Impact of COVID-19 on people with physical disabilities: A rapid review

Feasibility and acceptability of an adapted peer-based walking intervention for adults with moderate-to-severe traumatic brain injury

PURPOSE

To examine the feasibility and acceptability of a 6-week peer-based walking intervention for adults with moderate-to-severe TBI with telehealth supports.

MATERIALS AND METHODS

Pre-post feasibility trial with 18 community-dwelling adults (10 men; 8 women) with moderate-to-severe TBI aged 21-61 years (M = 40.6, SD = 11.3). Feasibility outcomes included participation, attrition, safety across 12 90-minute sessions, and telehealth platform quality. Acceptability outcomes included program satisfaction. Exploratory outcomes included daily step count with activity trackers and pre-post intervention questionnaires (mood, leisure satisfaction, exercise self-efficacy, quality of life) through video conferencing.

RESULTS

15/18 (83%) participants completed ≥ 9 sessions (75%). Three participants were lost to attrition. No major adverse events reported. Minor events included fatigue and muscle soreness. Participants reported high satisfaction (M = 9.2/10, SD = 0.9). Average weekly steps per day rose from 10,011 to 11,177 steps (12%). Three participants' step count data were not included due to tremors or forgetting to wear the device (≥ 9 days). One major and several minor connectivity problems occurred. Wilcoxon Signed Ranks tests identified a significant change in negative affect (p < 0.002).

CONCLUSIONS

Findings support the feasibility and acceptability of a 6-week peer-based walking intervention with telehealth supports for our sample.

Crisis interpreting and Deaf community understanding during the COVID-19 pandemic: results from a South Korea-based survey

This study explores the South Korean Deaf community's response to sign language interpreting during the COVID-19 (coronavirus disease 2019) health crisis, focusing on individual factors affecting the signers' comprehension. The data were collected from a mobile-based questionnaire survey conducted among 401 Deaf adults; binary probit modelling was adopted to analyse the data. The major findings are: (i) 59.9 per cent of the respondents understood less than 70 per cent of the interpreting; (ii) males and urban residents tend to understand better; (iii) younger people (less than 50 years) and signers with a Bachelor's degree or higher are likely to have lower comprehension; and (iv) Deaf adults who visited a doctor after the COVID-19 outbreak tended to have lower comprehension. The findings demonstrate that individual characteristics, including age, impact significantly on the extent to which Deaf individuals understand the sign language interpreting of COVID-19 information, indicating that steps are needed to achieve a Deaf-inclusive society during a health disaster.

Disabled from work and depressed: cognitive factors associated with exacerbated or attenuated depression over the COVID-19 pandemic

BACKGROUND

People who were disabled from working reported substantially worse depression in recent research [1] despite adjustment for demographic covariates, cognitive-appraisal processes, and COVID-specific stressors, thus motivating the present work.

OBJECTIVE

This study sought to "drill down" to understand employment-group differences (employed, retired, unemployed, disabled) in cognitive factors, and how these factors played into paths to depression during COVID early in the pandemic and depression trajectories over 15.5 months of follow-up.

METHODS

This longitudinal cohort study (n = 771) included chronically ill and general-population samples in the United States, characterized into the same depression-trajectory groups as the earlier study [1]. The Quality-of-Life Appraisal Profilev2 Short-Form assessed cognitive-appraisal processes. COVID-specific scales assessed hardship, worry, and social support. Chi-square, Analysis of Variance, classification and regression tree, and random effects modeling investigated factors associated with reported depression over time specifically by employment group, rather than in the whole sample which was the focus of the earlier study.

RESULTS

Disabled participants were disproportionately represented in the stably depressed trajectory group, reporting more hardship and worry, and lower social support than employed and retired participants (p < 0.0001). They were more likely to focus on health goals, problem goals, and emphasizing the negative (p < 0.001). They had different paths and cut-points to depression than employed/unemployed/retired participants. Even mild endorsement of emphasizing the negative and recent changes predicted higher depression. COVID-specific stressors and cognitive-appraisal processes were less implicated in depression among disabled participants compared to others.

CONCLUSIONS

Disabled participants were at greater risk of stable depression during the COVID pandemic. Small increases in emphasizing the negative were a path to worse depression, and disabled participants' depression may be less reactive to external circumstances or ways of thinking.

Navigating new normals: the influence of COVID-19 policies on community access and well-being of people with mobility disabilities in everyday life

Context

This study explores the influence of COVID-19 public health mandates on people with mobility disabilities in the United States in their everyday lives. It highlights the intersection of disability with social determinants of health, emphasizing the need for a comprehensive policy response.

Methods

Qualitative data were collected through 76 semi-structured interviews with people with mobility disabilities. Interviews focused on experiences with COVID-19 mandates and community access, analyzed using thematic analysis and coded for emergent subthemes.

Results

The relationship between community participation and COVID-19 compliance was complex for people with disabilities. Inaccessible environments and inflexible policies made it difficult for people with disabilities to practice good safety measures, while widespread noncompliance by community members limited their community participation. The findings revealed additional mixed lived experiences of COVID-19 policies on community participation, accessibility, and access to resources and support. While technology facilitated some aspects of community participation, issues with accessibility, public transportation, and personal assistance services were exacerbated.

Conclusion

COVID-19 policies have complex implications for people with mobility disabilities. Findings suggest a need for inclusive policymaking, improved disability awareness, and continued support for accessible technology and services. Future research should further explore these dynamics to inform policy and practice.

Exploring suicidal ideation prevalence in multiple sclerosis patients during the COVID-19 pandemic: A study on the relationship between drug use and suicidal ideation

BACKGROUND

The COVID-19 pandemic has exacerbated psychological challenges, leading to increased rates of clinically significant depression and suicidal ideation among MS patients. Despite advancements in MS treatments, there remains a need to investigate the impact of different drugs on the prevalence of suicidal ideation, particularly in the context of the pandemic.

METHOD

This cross-sectional study, conducted in 2021, received ethics approval from the Ethics Committee of Kerman University of Medical Science. The study involved 234 MS patients selected from the MS Association in Kerman Province. Questionnaires were prepared and distributed via Google Drive and WhatsApp, with participants providing informed consent. The collected data were analyzed using SPSS software. Inclusion criteria encompassed adults diagnosed with MS according to specific criteria and willing to complete the questionnaires, while exclusion criteria included unclear diagnostic criteria and lack of cooperation. The instruments included a demographic questionnaire, medication checklist, and the Beck Suicidal Thought Scale questionnaire, which has been validated in Iran.

RESULTS

202 MS patients completed the questionnaires, most of whom were women and married. The prevalence of Suicidal Ideation was 46.5 %, with 8.9 % at high risk. Factors such as gender, marital status, education, occupation, and city did not show statistically significant differences in SI. Patients with SI had a longer duration of illness and were more likely to have seen a psychiatrist. The COVID-19 pandemic affected the necessary care for 44.6 % of patients and worsened symptoms in 28.7 %. Additionally, 30.2 % of patients had seen a psychiatrist, and the prevalence of SI was significantly higher in this group. The study also explored the prevalence of SI with comorbidities and types of drugs used, finding no statistically significant differences.

CONCLUSION

The study revealed a high prevalence of suicide ideation among MS patients, emphasizing the need for tailored comprehensive support. Factors contributing to SI included limited healthcare access, fear of COVID-19 complications, social isolation, and heightened anxiety. Recommendations for healthcare providers stress early diagnosis, personalized treatment plans, and collaborative efforts to enhance the well-being of individuals with MS in Iran post-COVID-19.

Digital platforms to facilitate physical activities for people with physical or sensory disabilities: A scoping review

BACKGROUND

People with disabilities (PWD) commonly experience difficulties in accessing their environments, which can lead to restricted participation in outdoor leisure-time physical activity. Participating in outdoor leisure-time physical activity (OLTPA) provides health and social benefits to PWD and benefits to the communities in which they live.

OBJECTIVE

The aim of the study was to identify features existing in digital platforms that facilitate access to OLTPA for PWD.

METHODS

A scoping review was conducted in four library databases and in Google advance search to identify relevant scientific and grey literature, and websites. Each step of the review was independently conducted by two co-authors who confirmed consensus of results. Descriptive data analyses were performed.

RESULTS

Seven scientific studies and ten websites were included in the scoping review. Seven presented mobile apps, nine presented a website and one presented an online database. Sources reported five main obstacles to using digital platforms that support access to physical activities (e.g., lack of digital literacy, technical issues, unintuitive design), and 10 facilitators (e.g., possibility to personalize your online space, accessibility features of the navigation). Among these sources, a trend emerged in the most important factors and features to consider for the visuals and navigation of the platforms.

