Lower Levels Of Disability Research Articles

Multiple Sclerosis impact on employment and income in New Zealand.

We investigated the demographic, social and clinical characteristics associated with employment status and income for people with multiple sclerosis (MS) in New Zealand (NZ). The NZ National MS Prevalence study included all persons resident in NZ on census day 2006 diagnosed with MS (96.7% coverage). Factors associated with employment and income status among the working age population (25-64years) were identified by linear regression. Over 90% of working age people with MS (n=1727) had a work history, but 54% were not working. Work loss occurred early in the disease course, and at low disability (P<.001). Advancing age, progressive disease, longer disease duration, higher disability levels, partner loss and lower education were associated with work loss (P<.001). Working age people with MS had lower income than the NZ population (P<.0001). Higher qualifications yielded no additional income for MS females and about half the additional income for MS males (P<.0001). MS profoundly reduces employment and income early in the disease course, and at low levels of disability, however, unemployment is not entirely accounted for by clinical, social and demographic factors. These findings suggest social supports should be explored early in the disease course to reduce loss of income and unemployment for people with MS.

Pain expectations in neuropathic pain: Is it best to be optimistic?

Pain expectancy may be an important variable that has been found to influence the effectiveness of treatments for pain. Much of the literature supports a self-fulfilment perspective where expectations for pain relief predict the actual pain experienced. However, in conditions such as neuropathic pain (NeP) where pain relief is difficult to attain, expectations for pain relief could be unrealistic. The objective of this study was to investigate the relationship between realistic/unrealistic expectations and 6-month, post-treatment outcomes. We performed a retrospective analysis of a large cohort of patients with NeP (n=789) attending tertiary care centres to determine the association between unrealistic (both positive and negative) and realistic expectations with outcomes after multidisciplinary treatment. An expectation variable with three categories was calculated: realistic expectations were those whose expected reduction in pain was similar to the observed mean group reduction in pain, while optimistic and pessimistic expectations were those who over- or under-estimated the expected response to treatment, respectively. The association between baseline realistic/unrealistic expectations and 6-month pain-related disability, catastrophizing and psychological distress was assessed. Univariable analyses suggested that realistic expectations were associated with lower levels of disability, catastrophizing and psychological distress, compared to unrealistic expectations. However, after adjustment for baseline symptom severity, multivariable analysis revealed that patients with optimistic expectations had lower levels of disability, than those with realistic expectations. Those with pessimistic expectations had higher levels of catastrophizing and psychological distress at follow-up. These findings are largely congruent with the self-fulfilment perspective to expectations. This study defined realistic pain expectations with patient data. Examining the relationship between expectations between pain and disability in a large cohort of patients with neuropathic pain.

PARADISE 24 instrument: An observational study on psychosocial difficulties, quality of life, and disability levels in patients with epilepsy.

The aim of this observational study was to test the effectiveness of the PARADISE 24 instrument in describing the psychosocial difficulties (PSDs) reported by people with epilepsy, their relation with disability, and quality-of-life (QoL) levels and, overall, to explore a horizontal epidemiology methodology applied to a sample of patients with epilepsy. A convenience sample of 80 adult patients with epilepsy was included in this cross-sectional study. Patients were interviewed using a structured protocol composed of demographic, clinical, and patient-reported outcome measures to collect PSDs associated with epilepsy. There were 80 patients, 40 females; mean age was 41.2years; mean disease duration was 18.7years; and mean number of AED was 2.09. Moderate severity rating according to clinicians' rating scale, low impact of comorbidities (mean: 2.36, SD: 2.97), high levels of QoL (mean: 30.00, SD: 4.4), medium levels of resilience (mean: 13.56, SD: 2.66), high levels of perceived empathy (mean: 15.05, SD: 4.74), poor or moderate perceived social support, and low levels of disability (mean: 10.85, SD: 10.05) were observed. The most frequently reported PSDs were related to tiredness (80%), emotional problems (73.75%), anxiety (68.75%), depressive mood (66.25%), and driving problems (61.25%). The EUROHIS-QOL (p=.003) had a negative significant relationship with PARADISE 24 while WHODAS-12 (p=.000) and CRS (p=.027) had a positive significant relationship with PARADISE 24. The PARADISE 24 permits data comparison and the creation of a complete description of a person's functioning and of all of his/her PSDs and allows better and more tailored interventions.

