Showing papers on "Physical disability published in 1994"

Common Mental Disorders and Disability Across Cultures: Results From the WHO Collaborative Study on Psychological Problems in General Health Care

Abstract: Objective. —To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. Design. —A cross-sectional sample selected by two-stage sampling. Setting. —Primary health care facilities in 14 countries covering most major cultures and languages. Patients. —A total of 25916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). Main Outcome Measures. —Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. Results. —After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. Conclusions. —The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability. (JAMA. 1994;272:1741-1748)

The impact of depressive symptomatology on physical disability: MacArthur Studies of Successful Aging.

Abstract: OBJECTIVES. The purpose of these analyses was to test the hypothesis that depressive symptomatology affects the risk of onset of physical disability in high-functioning elderly adults. METHODS. The data come from the MacArthur Study of Successful Aging, a community-based cohort of high-functioning adults aged 70 through 79 years who were assessed twice at a 2.5-year interval. Physical and cognitive status was assessed by performance as well as by self-report measures. RESULTS. In gender-stratified logistic regression models, high depressive symptoms as measured by the depression subscale of the Hopkins Symptom Checklist were associated with an increased risk of onset of disability in activities of daily living for both men and women, adjusting for baseline sociodemographic factors, physical health status, and cognitive functioning. CONCLUSIONS. Joined with evidence that physical disability is a potential risk factor for depression, these findings suggest that both depressive symptoms and physical disabili...

Self‐Reported Causes of Physical Disability in Older People: The Cardiovascular Health Study

Abstract: OBJECTIVE: To determine the major conditions and symptoms reported to cause difficulty in 17 physical tasks of daily life and the criterion validity of self-report of diseases given as the causes of the difficulty in functioning, in community-dwelling older people. DESIGN: Cross sectional analyses of data obtained in an observational cohort study. SETTING: Research clinics in four US communities: Winston-Salem, NC, Hagerstown, MD, Pittsburgh, PA, and Sacramento, CA. PARTICIPANTS: 5201 community-dwelling people ≥ 65 years old. RESULTS: Arthritis and other musculoskeletal diseases were given as the primary causes of difficulty in performing physical tasks by 49.0% of the participants reporting difficulty in any task, followed by heart disease (13.7%), injury (12.0%), old age (11.7%), lung disease (6.0%), and stroke (2.9%). The self-reports of diseases that caused disability varied by task. Whereas arthritis was given as a cause of difficulty in most of the 17 different tasks, heart and lung disease were more likely to be reported as causing difficulty with activities requiring high aerobic work capacity such as walking one-half mile or doing heavy housework. Stroke was more likely to be reported as causing difficulty with use of the upper extremities and in performing basic activities of daily living. There was a high degree of consistency (91%) between the diseases and symptoms reported to cause disabilities. The percentage of people who reported a disease as the cause of their difficulty performing a task and had independent confirmation of the diagnosis was 85% in men and 71% in women, and varied according to type of disease and the individual's cognitive status and health status. CONCLUSION: These data suggest that age-related chronic diseases are important causes of disability in older people but that the type of disability is dependent on the underlying disease that causes the disability. Also, self-report of the cause of disability appears to be generally accurate but is influenced by gender, health status, and type of disease.

A randomized trial of physical rehabilitation for very frail nursing home residents.