CONCLUSION

The features of digital platforms that facilitate access to OLTPA include intuitive design compliant with accessibility guidelines and supported by navigation tools, personalization of the online space, and features for social interactions.

The impact of UK social distancing guidance on the ability to access support and the health and wellbeing of disabled people during the COVID-19 pandemic: a qualitative exploration

BACKGROUND

The sudden introduction of social distancing measures in response to the COVID-19 pandemic resulted in significant lifestyle changes for the UK population. People living with physical disabilities were deemed to be at greater risk of complications following COVID-19 infection and were subjected to stricter social distancing guidelines. But gaps remain in our understanding of how the COVID-19 pandemic and associated restrictions affected the ability to access support, health and wellbeing of people with physical disabilities. Such understanding is vital to ensure equitable future pandemic preparedness for people living with physical disabilities.

METHODS

We conducted qualitative semi-structured interviews with 31 people living in the UK between May 2020 and January 2022. All participants self-identified as having a physical disability that affected their mobility, sight, or hearing. We analysed the data using reflexive thematic analysis.

RESULTS

Six themes were identified that described the impact of the pandemic on ability to access support, health and wellbeing: (i) adaptations to healthcare provision led to difficulties in managing health and wellbeing; (ii) exacerbations of inequalities in access to public space due to social distancing guidelines; (iii) experiences of hostility from able-bodied people; (iv) loss of social lives and encounters; (v) difficulties maintaining distance from others and subsequent fear of infection and (vi) strategies to support wellbeing and coping when confined to the home.

CONCLUSION

The COVID-19 pandemic exacerbated existing health and social inequalities experienced by disabled people. The disproportionate impact of the pandemic on service provision and social connections resulted in challenging circumstances for disabled people who faced unmet medical needs, deteriorating health, and at times, hostile public spaces. Disabled people's experiences need to be incorporated into future pandemic or health-related emergency planning to ensure equality of access to services and public spaces to ensure their health and wellbeing is supported and maintained.

Racial Disparities in COVID-19 Experiences Among Older Adults With Disabling Conditions

OBJECTIVES

This paper examines the health, work, and financial experiences of older adults with disabling conditions during the COVID-19 pandemic. It also explores the role of county- and state-level conditions in these experiences.

METHODS

Using data from the 2020 Health and Retirement Study, we estimated regression models to assess differences in outcomes between those with and without disabling conditions and by race/ethnicity. We used multilevel modeling to assess whether and how county or state factors might be associated with the differences in these effects.

RESULTS

Older adults with disabilities were more likely to report experiencing financial hardships, delaying health care, and experiencing effects on work than those without disabilities; these differences are heighted between race and ethnicity. Older adults with disabilities were more likely to live in counties with greater social vulnerability.

DISCUSSION

This work underscores the importance of developing a robust, disability-inclusive public health response that protects older adults.

The association of multiple sclerosis, traumatic brain injury, and spinal cord injury to acute and long COVID-19 outcomes

BACKGROUND

Although persons with disabilities are a high-risk group, little is known about the association between specific disabling conditions and acute or long COVID outcomes.

OBJECTIVE

To examine the severity of acute SARS-CoV-2 infection and post-COVID outcomes among people with a preexisting diagnosis of multiple sclerosis (MS), spinal cord injury (SCI), or traumatic brain injury (TBI).

METHODS

This was a retrospective cohort study using the TrinetX Research Database, a large representative database of medical records. COVID-19-positive persons with MS, SCI, or TBI (cases) were matched 1:1 on age, gender, race, ethnicity, and comorbidities to COVID-19-positive persons without these diagnoses (controls). The main outcomes assessed were hospitalization for acute COVID-19, length of stay (LOS), the total number of hospitalizations, mortality, and incidence of six prevalent post-COVID sequelae within 6 months following a COVID-19 diagnosis.

RESULTS

There were 388,297 laboratory-confirmed COVID-19 cases identified. Of these cases, 2204 individuals had one of the following preexisting diagnoses: 51.3% TBI, 31.4% MS, and 17.3% SCI. People with TBI, MS, and SCI were significantly more likely to be hospitalized for COVID-19 (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.03-1.46) than matched controls. There was no difference in LOS, total hospitalizations, or mortality during the 6 months following the initial COVID diagnosis. Multivariable analyses reveal that persons with TBI, MS, and SCI were more likely to experience new weakness (OR = 1.54, 95% CI = 1.19-2.00), mobility difficulties (OR = 1.66, 95% CI = 1.17-2.35), and cognitive dysfunction (OR = 1.79, 95% CI = 1.38-2.33) than controls, even after controlling for the presence of these symptoms prior to their COVID infection and other risk factors. There were no differences in fatigue, pain, or dyspnea.

CONCLUSIONS

Having a history of MS, SCI or TBI was not associated with higher mortality risk from COVID-19. However, associations between these diagnoses and postacute COVID-19 symptoms raise concern about widening health outcome disparities for individuals with such potentially disabling conditions following COVID-19 infection.

Deciphering the correlation of depression, quality of life, and COVID-19 challenges in people with disability: A Saudi Arabian perspective

BACKGROUND

Disability is a serious health issue that can have a significant impact on both physical and mental health. This study attempted to investigate the relationship between depression, quality of life (QOL), and COVID-19 challenges faced by people with disabilities (PwD) from Saudi Arabia.

METHODS

A structured interview questionnaire to measure QOL (WHOQOL-BREF) and depression (PHQ-9) was used to conduct a cross-sectional study among PwDs in Saudi Arabia. Binary regression analysis was done using SPSS-IBM and predictors for depression, quality of life and COVID-19 challenges were determined.

RESULTS

Of the 111 study samples, two-thirds were male (67.6%), with only one-third employed (34.2%). Most of them (70%) reported moderate to severe disability-related difficulties. Only 28.8% of the samples were satisfied with the physical health domain of the quality of life, whereas 31.5%, 44.1%, and 50.5% were satisfied with the psychological, social, and environmental health domains, respectively. Approximately 62% of the participants had been diagnosed with depression. A significantly higher percentage of participants who had not received COVID-19 vaccination were depressed (P = 0.011), whereas the depression rate was lower among those who received three or four doses of vaccination (P = 0.006). Depression is 4.1 times more likely in people with comorbidities, and disability with increased difficulty (OR: 4.266). Furthermore, vaccinated people had a 5.3-fold higher chance of developing satisfactory QOL.

CONCLUSION

Regardless of the type, cause, or duration of disability, the degree of difficulty is a strong predictor of depression and a decrease in quality of life. A multidisciplinary approach is needed to improve the well-being of people with disabilities.

Measuring COVID-19 vaccine hesitancy among college students with disabilities: Sociodemographic and psychological correlates of COVID-19 vaccine hesitancy

Objective: The purpose of the study was to explore characteristics of vaccine hesitancy and behaviors among college students with disabilities. Participants and Methods: Participants consisted of 105 college students with disabilities (Mage=26.82, SD = 8.42), and a majority of participants were female (69.5%) and Hispanic (85%). Results: No demographic differences were observed in vaccine hesitancy scores in this sample. Those who do not know where to get reliable information about COVID-19 vaccination had higher scores on vaccine hesitancy than those who know how to obtain reliable information; and participants who had a negative experience with a previous vaccination also had higher scores of vaccine hesitancy. Additionally, findings demonstrated COVID-19 vaccine hesitancy scores were negatively associated with openness to experience personality trait and COVID-19-related perceived stress. Conclusions: Implications provide additional insight into factors associated with vaccine hesitancy among college students with disabilities.

Agreement of synchronous remote and in-person application of the Alberta Infant Motor Scale: Cohort study

INTRODUCTION

Using standardized scales to assess motor development via telemedicine can increase access for low-income populations. Our aim was to verify the agreement and feasibility between remotely and synchronously applying the Alberta Infant Motor Scale (AIMS) and the in-person format.

METHODS

This was a concordance study, with 77 typical infants aged 4-18 months (mean = 13 months). The AIMS was applied remote via video calls and face-to-face. We applied a questionnaire to caregivers to verify feasibility.

RESULTS

There was a high level of agreement between the remote and in-person assessments, with intraclass correlation coefficients above 0.98 and low standard error measure values (<1 item for each posture, <2 items for the total raw score, and =5% for the normative score). The smallest detectable change was between 1.67 and 2.45 for each posture, 3 for the total raw score, and 6% for the normative score. The Bland-Altman analysis showed low bias with the mean difference close to zero (<0.80) and low error with little dispersion of the difference points around the mean. Caregivers' perspectives on the synchronous remote assessment were positive, with good quality, clear information during the assessment, and comfort with the method.