Cost analysis of multiple sclerosis in Brazil: a cross-sectional multicenter study.

BackgroundMultiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus. The objective of this study was to determine the economic impact of multiple sclerosis from the Brazilian household and healthcare system perspectives. Secondary objectives were to assess the impact of fatigue on daily living and health-related quality of life (HRQL) of MS patients.MethodsThis is a cross-sectional study in which Brazilian eligible patients attending eight major MS specialized sites answered an interview capturing data on demographics, disease characteristics and severity, comorbidities, resource utilization, fatigue, utilities and health-related quality of life from November/2011 to May/2012 . Costs were assessed considering a prevalence-based approach within 1 year of resource consumption and were estimated by multiplying the amount used by the corresponding unit cost. Patients were classified as having mild, moderate or severe disability according to the Expanded Disability Status Scale (EDSS).ResultsIn total, 210 patients who met eligibility criteria were included, 40 % had mild, 43 % moderate and 16 % severe disability; disability level was missing for 1 %. The average total direct cost per year was USD 19,012.32 (SD = 10,465.96), and no statistically significant differences were not observed according to MS disability level (p = 0.398). The use of disease modifying therapies (DMTs) corresponded to the majority of direct expenditures, especially among those patients with lower levels of disability, representing around 90 % of total costs for mild and moderate MS patients. It was also observed that expenses with medical (except DMTs) and non-medical resources are higher among patients with more severe disease. Worsening disability also had an important influence on health-related quality of life and self-perceived impact of fatigue on daily living.ConclusionOur data demonstrates the significant economic impact of MS on both Brazilian household and health system, in terms of DMTs and other disease management costs. When patients move upwards on the disease severity scale, costs with health resources other than drugs are significantly increased.

Cognitive Behavior Therapy for psychosis based Guided Self-help (CBTp-GSH) delivered by frontline mental health professionals: Results of a feasibility study

Availability of Cognitive Behavior Therapy for psychosis (CBTp) is limited in spite of strong evidence base. The purpose of this study was to determine the feasibility of a CBTp based Guided Self-help (CBTp-GSH) in comparison to Treatment As Usual (TAU). The secondary outcomes were a reduction of symptoms of schizophrenia using Positive and Negative Symptom Scale (PANSS) & Disability (WHO DAS 2.0). A total of 33 adults with a DSM-IV diagnosis of schizophrenia was recruited from community mental health services in Kingston, ON, Canada, and randomly assigned to the 12–16week intervention with TAU (Treatment), or TAU alone (Control). End of therapy (16weeks) comparisons between the two groups were made on an Intention To Treat (ITT) basis. Post-intervention scores on measures of psychopathology were compared using Analysis of Covariance (ANCOVA) to adjust for baseline measurements. Recruitment proved feasible, retention rates were high and participants reported a high level of acceptability. There was significant “treatment group by outcome interaction” for Positive and Negative Symptoms, General Psychopathology, measures of disability, such that individuals who received the Treatment improved more than those in Control group. The results of this feasibility study indicate that CBTp based Guided Self-help is feasible and acceptable to the participants, and it can lead to improvement in psychopathology and the level of disability. Individuals in this study had a moderate degree of psychopathology and relatively low level of disability and, therefore, caution is warranted in applying these results to individuals with severe symptoms and with high levels of disability. An adequately powered randomized controlled trial of the intervention is warranted.

