Conceptualizing disability in US national surveys: application of the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) framework

Psychological Distress, Emergency Room Utilization, and Mortality Risk Among US Adults With History of Prostate Cancer

PURPOSE

Adults with a history of prostate cancer experience several physical and mental stressors. However, limited information is available about the prevalence of psychological distress in this population and its association with clinical outcomes in a nationally representative sample.

METHODS

We identified adults with history of prostate cancer from a nationally representative cohort (2000-2018 US National Health Interview Survey) and its linked mortality files through December 31, 2019. The six-item Kessler Psychological Distress Scale (K6) was used to assess psychological distress. The associations between psychological distress severity, emergency room (ER) usage, and mortality risk were estimated using multivariable logistic and Cox proportional hazards models, which were both adjusted for age, survey year, race/ethnicity, region, education, health insurance, comorbidities, functional limitations, and time since cancer diagnosis.

RESULTS

Among the 3,451 adults with history of prostate cancer surveyed, 96 (2.4%), 434 (11.3%), and 2,921 (86.3%) reported severe, moderate, or low/no mental distress, respectively. During the 12 months preceding the survey, 812 (22.8%) adults with history of prostate cancer visited the ER. After a median follow-up of 81 months, 937 (25.5%) deaths occurred. Compared with participants with low/no mental distress, those with severe mental distress reported the highest utilization of the ER (adjusted odds ratio [aOR], 2.57 [95% CI, 1.51 to 4.37]) and exhibited the highest all-cause mortality (adjusted hazard ratio [aHR], 1.83 [95% CI, 1.29 to 2.60]), followed by those with moderate mental distress (ER use aOR, 1.76 [95% CI, 1.29 to 2.42]; all-cause mortality aHR, 1.22 [95% CI, 0.92 to 1.62]).

CONCLUSION

Among US adults with history of prostate cancer, psychological distress was associated with increased ER use and mortality risk. Notably, severe psychological distress was correlated with the highest rates of ER visits and mortality risk. However, given the retrospective nature of this study, uncontrolled confounding variables need to be considered when interpreting the findings.

Psychological Distress, Emergency Room Utilization, and Mortality Risk Among US Adults With History of Prostate Cancer

PURPOSE

Adults with a history of prostate cancer experience several physical and mental stressors. However, limited information is available about the prevalence of psychological distress in this population and its association with clinical outcomes in a nationally representative sample.

METHODS

We identified adults with history of prostate cancer from a nationally representative cohort (2000-2018 US National Health Interview Survey) and its linked mortality files through December 31, 2019. The six-item Kessler Psychological Distress Scale (K6) was used to assess psychological distress. The associations between psychological distress severity, emergency room (ER) usage, and mortality risk were estimated using multivariable logistic and Cox proportional hazards models, which were both adjusted for age, survey year, race/ethnicity, region, education, health insurance, comorbidities, functional limitations, and time since cancer diagnosis.

RESULTS

Among the 3,451 adults with history of prostate cancer surveyed, 96 (2.4%), 434 (11.3%), and 2,921 (86.3%) reported severe, moderate, or low/no mental distress, respectively. During the 12 months preceding the survey, 812 (22.8%) adults with history of prostate cancer visited the ER. After a median follow-up of 81 months, 937 (25.5%) deaths occurred. Compared with participants with low/no mental distress, those with severe mental distress reported the highest utilization of the ER (adjusted odds ratio [aOR], 2.57 [95% CI, 1.51 to 4.37]) and exhibited the highest all-cause mortality (adjusted hazard ratio [aHR], 1.83 [95% CI, 1.29 to 2.60]), followed by those with moderate mental distress (ER use aOR, 1.76 [95% CI, 1.29 to 2.42]; all-cause mortality aHR, 1.22 [95% CI, 0.92 to 1.62]).

CONCLUSION

Among US adults with history of prostate cancer, psychological distress was associated with increased ER use and mortality risk. Notably, severe psychological distress was correlated with the highest rates of ER visits and mortality risk. However, given the retrospective nature of this study, uncontrolled confounding variables need to be considered when interpreting the findings.

The prevalence of disability and associated factors among community adults in the baseline of CHCN-BTH Cohort Study

BACKGROUND

Disability was a major public health problem in China. However, the prevalence of disabilities in community-dwelling adults and their relationships to chronic physical conditions were unclear. We aimed to estimate the prevalence of disabilities and associated factors among a large community-based cohort in China.