DISCUSSION

The synchronous remote application of the AIMS may be an alternative for families without access to in-person services that assess motor development.

Disability and COVID-19: Challenges, testing, vaccination, and postponement and avoidance of medical care among minoritized communities

BACKGROUND

People with disabilities face heightened vulnerability to COVID-19.

OBJECTIVE

This study investigated (1) the relationships between disability and COVID-19-related challenges, testing, vaccination, and infection and (2) predictors of loss of healthcare coverage and postponement and avoidance of medical care during the pandemic.

METHODS

This cross-sectional study was conducted in Miami, Florida, between March 2021 and February 2022 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations initiative. Disability was defined using a standard measure that assesses six universal functions. Participants reported sociodemographic data, COVID-19 testing, infection history, challenges, and healthcare history. Vaccinations were confirmed with medical records and COVID-19 positivity was assessed using real-time reverse transcription-polymerase chain reaction. Statistical analyses included multivariable logistic regression.

RESULTS

Among 1,689 participants with a median age of 57.0, 50.6% were male, and 48.9% were non-Hispanic Black. Disability was associated with greater odds of all assessed COVID-19 challenges: healthcare (aOR:1.60; 95% CI:1.23-2.07), housing (aOR:2.15; 95% CI:1.62-2.87), insufficient food (aOR:1.97; 95% CI:1.54-2.52), water scarcity (aOR:2.33; 95% CI:1.60-3.37), medications (aOR:2.04; 95% CI:1.51-2.77), and transportation (aOR:2.56; 95% CI:1.95-3.36). Those reporting employment disability were less likely to have received COVID-19 testing (81.1% vs. 85.3%, p = 0.026) or to have history of COVID-19 positivity (aOR:0.63; 95% CI:0.44-0.92). Disability predicted avoidance (aOR:2.76; 95% CI:1.95-3.91) and postponement (aOR: 2.24; 95% CI:1.72-2.91) of medical care.

CONCLUSIONS

Disability is associated with higher odds of COVID-19 challenges and postponement and avoidance of medical care. Those reporting employment disability had a lower likelihood of COVID-19 testing. Public health responses to healthcare crises should prioritize the special challenges of people living with disabilities.

Barriers to financial access of disabled people to health services in rural areas: A case study of Iran

BACKGROUND

People with disabilities (PWDs) account for a significant percentage of the world's population, with a higher prevalence in less developed countries. Access to healthcare services is the main component of health systems performance, with lower access for PWDs living in rural areas. The current study aimed to investigate PWD's access to healthcare services in rural areas of Iran and, secondly, factors that contribute to this issue.

MATERIALS AND METHODS

Following a cross-sectional design, the current descriptive-analytical study is performed in the north of Iran. Using the quota sampling technique, 471 PWDs were recruited. Data were collected using a valid and reliable questionnaire, covering three dimensions of access, by face-to-face interview. Data analysis was administered using central tendency indicators and multiple regression by SPSS version 17. Statistical significance was considered when the P value <0.05.

RESULTS

The mean score of PWD's access to healthcare services for dimensions of utilization, availability, and affordability was 8.91 (±6.86), 14.54 (±2.3), and 51.91 (±8.78), indicating very low, low, and moderate levels of access. All three regression models were significant (P < 0.05), and variables of gender, age, marital status, education level, residence status, the income of the household head, receiving financial aid, and house area showed a significant effect (P < 0.05).

CONCLUSION

This study demonstrated the seriousness of paying attention to PWD's financial access to healthcare services, particularly in rural areas of Iran. Hence, policymakers should better focus on this problem, mainly regarding accessibility and utilization and factors that result in inequalities.

Understanding the use of digital technologies to provide disability services remotely during the COVID-19 pandemic; a multiple case study design

BACKGROUND

Using digital technologies to provide services and supports remotely may improve efficiency and accessibility of healthcare, and support people with disabilities to live independently. This study aimed to explore the experience of using digital technologies to access and provide disability services and supports during the Covid-19 pandemic, from the perspective of people with disabilities, families and service providers.

METHODS

Using a multiple case study design, we purposively sampled three cases based on service user characteristics and geographical reach of the service. We conducted semi-structured interviews with 40 service users and service providers. Topic guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR). Analysis followed a largely deductive approach, using the CFIR constructs as a coding framework. A summary memo was developed for each case. Influence and strength of each construct was rated to identify constructs that influenced implementation of digital technologies. Ratings were compared across services to identify facilitators and barriers to implementation.

RESULTS

Service users and providers were positive about using digital technologies to access and provide disability services and supports remotely. Advantages over in-person delivery included reduced travel time, increased opportunity for peer support and peer learning, more choice and opportunity to participate in activities, and an enhanced sense of self while accessing services from the secure environment of their home. The urgency to identify new modes of service delivery to meet the needs of service users during Covid-19 was a strong facilitator but did not necessarily result in successful implementation. Other factors that were strong facilitators were the use of adaptations to enable service users to access the online service, service users' willingness to try the online service, service users' persistence when they encountered challenges, and the significant time and effort that service providers made to support service users to participate in the online service. Barriers to implementation included the complexity of accessing online platforms, poor design quality of online platforms, and organisations prioritising in-person delivery over online services.

CONCLUSIONS

These findings may allow service providers to leverage facilitators that support implementation of online disability services and supports.

Exploratory study on the adaptation of online services offered to people with disabilities, in the context of the COVID-19 pandemic

Aim: During the COVID-19 pandemic, many community organizations offering services to people with disabilities (PWD) changed their service delivery, switching from in-person to remote services. However, little is known about what it was like for organizations to quickly pivot their service delivery. The study explored barriers and facilitators to access community services for PWD and identified potential improvements to these services.Methods: The study used a mixed method, multiple case study design, which included a convenience sample of 27 participants recruited from four community organizations delivering services to PWD. Participating staff and members participated in six different focus groups and completed a questionnaire about their level of satisfaction regarding the evolution of the services. Inductive thematic analysis was conducted on the focus group data and the data from the questionnaires were descriptively analyzed.Results: The thematic analyses revealed four themes: "Succeeding in adapting the interventions to continue providing services", "Enjoying a lot of new things about the new online modality", "Key elements that have facilitated the transition" and "Facing some difficulties implementing online services". The median satisfaction score demonstrated that the participants were satisfied with the services. The success of these organizational changes relied on the adoption of new methods and approaches to service delivery.Conclusion: Through this study, barriers and facilitators that the organizations and their beneficiaries have experienced during the pandemic were identified as well as suggestions for improvement. The organizations consider maintaining online services beyond the pandemic to offer PWD easier access to community services.

Impacts of the COVID-19 pandemic on health and social professionals working with people with disabilities: A qualitative study

BACKGROUND

Since the beginning of the COVID-19 pandemic, protection and isolation measures established by the Canadian and Quebec governments have directly affected the work of health and social professionals (HSPs). These measures have added pressure on HSPs, complexified their work and added tasks to their already busy workload. However, few studies have explored in depth the impacts of the pandemic on HSPs working with people with disabilities.

OBJECTIVE

The objective of this study was to qualitatively explore the experiences of HSPs working among people with disabilities in the province of Quebec, Canada, during the COVID-19 pandemic (January and February 2021), including the impact on their work, the relationships with their colleagues, and on their immediate social and familial environment.

METHODS

HSPs participated in a semi-structured interview. A mixed thematic analysis approach, combining inductive and deductive coding, was carried out using N'Vivo 12.

RESULTS

Fifty-five HSPs participated in the interviews (mean [SD] age, 42 [9]). They mostly identified as women (91% ). Three main themes representing the impacts of the pandemic were identified, including 1) Health and Well-being; 2) Family and social networks including the subthemes; 2.1) Fear of being a vector of contamination for their loved ones; 2.2) Work-family balance; 2.3) Social Network, and finally 3) Work, highlighting, including 3.1) Workload and adaptative strategies developed; 3.2) Relationship with colleagues; 3.3) Perceived support received at work, and 3.4) Services offered to patients.

CONCLUSIONS

These findings highlight the importance of closely tracking and supporting the well-being of HSPs.

Changing levels of income and multidimensional poverty among persons with disabilities in Colombia: A pseudo panel analysis

In Colombia, more than 4 per cent of the population lives with disability and high levels of income and multidimensional poverty have been recognised within this group. However, there is no information on how the levels of poverty have changed over time or whether households with members with disabilities are more likely to be chronically poorer than households without disabilities in the country. In addition, no evidence exists on the potential effect of the Covid-19 pandemic on the socioeconomic characteristics of persons with disability. This study aims to contribute to the literature on this topic by analysing a nationally representative survey (Quality of Life Survey) from 2018 to 2022 and studying the changes in the levels of income and multidimensional poverty of persons with disabilities and their household, and identifying whether any changes associated with the Covid-19 pandemic.

