Adverse health behaviors and chronic conditions in working-age women with disabilities

Association between timed up and go test and future incidence of disability: A nationwide representative longitudinal study in Korea

Although previous studies examined the association between mobility and disability, they have used either subjective measure disability such as activity of daily living or instrumental activity of daily living or indirect measure such as long-term care service use with small size of participants. This study aimed to examine the association between timed up and go (TUG) test and disability incidence with national disability registration data in Korea longitudinally, by using a national representative sample. We used the National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS) database of National Health Information Database. The NHIS–HEALS dataset includes disability information of National Screening Programme participants, including registration date and type of disability, which is merged from Korean National Disability Registry (KNDR). We used Cox proportional hazard models to evaluate the association between TUG and disability incidence. We constructed three models with different levels of adjustment; Model 3 was a fully adjusted model. We conducted subgroup analysis according to the risk factors for disability. The study population comprised 81,473 participants; 86 of them were newly registered to KNDR, which were observed during a mean follow-up of 4.1 ± 2.6 (maximum, 8.9) years. For 334,200.9 person-year (PY) follow-up, the disability incidence rate was 0.208 per 1,000 PY. Disability incidence was significantly higher in participants with abnormal TUG results than in those with normal TUG results. (adjusted hazard ratio [aHR] 1.600, 95% confidence interval [CI] 1.036–2.472). In subgroup analysis, the disability incidence increased in participants of normal cognition, without obesity or without cardiovascular (CV) disease. Increased incidence in disability was noted in participants with abnormal TUG results. The increase was more evident for participants with normal cognition, without obesity or CV disease.

Association between disability and cardiovascular event and mortality: A nationwide representative longitudinal study in Korea

This study aimed to examine the association between disability and cardiovascular (CV) disease incidence and mortality in Korea longitudinally, using a national representative sample. We used the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database, which includes information on the disability of the National Screening Program participants such as severity and type of disability, which were obtained from the Korean National Disability Registry. Cox proportional hazard models were used to evaluate the association between disability and CV disease incidence and mortality. We constructed four models with different levels of adjustment, in which Model 3 was a fully adjusted model. This study included 514,679 participants, and 7,317 CV deaths were reported within a mean follow up of 10.8 ± 3.9 years (maximum, 13.9 years). For 5,572,130 person-year (PY) follow-up, the CV mortality rate was 1.313 per 1,000 PY. In Models 1 and 2, CV disease incidence was significantly higher in participants with disability than in those without disability. In Model 3, the incidence was higher only among participants aged 50–64 years and severe disabled participants aged <50 years. CV mortality was significantly higher in participants with disability than in those without disability in all Models, and the mortality increased in both sexes in Models 1 and 2 but only increased in men in Model 3. Similar results were observed in the subgroup analysis of health behavior and chronic diseases. People with disability showed higher CV disease incidence and mortality than those without disability, regardless of the type of disability or risk factors for CV disease.

Broadening horizons: the case for capturing function and the role of health informatics in its use

Background

Human activity and the interaction between health conditions and activity is a critical part of understanding the overall function of individuals. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) models function as all aspects of an individual’s interaction with the world, including organismal concepts such as individual body structures, functions, and pathologies, as well as the outcomes of the individual’s interaction with their environment, referred to as activity and participation. Function, particularly activity and participation outcomes, is an important indicator of health at both the level of an individual and the population level, as it is highly correlated with quality of life and a critical component of identifying resource needs. Since it reflects the cumulative impact of health conditions on individuals and is not disease specific, its use as a health indicator helps to address major barriers to holistic, patient-centered care that result from multiple, and often competing, disease specific interventions. While the need for better information on function has been widely endorsed, this has not translated into its routine incorporation into modern health systems.

Purpose

We present the importance of capturing information on activity as a core component of modern health systems and identify specific steps and analytic methods that can be used to make it more available to utilize in improving patient care. We identify challenges in the use of activity and participation information, such as a lack of consistent documentation and diversity of data specificity and representation across providers, health systems, and national surveys. We describe how activity and participation information can be more effectively captured, and how health informatics methodologies, including natural language processing (NLP), can enable automatically locating, extracting, and organizing this information on a large scale, supporting standardization and utilization with minimal additional provider burden. We examine the analytic requirements and potential challenges of capturing this information with informatics, and describe how data-driven techniques can combine with common standards and documentation practices to make activity and participation information standardized and accessible for improving patient care.

