Disability Groups Research Articles

Complex Multimorbidity and Trajectories of Functional Disabilities in the Last Three Years of Life: A Prospective Cohort Study of Older Adults in Japan.

We sought to understand the impact of multimorbidity (MM) on the trajectories of functional decline in the last three years of life among older people in Japan. We used nationwide longitudinal cohort data with 6-year follow-up and analyzed 3731 functionally independent residents aged 65years and older. The primary outcome was the five trajectory groups of functional disability in the last three years of life, defined by group-based trajectory modeling (GBTM). The explanatory variable was two alternative definitions of MM: basic MM (BMM; two or more comorbid diseases) versus complex MM (CMM; three or more body system disorders due to disease). A multinomial logistic regression analysis showed both MMs were associated with earlier trajectories of functional decline (maximum odds ratio: BMM 1.12 [0.99-1.27]; CMM 1.29 [1.16-1.44]). Preventing MMs, especially CMM, by providing appropriate care and support could contribute to healthy longevity by delaying the onset of functional disability.

Effects of probiotics on clinical manifestations and inflammatory markers in HTLV-1-associated myelopathy/tropical spastic paraparesis: A triple blind randomized, placebo controlled trial

Human T-lymphotropic virus type 1 (HTLV-1), leads to adult T-cell lymphoma/leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in a minority of infected individuals. The virus promotes inflammation, a major factor in chronic disease progression. Probiotics' immune modulation and anti-inflammatory effects present a potential therapeutic intervention for HTLV-1-related conditions. This study investigates the impact of probiotics on both clinical manifestations and inflammatory markers in HAM/TSP patients.Conducted at the HTLV-1 clinic of Ghaem Hospital (Mashhad, Iran) between 2019 and 2020, this study randomized 40 HAM/TSP patients into two groups: an intervention group receiving 500 mg LactoCare capsules twice daily and a control group receiving placebo capsules of identical appearance for 12 weeks. Baseline and follow-up assessments included muscle strength, spasticity, motor disability, urinary disturbance, and serum levels of IL-10, IL-4, and IFN-γ (measured by ELISA). Post-intervention analysis revealed no significant differences between intervention and control groups in muscle strength, spasticity, and motor disability. However, significant improvement was observed in the intervention group regarding urinary symptoms after 12 weeks of initiation of intervention (P = 0.003). No significant changes were detected in serum levels of IL-10, IL-4, and IFN-γ between the two groups. The probiotics showed positive effects on urinary symptoms in HTLV-1-associated myelopathy/tropical spastic paraparesis patients but did not significantly impact other clinical or paraclinical parameters within the 12-week study period. These findings suggest that probiotics may offer symptomatic relief for some symptoms of HTLV-1-associated myelopathy/tropical spastic paraparesis patients.

Physiotherapists as first-contact practitioners for patients with low back pain in French primary care: a pragmatic cluster randomised controlled trial.

A new model of care enables French physiotherapists (PT) working in collaboration with family physicians (FP) to expand their usual scope of practice for patients with acute low back pain (LBP). The aim of our study is to evaluate the impact of this new first-contact physiotherapy (FCP) advanced practice model compared to usual FP care. A multicentre pragmatic non-inferiority cluster randomised controlled trial (RCT) has been conducted in six multidisciplinary primary healthcare centres in France. Patients from 20 to 55 years old with acute LBP consulted either the PT or the FP. PT independently assessed and managed patients including medication prescription. The primary outcome measure was disability at six weeks (Roland Morris Disability Questionnaire, range 0-24). Secondary outcomes include pain, risk disability prognosis, satisfaction with care, healthcare resources use and wait times. Data were collected at baseline, six and twelve weeks. Outcomes across arms were compared using mixed models regression analysis. Except for non-inferiority analysis of the primary outcome measure, other analyses were performed with a two-sided significance level of 0.05. Sixty patients were recruited (PT: 32, FP: 28). The adjusted mean difference between groups for disability at 6 weeks was 0.39 in favour of the FP group (95%CI: -2.03; 2.81, p = 0.753). Considering a 5 points minimal clinically important difference, the FCP-led model of care was not inferior to usual FP care for the primary outcome. There was no statistically significant difference between groups in disability at 3 months and pain at 6 weeks and 3 months. PTs prescribed significantly less medications than FPs (p < 0.001). No statistically significant difference was found for other healthcare resource use outcomes, patients' satisfaction and wait times. This is the first RCT to evaluate the impact of a FCP advanced practice model of care including medical delegated acts in a primary care setting. Our results suggest that the FCP-led model of care is not inferior to usual FP care regarding disability at 6 weeks. The FCP model could result in possible benefits in terms of healthcare resources use. Further adequate powered studies with larger sample size are needed to draw stronger conclusions. The study has been registered in ClinicalTrials.gov (NCT05200533) on the 20th of January 2022.

