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Bagner DM, Berkovits MD, Coxe S, Frech N, Garcia D, Golik A, Heflin BH, Heymann P, Javadi N, Sanchez AL, Wilson MK, Comer JS. Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:231-239. [PMID: 36622653 PMCID: PMC9857733 DOI: 10.1001/jamapediatrics.2022.5204] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/15/2022] [Indexed: 01/10/2023]
Abstract
Importance Early behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD. Objective To evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD. Design, Setting, and Participants A randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories. Interventions Internet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU). Main Outcomes and Measures Observational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups. Results The sample included a total of 150 children (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27). Conclusions and Relevance Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families. Trial Registration ClinicalTrials.gov Identifier: NCT03260816.
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Affiliation(s)
- Daniel M. Bagner
- Department of Psychology, Florida International University, Miami
- Center for Children and Families, Florida International University, Miami
| | | | - Stefany Coxe
- Department of Psychology, Florida International University, Miami
- Center for Children and Families, Florida International University, Miami
| | - Natalie Frech
- Tulsa Schusterman Center, University of Oklahoma, Tulsa
| | - Dainelys Garcia
- Mailman Center for Child Development, University of Miami, Miami, Florida
| | | | - Brynna H. Heflin
- Department of Psychology, Florida International University, Miami
- Center for Children and Families, Florida International University, Miami
| | - Perrine Heymann
- Department of Psychology, Florida International University, Miami
- Center for Children and Families, Florida International University, Miami
| | - Natalie Javadi
- Department of Psychology, Florida International University, Miami
- Center for Children and Families, Florida International University, Miami
| | - Amanda L. Sanchez
- Department of Psychology, George Mason University, Fairfax, Virginia
| | | | - Jonathan S. Comer
- Department of Psychology, Florida International University, Miami
- Center for Children and Families, Florida International University, Miami
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Strydom A, Bosco A, Vickerstaff V, Hunter R, Hassiotis A. Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial. BMC Psychiatry 2020; 20:161. [PMID: 32293383 PMCID: PMC7158144 DOI: 10.1186/s12888-020-02577-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals. METHODS The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n = 11 clusters) or to treatment as usual (TAU; n = 12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months. RESULTS There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = - 2.10, 95% CI: - 11.3 7.13, p = 0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI - 0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080. CONCLUSIONS Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions. TRIAL REGISTRATION ClinicalTrials.gov: NCT01680276.
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Affiliation(s)
- Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK. .,Division of Psychiatry, University College London, London, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Alessandro Bosco
- grid.4563.40000 0004 1936 8868Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Victoria Vickerstaff
- grid.13097.3c0000 0001 2322 6764Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Rachael Hunter
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Angela Hassiotis
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK ,grid.451052.70000 0004 0581 2008Camden & Islington Foundation NHS Trust, London, UK
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Hunter RM, Vickerstaff V, Poppe M, Strydom A, King M, Hall I, Crabtree J, Omar R, Cooper V, Biswas A, Hassiotis A. Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial. BJPsych Open 2020; 6:e15. [PMID: 32019635 PMCID: PMC7176891 DOI: 10.1192/bjo.2020.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs). AIMS We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276). METHOD We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective. RESULTS Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI -0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI -603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold. CONCLUSIONS There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.
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Affiliation(s)
- Rachael Maree Hunter
- Associate Professor, Research Department of Primary Care and Population Health, University College London, UK
| | - Victoria Vickerstaff
- Senior Research Fellow, PRIMENT Clinical Trials Unit, University College London, UK
| | - Michaela Poppe
- Clinical Trial Manager, Division of Psychiatry, University College London, UK
| | - Andre Strydom
- Professor in Intellectual Disabilities, King's College London and South London and the Maudsley NHS Foundation Trust, UK
| | - Michael King
- Professor of Primary Care Psychiatry, Division of Psychiatry, University College London, UK
| | - Ian Hall
- Consultant Psychiatrist and Clinical Lead, Community Learning Disability Service, East London NHS Foundation Trust, UK
| | - Jason Crabtree
- Clinical Psychologist, East London NHS Foundation Trust, UK
| | - Rumana Omar
- Professor of Medical Statistics, Department of Statistical Science, University College London, UK
| | - Vivien Cooper
- Chief Executive, Challenging Behaviour Foundation, UK
| | - Asit Biswas
- Consultant Psychiatrist, Agnes Unit, Leicestershire Partnership NHS Trust & University of Leicester, UK
| | - Angela Hassiotis
- Professor of Psychiatry of Intellectual Disability, Division of Psychiatry, University College London; and Camden and Islington NHS Foundation Trust, UK
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Doble B, Schofield D, Evans CA, Groza T, Mattick JS, Field M, Roscioli T. Impacts of genomics on the health and social costs of intellectual disability. J Med Genet 2020; 57:479-486. [PMID: 31980565 DOI: 10.1136/jmedgenet-2019-106445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/17/2019] [Accepted: 01/03/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study provides an integrated assessment of the economic and social impacts of genomic sequencing for the detection of monogenic disorders resulting in intellectual disability (ID). METHODS Multiple knowledge bases were cross-referenced and analysed to compile a reference list of monogenic disorders associated with ID. Multiple literature searches were used to quantify the health and social costs for the care of people with ID. Health and social expenditures and the current cost of whole-exome sequencing and whole-genome sequencing were quantified in relation to the more common causes of ID and their impact on lifespan. RESULTS On average, individuals with ID incur annual costs in terms of health costs, disability support, lost income and other social costs of US$172 000, accumulating to many millions of dollars over a lifetime. CONCLUSION The diagnosis of monogenic disorders through genomic testing provides the opportunity to improve the diagnosis and management, and to reduce the costs of ID through informed reproductive decisions, reductions in unproductive diagnostic tests and increasingly targeted therapies.
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Affiliation(s)
- Brett Doble
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia .,Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Deborah Schofield
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,GenImpact, School of Economics, Faculty of Business and Economics, Macquarie University, Sydney, New South Wales, Australia
| | - Carey-Anne Evans
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Tudor Groza
- Pryzm Health, Gold Coast, Queensland, Australia
| | - John S Mattick
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mike Field
- The Genetics of Learning Disability Service, Waratah, New South Wales, Australia
| | - Tony Roscioli
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.,NSW Health Pathology East Laboratory, Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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Rojas-Garcia A, Woodhead C, Imwensi E, Hassiotis A, Aspinal F. Managing demand for social care among adults with intellectual disabilities: A systematic scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:111-125. [PMID: 31390116 DOI: 10.1111/jar.12652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Demand for formal social services support for adults with intellectual disabilities is increasing internationally. Initiatives which empower individuals with intellectual disabilities to improve their health, develop living skills or manage chronic illnesses may promote independence and reduce unnecessary dependency on social services. METHODS A "preventative framework" to managing demand comprising several domains was developed from existing literature to guide the search strategy. RESULTS Fourteen papers related to three domains in the predetermined preventative framework were selected for inclusion in the review, including twelve economic studies. Outcomes included measurement of care needs, and cost-comparison between social care models or cost-effectiveness of interventions. Due to the heterogeneity, the present authors were not able to quantitatively synthesize findings. CONCLUSIONS The present authors conclude that evidence linking initiatives across sectors to demand for adult social care is lacking. The present authors identify several gaps in the literature and make recommendations for future research and data recording in practice.
