Showing papers on "Physical disability published in 2004"

Skeletal Muscle Cutpoints Associated with Elevated Physical Disability Risk in Older Men and Women

Abstract: The purpose of this study was to determine skeletal muscle cutpoints for identifying elevated physical disability risk in older adults. Subjects included 4,449 older (> or = 60 years) participants from the Third National Health and Nutrition Examination Survey during 1988-1994. Physical disability was assessed by questionnaire, and bioimpedance was used to estimate skeletal muscle, which was normalized for height. Receiver operating characteristics were used to develop the skeletal muscle cutpoints associated with a high likelihood of physical disability. Odds for physical disability were compared in subjects whose measures fell above and below these cutpoints. Skeletal muscle cutpoints of 5.76-6.75 and < or =5.75 kg/m2 were selected to denote moderate and high physical disability risk in women. The corresponding values in men were 8.51-10.75 and < or =8.50 kg/m2. Compared with women with low-risk skeletal muscle values, women with moderate- and high-risk skeletal muscle values had odds for physical disability of 1.41 (95% confidence interval (CI): 0.97, 2.04) and 3.31 (95% CI: 1.91, 5.73), respectively. The corresponding odds in men were 3.65 (95% CI: 1.92, 6.94) and 4.71 (95% CI: 2.28, 9.74). This study presents skeletal muscle cutpoints for physical disability risk in older adults. Future applications of these cutpoints include the comparison of morbidity risk in older persons with normal muscle mass and those with sarcopenia, the determination and comparison of sarcopenia prevalences, and the estimation of health-care costs attributable to sarcopenia.

Gender differences in physical disability among an elderly cohort.

Abstract: Objectives We analyzed the role of sociodemographic factors, chronic-disease risk factors, and health conditions in explaining gender differences in disability among senior citizens. Methods We compared 1348 men and women (mean age = 79 years) on overall disability and compared their specific activities of daily living, instrumental activities of daily living (IADL), and mobility limitations. Analysis of covariance adjusted for possible explanatory factors. Results Women were more likely to report limitations, use of assistance, and a greater degree of disability, particularly among IADL categories. However, these gender differences were largely explained by differences in disability-related health conditions. Conclusions Greater prevalence of nonfatal disabling conditions, including fractures, osteoporosis, back problems, osteoarthritis and depression, contributes substantially to greater disability and diminished quality of life among aging women compared with men.

Loss of strength contributes more to physical disability after stroke than loss of dexterity

Abstract: Objective: The major contributors to physical disability after stroke are considered to be the negative impairments of loss of dexterity (defined here as loss of the ability to co-ordinate muscle activity in the performance of any motor task) and loss of strength. The aims of this study were: (1) to determine the relative contributions of strength and dexterity to function during recovery after stroke; and (2) to determine the predictive value of initial strength, dexterity and function on long-term function after stroke.Design: A longitudinal descriptive study.Setting: The inpatient and outpatient rehabilitation departments of two metropolitan hospitals.Subjects: Twenty-two patients undergoing rehabilitation after acute stroke participated.Main outcome measures: Strength and dexterity of the elbow flexors and extensors were measured, along with arm function, at 3, 5, 7, 9, 11, 15, 19, 23 and 27 weeks after stroke.Results: Standard multiple linear regression analysis demonstrated that strength and dexteri...

Marital functioning, chronic pain, and psychological distress

Abstract: This study examined whether marital functioning variables related uniquely to psychological distress and diagnoses of depressive disorder independent of pain severity and physical disability. Participants were 110 chronic musculoskeletal pain patients. Hierarchical regression results showed that marital variables (i.e. marital satisfaction, negative spouse responses to pain) contributed significantly to depressive and anxiety symptoms over and above the effects of pain severity and physical disability. In contrast, marital variables were not significantly related to diagnoses of depressive disorder (i.e. major depression, dysthymia, or both) after controlling for pain variables. In multivariate analyses, physical disability and marital satisfaction were uniquely related to depressive symptoms whereas physical disability, pain severity, and negative spouse responses to pain were uniquely related to anxiety symptoms. Only physical disability was uniquely related to major depression. The results suggest that models of psychological distress in chronic pain patients might be enhanced by attributing greater importance to interpersonal functioning and increasing attention to anxiety.

