Differences In Functional Disability Research Articles

Cerebellar repetitive transcranial magnetic stimulation versus propranolol for essential tremor.

Propranolol, a nonselective beta-adrenergic blocker, has long been used as one of the standard treatments for essential tremor (ET). Repetitive transcranial magnetic stimulation (rTMS) has also been used for a long time as a substitution therapy for ET patients. The main aim of this study was to evaluate the antitremor effect of 1-Hz (low-frequency) cerebellar rTMS and compare it to the use of propranolol in ET patients. In this single-blinded, randomized, controlled pilot study, a total of 38 patients with ET were randomized into two groups. One group (n=20) received 1200 pulses of 1-Hz rTMS at an intensity of 90% of the resting motor threshold to the bilateral cerebellar region for 10days. Another group (n=18) received oral propranolol for 30 days. The initial dose was 30mg/day, which was increased to 60mg/day after 5days, then to 90mg/day on the 11th day, and continued thereafter for 20days. The Fahn-Tolosa-Marin (FTM) clinical scale was assessed at baseline and at days 5, 10, and 30 to evaluate tremor severity, specific motor tasks, and functional disability. Low-frequency rTMS of the cerebellum significantly improved tremor severity, specific motor tasks (writing, spiral drawing, and pouring), and FTM total scores on days 10 and 30. Nevertheless, we found no significant difference in functional disability at any point in time (p>.05). There were no statistically significant differences in FTM Part A, Part B, Part C scores and total scores of patients in propranolol group on days 5 and 10 compared with before treatment (p>.05). However, FTM total scores and FTM Part A, Part B, and Part C scores were significantly improved for patients when the dose of propranolol was 90mg/day on day 30. Our study showed that there was no statistically significant difference in the total FTM scores and FTM Part A, Part B, and Part C scores between rTMS and propranolol on days 5, 10, and 30 (p>.05). We conclude that both cerebellar low-frequency rTMS and propranolol could be effective treatment options for patients with ET, but it is not clear which method is more effective.

Experience of Pediatric Chronic Pain for Gender Expansive and Cisgender Patients

Sex differences in chronic pain are well documented. However, very little research has examined the experience of chronic pain in gender-expansive youth, a population who experience significant healthcare disparities. This study examined characteristics of pain and psychosocial correlates in gender-expansive and cisgender patients seen for evaluation and treatment of chronic pain. Participants included 48 youth (16 gender-expansive, 32 matched cisgender; M=16.28 years) with chronic pain seen in an interdisciplinary pediatric pain management clinic. Independent samples t-tests were conducted comparing pain, pain-related cognitions, internalizing symptoms, and sleep difficulties between groups. Correlations were conducted for each group; differences in the strength of the correlations were evaluated using Fisher's r to z transformation. Patients reported moderate pain intensity (M=4.98), moderate functional disability (M=28.64), and decreased quality of life (M=42.84). The most common pain diagnosis was fibromyalgia. Cisgender patients reported significantly poorer sleep onset (p=.044). Differences in pain intensity trended toward significance with cisgender patients reporting greater pain (p=.095). Internalizing symptoms trended toward significance with gender-expansive patients reporting greater anxiety (p=.089) and depression (p=.086). There were no significant differences in functional disability, symptom severity, quality of life, or pain-related attitudes and beliefs. For both gender-expansive and cisgender patients, lower quality of life was associated with greater symptom severity and greater pain-related injustice (ps<.05). Of note, these correlations were significantly stronger for gender-expansive patients. Gender-expansive and cisgender patients with chronic pain experienced functional disability and poor quality of life. Results should be interpreted with caution given the small sample size, however, preliminary evidence suggests internalizing symptoms may be of particular importance when treating chronic pain in gender-expansive youth, whereas sleep concerns and pain intensity may be greater in cisgender youth. These results have the potential to influence clinical practice, treatment, and future research for gender-expansive youth receiving treatment for chronic pain.

