Showing papers on "Physical disability published in 2002"

Environmental Demands Associated With Community Mobility in Older Adults With and Without Mobility Disabilities

Abstract: Background and Purpose. In this study, the influence of 8 dimensions of the physical environment on mobility in older adults with and without mobility disability was measured. This was done in order to identify environmental factors that contribute to mobility disability. Subjects. Subjects were 36 older adults (≥70 years of age) who were recruited from 2 geographic sites (Seattle, Wash, and Waterloo, Ontario, Canada) and were grouped according to level of mobility function (physically able [ability to walk ½ mile (0.8 km) or climb stairs without assistance], physically disabled). Methods. Subjects were observed and videotaped during 3 trips into the community (trip to grocery store, physician visit, recreational trip). Frequency of encounters with environmental features within each of the 8 dimensions was recorded. Differences in baseline characteristics and environmental encounters were analyzed using an analysis of variance or the Fisher exact test, as appropriate. Results. Mobility disability among older adults was not associated with a uniform decrease in encounters with environmental challenges across all dimensions. Environmental dimensions that differed between subjects who were physically able and those with physical disability included temporal factors, physical load, terrain, and postural transition. Dimensions that were not different included distance, density, ambient conditions (eg, light levels and weather conditions), and attentional demands. Discussion and Conclusion. Understanding the relationship of the environment to mobility is crucial to both prevention and rehabilitation of mobility disability in older adults. Among older adults, certain dimensions of the environment may disable community mobility more than others.

Temporal and Reciprocal Relationship Between IADL/ADL Disability and Depressive Symptoms in Late Life

Abstract: A strong association between functional disability and depressive symptoms in older people has frequently been reported. Some studies attribute this association to the disabling effects of depression, others to the depressogenic effects of physical health-related disability. The authors examined the reciprocal effects between depressive symptoms and functional disability and their temporal character in a community-based cohort of 753 older people with physical limitations who were assessed at yearly intervals. They compared structural equation models that differed in terms of direction and speed of effects between patient-reported disability in instrumental and basic activities of daily living (IADL/ADLs) and depressive symptoms. The association between disability and depression could be separated into three components: (a) a strong contemporaneous effect of change in disability on depressive symptoms, (b) a weaker 1-year lagged effect of change in depressive symptoms on disability (probably indirect through physical health), and (c) a weak correlation between the trait (or stable) components of depression and disability. IADL/ADL disability and depressive symptoms are thus mutually reinforcing over time. Compensatory forces like effective treatment and age-related adaptation may protect elders against this potential downward trend. To improve quality of life in elderly adults, treatment should target disability when it is new and depression when it is persistent.

Effect of depression on vision function in age-related macular degeneration.

Abstract: Objectives To report the prevalence rate of depression in older patients with recent vision loss due to age-related macular degeneration (AMD) and to describe the effect of depression on self-reported vision function during 6 months. Methods Prospective cohort study of 51 older patients with recent-onset bilateral AMD attending the Retina Clinic of Wills Eye Hospital, Philadelphia, Pa. Main outcome measures included the Center for Epidemiological Studies Depression Scale, visual acuity, Functional Vision Screening Questionnaire, Chronic Disease Score, and Community Disability Scale. Results Seventeen patients (33%) were depressed at baseline and had worse visual acuity ( P = .04) and greater levels of vision-specific( P = .03) and general ( P = .002) physical disability than nondepressed patients. The correlations of Center for Epidemiological Studies Depression Scale score with visual acuity and visual-specific disability, however, were not significant after controlling for general physical disability. An increase in depressive symptoms over time predicted decline in self-reported vision function independent of changes in visual acuity or medical status ( P Conclusions The prevalence and disabling effects of depression in older patients with AMD are substantial. Recognizing that depression is a treatable disorder that exacerbates the effects of AMD will lead to improved outcomes. Innovative interventions to prevent or treat depression in specialty eye clinics are possible.

Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study.

Abstract: OBJECTIVE —To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women. RESEARCH DESIGN AND METHODS —Cross-sectional analysis of 1,002 women (aged ≥65 years) enrolled in the Women’s Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures. RESULTS —Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12–3.06), activities of daily living disability (1.61, 1.06–2.43), and severe walking limitation (2.34, 1.56–3.50), and their summary mobility performance score (0–12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women ( P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree. CONCLUSIONS —Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial.

Pain beliefs and perceived physical disability of patients with chronic low back pain.

