Lower Levels Of Disability Research Articles

Long-Term Trajectories of Cognitive Disability Among Older Adults Following a Major Disaster

Older adults are at high risk for cognitive impairments following natural disasters, but the persistence of such effects is not well understood. To track older adults' postdisaster cognitive disability trajectories over a decade and examine associations of cognitive disability with disaster damage exposure. This prospective cohort study used predisaster baseline surveys conducted in August 2010 and 4 follow-ups approximately every 3 years until November 10, 2022. Invitations were mailed at baseline to all citizens 65 years or older in Iwanuma City, Japan, a coastal municipality significantly impacted by the 2011 Great East Japan Earthquake and Tsunami. A total of 1988 respondents who were cognitively independent (ie, without cognitive disability) before the disaster completed the 4 postdisaster cognitive assessments. Experiences of residential damage, worsening financial conditions, loss of loved ones, and disruption in health care services. A composite score quantified these experiences, with higher scores indicating greater overall damage. Cognitive disability level was assessed using a standardized in-home evaluation under a national long-term care insurance scheme. Trained investigators evaluated participants' activities of daily living, cognitive function, and presence of mental and/or behavioral disorders. Latent class growth analyses (LCGA) identified distinct cognitive disability trajectories. Primary outcomes consisted of inclusion in these trajectories. The analytic sample consisted of 1988 participants who were cognitively independent at baseline, with a mean (SD) age of 72.4 (5.4) years, of whom 1159 (58.3%) were female. LCGA identified 3 cognitive disability trajectories: high and gradual deterioration (277 [13.9%]; high levels of cognitive disability with increasing impairment over time), low and progressive deterioration (541 [27.2%]; low levels of cognitive disability with accelerated decline in cognitive function over time), and low and stable (1170 [58.9%]; low levels of cognitive disability that remained stable). In multinomial regression analyses with the low and stable trajectory serving as the reference, housing damage (adjusted odds ratio [AOR], 2.52; 95% CI, 1.26-5.04), worsening financial conditions (AOR, 1.83; 95% CI, 1.15-2.90), and disruption in health care services (AOR, 1.76; 95% CI, 1.03-2.99) were associated with high and gradual deterioration. Worsening financial conditions (AOR, 1.38; 95% CI, 1.01-1.90) and higher composite damage scores (AOR, 1.16; 95% CI, 1.01-1.34) were associated with low and progressive deterioration. These associations no longer remained after adjusting for postdisaster depressive symptoms. In this cohort study of older adults who survived the 2011 Great East Japan Earthquake and Tsunami, disaster-related exposures were associated with worse long-term cognitive disability trajectories. These findings could inform tailored interventions to preserve cognitive function in older disaster survivors.

Health, an ageing labour force, and the economy: Does health moderate the relationship between population age-structure and economic growth?

Abstract Research often suggests that population ageing will be detrimental for the economy due to increased labour market exits and lost productivity, however the role of population health and disability at older ages is not well established. Identifying whether the health of older people affects economic outcomes is challenging due to methodological issues. Using country-level panel data, we estimate the relationship between the size of the older working age population (aged 55-69) and economic growth across 180 countries from 1990 to 2017. We run models using annual data and 5-year moving averages of real per capita GDP growth as dependent variables. This enables us to quantify the gains in real per capita GDP growth associated with a healthy older working-age population on a country-by-country basis. The initial models confirm an inverse-U or hump-shaped relationship between population age groups and economic growth. In the 5 year average GDP growth model, the coefficient for the inverse of YLDs among 55-69 year olds is positive and significant at p < 0.01. The interaction term is significant at p < 0.001 in the same model. Across all countries, a 5% improvement in YLDs is associated with at minimum 0.3% predicted additional annual real per capita GDP growth. While a larger share of the older working-age population at ages 55-69 has historically been associated with slower real per capita GDP growth, low levels of disability in this age group can reduce or even eliminate these adverse economic effects. We consistently find a significant positive interaction between disability and the share of the population at ages 55-69, suggesting that adverse economic effects are amenable to policy intervention.

The Online Health Information-Seeking Behaviors of People Who Have Experienced Stroke: Qualitative Interview Study.

Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke. This study aims to explore the online health information-seeking behaviors of people who have experienced stroke and any related barriers or navigational needs. Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive-deductive approach. In the deductive analysis, responses were mapped to an online health information-seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework. A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information-seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants' online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports. People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support.

