Social Participation Restrictions Research Articles

Ambulatory Activity Components Deteriorate Differently across Neurodegenerative Diseases: A Cross-Sectional Sensor-Based Study

Background and Purpose: Reduced ambulatory activity is a major burden in neurodegenerative disease (NDD), leading to severe restrictions in social participation and further deterioration of motor capacities. However, objective evidence on walking behavior patterns and components underlying this impairment and its decline with disease progression is scarce for many NDDs. We aimed to unravel the detailed metrics underlying the reduced ambulatory activity in selected NDDs, and their relation to disease duration. We hypothesized that progressively reduced ambulatory activity is a feature shared across different NDDs, characterized by changes in both common and distinct components. Methods: Sixty-five subjects with NDD (n = 34 degenerative ataxia; n = 15 progressive supranuclear palsy, and n = 16 Parkinson's disease) and 38 healthy older adults (total n = 103) wore a three-axial accelerometer (activPAL3™) for 7 consecutive days. Detailed metrics of ambulatory activity were calculated. Results: The average daily walking duration was significantly decreased in all three NDDs, yet characterized by a differential pattern of changes in number and length of walking bouts and sit-to-stand transfers. Decline in walking duration progressed with increased disease duration in all three NDDs, yet at a differing rate. This decline was associated with progressive reductions in walking bout length and walking behavior pattern diversity in all three NDDs. Conclusions: These findings provide objective evidence that reduced ambulatory activity is a shared feature across different NDDs. Moreover, they reveal that several underlying walking behavior components change with increasing disease duration, yet at a differing rate in different NDDs. This indicates that metric analysis of ambulatory activity might provide ecologically relevant and disease-specific progression and outcome markers in several NDDs.

Social Participation and Health Related Quality of Life in Early and Established Rheumatoid Arthritis Patients

Social participation has been recognized as one of the key variables to be addressed in disability research yet few studies addressed the association between restriction in participation and quality of life in the context of rheumatoid arthritis. The aim of this study was to explore the associations between restrictions in social participation and health related quality of life (HRQoL) in early and established group of rheumatoid arthritis (RA) patients. Two samples with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76 % women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86 % women) RA patients were collected. Respondents completed questionnaires on pain (NHP), fatigue (VAS), functional disability (HAQ), depression (HADS), social participation restrictions (Participation scale) and health related quality of life (SF-36). Data were analyzed using stepwise regression models controlling for the relevant variables. Perceived social participation restrictions in the group of early patients were found to be negatively associated with the mental health component of the HRQoL (β = −0.192; p ≤ 0.05) and in the established RA group with the physical health component of the HRQoL (β = −0.271; p ≤ 0.001). These results generally suggest the importance of social participation with regard to HRQoL in RA.

Evaluation of dance therapy effects on gait pattern in patients with previous cerebrovascular events: Randomized study results from a single center

Aims: As stroke is a complex medical condition involving physical, psychological and cognitive impairments, and also causes restrictions in daily activities and social participation, its rehabilitation is very important, but challenging. Therefore, we aimed to investigate the effects of therapeutic dance programs on walking ability and balance in post-stroke patients, when combined with botulinum toxin A (BTX-A) injections and conventional rehabilitation program. Methods: A total of 51 post-stroke hemiplegic patients treated with BTX-A, who attended the conventional neurological rehabilitation program of the Physical Therapy and Rehabilitation Clinic of Kocaeli University Medical School between November 2014 and December 2015, were included in this prospective, randomized, single center study. Patients were randomized as 1:1 into adapted tango classes (n = 27) and control group (n= 24). Clinical and functional outcomes were evaluated by the Modified Ashworth Scale (MAS), BBS, and Timed Up and Go (TUG) tests. Results: Patients in the tango and control groups were well-matched in age, gender, and stroke side during randomization. There were statistically significant improvements in the tango group in MAS (p = 0.002), in TUG (p lessthan 0.001), and Berg Balance Scale (BBS) (p lessthan 0.001) when compared with the control group, respectively (p lessthan 0.001, p=0.042, p lessthan 0.001). Balance improvement was more prominent in the tango group than in the control group (p= 0.003). Conclusion: Partner adapted tango dance therapy accompanying BTX-A injections may improve postural balance in ambulatory post-stroke patients, who are treated with the conventional rehabilitation program.