COVID-19, Disability, and the International Classification of Functioning, Disability and Health: A Scoping Review of Early-Stage Pandemic Response

Introduction

This study aimed to systematically identify the environmental factors that impacted people with disability during the COVID-19 pandemic.

Methods

A scoping literature review was conducted using LitCOVID (January 1-July 31, 2020). Sixty-six articles met the inclusion criteria that (1) discussed disability and/or health conditions related to functioning and (2) considered environmental factors. A qualitative content analysis was conducted using codes from the WHO International Classification of Functioning, Disability and Health.

Results

A total of 212 International Classification of Functioning, Disability and Health codes were used in the coding process. The most frequent codes referred to health services policies and public health guidelines. These policies, although generally considered facilitators for minimizing infection, were frequently identified as barriers to the health, participation, and human rights of people with disability. The lack of disability-specific population data was identified as a key barrier to planning and decision making.

Conclusions

The social determinants of health for people with disability were not adequately considered in the acute phase of infection prevention at the population level. Integrating the International Classification of Functioning, Disability and Health in emergency management provides a tool to evaluate functioning and address barriers for those in need.

Prevalence of Unmet Rehabilitation Needs Among Canadians Living With Long-term Conditions or Disabilities During the First Wave of the COVID-19 Pandemic

OBJECTIVE

We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic.

DESIGN

Cross-sectional survey.

SETTING

Individuals residing in Canada during the first wave of the COVID-19 pandemic.

PARTICIPANTS

Eligible participants were Canadians living with long-term conditions or disabilities, 15 years or older living in 1 of the 10 provinces or 3 territories (n=13,487).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

We defined unmet rehabilitation needs as those who reported needing rehabilitation (ie, physiotherapy/massage therapy/chiropractic, speech, or occupational therapy, counseling services, support groups) but did not receive it because of the COVID-19 pandemic. We calculated the national, age, gender, and province/territory-specific prevalence and 95% confidence interval of unmet rehabilitation needs.

RESULTS

During the first wave of the pandemic, the prevalence of unmet rehabilitation needs among Canadians with long-term conditions or disabilities was 49.3% (95% confidence interval [CI]; 48.3, 50.3]). The age-specific prevalence was higher among individuals 15-49 years old (55.6%; 95% CI [54.2, 57.1]) than those 50 years and older (46.0%; 95% CI [44.5, 47.4]). Females (53.7%; 95% CI [52.6, 54.9]) had higher unmet needs than males (44.1%; 95% CI [42.3, 45.9]). Unmet rehabilitation needs varied across provinces and territories.

CONCLUSIONS

In this sample, almost 50% of Canadians living with long-term conditions or disabilities had unmet rehabilitation needs during the first wave of the COVID-19 pandemic. This suggests that a significant gap between the needs for and delivery of rehabilitation care existed during the early phase of the pandemic.

A structural vulnerability approach to older adult suicides: Trends and potential impacts of the COVID-19 pandemic in Clark County, NV (2017-2021)

The ongoing SARS-CoV-2 (COVID-19) pandemic has affected all aspects of life in the United States and around the world. This is particularly true for marginalized and vulnerable groups who face disproportionate levels of violence and premature death within their communities. While general impacts of the pandemic have been well-studied overall, little has been done to examine the correlation between COVID-19 and the risk of suicide among older adults. Older adults are particularly at risk because they face challenges including ageism, inadequate support systems, unreliable transportation, and frequent social isolation. Medicolegal casework offers a unique vantage of these issues, as it aims to identify manner of death which may be influenced by underlying structural vulnerabilities. The current research draws upon data collected from the Clark County Office of the Coroner/Medical Examiner. A sample of 871 older adults (aged 50+), whose manner of death was deemed a suicide between the years 2017-2021, were included in this analysis. Statistical analyses investigated differences between adults aged 50-64, 65-84, and 85+ years. Results suggest statistically significant changes in mechanism of death between pre-pandemic and pandemic periods, indicating a shift in risk factors related to social isolation and the home environment. Understanding such changes in trends directly affects the interpretation of skeletal data in forensic anthropology and thus, should be taken into consideration when developing structural vulnerability profiles. Furthermore, the inclusion of a structural vulnerability approach in forensic case reports has the potential to provide additional context for deaths by suicide and may help develop policies and procedures for mitigating future risk.

Lived experiences of South African rehabilitation practitioners during coronavirus disease 2019

Background

In South Africa, the sharp rise in people with severe illness because of coronavirus disease 2019 (COVID-19) in early 2020, meant that health systems needed to adapt services and operations, including rehabilitation services. Important insights into the lived experiences of rehabilitation personnel enacting these adaptations in an African context are limited.

Objectives

The aim of this study was to explore the lived experiences of rehabilitation practitioners working in the public sector in South Africa during the COVID-19 pandemic.

Method

A phenomenological approach and a duo-ethnographic design were used. A recruitment letter was circulated requesting volunteers. Maximum variation sampling was used to select the 12 participants of this study. Data were collected through interviews via Zoom, and critical conversations were facilitated by a non-rehabilitation partner who is known for challenging health inequities. The interviews were audio-recorded and transcribed verbatim. Data were analysed through elements of qualitative content and thematic analysis. Data were coded, categorised, clustered into concepts and formulated into themes.

Results

Three themes were identified: (1) 'Management became the enemy', (2) 'Tired of being resilient' and (3) 'Think out of the box…think on our feet'.

Conclusion

The results of this study highlighted new ways of practice, innovative adaptations, and usage of resources and platforms.

Contribution

This study highlights the re-imagining of accessible rehabilitation services that could lead to deeper onto-epistemological shifts amongst the rehabilitation practitioners.

Community-based rehabilitation/community based inclusive development functioning during the COVID-19 pandemic: A secondary analysis of qualitative data

INTRODUCTION

The coronavirus (COVID-19) became a global pandemic in March 2020 and impacted nations worldwide not only because of the disease but also because the containment measures-imposed created ripple effects for the populations in each country. The COVID-19 pandemic disproportionately affected vulnerable groups, such as persons with disabilities. This study aimed to understand the impact of COVID-19 on the function of Community-Based Rehabilitation (CBR)/Community-Based Inclusive Development (CBID) across nations and for their target communities-persons with disabilities. The current article also described some measures CBR/CBID programs took in light of service closure to facilitate access to needed services for persons with disabilities.

METHODS

We conducted a secondary analysis of qualitative data to understand the impact of COVID-19 on the functioning of CBR/CBID programs and their target communities. The original qualitative data were collected through online dialogues among CBR/CBID partners across five regions of the world, facilitated for understanding of their practices on five other topics.

FINDINGS

COVID-19 significantly impacted the function of CBR/CBID programs across the world. Many services were halted due to public health measures, such as maintaining social distancing or lockdowns. The COVID-19 pandemic also had a negative impact on access to health, education and livelihood support for persons with disabilities. Additionally, many people with disabilities did not have access to COVID-19 related information and services like vaccines. However, we found that technology played a significant role in revitalizing CBR/CBID programs during COVID-19. CBR/CBID service providers across five regions used online platforms to disseminate information about COVID-19. Professionals also used technology to provide rehabilitation and educational services to people with disabilities through online platforms.

CONCLUSION

Our findings suggest that technology can play a vital role in continuing many services (e.g., CBR/CBID) that cannot be offered in person during crises like COVID-19. However, it is important to remember that technology may not be accessible to many individuals with disabilities, specifically those who reside in rural areas and who experience adverse situations like financial constraints. Additionally, many persons with disabilities may not have the necessary knowledge and skills to use technology. CBR personnel must consider that before adopting technology to provide services under CBR programs.

Medical, dental, and optical care utilization among community-living people with spinal cord injury in the United States

CONTEXT/OBJECTIVE

Information about patterns of healthcare utilization for people living with spinal cord injury (SCI) is currently limited, and this is needed to understand independent community living after SCI. This study investigates self-reported healthcare utilization among community-living people with SCI and assesses disparities across demographic, socioeconomic, and injury-related subgroups.

DESIGN

Secondary analysis of cross-sectional survey data administered via telephone interview.

SETTING

6 SCI Model Systems centers in the United States (California, Colorado, New Jersey, New York, Ohio, and Pennsylvania).

PARTICIPANTS

Adults with chronic, traumatic SCI who were community-living for at least one year after the completion of an inpatient rehabilitation program (N = 617).