Impact of Musculoskeletal Pain on Health-Related Quality of Life Among Adults in Saudi Arabia.

Background Musculoskeletal pain (MSP) is widely recognized as a prevalent public health issue that affects individuals of various genders and age groups. The aim of this study is to assess the influence of musculoskeletal pain on the quality of life (QoL)of adult individuals living in Saudi Arabia. Method This is a cross-sectional study using an online-administered questionnaire that was distributed via online platforms in Saudi Arabia for the duration between January and August 2023. Three questionnaire instruments were used in this study. The 36-item Short Form Health Survey questionnaire (SF-36), The 5-level EQ-5D version (EQ-5D-5L), and Roland-Morris Disability Questionnaire. Binary logistic regression analysis was used to identify predictors of better QoL and having mild to moderate disability. Results A total of 8359 participants were involved in this study. The most commonly reported sites of musculoskeletal pain were the lower back, neck, and shoulder, accounting for 36.8% (n= 3072), 30.5% (n= 2549), and 30.1% (n= 2514), respectively. The mean pain score for the study participants was 4.3 (SD: 2.3), which indicates mild degree of pain. The median EQ-5D-5L index value for the study participants was 0.827 (0.756-1.00), which demonstrates a high quality of life. The mean SF-36 score for the study participants was 63.11 (17.4), which demonstrates moderate quality of life. The median Roland-Morris Disability score for the study participants was 1.00 (0.00-7.00), which demonstrates a low level of pain-related disability. Male gender, younger age (30-39 years), having higher education attainment, having higher monthly income (more than SAR 20000), and having lower BMI (less than 25.8 kg/cm2) were predictors of better QoL (p<0.05). Conclusion Musculoskeletal pain is a multifactorial condition influenced by structural, physical, psychological, social, lifestyle, and comorbid health elements. It ranges from acute to chronic pain and, despite rarely being fatal, has a significant impact on QoL. Musculoskeletal discomfort varies in terms of intensity, affected regions, and demographic and lifestyle factors. This study sheds light on the multifaceted nature of MSP, its impact on QoL, and the significance of early intervention and individualized management strategies to improve the QoLof those affected.

On the Move: Correlation of Impaired Mobility with Spatial Navigation Ability in Persons with Multiple Sclerosis.

Spatial navigation ability is essential for independent living, and it relies on complex cognitive and motor processes that are vulnerable to decline in persons with multiple sclerosis (pwMS). The role of mobility in the physical act of navigation has been well documented; however, its association with cognitive processing that supports efficient navigation and recall of the environment is unknown. This study examined the relation between clinical mobility function and spatial navigation ability in pwMS. In a clinical sample of 43 individuals with relapsing-remitting MS (MPDDS = 2; age 25-67 years), we assessed spatial navigation ability in a virtual Morris water maze that allowed for active search by controlling a joystick while seated at a computer, and subsequent free recall of environment details. Individuals with worse mobility (measured by slower forward and backward walking) traveled less efficient virtual navigation routes to the goal location and recalled fewer accurate details of the environment. A stratified analysis by disability revealed moderate-strong correlations for those with a low level of disability, and effects were attenuated in individuals with a high level of disability. Given that the virtual navigation task was performed while seated, evidence of any correlation with mobility suggests differences in navigation ability that cannot be ascribed to general walking impairment, and instead suggests a role for mobility impairment to modify cognitive processing supporting navigation in pwMS.

Low back pain knowledge and associated disability among nursing staff in Oman

BackgroundLow back pain is a prevalent issue worldwide, impacting all healthcare professionals, in particular nurses, and leading to disability. ObjectiveThis study aimed to explore the predictive contribution of demographic factors, the presence of LBP, and knowledge about LBP in forecasting the level of disability among nurses in Oman. MethodA cross-sectional study was conducted using a paper-based questionnaire comprising two valid tools: the Low Back Pain Knowledge Questionnaire and the Oswestry Low Back Disability Questionnaire. A total of 236 nurses working in two tertiary hospitals in Oman participated in the study. ResultThe findings indicate that 66.8% of nurses had low back pain. The low back pain knowledge score was 13.81(SD 4.42). The mean disability score was 9.13 (SD 8.56), indicating mild disability. There is a negative significant association between low back pain knowledge (r = -0.24, p < .004) and disability level. The low back pain presence was also significantly associated with disability level (t (233) = 4.606, p < .001). The results of the regression indicated the two predictors (i.e., knowledge level and low back pain) explained 13 % of the variation in nurses’ disability level [F (3,230) = 11.447, p = .01]. ConclusionLow back pain is prevalent among nurses in Oman, and it is associated with disability. Preventive strategies need to be implemented.