Abstract: Cognitive-behavioural therapy and maintenance of exercise have emerged as major tools in the treatment of patients with chronic low back pain. Patients' beliefs about their problem may influence their uptake of and responses to particular treatment modalities. In particular, we hypothesised that patients' beliefs about the cause and treatment of pain may mediate changes in physical disability following participation in a multidisciplinary pain management programme. A cohort of 84 patients was invited to respond to booklets of self-report questionnaires prior to, immediately after and 3 months following participation in multidisciplinary pain management programmes. Questionnaires addressed subjects' beliefs about the nature and treatment of pain (Pain Beliefs Questionnaire), and their disability (Likert-modified Roland and Morris Disability Questionnaire, Physical Functioning scale of the Short Form-36 Health Survey, and Oswestry Low Back Pain Disability Questionnaire). Patients with chronic low back pain who more strongly endorsed 'organic' concepts about the nature and treatment of pain reported higher levels of physical disability at baseline, and displayed greater reductions in disability following participation in the pain management programmes. Reductions in reported 'organic' pain beliefs were associated with improvements in reported disability. Endorsement of 'psychological' concepts about the nature and treatment of pain was not associated with disability. These findings support a view that patients' beliefs about the nature and treatment of their pain can change during participation in a multidisciplinary pain management programme based on cognitive-behavioural intervention. Modification of these beliefs may be associated with improvements in patients' perceptions of the level of their disability.

Dementia as a predictor of functional disability: a four-year follow-up study.

Abstract: Background: Prospective studies have shown that cognitive impairment is a strong and consistent risk factor of physical disability However, cognitive impairment has been based on t

Physical impairment and disability: relationship to performance of activities of daily living in community-dwelling older men.

Abstract: Background and Purpose. The decline of physical function of older adults, associated with loss of independent living status, is a major public health concern. The purpose of this study was to examine the relationship of physical impairment and disability to performance of activities of daily living (ADL) among community-dwelling older adults. Subjects and Methods. Eighty-three community-dwelling older men who were referred to a comprehensive outpatient geriatric evaluation program (mean age=75.5 years, SD=7.0, range=64–97) were examined. Measurements of physical impairment (muscle force production, flexibility, and fitness) and physical disability (gait speed, stride length, risk for recurrent falls, and physical function) were recorded. Results. A stepwise linear regression was used to determine the relationship of physical impairments and disability measures with ADL. The results indicated that walking speed, fall risk, and muscle force contributed independently to the characterization of the activities of daily living of the community-dwelling older men studied (adjusted R 2=.68; F=56.81; df =3,80; P <.001). Using a principal components factor analysis, 4 domains were identified that explained 68.2% of the variance in performance of ADL: (1) mobility/fall risk=26.5%, (2) coordination=15%, (3) fitness=14.7%, and (4) flexibility=12.0%. Discussion and Conclusion. The identification of domains of physical function may be useful to physical therapists in the development of interventions targeted for physical impairments and disabilities that contribute to deficits in performance of ADL. Targeting interventions for physical impairments and disabilities related to function may improve the effectiveness of physical therapist interventions and reduce the loss of independence among community-dwelling older people.

Use of health services, mental illness, and self-rated disability and health in medical inpatients.

Abstract: Objective The primary objective of this study was to investigate if among medical inpatients their health service use was associated with 1) presence and type of mental disorders, 2) emotional distress and somatization, 3) self-rated physical disability and health. Method Health service use (number of admissions to nonpsychiatric departments and reimbursement of primary care services) as well as psychological distress (SCL-8D) and somatization (Whiteley-7) was assessed for 294 consecutive medical inpatients. Patients rated their own health and physical functioning, and medical consultants assessed them for chronic and life-threatening diseases. A subsample of 157 patients was assessed for ICD-10 psychiatric diagnoses by means of an extensive semistructured interview (SCAN). Results High use (above 80th percentile) of inpatient admissions was statistically significantly associated to mental disorders (adjusted OR = 3.6 [95%CI, 1.3–9.7]), to anxiety and/or depression, somatoform disorders, chronic and life-threatening physical disease, severe (self-rated) physical disability, and SCL-8 and Whiteley-7 scores. High use of primary care was statistically significantly associated to mental disorders (OR = 3.4 [95%CI, 1.5–8.0]), to anxiety and/or depression, somatoform disorders, moderate or severe (self-rated) physical disability, fair, poor or very poor (self-rated) health, and the Whiteley-7 score. The SCL-8D score was significant in men only. Conclusion Mentally disordered medical inpatients use health care more heavily than patients without, also after adjustment for medical disease severity. Use is closely associated to the Whiteley-7 and the SCL-8D.