Repetitive transcranial magnetic stimulation for prophylactive treatment of chronic migraine: A randomised, single-blind, parallel-group, sham-controlled trial

Background: Pilot studies suggest that repetitive transcranial magnetic stimulation could be effective in migraine. We studied its efficacy for prophylaxis of chronic migraine. Methods: We undertook a randomised, single-blind, sham-controlled study in patients with chronic migraine. Subjects were randomly allocated to sham, high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) or low-frequency repetitive transcranial magnetic stimulation (LF-rTMS). The primary outcome was the reduction of attacks at four weeks. In addition, reduction of severity of headache based on the Visual Analogue Scale score at two &amp; four weeks and a functional disability score at four weeks was recorded. Results: One hundred and eight patients were allocated to sham stimulation (n=36), HF-rTMS (n=36) and LF-rTMS (n=36) groups. The number of attacks per month decreased to 7.05+/-1.45 at four weeks post-rTMS in the HF-rTMS (p&lt;0.001) as compared to the LF-rTMS (10.61+/-1.69) and sham (10.83+/-3.37) groups. The VAS score in the HF-rTMS group was significantly lowered (p &lt; 0.001) from 8.61+/-1.15 at baseline to 6.63+/-0.96, and 7.19+/-0.98 at two and four weeks respectively. The duration of headache in hours over 4 weeks reduced from 32.4+/-14.9 to 11.6+/-6.14 in the HF-rTMS group (p&lt;0.001), but did not change significantly in the LF-rTMS (30.4+/-11.9 to 27.8+/-14, p&gt;0.05) and sham (26.8+/-11.06 to 37+/-15, p&gt;0.05) in sham groups. There was no significant difference in functional disability between all the study groups at four weeks. Conclusion: High-frequency, but not low-frequency, repetitive transcranial magnetic stimulation may be useful in management of chronic migraine.

Expert advice about therapeutic exercise in the management of sacroiliac dysfunction in pregnancy: Secondary analysis of a randomized trial

ObjectiveTo assess primiparous and multiparous women, and singleton and multiple pregnancies in a recently published randomized trial. Study designSecondary analysis of a randomized clinical trial was performed. In total, 500 women with sacroiliac dysfunction diagnosed in pregnancy were randomized into a study group (who received expert advice about therapeutic exercise) and a control group (who continued with their normal lifestyle habits). The outcome measures assessed were: pain intensity [visual analogue scale (VAS)] and degree of functional disability (Quebec scale) at enrolment and after 3 and 6 weeks. Primiparous and multiparous women, and singleton and multiple pregnancies in the study and control groups were analysed separately. ResultsSacroiliac dysfunction was more common in primiparous women compared with multiparous women (84.70% vs 77.16%), and in multiple pregnancies compared with singleton pregnancies (86.53% vs 80.07%). For all four subgroups analysed in this secondary analysis, the reduction in pain intensity (p = 0.001) and the degree of functional disability (p = 0.001) were better in the study group compared with the control group. Better results for the two outcome measures were found when comparing primiparous and multiparous women in the study group at follow-up, but the difference in functional disability disappeared 6 weeks after enrolment (p = 0.383). There was no difference in the two outcome measures between singleton and multiple pregnancies 3 and 6 weeks after enrolment (p = 0.061, p = 0.489 and p = 0.741, p = 0.353, respectively). ConclusionExpert advice about therapeutic exercise is effective for the reduction of symptoms of sacroiliac dysfunction in all four subgroups (primiparous and multiparous women, singleton and multiple pregnancies). Earlier reduction of pain intensity and degree of functional disability were obtained in primiparous women compared with multiparous women in the study group.

Patterns of internalizing symptoms and disability functioning in children and adolescents.

Despite findings from previous studies, there is still little consistent knowledge regarding the co-occurrence patterns of somatic, depressive and anxiety symptoms in childhood and adolescence. Moreover, functional disability due to somatic symptoms at different concomitant levels of depression and anxiety is understudied. The present study examined the co-occurrence patterns of somatic symptoms and symptoms of depression and anxiety, in children and adolescents using two-step cluster analysis. Differences in functional disability due to somatic symptoms were tested with ANCOVA controlling for gender and age. The sample comprised 1127 Italian children and adolescents (48.7% males, n = 549) aged 8-16years (Mage = 11.7, SD = 2.37). Data were collected using the Children Somatization Inventory-24, the Children Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, and the Functional Disability Inventory. A four-cluster solution based on the co-occurrence of internalizing symptoms best fit the data. The four clusters were labelled as follows: cluster 1: "High somatic symptoms and average depression/anxiety"; cluster 2: "High somatic symptoms and high depression/anxiety"; cluster 3: "Average somatic symptoms and above average depression/anxiety"; and cluster 4: "Low somatic symptoms and low depression/anxiety". Significant differences between the four groups according to gender and age were shown. Participants with high levels of somatic, depressive, and anxiety symptoms reported greater functional disability due to somatic symptoms than the other three groups. Our findings indicate that children and adolescents who demonstrate high symptoms of depression and anxiety also reported higher levels of disability in daily life due to somatic symptoms.