Does the Combination of Platelet-rich Plasma and Supervised Exercise Yield Better Pain Relief and Enhanced Function in Knee Osteoarthritis? A Randomized Controlled Trial.

Knee osteoarthritis is a leading cause of disability with substantial healthcare costs, and efficient nonsurgical treatment methods are still needed. Platelet-rich plasma (PRP) injections and exercise therapy are used frequently in clinical practice. Whether PRP or PRP combined with exercise is more effective than exercise alone is unclear. (1) Which treatment relieves knee osteoarthritis pain better: PRP alone, exercise, or PRP combined with exercise? (2) Does PRP alone, exercise, or PRP combined with exercise yield better results in terms of the WOMAC score, performance on the 40-m fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score? In this randomized, controlled, three-arm clinical trial, we recruited patients with mild-to-moderate (Kellgren-Lawrence Grade II or III) knee osteoarthritis with a minimum of 3 points on the 11-point numeric rating scale for pain. During the study period, 157 patients with a diagnosis of knee osteoarthritis were screened and 84 eligible volunteers were enrolled in the study. Patients were randomly allocated (1:1:1) into either the exercise group (28), PRP group (28), or PRP + exercise group (28). Follow-up proportions were similar between the groups (exercise: 89% [25], PRP: 86% [24], PRP + exercise: 89% [25]; p = 0.79). All patients were analyzed in an intention-to-treat manner. There were no between-group differences in age, gender, arthritis severity, and baseline clinical scores (pain, WOMAC, functional performance tests, and health-related quality of life). The exercise group underwent a 6-week structured program consisting of 12 supervised individual sessions focused on strengthening and functional exercises. Meanwhile, the PRP group received three weekly injections of fresh, leukocyte-poor PRP. The PRP + exercise group received a combined treatment with both interventions. The primary outcome was knee pain over 24 weeks, measured on an 11-point numeric rating scale for pain (ranging from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2). The secondary outcome measures included the WOMAC index (ranging from 0 to 100, with lower scores indicating a lower level of disability and an MCID of 12), the durations of the 40-meter fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score. For the a priori sample size calculation, we used the numeric rating scale score for pain at 24 weeks as the primary outcome variable. The MCID for the numeric rating scale was deemed to be 2 points, with an estimated standard deviation of 2.4. Based on sample size calculations, a sample of 24 patients per group would provide 80% power to detect an effect of this size between the groups at the significance level of p = 0.05. We found no clinically important differences in improvements in pain-defined as ≥ 2 points of 10-at 24 weeks when comparing exercise alone to PRP alone to PRP + exercise (1.9 ± 0.7 versus 3.8 ± 1.8 versus 1.4 ± 0.6; mean difference between PRP + exercise group and exercise group -0.5 [95% confidence interval -1.2 to 0.4]; p = 0.69). Likewise, we found no differences in WOMAC scores at 24 weeks of follow-up when comparing exercise alone to PRP alone to PRP + exercise (10 ± 9 versus 26 ± 20 versus 7 ± 6; mean difference between PRP + exercise group and exercise group -3 [95% CI -12 to -5]; p = 0.97). There were no differences in any of the other secondary outcome metrics among the PRP + exercise and exercise groups. PRP did not improve pain at 24 weeks of follow-up in patients with mild-to-moderate knee osteoarthritis compared with exercise alone. Moreover, exercise alone was clinically superior to PRP alone, considering function and the physical component of health-related quality of life. Despite the additional costs and endeavors related to PRP products, the combination of PRP and exercise did not differ from exercise alone. The results of this randomized controlled trial do not support the use of PRP injections in the treatment of patients diagnosed with mild-to-moderate knee osteoarthritis. Consequently, exercise alone is the recommended treatment for reducing pain and enhancing function throughout this timeframe. Level I, therapeutic study.

Reliability and Minimal Detectable Change for Respiratory Muscle Strength Measures in Individuals With Multiple Sclerosis.