The importance of leisure in the lives of persons with congenital physical disabilities.

Abstract: Although occupational therapists emphasize a balance among the three occupational areas of self-care, productivity, and leisure in people's lives, leisure often is focused on less than the other areas in both the research literature and clinical practice. Very little research has been conducted on the benefits of leisure activities in adults with congenital disabilities. The information contained in this article is a secondary analysis of the interview protocols of nine adults (30-50 years of age) with either cerebral palsy or spina bifida. The primary purpose of the interview was to determine protective processes surrounding turning points in the lives of persons with disabilities. This secondary analysis allowed us to determine the benefits and meaning of leisure for this population. Consistent with literature that focused on either persons without disabilities or persons with acquired disabilities, the participants in the present study reported that involvement in leisure activity provides mental and physical health benefits, enjoyment, opportunity to develop a self-concept and increase self-esteem, and opportunities to build and enhance social relationships. All these benefits enable people to find meaning in life through doing, belonging, and understanding self in the context of their worlds.

The Impact of Sexual Esteem, Body Esteem, and Sexual Satisfaction on Psychological Well-Being in People with Physical Disability

Abstract: The current study investigated the association between sexuality and psychological well-being in people with physical disabilities. A total of 1,196 participants completed the study. There were 748 participants who had a physical disability and 448 participants who were able-bodied. The results demonstrated that sexual esteem, body esteem, and sexual satisfaction were strong predictors of self-esteem and depression among people with physical disability, and that this relationship was stronger among people with physical disability than able-bodied participants. It was also found that body esteem was more closely associated with self-esteem in disabled women, while sexual esteem was more closely associated with self-esteem in disabled men. The results of the study suggest that researchers and clinicians who are concerned with the psychological health of people with physical disability should consider strategies to improve the body esteem and sexual well-being of people with physical disabilities.

Association Between Medical Comorbidity and Treatment Outcomes in Late‐Life Depression

Abstract: OBJECTIVES: Previous studies have demonstrated an association between major depression and physical disability in late life. The objectives of this study were to examine the relationship between specific medical illnesses and the outcomes of treatment for late-life depression. DESIGN: The study was a longitudinal assessment of medical illness, depression, and disability. Patients were assessed during an initial inpatient psychiatric hospitalization and 3 months postdischarge. SETTING: All patients were initially evaluated after admission to one of 71 inpatient psychiatric treatment facilities. PARTICIPANTS: A sample of 671 older patients who received inpatient treatment for depression was evaluated at entry into the hospital and 3 months after discharge. MEASUREMENTS: Depressive symptoms were measured using the Geriatric Depression Scale. Disability was measured using the instrumental activities of daily living scale and the Medical Outcomes Study 36-item short form. Medical illness was assessed using the medical illness checklist. RESULTS: As previously reported, physical disability and the total number of medical illnesses were significantly related to change in depressive symptoms. In this study, we find that arthritis, circulatory problems, a speech disorder, or a skin problem, but not other general medical conditions, were related to a worse outcome with respect to depression symptoms. The effect of these problems was statistically and clinically significant. After controlling for pretreatment disability, arthritis and skin problems continued to predict a worse outcome. However, the apparent effect of each of these conditions was mediated by the residual disability after treatment. CONCLUSION: The results of this study support the hypothesis that certain somatic disorders play a role in the treatment response of late-life depression and suggest that the effect of specific illnesses on depression may be mediated by the presence of functional disability.

Health Status of People Using Complementary and Alternative Medical Practitioner Services in 4 English Counties

Abstract: Objectives. This study was undertaken to establish the health status of users of complementary and alternative medicine (CAM) services in England. Methods. A postal questionnaire (response rate: 64%) covering long-standing illness, use of conventional medical and CAM services, and the United Kingdom Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was sent to more than 14 000 adults in 4 counties. Results. Sixty percent of CAM users reported having a chronic illness or disability; back pain and bowel problems were the conditions most commonly reported. Regardless of whether chronic illness was reported, CAM users reported poorer health than nonusers, particularly in the dimensions of pain and physical disability, and made more visits to general practitioners. Conclusions. In England, users of CAM services have poorer physical health than nonusers and make more frequent use of conventional medical services.

Suicide in Neurologic Illness.