Decomposing gender inequality in functional disability among older people in Vietnam

ObjectivesThis study compared functional disability in older men and women, and examined the extent to which social determinants contribute to the difference in functional disability between Vietnamese older men and women. MethodsA nationally representative sample of persons aged 60 and older in Vietnam, taken from the 2011 Vietnam Aging Survey, was analyzed (N = 2,693, consisting of 1,622 women and 1,071 men). Ordinary least squares regression (OLS) was used to identify factors associated with functional disability in men and women, while Oaxaca-Blinder decomposition for linear models was applied to examine how much of gender inequality in functional disability was attributed by the distribution of the social determinants. ResultsThe OLS results showed that functional disability score for women was significantly higher than that for men, and that men and women shared similarity in factors associated with functional disability (e.g., age, educational level, employment status, and perceived sufficiency of income). The decomposition results showed that the distribution of the social determinants explained about 54 per cent of gender inequality in functional disability; among the determinants, age, employment status, and educational level were the major drivers. Approximately 46 per cent of the inequality was explained by unobserved factors. ConclusionThe findings of this study highlight the need for policy to mitigate the social determinants (e.g., education and employment) that contribute to gender inequality in functional disability.

Biopsychosocial primary care versus physiotherapy as usual in chronic low back pain: results of a pilot-randomised controlled trial

Aim To compare the effectiveness of a biopsychosocial primary care intervention (Back on Track) with primary care physiotherapy as usual in patients with chronic low back pain (CLBP) experiencing low complex psychosocial complaints. Method A double-blind multicentre pilot-randomised controlled trial. Twenty-five patients (≥18 years) with non-specific CLBP (≥12 weeks) experience low psychosocial complaints and a low to moderate level of disability. The Back on Track intervention (four individual and eight group sessions) versus physiotherapy as usual (maximally 12 individual sessions). Primary outcome: functional disability (Quebec Back Pain Disability Score) at post-treatment and 3 months follow-up. Secondary measures Anxiety, depression, catastrophizing, pain intensity, kinesiophobia, self-efficacy, global perceived effect. Effects were analysed using linear mixed model analysis. Results No significant differences in functional disability were found between interventions at post-treatment (mean difference 0.10, 95% CI: −12.9 to 13.1) and 3 months follow-up (mean difference −5.4, 95% CI −19.1 to 8.3). Secondary outcomes also showed no significant differences. Conclusions No differences in effects were found between patients with CLBP experiencing low complex psychosocial complaints who receive the Back on Track intervention compared to patients receiving primary care physiotherapy as usual. Well-powered studies of sufficient methodological quality are needed to detect differences in effects.

Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease.

The risk factors and clinical significance of postoperative complications in moyamoya disease are still unclear. The aim of this study was to investigate the predictors of postoperative complications in moyamoya disease and examine the impact of complications on outcomes. The authors reviewed consecutive cases involving adult moyamoya disease patients who underwent indirect, direct, or combined bypass surgery in their hospital between 2009 and 2015. Preoperative clinical characteristics and radiographic features were recorded. Postoperative complications within 14 days after surgery were examined. Multivariate logistic regression analyses were performed to identify the risk factors for either postoperative ischemia or postoperative cerebral hyperperfusion. Outcome data, including recurrent strokes and neurological status (modified Rankin Scale [mRS]) during follow-up, were collected. Outcomes were compared between patients who had complications with those without complications, using propensity-score analysis to account for between-group differences in baseline characteristics. A total of 500 patients (610 hemispheres) were included in this study. Postoperative complications were observed in 74 operations (12.1%), including new postoperative ischemia in 30 cases (4.9%), hyperperfusion in 27 (4.4%), impaired wound healing in 12 (2.0%), and subdural effusion in 6 (1.0%). The complication rates for different surgery types were as follows: 12.6% (n = 25) for indirect bypass, 12.7% (n = 37) for direct bypass, and 10.0% (n = 12) for combined bypass (p = 0.726). Postoperative ischemic complications occurred in 30 hemispheres (4.9%) in 30 different patients, and postoperative symptomatic hyperperfusion occurred after 27 procedures (4.4%). Advanced Suzuki stage (OR 1.669, 95% CI 1.059-2.632, p = 0.027) and preoperative ischemic presentation (OR 5.845, 95% CI 1.654-20.653, p = 0.006) were significantly associated with postoperative ischemia. Preoperative ischemic presentation (OR 5.73, 95% CI 1.27-25.88, p = 0.023) and admission modified Rankin Scale (mRS) score (OR 1.81, 95% CI 1.06-3.10, p = 0.031) were significantly associated with symptomatic postoperative cerebral hyperperfusion syndrome (CHS). Compared with patients without postoperative complications, patients who experienced any postoperative complications had longer hospital stays and worse mRS scores at discharge (both p < 0.0001). At the final follow-up, no significant differences in functional disability (mRS score 3-6, 11.9% vs 4.5%, p = 0.116) and future stroke events (p = 0.513) between the 2 groups were detected. Advanced Suzuki stage and preoperative ischemic presentation were independent risk factors for postoperative ischemia; the mRS score on admission and preoperative ischemic presentation were independently associated with postoperative CHS. Although patients with postoperative complications had worse neurological status at discharge, postoperative complications had no associations with future stroke events or functional disability during follow-up.