The nature of referred subtypes of primary speech disability

Abstract: Of 1100 children referred to a mainstream paediatric speech and language therapy service in a 15-month period (January 1999 to April 2000), 320 had primary speech impairment. No referred child had significant hearing impairment, learning disability or physical disability. This paper describes the nature of the subtypes of speech disability referred. The results showed that of 320 children, 57.5% had phonological delay, 20.6% consistently made non-developmental errors, 9.4% made inconsistent errors on the same lexical item and 12.5% had articulation disorder; no child was diagnosed with develop-mental verbal dyspraxia. An estimate of the referral incidence of primary speech disability in a single year, calculated from referrals who attended, was 6.4% (estimated as 48000 children per year in the UK). The findings inform speech and language therapy service planning.

Trends in disability-free life expectancy.

Abstract: Purpose: To assess trends in Disability-Free Life Expectancy, in life expectancy with disabilities according to levels of severity and in Disability-Adjusted Life Expectancy in the Netherlands between 1989 and 2000.Method: The disability-free life expectancy, a composite population health status measure, was calculated with data on long-term disability. Weights reflecting the impact of disability on personal functioning were assigned to different levels of severity of disability, in order to calculate a Disability-Adjusted Life Expectancy and to define cut-off points, in order to distinguish between levels of severity.Results: At an aggregated level, for both males and females at the ages of 16 and of 65 years, an increase in years with disabilities and a decline in disability-free life expectancy were observed. These trends were mainly caused by a rise in the number of years with mild disabilities, with the number of years with moderate and severe disabilities decreasing. The combined changes have result...

Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: a case-control study.

Abstract: Background There is little published about the role of individual characteristics in occupational injuries. Construction workers have a high rate of injury; we assessed 11 personal characteristics in this professional sector. Methods A case-control study was conducted on 880 male workers who had had at least one occupational injury during a 2-year period and 880 controls. A questionnaire was administered by an occupational physician. Statistical analysis was made via logistic regression method. Results Young age (<30 years), sleep disorders and current smoker influenced all the injuries combined. Sleep disorders and young age were common risk factors for several jobs. Physical disabilities and no sporting activity had a role in masons, and 5 years or less in present job in plumbers and electricians only. Sleep disorders influenced both the injuries with and without hospitalization; young age, current smoker, and physical disability influenced those without hospitalization only. Conclusions Young age, sleep disorders, smoking, disabilities, sporting activity, and experience influenced the occupational injuries. The risk for each worker depended on his job. Occupational physicians could inform the workers of these risks and encourage them to take remedial action. Am. J. Ind. Med. 45:84–92, 2004. © 2003 Wiley-Liss, Inc.

Spousal congruence on disability, pain, and spouse responses to pain

Abstract: We examined congruence between chronic pain patients and their spouses on their reports of patient pain severity, patient disability, and spouse responses to pain. Patients reported that they were more physically and psychosocially disabled than their spouses reported them to be. However, spouses reported that the patients' pain was more severe than patients reported. Depressive disorders in the patient and gender interacted with patient-spouse ratings. For physical and psychosocial disability, depressed patient couples reported significantly larger differences in disability ratings than non-depressed patient couples. In addition, female patients' disability was rated as more severe by the female patients than by their husbands. Male patient couples did not report differences on physical disability. Findings relating to other forms of disability and to spouse responses are also described. The results are discussed in the context of an interpersonal perspective of chronic pain and have implications for the assessment of pain and disability.

Comparative Study of Workplace Policy and Practices Contributing to Disability Nondiscrimination

Abstract: Objective: To assess the impact of disability nondiscrimination legislation on employer practices in the United States and the United Kingdom. Study Design: U.S. and U.K. human resource professionals were surveyed about their experience with implementation of the legislation. Results: Both U.S. and U.K. employers are responding to their respective legislation by making accommodations-adjustments needed by applicants and employees with disabilities. Conclusions: Rehabilitation psychologists and other health care professionals working with people with disabilities must understand employee rights and employer responsibilities under this legislation, know where employers may have difficulty in responding to an accommodation request, and be familiar with the existing workplace resources and processes that can support an effective response to such requests. People with disabilities are often underemployed or unemployed, compared with their nondisabled peers—and approximately one in six people has a disability. In the 1990s, many world economies were stronger than they had been for decades. Unfortunately, the unemployment rate of persons with disabilities did not improve concurrently (Wehman, 1998), and in many countries it continues to be disproportionate to that of the general population. In the United States, for example, 34% of men and 33% of women with disabilities were employed in 1999, compared with 95% of men and 82% of women without disabilities (Burkhauser, Daly, Houtenville, & Nargis, 2001). This low employment rate represents a loss of income and social and economic participation for people with disabilities, as well as a significant loss of willing

Factors Associated with Self-Worth in Young People with Physical Disabilities

Abstract: Having a positive sense of self is associated with success for children and adults, with and without disabilities. This article reports on a cross-sectional study examining the correlates of global self-worth for 85 young people (ages eight to 23) with spina bifida (a condition present at birth) or spinal cord injury (an acquired condition). Significant correlations were found between perceptions of self-worth and age, perceived social support of close friends, and perceived social support from parents. Regression analysis revealed that perceived social support from parents was a stronger predictor of self-worth than gender, age, or diagnosis (onset of disability). Implications of this study for social work practice are discussed.