Abstract: Background. —Past studies suggest multidisciplinary interventions that include physical therapy (PT) can improve function of nursing home residents. This trial specifically evaluates effects of PT for frail long-stay nursing home residents. Design. —Randomized, controlled trial. Setting. —One academic nursing home and eight community nursing homes. Patients. —A total of 194 elderly nursing home residents dependent in at least two activities of daily living residing in the nursing home for at least 3 months. Interventions. —Patients were randomized to individually tailored one-on-one PT sessions or friendly visits (FVs) three times a week for 4 months. Physical therapy included range-of-motion, strength, balance, transfer, and mobility exercises. Main Outcome Measures. —Performance-based physical function assessed by the Physical Disability Index; self-perceived health status assessed with the Sickness Impact Profile; observer-reported activities of daily living; and falls. Results. —Eighty-nine percent and 92% of PT and FV sessions, respectively, were attended; 5% and 9% of subjects dropped out in the PT group and FV group, respectively. Compared with the FV group, the PT group experienced no significant improvements in overall Physical Disability Index, Sickness Impact Profile, or activities of daily living scores. A 15.5% improvement in the mobility subscale of the Physical Disability Index was seen (95% confidence interval [CI], 6.4% to 24.7%); no benefits in range-of-motion, strength, or balance subscales were found. Compared with the FV group, the PT group used assistive devices for bed mobility tasks less often ( P =.06) and were less likely to use assistive devices and wheelchairs for locomotion ( P P =.11). Charge for the 4-month PT program was $1220 per subject (95% CI, $412 to $1832). Conclusion. —This standardized physical therapy program provided modest mobility benefits for very frail long-stay nursing home residents with physical disability due to multiple comorbid conditions. ( JAMA . 1994;271:519-524)

Physical therapy and Parkinson's disease A controlled clinical trial

Abstract: In a randomized, single-blind, crossover study, we evaluated physical disability in moderately advanced Parkinson's disease (PD) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program. We used a timed motor task and a standard assessment of PD severity (the Unified Parkinson's Disease Rating Scale [UPDRS] with subscales for mentation, activities of daily living [ADL], and motor function) completed by an investigator blinded to the physical rehabilitation status of the patient. Following physical rehabilitation, there was significant improvement in the UPDRS ADL and motor scores, but no change in mentation score. During the 6 months following physical rehabilitation, patients did not regularly exercise, and the UPDRS scores returned to baseline. We conclude that physical disability in moderately advanced PD objectively improves with a regular physical rehabilitation program, but this improvement is not sustained when normal activity is resumed.

Treatment Seeking for Urinary Incontinence in Older Adults

Abstract: Objective: To examine treatment seeking for urinary incontinence among older adults and to identify characteristics associated with treatment-seeking behavior. Design: Survey. Setting: Five rural counties in northwestern Pennsylvania. Participants: 1104 community-dwelling ambulatory older adults aged 65 to 79 years with self-reported urinary incontinence. Participants were a subgroup of a large sample (n = 3884) who volunteered for a study of health promotion services. Those who reported urinary incontinence within the past year, during an in-person health risk appraisal, were included in this analysis. Measurements: Reporting incontinence to the participant's physician was the main dependent measure. Main Results: 37.6% of the participants had told their physician about loss of urine. Reporting incontinence to a physician was strongly associated with severity of incontinence as indicated by eight measures (P < 0.001). Treatment seeking was also related to type of incontinence (P < 0.001), physical disability (P < 0.01), and the pattern of health care utilization (P < 0.01). In multiple logistic regression analyses, younger age, physical disability, and frequency of physical and rectal examinations had significant predictive value independent of severity. Not associated with treatment seeking were gender, marital status, income, employment status, educational level, and distance from health care provider. Conclusions: The majority of older adults with urinary incontinence do not report the condition to their doctor. Severity of incontinence, physical disability, and a pattern of regular health care utilization appear to be the strongest predictors of treatment-seeking behavior.

Intensive physical and psychosocial training program for patients with chronic low back pain. A controlled clinical trial.

Abstract: Study design The authors conducted a controlled clinical trial with 1-year follow-up to define the effectiveness of an intensive physical and psychosocial training program on patients with low back pain. Summary of background data The intervention group included 152 patients (mean age 40.5 yr, Million index 45.1/100), and the reference group included 141 patients (mean age 40.4 yr, Million-index 44.5/100). Methods The progressive intervention program consisted of intensive physical training and psychosocial activation. The outcomes were physical and psychosocial measures, the pain and disability index (Million), sick leaves, and occupational handicap. Results The intervention was more efficient with respect to physical measures and pain and disability index. There were only mild or no differences in changes between the study groups in psychologic variables, sick leaves, or retirement. Conclusions The intervention program could improve physical disability, but to improve occupational handicap, activities of the whole society (social legislation, labor market policy) are needed.

Physical disability from knee osteoarthritis: the role of exercise as an intervention.