Recommendations

We recommend four specific actions to improve the capture and analysis of activity and participation information throughout the continuum of care: (1) make activity and participation annotation standards and datasets available to the broader research community; (2) define common research problems in automatically processing activity and participation information; (3) develop robust, machine-readable ontologies for function that describe the components of activity and participation information and their relationships; and (4) establish standards for how and when to document activity and participation status during clinical encounters. We further provide specific short-term goals to make significant progress in each of these areas within a reasonable time frame.

Double Jeopardy: The Effects of Comorbid Conditions among Older People with Vision Loss

This retrospective study used national survey data to examine multiple effects of nine comorbid conditions—breathing problems, depression risk, diabetes, heart problems, hearing impairment, hypertension, joint problems, low back pain, and stroke—on physical functioning, participation, and health status among older adults with visual impairments. Bivariate and multivariate procedures were used to compare older adults who had neither visual impairment nor these conditions with adults of similar age who had one of the nine conditions only, visual impairment only, or both visual impairment and the condition. Findings indicate that older adults with visual impairment frequently experience comorbid conditions, and that these conditions are associated with difficulties in walking and climbing steps, shopping, and socializing, and with significantly more self-reports of declining health. Results suggest that interventions by health care and mental health providers, as well as enhanced rehabilitation services, have the potential to reduce or prevent the deleterious effects of comorbid conditions.

Health-related lifestyles and obesity among adults with and without disability in Australia: Implication for mental health care

BACKGROUND

Numerous studies have reported people with disabilities are more likely to be obese and engaged in unhealthy lifestyles. Few studies explored the mechanism of health-related lifestyles and obesity among people with disabilities.

OBJECTIVE

We aimed to investigate health-related lifestyles and obesity in relation to disability among Australian adults. We further aimed to explore the potential mediating effect of psychological distress for disability in relation to health related lifestyles and obesity.

METHODS

Using the National Health Survey conducted in 2015 in Australia, we considered non-institutionalised adult participants (aged 18 + years old) as our study population (n = 11,598). Study outcomes included currently smoking, smoking daily, alcohol consumption, physical exercises, and obesity. We considered high psychological distress (Kessler 10 scores ≥ 22) a potential mediator for the disability-lifestyles and disability-obesity associations. Sample weights were calculated allowing for complex survey design. Adjusted Odds Ratios and 95% Confidence Intervals were evaluated using weighted Logistic regression models.

RESULTS

Compared to their disability-free counterparts, people with disabilities were more likely to be current smokers (aOR: 1.26, 95%CI: 1.08-1.47) and have obesity problems (1.44, 1.27-1.64), and were less likely to do physical exercises (0.67, 0.58-0.77), after controlling for socio-environmental factors. In the presence of high psychological distress, the disability-smoking association was no longer significant, and associations of disability-exercise (0.72, 0.62-0.84) and disability-obesity (1.38, 1.22-1.57) were influenced but remained significant.

CONCLUSION

High psychological distress demonstrated important mediating effects. Tailored mental health care for people with disabilities might have the utility to reduce unhealthy behaviors.

Use of Reversible Contraceptive Methods Among U.S. Women with Physical or Sensory Disabilities

CONTEXT

Women with disabilities experience a higher rate of adverse pregnancy outcomes than women without disabilities. Preventing or delaying pregnancy when that is the best choice for a woman is a critical strategy to reducing pregnancy-related disparities, yet little is known about current contraceptive use among women with disabilities.

METHODS

A cohort of 545 reproductive-age women with physical disabilities (i.e., difficulty walking, climbing, dressing or bathing) or sensory disabilities (i.e., difficulty with vision or hearing) was identified from among participants in the 2011-2013 National Survey of Family Growth. Those at risk for unplanned pregnancy were categorized by whether they were using highly effective reversible contraceptive methods (IUD, implant), moderately effective ones (pill, patch, ring, injectable), less effective ones (condoms, withdrawal, spermicides, diaphragm, natural family planning) or no method. Multinomial regression was conducted to examine the association between disability and type of contraceptive used.

RESULTS

Some 39% of women with disabilities were at risk of unplanned pregnancy, and 27% of those at risk were not using contraceptives. The presence of disability was associated with decreased odds of using highly effective methods or moderately effective methods, rather than less effective ones (odds ratio, 0.6 for each), but had no association with using no method.