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Affiliation(s)
- Antonio Rojas-Garcia
- Department of Applied Health Research, NIHR CLAHRC North Thames, University College London, London, UK
| | - Charlotte Woodhead
- Department of Applied Health Research, NIHR CLAHRC North Thames, University College London, London, UK
| | - Elsie Imwensi
- Adult Social Services, Redbridge Council, London, UK
| | - Angela Hassiotis
- Centre for Intellectual & Developmental Disabilities Research, University College London, London, UK
| | - Fiona Aspinal
- Department of Applied Health Research, NIHR CLAHRC North Thames, University College London, London, UK
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Bauer A, Taggart L, Rasmussen J, Hatton C, Owen L, Knapp M. Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks. BMC Public Health 2019; 19:706. [PMID: 31174506 PMCID: PMC6556058 DOI: 10.1186/s12889-019-6912-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK.
| | - Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, N Ireland, Newtownabbey, BT37 0QB, UK
| | - Jill Rasmussen
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, England, NW1 2FB, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Lancaster University, Lancaster, England, LA1 4YG, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, England, SW1A 2BU, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK
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Hassiotis A, Poppe M, Strydom A, Vickerstaff V, Hall I, Crabtree J, Omar R, King M, Hunter R, Bosco A, Biswas A, Ratti V, Blickwedel J, Cooper V, Howie W, Crawford M. Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT. Health Technol Assess 2019; 22:1-110. [PMID: 29596045 DOI: 10.3310/hta22150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). OBJECTIVE To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). DESIGN A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. SETTING Community ID services in England. PARTICIPANTS Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-CT)]. INTERVENTIONS Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. MAIN OUTCOME MEASURES Carer-reported changes in challenging behaviour as measured by the ABC-CT over 12 months. Secondary outcomes included psychopathology, community participation, family and paid carer burden, family carer psychopathology, costs of care and quality-adjusted life-years (QALYs). Data on main outcome, service use and health-related quality of life were collected for the 36-month follow-up. RESULTS A total of 246 participants were recruited from 23 teams, of whom 109 were in the intervention arm (11 teams) and 137 were in the control arm (12 teams). The difference in ABC-CT between the intervention and control arms [mean difference -2.14, 95% confidence interval (CI) -8.79 to 4.51; p = 0.528] was not statistically significant. No treatment effects were found for any of the secondary outcomes. The mean cost per participant in the intervention arm was £1201. Over 12 months, there was a difference in QALYs of 0.076 in favour of the intervention (95% CI 0.011 to 0.140 QALYs) and a 60% chance that the intervention is cost-effective compared with TAU from a health and social care cost perspective at the threshold of £20,000 per QALY gained. Twenty-nine participants experienced 45 serious adverse events (intervention arm, n = 19; control arm, n = 26). PBS plans were available for 33 participants. An independent assessment of the quality of these plans found that all were less than optimal. Forty-six qualitative interviews were conducted with service users, family carers, paid carers and service managers as part of the process evaluation. Service users reported that they had learned to manage difficult situations and had gained new skills, and carers reported a positive relationship with therapists. At 36 months' follow-up (n = 184), the mean ABC-CT difference between arms was not significant (-3.70, 95% CI -9.25 to 1.85; p = 0.191). The initial cost-effectiveness of the intervention dissipated over time. LIMITATIONS The main limitations were low treatment fidelity and reach of the intervention. CONCLUSIONS Findings from the main study and the naturalistic follow-up suggest that staff training in PBS as delivered in this study is insufficient to achieve significant clinical gains beyond TAU in community ID services. Although there is an indication that training in PBS is potentially cost-effective, this is not maintained in the longer term. There is increased scope to develop new approaches to challenging behaviour as well as optimising the delivery of PBS in routine clinical practice. TRIAL REGISTRATION This study is registered as NCT01680276. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Michaela Poppe
- Division of Psychiatry, University College London, London, UK
| | - Andre Strydom
- Division of Psychiatry, University College London, London, UK
| | | | - Ian Hall
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Jason Crabtree
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- University College London PRIMENT Clinical Trials Unit, London, UK
| | - Alessandro Bosco
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Asit Biswas
- Leicestershire Partnership NHS Trust, Directorate of Learning Disabilities, Frith Hospital, Leicester, UK
| | - Victoria Ratti
- Division of Psychiatry, University College London, London, UK
| | | | | | - William Howie
- South West London and St George's Mental Health Trust, Wandsworth Community Mental Health Learning Disabilities Team, Springfield University Hospital, London, UK
| | - Mike Crawford
- Centre for Mental Health, Department of Medicine, Imperial College London, London, UK
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House A, Bryant L, Russell AM, Wright-Hughes A, Graham L, Walwyn R, Wright JM, Hulme C, O'Dwyer JL, Latchford G, Meer S, Birtwistle JC, Stansfield A, Ajjan R, Farrin A. Managing with Learning Disability and Diabetes: OK-Diabetes - a case-finding study and feasibility randomised controlled trial. Health Technol Assess 2019; 22:1-328. [PMID: 29845932 DOI: 10.3310/hta22260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obesity and type 2 diabetes are common in adults with a learning disability. It is not known if the principles of self-management can be applied in this population. OBJECTIVES To develop and evaluate a case-finding method and undertake an observational study of adults with a learning disability and type 2 diabetes, to develop a standardised supported self-management (SSM) intervention and measure of adherence and to undertake a feasibility randomised controlled trial (RCT) of SSM versus treatment as usual (TAU). DESIGN Observational study and an individually randomised feasibility RCT. SETTING Three cities in West Yorkshire, UK. PARTICIPANTS In the observational study: adults aged > 18 years with a mild or moderate learning disability, who have type 2 diabetes that is not being treated with insulin and who are living in the community. Participants had mental capacity to consent to research and to the intervention. In the RCT participants had glycated haemoglobin (HbA1c) levels of > 6.5% (48 mmol/mol), a body mass index (BMI) of > 25 kg/m2 or self-reported physical activity below national guideline levels. INTERVENTIONS Standardised SSM. TAU supported by an easy-read booklet. MAIN OUTCOME MEASURES (1) The number of eligible participants identified and sources of referral; (2) current living and support arrangements; (3) current health state, including level of HbA1c, BMI and waist circumference, blood pressure and lipids; (4) mood, preferences for change; (5) recruitment and retention in RCT; (6) implementation and adherence to the intervention; (7) completeness of data collection and values for candidate primary outcomes; and (8) qualitative data on participant experience of the research process and intervention. RESULTS In the observational study we identified 147 eligible consenting participants. The mean age was 54.4 years. In total, 130 out of 147 (88%) named a key supporter, with 113 supporters (77%) being involved in diabetes management. The mean HbA1c level was 54.5 mmol/mol [standard deviation (SD) 14.8 mmol/mol; 7.1%, SD 1.4%]. The BMI of 65% of participants was > 30 kg/m2 and of 21% was > 40 kg/m2. Many participants reported low mood, dissatisfaction with lifestyle and diabetes management and an interest in change. Non-response rates were high (45/147, 31%) for medical data requested from the primary care team. In the RCT, 82 participants were randomised. The mean baseline HbA1c level was 56 mmol/mol (SD 16.5 mmol/mol; 7.3%, SD 1.5%) and the mean BMI was 34 kg/m2 (SD 7.6 kg/m2). All SSM sessions were completed by 35 out of 41 participants. The adherence measure was obtained in 37 out of 41 participants. The follow-up HbA1c level and BMI was obtained for 75 out of 82 (91%) and 77 out of 82 (94%) participants, respectively. Most participants reported a positive experience of the intervention. A low response rate and difficulty understanding the EuroQol-5 Dimensions were challenges in obtaining data for an economic analysis. LIMITATIONS We recruited from only 60% of eligible general practices, and 90% of participants were on a general practice learning disability register, which meant that we did not recruit many participants from the wider population with milder learning disability. CONCLUSIONS A definitive RCT is feasible and would need to recruit 194 participants per arm. The main barrier is the resource-intensive nature of recruitment. Future research is needed into the effectiveness of obesity treatments in this population, particularly estimating the longer-term outcomes that are important for health benefit. Research is also needed into improving ways of assessing quality of life in adults with a learning disability. TRIAL REGISTRATION Current Controlled Trials ISRCTN41897033. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 26. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise Bryant
