Levels Of Physical Impairment Research Articles

EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY

Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Fifty eight community-dwelling adults aged 67 to 94 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and level of physical impairment was matched. Main outcomes were (A) hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. Twenty nine patients were cared by primary care providers who received the IPETC;29 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021. An average cost-saving of $22,135 per patient was observed among those treated by the healthcare providers who received the IPE/telehealth curriculum training than those treated by the providers without the training. CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.8% to 42.8% in documented advance care plans. Innovative interdisciplinary education and telehealth primary care has shown improvement of quality and efficiency of dementia care in a provider shortage area.

A review of telehealth during the COVID-19 emergency situation in the public health sector: challenges and opportunities

PurposeThe purpose of this study is to provide current state of knowledge on how the COVID-19 emergency situation necessitated the behaviour influencing use and acceptance of telehealth. This study interlinks the health belief model (HBM) and the unified theory of acceptance and use of technology (UTAUT) to highlight the challenges and opportunities as a result of the COVID-19 pandemic in the public health sector.Design/methodology/approachThis study used three online databases (Emerald publishing, Science Direct and Taylor and Francis) that enabled the authors to access electronic journal articles. Search strategy was used to extract articles based on the relevance of this study.FindingsThe key findings from this study suggested that the COVID-19 emergency forced health-care workers and their patients to rapidly use and rely on telehealth to reduce the rate of COVID-19 transmissions. The key benefits of telehealth use highlighted an expansive cost effective and convenient access to health-care services irrespective of geographical local and levels of physical impairment. Moreover, telehealth inhibited in person human interaction, which was perceived as impersonal and not ideal for new patient consultations. The barriers outweighed the benefits; as a result, it is unlikely that there will be a wide use of telehealth beyond the COVID-19 emergency situation.Practical implicationsThe research findings are limited to discussions drawn from available secondary data. The criteria within telehealth for policymakers to note the technology acceptance and use for both health-care and outpatient stakeholders and their health seeking behaviour. Health-care sectors (private and public) and government need to understand enablers of effective telehealth in policymaking to ease the barriers during an emergency situation like a pandemic.Originality/valueThis study contributes to the emerging literature on how COVID-19 pandemic has disrupted and accelerated telehealth by extending both the UTAUT and HBM theories. This study is expected to contribute and expand literature on telehealth during emergency situations, given the novice nature of COVID-19 and limited literature surrounding it.

Self-perceived health among children with spina bifida in the West Bank: a cross-sectional study

BackgroundChildren born with spina bifida endure constant physical disability, which is challenging for themselves and their families. To date, the impact of spina bifida on the health-related quality of life (HRQOL; eg, physical, psychological, and social wellbeing) of these children has been assessed mainly through parent proxy reports, and self-perceived health among these children is rarely measured. This study aimed to measure self-perceived health in children with spina bifida in the West Bank, to compare this with that in a healthy reference group also from the West Bank, and to assess the potential association between self-perceived health and the level of disability in children with spina bifida. MethodsA cross-sectional study was conducted in the West Bank. The Paediatric Quality of Life Inventory (PedsQL) was administered to a convenience sample of 200 children aged 8–12 years, of whom 50 have spina bifida and 150 are healthy. For the children with spina bifida, their disability was categorised and ranked according to four aspects of impairment (mobility, bowel function, bladder function, and hydrocephaly). Data were analysed with SPSS version 24. Difference in PedsQL scores between the two groups of children was tested with the Mann-Whitney U-test. The Spearman's rank correlation coefficient was used to evaluate the association between the level of physical impairment in children with spina bifida and their self-perceived health. Written informed consent was obtained from the children's parents. The children's verbal assent was also obtained, and their right to withdraw from the study at any time was emphasised. FindingsChildren with spina bifida had lower overall PedsQL scores (mean 45·5, SD 14.5) than those reported by the reference group of healthy children (mean 80·0, SD 12·8). For children with spina bifida, social functioning had the lowest mean score (30·5, SD 20·8), followed by physical functioning (37·5, SD 16.6), emotional functioning (56·0, SD 17·2), and school functioning (62·6, SD 17.8), whereas the range for all of the PedsQL scores in the reference group was 71·7–84·5. The results demonstrate significant inverse associations between self-perceived health (overall PedsQL score) in children with spina bifida and both the level of mobility impairment (rs=−0·65, p<0·0001) and the presence of hydrocephalus (rs=−0·53, p<0·0001). A weak inverse association was found between self-perceived health and both bladder and bowel dysfunction. For both groups, no associations were found between demographic characteristics (age, gender, type of settlement of residence [city, village, camp]) and self-perceived health. InterpretationThe findings provide insights into the importance of social support and rehabilitation services for children with spina bifida in the occupied Palestinian territory. In particular, community awareness, and education of health care providers and family members, may be important. FundingNone.