CONCLUSION

There is a significant need to reduce contraceptive disparities related to physical or sensory disabilities. Future research should explore the extent to which contraceptive use differs by type and severity of disability, as well as identify contextual factors that contribute to any identified differences.

Physical activity of disabled individuals in the context of meeting WHO recommendations and support of local authorities

Objectives

This study aims to evaluate physical activity of disabled individuals in the context of fulfilling the World Health Organization (WHO) recommendations and to investigate the relationship between the risk of inactivity and activity of local authorities in this field.

Materials and methods

The sample consisted of 155 disabled individuals selected from a representative sample of the Polish society. The long version of the International Physical Activity Questionnaire (IPAQ-LF) and the survey of the determinants of a sport activity among the Polish population were applied. The relationship between meeting the WHO recommendations and environmental factors were investigated.

Results

According to the IPAQ-LF, 68.2% of the Polish disabled adults performed a recommended dose of physical activity during their leisure time. The total leisure activity was composed mainly of vigorous activities (58.8%), in a less extent of moderate activities (11.8%), and walking (7.2%). According to the survey of the sport activity determinants, 10.3% is active (0.7% exercises for ≥60 min 3 to 4 times a week, 3.9% per day).

Conclusion

Based on our study results, there is a need to increase the activity of local authorities, promoting a participation in sport for all among Polish disabled individuals. In addition, these study results indicate methodological problems related with the implementation of the IPAQ-LF.

Preventing health problems that disrupt community living: A health promotion needs assessment

People with physical disabilities experience health disparities and poor health outcomes that endanger community living and participation, and sometimes contribute to institutionalization. Centers for Independent Living (CILs) provide vital services to assist consumers with disabilities in achieving and maintaining community living; these organizations could be trusted sources in providing targeted health information. As first steps in devising a Health Promotion Assistance Tool for CIL staff to use with consumers, this project conducted a Needs Assessment study to collect feedback on what information would be most useful. First, researchers interviewed key informants from a sample of CIL staff members to gain input for a survey on the content of the proposed tool. Then, they disseminated the survey by e-mail to 426 CILs listed in a national data bank, and received responses from one or more staff members from 93 CILs. CIL staff reported that their consumers experienced a variety of chronic conditions (e.g., diabetes, high blood pressure) in addition to their physical disability, and that they also experienced secondary health conditions such as chronic pain and depression. CIL staff also reported that they believed their consumers were in need of supports to enable them to engage in preventive health care. We discuss implications for these findings to our further research.

Asthma and asthma-related health care utilization among people without disabilities and people with physical disabilities

BACKGROUND

Previous research has shown that people with disabilities have higher rates of some chronic diseases and receive poorer disease-specific care than their counterparts without disabilities. Yet, little is known about the relationship between asthma and disability.

OBJECTIVE

This study examines whether differences in the prevalence of asthma, asthma flare, and asthma-related measures of health care quality, utilization and cost exist among people with physical limitations (PL) and without any limitations.

METHODS

Data from the 2004-2010 Medical Expenditure Panel Survey were pooled to compare outcomes for working-age adults (18-64) with PL to those with no limitations.

RESULTS

People with PL had higher rates of asthma (13.8% vs. 5.9%, p < 0.001) and recent asthma flare (52.6% vs. 39.6%, p < 0.001) than people without limitations. There were no differences in health care quality, utilization or cost between people with PL and people without limitations in multivariate analyses.

CONCLUSIONS

Although there are no differences in asthma-related quality or utilization of health care, people with PL have poorer asthma control than people without limitations. Research is needed to determine what factors (e.g., focus on other acute ailments, perceptions that asthma control cannot improve) are related to this outcome. Future research must also examine differences in asthma severity, and its impact on asthma control and health care-related outcomes, among people with and without disabilities.

Disparities in Adverse Preconception Risk Factors Between Women with and Without Disabilities

OBJECTIVE

The objective of this study was to compare the prevalence of select preconception health indicators among women with and without disabilities.

METHODS

2010 Behavioral Risk Factor Surveillance System data were used to estimate the prevalence of health behaviors, health status indicators, and preventive health care among non-pregnant women ages 18-44 years with (N = 8370) and without (N = 48,036) disabilities. Crude percentages were compared with Chi square statistics. Multivariable logistic regressions adjusted for socio-demographic factors.