Aerobic exercise dysfunction in human immunodeficiency virus: a potential link to physical disability.

Abstract: Approximately 282,000 adults, adolescents, and children are currently living with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) in the United States as of the year 2002.1 With the advent of highly active antiretroviral therapy (HAART), the life span of these individuals has dramatically increased,2 and HIV infection is now considered a chronic illness with accompanying episodes of exacerbations and remissions of symptoms.3 Numerous conditions such as lipodystrophy syndrome4–6 and skeletal myopathy7–9 have been associated with HIV and its medical management, many of which may result in physical disability and diminished quality of life. Due to the chronic nature of this condition, physical therapists will continue to manage many of these conditions in increased numbers of people who are living with HIV. Although guidelines for physical therapy evaluation and management of this potentially disabling condition have not been established, it appears that aerobic exercise training may have a beneficial effect on the cardiorespiratory health of people who are living with HIV. Thus, an understanding of the factors that limit the oxidative metabolic response to physical activity is paramount in developing effective exercise training programs for people with this virus. The focus of this Update is to examine the biological factors that might limit the oxidative metabolic response to physical activity in people with HIV. HIV-related disability has been associated with fatigue and decreased physical functioning10–13 as well as other factors that may limit people's ability to carry out necessary life activities.12,14,15 Fatigue in adults with HIV has been identified using patient self-reports of physical and functional limitations while performing activities of daily living such as housework, climbing stairs, and walking15 and activities required for employment.10,11 Asymptomatic HIV …

Physical disability among older Italians with diabetes. The ILSA Study

Abstract: Aims/hypothesis We studied the role of diabetic complications and comorbidity in the association between diabetes and disability in the elderly.

Predictors of the Use of Assistive Devices that Address Physical Impairments Among Community-Based Frail Elders:

Abstract: Use of assistive devices is a type of health behavior utilized to maintain independence and enable living at home. The purpose of this study is to identify predictors of the use of assistive devices that address physical impairments among community-based frail elders. A convenience sample of 694 cognitively intact, physically frail elders older than 60, living at home, was used. Interviewers who visited their homes identified devices in use (M = 9.5). Predictors were determined by hierarchical multiple regression analyses. Among 15 independent variables, physical disability level (higher severity) was the strongest overall predictor. Medication intake (more) was the only predictor among health indicators. Race (White) was the strongest predictor among demographic variables, followed by region (south) and living arrangements (living alone). Among the psychosocial variables, depression was an important predictor to hinder assistive-device use. Further studies are encouraged to create a model of maintaining ...

Exploring the influence of depressive symptoms on physical disability: a cohort study of elderly in Beijing, China.

Abstract: Objectives: This study examined the influence of depressive symptoms on the prevalence of physical disability in a cohort study of Beijing elderly (1992–2000) and analyses the role of some confounding variables in this relationship. Methods: A cohort of 1828 elderly aged 55 and older who were initially free of any physical disability was followed up for 8 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability on activities of daily living (BADL and IADL) was measured in 1994, 1997, and 2000 respectively. Results: The cumulative percentages of persons who developed BADL disability and IADL disability during each follow-up interview was significantly greater among depressed than non-depressed individuals. Compare with the 1525 non-depressed individuals, the 303 depressed individuals had a relative risk (95% confidence interval) of 2.52 (2.02, 4.82) for BADL disability and 4.98 (2.46, 10.09) for IADL disability, respectively. Although adjustment for confounding factors reduced the risk to 2.20 (1.33, 3.62) and 4.29 (2.08, 8.86), the detrimental effect of depression on disability remained significant. The items of IADL which connected physical activity had higher impairment among depressed individuals. Conclusions: Depression in elderly persons may increase the risk for prevalent disability. It is very important for elders to prevent and reduce depression for improving the quality of their life and physical function.