Does Medicaid Hcbs Generosity Influence Nursing Home Placement for Dually Eligible Adrd Patients?

Research ObjectiveOlder adults with Alzheimer’s disease and related dementias (ADRD) often receive informal care to support their community living. As the disease progresses, the physical and emotional toll it exacts on caregivers may become unsustainable, and nursing home (NH) placement may become necessary. Medicaid Home and Community‐Based Services (HCBS) programs provide various types of services to support community living for Medicaid enrollees, which may reduce or delay NH placement for ADRD patients. This study aimed to examine the relationship between Medicaid HCBS generosity and the likelihood of NH placement for duals with ADRD, and their level of functional impairment at NH admission.Study DesignNational Medicare data, Medicaid Analytic eXtract (MAX), and MDS 3.0 for CY2010‐2013 were linked. Eligible Medicare‐Medicaid dual beneficiaries with ADRD were identified and followed for up to a year. Based on MAX data, two measures of HCBS generosity were constructed at the county level for older duals with ADRD: (a) breadth (ie, proportion of duals who used HCBS services); and (b) intensity (ie, average HCBS spending per user). Outcomes included NH placement during the follow‐up year (dichotomous) and the level of physical impairment (ie, activities of daily living [ADL, 0‐28 point scale], categorized into low, moderate, and severe impairment) at the time of NH admission. A linear probability model with county random‐effects and robust standard errors was estimated to examine the relationship between the likelihood of NH placement and HCBS generosity, accounting for individual (eg, sociodemographic characteristic, prior hospitalizations, and comorbidities) and county‐level covariates (eg, median household income, female labor participation). A multinomial logistic model was estimated to examine the relationship between HCBS generosity and ADL impairment among those who were admitted to NHs.Population StudiedCommunity‐dwelling older dual beneficiaries with ADRD who were enrolled in fee‐for‐service Medicaid between October 1, 2010, and December 31, 2012 (N = 365 310).Principal FindingsConsiderable variation in county‐level HCBS breadth and intensity was observed. 17.1% of duals with ADRD had NH placement within one year. After accounting for individual and county level covariates, we found that a 10 percentage‐point increase in HCBS breadth among individuals with ADRD was associated with 1.1 percentage point reduction (P &lt; 0.01) in the likelihood of NH placement. Among individuals with NH placement, greater HCBS intensity was related to a higher level of impairment at NH admission ($100 increase in HCBS intensity led to 1.03 and 1.04 times the likelihood of having moderate or severe physical impairment [P &lt; 0.01]). Greater HCBS breadth was associated with less physical impairment (10 percentage‐point increase led to 0.93 and 0.91 times the likelihood of having moderate or severe physical impairment [P &lt; 0.01]).ConclusionsAmong community‐dwelling duals with ADRD, Medicaid HCBS breadth was associated with a lower likelihood of NH placement, and HCBS intensity was associated with greater physical impairment at NH admission.Implications for Policy or PracticeInvestment in Medicaid HCBS may prevent or delay NH placement among community‐dwelling older adults with ADRD. More research is needed to identify how the utilization of different HCBS services may affect NH placement.Primary Funding SourceNational Institutes of Health.

Psychosocial difficulties of individuals with multiple sclerosis: the PARADISE-24 questionnaire.