Living well with chronic pain

ABSTRACTObjective: The aim of this study was to explore factors associated with resilience in chronic pain.Methods: A sequential mixed methods design was used. Six individuals reporting low levels of psychological distress on the Depression, Anxiety and Stress Scale and low levels of pain-related disability on the Roland Morris Disability Questionnaire were interviewed about their experiences of living with chronic pain. Participants were recruited from a general medical practice in Victoria, Australia and were interviewed between May and September 2013. Potential participants were identified by treating health professionals as individuals who appeared to be coping well with chronic pain.Results: Factors associated with resilience in chronic pain included social support, confidence for physical activity, optimism and positive thinking. Caring for others was also identified as a novel protective factor. Values driven behaviour may have motivated some participants to optimise their pain management via active coping approaches.Conclusions and implications for practice: This study highlights protective factors that may contribute to resilience in chronic pain. Improved understanding of such factors may help with development of interventions to promote better adjustment to chronic pain conditions.

Relationship between symptom change, relapse activity and disability progression in multiple sclerosis

BackgroundSymptom changes may serve as a risk factor for relapse activity (RA) and disability progression (DP), which could facilitate multiple sclerosis (MS) treatment decisions. ObjectiveTo assess the relationship of symptom change with RA and DP. MethodsWe evaluated the relationship of symptom change with subsequent RA and DP using NARCOMS registry data reported over a five-year period. Symptom change was evaluated using both symptom worsening (SW) and average of Performance Scales (APS) scores. Disability progression was defined as a one-point or more increase in Patient-Determined Disease Steps (PDDS) score between two consecutive updates. Repeated measures logistic regression was used to investigate the relationship between symptom change and RA and DP. ResultsSW and APS were both significant predictors of subsequent RA and DP. Both SW and APS have a significant interaction with levels of disability (Mildly Impaired versus Highly Impaired) for the prediction of the subsequent RA or DP. For Mildly Impaired MS subjects, both SW and APS were significant predictors of both RA and DP. However, for Highly Impaired MS subjects, SW did not significantly predict future RA and neither SW nor APS predicted disability progression. ConclusionChanges in self-reported overall symptomatology may precede and predict clinical relapse and future disability progression. The predictive power of symptom changes may only be present at lower levels of disability.

EVASEP: A Noninterventional Study Describing the Perception of Neurologists, Patients, and Caregivers on Caregivers' Role in the Support of Patients Suffering from Multiple Sclerosis Treated with Subcutaneous Interferon Beta 1a.

Background. The perception of the role of caregivers for people with multiple sclerosis (MS) is important but poorly studied, particularly in patients with low levels of disability. Objectives. To describe the perceptions of the role of caregivers from the perspective of the caregiver, the patient, and neurologists. Methods. This observational study was conducted in France on patients with relapsing remitting MS treated with subcutaneous (SC) interferon-β-1a (IFN-β-1a) for more than 24 months. Results. Caregiver, patients, and neurologists all considered providing moral support and fighting against the disease as the most important role of the care provider. Moral support was considered significantly more important by caregivers than the patients and neurologists (p = 0.002) and caregivers considered their role in helping patients to fight disease more important than did the neurologists (p = 0.006). Knowledge of disease and available treatments were less important among support providers than patients (p = 0.007 and p = 0.001). Conclusion. There are many unmet needs in the perception of the role of caregivers for people with MS which need to be addressed to deliver the most effective care package for patients and to support the needs of the support provider.

Utility of the Six-Spot Step Test as a Measure of Walking Performance in Ambulatory Individuals With Multiple Sclerosis