METHODS

Participants who were local permanent residents aged 18 years or above and completed the disability assessments were selected from the Cohort study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH) from 2017 to 2019. Disability was assessed using five questions about impairments and activity limitations based on the International Classification of Functioning (ICF), Disability and Health. Univariate, multivariate and multilevel logistic regressions were conducted to estimate the associations between disabilities and associated factors.

RESULTS

Totally, 12,871 community-dwelling adults completed the survey. Among of them, 12.9% (95% CI: 12.3%-13.5%) reported having any disability. The prevalence of any disability was significantly higher in participants who were older age, widowed, retired and smokers, had higher BMI, average monthly income < 5000 RMB, lower education level, lower physical exercise frequency and heavy physical labor. Multilevel logistic regressions showed that there were significant associations between disabilities with chronic physical conditions, especially in the vision impairment with lower back pain, and hearing impairment as well as difficulty walking without special equipment with injuries.

CONCLUSIONS

Many Chinese adults suffered from disabilities. Sustained efforts should be made to develop specific population-based health promotion and prevention programs for disabilities in China.

TRAIL REGISTRATION

ChiCTR1900024725 (25/07/2019).

Content comparison of long-term care instruments based on the international classification of functioning, disability and health (ICF)

BACKGROUND

Ageing poses a huge challenge to the Chinese social welfare system. However, a national long-term care (LTC) instrument has not been established yet. This study aimed to analyse and compare the content of six selected LTC instruments based on the linkage of the International Classification of Functioning, Disability and Health (ICF) to provide a content reference from a functioning perspective for the development of a Chinese national LTC instrument.

METHODS

Two trained health professionals performed the linkage analysis according to the refined ICF linking rules. The main concepts included in the items of three international LTC instruments, namely Minimum Data Set 3.0 (MDS 3.0), Initial Assessment Instrument (IAI), and New Assessment Tool for Determining Dependency on Nursing Care (NBA), as well as three Chinese instruments, namely Disability Assessment of Long-Term Care (DA-LTC), Specification for Elderly Care Unified Need Assessment in Shanghai Version 2.0 (SEC-UNA 2.0), and pictorial-based Longshi Scale (LS), were selected and linked to the ICF categories. The six selected LTC instruments were analysed and compared at the levels of ICF components, chapters, and categories.

RESULTS

The main concepts of 340 items of the six LTC instruments were linked to 112 different ICF categories. Within the ICF framework, the 'Activities and Participation' component was most frequently addressed in the LTC instruments, followed by 'Body functions', at 52% and 38%, respectively. At the chapter level, 'b1 mental functions', 'd4 mobility', and 'd5 self-care' were addressed by the majority of LTC instruments.

CONCLUSION

The ICF provides a general reference for the analysis and comparison of different LTC instruments. The findings indicate that all LTC instruments focused on older adults' physical needs; however, various important issues regarding their psychological and social participation needs were not addressed. Specific for China, the core elements of LTC instruments varied, and the ICF chapters 'b1', 'd4', and 'd5' are recommended to develop a national uniform one.

Assessing the content based on ICF and quality based on COSMIN criteria of patient-reported outcome measures of functioning in breast cancer survivors: a systematic review

PURPOSE

To identify currently used patient-reported outcome measures (PROMs) to evaluate disability in breast cancer survivors (BC) and critically evaluate their content and measurement properties.

METHODS

Four electronic databases (PubMed, EMBASE, CINAHL, Scopus and Google Scholar) were searched from 2001 to February 2021. PRISMA guidelines were followed. The content of the included PROM was evaluated by linking the items of the questionnaires to the International Classification of Functioning, Disability and Health (ICF) Core Set for BC using standard linking rules. Methodological quality and measurement properties were assessed using the COSMIN checklist. Qualitative synthesis was used to summarize the evidence on content validity and measurement properties. The overall quality of evidence on each measurement property was provided using GRADE principles.

RESULTS

Ten eligible studies reported measurement properties of seven PROMs. The content of included PROMs mostly focused on disability (70% of items), and less on body function and structure (23%) or environmental factors (6%). There was high linkage to The Comprehensive Core Set for BC, Q-DASH (100%), UEFI (95%) and DASH (92%). The Core Set Unique Disability Representation for DASH, and WHODAS2 was 39% and BCSQ-BC, Lymph-ICF was 34%. BCSQ-BC, and Lymph-ICF represented 32, and 20% of the content of the Core Set for BC, respectively, however, the other questionnaires covered less than 20% of the content of the Core Set. High quality of evidence supports sufficient results for internal consistency, testretest, and measurement error for BCSQ-BC, Lymph-ICF, DASH and WHODAS2.

