Research on prevalence of secondary conditions in individuals with disabilities: an overview

Comorbidity in spinal cord injury in Iran: A narrative review

Spinal cord injury (SCI) is a severe medical condition that affects millions of people worldwide each year. In Iran, an estimated 9 out of every 100,000 individuals experience traumatic SCI occurrences. Long-term disabilities and comorbidities stemming from SCI often necessitate multiple therapeutic interventions. The aim of this study is to evaluate the morbidity in Iranian SCI patients. In this study, a four-step process was used to select, extract, analyze, and synthesize relevant literature. The search covered 750 records from five databases, resulting in 25 articles included in the review. These articles, published between 2000 and 2023, utilized cross-sectional, qualitative, or cohort designs. The findings explored the prevalence, risk factors, and consequences of comorbidities associated with SCI, categorized into four themes: physical, sexual, psychological, and metabolic morbidity. Physical morbidity refers to medical conditions or complications affecting body functions or structures in SCI patients. The most frequently reported cases include pressure ulcers, pain, osteoporosis, fractures, impaired pulmonary function, renal failure, and obesity. Metabolic morbidity includes conditions such as vitamin D deficiency and cardiometabolic risk factors. Psychological morbidity encompasses depression, anxiety, and adjustment disorders. Sexual morbidity refers to conditions or complications affecting the sexual function or satisfaction of SCI patients. This narrative literature review offers a comprehensive examination of various aspects of SCI in Iranian patients. The review identifies numerous challenges and difficulties faced by SCI patients while also highlighting protective factors that can improve their well-being. Additionally, the review acknowledges gaps and limitations within the current literature and suggests possible avenues for future research.

Sleep-wake monitoring of people with intellectual disability: Examining the agreement of EMFIT QS and actigraphy

BACKGROUND

Gaining insight into sleep-wake patterns of persons with intellectual disabilities is commonly done using wrist actigraphy. For some people, contactless alternatives are needed. This study compares a contactless bed sensor with wrist actigraphy to monitor sleep-wake patterns of people with moderate to profound intellectual disabilities.

METHOD

Data were collected with EMFIT QS (activity and presence) and MotionWatch 8/Actiwatch 2 (activity, ambient light, and event marker/sleep diary) for 14 nights in 13 adults with moderate-profound intellectual disabilities residing in intramural care.

RESULTS

In a care-as-usual setting, EMFIT QS and actigraphy assessment show little agreement on sleep-wake variables.

CONCLUSION

Currently, EMFIT QS should not be considered an alternative to wrist actigraphy for sleep-wake monitoring. Further research is needed into assessing sleep-wake variables using (contactless) technological devices and how the data should be interpreted within the care context to achieve reliable and valid information on sleep-wake patterns of people with intellectual disabilities.

Longitudinal effects of time since injury and age at injury on outcomes of people with spinal cord injury in Queensland, Australia

STUDY DESIGN

Longitudinal cohort study.

OBJECTIVES

To investigate the longitudinal effects of time since injury and age at injury on outcomes of quality of life, physical function, secondary conditions and participation, in people with traumatic spinal cord injury (SCI).

SETTING

Community resident people with spinal cord injury in Queensland, Australia.

METHODS

A baseline sample of 270 people with SCI was recruited. Telephone surveys on measures of quality of life (WHOQOL-Bref), secondary conditions (Secondary Conditions Surveillance Instrument, subset), physical functioning (Functional Independence Measure motor subscale) and participation (Community Integration Measure) were conducted each year between 2004 and 2008, and again in 2018. Random-effect within-between models were used to determine the effect of time since injury and age at injury on each outcome variable. Inverse probability-of-censoring weights were used to correct for selection bias.

RESULTS

There was an effect of time since injury on secondary conditions, with a one-year change associated with 9% higher odds of having worse Secondary Conditions Surveillance Instrument scores (odds ratio = 1.09, 95% confidence interval = 1.02, 1.17; p = 0.006). We did not find any evidence of a time since injury effect on quality of life, physical function, or participation. Similarly, we did not find any evidence of an age at injury effect on any outcome variable.

CONCLUSIONS

Secondary conditions may increase with longer time since injury among people with SCI, suggesting appropriate formal and informal supports are required to minimise the impact of these emerging health problems as individuals age.

The impact of upper limb spasticity-correcting surgery on the everyday life of patients with disabling spasticity: a qualitative analysis

PURPOSE

The aim of this study was to explore the patient perspective of their experiences of daily life after spasticity-correcting surgery for disabling upper limb (UL) spasticity after spinal cord injury (SCI) and stroke.

MATERIALS AND METHODS

Eight patients with UL spasticity resulting from SCI (n= 6) or stroke (n= 2) were interviewed 6-9 months after spasticity-correcting surgery. A phenomenographic approach was used to analyze the interviews.

RESULTS

Five themes emerged from the interviews: (1) bodily changes, such as increased muscle strength, range of motion, and reduced muscle-hypertonicity; (2) improved occupational performance, facilitating tasks, mobility, and self-care; (3) regained control, explicating the perception of regaining bodily control and a more adaptable body; (4) enhanced interpersonal interactions, entailing the sense of being more comfortable undertaking social activities and personal interactions; and (5) enhanced psychological well-being, including having more energy, increased self-esteem, and greater happiness after surgery.