Abstract: Osteoarthritis (OA) of the knee is a common, nonfatal, chronic condition that causes pain and physical disability in older people. Persons with knee OA report difficulty with activities that require ambulation and transfer from the sitting to the standing position. Physical disability from knee OA is the result of a complex interplay among the severity of disease, pain, comorbid conditions, psychosocial factors, and deficits in physical capacity such as low aerobic work capacity and lower extremity muscle weakness. These deficits in physical capacity may be correctable with exercise training. Short-term studies indicate that persons with knee OA show gains in physical capacity and report less pain and disability with exercise training. However, the long-term effectiveness and safety of exercise in persons with knee OA remains unknown.

The psychological impact of motor neurone disease

Abstract: Self-report measures were completed by 59 individuals with motor neurone disease (MND) in order to assess whether: (a) MND affects patients' psychological well-being and quality of life; (b) if greater affective disorder is associated with greater physical disability; (c) whether accepting the illness and ways of coping have an impact on psychological distress, and (d) if beliefs over control of their health shift as the disease progresses. Results indicated that the effects of MND on everyday functioning accounted for incidence of depression and low self-esteem. Acceptance of illness was related to severity of symptoms and was a significant factor irrespective of level of physical symptomatology. Ways of coping with the illness did not relate in any significant way to severity of symptoms. Mild physical impairments were associated with an 'internal' view of control over health.

Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain.

Abstract: The need to document cost-benefit of comprehensive work rehabilitation services represents a critical requirement for its long-term viability as a treatment option for injured workers. One approach to improving cost-benefit is to identify patients who experience difficulty completing a rigorous goal-oriented treatment approach. This study examined a set of psychological, pain, perceived work environment, and patient expectation measures in order to determine whether such factors were associated with failure to complete rehabilitation. Patients (n = 168) presenting with low back pain who participated in a multidisciplinary work rehabilitation program (physical conditioning, work conditioning, work-related pain and stress management, ergonomie consultation, and vocational counseling) were categorized into 2 groups based upon whether they completed the 4 week, 5 day per week program (n = 84) or were discharged prior to program completion (n = 84). T tests were computed for return to work expectation, pain (average pain intensity, fear of re-injury), psychological measures (somatization, dysthymia), perceived work environment (work pressure, control, supervisor support), and disability (duration of work disability, physical disability, perceived disability) variables found in previous studies to affect successful rehabilitation and return to work. The discharged group was marked by lower return to work expectations, and heightened somatization, pain intensity, and perceived disability. In addition, this group was significantly younger and had been out of work longer. The groups did not differ on gender, marital status, ICD-9 diagnoses or perceived work environment. These findings indicate that patients displaying the pattern of low return to work expectations, heightened perceived disability, pain and somatic focus experience compliance problems in an intensive work rehabilitation program. Efforts should be made to identify these factors prior to program entrance and to provide interventions directed at increasing the likelihood of success.

Depression in Parkinson's disease.

Abstract: OBJECTIVE The authors assessed the prevalence of major depression (DSM-III-R) among Parkinson's disease patients and compared this rate with that of matched physically disabled subjects. METHOD The 30-item General Health Questionnaire and measures of physical disability were completed by all patients in Dunedin, New Zealand, identified as having Parkinson's disease. Patients scoring over 5 on the General Health Questionnaire were interviewed with the Structured Clinical Interview for DSM-III-R--Non-Patient Version. Each patient living in the community was matched for age, sex, and level of physical disability with a comparison subject who did not have a neurological condition. RESULTS Of the 73 subjects with Parkinson's disease who agreed to participate and were judged not to be demented, 34.2% scored higher than 5 on the 30-item General Health Questionnaire, but only 2.7% met the criteria for major depression. No difference from the comparison group was found. CONCLUSIONS The prevalence of major depression in patients with Parkinson's disease may be no greater than in age- and sex-matched physically disabled persons.