CONCLUSIONS

Despite a lack of evidence on all-important clinical measurement, two generic (DASH and WHODAS2) and two disease-specific (BCSQ-BC, Lymph-ICF) PROM demonstrated emerging evidence of adequate measurement properties. The stronger alignment of the BCSQ-BC to the breast cancer ICF core set makes it preferable is a disease-specific measure. The Lymph-ICF is recommended where lymphedema is a specific focus. The DASH and WHODAS2 might be most useful where patients with a variety of upper extremity conditions, including breast cancer survivors, are being evaluated in the clinic or research study.

Beyond question wording: How survey design and administration shape estimates of disability

BACKGROUND

Between 2008 and 2014, annual estimates of disability prevalence among U.S. adults varied somewhat across federal surveys that use a standardized measure of disability, but trends over-time were relatively stable and consistent. In 2014, however, estimates of disability from the Survey of Income and Program Participation (SIPP) increased markedly relative to previous years and were much higher than disability estimates from other federal surveys.

OBJECTIVE

To examine why disability prevalence among adults aged 40 and older substantially increased in the first wave of the 2014 SIPP Panel.

METHODS

We consider three factors that may have contributed to the rise in disability: data processing, context effects linked to question order, and sampling. To do so, we compare estimates with and without survey weights and imputed data, analyze supplemental disability-related data collected among SIPP participants, and employ decomposition analysis to assess what proportion of the increase in disability can be attributed to changes in sample composition.

RESULTS

We find evidence that differences in sample composition contributed to the observed rise in disability prevalence in SIPP between 2011 and 2014. There is less evidence that weighting and imputation or context effects played a role.

CONCLUSIONS

Previous studies emphasize differences in operationalization and conceptualization of disability as the major factor driving discrepancies in disability estimates. This study suggests that other factors related to survey design and administration may influence disability measurement. Such aspects of surveys, like question order and sampling, may be difficult to standardize, leading to meaningful cross-survey differences in disability estimates.

Estimating disability prevalence and disability-related inequalities: Does the choice of measure matter?

RATIONALE

Different measures for quantifying the percentage of people with a disability in surveys result in diverging estimates of prevalence and disability-related inequalities. Thus understanding the implications of using different disability measures is of vital policy importance. This study is the first to investigate the within-survey variation in disability prevalence based on two internationally recognized measures: the Washington Group Short Set (WGSS) and the Global Activity Limitation Indicator (GALI). It is also the first to examine the disability-related inequality in voter turnout, based on official validated voter records.

METHODS

We use data on 11,308 25-54-year-old respondents from the 2016 wave of the Survey of Health, Impairment and Living Conditions in Denmark (SHILD) to estimate the disability prevalence based on the WGSS and the GALI. Moreover, we investigate health characteristics of individuals with a disability according to the two measures and inequalities in two central social policy success parameters: voter turnout and employment.

RESULTS

The WGSS estimates higher disability prevalence (10.6%) than the GALI (5.5%). Only 2.5% of the sample are in both groups, implying that largely, different individuals are defined as having a disability depending on which measure is used. The health profiles of the two groups also differ, as people with a GALI-defined disability are significantly more likely to report a severe mental illness or a major physical health problem. The GALI estimates indicate larger inequalities between people with and without a disability than the WGSS for the probability of being employed, whereas there are no significant differences for voter turnout.

CONCLUSION

The choice of disability measure strongly influences within-survey estimates of disability prevalence, the health profile of the defined groups, and inequalities in outcomes. The WGSS underrepresents the number of people suffering from severe mental illness. Estimated inequalities in employment are larger for the GALI than for the WGSS.