Social participation in early and established rheumatoid arthritis patients

Purpose: The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients.Method: Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere–Terpstra test. Results: Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group. Conclusions: The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA.Implications for RehabilitationSupporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life.Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation.

The impact of depression and diabetes mellitus on older workers' functioning

ObjectiveUsing the International Classification of Functioning, Disability and Health as a framework, this study investigates the impact of depression and diabetes mellitus on older workers' functioning (problems with concentration, physical functioning, need for recovery and work and social participation restrictions). The study focuses on how these chronic conditions, in their interaction with the work context, affect older workers' functioning, which may be an important precursor of early retirement. MethodsOlder workers (≥45years) with depression (n=127) or diabetes mellitus (n=107) enrolled in the prospective Maastricht Cohort Study (MCS) were followed between October 2008 and October 2012. Linear, logistic and Cox regression analyses were performed to investigate the effect of these health conditions on workers' functioning compared to a reference group of older workers without a chronic condition (n=1612). The interaction with participants' working conditions (psychological job demands, decision latitude and strenuous work) was also analysed. ResultsCompared to the reference group, depression and diabetes mellitus were (over time) positively related with need for recovery caseness and restrictions in social participation but not with restrictions in work participation. Depression was positively related with concentration problems and need for recovery, whereas diabetes mellitus was negatively related with physical functioning. Finally, the relationship between functioning and depression and diabetes mellitus depends on working conditions. ConclusionOlder workers with depression or diabetes mellitus are vulnerable to losses in specific domains of functioning. The impact on functioning varies across working conditions, providing insight for disease-tailored preventive measures.

The Relationship between Online Social Networking and Offline Social Participation among People with Disability in Lithuania

People with disabilities are one of the targeted groups that have social participation restrictions due to the disabling barriers that exist in real world physical and social environments. Growing evidence from analyses of online social network site usage suggests that these sites could complement to and enhance people's networks of relationships present in the offline world by providing a platform for active communication between friends, acquaintances and other people in a network. However, it is important to know how people with disabilities self-assess online social networking as a means to overcome restrictions for social participation. The research objectives focused on the relationship between online social networking and offline social participation among people with motor, visual and hearing disabilities. The study aims to investigate the evaluation of the usefulness of social activity in OSN, types, frequency and motives of online social networks activity among people with disabilities and how it is related to their disability forms and the level of offline social participation restriction. For the purposes of the study a national representative survey of people with disabilities (18 years and older) who use social network sites, was conducted by Baltic Surveys Ltd, in June-July, 2014. Results of the statistical analysis showed that that evaluation of OSN as a facilitator of social involvement is quite high, but is only weakly positively correlated to offline participation. There are positive correlation between offline participation restrictions and motives to expand one‘s social network and to seek out people with similar disabilities. However, in Lithuania people with disabilities have a relatively not very high use of OSN as facilitated opportunities to compensate their offline participation restriction and to enhance their social capital.

Social participation after kidney transplantation as a predictor of graft loss and mortality over 10 years: a longitudinal study.

Social participation is considered to be an objective parameter for evaluating the success of transplantation. This study explores the association between posttransplant factors (kidney function, perceived side effects of immunosuppressive treatment, comorbidity, physical and mental health-related quality of life [HRQoL]) and social participation in patients 3 months to 6 years after kidney transplantation (baseline) and their impact on graft loss and mortality for up to 10 years (follow-up). At baseline, 331 patients provided their socioeconomic and medical data (comorbidity, kidney function) and completed the end-stage renal disease symptom checklist (perceived side effects), the Short Form Health Survey-36 and the Participation Scale. At follow-up, information on all-cause graft-loss and mortality was noted. Binary logistical regression exploring the effects of the independent variables on social participation and Cox regression analyses determining whether social participation predicted graft loss and mortality were performed. Restrictions in social participation were associated with living alone, poorer kidney function, lower perceived side effects of corticosteroids, higher perceived cardiac and renal dysfunction, higher perceived posttransplantation distress, lower physical HRQoL, and fewer working hours. Restrictions in social participation increased the risk of all-cause graft loss 2.29-fold and the risk of all-cause mortality 11.94-fold during follow-up. Education, kidney function, and comorbidity also increased the risk for poor patient outcome. Kidney function, perceived side effects, comorbidities, and HRQoL affect social participation in patients after kidney transplantation. Additionally, social participation has a positive effect on long-term patient outcomes, decreasing the odds of graft loss and mortality over 10 years.