First diagnosis of severe mental and physical disability : a study of doctor-parent communication

Abstract: This study investigates factors associated with satisfaction with medical communication at the time of diagnosis of a child's severe mental or physical disability. Two competing social psychological models that have been used to account for parent patient satisfaction are tested: Korsch's (1968) affective model and Ley's (1977) cognitive model. One hundred and sixty six mothers of children with severe learning disabilities were questioned about the time when their child's disability was first diagnosed. Measures included the child's age when diagnosis was made, the length of time parents had been anxious, and how satisfied they were with the way they were told the diagnosis. They were asked to rate the doctor's affective behaviour and their understanding and memory of the information they received. Fifty-eight per cent of parents reported dissatisfaction with the communication. Stepwise multiple regression analysis showed that Korsch's affective scale was much the strongest predictor, entering the equation first, and explaining 35.7% of the variance in satisfaction. Ley's cognitive scale entered second, explaining a further 1.4% of the variance. Further analysis including the other predictors found that six predictors explained 40% of the variance. The implications of the findings for the training of medical staff are discussed.

Social support and physical disability in older people after hospitalization: a prospective study.

Abstract: This prospective study examines the effects of social support on physical disability in older people. Hospital monitoring identified longitudinal study participants who were admitted for hip fracture (n = 84), stroke (n = 79), or myocardial infarction (n = 106). Interviews before the illness and at 6 weeks and 6 months after admission assessed social support and physical disability; medical records indicated illness severity and comorbidity. The number of emotional support providers and the adequacy of task support were higher after hospitalization. Medical factors and premorbid emotional support predicted disability at 6 weeks; not needing support was associated with less disability than needing and receiving adequate support. Task support adequacy at 6 weeks predicted less disability at 6 months. The results reveal a dynamic relationship between social support and recovery.

Disability and Severe Gastrointestinal Hemorrhage. A Prospective Study of Community‐Dwelling Older Persons

Abstract: OBJECTIVE: To describe the occurrence of severe gastrointestinal bleeding in community-dwelling older persons and to examine whether disability is a risk factor for this life-threatening condition independent of other known predictors. DESIGN: Prospective cohort survey. SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). PARTICIPANTS: 8205 persons age ≥68 years. MEASUREMENTS: The hospital discharge diagnoses provided by the Medicare Provider Analysis and Review files and the death certificates were prospectively surveyed for 3 years. Those with at least 1 discharge diagnosis of gastrointestinal bleeding and who received a blood transfusion or died were identified as cases of severe gastrointestinal hemorrhage. Physical disability, cognitive function, smoking and alcohol intake habits, body mass index, blood pressure, chronic conditions, number of hospital admissions in past year and medications taken were assessed at baseline. RESULTS: The occurrence rate of severe gastrointestinal bleeding was 10.8 per 1000 person-years (241 events/22,277 person-years). In proportional hazards regression models, compared with no disability, ≥ 1 disabilities in the Rosow-Breslau scale (RR = 2.1, 95% CI = 1.5–2.9), and ≥1 ADLs limitations (RR = 3.1, 95% CI = 2.1–4.6) independently predicted gastrointestinal hemorrhage after adjusting for age, gender, body mass index, comorbidity, number of hospital admissions, blood pressure, intake of coumarin, corticosteroids, aspirin and other nonsteroidal antiinflammatory drugs. CONCLUSIONS: In this prospective analysis, disability is an independent predictor of gastrointestinal hemorrhage. Further studies are needed to explain the mechanisms by which disability may cause gastrointestinal hemorrhage. Because physical disability is potentially modifiable, strategies to lower the risk of gastrointestinal bleeding should be evaluated.

Relationship of cognitive constructs to adjustment in rheumatoid arthritis patients