Life Functioning in Chinese Survivors of Childhood Cancer in Hong Kong

Background: Evidence on self-care ability and occupational outcomes in Chinese survivors of childhood cancer is clearly lacking. This study aims to identify clinical and behavioral factors associated with poor life functioning in this population. Methods: This was a cross-sectional study conducted at an ambulatory clinic of a public hospital in Hong Kong. Licensed occupational therapists administered the Life Functioning Assessment Inventory on survivors diagnosed with cancer <19 years old and ≥5 years post-diagnosis. Survivors' career development self-efficacy, subjective happiness, and motivation were evaluated using structured questionnaires. Clinical information was obtained from medical records. Multivariable linear regression was used to evaluate factors associated with life functioning outcomes, adjusting for clinically relevant variables. Results: Eighty survivors were recruited (58.7% male; age at diagnosis: 6.7 [standard deviation (SD) = 4.8] years; age at evaluation: 24.4 [SD = 6.5] years). Compared to survivors of leukemia, survivors of brain tumor performed worse in social functioning (β = -0.79, standard error [SE] = 0.36; p = 0.034). Survivors who had been treated with cranial radiation also had lower worker life functioning than those who had not (β = -0.91, SE = 0.031; p = 0.021). Higher activity motivation was significantly associated with better leisure functioning (β = 0.086, SE = 0.03; p = 0.008), social functioning (β = 0.036, SE = 0.02; p = 0.036), and career development self-efficacy (β = 1.04, SE = 0.26; p < 0.0001). Conclusion: Survivors of brain tumors and survivors who were treated with radiation have poorer life functioning, particularly in social and work domains. Future work includes validating the study findings in a larger cohort of survivors in Hong Kong. Addressing modifiable behavioral factors include motivating survivors to engage in meaningful activities that contribute to self-care and participation in society, as well as providing at-risk survivors with ongoing support from community vocational services.

Applicability of the ICF-CY in evaluating children with disabilities and family support: an integrative literature review

ABSTRACT Purpose: to verify and update information on the applicability of functional assessment through the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY) in children with disabilities. Methods: a search was carried out on the databases of the Virtual Health Library Research Portal, EBSCOhost and Google Scholar, using a combination of the key words "children with disabilities", "ICF" and "mobility". Results: altogether, 2,773 studies were identified; however, after the filters were applied, only 27 were selected. After an explored analysis of the themes of the articles, this diagnosis revealed four analytical categories: environment (4 articles), quality of movement (3 articles), family (4 articles), and professionals (16 articles). Conclusion: in face of the sufferings experienced by families with disabled people, different possible approaches to this phenomenon were pointed out. Therefore, a greater effort of investigation and intervention in these fields are necessary, further exploring this tool.

Biopsychosocial model in health care: reflections in the production of functioning and disability data

Abstract Introduction: In the last decade, the inclusion of a functioning indicator in health care has been discussed on the international agenda. The strategies related to the implementation of these indicators are issues that involve health education, governance, and medical records. Objective: study aims to discuss the International Classification of Functioning, Disability and Health (ICF) potential as a useful tool to produce information on health care services. Method: As theoretical assumptions, the universal model of the ICF based on the biopsychosocial model was used. Results: When used as a health indicator, functioning data can measure the real effect of some health conditions in different life domains. Based on the reflections carried out and theoretical foundations accessed, the study shows that the implementation of functioning indicators in periodical population health surveys and protocols of clinical documentation regardless the level of health service would be relevant for Patient Care Planning. Note that the group of functioning indicators should be proposed in a universal language and, therefore, ICF represents the most comprehensive model. Conclusion: Information regarding health status can be useful to enable health care management. Furthermore, ICF are essential to improve the documentation service of the health system and also can be used in planning and monitoring health care. It can also be used to collect disability data in surveys ensuring comparison among different surveys.

Health status changes with transitory disability over time

RATIONALE

The six-question disability set from the American Community Survey serves as the national standard for measuring disability across all surveys conducted by the U.S. Department of Health and Human Services. These questions are intended to identify people who experience a long-term disability, and data from these questions are frequently interpreted as capturing discrete groups of individuals. Recent research has shown that a significant proportion of individuals respond to these questions inconsistently over time, possibly indicating that the six-question set also identifies transitory disability. However, it is unclear if these inconsistent responses are associated with changes in health status. We begin to test the validity of these observations by exploring how changes in health related quality of life correspond to changes in disability status.

METHODS

We recruited 525 participants to complete a longitudinal paper and pencil survey four times over 18 months that included the six disability questions, measures of health related quality of life, and mobility equipment use. We computed within person changes in health related quality of life variables to investigate how changes in disability status are associated with changes in health status.