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amy M Russell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Liz Graham
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John L O'Dwyer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Ramzi Ajjan
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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Lunsky Y, De Oliveira C, Wilton A, Wodchis W. High health care costs among adults with intellectual and developmental disabilities: a population-based study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:124-137. [PMID: 30381849 DOI: 10.1111/jir.12554] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 08/27/2018] [Accepted: 09/12/2018] [Indexed: 05/08/2023]
Abstract
OBJECTIVE While it is generally accepted that adults with intellectual and developmental disabilities (IDDs) use health services to a greater extent than the general population, there is remarkably little research that focuses on the costs associated with their health care. Using population-based data from adults with IDD in Ontario, this study aimed to estimate overall health care costs, classify individuals into high and non-high cost categories and describe differences in the demographics, clinical profiles and health care use patterns between these groups. DESIGN A retrospective cohort study based in Ontario, Canada, was conducted with the use of linked administrative health data. METHODS A costing algorithm developed for the general population in Ontario was applied to estimate health care costs of adults with IDD under age 65 for 2009 and 2010. Individuals were categorised into two groups according to whether their total annual health care costs were among the highest decile in the general population. These groups were compared on demographic and clinical variables, and relative mean costs for six types of health care services in the two groups were computed. In addition, we computed the proportion of individuals who remained in the high cost group over 2 years. RESULTS Among adults with IDD, 36% had annual health care expenditures greater than $2610 CAD (top decile of all Ontario adults under 65). These individuals were more likely to be female, to be in the oldest age groups, to live in group homes and to be receiving disability income support than individuals whose expenditures were below the high cost threshold. In addition, they had higher rates of all the physical and mental health conditions studied. Greatest health care expenses were due to hospitalisations, especially psychiatric hospitalisations, continuing care/rehabilitation costs and medication costs. The majority of individuals whose health care costs placed them in the high cost category in 2009 remained in that category a year later. DISCUSSION Adults with IDD are nearly 4 times as likely to incur high annual health care costs than those without IDD. Individuals with IDD and high health care costs have unique health and demographic profiles compared with adults with IDD whose annual health care costs are below the high cost threshold. Attending to their health care needs earlier in their health care trajectory may be an opportunity to improve health and reduce overall health care costs. It is important that we explore how to best meet their needs. Models proposed to meet the needs of adults with high health care costs in the general population may not apply to this unique group.
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Affiliation(s)
- Y Lunsky
- Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C De Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - W Wodchis
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Folch-Mas A, Cortés-Ruiz MJ, Salvador-Carulla L, Kazah-Soneyra N, Irazábal-Giménez M, Muñoz-Lorente S, Tamarit-Cuadrado J, Martínez-Leal R. [New considerations on the health of the persons with intellectual developmental disorders]. SALUD PUBLICA DE MEXICO 2018; 59:454-461. [PMID: 29211267 DOI: 10.21149/8201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/12/2017] [Indexed: 11/06/2022] Open
Abstract
Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon countries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue.
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Affiliation(s)
- Anabel Folch-Mas
- Unidad de Investigación en Discapacidad Intelectual y Trastornos del Desarrollo, Fundació Villablanca, URU, IISPV. Reus, Spain
| | - María José Cortés-Ruiz
- Unidad de Investigación en Discapacidad Intelectual y Trastornos del Desarrollo, Fundació Villablanca, URU, IISPV. Reus, Spain.,Centre of Biomedical Research Network on Mental Health, CIBERSAM. Spain
| | | | - Natalia Kazah-Soneyra
- Parc Sanitari Sant Joan de Dèu. Barcelona, Spain.,Centre of Biomedical Research Network on Mental Health, CIBERSAM. Spain
| | - Marcia Irazábal-Giménez
- Parc Sanitari Sant Joan de Dèu. Barcelona, Spain.,Centre of Biomedical Research Network on Mental Health, CIBERSAM. Spain
| | | | | | - Rafael Martínez-Leal
- Unidad de Investigación en Discapacidad Intelectual y Trastornos del Desarrollo, Fundació Villablanca, URU, IISPV. Reus, Spain.,Centre of Biomedical Research Network on Mental Health, CIBERSAM. Spain
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11
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O'Dwyer JL, Russell AM, Bryant LD, Walwyn REA, Wright-Hughes AM, Graham EH, Wright JM, Meer S, Birtwistle J, Farrin AJ, House AO, Hulme CT. Developing and feasibility testing of data collection methods for an economic evaluation of a supported selfmanagement programme for adults with a learning disability and type 2 diabetes. Pilot Feasibility Stud 2018; 4:80. [PMID: 29713494 PMCID: PMC5911950 DOI: 10.1186/s40814-018-0266-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background The challenges of conducting research with hard to reach vulnerable groups are particularly pertinent for people with learning disabilities. Data collection methods for previous cost and cost-effectiveness analyses of health and social care interventions targeting people with learning disabilities have relied on health care/health insurance records or data collection forms completed by the service provider rather than by people with learning disabilities themselves. This paper reports on the development and testing of data collection methods for an economic evaluation within a randomised controlled trial (RCT) for a supported self-management programme for people with mild/moderate learning disabilities and type 2 diabetes. Methods A case finding study was conducted to identify types of health and social care use and data collection methods employed in previous studies with this population. Based on this evidence, resource use questionnaires for completion by GP staff and interviewer-administered participant questionnaires (covering a wider cost perspective and health-related quality of life) were tested within a feasibility RCT. Interviewer-administered questionnaires included the EQ-5D-3L (the NICE recommended measure for use in economic evaluation). Participants were adults > 18 years with a mild or moderate learning disability and type 2 diabetes, with mental capacity to give consent to research participation. Results Data collection for questionnaires completed by GP staff requesting data for the last 12 months proved time intensive and difficult. Whilst 82.3% (121/147) of questionnaires were returned, up to 17% of service use items were recorded as unknown. Subsequently, a shorter recall period (4 months) led to a higher return rate but with a higher rate of missing data. Missing data for interviewer-administered participant questionnaires was > 8% but the interviewers reported difficulty with participant recall. Almost 60% (48/80) of participants had difficulty completing the EQ-5D-3L. Conclusions Further investigation as to how service use can be recorded is recommended. Concerns about the reliability of identifying service use data directly from participants with a learning disability due to challenges in completion, specifically around recall, remain. The degree of difficulty to complete EQ-5D-3L indicates concerns regarding the appropriateness of using this measure in its current form in research with this population. Trial registration Current Controlled Trials ISRCTN41897033 (registered 21 January 2013).