Abstract: The present study investigated the interrelationship of several commonly used arthritis-related cognitive measures and their relationship to physical disability, pain, depression, and anxiety in rheumatoid arthritis (RA)_patients. Subjects were 103 RA patients recruited from an outpatient rheumatology clinic. Each subject completed the Cognitive Errors Questionnaire (CEQ), the Arthritis Self-Efficacy Scale, the Coping Strategies Questionnaire (CSQ), the Pain Beliefs and Perceptions Inventory (PBAPI), and the Arthritis Impact Measurement Scale (AIMS). Correlational analysis indicated that the cognitive measures were highly interrelated. Factor analysis of the summary scores from these cognitive measures suggested two separate factors, labeled a distorted cognition factor and an efficacy expectations factor. Regression analyses revealed that after controlling for age, gender, and physician disease severity rating, each factor separately was significantly related to all measures of adjustment. However, in a regression model including both factors, the efficacy expectations factor was more strongly related to all adjustment measures. Patients scoring higher on the efficacy expectations factor had lower levels of physical disability, pain, depression, and anxiety. Taken together, these findings physical disability, pain, depression, and anxiety. Given the strength of this relationship, further investigation detailing the relative importance and interrelationships of cognitive constructs and their association with other clinical variables will be a useful next step in assisting RA patients with a chronic and painful disease.

Physical disability and psychological well being in recent onset rheumatoid arthritis.

Abstract: OBJECTIVE The association between self-report physical disability scores and psychological well being in patients with rheumatoid arthritis (RA) has been described in several recent publications on patients with widely varying disease durations. We describe the results of a study into these relationships in patients with RA with a disease duration of less than 1 year. METHODS In this cross sectional study on 113 patients with recent onset RA disability was assessed with 3 self-report indices and with measurement of grip strength. Correlation coefficients between disability measures and disease activity measures (joint tenderness/swelling score, erythrocyte sedimentation rate [ESR)]), psychological well being (cheerful mood, depressive mood, and anxiety), and demographical variables were calculated; hierarchical regression analysis was done with disability measures as the dependent variables. RESULTS All disability scales were correlated moderately strongly with the joint score and ESR, and with psychological well being. No relation was found with age, sex, marital status, or rheumatoid factor status. Regression analysis showed the variance of 9-15% in disability could be explained by psychological well being after disease activity had been controlled for. CONCLUSION Patients with recent onset RA appear not to be obviously different with respect to the moderately strong association between physical disability and psychological well being from patients with RA of longer duration in other published reports.

Strategies for Enhancing Career Maintenance Self-Efficacy of People with Multiple Sclerosis

Abstract: Strategies for Enhancing Career Maintenance Self-Efficacy of People with Multiple Sclerosis(1) The purpose of this article is to apply a psychosocial theory for human behavior (self-efficacy theory) to the career maintenance problems encountered by people with evere disabilities such as multiple sclerosis (MS). Specifically, their employment retention rates following diagnosis are lower than those reported by people with disabilities in general and, according to experts, lower than would be expected based solely on the severity of the symptoms associated with MS (LaRocca, Kalb, Scheinberg, & Kendall, 1985). Two explanations are offered for the high unemployment rate of people with MS. The severe and pervasive impact of multiple sclerosis is, of course, one reason for the low rate of post-diagnosis employment. However, factors other than disability-related symptoms result in poor career maintenance outcomes. A self-efficacy theoretical position is used to explain the exceptional problems that people with multiple sclerosis face in attempting to continue working. We propose that the lack of predictability of MS symptoms (Falvo, 1991) and the resulting uncertainty about one's life and future (LaRocca et al., 1985) have a negative impact on one's sense of self-efficacy. Decreased feelings of efficacy result in less frequent proactive behaviors that are required to maintain one's career. A psychosocial training intervention is, therefore, needed to enhance feelings of self-efficacy among people with MS and, thereby, increase the likelihood that they will initiate such career maintenance actions as requesting that their employers review their needs for reasonable accommodations on the job. Career Maintenance and Multiple Sclerosis Recent statistics document the assertion that most people with disabilities find it difficult to maintain employment. According to figures cited by Ficke (1992) and Yelin (1991), only 36% of males and 28% of females with work disabilities are in the labor force, compared to 89% and 69% of males and females who do not have work disabilities. Retention of employment among people with MS is lower than the previously cited figures for people with disabilities in general and lower than would be expected even given the presence of a severe physical disability. LaRocca and Hall (1990) reported that more than 90% of people with MS have employment histories, and most (60%) were working at the onset of MS. Unfortunately, only one in four people with MS (25%) is typically able to retain employment (Jackson & Quaal, 1991), and some research suggests that the employment outlook for women with MS is even worse. LaRocca et al. (1985) found that only 14% of women with MS were employed. The employment rates of 25% and 14% respectively for all people with MS and women with MS are clearly lower than for a comparison group of people with work disabilities. But the surprising fact is that some experts believe that the poor rates of career maintenance reported by people with MS exceed what one might expect even considering the severity of the disability. Consistent with common sense, research indicates that the physiomedical impairments of MS reduce the likelihood that a person who acquires the illness will return to or retain employment (Jackson & Quaal, 1991; Komblith, LaRocca, & Baum, 1986). In concluding their research on the topic, however, LaRocca and Hall (1990, p. 53) noted that "the physical aspects of MS do not come close to fully explaining the high rate of unemployment." They stressed that both the symptoms associated with MS and the unpredictability of those symptoms, that is, exacerbations followed by remissions, have a debilitating psychological effect on people with MS which decreases their capacity to cope with on-the-job barriers to career maintenance. Symptom Unpredictability and its Impact on Self-Efficacy In unraveling the complicated relationship between MS and the high unemployment rates associated with it, LaRocca and Hall (1990) proposed that the unpredictable medical symptomatology of MS causes diminished feelings of self-efficacy and self-control. …