Progress and development trends of lower limb exoskeleton rehabilitation robots

Abstract. Currently, as the aging population intensifies, many elderly people are trapped by lower limb dysfunctions caused by diseases such as stroke sequelae, spinal cord injuries, and bone injuries. Research on lower limb exoskeleton robots has made progress both domestically and internationally. Foreign lower limb exoskeleton robot technology is very mature and widely applied; although starting later, domestic development in this field has been rapid. This paper studies the key technologies of lower limb exoskeleton robots from several aspects: the degrees of freedom in human lower limb movement, the cyclic movement of human gait, structural design, driving methods, and interactive control. With the continuous advancement of technology, lower limb exoskeleton robots will become more intelligent and focus more on personalized services and wearing comfort in future development, aiming to bring more convenience and help to disabled individuals, rehabilitation patients, and groups with special needs.

Disability and Vulnerable Groups Inclusion in COVID-19 Policy and Planning in Sub-Sahara African Countries

Background: The COVID-19 pandemic has caused an excess burden of disease in disabled and vulnerable populations. These populations may face an increased risk of contracting COVID-19, greater demand for services and social support, and reduced access to treatment. Despite various national and international efforts towards disability rights and inclusion, substantial gaps exist between disability rights legislation and its implementation. Aims: To assess the inclusion of people with disability and other vulnerable groups in policy and planning documents related to the COVID-19 pandemic response in sub-Sahara Africa. Methods: We conducted content analysis using the EquiFrame policy analysis tool and assessed commitment to 12 vulnerable groups and 21 core human rights in policy and planning documents related to the COVID-19 pandemic. We included documents on general pandemic response, stakeholder engagement, risk communication, and the COVID-19 vaccine from five sub-Saharan African countries, including Nigeria, South Africa, Ethiopia, Kenya, and Zambia. Results: The study highlights the varying degrees to which countries integrate disability, vulnerable groups, and other core human rights concepts into their COVID-19 health policies and planning documents. Only Kenya mentioned disability in their pandemic response plan. However, all countries have explicitly mentioned disability in their stakeholder engagement plans. Except for Kenya, all countries have included disability in their risk communication plans. Notably, South Africa and Zambia demonstrated extensive disability inclusion in their stakeholder engagement and vaccine plan. Thus, these countries have the potential for comprehensive and inclusive health policymaking. In contrast, Nigeria and Ethiopia lag, therefore highlighting areas of improvement across all policy domains. Conclusion: The findings emphasize the critical importance of not only mentioning disability and other vulnerable groups, but also ensuring the depth and quality of this inclusion. While there are positive strides in certain areas, there remains a consistent need for deeper and broader inclusion across all policy domains. Received: 10 September 2024 | Reviewed: 16 October 2024 | Revised: 03 November 2024 | Accepted: 05 November 2024.

InclusiveWeb : A Smart Browser Approach to Enhancing Web Accessibility for Users with Diverse Disabilities

This article presents InclusiveWeb, an innovative accessibility-focused web browser designed to enhance digital inclusion for users with diverse disabilities. The browser addresses the persistent challenge of widespread non-compliance with web accessibility standards by implementing real-time content adaptation mechanisms, disability-specific tools, and a highly customizable user interface. InclusiveWeb's architecture incorporates advanced machine learning algorithms to dynamically modify web content, offering tailored solutions for users with visual impairments, dyslexia, language disorders, cognitive disabilities, and ADHD. The article details the browser's design principles, technical considerations, and user experience features, supported by a comprehensive evaluation methodology involving user studies with various disability groups. Results demonstrate significant improvements in task completion rates, user satisfaction, and overall accessibility compared to standard browsers. While acknowledging limitations and areas for future research, this article highlights InclusiveWeb's potential to revolutionize web accessibility, shifting the paradigm from reliance on content creators' compliance to browser-level adaptations. The implications of this approach for web accessibility standards, digital inclusion, and future technological developments are discussed, emphasizing the browser's role in creating a more equitable digital landscape.