Correction: Persisting Social Participation Restrictions among Former Buruli Ulcer Patients in Ghana and Benin

Correction: Persisting Social Participation Restrictions among Former Buruli Ulcer Patients in Ghana and Benin

Persisting Social Participation Restrictions among Former Buruli Ulcer Patients in Ghana and Benin

BackgroundBuruli ulcer may induce severe disabilities impacting on a person's well-being and quality of life. Information about long-term disabilities and participation restrictions is scanty. The objective of this study was to gain insight into participation restrictions among former Buruli ulcer patients in Ghana and Benin.MethodsIn this cross-sectional study, former Buruli ulcer patients were interviewed using the Participation Scale, the Buruli Ulcer Functional Limitation Score to measure functional limitations, and the Explanatory Model Interview Catalogue to measure perceived stigma. Healthy community controls were also interviewed using the Participation Scale. Trained native interviewers conducted the interviews. Former Buruli ulcer patients were eligible for inclusion if they had been treated between 2005 and 2011, had ended treatment at least 3 months before the interview, and were at least 15 years of age.ResultsIn total, 143 former Buruli ulcer patients and 106 community controls from Ghana and Benin were included in the study. Participation restrictions were experienced by 67 former patients (median score, 30, IQR; 23;43) while 76 participated in social life without problems (median score 5, IQR; 2;9). Most restrictions encountered related to employment. Linear regression showed being female, perceived stigma, functional limitations, and larger lesions (category II) as predictors of more participation restrictions.ConclusionPersisting participation restrictions were experienced by former BU patients in Ghana and Benin. Most important predictors of participation restrictions were being female, perceived stigma, functional limitations and larger lesions.

The role of emotion regulation on social participation following stroke

Following stroke, individuals often experience reduced social participation, regardless of physical limitations. Impairments may also occur in a range of cognitive and emotional functions. Successful emotion regulation, which has been identified as important in psychological adaptation to chronic illness, is associated with better perceived psychological well-being and social functioning. However, there is little evidence about the effect of stroke on emotion regulation difficulties, and associated impact on important outcomes in recovery from stroke. The objectives were (1) to determine whether people who have had a stroke reported greater difficulties in emotion regulation than controls and (2) to establish whether emotion regulation difficulties relate to social participation. 75 stroke and 40 healthy participants completed measures of emotion regulation (DERS), social participation (Modified Functional Limitation Profile [mFLP], WHOQoL-Bref) and activity limitations (mFLP). Stroke participants were seen at the acute stage (63 days post-stroke) for Study 1 and 18 months post-stroke for Study 2. In Study 1, acute-stage stroke patients had significant impairments on impulse control, awareness of emotions, and strategies for emotion regulation. There was also evidence that emotion regulation difficulties (impulse control, awareness and clarity about emotions) were associated with social participation in the stroke sample, even after controlling for potential confounders. In Study 2, there was evidence that, in the chronic-stage post-stroke, difficulties with strategy and acceptance of emotions were associated with social participation restrictions. Whilst emotion regulation as a whole in the acute phase predicted social participation in the chronic phase of stroke, no one domain of emotion regulation was a significant predictor of social participation >1 year later. These results indicate that multiple aspects of emotion regulation are impaired following stroke, with implications for social participation and recovery. This research highlights the following important clinical implications: Following a stroke, emotion regulation can be immediately and persistently affected, with post-stroke individuals experiencing greater difficulties with their emotion regulation than control participants. Emotion regulation can significantly predict important stroke outcomes including social participation and quality of life, over and above physical limitations and other post-stroke confounders. This study highlights the potential for developing a behaviour change intervention to address emotion regulation difficulties and thus ensuring individuals maximize their potential rehabilitation outcome. Cautions of the study for consideration: Emotion regulation was a self-report measure, and proxy measures would have been desirable. We are unable to establish if the post-stroke individuals differed from the controls on their emotion regulation prior to stroke.