Burden of disability in a post war birth cohort in the UK.

Abstract: STUDY OBJECTIVE--To report the prevalence of physical disability in a national sample of 43 year old men and women, and examine the relationship between disability and the consumption of hospital care. To assess the contribution of childhood health and social circumstances to the risk of adult disability, and the socioeconomic consequences of disability. DESIGN--The assessment of disabilities of physical movement was based on criteria developed by OPCS for their national survey of disability. The analysis used data on socioeconomic circumstances from childhood to 43 years and on serious illness in the first 25 years of life collected prospectively on members of the MRC National Survey of Health and Development, the 1946 birth cohort study. SETTING--England, Wales, and Scotland. PARTICIPANTS--A general population sample of 3235 men and women aged 43 years. MAIN RESULTS--Seven per cent of cohort survivors at 43 years were physically disabled and a further 3% reported difficulties although they were not assessed as disabled according to OPCS criteria. The prevalence of severe disability at this age was similar to that derived from the OPCS survey but the prevalence of mild disability was substantially greater. Disability was associated with a greater use of hospital care in recent years and throughout life. Those who had experienced a serious illness in earlier life were over twice as likely to be disabled; certain conditions, such as polio, were associated with a particularly high relative risk. Those who had had a socially disadvantaged start to life were more likely to be physically disabled at 43 years but the strength of this relationship was considerably weakened by adjustment for later social factors, suggesting that social disadvantage throughout life, or during adult life, increased the risk of disability. Taking these results into account the relative impact of disability on income and employment was found to be greatest for those from the unskilled and semi-skilled classes. CONCLUSIONS--The prevalence of physical disability among those in early middle age may be greater than previously estimated. The strong links between childhood ill health and adult disability and its association with high levels of hospital care support longstanding recommendations for better coordination between child and adult health services. Social disadvantages affects the risk of disability and its financial and employment consequences.

Attentional impairment in persons with multiple sclerosis.

Abstract: Multiple sclerosis (MS) entails various cognitive and psychological changes. The capacity to direct attention (CDA) is the ability to inhibit competing and distracting stimuli while processing information from the environment. A strong CDA is essential for effective functioning in daily life. The CDA may be reduced by MS lesions and by excessive attention-draining demands imposed by the disease. The purpose of this study was to assess CDA using a one-group descriptive correlational design. The sample consisted of 33 outpatients in symptom remission with relapsing-remitting MS who had virtually no physical disability. As theorized, the MS group presented with attentional deficits of varying severity, despite the presence of few physical symptoms. These deficits were unrelated to depressive symptoms. Findings indicate that nurses need to consider attentional problems even in the most early disease states. Further research is needed to better understand the impact of attentional deficits on daily life functioning and to develop nursing interventions for conservation or restoration of CDA in individuals with relapsing-remitting MS.

A Brief History of Psychotherapy and Physical Disability

Abstract: The history of psychotherapy and physical disability is reviewed. The scope of the review ranges from the early writings to contemporary findings on psychotherapy with the physically disabled. Part...