Childhood Maltreatment, School Social Bonds, and Dating Violence Victimization: Mediational Model Differences by Disability Status

Abstract Purpose Childhood maltreatment (CM) and dating violence victimization (DVV) are significant social concerns with far-reaching consequences for the well-being and development of young adults. The purpose of this study is to understand the role of school social bonds (SSB) in the association between CM and DVV during young adulthood and to compare these relationships between young adults with and without disabilities. Methods Using a weighted sample consisting of 21.1% youth with disabilities and 78.9% youth without disabilities from the National Longitudinal Study for Adolescent to Adult Health (Add Health), Structural equation models (SEM) were tested for both the non-disabled and disabled groups. Results Results from SEM indicated a direct relationship between CM and DVV for both groups with significant path coefficients. CM had a negative influence on SSB for the disabled group. Mediation analyses underscored the significance of SSB, demonstrating that higher CM levels were associated with increased rates of DVV, while stronger SSB was correlated with a reduced risk of DVV. The indirect effect of CM on DVV through SSB was statistically significant only for young adults with disabilities. Conclusions This study emphasizes the importance of evidence-based policies, practices, and interventions aimed at breaking the pathways from CM to DVV by establishing positive SSB and promoting the well-being of young adults, particularly those with disabilities.

스크린 골프 이용자의 수준별 경기력 비교 분석 및 스코어 예측

This study aimed to analyze and compare various performance variables, such as hole-by-hole scores, putts, greens in regulation, and par save rates among screen golf users at different skill levels, to identify their characteristics and predict round scores based on these variables. To achieve this, images of 'screen golf score cards' were collected from an internet portal using the keyword, resulting in a total of 441 records. Performance variables, including putts per hole, greens in regulation, and par save rates, were input into an Excel program for calculation. The analysis revealed differences in performance variables such as hole-by-hole scores, total putts, occurrences of three-putts or more, greens in regulation, and par save rates across different skill levels. Specifically, greens in regulation was found to have the greatest impact on scores. The proportion of putts in scores did not differ between the under and single handicap groups, and differences in par save opportunities were not observed except in the double bogey group. Therefore, it is essential to focus on improving greens in regulation through accurate iron shots and developing the ability to finish with a one-putt even if greens are missed. Future research should consider including variables related to tee shots, such as driver distance and fairway accuracy.

Match internal load in wheelchair basketball games – an exploratory study

ABSTRACT This study aimed to compare the match internal load according to the type of disability at different moments in the wheelchair basketball game and the effect of playing the last 5 min of the half on Lactate (LA+) concentrations. Thirty athletes (34.4 ± 6.8 years) from 5 wheelchair basketball Brazilian teams were analysed during five official games. For the analyses, athletes were separated by disability [spinal cord injury, polio sequels and lower limb amputation]. A generalised estimating equation analysis was performed to verify the effects of moment, disability and playing the last 5 min of each period on the La+ concentrations. No significant differences were found between disability groups for the TRIMP and the La+ concentrations at different moments in the game. The results pointed out that unbalanced games seem to cause higher lactate concentrations in the first period of the game, especially in players who end up playing in the second quarter. Finally, unbalanced games, whether the player finishes playing the game, seems not to influence the final lactate concentrations. The internal load of the WB game does not differ in the different disabilities, and, in unbalanced games, the players finish the game with low concentrations of lactate.

Trajectories of cold but not mechanical sensitivity correspond with disability trajectories after whiplash injury.

Developmental trajectories for neck disability after whiplash injury have been identified. Their relationship to cold and mechanical sensitivity trajectories is not known. We aimed to (1) identify recovery trajectories of cold and mechanical sensitivity, (2) explore their codevelopment with disability trajectories, (3) identify predictors of sensitivity trajectories, and (4) explore codevelopment of cold and mechanical sensitivity trajectories. Participants (n = 233) were assessed at <1, 3, 6, and 12 months after whiplash injury. Outcomes were cold pain detection threshold (CPT at neck), pressure pain detection thresholds (PPT, neck C5, and tibialis anterior), and the Neck Disability Index. We used group-based trajectory models to identify postinjury recovery trajectories and multinominal logistic regression to explore associations between baseline characteristics and trajectory membership. We identified the following trajectory groups: CPT (low [50.0%], moderate [29.7%], and high [20.4%] sensitivity); PPT C5 (low [10.8%] and high [89.2%] sensitivity); and PPT tibialis anterior (low [23.9%], moderate [39.0%], and high [37.1%] sensitivity); all were stable over the 12 months. There was good correspondence between disability and cold sensitivity trajectory groups but not for mechanical sensitivity; cold and mechanical sensitivity trajectories were not well associated. Higher baseline pain predicted membership of the high cold sensitivity trajectory (RR 1.27, 95% CI 1.01-1.59) and hyperarousal symptoms predicted membership of the moderate cold sensitivity trajectory (RR 1.17, 95% CI 1.01-1.36). We found no associations between baseline characteristics and mechanical sensitivity. There is an interplay between cold allodynia, pain, and hyperarousal symptoms in development of ongoing disability after whiplash injury. Different mechanisms likely underlie cold and mechanical sensitivity.

Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017

Abstract Aims The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea. Methods To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables. Results The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female. Conclusions Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health &amp; Welfare, Republic of Korea (No. HC23C016500). Key messages • The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. • In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

New onset work disability in rheumatoid arthritis is an underrecognized cardiovascular risk factor: A retrospective cohort study using the CorEvitas registry

ObjectivesPatients with rheumatoid arthritis (RA) are more likely to develop work disability than the general population. We investigated whether individuals younger than 65 years of age who had both RA and new-onset work disability were at higher risk of CVD compared to similarly aged individuals with RA who did not develop disability. We identified the factors that best explained the excess risk. MethodsThis was a retrospective cohort study using data from the CorEvitas RA registry. Patients younger than 65 with RA were included. Exposure was new-onset work disability, and comparator was consistently working individuals. Cohorts were age- and sex-matched. Demographics, medications, and disease specific factors were collected for all patients. Incidence rates (IR) for cardiovascular events were calculated using Poisson regression and explanatory multivariable models were built using Cox proportional hazard ratios (HR) to determine the factors that explained the excess CVD risk. ResultsAge and sex-adjusted IR was 5.40 per 1,000 person-years in the new-onset work disability group compared to 2.17 per 1,000 person-years in the working group. Work disability associated with CVD with HR = 2.32 (95 % CI 1.52, 3.53) in the age- and sex-adjusted model. Multivariate models accounting for functional status, education, medications, and traditional CVD risk factors could not fully explain the excess risk for CVD in newly work disabled patients with RA: HR = 1.78 (1.09, 2.91). ConclusionsPatients younger than 65 with RA and new-onset work disability are at significantly increased risk for incident CVD compared to working peers. The excess CVD risk remained unexplained after accounting for multiple variables, possibly due to variables we cannot fully account for, such as social determinants of health and allostatic load.

Adapting a human sexuality curriculum for students with disabilities

Background: The US Individuals with Disabilities Education Act requires that children with disabilities receive a free appropriate public education. However, it does not specifically include the subject of health education. Currently, 30 US states require public schools to teach sexuality education as a part of the health education curriculum, but 36 do not include youth with disabilities in their sexuality education requirements. Objective: The current situation is particularly concerning due to the higher rates of unplanned pregnancy, sexual abuse, and sexually transmitted infections experienced by teenagers with disabilities. Students from across several disability groups report societal barriers, physical barriers, and poor educational outcomes with respect to sexuality education. Results: This review article sought to investigate the current state of sexuality education for students with disabilities, as well as best practices to support the learning of sexuality education content. Conclusion: Focusing sexuality education classes on practical ways so as to develop relationships, promote self-advocacy and self-determination, and incorporate privacy messages, can support students with disabilities to make healthy choices.

Exploring Mathematical Problem-Solving Through Process Mining: Insights from Large-Scale Assessment Log Data

In this study, we explore the application of process mining techniques on assessment log data to explore problem-solving strategies in Algebra. By analyzing sequences of student activities, we demonstrate the significant potential of process mining in identifying problem-solving strategies that lead to successful and unsuccessful outcomes. Our findings reveal that students who successfully solve the problem tend to follow one of three structured strategies, displaying a systematic process in filling the boxes of a Pascal’s triangle. Conversely, those who falter often start with a correct strategy but deviate by inserting incorrect values, especially in central boxes. Further analysis provides insights into the strategies and potential misconceptions among students from various disability groups. Notably, autistic students exhibit unique patterns, such as initiating the solution from the triangle’s right side, contrary to the common left-to-right strategy, and consistently applying this approach even when errors occur.