Türkiye’de farkli engellere sahip çocuklarin annelerinin yaşam kalitesinin ve psikososyal destek ihtiyaçlarinin araştirilmasi: pilot çalişma

This study was planned to investigate depression, anxiety and quality of life (QoL) and psychosocial support needs of mothers have a child with disabilities. Forty mothers who have a child with 10 amputees, 10 cerebral palsy (CP), 10 mental retardation (MR), and 10 healthy children between 4-9 years of age participated in the study. Demographic information of children and mothers, time spend for caring and income level were determined. Nottingham Health Profile (NHP), Child Health Questionnaire Parent Form (CHQ-PF50), State-Trate Anxiety Inventory (STAI-I, STAI-II), and Hospital Anxiety and Depression Scale were used to determine QoL and psychological status of mothers. No differences were determined between the groups in terms of mothers and children age (p>0.05). When the groups were compared, differences in terms of STAI-I were found between amputee/CP and healthy groups (p 0.05), but depression scores were found different between amputee and healthy groups (p<0.05). Energy level and social isolation of NHP were found different against of amputees (p<0.05). Significant differences were found between all disability groups and healthy group in terms of physical functioning, general health perception and restrictions in role performance and social participation due to emotional status of the CHQ-PF50 (p<0.05). It was determined that QoL, anxiety, depression levels, and psychologies of the mothers who have disabled children were affected negatively. Therefore, to cope with these situations, they should be referred psychosocial support programs.

Auditory Rehabilitation Programmes for Adults: What Do We Know About Their Effectiveness?

Introduction and objectiveHearing loss ranks third among the health conditions that involve disability-adjusted life years. Hearing aids are the most commonly used treatment option in people with hearing loss. However, a number of auditory rehabilitation programmes have been developed with the aim of improving communicative abilities in people with hearing loss. The objective of this review was to determine the effectiveness of auditory rehabilitation programmes focused on communication strategies. Materials and methodsThis was a narrative revision. A literature search using PUBMED was carried out. This search included systematic reviews investigating the effectiveness of auditory training and individual and group auditory rehabilitation programmes with the main focus on counselling and communicative strategies for adults with hearing loss. Each study was analysed in terms of the type of intervention used and the results obtained. ResultsThree articles were identified: one article about the effectiveness of auditory training programmes and 2 systematic reviews that investigated the effectiveness of communicative programmes in adults with hearing loss. The “Active Communication Education” programme appears to be an effective group programme of auditory rehabilitation that may be used with older Spanish-speaking adults. ConclusionsThe utility of hearing aid fitting and communicative programmes as rehabilitation options are associated with improvements in social participation and quality of life in patients with hearing loss, especially group auditory rehabilitation programmes, which seem to have good potential for reducing activity limitations and social participation restrictions, and thus for improving patient quality of life.

Patterns of decline in upper limb function of boys and men with DMD: an international survey

With increasing life expectancy, upper extremity (UE) function becomes more and more important in boys with Duchenne muscular dystrophy (DMD). Knowledge of UE function in these children is, however, limited. The aim of this study was to gain insight into the changing patterns of UE function during the course of DMD. A Web-based questionnaire on UE function, covering all domains of the International Classification of Functioning Disability and Health, was distributed worldwide. Primary domains of the questionnaire were: participant characteristics, UE pain and stiffness, UE activities, and social participation. Data were described per disease stage and analyzed using descriptive analysis. A total of 213 boys/men with DMD (1-35 years) were included in this study. UE pain, stiffness, and activity limitations increased with disease stage. UE activity limitations already occurred in the early ambulatory stage. Compared to the healthy population, social participation was restricted in DMD patients and about 70% of the respondents experienced UE limitations when performing social activities. Despite the existence of UE impairments, only 9% of the respondents used supportive aids. Functional capacities and activities of the UE are limited already in the early ambulatory stage of patients with DMD affecting their social participation. Therefore, clinicians should pay attention to UE limitations before DMD patients lose their capacity to walk. Effective and adequate aids as well as attention for pain and stiffness in the therapeutic management could help to reduce UE activity limitations and related restrictions in social participation.

Programas de rehabilitación auditiva en adultos mayores, ¿qué sabemos de su efectividad?

Introduction and objectiveHearing loss ranks third among the health conditions that involve disability-adjusted life years. Hearing aids are the most commonly used treatment option in people with hearing loss. However, a number of auditory rehabilitation programmes have been developed with the aim of improving communicative abilities in people with hearing loss. The objective of this review was to determine the effectiveness of auditory rehabilitation programmes focused on communication strategies. Material and methodsThis was a narrative revision. A literature search using PUBMED was carried out. This search included systematic reviews investigating the effectiveness of auditory training and individual and group auditory rehabilitation programmes with the main focus on counselling and communicative strategies for adults with hearing loss. Each study was analysed in terms of the type of intervention used and the results obtained. ResultsThree articles were identified: one article about the effectiveness of auditory training programmes and 2 systematic reviews that investigated the effectiveness of communicative programmes in adults with hearing loss. The «Active Communication Education» programme appears to be an effective group programme of auditory rehabilitation that may be used with older Spanish-speaking adults. ConclusionsThe utility of hearing aid fitting and communicative programmes as rehabilitation options are associated with improvements in social participation and quality of life in patients with hearing loss, especially group auditory rehabilitation programmes, which seem to have good potential for reducing activity limitations and social participation restrictions, and thus for improving patient quality of life.