ObjectiveTo examine the concurrent validity of the Six-Spot Step Test (SSST) with clinical measures of walking and spatiotemporal measures of gait in multiple sclerosis (MS), and to understand the utility of the SSST in individuals with both low and high levels of disability. DesignCross-sectional study. SettingLaboratory. ParticipantsIndividuals with relapsing-remitting MS (N=29). InterventionsNot applicable. Main Outcome MeasuresIn a single visit, demographic information (age, sex, Expanded Disability Status Scale [EDSS], symptom duration) and functional measures (SSST, timed Up and Go [TUG] test, timed 25-foot walk [T25FW] test, spatiotemporal measures of walking) were collected. ResultsThe SSST demonstrates concurrent validity with the TUG test, T25FW test, and 2-minute walk test (2MWT) (P≤.0002). Both spatial and temporal measures of gait are significantly related to SSST performance (P<.004). In individuals with lower disability (EDSS score 1–3.5), the SSST remains strongly related to the TUG test and T25FW test performances, whereas it fails to relate to any other measures. However, in the higher disability group (EDSS score 4–6), the SSST is significantly related to the TUG test, T25FW test, 2MWT, walk velocity, and both temporal and spatial measures of gait. ConclusionsThe SSST is an alternative test for lower-extremity function in the clinical setting that may useful in both higher and lower EDSS groups. The SSST requires minimal training to administer and may be a time-efficient measure of real-life functional performance that would be useful in large clinical trials.

The clinical profile of employees with mental health problems working in social firms in the UK

Background: UK social firms are under-researched but are a potentially important vocational option for people with mental health problems.Aims: To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems.Method: Clinical, work and service use characteristics were collected from social firms’ employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively.Results: Predominantly, social firms’ employees (N = 80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations.Conclusions: The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams.

Analysis of epidemiology, lifestyle, and psychosocial factors in patients with back pain admitted to an orthopedic emergency unit.

ABSTRACTObjective:To correlate epidemiological data, lifestyle, and psychosocial factors as predictors for clinical manifestation of back pain in patients treated at the orthopedic emergency unit of a Brazilian tertiary care hospital, and to evaluate their interest in participating in a hypothetical program for physical rehabilitation.Methods:This is an observational cross-sectional study. We evaluated 210 patients from the emergency department of a tertiary hospital with a major complaint of back pain. We used: epidemiological multiple-choice questionnaires developed for this study; Oswestry questionnaire for physical disability; Hospital Anxiety and Depression Scale (HAD) scale. Data analyses were performed using SAS - Statistical Analysis System (SAS Institute, 2001). Measurements were performed with the SAS functions Proc MEANS and Proc Freq.Results:The mean age was 39.1 years and there was no predominance between genders. The usual work activity was administrative (65.2% of cases). The mean body mass index was 26.0, indicating overweight. The majority (83.3%) of patients had low physical disability (Oswestry 0 – 40%). The number of medical visits in the previous 6 months (p=0.04) and the scores of anxiety and depression (p=0.05), independently, were correlated with physical disability. Most patients (77%) would agree to participate in a hypothetical program of physical rehabilitation for prevention of back pain.Conclusion:Patients with back pain complaints were predominantly young adults, sedentary or hypoactive, overweight, and with recurrent complaints of symptoms. Most participants had low levels of physical disability and would accept participation in a hypothetical physical rehabilitation program for the prevention of back pain.

Internet cognitive failure and fatigue relevant to learners' self‐regulation and learning progress inEnglish vocabulary with a calibration scheme

AbstractTo determine the factors of learning effectiveness inEnglish vocabulary learning when using a calibration scheme, this study developed a freshman English mobile device application (for iPhone 4) for students with low levels ofEnglish proficiency to practise vocabulary in the beginning of theirFreshmanEnglish course. Data were collected and validated from 243 subjects for confirmatory factor analysis and structural equation modeling. The findings revealed thatInternet cognitive failure (i.e., trait cognitive disability) was positively correlated to Internet cognitive fatigue (i.e., state cognitive disability). Both types of Internet cognitive disability were negatively correlated to self‐regulation in English vocabulary learning (SREVL).SREVLwas positively correlated to the degree of learning improvement. The findings implied that the use of a calibration design for mobile English vocabulary learning could benefit students with low levels of Internet cognitive disability but high levels ofSREVL.