Occupational Adaptation: The Experiences of Older Persons With Physical Disabilities

Abstract: The purpose of this phenomenological study was to explore the experiences of occupational adaptation among a small number of older Dutch persons with physical disabilities. Occupational adaptation was tentatively defined as overcoming disabling influences on occupational functioning. Eight occupational therapy clients, who were living in the community, were interviewed using an open in-depth interview format. A phenomenological analysis resulted in descriptions of occupational adaptation as a process that required these clients' active engagement. The clients recruited already familiar problem-solving strategies and personal resources as well as resources in their social and physical environments to identify prospects of potential solutions and to create solutions to overcome constraints on occupational functioning. Furthermore, participants strived for finding satisfaction through occupations, a meaning theme which emerged as the object of occupational adaptation. Satisfaction through occupations was found in maintaining daily routines and engaging in fulfilling occupations.

The relationship between catastrophizing and disability in amputees experiencing phantom pain.

Abstract: Purpose: In recent years, researchers have noted that catastrophizing predicts both self-reported and objective measures of disability in a variety of chronic pain conditions. The present study sought to examine this in a working-age amputee population experiencing phantom pain.Method: Participants completed a postal questionnaire incorporating measures of pain, disability and coping. A response rate of 62% resulted in 315 completed data sets being incorporated into the study.Results: Utilizing the three subscales of the Sickness Impact Profile, catastrophizing uniquely predicted 11% of the variance in overall level of disability, 6% in physical disability and 13% in psychosocial disability after accounting for demographic, amputation and pain-related variables.Conclusion: The findings suggest that catastrophizing is a significant predictor of self-reported disability in an amputee population. This population have lifetime rehabilitation needs in that prostheses have to be remade on a regular basis. The s...

Mental Health Problems, Disability and Income Support Receipt: A Replication and Extension Using the HILDA Survey

Abstract: There is considerable evidence that social position and economic status are related to mental health This article uses data from the first wave of the HILDA Survey to replicate and extend previous research demonstrating the elevated prevalence of mental disorders among different groups of Australian income support recipients Welfare recipients were significantly more likely to experience moderate or severe disability due to poor mental health than non-recipients, with rates particularly elevated among clients receiving disability, lone parent and unemployment payments To a large extent, these elevated rates of mental disability are consistent with the pattern of financial hardship and demographic characteristics such as gender and partnered status, and physical disability However, a significant proportion of mental disability remains unexplained in several client segments These findings have important implications for the design, delivery and evaluation of interventions to improve the social and economic participation of different welfare client groups

Children's Understanding of the Causal Origins of Disability

Abstract: This study explores children's understanding of the causal origins of disabilities. Using a forced-choice explanation task, children's understanding of social-psychological, physical, and biological causal explanations of disabilities was considered. We presented 79 children (26 4- to 5-year-olds, 26 6- to 7-year-olds, and 27 10- to 11-year-olds) with 4 vignettes describing a child with a particular disability (physical disability, blindness, learning disability, attention deficit hyperactivity disorder). Participants rated their agreement with a variety of causal explanations of disability. Results showed significant age, disability, and causal explanation differences in children's causal understandings of disability. Children of all ages showed a preference for physical and biological causes of disability and rejected social-psychological causal explanations. These findings highlight the usefulness of employing a forced-choice methodology to examine young children's concepts of the causal origins of dis...

Appraisal and coping as predictors of psychological distress and self-reported physical disability before lung transplantation.

Abstract: Context—Certain appraisals and coping strategies have been associated with increased levels of psychological distress and disability in other medical populations, but no study has examined this relationship with patients who are awaiting lung transplantation.Objective—To describe the cognitive appraisal and coping strategies used by patients who are pursuing lung transplantation and to evaluate the extent to which these processes are associated with depression, anxiety, and disability. Methods—This is a cross-sectional design with 160 participants (42.5% men) who have end-stage lung disease and were evaluated for lung transplantation at a large medical center.Measures—The outcome variables of depression, anxiety, and physical disability were assessed using the Beck Depression Inventory, Spielberger Trait Anxiety Inventory, and the Sickness Impact Profile, respectively. The predictor variables, coping and appraisal styles, were measured using the COPE and the Stress Threat Questionnaire, respectively. Demo...

Developing Issues in the Classification of Mental and Physical Disabilities

Abstract: In this analysis, the authors explore the implications of changing classifications and definitional criteria for mental disability and physical disability. Much of this discussion is set against th...