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

Utilization of a usual source of 4 types of health care in the past 12 months: primary, SCI, dental, and optical.

RESULTS

84% of participants reported utilizing primary care in the past year. More than half reported utilizing SCI (54%) and dental (57%) care, and 36% reported utilizing optical care. There were no significant differences across key subgroups in the utilization of primary care. Participants who had been injured for 5 years or less and participants with greater educational attainment were more likely to report utilizing SCI care. Participants with higher household income levels were more likely to report using dental care. Female participants and older age groups were more likely to report using optical care.

CONCLUSION

Rates of healthcare utilization among people with SCI are below recommended rates and vary across demographic, socioeconomic, and injury-related subgroups. This information can inform future research to target barriers to using healthcare services among community-living people with SCI.

Impacts of COVID-19 on Young Children and Families: A Qualitative Study Using Best Starts for Kids Health Survey Data in King County, WA

OBJECTIVES

To evaluate the impacts of the COVID-19 pandemic on parents and caregivers with young children in King County, Washington using data from a local population-based survey, the Best Starts for Kids Health Survey (BSKHS).

METHODS

7033 parents and caregivers in King County, Washington with children 5th grade and younger participated in the BSKHS in 2021. Three evaluators adopted a framework method approach to thematic analysis for open-ended survey responses regarding the impacts of COVID-19 on families.

RESULTS

Children aged 0-5 years missed important social development opportunities, while elementary-school children missed social interactions and felt isolated during remote schooling. Parents were exhausted by the competing demands of work and schooling/childcare, with mothers bearing the brunt of additional responsibilities. Many families faced financial uncertainty and were unable to meet basic needs. Yet, families were grateful for more quality time with family members.

CONCLUSIONS FOR PRACTICE

Parents expressed that children aged 0-5 years missed out on social development opportunities with both adults and children their own age and elementary-school children and felt isolated while schools were closed to in-person schooling.

What the pandemic and its impact on the mobility and well-being of older people can teach us about age-friendly cities and communities

From the start of the pandemic, questions were raised concerning how the pandemic could change or even transform relationships to our living environments. COVID-19 has had a disproportionate impact on the health and well-being of older people due to the increased risk of severity of the disease with both advancing age and associated co-morbidities. Restrictions on the movement of older people have also been more severe, with many countries imposing restrictions based on chronological age. In Portugal, confinement measures were targeted at older persons in terms of sheltering-at-home orders for those over 70. This paper looks at the impact of these restrictions on the lives of older people and asks what we can learn from the pandemic about the concept of age-friendly cities (WHO, 2007a). We look at the lived experience of older people to understand how their well-being and mobility were impacted during the crisis and its aftermath. The study was undertaken in four urban areas: Aveiro, Coimbra, Lisbon, and Faro. Data was collected using semi-structured interviews analysed using a process of thematic coding based on the eight pillars of the WHO's Age-Friendly City Checklist (WHO, 2007b). The results are discussed using conceptualisations from the new mobilities paradigm: existential mobility, connection and (im)mobility governance, offering new ways of thinking about age-friendliness in and out of crisis.

COVID-19-related global health governance and population health priorities for health equity in G20 countries: a scoping review

Since the declaration of the COVID-19 pandemic, the promotion of health equity including the health of various population sub-groups has been compromised, human rights jeopardised, and social inequities further exacerbated. Citizens worldwide, including in the Group of 20 (G20) countries, were affected by both global health governance (GHG) processes and decisions and public health measures taken by governments to respond to COVID-19. While it is critical to swiftly respond to COVID-19, little is known about how and to what extent the GHG is affecting population health priorities for health equity in global economies such as the G20 countries. This scoping review synthesised and identified knowledge gaps on how the COVID-19-related GHG is affecting population health priorities for policy, programme, and research in G20 countries. We followed the five-stage scoping review methodology promoted by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews guidelines. We searched four bibliographic databases for references conducted in G20 countries and regions and published in English and French, between January 2020 and April 2023. Out of 4,625 references and after two phases of screening, 14 studies met the inclusion criteria. G20 countries included in the review were Australia, Brazil, Canada, China, France, India, Italy, Japan, Russia, South Africa, the United Kingdom, the United States of America, and the European Union. We found insufficient collaboration and coordination and misalignment among governance actors at multiple levels. In most cases, equity considerations were not prioritised while unequal consequences of COVID-19 public health measures on population groups were widely reported. COVID-19-related population health priorities mainly focused on upstream and midstream determinants of health. Our scoping review showed the stark inequities of COVID-19 public health outcomes, coupled with a prevalent lack of coherent collaboration and coordination among governance actors. Moreover, governance as an object of empirical study is still emerging when examining its intersection with global health and population health policy, programme, and research. An urgent shift is required to effectively act upon structural health determinants that include transformative and comprehensive policies for prevention, equity, resilience, and sustainable health.

Communication to promote and support physical distancing for COVID-19 prevention and control

BACKGROUND

This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.

OBJECTIVES

To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.

SECONDARY OBJECTIVE

to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.

SEARCH METHODS

We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).

SELECTION CRITERIA

Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.

DATA COLLECTION AND ANALYSIS

Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.

MAIN RESULTS

This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.

AUTHORS' CONCLUSIONS

Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.

Service delivery and programing adaptations for individuals with disabilities by municipalities and non-profit organizations during the COVID pandemic

Municipalities and nonprofit organizations play a major role in administrating services that support individuals with disabilities. The purpose of this study was to explore how these organizations responded to the COVID-19 pandemic in regards to service delivery and programming for people with disabilities. This qualitative interpretative description study used semi-structured individual interviews for data collection. Recordings of the interviews were transcribed. Then the transcripts were analyzed qualitatively for themes following an inductive approach. Twenty-six individuals working for nonprofit organization or municipalities participated in the study. Six themes were identified: doing more with less; adapting rather than creating new services; ongoing consultation with stakeholders; feeling successful at adapting the services; being innovative with fundraising and embracing radical change. Flexibility and iterative user-centered approach appeared to be common coping strategies. Remote services were privileged to adapt service delivery during the COVID-19 pandemic.

Physiotherapists' experiences on assisting physiotherapy users during the COVID-19 pandemic with lockdown measures in Spain

BACKGROUND

Physiotherapists had faced a new healthcare scenario characterised by the restrictions caused by the COVID-19 pandemic.

PURPOSE

To explore the impact of the COVID-19 pandemic on the physiotherapy profession from the perspective of physiotherapists working in the public and private sectors.

METHODS

Qualitative study based on semi-structured personal interviews with 16 physiotherapists working in public, private, or public-private partnership sectors in Spain. The data were collected between March and June 2020. Inductive qualitative content analysis was performed.

RESULTS

The participants (13 women, 3 men; aged 24-44 years) had professional experience in diverse healthcare settings (primary, hospital, home, consultations, insurance companies, associations). Five categories were identified: (1) the impact of lockdown on the health of physiotherapy users; (2) managing the demand for physiotherapy services during lockdown; (3) introducing protocols and protective measures in physiotherapy consultations; (4) changes in therapeutic approaches; and (5) future expectations in the physiotherapy care model. Physiotherapists perceived that lockdown caused a decline in the functionality of people with chronic conditions, together with a reduction in the physiotherapy services. Difficulties in prioritising users considered urgent became evident, and the inclusion of prophylactic measures affected treatment duration differently depending on the care setting and the pandemic prompted the use of telerehabilitation.

DISCUSSION

The pandemic affected the functional status of chronic physiotherapy users and made treatment time, quality of care and triage protocols visible. In physiotherapy, technological barriers need to be solved, such as digital literacy, families without resources, situations of dependency and cultural barriers.

A systematic review of the impact of the COVID-19 pandemic on the mental health of adolescents and young people with disabilities aged 15-29 years

BACKGROUND

The COVID-19 pandemic has exacerbated the psychological burden on young people around the world and may have disproportionately large impacts for young people with disabilities. This review aims to systematically review the quantitative evidence on the impact of the COVID-19 pandemic on the mental health of young people with disabilities and evaluate the quality of included studies.

METHODS

A systematic search was conducted using 5 electronic databases. The quality of the studies was assessed using the SIGN risk of bias assessment tool. A narrative synthesis was performed to synthesize the results of included studies.