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Affiliation(s)
- John L O'Dwyer
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amy M Russell
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Louise D Bryant
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Rebecca E A Walwyn
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Alexandra M Wright-Hughes
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Elizabeth H Graham
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Judy M Wright
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Shaista Meer
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Jacqueline Birtwistle
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amanda J Farrin
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Allan O House
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Claire T Hulme
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
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12
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Martin L, Ouellette-Kuntz H, McKenzie K. Use of home care services among adults with intellectual and developmental disabilities: does where you live matter? ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23297018.2018.1443023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences, Queen's University, and Epidemiologist, Kingston, Ontario, Canada
| | - Katherine McKenzie
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
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13
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Mulhall P, Taggart L, Coates V, McAloon T, Hassiotis A. A systematic review of the methodological and practical challenges of undertaking randomised-controlled trials with cognitive disability populations. Soc Sci Med 2018; 200:114-128. [PMID: 29421458 DOI: 10.1016/j.socscimed.2018.01.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
Approximately 10% of the world's population have a cognitive disability. Cognitive disabilities can have a profound impact on a person's social, cognitive or mental functioning, requiring high levels of costly health and social support. Therefore, it is imperative that interventions and services received are based upon a sound evidence-base. For many interventions for this population, this evidence-base does not yet exist and there is a need for more Randomised Controlled Trials (RCTs). The process of conducting RCTs with disabled populations is fraught with methodological challenges. We need a better understanding of these methodological barriers if the evidence-bases are to be developed. The purpose of this study was to explore the methodological and practical barriers to conducting trials with adults with cognitive disabilities. As a case example, the literature regarding RCTs for people with intellectual disabilities (ID) was used to highlight these pertinent issues. A systematic literature review was conducted of RCTs with adults with ID, published from 2000 to 2017. A total of 53 papers met the inclusion criteria and were reviewed. Some of the barriers reported were specific to the RCT methodology and others specific to people with disabilities. Notable barriers included; difficulties recruiting; obtaining consent; resistance to the use of control groups; engaging with carers, staff and stakeholders; the need to adapt interventions and resources to be disability-accessible; and staff turnover. Conducting RCTs with people with cognitive disabilities can be challenging, however with reasonable adjustments, many of these barriers can be overcome. Researchers are not maximising the sharing of their experience-base. As a result, the development of evidence-bases remains slow and the health inequities of people with disabilities will continue to grow. The importance of the MRC guidelines on process evaluations, together with implications for the dissemination of 'evidence-base' and 'experience-base' are discussed.
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Affiliation(s)
- Peter Mulhall
- School of Nursing, Ulster University, Shore Rd, Newtownabbey, BT37 0QB, Northern Ireland, United Kingdom.
| | - Laurence Taggart
- School of Nursing, Ulster University, Shore Rd, Newtownabbey, BT37 0QB, Northern Ireland, United Kingdom
| | - Vivien Coates
- School of Nursing, Ulster University, Shore Rd, Newtownabbey, BT37 0QB, Northern Ireland, United Kingdom
| | - Toni McAloon
- School of Nursing, Ulster University, Shore Rd, Newtownabbey, BT37 0QB, Northern Ireland, United Kingdom
| | - Angela Hassiotis
- University College London, Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
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14
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He P, Chen G, Wang Z, Guo C, Li N, Yun C, Zheng X. Adults with intellectual disabilities in China: comorbid psychiatric disorder and its association with health service utilisation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:106-114. [PMID: 29178565 DOI: 10.1111/jir.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 10/09/2017] [Accepted: 10/22/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) often have multiple comorbidities. Psychiatric disorders in this population have been poorly studied in developing countries. We aimed to investigate the prevalence of psychiatric disorders in adults with ID and whether comorbid psychiatric disorders were associated with health service utilisation. METHODS We obtained data from the Second National Sample Survey on Disability, conducted in 31 provinces of China and selected a subsample of 13 631 adults aged 18 years and above with ID. ID were defined by intelligence quotient score under 70, deficits in two or more adaptive behaviours and age of onset under 18 years. Psychiatric disorders were identified according to the International Statistical Classification of Diseases, Tenth Revision. Logistic regressions were used for data analyses. RESULTS The prevalence of psychiatric disorders in adults with ID was 16.7%. The most prevalent type of psychiatric disorder was dementia. Older adults, females, being minorities, urban residents, being literate, low-income groups and having severe ID, were associated with elevated risk of psychiatric disorder among adults with ID. Compared with individuals without psychiatric disorders, those with comorbid psychiatric disorders were more likely to use medical service and less likely to use rehabilitation service. CONCLUSIONS The prevalence of psychiatric disorder in adults with ID was strikingly higher than that in the general population. Health service utilisation among Chinese adults with ID remained a big challenge. There is a possibility of diagnostic overshadowing by local clinicians, which may have resulted in overdiagnosis of dementia and underdiagnosis of common mental disorders. This study informs further investigations regarding common mental disorders among people with ID and has implications for public health strategies and health policies to meet health service need for this population.
