Secondary Health Conditions Research Articles

Disability Inclusion in Primary Health Care in Nepal: An Explorative Study of Perceived Barriers to Access Governmental Health Services

Purpose: Persons with disabilities face additional barriers in accessing primary healthcare services, especially in developing countries. Consequently the prevalence of secondary health conditions is higher among this population. This study aims to explore the perceived barriers to access primary healthcare services by persons with disabilities in the Western region of Nepal. Methods: 10 primary healthcare providers and 11 persons with disabilities (physically or visually impaired) were selected by non-governmental organisations from the hilly and lower areas. Based on the International Classification of Functioning and the health accessibility model of Institute of Medicine, semi-structured interviews were conducted and analysed using analytical induction. Results: In general, healthcare providers and persons with disabilities reported similar barriers. Transportation and the attitude of family members and the community were the main environmental barriers . Even with assistive devices, people still depend on their families. Financial barriers were mainly reported, such as lack of funds for health expenses, problems in generating an income by persons with disabilities themselves, and the low socio-economic status of their families. Personal barriers, which affect help-seeking behaviour in a major way, were most often mentioned in relation to financial and socio-environmental barriers. Low self-esteem of the person with disability determines the family’s attitude and the motivation to seek out healthcare. Lastly, poor public awareness about the needs of persons with disabilities was reported. Conclusions: Besides the known physical environmental barriers, this study found several environmental, financial and personal barriers that also affect access to primary healthcare. In particular, the attitudes of families and poor financial conditions seem to be interrelated and greatly influence help-seeking behaviour. Implications: There is a definite need to educate primary healthcare providers who work at the community level about disability-related health conditions, and train them to diminish barriers to access health services. In addition, the government support system for persons with disabilities should be revised and implemented accordingly. Lastly, further research is needed to understand the interaction between the reported barriers that influence the inclusion of persons with disabilities in healthcare.

Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging.

This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging. A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables. The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS. Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.

An Exploratory Analysis of the Potential Association Between SCI Secondary Health Conditions and Daily Activities.

Secondary health conditions (SHCs) are common following traumatic spinal cord injury (tSCI) and are believed to influence a person's ability to participate in daily activities (DAs). This association should be understood so that health care providers may target interventions with clarity and purpose to manage SHCs and facilitate DAs to maximal effect. To explore the association between SHCs and DAs expressed as the increased chance of not participating as much as wanted in a DA when an SHC is present. Community-dwelling persons with tSCI (n = 1,137) responded to the SCI Community Survey. The occurrence and frequency of 21 SHCs were determined. The extent of participation in 26 DAs was measured. The relative risk (RR) of not participating as much as wanted in a DA when a SHC is present was calculated. When some SHC were present, the RR of not participating as much as wanted increased significantly (range, 15%-153%; P < .001). Certain SHCs (light-headedness/dizziness, fatigue, weight problems, constipation, shoulder problems) were associated with a greater chance of not participating in many DAs. No single SHC was associated with every DA and conversely not every DA was associated with an SHC. Maximizing participation in DAs requires minimizing SHCs in every instance. Understanding the association between SHCs and DAs may facilitate targeted care resulting in less severe SHCs, greater participation in DAs, and benefits to both the individual and society.

Health Care Utilization in Persons with Traumatic Spinal Cord Injury: The Importance of Multimorbidity and the Impact on Patient Outcomes

Persons with spinal cord injury (SCI) living in the community have high health care utilization (HCU). To date, the interrelationships among multiple secondary health conditions (multimorbidity due to comorbidities and complications) that drive HCU and their impact on patient outcomes are unknown. To determine the association among multimorbidity, HCU, health status, and quality of life. Community-dwelling persons with traumatic SCI participated in an online/phone SCI Community Survey. Participants were grouped using the 7-item HCU questionnaire (group 1 did not receive needed care and/or rehospitalized; group 2 received needed care but rehospitalized; group 3 received needed care and not rehospitalized). Personal, injury, and environmental factors; multimorbidity (presence/absence of 30 comorbidities/ complications); health status (Short Form-12); and quality of life measures (Life Satisfaction-11 first question and single-item quality of life measure) were collected. Associations among these variables were assessed using multivariate analysis. The 1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2 (n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary health conditions (15.14 ± 3.86) followed by group 2 (13.60 ± 4.00) and group 3 (12.00 ± 4.16) (P < .05). Multimorbidity and HCU were significant risk factors for having a lower SF-12 Mental (P < .001) and Physical Component Score (P < .001). They in turn were associated with participants reporting a lower quality of life (P < .001, for both questions). Multimorbidity and HCU are interrelated and associated with lower health status, which in turn is associated with lower quality of life. Future work will include the development of a screening tool to identify persons with SCI at risk of inappropriate HCU (eg, rehospitalization, not able to access care), which should lead to better patient outcomes and cost savings.