Gender differences in functional disability and self-care among seniors in Bangladesh

BackgroundDisability among older adults is a public health concern. To date there are no in-depth and comprehensive analyses on older adults’ disabilities in Bangladesh. This study investigated gender differences in the prevalence of disability and the socio-demographic factors associated with disability among older adults in Bangladesh.MethodsThis research used a sample of 4176 elderly males and females aged 60 years and over from a nationally representative data set- Bangladesh’s 2010 Household Income and Expenditure Survey. The study used both household level and individual level data and applied a wealth index, which was constructed based on household assets using principal component analysis. The Washington Group’s short set of questions on disability were used to measure disability. Chi-square tests and ordinal logistic regression models were fit.ResultsForty-two percent of older had some form of functional disability, including 5% of elderly with severe/extreme functional disability. Seven percent of older adults had a self-care disability, including 3% of elderly with a severe/extreme form of self-care disability. Elderly females suffered from all the studied disabilities, including functional and self-care disabilities in higher percentages, and had higher odds ratios of having both functional disability and self-care disability compared to elderly males. The study also identified some significant factors affecting functional disability and self-care disability, namely age, having a chronic condition, wealth status and place of residence, including divisional differences.ConclusionsPrograms aimed at reducing functional disability among seniors, particularly elderly females, should be granted the highest priority in Bangladesh.

Racial disparities in functional disability among older women with newly diagnosed nonmetastatic breast cancer

This study sought to assess racial differences in functional disability among older women with nonmetastatic breast cancer. In this cross-sectional study, between April 2008 and December 2012, women aged ≥ 65 years with newly diagnosed stage I through III breast cancer were recruited from ambulatory oncology clinics at an academic center. Prior to receiving any adjuvant treatment, participants completed a comprehensive geriatric assessment. The primary outcome was functional disability, defined as dependency in any basic or instrumental activity of daily living, categorized as "yes" or "no." Logistic regression analyses were undertaken. The study enrolled 190 women whose mean age was 75.0 years at diagnosis (standard deviation = 7.0, range = 65-93 years). Thirty-two percent were African American (AA), and 39% had functional disability. Controlling for age, participants with functional disability were more likely to be AA (versus non-Hispanic white), odds ratio = 4.19, 95% confidence interval = 2.12-8.27. Fifty-nine percent of the racial difference in functional disability was explained by a higher prevalence of lower income and education among AAs. In addition, the higher prevalence of chronic medical conditions and obesity among AAs, after accounting for socioeconomic factors, further explained 40% of the black-white difference in functional disability. Among older women with newly diagnosed nonmetastatic breast cancer, functional disability is highly prevalent, and AAs are disproportionately affected. Interventions to optimize the functional status of at-risk individuals, particularly AAs, during and after cancer treatment may improve treatment tolerance and overall survival outcomes.

AB0423 Impact of fibromyalgia on perceived pain in patients with systemic lupus erythematosus

BackgroundPersistent pain is the hallmark of various rheumatologic conditions, including systemic lupus erythematosus (SLE). The presence of diffuse pain compromises the quality of life of the patients. Fibromyalgia (FM) is...

THU0209 Disease Activity and Structural Damage-Related Differences in Functional Disability in Early and Established Rheumatoid Arthritis

BackgroundA measure of functional impairment, the Health Assessment Questionnaire Disability Index (HAQ), consists of a reversible disease activity-related component (ACT-HAQ) and a joint damage component that increases with time (DAM-HAQ).ObjectivesTo...