Limited activity and social participation after hospital discharge from leprosy treatment in a hyperendemic area in North Brazil.

Neural damages are among the main factors that contribute to physical disability in leprosy. Systematic monitoring using a broad physical, psychological and social approach is necessary. The objective of this study was to characterize the limitation of activity and social participation and its correlation with disabilities and/or impairment in individuals after being discharged from a multidrug leprosy therapy. A cross-sectional study conducted in Araguaína, state of Tocantins, which is a leprosy hyperendemic municipality. We included cases of patients who were discharged from treatment considered as cured from January 2004 to December 2009. We performed dermatological examination and applied the Screening Activity Limitation and Safety Awareness (SALSA) and social participation scales. We included 282 individuals (mean age: 45.8 years old). The paucibacillary operational classification was more common (170; 60.3%). The eye-hand-foot score ranged from 0 to 12 (mean: 0.7). A total of 84 (29.8%) individuals presented limited activity. A slight restriction in social participation occurred in 18 (6.3%) cases. There was a statistically significant correlation between activity limitation, age (r = 0.40; p < 0.0001) and degree of functional limitation (r = 0.54; p < 0.0001), as well as of restricted social participation, activity limitation (r = 0.56, p < 0.0001) and functional limitations (r = 0.54, p < 0.0001). Functional limitation due to leprosy had an impact on the conduct of activities and social participation after the discharge from a leprosy treatment. The association between Screening of Activity Limitation and Safety Awareness and participation scales will assist in designing evidence-based assistance measures.

Risk Factors of Posttraumatic Stress Disorder After an Earthquake Disaster

This study sought to predict posttraumatic stress disorder (PTSD) from women's reproductive health events after an earthquake experience. Data on antenatal care, pregnancy outcomes, family planning, socioeconomic status, earthquake experiences, and mental health were collected from a random sample of 425 women of reproductive age using the Centers for Disease Control and Prevention Reproductive Health Assessment Toolkit and the Harvard Trauma Questionnaire. Data were analyzed using multivariate regression analysis to predict PTSD symptoms from posttrauma care variables and reproductive health events. Restricted social participation, use of temporary accommodation, pregnancy complications, and use of injectable contraceptives were significant risk factors of PTSD. These factors may be exacerbated by the social context of conservative societies, traditions about health care-seeking behavior, and access to health care. Antecedent reproductive health events influence women's reaction to major trauma including events such as an earthquake.

Links between emotion perception and social participation restriction following stroke

Objectives: Stroke can cause impairment in emotion perception, but the social consequences of these problems have not been explored to date. In a group of patients with stroke, this study investigated whether difficulties in emotion perception related to social participation and quality-of-life. It also assessed whether these relationships remained significant when controlling for activity limitations.Method: Individuals 1 year post-stroke (n = 28) and control participants (n = 40) were assessed on emotion perception across different modalities. Activity limitations, social participation, and multiple domains of quality-of-life were assessed in patients.Results: Participants with stroke were impaired on emotion perception compared to controls. Emotion perception problems in stroke were significantly correlated with social participation and psychological aspects of QoL, but not with activity limitations.Conclusions: The strong relationships of emotion perception with social participation and psychological aspects of QoL following stroke may have implications for post-stroke outcomes.