The Participation and Quality of Life (PAR-QoL) Tool-Kit: Outcomes and Next Steps

The selection process for an appropriate quality of life (QoL) outcome tool for persons with spinal cord injury (SCI) can be a challenge. To help address this issue, the Participation and Quality of Life (PAR-QoL) tool-kit (www.parqol.com) was developed as a web-based resource designed to support SCI researchers and clinicians with the QoL outcome measure selection process. The current paper provides an overview on the development of the PAR-QoL Tool-Kit, outcomes to-date, and planned next steps. Review. Toronto, ON; Quebec, QC. Not applicable. The PAR-QoL Tool-Kit, a web-based educational resource. Web-analytics. The PAR-QoL Tool-Kit provides information on over 60 QoL outcome measures, and summarizes which ones (a) have been used to assess specific secondary health conditions, (b) are sensitive to its impact, and (c) have appropriate psychometrics for the SCI.To help clarify QoL concepts, Dijkers (2005) model was used to classify each outcome measure to delineate if they assess an objective (i.e., societal) perspective of QoL or a subjective one (i.e., individual). To build a strong community of users, the site hosts a number of 'dynamic' features, which includes a monthly blog, news and events, newsletter, ask-an-expert spotlight, and forum.Between Apr. 2012 and Mar. 31, 2014, the website received 77,453 visitors (15% return visitors), with the largest groups of visitors originating from the U.S. (28.7%), U.K. (11.5%), and Canada (9.4%). Although analytics demonstrate that the PAR-QoL tool-kit is being accessed by a significant number of users across the world, further work is needed to identify strategies for effective implementation.

Predicting health preference in chronic spinal cord injury

Context/ObjectiveHealth preference values relate to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health). Health preference plays a key role in health economics and health policy, particularly in interpreting the results of cost-effectiveness studies, and supports the allocation of healthcare resources. The current study used elements of the International Classification of Functioning, Disability and Health (ICF) framework to predict health preference in persons with spinal cord injury (SCI).MethodsData were collected by telephone survey on (1) demographics, (2) impairment (etiology, neurological level of injury, and ASIA impairment scale), (3) secondary health conditions (SHCs) using the SCI-Secondary Conditions Scale-Modified, (4) functional abilities using the Spinal Cord Independence Measure (SCIM), and (5) health preference using the Health Utilities Index-Mark III (HUI-Mark III) among adults with chronic SCI. Variables were categorized according to ICF headings and hierarchical regression analyses were used to predict HUI-Mark III scores.ResultsAdults with chronic traumatic or non-traumatic SCI (N = 357) reported a mean health preference score of 0.27 (±0.27). In predicting health preference, our model accounted for 55.1% of the variance with “body functions and structure”, and “activity and participation”, significantly contributing to the model (P < 0.0001). In particular, older age, being employed, and having higher SCIM scores were positively associated with health preference. Conversely, a higher SHC impact score was associated with poorer health preference.ConclusionsVariables representative of “activity and participation” largely influence health preference among persons with chronic SCI, which may be amenable to intervention. These findings could be applied to advocate for health promotion and employment support programs to maximize well-being in persons aging with chronic SCI in the community.

Lifestyle interventions targeting changes in body weight and composition among youth with an intellectual disability: A systematic review.

Over the past three decades, the potential effects of lifestyle interventions targeting changes in body weight and composition (weight, body mass index, fat mass, waist circumference) among adults with an intellectual disability (ID) have been examined in various systematic reviews. Nevertheless, since the middle of the 1980s, the potential effects of these interventions for youth with an ID remain an open question. The purpose of this article is to review the effects of lifestyle interventions targeting changes in body weight and composition among youth with an ID. This review will focus on changes in body weight and composition, healthy lifestyle, and secondary health conditions. A systematic review of English- and French-language studies, published between 1981 and 2013, was performed on Academic Search Complete, PsycARTICLES, Medline and Scopus. The nine studies included in this review focused mainly on: a sample with a wide age range (e.g., 7-22 years); males; overweight-obese youth having a mild-to-moderate ID with Down or Prader-Willi syndrome; physical activity interventions; cohort pre- and post-test designs with/without a control group; and changes in body weight and composition. Taken together, results from these studies suggest successful changes in weight, body mass index and fat mass. However, intervention effects on healthy lifestyle and secondary health conditions are scarce and inconclusive. Given the weaknesses of the reviewed studies, the present findings should be considered preliminary and indicative of the need for future research.

Evaluation of an online health promotion program for vocational rehabilitation consumers.