The test-retest reliability and minimal detectable changes (MDCs) for respiratory muscle strength measures have not been determined in individuals with multiple sclerosis (MS). This study determined the test-retest reliability and MDCs for specific respiratory muscle strength measures, as well as their associations with health-related quality of life (HRQoL), disability, dyspnea, and physical activity level measures in this population. In addition, the study examined differences in respiratory muscle strength between different degrees of disability. Sixty-one individuals with MS attended 2 appointments separated by 7 to 10 days. Respiratory muscle strength was evaluated by maximal inspiratory and expiratory pressures (MIP/MEP), HRQoL by EuroQol-5D-5L (index and visual analog scale [EQ-VAS]), disability by the Expanded Disability Status Scale, dyspnea by the Medical Research Council scale, and physical activity levels by the International Physical Activity Questionnaire. Respiratory muscle strength measures had excellent test-retest reliability (ICC ≥ 0.92). The MDC for MIP is 15.42 cmH 2 O and for MEP is 17.84 cmH 2 O. Participants with higher respiratory muscle strength (MIP/MEP cmH 2 O and percentage of predicted values) had higher HRQoL ( r = 0.54-0.62, P < 0.01, EQ-5D-5L index; r = 0.30-0.42, P < 0.05, EQ-VAS); those with higher expiratory muscle strength (cmH 2 O and percentage of predicted values) had lower levels of disability ( r ≤ -0.66) and dyspnea ( r ≤ -0.61). There were differences in respiratory muscle strength between different degrees of disability ( P < 0.01; d ≥ 0.73). Respiratory muscle strength measures provide excellent test-retest reliability in individuals with MS. MDCs can be interpreted and applied in the clinical setting. Low respiratory muscle strength can contribute to a poor HRQoL; specifically, expiratory muscle strength appears to have the strongest influence on disability status and dyspnea.

Translation and validation of the multiple sclerosis walking scale 12 for the German population – the MSWS-12/D

BackgroundGait impairment is a relevant problem in persons with multiple sclerosis (pwMS). The Multiple Sclerosis Walking Scale 12 (MSWS-12) is a valid Patient Reported Outcome Measure (PROM) to evaluate walking ability in pwMS. The aim of this study was to provide a linguistically valid translation of MSWS-12 into German language (MSWS-12/D) and to evaluate its psychometric properties.MethodsThe MSWS-12 was translated in a process modified from guidelines for the cross-cultural adaption of PROMs, and a pre-test was applied in a small sample of 20 pwMS to evaluate comprehensibility and acceptance. Psychometric properties (floor and ceiling effects, internal consistency, construct validity) were then assessed in 124 pwMS seen at academic MS centers. Construct validity was evaluated against Expanded Disability Status Scale (EDSS) and maximum gait speed in the Timed 25-Foot Walk (T25FW).ResultsAlthough the sample covered a wide spectrum of symptom severity, the majority had rather low levels of disability (EDSS median 2.0) and 6.5% scored EDSS of 0. In this sample, MSWS-12/D showed floor effects (36% with score 0) and for internal consistency, a Cronbach’s alpha of 0.98 was calculated. MSWS-12/D score showed a relevant correlation to EDSS (ρ = 0.73) and T25FW speed (r=-0.72).ConclusionWe provide MSWS-12/D as a linguistically valid German version of MSWS-12. Psychometric properties (acceptance, floor and ceiling effects, internal consistency and construct validity) in pwMS were similar to those described for the original version. This indicates that MSWS-12/D can be applied as equivalent to the original version in German speaking pwMS. Results support the relevance of PROMs to capture patient perception of walking ability in addition to performance-based assessments such as maximum walking speed or maximum walking distance.

Effectiveness of teriflunomide on No Evidence of Disease Activity and cognition in relapsing remitting multiple sclerosis: results of the NEDA3PLUS study.