The aim of this study is to identify the most relevant psychosocial difficulties (PSDs) experienced by persons with multiple sclerosis (PwMS); to evaluate the relation between an overall level of PSDs measured with the PARADISE-24 and other variables; to assess which factors may predict PARADISE-24 overall score. Adults PwMS were consecutively enrolled and completed a battery of eight self-reported instruments (i.e. SCQ, EUROHIS-QOL 8, BRS, BFI-10, JSPE, OSS-3, WHODAS-12, PARADISE-24). A clinical evaluation was performed for each patient and the Expanded Disability Status Scale (EDSS) score was determined by neurologists. A total of 80 PwMS, mean age 41.0, 65% women, 62% married, and 76.3% working, 86.3% relapsing-remitting MS, with an EDSS median score of 1.5, took part in the study. The mean disease duration was 7.7 years. The most frequently reported PSDs involved motor and emotional functioning. Free of charge access to medicines; health treatments and family, friends and health professionals' assistance represented the most important facilitators. WHODAS-12 and EUROHIS-QOL 8 were excluded from regression because of their strong correlation with PARADISE-24. EDSS, BRS, OSS-3, and neuroticism were the main predictors of the PARADISE-24 score. Despite MS heterogeneity, a common pattern of PSDs can be observed among PwMS. The level of physical impairment and personal resilience were the main predictors of the overall level of PSDs in PwMS, with a lower but significant additional role played by social support and personality traits. Attention to PSDs and their predictors, using PARADISE-24, can help clinicians to plan tailored and personalized rehabilitation programs.

Both projection and commissural pathways are disrupted in individuals with chronic stroke: investigating microstructural white matter correlates of motor recovery.

BackgroundComplete recovery of motor function after stroke is rare with deficits persisting into the chronic phase of recovery. Diffusion tensor imaging (DTI) can evaluate relationships between white matter microstructure and motor function after stroke. The objective of this investigation was to characterize microstructural fiber integrity of motor and sensory regions of the corpus callosum (CC) and descending motor outputs of the posterior limb of the internal capsule (PLIC) in individuals with chronic stroke and evaluate the relationships between white matter integrity and motor function.ResultsStandardized measures of upper extremity motor function were measured in thirteen individuals with chronic stroke. Manual dexterity was assessed in thirteen healthy age-matched control participants. DTI scans were completed for each participant. Fractional anisotropy (FA) of a cross-section of sensory and motor regions of the CC and the PLIC bilaterally were quantified. Multivariate analysis of variance evaluated differences between stroke and healthy groups. Correlational analyses were conducted for measures of motor function and FA. The stroke group exhibited reduced FA in the sensory (p = 0.001) region of the CC, contra- (p = 0.032) and ipsilesional (p = 0.001) PLIC, but not the motor region of the CC (p = 0.236). In the stroke group, significant correlations between contralesional PLIC FA and level of physical impairment (p = 0.005), grip strength (p = 0.006) and hand dexterity (p = 0.036) were observed.ConclusionsMicrostructural status of the sensory region of the CC is reduced in chronic stroke. Future work is needed to explore relationships between callosal sensorimotor fiber integrity and interhemispheric interactions post-stroke. In addition, contralesional primary motor output tract integrity is uniquely and closely associated with multiple dimensions of motor recovery in the chronic phase of stroke suggesting it may be an important biomarker of overall motor recovery.

Quality of life of patients with amyotrophic lateral sclerosis

The aim of this study is to evaluate the correlation between different measures of quality of life (QoL), functional status and mood status in patients with amyotrophic lateral sclerosis (ALS). A sample of 40 patients with ALS was recruited and scales for the evaluation of health-related QoL (SF36), patient-centered QoL (SEIQoL), functional status (ALSFRS) and depression (ZDS) have been administered to them. All the correlations (Pearson's r) between the scores have been considered and the t-test was performed in order to compare male with female patients. No correlation emerged between the different measures of QoL and functional status, apart from the scores of the Physical Functioning subscale of the SF36 which resulted positively correlated (p < 0.01) with those of the ALSFRS. Mood status resulted negatively correlated with many aspects of health-related QoL but not with patient-centred QoL. Data suggest that the relationship between functional status and different domains of QoL in this population of patients with a severely compromising disease is not linear and that the satisfaction with life of the patients themselves is not strongly related to the level of physical impairment.

Disability, Doctors and Sexuality: Do Healthcare Providers Influence the Sexual Wellbeing of People Living with a Neuromuscular Disorder?