Investigational Vertebroplasty Safety and Efficacy Trial (INVEST): Patient-reported Outcomes through 1 Year

To evaluate 1-year outcomes of the Investigational Vertebroplasty Safety and Efficacy Trial (INVEST), a blinded, randomized, controlled trial to investigate the effectiveness of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures. Patients were enrolled at 11 sites in the United States, the United Kingdom, and Australia by using an institutional review board-approved protocol and HIPAA compliance, and all patients provided written informed consent. Patients were randomized to undergo vertebroplasty or a control procedure. After 1 month, patients were allowed to cross over and undergo the alternate procedure. Coprimary outcomes were patient-reported function, measured with the modified Roland-Morris Disability Questionnaire (RDQ), and pain (on a scale of one to 10) at 1 year. Intention-to-treat (ITT) and as-treated (AT) analyses were used to compare outcomes. One hundred thirty-one participants (68 in the vertebroplasty group and 63 in the control group) were included in the analyses. Patients in both groups showed improvements in pain and function at 1 year. In ITT analyses, patients randomized to vertebroplasty did not differ from control subjects in terms of RDQ results (difference, 1.37 points; 95% confidence interval [CI]: -0.88, 3.62; P = .231) but reported lower levels of pain (difference, 1.02 points; 95% CI: 0.04, 2.01; P = .042). Eleven of 68 patients who underwent vertebroplasty (16%) and 38 of 63 control subjects (60%) crossed over and elected to undergo the alternate procedure (P < .001). In AT analyses, patients treated with vertebroplasty did not differ from control subjects in terms of RDQ results (difference, 0.66 points; 95% CI: -1.98, 3.30; P = .625) or pain (difference, 0.85 points; 95% CI: -0.35, 2.05; P = .166). Vertebroplasty may provide a modest reduction in pain at 1 year compared with a control procedure; however, no difference in functional disability was observed. Clinical trial registration no. NCT00068822.

What Does Therapeutic Ultrasound Add to Recovery From Acute Ankle Sprain? A Review

To evaluate the effectiveness of therapeutic ultrasound (US) for acute ankle sprains. The Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched to September 2010, for trials in any language; CINAHL to 2004, and PEDro to 2009. The Cochrane Rehabilitation and Related Therapies Field database, reference lists of articles, and the World Health Organization International Clinical Trials Registry Platform were also searched for additional trials. Criteria for selection were randomized or quasi-randomized trials; $1 study group was treated with therapeutic US; participants had acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Two authors independently selected the studies, and disagreements were resolved by consensus. Of 9 potentially relevant studies, 6 (4 from MEDLINE and 2 from other sources) met selection criteria. Data on participants, treatments, outcomes, duration of followup,and study methods (using the 10-point Amsterdam-Maastricht Consensus List for Quality Assessment) were independently extracted by the investigators who selected the studies. Results were pooled if the data were sufficiently homogeneous. The trials included 606 participants in 5 comparisons of US therapy with sham US (placebo) and 3 comparisons with 3 other treatments(immobilizing elastic bandage, Felbinac anti-inflammatory gel, or electrotherapy). The studies varied in time since injury(<48-100 hours), final assessments (1-4 weeks), and number and spacing of US treatments (3-10 sessions over 3 days-2 weeks). Studies varied in using pulsed or continuous US. None of the studies comparing US therapy with sham US reported statistically significant differences on any outcome, but most participants were fully recovered at final follow-up. For the 3 homogeneous studies, the pooled risk ratio after US therapy for general improvement was 1.04 (95% confidence interval [CI], 0.92-1.17), and the pooled risk difference was 3.0% (95% CI, 26%-12%). In 3 studies, no differences in pain at 7, 14, or 21 days or in swelling were found. In 4 studies, differences in functional disability(ability to walk or bear weight or postural stability) were small and nonsignificant.No significant differences were found in range of motion or plantar or dorsal flexion in 2 studies. Adverse reactions were only documented in 1 study (11 nonserious gastrointestinal events and skin reactions and 1 skin reaction that caused the participant to withdraw). In the comparison between US therapy and immobilization with elastic bandage,estimated risk difference in recovery favored US therapy after 2 weeks(27%; 95% CI, 8%-46%). The comparison between US therapy and Felbinac gel detected no differences after 1 week in overall improvement, pain, or ability to bear weight. The comparison between US therapy and electrotherapy found no significant differences after 1 week in pain-free status, minimal swelling, or ability to walk. The methods of the studies were lacking in details of allocation concealment, baseline similarity of groups, and adherence to treatment. Follow-up of participants was, except for 1 study, inadequate or not reported. Ultrasound therapy had few beneficial effects on overall improvement,pain, or ability to bear weight in acute ankle sprain. Follow-up of 2 to 4 weeks suggested that most participants would recover regardless of intervention.