CONCLUSIONS

The participants experienced improvements in their everyday lives, including body functions, activities, social life, and psychological well-being. The benefits derived from surgery made activities easier, increased occupational performance, allowed patients regain their roles and interpersonal interactions, and enhanced their psychological well-being.Implications for rehabilitationSpasticity-correcting surgery benefits patients by improving bodily functions, which in turn, enable gains in activities, social life, and psychological well-being.Patients' experiences of increased body functions, such as enhanced mobility and reduced muscle hypertonicity, appear to increase the sense of bodily control.The surgery can increase participation and psychological well-being, even for patients whose functional or activity level did not improve after the treatment.The benefits expressed by the individuals in this study can be used to inform, planning, and in discussion with patients and other healthcare professionals about interventions targeting spasticity.

Association between physical disability and incidence of depressive symptoms in older Mexican adults

Introducción.

Las limitaciones funcionales asociadas con el proceso de envejecimiento pueden conducir al desarrollo de síntomas depresivos e incrementar la vulnerabilidad de los adultos mayores.

Objetivo.

Estimar la asociación entre la discapacidad física y la incidencia de síntomas depresivos clínicamente significativos en adultos mayores mexicanos.

Materiales y métodos.

Se hizo un estudio retrospectivo de cohorte con datos provenientes de la Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM). La muestra analítica (n=6.780) incluyó a adultos mayores de 50 años que contaran con mediciones de las variables principales y que no presentaran síntomas depresivos clínicamente significativos en la ronda cero. Estos síntomas se evaluaron con la escala CESD-9 y, la discapacidad, mediante el reporte de limitaciones para la realización de actividades básicas o instrumentales de la vida diaria. Se hicieron análisis descriptivos, bivariados y multivariados, utilizando el modelo de regresión logística y ajustando según las variables sociodemográficas, las condiciones de salud, las adversidades de la infancia, la participación social y los eventos vitales estresantes.

Resultados.

La incidencia de síntomas depresivos clínicamente significativos fue de 25,75 % (IC₉₅% 24,70-26,80). Comparados con aquellas personas sin limitaciones para las actividades instrumentales, se encontró un incremento del 68 % en el riesgo para el desarrollo de dichos síntomas (IC₉₅% 1,10-2,57; p=0,015). En el modelo de actividades básicas de la vida diaria, la razón de probabilidad (odds ratio, OR) para su desarrollo fue de 1,36 (1,01-1,81; p=0,039), ambos ajustados por variables de confusión.

Conclusión.

Las limitaciones en la vida diaria son un factor de riesgo importante para el desarrollo de síntomas depresivos clínicamente significativos en personas con seguimiento de dos años.

People with Disabilities and Other Forms of Vulnerability to the COVID-19 Pandemic: Study Protocol for a Scoping Review and Thematic Analysis

OBJECTIVES

To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage.

METHODS

We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis.

CONCLUSIONS

This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.

A 'new normal' following COVID-19 and the economic crisis: Using systems thinking to identify challenges and opportunities in disability, telework, and rehabilitation

BACKGROUND

The novel coronavirus (COVID-19) that emerged in late 2019, and later become a global pandemic, has unleashed an almost unprecedented global public health and economic crisis.

OBJECTIVE

In this perspective, we examine the effects of COVID-19 and identify a likely 'new normal' in terms of challenges and opportunities within the fields of disability, telework, and rehabilitation.

METHODS

We use a systems thinking lens informed by recent empirical evidence and peer-reviewed qualitative accounts regarding the pandemic to identify emerging challenges, and pinpoint opportunities related to health and changing employment infrastructure of people with disabilities and rehabilitation professionals.

RESULTS

From our interpretation, the key leverage points or opportunities include: (1) developing disability-inclusive public health responses and emergency preparedness; (2) enabling employment and telework opportunities for people with disabilities; (3) addressing the new requirements in rehabilitation service provision, including participating as essential team members in the care of people with infectious diseases such as COVID-19; (4) embracing the added emphasis on, and capacity for, telehealth; and (5) developing greater resilience, distance learning, and employability among the rehabilitation workforce.

CONCLUSIONS

The COVID-19 pandemic has become increasingly challenging to the lives of people with disabilities and rehabilitation professionals; however, key challenges can be minimized and opportunities can be capitalized upon in order to 'build back better' after COVID-19.

Assessing Perceived Success in Valued Living in Individuals With Long-Term Physical Health Conditions

Objective: To evaluate the reliability and validity of a brief measure of successful aging in a sample of adults with long-term health conditions. Method: The brief (eight-item) version of the valued living scale (VLS) and measures of pain intensity, pain interference, and depression were administered to 1,457 adults aging with one of four long-term health conditions. Results: Analyses indicated that the VLS items assessed two types of valued living domains: (a) a social and relational domain and (b) a health and productivity domain. The findings also supported the construct validity for the VLS items, in that both domains were associated significantly (and negatively) with the measures of pain intensity, pain interference, and depression. Discussion: The results provide preliminary support for the reliability and validity of the VLS items for assessing two important domains of successful aging in individuals with long-term health conditions.