Link Family Support – an evaluation of an in-home support service

Abstract: A significant body of research has shown that parents who have a child or a dependent adult with a disability experience significant and persistent levels of stress. One of the recognized strategies for coping includes the provision of in-home practical support. Enable Ireland provides a range of services for children and adults with a physical disability. The present study explored home support services with a sample of 16 families of service users of Enable Ireland Cork. Practical support was deemed to be whatever support or intervention requested by the parent of the child/dependent adult which afforded the service user the opportunity to engage in social/recreational opportunities and that gave the parent free time. Sixteen members of the chosen families were interviewed (15 mothers and one father) using a semi-structured interview schedule and a standardized stress measure before and after the introduction of Link Family Support (LFS). LFS was put in place for a period of 12 months, tailored to the families and service users' individual needs. Although levels of stress continued to be high and scores on the Parenting Stress Index (PSI) did not show a statistically significant reduction after the programme, reported stress levels had improved. Parents reported LFS to be very helpful in reducing perceived stress and improving family's quality of life through providing free time and access to leisure and recreation facilities. This study provided limited but clear evidence of the need for regular, flexible, in-home support for families with children and dependent adults with a disability. LFS provided a personal, regular and effective means of meeting this need as the findings of this study demonstrated.

Psychosocial Adjustment to Multiple Sclerosis

Abstract: Research has suggested that successful adaptation to multiple sclerosis (MS) and its psychological sequelae is affected by a variety of factors, but many questions remain unanswered. This study examined the extent to which certain factors contribute to successful psychosocial adjustment. Subjects were 100 MS outpatients from several MS centers and neurology clinics in the Washington, D.C. metropolitan area. Analysis showed that the following variables contributed significantly to psychosocial adjustment: disease status (i.e., remission versus exacerbation), medication, cognitive disability, and perceived uncertainty. Coping style, social support, and perceived level of physical disability did not contribute significantly to adjustment. The findings suggest that efforts should be made to reduce patients' perceptions of uncertainty regarding their MS and that cognitive functioning be assessed and appropriately accommodated in treatment.

The relationship between physical impairment and disability during stroke rehabilitation: effect of cognitive status.

Abstract: The objectives of this study were to assess the relationship between physical impairment and disability during stroke rehabilitation and to determine the effect of cognitive functions on physical impairment during rehabilitation. Prospectively collected data from stroke patients admitted for rehabilitation were compared at admission and at discharge by the Chedoke-McMaster Stroke Assessment (the Chedoke Assessment) impairment inventory and subscores of the Functional Independence Measure (FIM). The Chedoke Assessment was used to measure physical impairment in the lower extremities and the FIM was used to measure physical disability; motor and cognitive subscales of the FIM instrument were also evaluated. Although stroke-related impairment and motor FIM were significantly correlated with each other, cognitive measures on the FIM at discharge were not correlated with motor impairment, although cognitive disability was slightly improved. It is possible that dependency in physical activities of daily living and walking after stroke are mostly affected by degree of motor impairment.

Morbidity Experiences and Disability Among Canadian Women

Abstract: Women are more frequently affected by chronic conditions and disability than men. Although some of these sex differences have been in part attributed to biological susceptibility, social determinants of health and other factors, these gaps have not been fully explained in the current literature. This chapter presents comparisons of hospitalization rates, and the prevalence of chronic conditions and physical disability between Canadian women and men and between various subgroups of women, adjusting for selected risk factors. The Canadian Hospital Morbidity Database (2000–2001) and Canadian Community Health Survey (2000–2001) were used to examine inpatient hospital morbidity, prevalence of chronic conditions and disability. Hospitalization rates were 20% higher among women than men. This was due to the large number of hospitalizations for pregnancies and childbirth. When "normal" deliveries were excluded, hospitalization rates remained higher among women. Women had slightly lower rates of hospitalizations for ambulatory-care sensitive conditions than men. Prevalence of activity limitation (mild and severe) was higher among women than men, and differences remained after adjusting for age, chronic conditions, socio-economic status, and smoking. Women who reported a disability were less likely than men to be in a partnered relationship, have less tangible social support, and have lower income and employment rates. The impact of morbidity and disability on Canadian women is substantial. These results identify areas for interventions among more vulnerable subgroups, and point to the need for further research in the area of risk factors for the prevention of morbidity and disability in the population.