RESULTS

Among respondents who reported disability, half or less consistently reported the same disability. Additionally, respondents who changed disability responses also reported changes in health related quality of life. For example, when individuals transition into walking disability, their health-related quality of life index decreases by, on average, 0.18 s.d. (p<0.05), and when individuals transition out of walking disability their health-related quality of life index increases by, on average, 0.27 s.d. (p<0.001).

CONCLUSION

The six-question set identifies people who experience both enduring and transitory disability. Changes in health related characteristics correlate with changes in disability status. This suggests that observed transitions in disability reflect real changes in perceived health and impairment.

Treatments and rehabilitation in the acute and chronic state of traumatic brain injury

Traumatic brain injury (TBI) is a major cause of acquired disability globally, and effective treatment methods are scarce. Lately, there has been increasing recognition of the devastating impact of TBI resulting from sports and other recreational activities, ranging from primarily sport-related concussions (SRC) but also more severe brain injuries requiring hospitalization. There are currently no established treatments for the underlying pathophysiology in TBI and while neuro-rehabilitation efforts are promising, there are currently is a lack of consensus regarding rehabilitation following TBI of any severity. In this narrative review, we highlight short- and long-term consequences of SRCs, and how the sideline management of these patients should be performed. We also cover the basic concepts of neuro-critical care management for more severely brain-injured patients with a focus on brain oedema and the necessity of improving intracranial conditions in terms of substrate delivery in order to facilitate recovery and improve outcome. Further, following the acute phase, promising new approaches to rehabilitation are covered for both patients with severe TBI and athletes suffering from SRC. These highlight the need for co-ordinated interdisciplinary rehabilitation, with a special focus on cognition, in order to promote recovery after TBI.

Comparing estimates of disability prevalence using federal and international disability measures in national surveillance

BACKGROUND

The National Health Interview Survey (NHIS) is changing the annual inclusion of standardized disability identifiers, reinvigorating the priority to examine existing disability question sets. These sets include questions developed by the United States (U.S.) National Center for Health Statistics in conjunction with the U.S. Census Bureau (the American Community Survey questions, ACS) and United Nations (the Washington Group Short Set questions, WGSS), that are policy relevant, comparable across populations, and short enough to be included in censuses and surveys across countries.

OBJECTIVE

To compare disability prevalence estimates from federal and international standardized disability questions across demographic factors.

METHODS

Bivariate analysis of disability question sets asking adults about vision, hearing, ambulation, cognition, and self-care difficulties and demographic factors using secondary data from supplements in the 2010 and 2013-2015 NHIS.

RESULTS

Our study found substantial and statistically significant differences in the percentage of disabilities (overall and by type) based on comparable ACS and WGSS questions across demographic categories. Dependent on response coding, WGSS-based disability prevalence was consistently and significantly larger or smaller than ACS-based disability prevalence. Overall disability prevalence using ACS and two different WGSS response combinations were 16.3% and 9.2% or 39.4%, respectively.

CONCLUSION

ACS and WGSS measures identify predictably different sized populations of adults with disabilities. Further, with some exceptions, ACS and WGSS questions identify populations with disabilities with relatively consistent demographic factors. Additional research is recommended to understand the comparability of disability prevalence and health disparities and inequities people with disabilities experience when using these measures.

Estimates of prevalence, demographic characteristics and social factors among people with disabilities in the USA: a cross-survey comparison

OBJECTIVE

A national priority for disability research in the USA is the standardised identification of people with disabilities in surveillance efforts. Mandated by federal statute, six dichotomous difficulty-focused questions were implemented in national surveys to identify people with disabilities. The aim of this study was to assess the prevalence, demographic characteristics and social factors among people with disabilities based on these six questions using multiple national surveys in the USA.

SETTING

American Community Survey (ACS), Current Population Survey Annual Social and Economic Supplement (CPS-ASEC), National Health Interview Survey (NHIS) and the Survey of Income and Program Participation (SIPP).

PARTICIPANTS

Civilian, non-institutionalised US residents aged 18 and over from the 2009 to 2014 ACS, 2009 to 2014 CPS-ASEC, 2009 to 2014 NHIS and 2008 SIPP waves 3, 7 and 10.

PRIMARY AND SECONDARY OUTCOME MEASURES

Disability was assessed using six standardised questions asking people about hearing, vision, cognition, ambulatory, self-care and independent living disabilities. Social factors were assessed with questions asking people to report their education, employment status, family size, health and marital status, health insurance and income.

