended.

Aged↗

PubMed1997

Religion among disabled and nondisabled persons II: attendance at religious services as a predictor of the course of disability.

Does religious involvement influence changes in physical health? We perform a longitudinal analysis of the effect of religious participation on functioning over a 12-year follow-up period, in a large, prospective, representative sample of elderly persons from New Haven, Connecticut, a religiously diverse community. To examine the possibility that disability or changes in disability may be affecting religious involvement, we perform a second longitudinal analysis of changes in religious practices. Finally, we ask whether psychosocial correlates explain the effect of religious involvement on disability. Findings are (a) that attendance at services is a strong predictor of better functioning, even when intermediate changes in functioning are included, (b) that health practices, social ties, and indicators of well-being reduce, but do not eliminate these effects, and (c) that disability has minimal effects on subsequent attendance. The findings illustrate the short- and long-term importance of religious participation to the health and well-being of elderly people, and suggest a particular significance for religious participation in the lives of disabled elders.

Aged↗

PubMed1994

Impairments and disabilities--the difference: proposal for adjustment of the International Classification of Impairments, Disabilities, and Handicaps.

In this article, a proposal for adjustment of the Classification of Impairments and the Classification of Disabilities of the International Classification of Impairments, Disabilities, and Handicaps is presented. This proposal is a result of a project conducted by the Dutch National Institute for Research and Postgraduate Education in Physical Therapy. The project was executed in collaboration with the professional national organizations of five health professions: occupational therapy, chiropody, Cesar therapy (exercise therapy), Mensendieck therapy (exercise therapy), and physical therapy. The proposal includes reformulated definitions of impairment and disability, an inventory of the impairments and disabilities that are relevant for the health professions that participated in the project, a description of the domain of the Classification of Impairments and the Classification of Disabilities, a new subdivision for both classifications in chapters, and a set of "types of characteristics" and "characteristics" that subdivide the different chapters of the two classifications.

Disability Evaluation↗

PubMed2002

Disability examinations: a look at the Social Security Disability Income System.

Disability income protection is an important part of a worker's safety net. U.S. workers who pay into Social Security are eligible for coverage under the federal government, and additional coverage is available in the free market. However, the costs to taxpayers and disability insurance policyholders are high, and a great deal of responsibility rests on the physician providing information on disability issues. A neutral attitude toward a patient requesting disability allows the physician to collect the facts regarding the patient's impairments. A history of the patient's work duties helps the examiner determine the basis for setting limitations or restrictions at work or home. The physician's knowledge base of treatment options assists in determining maximal medical improvement. Records released to the adjudicating body should contain a thorough history, pertinent physical findings, and a review of previous medical records, all of which are to be separated from the opinion of the examiner regarding specific limitations and restrictions. The physician should be aware of symptom magnification and depression as confounders to the patient's perception of disability.

Disability Evaluation↗

PubMed2003

Navigating the disability process: persons with mental disorders applying for and receiving disability benefits.

Persons with mental disorders are less likely to be working and more likely to apply for and receive SSDI and/or SSI benefits than are those without such disorders. Data from the National Health Interview Survey on Disability (NHIS-D) were examined to identify the predictors of SSDI/SSI application and receipt among persons with self-reported mental disorders. Compared with nonapplicants, applicants had higher levels of disability, fewer financial and interpersonal resources, and better access to information about the disability programs. Among applicants, similar factors distinguished recipients from those who did not receive benefits. Navigating the disability process is associated with the extent of impairment, economic and social disadvantage, and linkage to the disability determination process.

Disability Evaluation↗

PubMed1989

Diabetes mellitus and disability pension. A descriptive study of all diabetic subjects granted disability pension in Sweden in 1980.

Disability documents of all diabetic persons (n = 1,707) granted a disability pension in Sweden during 1980 were studied. The following factors were analysed: age, sex, civil status, profession, unemployment, being a housewife, immigration status, form for disability pension application, duration of diabetes, type of treatment, presence of classical late complications and age at onset of diabetes, obesity and alcohol problems. Functional handicaps and symptoms related to a clinically advanced diabetes mellitus could be regarded as the basis for the decision to grant a disability pension to 20-25% of the pensioners. For the remaining 75-80% neither the diabetic state nor its late complications could be held responsible for reduced work capacity. Rather, symptoms like angina pectoris and rheumatic symptoms and many other factors such as obesity, alcohol problems, being an immigrant, or being unemployed influenced the decision to grant a disability pension.

Adolescent↗

PubMed1987

Impairment, disability, and the ICIDH model. III: Underlying disease, impairment, and disability.

Secondary analysis of data carried out in a national survey of the disabled is used to explore the relationship between underlying condition, impairment and disability, where the conditions are considered in three groups depending on whether they affect control, mechanical performance or energy. Comparison of impairment and disability profiles highlights the role of functional limitation in mediating between disease and disability. Disability profiles were found to be less associated with the underlying condition than were impairment profiles, but this can to some extent be explained by the nature of the functional limitation.

Activities of Daily Living↗

PubMed1999

Not disabled enough: the ADA's "major life activity" definition of disability.

Michelle Friedland argues in this note that the Americans with Disabilities Act fails to adequately distinguish between the separate goals of preventing pure discrimination and providing affirmative accommodation. The Act's conflation of these two different objectives, and its reliance on a single definition of disability for both, hinders its effectiveness in improving the status of individuals with disabilities in the employment setting. To illustrate this, she points to the counterintuitive results reached in recent court decisions. Friedland further traces the legislative origins of the Act's definition of disability and the ambiguity it leaves as to Congress's goals for the Act's employment provisions. She posits three possible goals the Act might be designed to achieve and recommends basic reforms for accomplishing each. Her ultimate conclusion is that provisions dealing with accommodation and discrimination need to be divided so that each can have its own definition of disability. In addition, she believes funding mechanisms for providing accommodation should be altered to ameliorate inequalities in burdens borne by employers and to avoid improper incentives to circumvent the Act.

Activities of Daily Living↗