Enhancing Workplace Safety for Disabled Farmers in Thailand: A Quasi-Experimental Study of Ergonomic Interventions in Vermicompost Production

The aim of this study was to improve the working environment for disabled farmers in vermicompost production using participatory action-oriented training (PAOT). Potential hazards were identified through Job Safety Analysis (JSA), and improvements were implemented based on the analysis. The winnowing step was found to have the highest risk, as farmers had to manually separate vermicompost and earthworms by shaking the mixture through a filter. To address this, a vermicompost winnowing machine was developed specifically for disabled farmers, reducing their working time and the risk of muscle injuries. Ergonomic assessments were conducted using Rapid Entire Body Assessment (REBA). The assessments compared the risks associated with the manual process to those when using the newly developed winnowing machine. The results indicated a reduction in musculoskeletal disorder (MSD) risk for all disabled groups. The findings of this study emphasize the importance of considering occupational health and safety for disabled individuals in agriculture. By implementing ergonomic improvements such as redesigned tools and adjusted workstations, the safety and well-being of disabled farmers can be enhanced. This contributes to creating inclusive and productive work environments. In conclusion, through the application of PAOT and ergonomic assessments, this study successfully identified potential hazards and implemented improvements in vermicompost production for disabled farmers. The development of a specialized winnowing machine reduced the risk of musculoskeletal disorders. Promoting occupational health and safety measures is crucial for supporting the participation and well-being of disabled individuals in agricultural work.

Disability trajectories individuals with spinal cord injury in mainland China: do psychosocial resources and diseases factors predict trajectories?

Observational cohort study. To identify classes of disability trajectories from 1 month post-injury (acute hospital) to 6 months post-injury (individuals with SCI individuals who stay in rehabilitation setting or back in the community), and to investigate whether psychosocial resources and disease factors can predict disability trajectory. Spinal surgery in three Class III hospitals. Hospitals in China are divided into three classes (Class I, II and III). All the participants were submitted to WHO Disability Assessment Schedule (WHO-DAS 2.0) at three times; and personal data anamnesis, level of hope, level of PTSD, level of social support were recorded at first time. All the data collected by the master's students who participated in this study. Two disability trajectories were identified using the latent class growth model: the continuous high disability group (N = 196, 93.3%) and the low starting point stabilization group (N = 14, 6.7%). Complete injury(ASIA-A) with SCI and more depression in the stable condition after SCI surgery were more likely to be classified as having higher disability than those with a lower disability trajectory. Occupation, annual family income, hope, social support, and Post-traumatic Stress Disorder (PTSD) cannot predict individuals belonging to trajectory classes. These findings emphasize the importance of ASIA and depression in the early recovery stage after SCI and support the opinion that strengthening psychological nursing and rehabilitation management at an early stage after SCI will benefit individuals with a lower disability trajectory.

Continuity of care and hospitalization frequency for ambulatory care-sensitive conditions after hearing-disability onset: a retrospective cohort study

We assessed the effect of continuity of care (COC) on the frequency of hospitalization for Ambulatory care-sensitive conditions (ACSCs) to estimate the impact of COC and hearing disability relative to the controls. This retrospective cohort study used claim data of Korean National Health Insurance Service – National Sample Cohort 2.0 DB. We used propensity score matching to determine a control group for the hearing disability group by age, sex, and the Charlson Comorbidity Index. The hearing-impaired group included 720 participants, and the non-disabled control group, consisting of individuals without any form of disability, had 1,423 individuals. We used the frequency of hospitalization for ACSCs during one-year follow-up as the dependent variable for Poisson regression. We measured COC with the Bice–Boxerman Continuity of Care Index (COCI); higher COCI values represent better continuity of care, with COCI values ranging from 0 to 1. Poisson regression showed that disability status modifies the effect of COCI on the incidence of hospitalization. COCI = 1 reduced hospitalizations in people with hearing disabilities (adjusted Incidence Rate Ratio [aIRR]: 0.30, 95% CI: 0.20–0.44) but was not statistically significant for controls. In the COCI = 1 group, the effect of disability was not significant(aIRR: 1.10, 95% CI: 0.83–1.44). Compared to people without disabilities, enhanced COC for people with hearing disabilities was more effective in preventing hospitalizations for ACSCs.