Predictors of Physical Functional Disability at 5 to 6 Years after Heart Transplantation

Abstract: Background Few reports were found in the literature that examined predictors of physical functional disability after heart transplantation. Therefore, the purpose of this study was to (1) describe physical functional disability, (2) identify differences in physical functional disability by demographic and clinical variables, and (3) identify predictors of physical functional disability at 5 to 6 years after heart transplantation. Methods A nonrandom sample of 311 patients (approximately 60 years of age, 78% male, and 90% Caucasian) who were 5 to 6 years post-heart transplantation were investigated. Patients completed 8 reliable and valid quality-of-life instruments via self-report. Data analyses included descriptive statistics, chi-square, independent t -tests, correlations, and stepwise multiple regression. Level of significance was set at p = 0.05. Results The level of physical functional disability was low at 5 to 6 years after heart transplantation, yet 59% of patients reported having physical disability. Women experienced more functional disability than men, and patients with comorbidities (i.e., diabetes mellitus and orthopedic problems) experienced more functional disability than patients without these comorbidities. At 5 to 6 years after heart transplantation, 70% of variance in physical functional disability was explained by activities of daily living, symptoms, comorbidities, psychologic status, and resource utilization variables. Conclusions At 5 to 6 years after heart transplantation, most patients experienced low levels of physical functional disability. Differences in physical functional disability were identified by both demographic characteristics and clinical variables. Predictors of physical functional disability included activities of daily living and symptoms, and clinical, psychologic, and resource utilization variables. Knowledge of factors related to physical disability long-term after heart transplantation provides direction for the development of strategies to assist patients to reduce their level of disability or function adequately despite their disability.

Using Cognitive Mapping to Understand Problems Experienced by Family Caregivers of Persons with Severe Physical Disabilities

Abstract: Individuals who provide ongoing care for family members who have a chronic disease or disability are likely to encounter a wide array of problems that can compromise their own health and their ability to function effectively in a caregiving role. Structured focus group meetings were conducted to elicit a comprehensive list of the problems that caregivers experienced during their first year of providing care to a person with a severe physical disability. A separate group of caregivers (N = 60) individually sorted problems into piles based on their similarity and assigned relative importance to each problem. The aggregated data were analyzed with multidimensional scaling and hierarchical cluster analysis. Results indicated that caregivers cognitively organize problems along three dimensions: I. Centeredness–caregiver versus patient-oriented; II. Relationship Demands–physical versus emotional; and III. Caregiver Burden–time versus emotional. Additionally, 6 clusters of substantively similar problems were identified and prioritized in terms of personal relevance: Basic Needs (lowest); Perceived Constraints; Caregiver Challenges; Patient Resentment; Patient Withdrawal; and Patient Intrapsychic Adjustment (highest). Further examination of the organization of problems identified by caregivers should provide important insights about the experience of caregivers and how more targeted interventions can be developed to address their specific needs.

Beyond Disability: Assessing Participation and Autonomy in Medical Rehabilitation

Abstract: The objective of the study was to explore the concept of participation and autonomy in relation to medical rehabilitation, and to develop a questionnaire addressing this theme. In rehabilitation, the traditional method of assessing the needs of people with a chronic disabling condition is to measure their level of physical disability. However, a focus on physical aspects alone misrepresents the complexity of human functioning in everyday life, and may distract the attention from other areas of importance. Long-term outcomes in terms of the impact of physical disability on social participation are paramount, since people with a chronic disabling condition are faced with the consequences of illness or disability for the rest of their life. When considering social participation, individual autonomy is a vital concept, because different people lead different lives in different contexts. Respect for individual autonomy is central to a client-centred approach.

[Psychiatric disorders and disability among leprosy patients; a review].

Abstract: As a gross estimate, leprosy currently affects 11-16 million patients worldwide There are currently 3600 registered patients in Turkey. The social stigma connected to leprosy makes this disease completely different from others. Even nowadays people affected by leprosy have to leave their village or are socially isolated. The physical deformity ratio is approximately 25% in other countries whereas it is more than half in Turkey. The prevalence of mental disorders among leprosy patients is higher than that among the general population. Depression is the most common psychiatric disorder among leprosy patients. Another important finding is that the long duration of the illness and physical handicaps raise the risk of psychiatric disorders. Nevertheless, the results of two studies conducted in Turkey on this subject contradict the results of international studies. Leprosy patients experience functional disabilities that limit their lives and ability to establish relation ships with others both in social and occupational fields. The physical disability rate is high (75%) in Turkey. A review of the literature revealed several papers on the psychosocial aspects of illness but few references to the degree or pattern of psychiatric disorders among leprosy patients. The main purpose of this paper is to review psychiatric disorders and disabilities in leprosy patients and to obtain concrete results.