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Affiliation(s)
- P He
- Institute of Population Research, Peking University, Beijing, China
| | - G Chen
- Institute of Population Research, Peking University, Beijing, China
| | - Z Wang
- Institute of Population Research, Peking University, Beijing, China
| | - C Guo
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
| | - N Li
- Institute of Population Research, Peking University, Beijing, China
| | - C Yun
- Institute of Population Research, Peking University, Beijing, China
| | - X Zheng
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
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15
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Torres-Unda J, Polo V, Dunabeitia I, Bidaurrazaga-Letona I, García-Gil M, Rodriguez-Larrad A, Irazusta J. The Feldenkrais Method improves functioning and body balance in people with intellectual disability in supported employment: A randomized clinical trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 70:104-112. [PMID: 28923375 DOI: 10.1016/j.ridd.2017.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/26/2017] [Accepted: 08/26/2017] [Indexed: 06/07/2023]
Abstract
Loss of functioning and age-related health problems tend to appear earlier in individuals with intellectual disability (ID) than in their non-disabled peers. The Feldenkrais method (FM) is a movement-based form of learning that enhances body balance and physical functioning. We carried out an intervention based on Awareness Through Movement, a form of the FM. Thirty-two middle-aged (48.94±6.01years old) adults with ID who were in supported employment were recruited and randomly assigned to the experimental group (EG) or control group (CG). The EG received 30 Awareness Through Movement classes while the CG did not receive any movement-based intervention. Physical functioning (body balance, gait speed and chair stands) was assessed with the Short Physical Performance Battery (SPPB) and balance by stabilometry. After 30 FM classes, individuals in the EG had significantly improved their chair stand test score (p<0.005) and SPPB total score (p<0.005), and reduced their sway area (p<0.05) in the stabilometric test. These results indicate that the FM could be a good tool for the prevention of loss of functioning and body balance in middle-aged individuals with ID.
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Affiliation(s)
- Jon Torres-Unda
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Spain.
| | - Vanesa Polo
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Spain
| | - Iratxe Dunabeitia
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Spain
| | - Iraia Bidaurrazaga-Letona
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Spain
| | - María García-Gil
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Spain
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16
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Martin L, Ouellette-Kuntz H, McKenzie K. Care in the Community: Home Care Use Among Adults With Intellectual and Developmental Disabilities Over Time. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2017. [DOI: 10.1111/jppi.12171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lynn Martin
- Lakehead University, Thunder Bay, Ontario, Canada
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17
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Folch-Mas A, Cortés-Ruiz MJ, Vicens-Calderón P, Martínez-Leal R. Health profiles in people with intellectual developmental disorders. ACTA ACUST UNITED AC 2017; 59:400-407. [DOI: 10.21149/8199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/12/2017] [Indexed: 12/16/2022]
Abstract
Objective. To better understand the health profiles of people with intellectual disability (ID), focusing on the variables that are associated with a poorer health status. Materials and methods. Data were collected from the Survey on Disability, Personal Autonomy and Dependency (EDAD 2008) of the Spanish National Statistics Institute (INE). The health data of 2 840 subjects with IDD were analyzed in order to verify the impact of different variables on their health profiles. Results. People with severe and profound levels of IDD presented a higher number of medical diagnoses.At residence centers there was a larger proportion of individuals with a higher prevalence of chronic diseases and more severe conditions; age also was an important factor. Conclusion. The health profiles of individuals with IDD differ depending on the severity level of their IDD and their degree of institutionalization. Further research is needed to provide better health care for people with IDD.
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Watchman K, Janicki MP, Splaine M, Larsen FK, Gomiero T, Lucchino R. International Summit Consensus Statement: Intellectual Disability Inclusion in National Dementia Plans. Am J Alzheimers Dis Other Demen 2017; 32:230-237. [PMID: 28417674 PMCID: PMC10852755 DOI: 10.1177/1533317517704082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The World Health Organization (WHO) has called for the development and adoption of national plans or strategies to guide public policy and set goals for services, supports, and research related to dementia. It called for distinct populations to be included within national plans, including adults with intellectual disability (ID). Inclusion of this group is important as having Down's syndrome is a significant risk factor for early-onset dementia. Adults with other ID may have specific needs for dementia-related care that, if unmet, can lead to diminished quality of old age. An International Summit on Intellectual Disability and Dementia, held in Scotland, reviewed the inclusion of ID in national plans and recommended that inclusion goes beyond just description and relevance of ID. Reviews of national plans and reports on dementia show minimal consideration of ID and the challenges that carers face. The Summit recommended that persons with ID, as well as family carers, should be included in consultation processes, and greater advocacy is required from national organizations on behalf of families, with need for an infrastructure in health and social care that supports quality care for dementia.
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Affiliation(s)
- Karen Watchman
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - Matthew P. Janicki
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Frode K. Larsen
- Norwegian National Advisory Unit on Ageing and Health, Oslo, Norway
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Axmon A, Karlsson B, Ahlström G. Health care utilisation among older persons with intellectual disability and dementia: a registry study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:1165-1177. [PMID: 27730719 DOI: 10.1111/jir.12338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/18/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Both persons with intellectual disability (ID) and persons with dementia have high disease burdens, and consequently also high health care needs. As life expectancy increases for persons with ID, the group of persons with the dual diagnosis of ID and dementia will become larger. METHOD Through national registries, we identified 7936 persons who had received support directed to persons with ID during 2012, and an age- and gender-matched sample from the general population. A national registry was also used to collect information on health care utilisation (excluding primary care) for the period 2002-2012. Health care utilisation was measured as presence and number of planned and unplanned in-patient and out-patient visits, as well as length of stay. RESULTS In comparison with persons with ID but without dementia, persons with ID and dementia were more likely to have at least one planned out-patient visit (odds ratio [OR] 8.07), unplanned out-patient visit (OR 2.41), planned in-patient visit (OR 2.76) or unplanned in-patient visit (OR 4.19). However, among those with at least one of each respective outcome, the average number of visits did not differ between those with and without dementia. Persons with ID and dementia were less likely to have at least one planned out-patient visit than persons with dementia in the general population sample (OR 0.40), but more likely to have at least one unplanned in-patient visit (OR 1.90). No statistically significant differences were found for having at least one unplanned out-patient or planned in-patient visit. Nevertheless, among those with at least one unplanned out-patient visit, the number of visits was higher in the general population sample. CONCLUSIONS Persons with ID and dementia are less likely to receive planned health care than persons with dementia in the general population. They have, however, higher levels of unplanned health care utilisation. This may be an indication that the current support system is not sufficient to meet the challenges of increased longevity among persons with ID.
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Affiliation(s)
- A Axmon
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - B Karlsson
- Healthcare and medical services, County Council, Uppsala, Sweden
| | - G Ahlström
- Department of Health Sciences, Lund University, Lund, Sweden
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20
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Axmon A, Björne P, Nylander L, Ahlström G. Psychiatric care utilization among older people with intellectual disability in comparison with the general population: a register study. BMC Psychiatry 2016; 16:389. [PMID: 27829383 PMCID: PMC5103447 DOI: 10.1186/s12888-016-1094-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with intellectual disability have been found to have higher prevalence of psychiatric disorders than the general population. However, they do not seem to have a corresponding increase in psychiatric care utilization. The aim of the present study was to investigate psychiatric care utilization among older people with intellectual disability. METHODS We used a cohort of people with intellectual disability, 55+ years in 2012 (n = 7936), and an equally sized age and sex matched reference cohort from the general population. Psychiatric care utilization was measured using registrations in the Swedish National Patient register during 2002-2012, where each registration corresponds to a psychiatric care occasion. RESULTS About 20 % of those with intellectual disability had at least one registration during the study period, compared to some 6 % in the general population sample. In the whole cohort as well as stratified by sex, people with intellectual disability were 3-4 times more likely than those in the general population sample to have had at least one registration during the study period. The effect was, however, only consistent in age groups comprising people younger than 65 years. Among people with intellectual disability, men were more likely than women to have had at least one registration, and people living in special housing (group home or service home) during the entire study period were less likely than those who only lived in special housing for parts of the study or not at all. People with intellectual disability had longer stays per inpatient registration compared with the general population sample. When stratifying on sex, the effect was found only among men, although there were no sex differences within the cohort of people with intellectual disability. Among people with intellectual disability, living in special housing during the entire study period was associated with shorter stays per inpatient registration. CONCLUSIONS Although people with intellectual disability had higher psychiatric care utilization than the general population during the 11 year study period, it does not correspond to the high prevalence of psychiatric disorders in this population. Future research is required to establish if the level of care utilization is appropriate among older people with intellectual disability.