Abstract: The risk of attempted or completed suicide is increased in patients with migraine with aura, epilepsy, stroke, multiple sclerosis, traumatic brain injury, and Huntington’s disease. Contrary to the general perception that the risk of suicide among patients with Alzheimer’s disease and other dementing conditions is low, several reports suggest that the risk of suicide in these patients increases relative to the general population. Some patients at risk for neurologic disorders are also at increased risk for suicide; in particular, the risk of suicide is increased among persons at risk for Huntington’s disease, independent of the presence or absence of the Huntington’s gene mutation. The risk of attempted or completed suicide in neurologic illness is strongly associated with depression, feelings of hopelessness or helplessness, and social isolation. Additional suicide risk factors in persons with neurologic illness include cognitive impairment, relatively younger age (under 60 years), moderate physical disability, recent onset or change in illness, a lack of future plans or perceived meaning in life, recent losses (personal, occupational, or financial), and prior history of psychiatric illness or suicidal behavior. Substance dependence, psychotic disorders, anxiety disorders, and some personality disorders (eg, borderline personality disorder) may also contribute to increased risk of suicide among persons with neurologic illnesses. Identification and aggressive treatment of psychiatric problems, especially depression, as well as reduction of modifiable suicide risk factors among patients with neurologic illness is needed to reduce the risk of attempted and completed suicide in this population.

Using the Nominal Group Technique to Identify the Problems Experienced by Persons Living with Severe Physical Disabilities

Abstract: Changes in health care have dramatically curtailed services to people with severe physical disability and their families. This has placed a greater burden of responsibility on those who live with these conditions and have ongoing care needs. Yet little is known about the subjective problems, challenges, and solutions reported by these people. We demonstrate how the nominal group technique can be used to obtain consumer-oriented information germane to these individuals and their concerns. We conducted nominal group technique meetings with 2 groups for persons with physical disability and a third with a group for family members in caregiving roles. We demonstrate how focus groups can be conducted with the nominal group technique to identify problems experienced by individuals who live with severe physical disability. Recommendations for using the nominal group technique with client populations are presented, and implications for clinical practice are discussed.

Aging and physical disability: on integrating group and individual counseling with the promotion of physical activity.

Abstract: This review examines selected conceptual models on physical disability that have been commonly employed in the study of chronic disease and aging, and suggests including self-efficacy beliefs and physical symptoms into the main pathway of the disablement process. The resulting model of disability has direct implications for integrating group and individual counseling into exercise prescription.

The school as social context: social interaction patterns of children with physical disabilities.

Abstract: OBJECTIVE. The purpose of this study was to investigate the characteristics of the school social environment experienced by children with physical disabilities and the social interactional characteristics of children with physical disabilities in the school environment. The goal was to understand the interactive processes that support or inhibit these children’s social interactions. METHOD. Naturalistic observation and participant interviews were used to collect data on social interaction patterns of three children with physical disabilities 5 to 8 years of age who were enrolled in age-appropriate regular education classrooms. Descriptive codes were obtained through constant comparative analysis. RESULTS. Four themes were identified that characterized aspects of the social environment affecting the social interactions of children with disabilities: reciprocity, characteristics of social and play interactions, effects of adult involvement, and quality of occupational engagement. CONCLUSION. The study supports the need for occupational therapists to focus intervention on multiple aspects of the social environment to facilitate children’s socialization.

Public financial support for disability at the dawn of the 21st century.

Abstract: This is an empirical study of contemporary public financial support for disability in the United States. Public support for disability programs in the United States totaled dollars 294 billion in 1997 (41.5 million recipients) and was estimated to be dollars 426 billion in 2002. Nationally, 52% of public long-term care financial resources supported persons with disabilities in institutions, although great variation existed among states and across disability groups (i.e., mental retardation, mental illness, physical disability). State financial commitments for community long-term care services for each of the three disability groups was strongly associated with state participation in the Medicaid HCBS Waiver and Personal Assistance programs and for persons with MR/DD, with states' early adoption of civil rights statutes promoting racial equality.

Depression and Disability

Abstract: In some lights, the connection between depression and disability seems almost commonsensical and obvious. But empirical data on the nature of this relationship suggest that the links between the two are surprisingly subtle and complex. This chapter has recommended a number of analytic strategies that could be useful to clarifying these relationships. Given the heterogeneity of both depression and disability, it is likely that simple solutions will be insufficient. In a very real sense, this complexity offers the potential that not one but a variety of strategies may be useful in reducing the burden of depression and disability in the lives of older adults.