RESULTS

Risk ratios and demographic distributions for people with disabilities were consistent across survey. People with disabilities were at decreased risk of having college education, employment, families with three or more people, excellent or very good self-reported health and a spouse. People with disabilities were also consistently at greater risk of having health insurance and living below the poverty line. Estimates of disability prevalence varied between surveys from 2009 to 2014 (range 11.76%-17.08%).

CONCLUSION

Replicating the existing literature, we found the estimation of disparities and inequity people with disabilities experience to be consistent across survey. Although there was a range of prevalence estimates, demographic factors for people with disabilities were consistent across surveys. Variations in prevalence estimates can be explained by survey context effects.

Using the Health and Retirement Study for Disability Policy Research: A Review

The Health and Retirement Study (HRS) is a preeminent data source for research related to the experiences of workers nearing retirement, including the large share of those workers who experience a health shock or disability onset after age 50. In this article, we highlight key information collected from HRS respondents that benefits disability policy research and the body of knowledge that has resulted from this information. Our main goal is to identify from this research experience potential improvements in data collection and documentation that would further strengthen the HRS as a data source for disability policy researchers.

Sexual orientation differences in functional limitations, disability, and mental health services use: Results from the 2013-2014 National Health Interview Survey

OBJECTIVES

The authors investigated sexual orientation differences in risk for mental health morbidity, functional limitations/disability, and mental health services use among adults interviewed in the nationally representative 2013-2014 National Health Interview Survey.

METHOD

Respondents were 68,816 adults (67,152 heterosexual and 1,664 lesbian, gay, and bisexual [LGB] individuals), age 18 and older. Fully structured interviews assessed sexual orientation identity, health status, and services use. Using sex-stratified analyses while adjusting for demographic confounding, the authors compared LGB and heterosexual individuals for evidence of mental health-related impairments and use of mental health services.

RESULTS

LGB adults, as compared to heterosexual adults, demonstrated higher prevalence of mental health morbidity and functional limitations. However, this varied by gender with LGB women evidencing elevated risk for both mental health and substance abuse (MHSA) and non-MHSA limitations. Among men, sexual orientation differences clustered among MHSA-related limitations. Overall, LGB adults were more likely than heterosexual adults to use services, with the source of functional limitations moderating these effects among men.

CONCLUSION

MHSA-related morbidity is a significant concern among LGB individuals and is associated with higher levels of functional limitations/disability. The findings highlight that LGB persons use MHSA-related treatment at higher rates than heterosexuals do, and, among men, are more likely to do so absent MHSA or non-MHSA-related functional limitations. This presents a unique set of concerns within the integrated care setting, including the need to deliver culturally competent care sensitive to the context of probable sex differences among LGB individuals. (PsycINFO Database Record

Disability Items From the Current Population Survey (2008-2015) and Permanent Versus Temporary Disability Status

OBJECTIVES

To examine longitudinal responses to the disability indicator questions that have been adopted as the standard across national surveys sponsored by the US Department of Health and Human Services.

METHODS

Data from the Current Population Survey between 2008 and 2015 were linked to create a longitudinal sample of 721 178 individual respondents.

RESULTS

Responses to the disability questions fluctuated significantly. Although 17% of all respondents reported a disability at some point, only 3% consistently reported the same set of disabilities. Demographic differences were found between people who always reported a consistent set of disabilities and those whose responses fluctuated.

CONCLUSIONS

The disability questions capture 2 discrete groups: people who experience a permanent disability and those who experience a temporary disability. Demographic differences between these groups suggest that this is not simply due to measurement error.

The influence of walkability on broader mobility for Canadian middle aged and older adults: An examination of Walk Score™ and the Mobility Over Varied Environments Scale (MOVES)