Fitness Programming and Physical Disability

Abstract: No single book offers more information for developing and conducting exercise programs for groups that include people with physical disabilities. In "Fitness Programming and Physical Disability," a dozen authorities in exercise science and adapted exercise programming explain how to effectively and safely modify existing programs for individuals with physical disabilities--without changing the quality or nature of the activity. "Fitness Programming and Physical Disability" is an important reference for health fitness instructors, rehabilitation specialists, and fitness directors who design and lead group exercise programs. The book is also used as the text for Disabled Sports USA's "Fitness Is For EveryoneSM" Adaptive Fitness Instructor Certification Workshops. The book is organized in four parts that guide the reader from theory into practice. Part I, an introduction, describes several common physical disabilities, provides insights to help exercise leaders better understand and communicate with people with disabilities, and draws attention to potential barriers that may limit access to community programs.Part II explores the effects of physical disabilities on exercise and training, with particular emphasis on how physically disabling conditions may alter the structure and function of the physiological systems that interact to support aerobic and anaerobic exercise. Part III offers guidelines for adapting specific fitness programs, such as resistance training, stretching, and aerobic dance, to meet the unique needs of people with physical disabilities. Part IV provides practical guidelines for managing accessible fitness programs, including program development and promotion, handling medical emergencies in an exercise situation, tips for working with program participants who use wheelchairs, and much more.

Personal and familial adaptation of women with severe physical disabilities: A further validation of the double ABCX model

Abstract: The Double ABCX model, developed by McCubbin and colleagues, served as a theoretical framework for examining the major variables that contribute to the psychosocial adaptation of women. Ninety-four women with severe physical disabilities and 94 healthy women who served as controls completed eight questionnaires dealing with stress, coping resources, and adaptation. The results indicate that a high level of stress and strain and a low level of individual resources contribute to a low personal and familial adaptation. The predicted causal relationships among the models' variables of stress and adaptation were similar in the two research groups, although the magnitude of these relationships differ. The results confirm the applicability of the theoretical model for understanding long-term adaptation of women with severe physical disabilities. In recent years, one of the major areas of interest of researchers and practitioners in social science has been coping and adapting to chronic stressful conditions. The professional literature analyzed stressor characteristics along three main dimensions: normative-nonnormative, acute-chronic, and predictable-unpredictable (Boss, 1987; McCubbin & Figley, 1983: Pearlin, 1989). One of the well-established groups of people who have to face continuous chronic stressful conditions consists of those with chronic disabling illnesses (Moos & Schaefer, 1984; Rolland, 1987; Turner & Noh, 1988). These people face nonnormative, chronic, and unpredictable stressors, stemming from the daily requirements and demands of living with physical disabilities, and they usually have to deal with negative social attitudes and reactions (Wright, 1983). Although a great deal of knowledge about the process of coping and adjustment to physical disability can be found in the professional literature, a careful examination reveals that most of these studies were carried out mainly on male subjects (Asch & Fine, 1988; Crewe & Krause, 1988; Moos b Schaefer, 1984). Both researchers and clinicians acknowledge the fact that much less is known about the special needs and difficulties encountered by women with physical disabilities (Asch & Fine, 1988; Britt, 1988). From the handful of studies conducted in the United States (Asch & Fine, 1988; Britt, 1988; Deegan, 1985), Canada (Ridington, 1989a, 1989b, 1989c), and England (Lonsdale, 1990; Morris, 1989), the following socioeconomic profile emerged: Women with physical disabilities live near or below the poverty line (Mudrick, 1988; Ridington, 1989b; Russo & Jensen, 1988). Fewer women with physical disabilities are married, more are separated and divorced, and if they have children, these women often raise them alone (Asch & Fine, 1988; Harrison & Wayne, 1986). When compared with other women, disabled women have a lower level of education (Asch & Fine, 1988). An extensive review of the literature discussing coping and adjustment of women to their chronic stressful situation revealed the following: (a) Usually research has dealt with a specific physical condition, the most frequent ones being rheumatoid arthritis (Allaire, 1992; Reisine, Goodenow, & Grady, 1987; Smith & Wallston, 1992) and spinal cord injury (Bonwich, 1985; Morris, 1989); (b) some studies examined only specific aspects related to the women functioning as housewives (Hafstrom & Schram, 1984), at work (Allaire, 1992), or as mothers; and (c) only a few studies attempted to assess factors that may contribute to women's adjustment, such as chronic stressors (Turner & Avison, 1992), perceived support provided by husbands (Goodenow, Reisine, & Grady, 1990), and appraisal of the illness' implications and coping (Smith & Wallston, 1992). Therefore, it seems that the picture depicted from these studies provides only partial information on the particular adjustment outcomes of specific groups of women with physical disabilities. …