The recognition that people living with impairments are sexual beings is a relatively new one. Historically, people living with a physical impairment including neuromuscular disorders (NMDs) have been perceived as asexual or potentially deviant. They can experience a lack of information as well as distress and anguish around their sexual and personal relationships. They often face obstacles to maximizing their sexual potential and may internalize negative societal assumptions and attitudes about their sexuality. The extent to which both sexual expression and interactions with healthcare providers influence the impact of physical impairment on the quality of life (QoL) of NMD patients has not previously been determined, providing the rationale for this study. The purpose of this study was (a) to determine if the levels of sexual expression and interactions with healthcare providers varied significantly between people with and without a NMD, and (b) to explore the extent to which sexual expression and interactions with healthcare providers significantly influenced the impact of NMDs on QoL. Responses were collected via an online survey using seven instruments: a demographic questionnaire; the Individualised Neuromuscular Quality of Life (INQoL); the Watts Sexual Function Questionnaire (WSFQ Male and Female); the Client Satisfaction Questionnaire (CSQ-8); WHO (five) Wellbeing Index; the Brief Burns Depression Checklist (BDC); and the Neuromuscular Patients and HCPS Sexuality Questionnaire. The participants included 144 people living with a NMD (termed the NMD group) and 134 people without a NMD (termed the control group). The scores for sexual expression were significantly lower in the NMD group. The impact on QoL was significantly higher in the NMD group. The frequency of sexual intercourse, the consistency of engagement in fulfilling sexual activity, and to a lesser extent, the facilitation of sexual expression by healthcare providers, was found to significantly reduce the deleterious impact of NMDs on QoL of the NMD group. The inhibition of sexual expression associated with the negative attitudes of healthcare providers was predicted to significantly increase the deleterious impact of physical impairment on the QoL of the NMD group. Sexual expression may help to diminish the deleterious impact of physical impairment on the QoL of people living with a NMD, and interactions with healthcare providers may moderate the strength of this impact. The clinical implications include healthcare providers being encouraged to facilitate sexual expression in all patients, irrespective of their level of physical impairment. Patients with a NMD are encouraged to understand their psychosexual health rights and to assert those rights when consulting with healthcare providers.

Job Satisfaction, Stress and Burnout in Anaesthetic Technicians in New Zealand

Anaesthetic technicians play a key role in the operating room, yet little is known about their levels of job satisfaction or workplace stress. A blinded, confidential single mail-out survey was posted to anaesthetic technicians in New Zealand. The survey consisted of demographic information, a job satisfaction survey, the Maslach Burnout Inventory and the Short Form 12. At total of 154 forms were returned (51% response rate). Respondents worked predominantly in public hospitals and many had duties outside the operating room. Job satisfaction was related to teamwork, practical nature of work and patient contact, while dissatisfaction was related to lack of respect from nurses and limited career pathway. High to moderate levels of emotional exhaustion (48%), depersonalisation (39%) and low levels of personal accomplishment (58%) were indicators of burnout. The Short Form 12 revealed high levels of physical impairment in 24% and emotional impairment in 35% of respondents. These data suggest that work is needed to evaluate anaesthetic assistants' job structure and actively manage their important physical and emotional sequelae.

Caregiving Outside of the Home: The Effects of Race on Depression

Objective . This research examines the conditions that determine whether Blacks experience lower or higher levels of depression while caregiving outside of the home, as compared to Whites. Some prior literature has found that African Americans report a lesser caregiver burden despite an increased likelihood that they will acquire this role, and decreased resources to do so. Others have found that African Americans experience the same caregiver burden and distress as Whites. Given these mixed findings, we use the stress process model to examine whether African American caregivers experience lower or higher levels of depression when they provide care outside of the home. Design . A sample of care workers who provide care to others outside of the home was drawn from the 1992–4 National Survey of Families and Households. The final sample included 275 (11%) Blacks, and 2,218 (89%) Whites (not of Hispanic origin). The primary statistical method for predicting differences in caregivers’ depressive symptomatology was OLS regression analysis with progressive adjustment. Results . We examined sociodemographics, family structure, resources, and stressors and found that African Americans, those with lower socioeconomic status, the unmarried, spending more weeks caregiving, having a physical impairment, and surprisingly receiving more help from parents are associated with higher depressive symptomatology. Stronger religious beliefs decreased depressive symptomatology for Blacks. The race effect was, in part, explained by family structure, amount of caregiving, and impairment of care worker. Conclusion . Contrary to prior literature, we found that Blacks are more depressed than White caregivers in large part because of lower socioeconomic status and greater stressors, and higher levels of physical impairment. Yet, strength in religious belief has a stress-buffering effect for African Americans. We suggest that policies that attempt to eliminate racial disparities in socioeconomic status and health could benefit these caregivers.