RESULTS

Women with disabilities were more likely than women without disabilities to currently smoke (30.5 vs. 14.5 %, p < 0.0001) and less likely to exercise in the past month (67.1 vs. 79.8 %, p < 0.0001). Heavy drinking was similar in the two groups (4.4 vs. 4.5 %, p = 0.9). Health status indicators were worse among women with disabilities, with 35.0 % reporting fair/poor health and 12.4 % reporting diabetes, compared with 6.7 and 5.6 %, respectively, among women with no disabilities (p < 0.0001 for both). Frequent mental distress, obesity, asthma, and lack of emotional support were also higher among women with disabilities compared with their non-disabled counterparts. Women with disabilities were more likely to receive some types of preventive care, (HIV), but less likely to receive others (recent dental cleaning, routine checkup). Disparities in health behaviors and health status indicators between the two groups remained after adjusting for socio-demographic factors.

CONCLUSION

Women with disabilities at reproductive age are more vulnerable to risk factors associated with adverse pregnancy outcomes compared to their counterparts without disabilities. Our findings highlight the need for preconception health care for women with disabilities.

Health behaviors of people with retinitis pigmentosa in the republic of Korea

PURPOSE

To investigate the health behaviors of people with retinitis pigmentosa (RP) in the Republic of Korea.

METHODS

An online questionnaire was used to survey members of the Korean Retinitis Pigmentosa Society (KRPS), over 3 months from December 2010 to February 2011. Controls were selected from participants of the 4th Korean National Health and Nutrition Examination Survey and were matched with people with RP using the propensity score method to optimize comparative analysis. A semi-structured interview was also conducted with five members of the KRPS to identify potential reasons for physical inactivity and unhealthy diet and to develop effective interventions.

RESULTS

A total of 194 eligible people with RP responded to the online survey, and 187 individuals were matched with the control population by propensity score matching. RP subjects reported a lower rate of current smoking and greater use of preventive healthcare services. However, people with RP were more physically inactive (50.8% vs 27.3%, p < 0.001) and consumed more fast food (69.5% vs 58.3%, p = 0.024) than the control population.

CONCLUSION

Physical inactivity and fast food consumption were more frequently reported in people with RP than the general population. Efforts to understand the possible reasons and develop interventions to improve these health behaviors are warranted.

Smoking behaviors among people with disabilities in Korea

BACKGROUND

Most reports concerning smoking behaviors in people with disabilities have been from Western societies; knowledge of smoking behaviors in Asian countries, including Korea, is insufficient.

OBJECTIVES

This study investigates the smoking behaviors of people with a disability compared to the general population in Korea.

METHODS

We compared the smoking behaviors of people with a disability with the general population by using datasets from the 2011 National Survey of Disabled People and an age- and sex-matched random sample from the 5th Korean National Health and Nutrition Examination Survey. Random samples of people 18 years of age and older with disabilities (n = 5636) and of the general population were used (n = 5636). The main outcome measures include smoking behaviors by type, severity, and age at disability onset.

RESULTS

People with a mental or physical impairment have higher current smoking rates (38.1% and 26.3%, respectively) than the general population (23.3%). In particular, current smokers with psychiatric impairment were more likely to smoke more than 20 cigarettes a day (61.2%). People with a disability, regardless of severity or age at onset, were less likely than the general population to have attempted to quit smoking.

CONCLUSIONS

Smoking behaviors differed according to the type of disability. These results suggest that interventions for smoking prevention and cessation need to be tailored according to disability characteristics.

Health disparities among workers and nonworkers with functional limitations: implications for improving employment in the United States

PURPOSE

The aim of this study was to compare workers and nonworkers who reported mild, moderate, and severe/complete functional limitations to identify disparities in 19 health and social indicators.

METHOD

Using the International Classification of Functioning, Disability and Health as our conceptual framework, we analyzed data from the combined 2000-2008 National Health Interview Survey, comparing workers and nonworkers by severity of functional limitations, as measured by the FL12 Scale of Functional Limitation Severity.

RESULTS

Only 9.5% of people reporting moderate/severe functional limitations worked. Although not without exception, not working and severity of functional limitation were associated with poorer health outcomes, with nonworkers reporting severe/complete limitations having least optimal health. Prevalence of chronic conditions was associated with level of functional limitation severity, with the strongest associations among nonworkers.