Empowerment Model for Persons with Disabilites: Application Village Inclusion for Incumbent Disability in the Village Mangliawan Pakis District, Malang Regency

Disability is a condition that restricts an individual’s ability to fully participate in social, economic, and political activities, whether physically, mentally, or sensorily. Disability groups, especially people with disabilities, are vulnerable to discrimination and marginalization due to a lack of support, facilities, and adequate opportunities. The empowerment model of people with disabilities is an approach aimed at enhancing their independence, social participation, and quality of life. This article discusses the empowerment model of people with disabilities, including the benefits and challenges in its implementation. Disability empowerment is focused on enabling them to reach their full potential and participate equally in society by overcoming everyday barriers. Mangliawan Village, a rural area in the Pakis District, Malang Regency, Indonesia, faces similar challenges. Despite the lack of resources and adequate support for people with disabilities, Mangliawan Village has taken significant steps by implementing the principles and goals of Inclusive Village. The implementation of the Inclusive Village in Mangliawan Village begins with an assessment of the needs and challenges of people with disabilities involving local stakeholders, including people with disabilities, families, community leaders, and government officials. The results of this assessment form the basis for developing a comprehensive plan to enhance accessibility and inclusion in Mangliawan Village. This article highlights Mangliawan Village’s efforts to create a more inclusive environment and inspires the development of similar programs in other rural areas. Keywords: empowerment, persons disabilities, social inclusion, participation, training skills

Trajectories of work disability and unemployment before and after a common mental disorder diagnosis among young private sector employees in Sweden-a register-based longitudinal study.

To identify trajectory groups of work disability (WD), including sick leave and disability pension, and unemployment three years before and sixyears (from Y-3 to Y + 6) after a common mental disorder (CMD) diagnosis and to investigate associations of socio-demographic, work-related and clinical factors with trajectory membership. A longitudinal nationwide register-based study was conducted including individuals aged 22-29 years, gainfully employed in the private sector, with a CMD diagnosis in specialised healthcare or prescribed antidepressant (N = 12,121) in 2014 (Year 0/Y0), with follow-up from Y-3 to Y + 6. Group-based trajectory analyses identified groups of individuals who followed similar trajectories of months of WD and unemployment, respectively. Multinomial logistic regression determined associations between socio-demographic, work-related and clinical factors and trajectory membership. In the CMD group, we identified three trajectory groups, each for WD and unemployment. Only 7% individuals belonged to a 'Fluctuant high' trajectory group with four months of WD in Y0, which peaked at 7months in Y + 3 and reduced to 5months in Y + 6. For unemployment, 15% belonged to an 'Increasing medium' trajectory group that steadily increased from 1.3months in Y0 to 2.6months in Y + 6. Sex, educational level and musculoskeletal disorders for WD, and educational level, living area and occupational class for unemployment, influentially determined the variance across the CMD trajectory groups. Specific vulnerable groups regarding unfavourable WD (women, low education and musculoskeletal disorders) and unemployment (manual work, low education and rural residence) trajectories require special attention regarding their return-to-work process following a CMD diagnosis.

Cut-off point of the risk assessment scale for the 9-year risk of functional disability

Objectives This study aimed to examine the cut-off point of the Risk Assessment Scale (RAS) for predicting the 9-year risk of functional disability among older Japanese adults.Methods This prospective, 9-year follow-up study used data from the Sasaguri Genkimon Study in Fukuoka. Of the 2,629 older adults who did not have functional disabilities and participated in the baseline survey in 2011, 2,254 with complete data were included in the analysis. The RAS was assessed using a questionnaire that showed good predictive and external validity for the 3-year risk of functional disability. The outcome was the incidence of functional disability during follow-up, which was defined as a new certification for the need for support or care. The cut-off point of the RAS was estimated as the point indicating the maximum χ2 value of the log-rank test. The predictive validity of the RAS for functional disability was examined using C-statistics for the total score, and sensitivity and specificity for the cut-off point, respectively. Participants were then categorized into two groups according to the cut-off point (high-score and low-score groups). Hazard ratio (HR) and 95% confidence interval (95% CI) of the 9-year risk of functional disability for the high-score group compared with the low-score group were calculated using the Cox proportional hazard model. In the multivariate model, HR was adjusted for living alone, education, economic status, drinking, smoking, and multimorbidity.Results New functional disability was certified in 647 participants (28.7%) during a median follow-up period of 8.75 years. The cut-off point for functional disability was 13/14. The C-statistic was 0.774, and the sensitivity and specificity were 0.726 and 0.712, respectively. Compared to the low-score group (0-13 points), the HR (95% CI) of the high-score group (≥ 14 points) for incident functional disability in 9 years was 5.50 (4.62-6.54) in the crude model, and 4.81 (4.00-5.78) in the multivariate model (P<.001).Conclusion This study, with its long follow-up period of 9 years, demonstrated that the 13/14 cut-off point of the RAS is suitable for the long-term assessment of functional disability risk. Our results suggest the possibility of using the 13/14 cut-off point of the RAS as a promising tool to grasp the risk of functional disability over a longer time frame, highlighting the potential for early prevention and intervention.