P1114 NUTRITIONAL INTAKE AND GROWTH IN CHILDREN WITH NEURODISABILITY: A 6 MONTH COHORT

Introduction: Feeding difficulty and undernutrition is common in children with neurodisability. Gastrostomy is a useful adjunct in feeding management. There are limited data on the nutrient intake in this patient group. The aim of our present study is to evaluate quality (micronutrient) and quantity (macronutrient) of nutritional intake in children with neurodisability and to relate this to their growth, functional abilities and route of feeding. Methods: A standardised three day diet diary was completed by carers of all new patients (n = 42) attending a multidisciplinary feeding clinic over six months. Nutrient intake was analysed using the Salford micro-diet system. Results: Thirty nine(92%) diet diaries were analysed (mean age - 26 months). Feeding routes: - oral (O)(n=14), gastrostomy only (G)(n=7) and combination of gastrostomy and oral (C)(n=18). Median Gross Motor Function Classification System (GMFCS) levels: - O:G:C 2:4:4. Median ‘z-scores’ (weight, height):- O (−0.6, −1.22); G (−1.27, −3.75); C (−2.35. −2.53). Mean Percentage Estimated Average Requirement (%EAR) intake for calories: - O (78.64); G (65.33) and C (85.46).All other Macronutrients were adequate to dietary reference values. The mean micronutrients percentage RNI for zinc (O:G:C– 98%:146%:150%), vitamin D (O:G:C − 58%:111%:111%), selenium (O:G:C–75%:139%:168%) and the intake for biotin, manganese and panthothenate were lower in the orally fed group. Conclusion: The level of physical impairment (GMFCS) has an impact on nutritional status and feeding ability. There was significant deficit in the energy intake irrespective of the route of feeding. Micronutrient deficiencies were variable with a trend towards lower intake in the orally fed group. This could relate to the use of nutrient dense feeds or use of low micronutrient content foods.

Experience of Severe Fatigue Long after Stroke and Its Relation to Depressive Symptoms and Disease Characteristics

Although the experience of abnormal fatigue is recognised as a major disabling symptom in many chronic neurological diseases, little is known about the persistence of severe fatigue after an abrupt neurological incident like a stroke. Therefore, the objectives of this study were to test whether the experience of severe fatigue persists long after a stroke has occurred, and to assess the relation between experienced fatigue and levels of physical impairment and depression. Ninety stroke outpatients and 50 controls returned mailed questionnaires. Compared to age-matched controls, a significantly larger proportion (16 vs. 51%) of the stroke respondents experienced severe fatigue, while 20% of the patients and 16% of the controls had elevated depression symptom scores. The time which had elapsed since the stroke occurred could not explain levels of fatigue. In the control group, the number of depressive symptoms explained most of the variance in levels of fatigue, while impairment of locomotion explained most of the variance in the stroke group.

Spinal troubles in sewage workers: epidemiological data and work disability due to low back pain.

To determine the prevalence of spinal troubles (i.e., neck, upper back and low back pain) in a population of sewage workers, and to establish the effect of sociodemographic, work-related, physical, and psychosocial factors on the reported work disability due to low back pain (LBP) during the previous 12 months. Data from 255 sewage workers were obtained by standardized questionnaire, structured interview, and standardized physical examination. Data on the prevalence of neck, upper back and low back pain were obtained with the use of the Nordic Questionnaire. The level of disability was assessed from a modified Low-Back Outcome Scale. Work history included physical factors and job perception based on a modified Work APGAR Score. Other questionnaires recorded the psychosocial aspects of the work environment. In addition, we compared the risk factors between sewage workers who had been prevented from doing their normal work, at any time during the preceding 12 months, as a result of LBP (n = 92), and those without any history of work disability during the previous 12 months (n = 157). The 12-month prevalence rates of neck, upper back and low back pain were 52.4%, 54.8%, and 72.8%, respectively. The prevalence of spinal troubles increased with age. Work disability during the preceding 12 months due to LBP was significantly positively associated with age, disability, the weekly duration of stooping and lifting 5 years previously and higher abnormal illness-behavior scores (odds ratio between 1.26 and 0.94). Moreover, when adjusted for age, the results showed that the subjects in the work disability group were more likely to report higher pain intensities, decreased participation in sports activities, higher levels of physical impairment, the belief that their LBP was related to the physical demands of their job, and a lack of drive (P < 0.05). This study revealed a high incidence of spinal troubles among sewage workers. In a multidisciplinary approach, we demonstrated that not one factor alone but a combination of sociodemographic, work-related and psychosocial factors have shown associations with work disabilities due to LBP. Additional studies evaluating the relative importance of individual risk factors are warranted.

