Rates Of Functional Limitations Research Articles

Functional Limitations and Gender Differences

Rates of functional limitations are consistently higher for women than for men, but it is not clear why. While some studies have examined individual risk factors, others have turned to broader social characteristics. We examined the effects of both individual and neighborhood characteristics associated with the functional limitations of older men and women. Multilevel structural equation models were developed using data from a random digit dial sample of 5,688 adults aged 50 to 74 years living in New Jersey. We found that greater numbers of fast-food restaurants, storefronts, and supermarkets was associated with more functional limitations of women, while greater numbers of fast-food restaurants was the only neighborhood characteristic associated with more functional limitations of men. Functional limitations of women, but not men, are affected by multiple neighborhood characteristics. This research reveals that specific neighborhood contextual characteristics, not just poverty, are associated with the health of community-dwelling adults.

Prospective study of iliac crest bone graft harvest site pain and morbidity

Background context Morbidity associated with autologous bone graft harvest is an important factor in determining the utility of expensive alternatives such as recombinant bone morphogenic protein. The most frequently reported complication associated with graft harvest is chronic pain. Purpose To prospectively determine the degree of pain and morbidity associated with autologous iliac crest bone graft harvest and its effect on activities of daily living. Study design Prospective observational cohort study. Patient sample One hundred ten adult patients undergoing elective posterior lumbar spinal fusion surgery involving autologous iliac crest bone graft harvest. Outcome measures Patient self-reported Visual Analog Scale (VAS) scores for pain and a study-specific questionnaire regarding activities of daily living. Methods One hundred ten patients were prospectively enrolled. Postoperative VAS scores (0–100) for harvest site pain were obtained at 6-week, 6- and 12-month follow-up. Patients completed a 12-month questionnaire regarding the persistence of specific symptoms and resulting limitation of specific activities. Results One hundred four patients were available for 1-year follow-up. Mean VAS pain scores (scale 0–100) at 6 weeks, 6 and 12 months were 22.7 (standard deviation [SD], 25.9), 15.9 (SD, 21.5), and 16.1 (SD, 24.6), respectively. At 12 months, 16.5% reported more severe pain from the harvest site than the primary surgical site, 29.1% reported numbness, and 11.3% found the degree of numbness bothersome, whereas 3.9% were bothered by scar appearance. With respect to activity limitations resulting from harvest site pain at 1 year, 15.1% reported some difficulty walking, 5.2% with employment, 12.9% with recreation, 14.1% with household chores, 7.6% with sexual activity, and 5.9% irritation from clothing. Conclusions There is a significant rate of persistent pain and morbidity from iliac crest bone graft harvest when associated with elective spine surgery. Mean pain scores progressively decline over the first postoperative year. Nevertheless, harvest site pain remains functionally limiting in a significant percentage of patients 1 year after surgery. Rates of functional limitation are higher than previously reported and may be because of increased sensitivity of the prospective study design and targeted investigation of these specific symptoms. Validity of these findings is necessarily limited by patient ability to discriminate harvest site pain from alternative sources of back and buttock pain.

Are Rates of Functional Limitations Associated with Access to Care? A State-Level Analysis of the National Survey of Children with Special Health Care Needs

Health-related services and compensatory mechanisms have a potential role in minimizing functional limitations and increasing quality of life among children with special health care needs (CSHCN). We examined whether rates of functional limitations among CSHCN in the 50 states and District of Columbia were associated with state-level characteristics that reflect access to such services among CSHCN. We aggregated child-level survey data from the National Survey of CSHCN to create 51 state-level estimates of the proportions who had functional limitations, had >/=1 unmet health needs, and lacked medical insurance coverage. State-level information about Medicaid spending per child enrollee in federal fiscal year 2000 was obtained from The Henry J. Kaiser Family Foundation website. We examined correlations between the percentages of CSHCN having functional limitations and each of the other state-level variables, and conducted multiple regression analyses that examined these associations while controlling for the statewide percentages of children living in poverty. The proportions of CSHCN with functional limitations were higher in states with higher rates of uninsured CSHCN (r = .49; p < .0001) and higher rates of CSHCN with unmet health needs (r = .62; p < .0001). Proportions of CSHCN with functional limitations were unrelated to per child Medicaid spending. These findings were robust when we controlled for percentages of children in poverty across states. Fewer unmet needs for health-related services are associated with lower statewide rates of functional limitations in CSHCN. As health care costs increase and state revenues decrease, CSHCN are at increasing risk of losing access to required services. Were this to happen we might expect an increase in the proportion of CSHCN who experience significant functional limitations. Thus, a key challenge is to provide CSHCN access to the amount and quality of health-related care they require to achieve their potential.