The role of pain, physical disability, and reduced social participation in insomnia onset in community dwelling older adults: a prospective cohort study

BackgroundMost patients with chronic pain have insomnia that warrants clinical attention. This study examined the role of pain, physical disability, and reduced social participation in predicting and mediating insomnia onset in community dwelling older adults. Theories of pain-related insomnia identify activity dysregulation as a behavioural mechanism augmenting sleep disturbance. Participation in social and physical activities was hypothesised to be sleep promoting because engagement in activities generates sleep pressure and brings the exposure to light and stimulation that entrain the circadian rhythm. MethodsWe undertook a prospective cohort study based in North Staffordshire, UK (approved by the North Staffordshire Research Ethics Committee). 13 986 individuals aged at least 50 years were recruited from six general practices. 9457 respondents to the baseline questionnaire consented to further contact. 7230 completed responses were received at 3 years. Of these, 6676 had data at both timepoints and were used for the analysis. Pain was assessed by a body manikin. Participants were classified into no pain, regional pain, and widespread pain according to the American College of Rheumatology criteria of fibromyalgia, which count the number of reported pain sites. Insomnia was measured with the Jenkins sleep questionnaire. Mediators were physical disability and reduced social participation, respectively measured by the 36-item short form physical function subscale (PFS) and Keele Assessment of Participation (KAP). The association between baseline pain and insomnia onset at 3 years was examined with logistic regression among those who did not have insomnia at baseline. Path analysis was used to test the mediating role of physical disability and reduced social participation in the pain–insomnia relation. FindingsAt baseline, 1767 (26·5%) of 6676 participants had no pain, 3074 (46·0%) had regional pain, and 1835 (27·5%) had widespread pain. 491 (28·9%) of 1698 participants in the no pain group, 1814 (61·7%) of 2939 in the regional pain group, and 1515 (85·6%) of 1771 participants in the widespread pain group were moderately (50·1–84·9) or severely (0–50) disabled based on their PFS scores. 237 (13·4%) of 1767 of participants in the no pain group, 749 (24·3%) of 3074 in the regional pain group, and 766 (41·7%) of 1835 participants in the widespread pain group reported at least two social participation restrictions on the KAP. Regional pain (adjusted odds ratio 1·83, 95% CI 1·54–2·18) and widespread pain (2·86, 2·35–3·48) increased the risk of developing insomnia at 3 years, after adjustment for age, sex, social economic class, education attainment, anxiety, depression, and sleep at baseline. The combination of physical disability and reduced social participation explained up to 74% of the total effect of regional pain and 70% of the effect of widespread pain on insomnia onset. Probability weighted analyses to assess the effect of attrition suggested no differences in the reported association between the weighted and unweighted analyses. InterpretationThere was a dose–response association between the extent of pain at baseline and insomnia onset at 3 years. The effect of pain on subsequent insomnia onset was mediated by physical disability and reduced social participation. If these two factors are reasonable proxies of reduced engagement in activities, interventions that strengthen them in older adults with pain may buffer the risk of insomnia onset. These interpretations, however, are based on self-reported data and might not generalise to communities of different cultural and demographic characteristics. FundingThe study was supported by the Medical Research Council, UK (G9900220).

Social participation restriction among US adults with arthritis: a population-based study using the International Classification of Functioning, Disability and Health.

To examine arthritis impact among US adults with self-reported doctor-diagnosed arthritis using the International Classification of Functioning, Disability and Health (ICF) framework (including the impairments, activity limitations, environmental, and personal factors domains and social participation restriction [SPR] as the outcome) overall and among those with and without SPR, and to identify the correlates of SPR. Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of the ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated to identify the correlates of SPR. Analyses using SAS, version 9.2 survey procedures accounted for the complex sample design. SPR prevalence was 11% of adults with arthritis (5.7 million). After initial multivariable adjustment by ICF domain, serious psychological distress (impairments domain; PR 2.5 [95% CI 2.0-3.2]), ≥5 medical office visits (environmental domain; PR 3.4 [95% CI 2.5-4.4]), and physical inactivity (personal domain; PR 4.8 [95% CI 3.6-6.4]) were most strongly associated with SPR. A combined measure (key limitations [walking, standing, or carrying]; PR 31.2 [95% CI 22.3-43.5]) represented the activity limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were key limitations (PR 24.3 [95% CI 16.8-35.1]), ≥9 hours of sleep (PR 1.6 [95% CI 1.3-2.0]), and income-to-poverty ratio <2.00 and severe joint pain (PR 1.4 [95% CI 1.2-1.6] for both). SPR affects 1 of 9 adults with arthritis. This study is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas as priorities for intervention to reduce negative arthritis impacts on disability, including SPR. Increased use of existing clinical and public health interventions is warranted.

FRI0487-HPR Dilemmas of participation in everyday life in early rheumatoid arthritis (RA), a qualitative interview study (the swedish TIRA study)

BackgroundAn important perspective in research is the patients’ own experiences of how it is to live with RA, in terms of dilemmas and consequences in everyday life. Although there have...