Prospective study on the relation between living arrangement and change in functional health status of elderly women.

Limited prospective data exist on how living arrangements are associated with change in functional health. This study evaluated whether elderly women living alone were less likely to experience functional decline when compared with women who lived with others. A total of 619 community-dwelling, white women from Baltimore, Maryland, aged 65-99 years at baseline were questioned annually from 1984 to 1986. Functional health was measured as the sum of limitations in seven physical and seven instrumental activities of daily living (Instrumental ADL). A total of 148 women experienced functional decline over the 2 years, primarily as a deterioration in Instrumental ADL. The association between living arrangement and change in Instrumental ADL depended on the level of physical impairment. Among women without severe impairment, Instrumental ADL deterioration was significantly less for those living alone compared with those living with spouses (odds ratio (OR) = 0.60, 95% confidence interval (CI) 0.45-0.92) or nonspouse others (OR = 0.62, 95% CI 0.45-0.96). For women with severe impairment, however, those living alone had a greater decline in Instrumental ADL, especially when compared with those living with nonspouse others (OR = 5.13, 95% CI 1.23-21.28). These results suggest that, unless severely physically impaired, women living independently have less deterioration in functional health when compared with peers in alternate living arrangements.

The role of anxiety and depression in quality of life and symptom reporting in people with diabetes mellitus.

Although quality of life evaluations are widely used throughout medicine, relatively little is known about the psychological processes involved in making these judgements. What is known is that quality of life judgements are not straightforwardly associated with objective measures of health status or clinician ratings. In particular, patient affect appears to be associated with quality of life ratings but whether this relationship is secondary to physical health or not is controversial. The aim of this study was to determine the role of anxiety and depression in the reporting of quality of life in a group of patients with diabetes mellitus. One hundred consecutive patients with diabetes (insulin-dependent diabetes mellitus n = 36 and non-insulin-dependent diabetes n = 64) were assessed using a self-report measure of quality of life, a symptom checklist and a questionnaire measure of anxiety and depression. In addition, they were independently rated for their level of physical impairment. The results showed that depression and, to a lesser extent, anxiety were significantly related to self-reported quality of life even when the differences in physical health and age were controlled for statistically. This study shows that, independent of the level of physical illness, affect, particularly depressive affect, is an important factor in the determination of quality of life.

Correlations between Ratings of Pain, Disability and Impairment in Chronic Whiplash‐Associated Disorder

OBJECTIVE: To investigate the level of correlation among pain, disability and physical impairment scores in chronic whiplash‐associated disorder patients.SUBJECTS: Adults with chronic whiplash‐associated disorder referred for secondary independent assessment.METHODS: Forty‐four subjects (16 males, 28 females) were included in the sample. Self‐rated pain was measured on a five‐point verbal rating scale. Self‐rated disability was measured using the Neck Disability Index (NDI) and the Disability Rating Index (DRI). Physical impairment was measured as active cervical ranges of motion obtained with a cap goniometer. Descriptive statistics were reported and Pearson product moment correlations were obtained with the P value at 0.01.RESULTS: Mean ± SD age of the subjects was 36.4±8.7 years. Mean duration of complaint was 15.2±12.3 months. Mean pain score out of 5 was 2.5±1.2. Mean NDI and DRI scores were 23.2±9.3 out of 50 and 21.6±9.1 out of 48, respectively. These scores correlated very highly (r=0.89, P=0.0001). The average reduction of ranges of motion compared with published norms was approximately 25%. The correlations among ranges of motion, NDI, DRI and pain scores ranged from ‐0.32 to ‐0.66 (P&lt;0.05 to P=0.0001). Age and duration of complaint correlated poorly with ranges of motion.CONCLUSIONS: The self‐ratings of pain and disability obtained from these chronic whiplash‐associated disorder sufferers appear to be consistent with, and correlate reasonably well with, levels of physical impairment. Physical impairment ratings do not appear to correlate well with duration, which suggests that factors related to pain and physical impairment may play an important role in the development of chronicity in whiplash‐associated disorder.