Orthotic Management of Children with Cerebral Palsy

The International Classification of Functioning, Disability and Health (ICF) distinguishes impairments of body structure from activity limitations and participation exclusions. By definition, the impairment known as cerebral palsy (CP) describes damage to the immature brain resulting in problems with balance, coordination, and movement. Understanding the effects of such a complex condition is a constant challenge to developing treatment regimens to improve the health of children with CP. A consensus for describing the primary neurological impairment has been presented by the group for the Surveillance of Cerebral Palsy in Europe (SCPE). The impact of skeletal growth during childhood can compound the primary problem if muscles fail to lengthen in proportion to their adjacent long bones. Therefore, although CP is by definition a static neurological lesion, the phenotype has also been labeled with the secondary impairment of a ‘progressive neuromuscular deformity.’ Children with CP are often limited in their activities because of primary and secondary impairments. A valid and reliable means of measuring functional limitations in children with CP is now possible using the Gross Motor Function Classification System (GMFCS) for children up to 12 years old. The GMFCS enables clinicians to describe the severity of a child’s functional limitations in one of five levels. Children in Level I are only mildly affected and can achieve most the activities of their age-matched healthy counterparts, with only modest qualitative differences. Conversely, children in Level V are the most limited in their activities and have little ability to control their head and trunk posture to counter the effects of the motor impairment and gravity. Rates of functional limitation in mobility, manual dexterity, speech, and vision, and to a lesser extent hearing and cognition, have been shown to correlate with GMFCS level.

Health status of school-aged children with cerebral palsy: information from a population-based sample.

In this study parents' systematic accounts of the health status of 408 school-aged children with cerebral palsy (CP) are reported (221 males, 187 females; mean age 8 years 5 months, SD 1 year 11 months; range 5 to 13 years), as are relations between severity of functional motor impairment and eight functional health status domains. Data were collected as part of a longitudinal study of the motor development of a population-based, stratified, random sample of children with CP from across Ontario, Canada. The Gross Motor Function Classification System (GMFCS) was used to classify severity of CP and functional health status was described with the eight-level Health Utilities Index-Mark 3. Rates of functional limitations in Mobility, Dexterity, Speech, and Vision were statistically significantly associated with GMFCS levels (all p<0.01), with correlation values (tau-b) of 0.82, 0.58, 0.46, and 0.36, respectively. Functional limitations in hearing (tau-b=0.16; p=0.04) and cognition (tau-b=0.27; p<0.01) were both statistically significantly associated with GMFCS levels, though correlations were low. Neither emotion (tau-b=0.03; p=0.24) nor pain (tau-b=0.07; p=0.37) was associated with degree of functional limitation as described by the GMFCS. Clinical and epidemiological implications of findings are discussed.

Health status of school‐aged children with cerebral palsy: information from a population‐based sample

In this study parents’systematic accounts of the health status of 408 school‐aged children with cerebral palsy (CP) are reported (221 males, 187 females; mean age 8 years 5 months, SD 1 year 11 months; range 5 to 13 years), as are relations between severity of functional motor impairment and eight functional health status domains. Data were collected as part of a longitudinal study of the motor development of a population‐based, stratified, random sample of children with CP from across Ontario, Canada. The Gross Motor Function Classification System (GMFCS) was used to classify severity of CP and functional health status was described with the eight‐level Health Utilities Index ‐ Mark 3. Rates of functional limitations in Mobility, Dexterity, Speech, and Vision were statistically significantly associated with GMFCS levels (all p&lt;0.01), with correlation values (tau‐b) of 0.82,0.58,0.46, and 0.36, respectively. Functional limitations in hearing (tau‐b=0.16; p=0.04) and cognition (tau‐b=0.27;p&lt;0.01) were both statistically significantly associated with GMFCS levels, though correlations were low. Neither emotion (tau‐b=0.03;p=0.24) nor pain (tau‐b=0.07;p=0.37) was associated with degree of functional limitation as described by the GMFCS. Clinical and epidemiological implications of findings are discussed.