CONCLUSIONS

By focusing exclusively on people with functional limitations, we were better able to examine factors contributing to health and participation of workers and nonworkers. People who worked and had moderate or severe/complete limitations often did so while reporting poor health. With improved access to health care, health promotion activities, and other support systems, the quality of life and likelihood of work participation of people with greater functional limitations might also be improved.

Methods used to quit smoking by people with physical disabilities

PURPOSE/OBJECTIVE

People with mobility impairments (MIs) have higher smoking rates than the general population. We evaluated the use of psychosocial and pharmacological methods to quit smoking and readiness to quit smoking in this population in a cross-sectional study.

RESEARCH METHOD/DESIGN

Current and former smokers with MIs who needed equipment to ambulate (e.g., cane, wheelchair; n = 152, 53.3% female, 86.2% current smokers) were recruited from the community and interviewed by telephone regarding their lifetime use of various quit methods and readiness to quit smoking.

RESULTS

Results indicated that 57.3% reported a quit attempt in the past year, and 62% and 88.4% were planning on quitting in the next 30 days and six months, respectively. A minority of smokers with MIs reported using any type of counseling (5.3%; 3.3% in-person counseling and 2.6% phone counseling) or tablet medication (8.6%); 75% had made a "cold turkey" quit attempt (e.g., without any assistance). 36.8% and 19.7% reported using the nicotine patch and gum, respectively. Regression analyses indicated that greater nicotine dependence was associated with lower use of psychosocial treatments (p < .05), greater education was associated with greater tablet medication use (p = .051), and higher income was associated with both greater nicotine replacement therapy (NRT) and tablet medication use (p < .05). Minorities with MIs were significantly less likely to use NRT than non-Hispanic Whites (p < .05).

CONCLUSIONS

Individuals with MIs are motivated to quit smoking but underuse some empirically validated cessation treatment options.

Disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions for people with disabilities: the Korean National Health and Nutrition Examination Survey

OBJECTIVE

To examine how disability status is related with health disparities in South Korea.

DESIGN

The study compared 3 indicators of health (health-risk behaviors, preventive health care utilizations, and chronic health conditions) according to the presence of disabilities using the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III).

SETTING

We obtained data from the KNHANES III, which is the third nationwide representative study using a stratified, multistage probability sampling design.

PARTICIPANTS

Subjects (N=5475) aged 20 years or older were included in the study; persons with disabilities (n=218) and persons without disabilities (n=5257).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Nonconditional multiple logistic regression and adjusted mean were used to identify health disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions.

RESULTS

Subjects with disabilities were more likely to be physically inactive (adjusted odds ratio [AOR]=3.06; 95% confidence interval [CI], 1.71-5.48 for no physical activity; AOR=1.70; 95% CI, 1.19-2.43 for insufficient physical activity) than those without disabilities. Women aged 40 years or older with disabilities were less likely to receive cervical cancer screening services (AOR=0.52; 95% CI, 0.27-0.98). Adults with disabilities had higher proportion of osteoporosis (AOR=2.41; 95% CI, 1.50-3.88), underweight (AOR=2.14; 95% CI, 1.07-4.28), suicidal thoughts (AOR=1.86; 95% CI, 1.35-2.56), and had impaired quality of life (95% CI of adjusted mean, 60.89-65.35 compared to 69.95-70.84 in adults without disabilities).

CONCLUSIONS

There exists substantial disability-related health disparities in South Korea. People with disabilities may be the underserved subpopulation demonstrating health disparities. The findings in this study underscore the continued needs in order to reduce health problems and disparities for people with disabilities.

Determining factors required for a holistic approach to weight management of those with obesity

A prospective 6-month longitudinal survey was carried out to ascertain the extent of relationships between weight beliefs, expectations of weight loss; physical, social, emotional, and well-being; and weight management from the perspective of obese individuals who did not have an identified eating disorder. Physical, social, and emotional factors in weight management show interrelationship and are associated with weight change. Therefore, understanding the relationships between physical, social, and emotional factors of obese individuals would facilitate a holistic, person-centered approach and, it is suggested, have an impact on achieving weight loss and thereby reduce considerable detrimental health effects.