Relationship between the Level of Physical Impairment and Sports Performance in Elite Wheelchair Basketball Athletes

Fifty-two male elite wheelchair basketball athletes, classified into four functional ability classes, were studied to determine whether overall wheelchair basketball performance in a game situation is related to the functional ability level of the participant. To determine the quality of the individual’s game performance, 18 championship games were videotaped and analyzed by means of the Comprehensive Basketball Grading System. Physical fitness parameters (propulsive force and aerobic power) were determined in specific laboratory conditions. Force application on the wheelchair handrims was measured by means of an ergodyn device. Finally, the subjects, while in their wheelchairs, performed a maximal exercise capacity test on a motordriven treadmill. The analyses indicated significant differences in field performance and aerobic power between Class I and the rest of the classes. However, isometric and dynamic force application on the handrims could not be proven to be functional ability dependent. In conclusion, reducing the number of classes to improve fair and equitable competition in wheelchair basketball was considered viable.

The Assessment and Prevalence of Affective Disorders in Advanced Cancer

The assessment of depression in patients with advanced cancer presents a difficult clinical challenge. Reported prevalence rates of depression in cancer patients range from 3.7% to 58%. Studies using structured diagnostic interviews and clearly defined diagnostic criteria are presented. The current literature suggests that among hospitalized cancer patients with significant levels of physical impairment at least 25% suffer from clinically important depression. Risk of suicide and recent literature regarding early wish to die are also discussed.

Family support, physical impairment, and adherence in hemodialysis: an investigation of main and buffering effects.

Patient noncompliance is a pervasive problem among end-stage renal disease (ESRD) patients. Previous studies have implicated social support as an important correlate of adherence behavior in other chronic illness groups, but little research has examined this relationship in a hemodialysis population. The present study examined the main and interactive effects of social support in the family and illness-related physical impairment with regard to patient compliance in a sample of 78 hemodialysis patients. Results indicated that patients holding perceptions of a more supportive family environment exhibited significantly more favorable adherence to fluid-intake restrictions than did patients reporting less family support. Family support was not associated with adherence to dietary restrictions. The effect of family support on fluid-intake adherence was not moderated by level of physical impairment. This pattern suggests that the influence of support on adherence is more attributable to a main or direct effect, as opposed to a buffering process in the face of increased physical impairment.

The relationship of psychological distress, extent of disease, and performance status in patients with lung cancer.

This study examined the association between two primary covariates, extent of disease (ED) and performance status rating (PSR), and the outcome of psychological distress in patients with small cell carcinoma of the lung. Patients were studied at the time of entry onto one of three Cancer and Leukemia Group B (CALGB) protocols: 7781 (N = 165) and 8083 (N = 139) for limited disease; and 7782 (N = 151) for extensive disease. Besides ED (limited versus extensive), a four-point rating of PSR was obtained. Psychological distress was measured by the standardized Profile of Mood States (POMS). Gender, age, marital status, education, PSR, ED and two relevant interaction terms (PSR X ED; gender X ED) were analyzed using multiple linear and hierarchical regressions. Of the six main variables, gender and PSR had significant association with POMS total mood disturbance, a summary score for POMS emotional subscales, and most of the individual subscales. The PSR X ED interaction provided a rationale for testing a new regression model in which PSR and ED were combined into a single index of impairment. The final index resulted in five levels of physical impairment which bear an approximately linear relationship to increasing levels of distress (Overall regression, P less than 0.001). These data suggest that PSR is an important factor in modelling POMS distress at both levels of ED, and that ED becomes an important factor with poorer performance status only.