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Affiliation(s)
- A. Axmon
- Department of Occupational and Environmental Medicine, Lund University, SE-221 00 Lund, Sweden
| | - P. Björne
- Research and Development Unit, City Office, City of Malmö, SE-205 80 Malmö, Sweden
| | - L. Nylander
- Department of Clinical Sciences/Psychiatry, Lund University, SE-221 00 Lund, Sweden ,Gillberg Neuropsychiatry Centre, University of Gothenburg, SE-411 19 Göteborg, Sweden
| | - G. Ahlström
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
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Unwin G, Deb S, Deb T. An Exploration of Costs of Community-Based Specialist Health Service Provision for the Management of Aggressive Behaviour in Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:316-325. [PMID: 26970410 DOI: 10.1111/jar.12241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the UK, people with intellectual disabilities who exhibit aggressive behaviour often receive community-based specialist health services from a community learning disability team (CLDT). Our aim was to estimate costs associated with this provision and to identify predictors of higher costs. METHOD Costs were estimated for 60 adults with intellectual disabilities and aggressive behaviour who attended specialist psychiatric outpatient clinics in the West Midlands region of the UK, including contact time with members of the CLDT and use of psychotropic medication over a 12-month period. RESULTS Mean total cost of 12-month service provision was £418 (95% confidence interval [CI] £299-557). Mean total cost of 12-month psychotropic medication was £369 (95% CI £256-492). Amongst individual members of the CLDT, mean costs were highest for psychiatrists (£181) and relatively lower for community nurses (£70) and clinical psychologists (£30), and lowest for physiotherapists (£13). Male sex, presence of expressive verbal communication and presence of epilepsy were independently associated with 12-month medication and service use costs, accounting for 23% of the variance in cost. CONCLUSIONS It seems that in terms of costs, there is an overreliance on medication and psychiatrists and a relatively lesser reliance on other CLDT members such as community nurses and clinical psychologists for the management of aggressive behaviour in adults with intellectual disabilities within community settings. Health commissioners may wish to explore this relative cost discrepancy further and try to redress the balance where appropriate.
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Affiliation(s)
- Gemma Unwin
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Shoumitro Deb
- Division of Brain Sciences, Department of Medicine, Centre for Mental Health, Imperial College London, London, UK
| | - Tanya Deb
- Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Felce D, Cohen D, Willner P, Rose J, Kroese B, Rose N, Shead J, Jahoda A, MacMahon P, Lammie C, Stimpson A, Woodgate C, Gillespie D, Townson J, Nuttall J, Hood K. Cognitive behavioural anger management intervention for people with intellectual disabilities: costs of intervention and impact on health and social care resource use. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:68-81. [PMID: 24404992 DOI: 10.1111/jir.12112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Anger and aggression among adults with intellectual disability (ID) are associated with a range of adverse consequences for their well-being and that of their family or staff carers. The aims were to evaluate the effectiveness of an anger management intervention for adults with mild to moderate ID and to evaluate the costs of the intervention and its impact on health and social care resource use. This paper is concerned with the latter aim. METHODS A cluster-randomised controlled trial was conducted involving day services for adults with ID in Scotland, England and Wales. Incremental costs of delivering the intervention and its impact on subsequent total health and social care package costs were calculated. Full data comparing costs between baseline and follow-up 10 months later were collected for 67 participants in the intervention arm and 62 participants in the control arm. Cost differences between the groups at follow-up, adjusted for baseline levels, were calculated using non-parametric bootstrapping controlling for clustering. RESULTS The mean hourly excess cost of intervention over treatment as usual was £12.34. A mean adjusted cost difference of £22.46 per person per week in favour of the intervention group was found but this was not statistically significant. CONCLUSIONS The baseline-adjusted cost difference at follow-up would result in a fairly immediate compensation for the excess costs of intervention, provided the difference is not a statistical artefact. Further research is needed to clarify the extent to which it might represent a real saving in service support costs.
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Affiliation(s)
- D Felce
- Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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Ricceri L, Catania MV, Bardoni B. Editorial: neural and behavioral biology of intellectual disability (ID). Neurosci Biobehav Rev 2014; 46 Pt 2:159-60. [PMID: 25443630 DOI: 10.1016/j.neubiorev.2014.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Riewpaiboon A, Van Minh H, Huong NT, Dung P, Wright EP. Burden of care for persons with disabilities in Vietnam. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:660-671. [PMID: 25257047 DOI: 10.1111/hsc.12147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 06/03/2023]
Abstract
Vietnam has more than 6 million persons with disabilities (PWD), or 7.8% of the population. To provide better services for them, it is important to investigate the care they currently receive, and to obtain evidence on the health outcomes from that care. This study aimed to estimate the quality of life and functional status of a group of PWD in Vietnam and the cost of care they receive. This was an analytical study exploring the time and cost of informal care, the cost of illness (prevalence-based, patient perspective), quality of life using EuroQoL and functional status using the Barthel Index. The sample was selected from urban and rural areas of Quang Tri province in Central Vietnam, using systematic random sampling. Data were collected by face-to-face interviews, and in a 1-month diary recorded during July-August 2010 for summer and in December 2010 for winter. The costs are presented in 2010 USD values. The data were analysed by descriptive, univariate and multivariate statistics to summarise and explore the relationships among dependent and independent variables. The study sample included 210 PWD, with an average age of 38 years and duration of disability on average 26 years. The health-related quality of life measured in terms of the health utility score (0 = death, 1 = full health) was on average 0.44 and 0.39 in summer and winter respectively. The total cost of illness per year per case was USD 971 (83% of gross domestic product per capita); explanatory variables were the age of the PWD, receiving community-based rehabilitation, receiving government support and the severity of the disability. This illustrates the importance of services and support for reduction of the economic burden on the family. In conclusion, the results of this study provide information on the burden caused by disabilities in rural and urban households in Vietnam.