Health disparities between women with and without disabilities: a review of the research

As part of a women's health center project, we reviewed 16 years of research to examine health disparities between women with and without disabilities. We reviewed MEDLINE-indexed articles between 1990 and 2005 with data on women with and without physical, sensory, intellectual, developmental, or psychiatric disabilities. Our review found few articles examining health disparities in chronic disease, cancer, mental health and substance abuse, preventive screening, health-promoting behaviors, and health services utilization. Results reflect apparent health disparities between women with and without disabilities. Challenges for the field exist in standardizing disability definitions and determining a future course for health disparity research and policy.

Multiple health disparities among minority adults with mobility limitations: san application of the ICF framework and codes

PURPOSE

To examine the interface between mobility limitations and minority status and its effect on multiple health and health-related domains among adults, using the framework of the International Classification of Functioning, Disability and Health (ICF).

METHODS

We combined 8 years of data from the 1997-2004 US National Health Interview Survey to investigate health disparities among minorities with mobility limitations as defined by the ICF. A total of 79,739 adults surveyed met these criteria.

RESULTS

Adults with both mobility limitations and minority status experienced the greatest disparities (p<0.001) in worsening health (adjusted odds ratio [AOR]=8.5), depressive symptoms (AOR=17.2), diabetes (AOR=5.5), hypertension (AOR=3.4), stroke (AOR=7.2), visual impairment (AOR=4.6), difficulty with activities of daily living (AOR=42.7) and instrumental activities of daily living (AOR=27.7), use of special equipment (AOR = 28.1), obesity (AOR=3.3), physical inactivity (AOR=2.7), and low workforce participation (AOR=0.35).

CONCLUSIONS

For most outcome measures, findings supported our hypothesis that persons with both mobility limitations and minority status experience greater health disparities than do adults with minority status or mobility limitations alone.

Health needs of women with disabilities across the lifespan

Women with disabilities experience a variety of unique health needs from adolescence to older age. They require compassionate and comprehensive health care services to manage their physical disabilities and to prevent secondary conditions. Unfortunately, many women with disabilities encounter attitudinal, informational, environmental, and geographic barriers as they seek access to health care. A variety of measures can be implemented to overcome these barriers and to improve the quality of health care that women with disabilities receive.

Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry

Individuals with physical disabilities are less likely to utilise primary preventive healthcare services than the general population. At the same time they are at greater risk for secondary conditions and as likely as the general population to engage in health risk behaviours. This qualitative exploratory study had two principal objectives: (1) to investigate access barriers to obtaining preventive healthcare services for adults with physical disabilities and (2) to identify strategies to increase access to these services. We conducted five focus group interviews with adults (median age: 46) with various physically disabling conditions. Most participants were male Caucasians residing in Virginia, USA. Study participants reported a variety of barriers that prevented them from receiving the primary preventive services commonly recommended by the US Preventive Services Task Force. We used a health services framework to distinguish structural-environmental (to include inaccessible facilities and examination equipment) or process barriers (to include a lack of disability-related provider knowledge, respect, and skilled assistance during office visits). Participants suggested a range of strategies to address these barriers including disability-specific continuing education for providers, the development of accessible prevention-focused information portals for people with physical disabilities, and consumer self-education, and assertiveness in requesting recommended services. Study findings point to the need for a more responsive healthcare system to effectively meet the primary prevention needs of people with physical disabilities. The authors propose the development of a consumer- and provider-focused resource and information kit that reflects the strategies that were suggested by study participants.

Health promotion for persons with disabilities: what does the literature reveal?

A search of MEDLINE and CINAHL databases for research on disability and health promotion was done. Twenty-three articles were categorized into 1 of 3 areas: the meaning of health and health promotion, factors that contribute to health and health promotion, and health promotion interventions. Overall, health and health promotion were inductively defined concepts that emphasized function, relationships, and a positive mental attitude. Barriers to health promotion were frequently reported, fatigue being most common. Moreover, better health outcomes were reported when people with disabilities engaged in health-promoting behaviors. There were few interventions found, with only 1 being a randomized clinical trial.

Physical disability and obesity

Nearly 20% of US citizens are disabled. Epidemiologic studies have shown that people with physical disabilities have a 1.2- to 3.9-fold increase in obesity prevalence. Obesity is becoming a serious problem in disabled individuals. The mechanisms by which obesity occurs in people with physical disabilities is not clear, but pathophysiological changes of body composition and energy metabolism, physical inactivity, and muscle atrophy all favor the development of obesity. Health professionals should identify disabled patients at risk and provide early prevention guidance. Research is needed to help generate detailed clinical guidelines to promote weight control among people with physical disabilities.