RESULTS

The initial search yielded 1935 studies, of which two met the eligibility criteria, one longitudinal study and one cross-sectional study, both assessed to be of low quality. In the cross-sectional study, young people with intellectual and developmental disabilities self-reported an increase in mental health symptoms. The longitudinal study found no evidence of a change in mental health symptoms from pre-pandemic to during the pandemic among young people with autism spectrum disorder, although these individuals reported negative impacts of the COVID-19 pandemic on their emotional or mental health.

CONCLUSIONS

The findings of this review provide some weak evidence of a negative impact of the COVID-19 pandemic on the mental health of young people with disabilities. Importantly, the findings highlight the lack of research in this area. More research is needed to investigate the impact of the pandemic on the mental health of young disabled people, in order for governments to develop emergency preparedness plans to safeguard the well-being of this population.

How Did Governments Address the Needs of People With Disabilities During the COVID-19 Pandemic? An Analysis of 14 Countries' Policies Based on the UN Convention on the Rights of Persons With Disabilities

BACKGROUND

People with disabilities have experienced heightened social risks in the context of the pandemic, resulting in higher rates of infection and mortality. They have also borne elevated burdens associated with public health measures. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) obliges its 184 state parties to eliminate discrimination and ensure equality and inclusion for persons with disabilities, including protection and safety in situations of emergency. It remains unclear to what extent national COVID-19 policies have aligned with these commitments under the UNCRPD. Our objective in this exploratory study was to assess alignment between the UNCRPD indicators and COVID-19 policies from 14 countries with the goal of informing policy development that is inclusive of persons with disabilities and responsive to rights under the UNCRPD.

METHODS

We identified COVID-19 policy documents from 14 purposively selected countries. Country selection considered diversity based on geographic regions and national income levels, with restriction to those countries that had ratified the UNCRPD and had English or French as an official language. We used a computational text mining approach and developed a complex multilevel dictionary or categorization model based on the UNCRPD Bridging the Gap indicators proposed by the Office of the High Commissioner on Human Rights (OHCHR). This dictionary was used to assess the extent to which indicators across the entirety of the UNCRPD were represented in the selected policies. We analyzed frequency of associations with UNCRPD, as well as conducting 'key word in context' analyses to identify themes.

RESULTS

We identified 764 COVID-19 national policy documents from the period of January 2020 to June 2021. When analyzed in relation to the Articles of the UNCRPD, the most frequently identified were Articles 11 (risk and humanitarian emergencies), 23 (home and family), 24 (education), and 19 (community living). Six countries produced 27 policies that were specifically focused on disability. Common themes within these documents included continuation of services, intersectionality and equity, and disability considerations in regulations and public health measures.

CONCLUSION

Analyzing country policies in light of the UNCRPD offers important insights about how these policies do and do not align with states' commitments. As new policies are developed and existing ones revised, more comprehensive approaches to addressing the rights of persons with disabilities are urgently needed.

Impact of Prolonged Cessation of Organized Team Training Due to the COVID-19 Pandemic on the Body Composition of Japanese Elite Female Wheelchair Basketball Athletes

Studies on the effects of training confinement on athletes with physical impairments are limited. Hence, in this retrospective cohort study, we aimed to investigate the impact of prolonged cessation of organized team training due to the coronavirus disease 2019 pandemic on the body composition of elite female Japanese basketball athletes. Fourteen female wheelchair basketball athletes (aged ≥20 years) were enrolled. The primary outcomes were lean and adipose indices measured using whole-body dual-energy X-ray absorptiometry. The impact of prolonged organized team training cessation on body composition was investigated by comparing the body composition at baseline and post-training confinement. A reduced whole-body lean mass (p = 0.038) and percent lean mass (p = 0.022), as well as an increased percent body fat (p = 0.035), were observed after the confinement period. The regional analysis revealed reduced percent lean and increased percent fat masses in the trunk (p = 0.015 and p = 0.026, respectively) and upper limbs (p = 0.036 and p = 0.048, respectively). In conclusion, prolonged organized team training cessation reduced lean mass and increased body fat percentage, primarily in the trunk and upper limbs. Individualized training programs targeting these body regions should be implemented to improve body composition and physical conditions in athletes during and after prolonged cessation of organized team training.

"At First It Wasn't so Bad": How Adults Aged 60 and Older Feel About Social Distancing During COVID-19

We conducted an exploratory study to describe the emotional experience of adults aged 60 and older in the United States practicing social distancing during COVID-19. The survey asked respondents how they were feeling during social distancing. Responses (n=673) were coded into segments by affect and then specific emotional states. A large portion of respondents reported negative emotions (e.g. anxiety, loneliness). A smaller portion reported positive emotions (e.g. optimism, gratitude). Younger respondents (aged 60-70) reported more feelings of anxiousness and fear compared to older respondents (71+). Older respondents were more likely to report negative feelings towards the government. For both age groups, female respondents were significantly more likely to report feeling afraid and having negative feelings about their own health. We conclude that many older adults are vulnerable to negative emotional outcomes during the pandemic. This highlights the importance of interventions targeting vulnerable older adults.

Impact of the COVID-19 Pandemic on Individuals With Hearing Loss and Audiology Practice in a Developing Country

OBJECTIVE

This study aimed to determine the challenges faced by individuals with hearing loss at a time when many nations were attempting to move from the COVID-19 pandemic to endemic.

DESIGN

A cross-sectional survey was conducted on Malaysian adults with hearing loss to determine the impact of the COVID-19 crisis on hearing aid management, communication difficulties, psychosocial challenges, and access to audiological services.

STUDY SAMPLE

One hundred forty-six individuals aged 18 years old and above with hearing loss were recruited from hearing health care centers to participate in the survey.

RESULTS

Many of the participants (54.2%) reported significant difficulties communicating with people wearing face masks. For hearing aid management, repairing (36.3%) and fine-tuning devices (30.2%) were considered more challenging than obtaining a battery (21.3%). The COVID-19 pandemic had a serious psychosocial impact on a small portion of the individuals surveyed. Remote services were rarely offered by the audiologists, and most participants preferred in-person treatment. However, the majority perceived that creating awareness and training on telehealth was important.

CONCLUSIONS

Effective management for people with hearing loss needs to consider the challenges faced by them, as the world prepares to live with the coronavirus. Clinical protocols should consider providing a service that is helpful for the clients as well as safe and sustainable in future pandemics.

Feasibility of a remotely supervised home-based group eHealth Fitness and Mobility Exercise program for stroke: French-Canadian version preliminary study

BACKGROUND

The numerous barriers to community-based physical activity programs have been exacerbated by the COVID-19 pandemic, especially among individuals with disabilities. eHealth programs may provide an alternative approach to address the physical activity needs of stroke survivors, but little is known about their feasibility or acceptance.

OBJECTIVE

The aims of this study were to 1) evaluate the feasibility of a remotely supervised home-based group eHealth program called Fitness and Mobility Exercise (FAME@home); 2) explore the influence of FAME@home on physical condition, mobility, self-efficacy, depression and anxiety; and 3) describe participants' satisfaction and experiences.

METHODS

A pre-post pilot study was used to recruit stroke survivors (>1 y post stroke) to complete a 12-week (2 days/week) eHealth program in small groups (n = 3). Feasibility indicators were assessed for process (e.g. inclusion criteria), resources (e.g. ability to use technology), management (e.g. major challenges), and treatment (e.g. influence on clinical outcomes and adverse events).

RESULTS

Nine participants were recruited with a mean (SD) of 60 (13) years of age and 7 (4) years post-stroke; eight completed the program. FAME@home was feasible for indicators of process, management, and treatment. Minor considerations to improve resources were suggested (i.e. support for technology use). There were statistically significant improvements in mobility after completion of FAME@home and 100% of the participants reported satisfaction. No adverse events occurred.

CONCLUSION

FAME@home was feasible to deliver as a remotely supervised group exercise program to community-dwelling stroke survivors, with high levels of retention and adherence. FAME@home improved accessibility to exercise and facilitated engagement by having a class schedule and social interaction.

The perceived impact of Covid-19 pandemic on the children with cerebral palsy: the parents' perspective explored within the "6-F words" framework

BACKGROUND

In 2020 the world faced the spread of the coronavirus infection disease (Covid-19). This was a general public health emergency but many people with disabilities might have been particularly affected.

OBJECTIVE

This paper aims to investigate the impact of the Covid-19 pandemic on children with Cerebral Palsy (CP) and their families.

METHODS

110 parents of children with CP (aged 2 to 19) who completed a questionnaire were included. These children were under the care of one of the Italian Children Rehabilitation Centers. Socio-demographic and clinical information about patients and their families were collected. In addition, difficulties on adopting protective measures and in respecting lockdown rules by children were explored. We adopted the ICF (International Classification of Functioning, Disability and Health) framework to create multiple choice questions. Descriptive statistics were reported and logistic regression analyses were run in order to identify the predictors of perceived impairment in motor, speech, manual and behavioral abilities.