Cognitive impairment (CI) is a prevalent and debilitating manifestation of multiple sclerosis (MS); however, it is not included in the widely used concept of No Evidence of Disease Activity (NEDA-3). We expanded the NEDA-3 concept to NEDA-3 + by encompassing CI assessed through the Symbol Digit Modality Test (SDMT) and evaluated the effect of teriflunomide on NEDA3 + in patients treated in a real-world setting. The value of NEDA-3 + in predicting disability progression was also assessed. This 96-weeks observational study enrolled patients already on treatment with teriflunomide for ≥ 24weeks. The predictiveness of NEDA-3 and NEDA-3 + at 48weeks on the change in motor disability at 96weeks was compared through a two-sided McNemar test. The full analysis set (n = 128; 38% treatment naïve) featured relatively low level of disability (baseline EDSS = 1.97 ± 1.33). NEDA-3 and NEDA-3 + statuses were achieved by 82.8% and 64.8% of patients, respectively at 48weeks vs. baseline, and by 57.0% and 49.2% of patients, respectively at 96weeks vs. baseline. All patients except one were free of disability progression at Week 96, and NEDA-3 and NEDA-3 + were equally predictive. Most patients were free of relapse (87.5%), disability progression (94.5%) and new MRI activity (67.2%) comparing 96weeks with baseline. SDMT scores were stable in patients with baseline score ˃35 and improved significantly in those with baseline score ≤ 35. Treatment persistence was high (81.0% at Week 96). Teriflunomide confirmed its real-world efficacy and was found to have a potentially beneficial effect on cognition.

Exploration of the Golf-Specific Low Back Pain Questionnaire.

The primary purpose of this study was to determine internal consistency and concurrent validity of the Golf-specific Low Back Pain questionnaire (GLBP). Cross-sectional study. Online questionnaire. Fifty-two adult golfers with a history of LBP. GLBP, Oswestry Disability Index (ODI). Cronbach alpha values for the GLBP and its 3 subscales. Pearson correlations between the ODI, GLBP, and the GLBP subscales. Cronbach alpha for the GLBP was 0.94. Cronbach alpha for the 3 GLBP subscales ranged from 0.85 to 0.91. All Pearson correlations were significant at P < 0.05. The correlation between the ODI and GLBP was -0.64, and correlations between the ODI and GLBP subscales ranged from -0.53 to -0.63. Mean GLBP score was 72.01% ± 16.15%, and mean ODI score was 12.00% ± 7.98%. The GLBP has excellent concurrent validity to quantify LBP in golfers. The GLBP total and each individual subscale have excellent internal consistency and a moderate inverse relationship with the ODI. The GLBP offers a more sport-specific patient-reported outcome measure for this population. The GLBP may more adequately quantify LBP-related disability, especially at lower levels of disability. Findings provide initial evidence that the GLBP may be a valid tool to quantify LBP symptoms and dysfunction in golfers. Clinicians should consider using sport-specific outcome measures when evaluating for LBP-related disability.

Self-reported restrictions in different life domains and associated factors among people with multiple sclerosis in Sweden.

The heterogeneous symptoms of multiple sclerosis (MS) can considerably impact the lives of people with MS (PwMS). The aim of this study was to describe the extent of restrictions in different life domains that PwMS experience in relation to their symptoms and level of disability. A cross-sectional survey was conducted among working-age PwMS in Sweden. The 4052 participants who answered the questions on restrictions in work and private life domains (family, leisure activities, and contact with friends/acquaintances) were included. Predictors of restrictions in the four domains were determined through multinomial logistic regression. Approximately one-third of the PwMS reported no restrictions in the domains of work (35.7%), family (38.7%), leisure activities (31.1%) or contact with friends/acquaintances (40.3%), the remaining participants reported moderate to severe restrictions. Tiredness/fatigue was the most commonly reported most-limiting symptom (49.5%). PwMS with Expanded Disability Status Scale (EDSS) scores of zero reported restrictions in life domains ranging from 39.6% (friends/acquaintances) to 45.7% (leisure activities). Age, sex, education, type of living area, MS type, type of most-limiting symptom, and EDSS score predicted restrictions in work and private life domains. Most PwMS reported similar levels of restrictions in both their work and private lives. Restrictions in these life domains were also reported by PwMS with low disability levels (EDSS = 0) and were often associated with invisible symptoms such as fatigue. Even in a contemporary MS cohort, close to 90% of PwMS report limitations due to MS.