Development and Validation of the Physical Disability Sexual and Body Esteem Scale

Abstract: The Physical Disability Sexual and Body Esteem (PDSBE) scale was developed to assess respondents' capacity to feel positive about their sexuality and their body while living with a physical impairment The current paper presents four studies that were conducted to develop and assess the psychometric properties of the 10 item PDSBE scale The first study was an exploratory factor analysis involving 348 participants with physical disabilities The factors were: Sexual Esteem, Attractiveness to Others, and Body Esteem The second study was a confirmatory factor analysis, with a total of 338 participants This analysis confirmed the factor structure established in study 1 The third study revealed good test-retest reliability on a total of 47 participants with physical disabilities The final study was conducted with 748 participants with physical disabilities and showed that the PDSBE had high reliability and good convergent and divergent validity Mean scores showed that women scored significantly higher than men on the total PDSBE scale and on the Sexual Esteem and Attractiveness to Others subscales Future applications for the PDSBE scale are discussed

Sport Participation of Hong Kong Chinese Children with Disabilities in Special Schools.

Abstract: The purpose was to examine sport participation (excluding physical education classes) of school-aged Chinese children with disabilities attending special schools in Hong Kong. A sample of 237 children, ages 9 to 19, attending 10 special schools in Hong Kong, responded to a sport participation questionnaire in individual interviews. Data were analyzed by gender, two school levels, and five disability types. Results relating to participation frequency and extent indicated that girls were significantly less active than boys. Children with physical disability, visual impairment, and mental disability were less active than children with hearing impairment and maladjustment. Children with different types of disabilities varied in their participation patterns and choices of physical activities as well as their motives for sport participation, nonparticipation, and withdrawal. We concluded that disability type is more related to children’s participation behaviors in sport and physical activities than to gender an...

Physical Functioning in Female Caregivers of Children With Physical Disabilities Compared With Female Caregivers of Children With a Chronic Medical Condition

Abstract: Objectives: To evaluate if physical functioning is different in female caregivers of children with physical disabilities compared with female caregivers of children with nondisabling medical illnesses, and to investigate the factors associated with functioning level. Design: Cross-sectional survey. Setting: University-based clinics. Patients: Ninety consecutive female caregivers of children presenting to a pediatric physical medicine and rehabilitation (PMR 95% confidence interval, �0.9 to �18.4). The physical functioning score of 77.7 (22.9) in caregivers of PMR 95% confidence interval, �2.0 to �23.6). This decrease is associated with the average pain severity, mood, and total length of time of back pain in the previous 12 months. Regression analysis shows that pain severity and caregiver mood are significantly related to the physical functioning status of the caregiver. Conclusions: Physical functioning is decreased in female caregivers of children with a physical disability. This decrease is associated with caregiver pain severity and mood. Arch Pediatr Adolesc Med. 2002;156:1138-1142

Vignettes from "Sesame Street": Preschooler's Ideas about Children with Down Syndrome and Physical Disability.

Abstract: The results of previous research suggest that while preschool children have a beginning understanding of disabilities that involve the use of adaptive equipment, they have little awareness of disabilities such as Down syndrome which have less overt distinguishing characteristics. In this study, videotaped segments from the children's television show, Sesame Street, were used to explore children's ideas about Down syndrome and physical disability. Participants included 41 preschool children. While a majority of participating children were aware that each child in the videotapes had some difficulties performing age-appropriate tasks, children had significantly fewer ideas about why the child with Down syndrome had this difficulty. Significantly more thought that the child with Down syndrome could do more "if he tried really hard" when compared with the child with a physical disability. These results are discussed in terms of children's developing understanding of disabilities and implications for using medi...

Pediatric Rehabilitation in Children with Cerebral Palsy: General Management, Classification of Motor Disorders

Abstract: Cerebral palsy (CP) is the most common physical disability in childhood. The motor impairment syndrome is obligatory for the diagnosis, but a broad range of neurological deficits can be present as well. Professionals in pediatric rehabilitation are faced with a diversity of problems in the child and

The impact of disability and disease duration on social support of women with rheumatoid arthritis.

Abstract: The objective was to investigate the impact of physical disability and disease duration on the amount of social support received by female patients with rheumatoid arthritis. Two hundred sixty-four patients were assessed in a cross-sectional study. Disease duration had a negative relationship to daily emotional support; the length of disease duration was related to less emotional support. A combination of long disease duration and high disability was related to a low degree of problem-oriented emotional support. High physical disability was associated with less social companionship. Patients with high disability and few friends and patients with high disability and few neighbours reported less social companionship than patients with high disability and four or more friends or three or more neighbours. The combination high disability and few friends were associated with less problem-oriented instrumental support. Number of friends, age, and personality type all contributed to the variance in social support.