Differences in Functional Disability of Rural American Indian and White Older Adults With Comorbid Diabetes

This study examines racial/ethnic differences in functional disability among a sample of rural older adults with comorbid diabetes. In 2002, interviews were conducted with 62 rural American Indian and 64 White community-dwelling persons aged 65 years or older. Examination of disability levels by group suggested that functional disability for Whites was concentrated in the lower levels (1-2 limitations), whereas disability for American Indians was concentrated in the higher levels (3 or more limitations). Adjusted prevalence rates indicated that American Indian older adults were significantly more likely than Whites to require assistance with dressing, walking, bathing, and shopping. Conversely, for reaching the toilet in time, Whites were significantly more likely than American Indians to report a limitation. Results of this study, coupled with previous literature, suggest that American Indians are more functionally disabled than other racial/ethnic groups and have a marked need for future long-term care.

Routine physiotherapy is as effective as one advice and assessment session for reducing disability in people with low back pain

QuestionDoes routine physiotherapy reduce functional disability compared with a single assessment and advice session in people with low back pain?Study designRandomised controlled trial.Main resultsIn people with low back pain, with or without leg pain or neurological signs, there was no significant difference in functional disability between physiotherapy and assessment and advice alone at 12 months (mean change in Oswestry disability index: −3.27 with advice and assessment v −2.23 with physiotherapy, mean difference −1.04, 95% CI −3.70 to 1.59).Authors’ conclusionsFor the treatment of low back pain, routine physiotherapy is as effective as one general advice and assessment session.

A Randomized Controlled Trial of a Cognitive-Behavioral Family Intervention for Pediatric Recurrent Abdominal Pain

To investigate whether the combination of standard medical care (SMC) and short-term cognitive-behavioral family treatment (CBT) in the treatment of recurrent abdominal pain (RAP) was more effective than SMC alone. Children recently diagnosed with RAP via physician examination were randomized into SMC (n = 29) and SMC plus CBT (n = 40) groups. Outcome measures included multiple dimensions of child and parent reported child pain, somatization, and functional disability, and school absences and physician contacts. Children and parents participating in the combined SMC + CBT intervention reported significantly less child and parent reported child abdominal pain than children in the SMC intervention immediately following the intervention and up to 1 year following study entry, as well as significantly fewer school absences. Significant differences in functional disability and somatization were not revealed. These results, in combination with previous studies, add support to the effectiveness of CBT intervention in reducing the sensory aspects of RAP. Results are discussed with respect to the cost-benefit of integrated medical and short-term psychological services.

Primary juvenile fibromyalgia: psychological adjustment, family functioning, coping, and functional disability.

1) To determine the importance of psychological adjustment and family functioning in primary juvenile fibromyalgia by assessing these factors in children with fibromyalgia and in their parents, compared with children with juvenile rheumatoid arthritis (JRA) and with pain-free control children and their parents. 2) To examine which of these factors predict functional disability. Fifteen children in each of the 3 study groups, and their parents, completed self-report questionnaires and pain diaries. A medical evaluation of each child was performed, including assessment of tender points by palpation and by dolorimetry. All children in the fibromyalgia group met the Yunus and Masi criteria for fibromyalgia, and 11 met the American College of Rheumatology criteria. There were almost no significant group differences in the children's or parents' psychological adjustment, ratings of family functioning, or coping strategies. Significant group differences in functional disability, pain, fatigue, tender point threshold, and control point tolerance were found. A number of the psychological adjustment, pain, fatigue, and coping variables were significantly associated with functional disability. The notion that fibromyalgia is a psychogenic condition is not supported by these results. Fibromyalgia is associated with disability of a magnitude comparable to that of other chronic pain conditions. Disability among children with fibromyalgia or JRA is a function of the children's psychological adjustment and physical state, and of the parents' physical state and method of coping with pain.

Gender differences in disability, assistance, and subjective well-being in later life.

This study focused on gender differences in functional disability among older adults, their reliance on personal assistance and technical aids, and relationships among the use of these sources of assistance, functional disability, and subjective feelings of well-being. The analyses employ data from interviews conducted with 1,406 community-dwelling elders living in Manitoba, Canada. The results reveal (a) greater disability and somewhat greater use of personal assistance among women, and (b) differences between men and women in relationships between both personal and technical resources and subjective feelings of well-being across levels of functional disability.