THE IMPACT OF DIFFERENT PATTERNS OF HOME- AND COMMUNITY-BASED SERVICES AND FACTORS ON MULTIDIMENSIONAL UNMET NEEDS

Abstract Background Long-Term Care (LTC) in Taiwan has been implemented over the last 15 years, focusing on providing home- and community-based services (HCBS). Previous studies have shown that care recipients’ level of unmet needs is associated with adverse health outcomes. This study aimed to identify HCBS use patterns among LTC care recipients and examine the impact of different patterns of HCBS on unmet needs. Methods Surveys of service users were conducted in eight counties. Latent class analysis was used to identify the underlying subgroups of LTC recipients. Multiple regression analysis was used to assess the impact of HCBS patterns and care recipients’ predisposing, enabling, and need factors on the level of unmet needs. Results A total of 952 participants from northern, middle, and southern Taiwan completed the surveys. Three subgroups based on HCBS use were identified, including home-based personal care (HB-PC), home-based personal care and medical care (HB-PC/MC), and community care (CC). Care recipients in the HB-PC group (β = −1.922, p = 0.028) and the CC group (β = −2.177, p = 0.019) had lower unmet needs than those in the HB-PC/MC group. A lower disability level, living in a highly urbanized city, and lower levels of quality of life were associated with higher unmet needs (p &amp;lt; 0.05). Conclusions Our results demonstrating that care recipients with lower disability levels had higher unmet needs may indicate insufficient funding support from Taiwan’s LTC plans. However, multiple service users had high unmet needs, which warrants further investigation.

Physical activity, fear avoidance beliefs and level of disability in a multi-ethnic female population with chronic low back pain in Suriname: A population-based study.

Chronic low back pain (CLBP) is an important cause for reduced daily physical activity (PA) and loss of quality of life, especially in women. In Suriname, a middle-income country in South America, the relationship between PA and CLBP is still unknown. To assess the level of PA in women with CLBP of different ethnicity, and to identify whether fear avoidance beliefs (FAB), disability, co-occurring musculoskeletal pain sites and various sociodemographic and lifestyle factors were associated with self-reported PA. A cross-sectional community-based house-to-house survey was conducted between April 2016 and July 2017. The survey followed the Community Oriented Program for Control of Rheumatic Diseases methodology. Selection criteria were being female of Asian-Surinamese, African-Surinamese or of Mixed ethnicity and aged 18 or older, living in an urban area, and reporting CLBP. Data was collected on PA, FAB, disability, co-occurring musculoskeletal pain sites, CLBP intensity and sociodemographic and lifestyle factors. Urban adult women with current CLBP (N = 210) were selected. Nearly 57% of the population met the WHO recommendation on PA, with work-related PA as the largest contributor to total self-reported PA. Most women showed low FAB scores (FABQ-Work ≤34 (96.2%) and FABQ-PA ≤14 (57.6%)) and low disability levels (Oswestry Disability Index ≤20 (62.4%)). An inverse association between total PA and FABQ-Work (OR = 0.132, CI: 0.023; 0.750) was found. In contrast, total PA had a significant, positive association with disability (OR = 2.154, CI: 1.044; 4.447) and workload (OR = 2.224, CI: 1.561; 3.167). All other variables showed no association with total PA. This was the first study in Suriname reporting that 43.3% of urban adult women with CLBP were physically inactive. Total self-reported PA is influenced by FABQ-Work, average to heavy workload and moderate to severe disability. In this study, PA-Work was the major contributor to total PA. Therefore, future longitudinal studies should evaluate different types and aspects of PA in relation to CLBP management.

발달장애인의 장애정도가 생활만족도에 미치는 영향: 재난 안전 인식의 매개효과

Based on 2020 “A Survey on the status of people with disabilities” conducted by Korea Institute for Health and Social Affairs, we identified 7025 development people with disabilities and selected 3820 from this sample, which was used in our study. Our findings can be summarized as follows. Firstly, we found statistical differences in the level of developmental disability and disaster safety across gender, age, self-reported income percentiles, and education. Meanwhile, the difference in life satisfaction was only found in age, reported income percentiles, and education. We also found that men and those between the ages of 30 and 40 were more likely to have a positive view of disaster safety. While those that were self-reported to be part of the upper-income percentile have a more positive view of disaster safety. Meanwhile, the level of education was positively correlated with disaster safety. Secondly, we found that the level of developmental disability has a statistically significant association with life satisfaction. That is, a lower level of developmental disability suggested a higher level of life satisfaction. Thus, both the level of developmental disability and disaster safety had a positive association with life satisfaction. We also found that the low level of developmental disability is positively correlated with disaster safety and that disaster safety is positively correlated with life satisfaction. Meanwhile, the relative effect of disaster safety on life satisfaction was higher than that of the level of developmental disability. Thirdly, we found that the level of developmental disability has a direct effect on life satisfaction and that disaster safety mediates its effect on life satisfaction. That is, those that were reported to have high disaster safety tend to have higher life satisfaction. Our findings provided a few implications regarding the disaster safety of persons with a developmental disability.