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Affiliation(s)
- Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
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Clinical and cost effectiveness of staff training in Positive Behaviour Support (PBS) for treating challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial. BMC Psychiatry 2014; 14:219. [PMID: 25927187 PMCID: PMC4149205 DOI: 10.1186/s12888-014-0219-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/22/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services. METHOD The study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS. DISCUSSION The study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour. TRIAL REGISTRATION This trial is registered with Clinical Trials.gov (Ref NCT01680276 ). Clinical Trials Unit: PRIMENT https://www.ucl.ac.uk/priment/ .
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Stén KD, Soares JJF, Viitasara E, Stankūnas M, Sundin Ö, Melchiorre MG, Macassa G, Barros H, Lindert J, Torres-Gonzalez F, Ioannidi-Kapolou E. The relationship between abuse, psychosocial factors, and pain complaints among older persons in Europe. MEDICINA-LITHUANIA 2014; 50:61-74. [PMID: 25060206 DOI: 10.1016/j.medici.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/02/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Abuse and pain complaints are common among older persons. However, little is known about relationships between abuse (e.g. psychological) and pain complaints (e.g. backache) among older persons while considering other factors (e.g. depression). Therefore, the aim of this study was to determine these relationships. MATERIALS AND METHODS The design was cross-sectional. A total of 4467 women and men aged 60-84 years from Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden answered questionnaires regarding various areas such as abuse, mental health (e.g. anxiety) and pain complaints (e.g. backache). The data were examined with bivariate (analyses of variance) and multivariate methods (linear regressions). RESULTS The bivariate analyses showed that psychological abuse was connected with all pain complaints; physical with headache and head pressure; sexual with neck or shoulder pain and headache; injury with all complaints (except pain in joints or limbs); financial with pain in joints or limbs and head pressure; and overall abuse (one or more types) with all complaints (except headache). The regressions showed that psychological abuse increased the likelihood of being affected by head pressure and heaviness or tiredness in the legs; physical abuse of being affected by headache and head pressure; financial abuse of being affected by head pressure; and overall abuse of being affected by headache and head pressure. In general, respondents from Sweden and younger (60-64 years) were less affected by the complaints than those from other countries (e.g. Germany) and older (e.g. 70-74 years), respectively. Respondents on medication (e.g. pain killers) were less affected by all pain complaints and those with high social support by pain in joints or limbs. High scores on anxiety and depression and having many diseases increased the likelihood of being affect by all pain complaints. CONCLUSIONS Abuse was related with certain pain complaints (e.g. headache), but other factors and in particular mental health and physical diseases impacted on all pain complaints. Medication and partly social support had a positive effect on the pain experience, i.e. the complaints interfered less with for instance the daily-life of the respondents.
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Affiliation(s)
- Kersti Danell Stén
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Joaquim J F Soares
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
| | - Eija Viitasara
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Mindaugas Stankūnas
- Department of Health Management, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Maria Gabriella Melchiorre
- Scientific Technological Area, Socio Economic Research Centre, Italian National Institute of Health and Science on Aging, I.N.R.C.A., Ancona, Italy
| | - Gloria Macassa
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Henrique Barros
- Department of Hygiene and Epidemiology, University of Porto, Medical School, Porto, Portugal
| | - Jutta Lindert
- Department of Public Health Science, Protestant University of Applied Sciences, Ludwigsburg, Germany
| | - Francisco Torres-Gonzalez
- Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain
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Wu CS, Desarkar P, Palucka A, Lunsky Y, Liu SK. Acute inpatient treatment, hospitalization course and direct costs in bipolar patients with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4062-4072. [PMID: 24051362 DOI: 10.1016/j.ridd.2013.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/20/2013] [Indexed: 06/02/2023]
Abstract
To explore the impacts of intellectual disability (ID) on psychotropic medication use, length of hospital stay (LOS) and direct hospitalization costs during inpatient treatment for acute bipolar episodes, all 17,899 index hospitalizations due to acute bipolar episodes between 1998 and 2007 in Taiwan were identified from a total population health insurance claims database, amongst which 544 subjects had a concomitant diagnosis of ID. Pattern of psychotropic medication use, LOS, discharge outcome and direct costs during hospitalization were compared between bipolar patients with ID and without ID and multivariate models controlling for major cost confounders were used to explore the impacts of ID on LOS, discharge outcome and inpatient costs. The results indicated that, compared to bipolar patients without ID, bipolar patients with ID were younger, had longer LOS and received significantly lower daily equivalent dosages of antipsychotics, mood stabilizers, lithium and benzodiazepines. Significantly more bipolar patients with ID could not be discharged successfully. The longer LOS possibly reflected slower clinical stabilization, conservative use of medications and difficulty in community placement. The lower average daily reimbursements indicated that treatment of bipolar patients with ID were under-funded, whereas the higher total direct costs resulting from prolonged LOS placed greater economic straint on healthcare system. The findings support that bipolar patients with ID are clinically unique but relatively under-supported during acute hospitalization. Modifying current pharmacological intervention, health care resources allocation and community supporting structure is paramount to reducing LOS and improving hospitalization outcome.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Hassiotis A, Serfaty M, Azam K, Strydom A, Blizard R, Romeo R, Martin S, King M. Manualised Individual Cognitive Behavioural Therapy for mood disorders in people with mild to moderate intellectual disability: a feasibility randomised controlled trial. J Affect Disord 2013; 151:186-95. [PMID: 23827533 DOI: 10.1016/j.jad.2013.05.076] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/24/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evaluation of complex interventions, including standardisation of the intervention, types of outcomes selected and measures of change, is a fairly novel concept in the field of intellectual disabilities. Our aim was to explore these issues in a feasibility study of Manualised Individual Cognitive Behaviour Treatment (M-iCBT) compared to the treatment as usual alone (TAU). METHODS Service users with mild to moderate intellectual disability experiencing a mood disorder or symptoms of depression and/or anxiety (mini PAS-ADD total score >10 or 7 respectively) were randomly assigned to either. RESULTS In total, 32 participants were randomly assigned to 16 sessions of M-iCBT (n=16) in addition to TAU or TAU alone (n=16). We explored recruitment and accrual rates, willingness to participate, acceptability of the intervention and suitability of assessment tools. Mean change (95% CI) in the Beck Depression Inventory-Youth (BDI-Y) score from baseline to the 16 week endpoint (primary variable) was 0.10 (95% CI: -8.56, 8.76) and in the Beck Anxiety Inventory-Youth (BAI-Y) 2.42 (95% CI: -5.27, 10.12) in favour of TAU. However, there was a clear trend in favour of CBT in depressed participants with or without anxiety. LIMITATIONS The intervention targeted both depression and anxiety following a transdiagnostic model. This may have impacted the anticipated size of change in the primary outcome. The precise impact of cognitive limitations on ability to use therapy effectively is not fully understood. CONCLUSIONS This study demonstrates that it is feasible to carry out a pragmatic randomised controlled trial of M-iCBT for people with mild to moderate intellectual disability. However, uncertainties about its clinical and cost effectiveness can only be fully answered by further examination of its superiority against other treatments.