Neighborhood built environments may play an important role in shaping mobility and subsequent health outcomes. However, little work includes broader mobility considerations such as cognitive ability to be mobile, social connections with community, or transportation choices. We used a population-based sample of Canadian middle aged and older adults (aged 45 and older) from the Canadian Community Health Survey-Healthy Aging (CCHS-HA, 2008-2009) to create a holistic mobility measure: Mobility over Varied Environments Scale (MOVES). Data from CCHS-HA respondents from British Columbia with MOVES were linked with Street Smart Walk Score™ data by postal code (n=2046). Mean MOVES was estimated across sociodemographic and health characteristics. Linear regression, adjusted for relevant covariates, was used to estimate the association between Street Smart Walk Score™ and the MOVES. The mean MOVES was 30.67 (95% confidence interval (CI) 30.36, 30.99), 5th percentile 23.27 (CI 22.16, 24.38) and 95th percentile was 36.93 (CI 35.98, 37.87). MOVES was higher for those who were younger, married, higher socioeconomic status, and had better health. In unadjusted models, for every 10 point increase in Street Smart Walk Score™, MOVES increased 4.84 points (CI 4.52, 5.15). However, results attenuated after adjustment for sociodemographic covariates: each 10 point increase in Street Smart Walk Score™ was associated with a 0.10 (CI 0.00, 0.20) point increase in MOVES. The modest but important link we observed between walkability and mobility highlights the implication of neighborhood design on the health of middle aged and older adults.

Associations between chronic conditions, body functions, activity limitations and participation restrictions: a cross-sectional approach in Spanish non-clinical populations

OBJECTIVES

To analyse the relationships between chronic conditions, body functions, activity limitations and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) framework.

DESIGN

A cross-sectional study.

SETTING

2 geographical areas in the Autonomous Region of Aragon, Spain, namely, a rural area, Cinco Villas, and an urban area in the city of Zaragoza.

PARTICIPANTS

864 individuals selected by simple random sampling from the register of Social Security card holders, aged 50 years and over, positive to disability screening.

MAIN OUTCOME MEASURES

ICF Checklist-body function domains, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0, 36-item (WHODAS-36)) global scores and medical diagnoses (chronic conditions) from primary care records.

RESULTS

Mild disability (WHODAS-36 level 5-24%) was present in 51.5% of the sample. In the adjusted ordinal regression model with WHODAS-36 as the dependent variable, disability was substantially associated with moderate-to-complete impairment in the following functions: mental, OR 212.8 (95% CI 72 to 628.9); neuromusculoskeletal, OR 44.8 (24.2 to 82.8); and sensory and pain, OR 6.3 (3.5 to 11.2). In the relationship between health conditions and body function impairments, the strongest links were seen for: dementia with mental functions, OR 50.6 (25.1 to 102.1); cerebrovascular disease with neuromusculoskeletal function, OR 5.8 (3.5 to 9.7); and chronic renal failure with sensory function and pain, OR 3.0 (1.49 to 6.4). Dementia, OR 8.1 (4.4 to 14.7) and cerebrovascular disease, OR 4.1 (2.7 to 6.4) were associated with WHODAS-36 scores.

CONCLUSIONS

Body functions are heterogeneously linked to limitations in activities and restrictions on participation, with the highest impact being due to mental and musculoskeletal functions. This may be relevant for disability assessment and intervention design, particularly if defined on a body function basis. Control of specific health conditions, such as dementia and cerebrovascular disease, appears to be paramount in reducing disability among persons aged 50 years and over.

A qualitative study: Barriers and support for participation for children with disabilities

BACKGROUND

This qualitative-exploratory study examined the barriers to participation amongst children with disabilities in Lusaka, Zambia, from the mothers' perspective.

OBJECTIVES

The objectives of this study were to understand how mothers of children with physical and cognitive disabilities who engaged their children in community-based rehabilitation (CBR) services in Lusaka, Zambia, perceived and described (1) the level of support they received and the barriers they encountered in terms of their child's meaningful social participation; (2) the use and awareness of these barriers to identify and pursue advocacy strategies; and (3) hopes for their child's future.

METHODS

Data were collected through semi-structured interviews with each mother in her home. Results: Findings revealed both support and barriers to the child's social participation in relationship to their family, friends and community. Support also came from the CBR programme and mothers' personal resourcefulness. Mothers identified their child's school, their immediate environment and financial burdens as barriers to participation as well as their own personal insecurities and fears. Strategies to overcome barriers included internal and external actions. The mothers involved in the study hope their child's abilities will improve with continued CBR services. Some mothers described a bleak future for their child due to a lack of acceptance and access to education.

CONCLUSION

The findings of this study suggest the significant role the mother of a child with a disability plays in her child's social participation. Recommendations include enhancing CBR programming for families, especially for mothers, and advocating on behalf of children with disabilities and their families to attract the attention of policy makers.