RESULTS

Daily activities of children, as well as rehabilitation and fitness sessions, underwent a change during the pandemic. Spending more time with family due to lockdown measures, has had, in some cases a positive effect however there was a perceived decrease in rehabilitation support and school activities. The age range (between 7 and 12 years) and difficulty in respecting rules emerged as significant predictors of the perceived impairment due to Covid-19 pandemic.

CONCLUSIONS

The pandemic has had different impacts on children and their families on the basis of children's characteristics. Rehabilitation activities during a hypothetic lockdown should consider these characteristics.

Impact of the COVID-19 Pandemic on the Perceived Physical and Mental Health and Healthy Lifestyle Behaviors of People With Disabilities: A Quantitative Analysis of the International Community Survey

OBJECTIVE

This study aims to determine the perceived impact of the coronavirus pandemic on physical and mental health and healthy lifestyle behaviors in community-dwelling persons with disabilities, as compared with those without disabilities.

DESIGN

A prospective cross-sectional study was conducted with a web-based global survey.

RESULTS

Over 3 mos, 3550 responses were collected from 65 countries. The study included 2689 responses without skipped questions as full data for analysis. Most respondents were women (82.82%), and approximately half (52.81%) were between the ages of 25 and 39 yrs, followed by those between the ages of 40 and 60 yrs (38.6%). Among the participants, 52% indicated physical activity levels decreased and 20% reported eating less fruit and vegetables than before. Furthermore, 45% noted that they slept less than before. Perceived physical and mental health and changes to eating habits during the pandemic showed a significant difference in people with and without disabilities. Furthermore, perceived effects on physical health had a significant effect on the reported degree of disability.

CONCLUSIONS

This study indicates that the pandemic had a larger impact on perceived physical and mental health and changes in eating habits and tobacco use among people with disabilities than people without disabilities.

Needs of an uninsured equity-deserving minority patient cohort with physical disabilities during the first wave of the COVID-19 pandemic

Background

Patients with disabilities and those from diverse equity-deserving backgrounds have been disproportionately affected by the SARS COV-2 ("COVID-19") pandemic.

Objective

To describe the significant needs and social determinants of health that affected a group of uninsured patients (from equity-deserving groups) with rehabilitation diagnoses during the early months of the COVID-19 pandemic.

Design

Retrospective cohort study utilizing a telephone-based needs assessment from April to October, 2020.

Setting

Free interdisciplinary rehabilitation clinic serving patients with physical disabilities from equity-deserving minority backgrounds.

Participants

51 uninsured, diverse patients with spinal cord injuries, brain injuries, amputations, strokes, and other diagnoses requiring interdisciplinary rehabilitation care.

Methods

Using a non-structured approach, telephone-based needs assessments were collected monthly. Reported needs were summarized into themes and the frequencies of each theme were recorded.

Results

From the total number of concerns, medical issues were reported with the highest frequency (46%), followed by equipment needs (30%) and mental health concerns (30%). Other frequently mentioned needs centered around themes of rent, employment, and supplies. Rent and employment were more frequently cited in earlier months, and equipment problems were more frequently cited in later months. A minority of patients reported they had no needs, some of whom had acquired insurance.

Conclusions

Our objective was to describe the needs of a racially and ethnically diverse set of uninsured individuals with physical disabilities seen at a specialized interdisciplinary rehabilitation pro bono clinic during the early months of COVID-19. Medical issues, equipment needs, and mental health concerns were the top three needs. To optimally serve them, care providers must be aware of current and future needs for their underserved patients, especially if future lockdowns occur.

Expert consensus for a digital peer-led approach to improving physical activity among individuals with spinal cord injury who use manual wheelchairs

CONTEXT

Active Living Lifestyles for manual wheelchair users (ALLWheel) uses a digital peer-led approach to incorporate two behavior change theories to address a critical need for leisure-time physical activity (LTPA) programs for individuals with spinal cord injury (iSCI).

OBJECTIVE

The objective of this study was to obtain expert opinion and consensus for the ALLWheel program.

DESIGN

Mixed-methods (qualitative and quantitative) were used to gather expert opinion and consensus for the ALLWheel program using an action research approach.

SETTING

Rehabilitation center.

PARTICIPANTS

Experts in SCI and LTPA included iSCI who used manual wheelchairs, healthcare professionals, and community collaborators.

PROCEDURES

Two, 90-minute focus groups were conducted and transcribed verbatim, analyzed thematically, and the results were used to create a Delphi survey. Delphi surveys were completed online using consecutive rounds until ≥70% consensus per item was attained. Cumulative percent concordances were calculated to determine consensus.

RESULTS

Twelve experts in SCI and LTPA participated in focus groups. Four themes were generated: Need for LTPA programs; Important considerations; Perceptions about peer-coaches; and Feelings about smartphones, which were used to generate the Delphi survey. Consensus on the ALLWheel program was attained in two rounds.

CONCLUSIONS

Experts established a need for fun and personalized community-based LTPA programs. Ensuring that healthcare professionals would be involved in the ALLWheel program alleviated safety concerns, and experts agreed there were benefits of peers delivering the program. Experts agreed that the ALLWheel program targeted important psychological factors (i.e. autonomy, relatedness, self-efficacy, and motivation) and affirmed the potential for a potentially large geographic reach.

The relationship between fear of COVID-19 and depression, anxiety and stress in persons with disabilities: A cross-sectional study

AIM

This study aimed to determine the relationship between the fear of COVID-19 and the depression, anxiety and stress in persons with disabilities.

METHODS

In this cross-sectional study, the data were collected using an online survey from 178 persons with disabilities using the Personal Information Form, Depression Anxiety Stress Scales-21 (DASS-21) and the Fear of COVID-19 Scale (FCV-19S).

RESULTS

The mean age of the participants was 34.08 ± 11.8 years. The disability types that participants had were related to vision (47.2 %), hearing (25.8 %), mobility (24.7 %), cognitive (8.4 %), and chronic disease (10.1 %). It has been determined that 73.6 % of the participants stated that their access to healthcare services was restricted due to the COVID-19 pandemic. The mean DASS-21 was 10.24 ± 8.25 and the mean FCV-19S was 17.71 ± 5.05. A positive correlation was found between DASS-21 and FCV-19S.

CONCLUSION

The pandemic has created a need to provide appropriate interventions to improve the psychosocial health of persons with disabilities.

Changes in essential care in individuals with spinal cord injury during the COVID-19 pandemic

STUDY DESIGN

Cross-sectional, observational study.

OBJECTIVES

To determine whether changes in essential care during the COVID-19 pandemic impacted satisfaction with activities, participation, and relationships among individuals with spinal cord injury (SCI).

SETTING

Data were collected online between December 31, 2020 and February 14, 2021 among community dwelling adults with SCI (N = 123).

METHODS

The primary outcome variables were satisfaction with the ability to complete activities of daily living (ADLs) (mobility, dressing, feeding, and toileting), as well as satisfaction with participation in household and recreational activities, and satisfaction with relationships among friends, family, and with the status of one's relationship measured with the International Spinal Cord Injury Data Sets Activities and Participation Basic Data Set. Primary predictors were age, gender, time since injury, completeness of injury, injury level, access to mental health, access to medications, access to medical supplies, and access to personal care assistants (PCAs).

RESULTS

Impact on access to mental health and impact on access to supplies were the most common factors affecting satisfaction with activities, participation, and relationships for individuals with SCI during the COVID-19 pandemic. Impact on access to PCAs/homecare was also found to impact certain outcomes including feeding and participation in household activities.

CONCLUSIONS

Future supply chain disruptions from pandemics or natural disasters could have wide-reaching effects for individuals with SCIs. Thus, further research and advocacy is needed to improve mental health care planning and supply chain access during subsequent natural disasters.

Post-COVID conditions and healthcare utilization among adults with and without disabilities-2021 Porter Novelli FallStyles survey

BACKGROUND

Adults with disabilities are at increased risk for SARS-CoV-2 infection and severe disease; whether adults with disabilities are at an increased risk for ongoing symptoms after acute SARS-CoV-2 infection is unknown.

OBJECTIVES

To estimate the frequency and duration of long-term symptoms (>4 weeks) and health care utilization among adults with and without disabilities who self-report positive or negative SARS-CoV-2 test results.