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Affiliation(s)
- Angela Hassiotis
- UCL Mental Health Sciences Unit, 1st Floor, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK.
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Strydom A, Chan T, King M, Hassiotis A, Livingston G. Incidence of dementia in older adults with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1881-1885. [PMID: 23578903 DOI: 10.1016/j.ridd.2013.02.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/15/2013] [Accepted: 02/15/2013] [Indexed: 06/02/2023]
Abstract
Dementia may be more common in older adults with intellectual disability (ID) than in the general population. The increased risk for Alzheimer's disease in people with Down syndrome (DS) is well established, but much less is known about dementia in adults with ID who do not have DS. We estimated incidence rates from a longitudinal study of dementia in older adults with ID without DS and compared them to general population rates. 222 participants with ID without DS aged 60 years and older were followed up an average of 2.9 years later to identify those who had declined in functional or cognitive abilities. Those who screened positive had a comprehensive assessment for dementia, diagnosed using ICD 10 and DSM IV criteria. 134 participants who did not have dementia at initial assessment were alive and interviewed at follow up; 21 (15.7%) were diagnosed with dementia. Overall incidence rate for those aged ≥ 60 was 54.6/1000 person years (95% CI 34.1-82.3). The highest incidence rate (97.8/1000 person years) was in the age group 70-74. Standardised incidence ratio for those aged ≥ 65 was 4.98 (95% CI 1.62-11.67). Incidence of dementia in older people with intellectual disabilities are up to five times higher than older adults in the general population. Screening may be useful in this population given the high incident rates, particularly as more effective treatments become available. Studies to explore the underlying aetiological factors for dementia associated with intellectual disability could help to identify novel protective and risk factors.
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Affiliation(s)
- Andre Strydom
- UCL Mental Health Sciences Unit, Charles Bell House, 2nd Floor, 67-73 Riding House Street, London W1W 7EJ, United Kingdom.
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Barron DA, Molosankwe I, Romeo R, Hassiotis A. Urban adolescents with intellectual disability and challenging behaviour: costs and characteristics during transition to adult services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:283-292. [PMID: 23398559 DOI: 10.1111/hsc.12015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Young persons with intellectual disabilities and challenging behaviour in transition usually have complex needs, which may not be served well within existing resources. In this article, we present a survey of all the young people, between 16 and 18 years of age with intellectual disabilities and challenging behaviour identified in one inner London borough. They were in transition to adult services at the time of the study (between 2006 and 2008). The objective was to examine their socio-demographic and clinical characteristics, pattern of service use and associated costs of care. An assessment toolkit was devised to measure the mental and physical health, challenging behaviour and service use of the sample. Instruments within the toolkit included the Strengths and Difficulties Questionnaire, challenging behaviour scale, Client Service Receipt Inventory (CSRI) and socio-demographic data form. Twenty-seven individuals in transition to adult services had challenging behaviour, 23 of whom had mental health diagnoses and 18 of whom had physical diagnoses. Severity of challenging behaviour did not correlate with cost of care. Informal care accounted for the highest proportion of the total cost of care (66%) with education being the second largest contributor at 22%. Evidence on transition outcomes for young people with complex needs and intellectual disabilities and associated costs is lacking. This article illustrates some of the relevant issues in this area. Further research is required to investigate these aspects and guide commissioning of appropriate services.
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Affiliation(s)
- Diana A Barron
- Research Department of Mental Health Sciences, University College London Medical School, London, UK.
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Abstract
PURPOSE OF REVIEW Improvements in health and social care for people with intellectual disability have led to a dramatic increase in the life expectancy of this population, resulting in a large and growing number of older adults with intellectual disability. They are at risk of age-related mental disorders such as dementia and continue to present with high rates of mental illness. RECENT FINDINGS Recent research with older adults with intellectual disability has included physical health issues that may affect mental well being, and biological and clinical features of dementia in people with Down syndrome. Two key clinical trials of memantine and antioxidants for dementia in Down syndrome showed that these treatment options were ineffective in the short term. Other research focussed on environmental and psychosocial issues (including carer issues) and end-of-life care. SUMMARY Improved mental well being requires effective management of mental illness and co-morbid physical health problems as well as consideration of environmental and social issues. Biological research has identified potential treatments for age-related decline, which has led to the development of medication trials. Despite disappointing results, two recent medication trials showed that randomized controlled trials are feasible in older people with intellectual disabilities - a group who are often excluded from trials.
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Salvador-Carulla L, Reed GM, Vaez-Azizi LM, Cooper SA, Martinez-Leal R, Bertelli M, Adnams C, Cooray S, Deb S, Akoury-Dirani L, Girimaji SC, Katz G, Kwok H, Luckasson R, Simeonsson R, Walsh C, Munir K, Saxena S. Intellectual developmental disorders: towards a new name, definition and framework for "mental retardation/intellectual disability" in ICD-11. World Psychiatry 2011; 10:175-80. [PMID: 21991267 PMCID: PMC3188762 DOI: 10.1002/j.2051-5545.2011.tb00045.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although "intellectual disability" has widely replaced the term "mental retardation", the debate as to whether this entity should be conceptualized as a health condition or as a disability has intensified as the revision of the World Health Organization (WHO)'s International Classification of Diseases (ICD) advances. Defining intellectual disability as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. This paper presents the consensus reached to date by the WHO ICD Working Group on the Classification of Intellectual Disabilities. Literature reviews were conducted and a mixed qualitative approach was followed in a series of meetings to produce consensus-based recommendations combining prior expert knowledge and available evidence. The Working Group proposes replacing mental retardation with intellectual developmental disorders, defined as "a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The Working Group further advises that intellectual developmental disorders be incorporated in the larger grouping (parent category) of neurodevelopmental disorders, that current subcategories based on clinical severity (i.e., mild, moderate, severe, profound) be continued, and that problem behaviours be removed from the core classification structure of intellectual developmental disorders and instead described as associated features.
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Affiliation(s)
- Luis Salvador-Carulla
- Intellectual Disability-Developmental Disorders Research Unit, Fundación Villablanca, Reus (Tarragona), Spain
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Abstract
PURPOSE OF REVIEW There has been a drive to meet the needs of people with intellectual disabilities in an environment of resource scarcity. It is also recognized that intervention has the potential to improve social and economic welfare. Economic analyses can be used to inform decision makers about what additional investment is needed (if any) and the impacts on a range of stakeholders of intervention. RECENT FINDINGS There is a paucity of economic studies in intellectual disability. The lack of economic studies is a barrier to making policy and practice decisions for people with intellectual disabilities. In the period of review, 10 economic studies were found. SUMMARY Information on resource and cost implications of various treatments and support for people with intellectual disabilities is needed. Economic evaluation techniques can be used to inform decision making. We conducted a systematic review of the literature from January 2006 to February 2010. There was a paucity of economic studies in the field. Analyses assessing a wide range of outcomes alongside costs were the most widely used evaluation method in the review. There is a need for more economic studies in this area.
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