Risk stratification of patients with low back pain seen in physical therapy practice

DesignA secondary analysis of a retrospective cohort was conducted using data obtained from a commercial outcomes database. ObjectiveTo identify predictive characteristics related to patients with lumbar impairments who have a high risk of a bad prognosis (lowest functional recovery compared to visit utilization) as well as those who are at low risk of a bad prognosis (highest functional recovery compared to visit utilization). BackgroundLumbar impairments are highly prevalent and routinely cause people to seek medical care, including physiotherapy. Most prognostic studies focus solely on good outcomes but do not factor in the intensity of care needed to achieve the outcome. Understanding care intensity needed per outcome achieved could help assign appropriate care quantities. MethodsData from 6379 patients with lumbar impairments were analyzed to determine predictive characteristics that identify patients who either have a low or high risk of a bad prognosis to physiotherapy care. Multinomial regression was used to identify significant patient characteristics predictive of treatment response. ResultsStatistically significant predictors for high risk categorization included older age, longer duration of symptoms, surgical history, current use of medications, lower levels of disability at baseline, and insurance categorization. Statistically significant predictors of low risk categorization included younger age, male gender, shorter duration of symptoms, no surgical history, higher levels of disability at baseline, and insurance status. ConclusionSelected variables were associated with both poor and good recovery. Further research on prognosis, efficacy of physiotherapy care, and cost appear warranted for patients with lumbar impairments.

Whiplash: are you at risk for ongoing pain or disability?

Have you recently sustained an injury and been diagnosed with whiplash or a whiplash-associated disorder? If so, you may be wondering what your recovery will be like. If health care providers could identify, soon after the initial injury, which patients would probably improve naturally over time and which ones would not, they could better manage the patient's treatment in the early stages of recovery. A study published in the April 2015 issue of JOSPT provides new insights into this challenge, which may help improve decision making for providers and outcomes for patients.

Low Pain Catastrophization and Disability Predict Successful Outcome to Radiofrequency Neurotomy in Individuals with Chronic Whiplash.

Physical and psychological symptoms of individuals with chronic whiplash-associated disorders (WAD) are modulated by successful treatment with cervical radiofrequency neurotomy (cRFN). However, not all individuals respond to cRFN, and it is unknown which clinical features predict successful response to cRFN. This prospective cohort study investigated 53 individuals with chronic WAD (36 female, 17 male; mean age = 44.7 ± 10.9 (SD) years) who underwent cRFN. Predictor variables measured at baseline (prior to RFN) included self-reported pain (VAS), disability (NDI), post-traumatic stress symptoms (PDS), pain catastrophizing (PCS), and measures of sensory hypersensitivity (pressure and cold pain thresholds). The outcome measure was perceived Global Rating of Change (where scores ≥ 4 were classified as a successful response) 3 months post-cRFN. Univariate logistic regression demonstrated that lower levels of disability and pain catastrophizing were associated with successful response of cRFN (both P < 0.05). Multivariable logistic regression demonstrated that low levels of pain catastrophizing and disability remained significant predictors of a successful response to cRFN (both P < 0.05). Low levels of pain catastrophizing and disability independently predicted a successful response to cRFN in patients with chronic WAD.

Clinical-Epidemiological Profile Of Patients Living With Leprosy

Background: Leprosy is an infectious disease that is manifested in dermatological signs and symptoms and can interfere with activities of daily living. Objective: To describe the clinical and epidemiological profile of leprosy patients. Methods: A cross-sectional study was conducted with 41 patients diagnosed with leprosy, treated between 2011 and 2013. The SALSA scale was applied to check the limitations in activities of daily living and data were analysed quantitatively and statistically. Result: The patients were aged between 23 and 59 years, mostly male, with a high prevalence of tuberculoid leprosy, without co-morbidities and outpatient discharge. The SALSA scale score was relevant for individuals without limitations in domains such as mobility, self-care, work and dexterity. Conclusion: Patients have few limitations for carrying out their daily activities, as well as a low disability level.