METHODS

Data from a nationwide survey of 4510 U.S. adults administered from September 24, 2021-October 7, 2021, were analyzed for 3251 (79%) participants who self-reported disability status, symptom(s), and SARS-CoV-2 test results (a positive test or only negative tests). Multivariable models were used to estimate the odds of having ≥1 COVID-19-like symptom(s) lasting >4 weeks by test result and disability status, weighted and adjusted for socio-demographics.

RESULTS

Respondents who tested positive for SARS-CoV-2 had higher odds of reporting ≥1 long-term symptom (with disability: aOR = 4.50 [95% CI: 2.37, 8.54] and without disability: aOR = 9.88 [95% CI: 7.13, 13.71]) compared to respondents testing negative. Among respondents who tested positive, those with disabilities were not significantly more likely to experience long-term symptoms compared to respondents without disabilities (aOR = 1.65 [95% CI: 0.78, 3.50]). Health care utilization for reported symptoms was higher among respondents with disabilities who tested positive (40%) than among respondents without disabilities who tested positive (18%).

CONCLUSIONS

Ongoing symptoms among adults with and without disabilities who also test positive for SARS-CoV-2 are common; however, the frequency of health care utilization for ongoing symptoms is two-fold among adults with disabilities.

Workplace accommodations during the COVID-19 pandemic: A scoping review of the impacts and implications for people with disabilities

BACKGROUND

The COVID-19 pandemic has led to widespread changes in the way people work. Some of these changes represent the same kinds of work modifications or adjustments that have often been requested as workplace accommodations, and which may improve labour market and employment outcomes for people with disabilities.

OBJECTIVE

The aim of this scoping review was to examine the literature on workplace accommodations in the pandemic and their impacts and implications for people with disabilities.

METHODS

Following a search of six international databases, articles were selected by two reviewers, and data were abstracted in accordance with scoping review methodology. A thematic analysis was used to report the relevant findings.

RESULTS

Thirty-seven articles met the inclusion criteria, and three main themes were identified: positive impacts of pandemic-related workplace accommodations on people with disabilities (e.g., improved accessibility, reduced stigma around workplace accommodations, rapid implementation of workplace accommodations, opportunities for advocacy); negative impacts (e.g., worsened physical and mental health, new accommodation needs); and action needed and recommendations (e.g., revisit legislation and policy on accommodations, ensure representation of people with disabilities). Overall, our review identified a mixed assessment of the impacts of pandemic-related accommodations on people with disabilities. However, there was a broader consensus regarding the importance of learning from the experiences of the pandemic to improve workplace accommodation policies in the future.

CONCLUSIONS

The pandemic may present opportunities for improving workplace accommodation policies, but our review also highlights the need for more research examining how workplace changes due to the COVID-19 pandemic have impacted people with disabilities.

Providing community services for persons with disabilities during the COVID-19 pandemic: A scoping review

Community organisations and municipalities support people with disabilities by providing resources and services that are essential for their engagement in the community. Their services were particularly impacted by restrictions related to the COVID-19 pandemic. The aim of the study is to identify scientific literature that examines how community organisations and municipalities adapted services and resources provided to people with disabilities as a result of the COVID-19 pandemic. A scoping review was conducted by searching the databases Medline, Embase, CINAHL, PsycINFO and Web of Science Core Collection in January 2021. Fifteen studies were included from the initial search strategy of 7651 individual studies. Most of the studies were quantitative studies (73.3%; n = 11) and aimed at describing the adaptations put in place during the COVID-19 pandemic (66.7%; n = 10). Most services and resources involved some form of preventive healthcare (66.7%; n = 10). The adaptation of modalities for delivering resources and services varied widely across organisations (e.g. online or a combination of online and in-person) but mostly led to an improvement of the studied outcome (e.g. social skills, quality of life). Barriers (e.g. need for a reliable internet connection, lack of technology literacy from the member) and facilitators (e.g. flexibility and planning from the organisations) for these adaptations have been identified, but there is little information surrounding their cost. The results highlight that the delivery of online services has increased since the inception of the COVID-19 pandemic with valuable outcomes. However, further research is needed to better identify the barriers, facilitators and outcomes of remote services to better face future large-scale disasters like the COVID-19 pandemic and to better support individuals who cannot reach in-person services.

A multinational Delphi consensus to end the COVID-19 public health threat

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

A Pilot, Virtual Exercise Intervention Improves Health and Fitness during the COVID-19 Pandemic

Physical activity levels are low in individuals with chronic disease (e.g., obesity) and have worsened during the COVID-19 pandemic.

PURPOSE

Our pilot study tested a virtual exercise intervention for rural-dwelling adults with chronic disease from January-April 2021 for changes in mental health, physical fitness, and physical activity and for intervention fidelity.

METHODS

Participants (n = 8 [7 female]; age = 57.5 ± 13.8 years, body mass index = 38.2 ± 8.0 kg/m²) completed an exercise intervention led virtually by collegiate health science majors. Participants attended two 60-minute sessions/week for 12 weeks, completing individually-tailored and progressed aerobic and muscle-strengthening training. A non-randomized control group matched on gender and age continued normal activity during the 12 weeks. Changes in mental health, physical fitness, and physical activity measures were evaluated using a 2×2 (group × time) analysis of covariance.

RESULTS

Both groups improved mental health, but only intervention participants lost weight (3.1 ± 1.0 kg; no change in controls). Step test, arm curls, and chair stands improved by 16.1-20.6% in the intervention and 7.8-12.1% in the control groups. Intervention participants did not increase overall physical activity during or after the intervention. Intervention fidelity was high; participants attended ~73% of sessions and rated the sessions 4.7 ± 0.6 (out of 5). Researcher observations rated exercise sessions as meeting 12.7 ± 0.6 of 16 goals.

CONCLUSIONS

Our virtual exercise program was associated with positive mental health and physical fitness changes. Such programs may provide a method, even beyond the pandemic, to improve fitness in adults with chronic disease.

Designing Innovative Assistive Technology Devices for Tourism

Active tourism improves human health and well-being regardless of age or disabilities. The paper analyses and describes current issues concerning the tourism of people with disabilities. The starting point is the currently insufficient availability of tourist offers for individuals with considerable motor dysfunctions. One of the causes for these limitations stems from deficiencies in transport means for people with disabilities. It was found that for a disabled passenger using public transport, it is crucial to consider its accessibility in the context of the entire transport system. Another cause is the limited popularity of innovative, atypical assistive equipment for people with disabilities. Those insights point out that novel assistive technologies need to be developed, as it is necessary to more effectively support the activity of people with disabilities in all areas of life, including tourism, as this enhances their social rehabilitation. This paper indicates the needs and describes and analyses examples of own original, innovative devices supporting the areas mentioned above of activity for people with disabilities. These analyses resulted in developing an algorithm to design innovative equipment, considerably expanding the tourism potential of people with motor disabilities. This design process focuses on the needs of people with disabilities and facilitates the development of novel classes of assistive technologies, thus promoting new areas of activity for all.

The double burden of COVID-19 and Israeli military rule on persons with disabilities in the West Bank of the occupied Palestinian territory

Background

The COVID-19 pandemic has enormous negative effects on people’s lives. People with disabilities (PWDs) who have been made vulnerable and who tend to face significant barriers in accessing public services are likely to be affected even more. This study aims to shed light on the impact of the COVID-19 pandemic on PWDs with special attention to their ability to access public services in the West Bank region of the occupied Palestinian territory.

Methods

This qualitative study was conducted between March 2021 and October 2021. The study was divided into two phases. The first phase consisted of interviews with people with different disabilities, while the second phase targeted policymakers and stakeholders in discussion of the results of the first phase. A total of 16 interviews with people with different types of disabilities (7 males, 9 females) were conducted via telephone. For the second phase, a total of 6 interviews were conducted with stakeholders most responsible for addressing the issue of disability and the needs of PWDs in the West Bank. Analytical memos were prepared for all interviews. Main themes and subthemes were identified by reading and re-reading memos and transcripts until themes and subthemes emerged.

Results

All participants agreed that the COVID-19 pandemic had affected all aspects of life for all groups of people, including PWDs. The effects of the pandemic exacerbated the overall living conditions and access to basic services for PWDs. The results show that access to public transportation, public services, and to health services was all interrupted during the pandemic. This was compounded by deterioration of the financial situation for PWDs which further worsened their access. The stakeholders’ interviews confirmed and explained the findings as mainly due to lack of prioritization of PWD’s rights and needs.

Conclusion

The study emphasized that most of the reported barriers to accessing essential services were intensified during the pandemic. Furthermore, the results show that PWDs and their needs are not considered a priority by the Palestinian Authority, exacerbated by the Israeli occupation. Our findings underline the importance of including PWDs in any future crisis planning.