Interpersonal Communication with the Deaf in the Metaverse Age

Tanjung Selamat Village is one of the villages located in Sunggal District, Deli Serdang Regency, Nort Sumatra Province, Indonesia. According to data from the Tanjung Selamat Village population census, this village is a village with a low level of disability. There are only 0.001% of the total population with disabilities. However, technological advancements in the village have advanced, the community is familiar with the term metaverse, thia Cn be seen from the number of internet users in the village because the internet is part of the metaverse. The goal of this study was to determine the evolution of metaverse use for deaf people. This study combines descriptive research with an observational approach to provide a comprehensive picture of deaf people's use of the metaverse. This study included four participants: the village head of Tanjung Selamat Village, two people deaf and their families who are natives the village of Tanjung Selamat, and one metaverse user who are in the city of Medan. According to the findings of this study, the deaf in Tanjung Selamat Village have not been able to use metaverse to facilitate communication, but the seeds of technological progress have been used by the deaf, as evidenced by their use of an application to send messages as an easy way to communicate. On the other hand, there is great hope that technological advancements, particularly the metaverse, will reach all corners of the globe and be put to good use.

Six-Minute Walk as a Measure of Walking Capacity and Endurance in Patients With Pediatric-Onset Multiple Sclerosis.

Despite low levels of disability, youth with pediatric-onset multiple sclerosis (POMS) engage in less physical activity compared with peers. The contribution of walking capacity, endurance, behavior, and MS comorbidities remains relatively undefined and may provide valuable insights into the limitations toward physical activity in youth with MS. The primary objective of this study was to investigate differences in walking capacity, endurance, and real-world behaviors of daily activity between youth with POMS and controls. Youth diagnosed with MS prior to 18 years and aged 21 years or younger were recruited in addition to healthy controls. Participants completed questionnaires to quantify fatigue, depression, and physical activity levels and the timed 2- and 6-minute walk (6MW) as an assessment of walking capacity and endurance. Participants completed questionnaires to quantify fatigue, depression, and physical activity levels. Participants also completed the timed 2- and 6-minute walk (6MW) as an assessment of walking capacity and endurance and were sent home with a waist-worn accelerometer to assess real-world walking behavior. Forty-five patients with POMS and 85 control participants were enrolled. The POMS cohort had a mean age of 16.9 ± 2.7 years, with a mean disease duration of 2.8 ± 2.6 years. A greater proportion of the POMS cohort was overweight/obese compared with controls (75% vs 33%). Participants with MS walked a significantly shorter distance in 6 minutes compared with controls (1,848 feet vs 2,134 feet, p < 0.0001) and, unlike controls, were unable to accelerate to their peak speed at the end of the 6MW. Body mass index category and MS disease significantly affected 6MW performance. Using continuous accelerometry, participants with MS spent less time in moderate-to-vigorous physical activity compared with controls (20.4 vs 35.4 min/d, p = 0.0003). The POMS cohort reported significantly higher levels of depression and fatigue but self-reported similar levels of daily physical activity as controls. Youth with POMS exhibit slower 6MW performance and less daily engagement in moderate-to-vigorous physical activity, suggesting limitations in functional walking capacity, endurance, and daily activity behavior. Limitations in walking endurance and capacity are most prominent in those youth who are overweight/obese and living with MS. This study provides Class III evidence that, compared with healthy controls, patients with POMS walk shorter distances on the 6MW test, are less able to accelerate to peak speed at the end of the test, and are less physically active.