Indicators of primary disability due to musculoskeletal and connective tissue diseases in Russian Federation and Volga federal district in 2011-2013

Aim. To distinguish the regularities for primary disability occurrence due to musculoskeletal and connective tissue diseases in Russian Federation and Volga Federal District in 2011-2013. Methods. Data copying, comparative analysis of indicators of primary disability due to musculoskeletal and connective tissue diseases in Russian Federation, and federal districts ranking by level of disability due to musculoskeletal and connective tissue diseases in 2011-2013 were performed. Results. Central Federal District of Russian Federation had a high level of primary disability due musculoskeletal and connective tissue diseases registered in 2011-2013. Southern, North-Caucasian and Volga Federal Districts had low levels of disability due to the same diseases. Among the subjects of the Russian Federation included in the Volga Federal District, high levels of primary disability due to musculoskeletal and connective tissue diseases in 2011-2013 were registered in the Kirov region (17.1-15.3-11.1 per 10 000 of the adult population), low levels of primary disability - in the Saratov region (4.1-3.4-3.5 per 10 000 of the adult population). Conclusion. The trend for reducing the primary disability in the Volga Federal District in 2011-2013 (6.6-6.3-5.9 per 10 000 of the adult population) indicates the success of regional rehabilitation programs for persons with disabilities.

Rasch Analysis of the Arabic Language Version of the Functional Disability Inventory.

It is important for the responsive and effective treatment of pediatric cancer patients that functional disability is successfully measured, but no measures of functional disability have been validated for use with Arabic-speaking children and adolescents. The purpose of this study was to examine the psychometric characteristics of the first Arabic translation of the Functional Disability Inventory (FDI). A methodological study limited to the secondary analysis of functional disability data on 62 pediatric patients in Lebanon using the rating scale model and WINSTEPS Rasch analysis software was used. Disordered responses to 4 FDI times suggest that the Arabic translation of the rating scale categories might need revision or supplementation with a visual analogue scale. The dimensionality of the FDI needs further exploration because principal component analyses of residuals suggested the presence of secondary and possibly higher order dimensions. Additional FDI items are needed to improve targeting if low levels of functional disability are demonstrated to be clinically important for patient assessment and pain management. The FDI-A is suitable for clinical assessment and for monitoring the outcomes of pain management in Lebanese pediatric cancer patients. Our findings support the construct validity of the FDI-A and acceptable reliability for the 15-item scale, Cronbach α .93 and .85 for 4 of the item subsets we examined. Rating scale categories and the dimensionality of the FDI-A require further examination. The clinical relevance of distinctions between levels of functional disability in children and adolescents with cancer pain remains to be established.

Screening for cervical cancer in women with disability and multimorbidity: a retrospective cohort study in Ontario, Canada.

People with disability, multiple chronic conditions or both may experience challenges in accessing primary care. We aimed to determine the association between appropriate cervical cancer screening and level of disability among women eligible for screening in Ontario and the influence of relevant sociodemographic and health-related variables, including level of morbidity (measured by number of chronic conditions), on screening. We used multiple linked databases, including 2 waves of the Canadian Community Health Survey (2005 and 2007/08). Of the 22824 women included in the study, 7600 reported some level of disability. We used Ontario Health Insurance Plan fee codes to identify appropriate cervical cancer screening. Compared with women without disability, women with disability were older, less educated, had lower income and had more chronic conditions (36.2% had at least 2 conditions v. 8.4% of women without disability). Women with no disability and no chronic conditions were more frequently screened appropriately than those with severe disability and 2 or more chronic conditions (64.5% v. 39.8%). In multivariable logistic regression analysis, age, rurality, education, marital status and household income were each independently associated with cervical cancer screening. There was a significant interaction between level of morbidity and level of disability. Women with a higher level of disability were less likely to be screened than women with lower level of disability as their level of morbidity increased. The rate of screening for cervical cancer is low among women with both disability and multimorbidity. Policymakers should note these results as they work toward improving cancer screening rates for an aging population with complex medical needs.

Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life?

In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability. This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score. Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability. Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.