Locomotor disability in the elderly : an epidemiological study of its occurrence and determinants in a general population of 55 years and over : the Rotterdam study

Abstract: textSince the beginning of this century life-expectancy has increased by several decades. In 1990 newborn boys and girls in the Netherlands had a life-expectancy of 73 and 78 years respectively, compared to 51 years for boys and 53 years for girls born in 1910. The consequences are twofold. Firstly, with stable birthrates the elderly become an ever-larger proportion of the population. Secondly with the improvement of health care which can prevent premature death, the number of elderly people with chronic disease and disability steadily grows. Little is known about the burden of this on the health care system and on society as a whole, In a few countries some aspects of chronic disease and disability have been studied. From 1986 to 1988 the Netherlands Central Bureau of Statistics studied physical disability in the Dutch population. Disability was defined as difficulties in some activities of daily living as a result of some underlying impairment. At present no data are available on disability in the population at large, regardless of its cause. Disability can result from a wide array of organ impairments. A major organ of interest is the locomotor apparatus and more specifically the lower limbs. Locomotor disability is then defined as the amount of difficulty a person experiences when walking, climbing stairs, rising from a chair or bed or otherwise.

Capture-recapture techniques. Quick and cheap.

Abstract: EDITOR, - Capture-recapture techniques can be used as a quick and cheap alternative to population surveys for estimating the prevalence of physical disability.1 We used the technique as part of a needs assessment for a new rehabilitation service. We sent a letter to every general practitioner and district nurse in West Berkshire, requesting the name, age, address, and diagnosis of every patient aged 16 to 65 who had severe disability of neurological, musculoskeletal, or peripheral vascular origin and required daily help from carers or other professional or non-professional helpers. People whose primary disability was mental illness or handicap, blindness, or deafness were excluded. Altogether 177 (71%) of 249 general practitioners, and district nurses from 42 (76%) of 55 practices, replied. A total of 356 patients were identified (243 by general practitioners alone, 56 by nurses alone, and 57 by both general practitioners and nurses). A capture-recapture technique2,3 gave the estimated unidentified population as 230. The total population was therefore 594 (95% confidence intervals 494 to 694) and the prevalence 1.9/1000 adults aged 16 to 65. The main problem with this estimation was that general practitioners and district nurses may have interpreted the definition of severe physical disability inconsistently. Comparison of prevalences estimated in published population surveys is also difficult because of differences in the definition of disability and its severity and in the categorisation of age and underlying disease. But Harris's …

A prediction model of performance in level II fieldwork in physical disabilities.

Abstract: Objectives A prediction model of performance in physical disabilities fieldwork was generated with grades received in the occupational therapy curriculum and in prerequisite courses. Method Grades included those from functional anatomy, neuroanatomy, physical disabilities lecture, physical disabilities clinic, and prerequisite anatomy and physiology courses. Sampling was done collectively over graduated occupational therapy classes from 1987 to 1992 at the University of Puget Sound. A multiple regression analysis was performed and prediction equations were generated for each subscale of the Fieldwork Evaluation for the Occupational Therapist. Equations for combinations of the subscale categories were also produced. Results Adjusted R2 values were found to be less than 10% in all equations. Conclusion This poor ability of grades to predict fieldwork performance suggests that future investigation be focused on variables other than grades. Such variables might include student motivation, rapport between the student and fieldwork supervisor, and hospital experience in physical disabilities.