Community reintegration of people with traumatic brain injury in South Africa

ABSTRACT Background Traumatic brain injury (TBI) affects cognitive, behavioral and physical function, influencing community reintegration. Objectives To describe the level of community reintegration and the associated influencing factors post-TBI in South Africa. Methods A cross-sectional analysis of patients living with TBI was done, using the Community Integration Questionnaire (CIQ), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Quality of Life after Brain Injury Overall Score (QOLIBRI-OS). Results Of the 80 participants 54.0% presented with mild TBI. The median (IQR) score of the CIQ, WHODAS 2.0 and QOLIBRI-OS was 22 (7.5)/29, 31(18)/100 and 73 (45.5)/100. There was a moderate inverse relationship between the WHODAS 2.0 and CIQ scores (r = −0.68; p < 0.001) and a moderate positive correlation between the QOLIBRI-OS and CIQ scores (r = 0.54; p < 0.001). The WHODAS 2.0 scores also showed a strong inverse correlation with the QOLIBRI-OS scores (r = −0.76; p < 0.001). Conclusion The participants had high levels of functioning and low levels of disability, both of which were found to be in tandem with high CIQ scores and generally good quality of life. Post-TBI patients are capable of achieving good community integration provided they attain high levels of functioning.

Evidence for validity of the Swedish self-rated 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in patients with mental disorders: a multi-centre cross-sectional study using Rasch analysis

BackgroundThe World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic instrument for the assessment of functioning in six domains, resulting in a total health-related disability score. The aim of this study was to investigate the psychometric properties of the Swedish-language version of the self-rated 36-item version in psychiatric outpatients with various common psychiatric diagnoses using Rasch analysis. A secondary aim was to explore the correlation between two methods of calculating overall scores to guide clinical practice: the WHODAS simple (summative) model and the WHODAS complex (weighted) model.MethodsCross-sectional data from 780 Swedish patients with various mental disorders were evaluated by Rasch analysis according to the partial credit model. Bivariate Pearson correlations between the two methods of calculating overall scores were explored.ResultsOf the 36 items, 97% (35 items) were within the recommended range of infit mean square; only item D4.5 (Sexual activities) indicated misfit (infit mean square 1.54 logits). Rating scale analysis showed a short distance between severity levels and disordered thresholds. The two methods of calculating overall scores were highly correlated (0.89–0.99).ConclusionsThe self-administered WHODAS 2.0 fulfilled several aspects of validity according to Rasch analysis and has the potential to be a useful tool for the assessment of functioning in psychiatric outpatients. The internal structure of the instrument was satisfactorily valid and reliable at the level of the total score but demonstrated problems at the domain level. We suggest rephrasing the item Sexual activities and revising the rating scale categories. The WHODAS simple model is easier to use in clinical practice and our results indicate that it can differentiate function among patients with moderate psychiatric disability, whereas Rasch scaled scores are psychometrically more precise even at low disability levels. Further investigations of different scoring models are warranted.

Real-life evidence of treatment with alemtuzumab in patients diagnosed with relapsing-remitting multiple sclerosis in Colombia

Physical disability, cognitive impairment, depression, and fatigue are poorly understood in Latin American patients with multiple sclerosis following alemtuzumab infusion. To describe Sustained changes in physical disability in an average 22-month follow-up period after alemtuzumab infusion, and which demographical or clinical variables modulate change in EDSS, and adverse events, changes in cognition, fatigue, and depressive symptoms after an average 15-month follow-up period. Retrospective cohort observational study. Following the review of medical records, 23 patients with Relapsing Remitting Multiple Sclerosis treated with alemtuzumab were identified; of these, 17 had a baseline neuropsychological assessment and 12 had at least one follow-up neuropsychological assessment. Most of the patients presented a low level of physical disability, depression, fatigue, and cognitive impairment, which was more pronounced in the processing speed and visuospatial memory at baseline. Fifteen of 23 (65.2%) of patients showed disability improvement, 7 (30.1%) patients remained stable, and 1 (4.3%) patient worsened, and change was not influenced by age or baseline disability score. Twenty (87%) patients remained free of clinical relapses. Performance improved on the BVMT-R visual memory test, 9 (75%) remained stable or improved on the BICAMS, and 66.6% perceived decreased fatigue on the d-FIS. Adverse events occurred in 7 (30.1%) of patients, the most common were opportunistic infections in 2 (8.6%) patients, and one 29-year-old patient presented papillary thyroid carcinoma after infusion of the second course of alemtuzumab. Results suggest that treatment with alemtuzumab has a beneficial impact on disability, cognitive impairment, and perception of fatigue. The percentage and type of adverse events observed in the cohort are similar to those reported for other real-life studies.