The purpose of this study was to test the comparative effectiveness of three variations of an online-based health promotion program for improving health and employment outcomes in a sample of Vocational Rehabilitation consumers. A total of 222 VR consumers participated in a randomized trial of three health promotion variations and provided baseline, 2-, 4-, and 6-month data. Data were analyzed using repeated measures ANOVA. The three health promotion variations included (a) FACTSHEETS-a series of four electronic factsheets; (b) HPE-an online interactive health promotion website that included health behavior content and tailored action planning, and (c) HPE + MI-the online health promotion website plus two 30-minute calls with a trained motivational interviewer. Contrary to expectations, evidence did not support between-group differences based on intervention intensity. In fact, the Factsheet, HPE, and HPE + MI participants all experienced significant reductions in secondary conditions, F(2.85, 489) = 7.808, p < .001, HRQoL symptom days, F(2.7, 495) = 4.795, p = .004; and significant improvements in healthy lifestyle behaviors, F(2.6, 495) = 3.66, p = .017 over the 6-month study period. Although this study did not include a control group, a control group from another study with a similar population did not experience similar outcomes. People with disabilities experience significantly higher rates of secondary health conditions and lower employment rates than people without disabilities. The combination of these factors signifies the need for health promotion programming outside the work setting.

Barriers to and facilitators of sports participation for people with physical disabilities: a systematic review.

Most people with physical disabilities do not participate in sports regularly, which could increase the chances of developing secondary health conditions. Therefore, knowledge about barriers to and facilitators of sports participation is needed. Barriers and facilitators for people with physical disabilities other than amputation or spinal cord injuries (SCI) are unknown. The aim of this study was to provide an overview of the literature focusing on barriers to and facilitators of sports participation for all people with various physical disabilities. Four databases were searched using MeSH terms and free texts up to April 2012. The inclusion criteria were articles focusing on people with physical disabilities, sports and barriers and/or facilitators. The exclusion criteria were articles solely focusing on people with cognitive disabilities, sensory impairments or disabilities related to a recent organ transplant or similar condition. Fifty-two articles were included in this review, with 27 focusing on people with SCI. Personal barriers were disability and health; environmental barriers were lack of facilities, transport and difficulties with accessibility. Personal facilitators were fun and health, and the environmental facilitator was social contacts. Experiencing barriers to and facilitators of sports participation depends on age and type of disability and should be considered when advising people about sports. The extent of sports participation for people with physical disabilities also increases with the selection of the most appropriate sport.

An exercise trial targeting posterior shoulder strength in manual wheelchair users: pilot results and lessons learned

Purpose: Because wheelchair users are unable to use standard fitness equipment such as treadmills and bikes, we developed an upper body rowing ergometer (UBRE) that can be retrofitted onto a standard stationary cycle and used to perform a rowing exercise. We validated a graded exercise testing protocol utilizing the UBRE and completed a 12-week pilot intervention to compare the training effects of the UBRE to a standard arm cycle ergometer (ACE) in manual wheelchair users. Methods: Repeat graded exercise tests were compared on the two pieces of equipment. Twenty-seven manual wheelchair users participated in the intervention. Outcomes included pre- versus post-test change in shoulder pain, strength and cardiorespiratory fitness measures. Results: Testing results obtained with the UBRE were comparable to those on the ACE. In the exercise intervention, most outcome measures did not change significantly, but individuals assigned to the UBRE were able to increase their peak exercise test power by 31 W and duration by 3.6 min. Conclusion: There is biomechanical reason to believe that rowing exercises may improve shoulder muscle balance in this population, which could reduce the risk of impingement. This may be of benefit to manual wheelchair users, who are at high risk for shoulder injury.Implications for RehabilitationRegular exercise improves cardiorespiratory fitness and did not exacerbate shoulder pain in this group of manual wheelchair users.Exercises that target posterior shoulder muscle groups, such as rowing, may improve muscle balance and reduce the risk of shoulder impingement.Participation in exercise is hindered in this population by a high rate of secondary health conditions and difficulty accessing facilities and equipment.

Longitudinal employment outcomes in adults with pediatric-onset spinal cord injury

Longitudinal survey. To determine in adults with pediatric-onset spinal cord injury (SCI) employment outcomes, longitudinal changes in employment over time and changes in psychosocial outcomes associated with employment status. Community setting. Adults who had sustained a SCI before 19 years of age and had completed at least three consecutive annual interviews were included in the study. Generalized estimating equation models were formulated to obtain odds ratio (OR) of change in employment status and outcomes over time. Total 1691 interviews were conducted in 283 participants, 182 men and 101 women (88% Caucasian; age at baseline, 27.3±3.7 years; duration at baseline, 12.7±5.0 years). At the last interview (age, 34.4±5.2 years; duration, 19.9±6.1 years), 49.5% were employed and 47.0% had a baccalaureate or post-baccalaureate degree. There was no significant change in employment status over time (OR 1.01, confidence interval (CI) 0.98-1.04). Odds of employment increased over time in participants who were women (1.04, CI 1.00-1.08), married (1.05, CI 1.02-1.08) and attained baccalaureate (1.03, CI 1.00-1.07) or post-baccalaureate (1.05, CI 1.02-1.08) degree. Employment odds decreased with occurrence of autonomic dysreflexia (0.80, CI 0.65-0.99), spasticity (0.80, CI 0.59-0.99) or chronic medical condition (0.83, CI 0.71-0.98). Life satisfaction scores increased over time in those who remained employed (1.11, CI 1.01-1.22); odds of depression increased over time in those who remained unemployed (1.13, CI 1.04-1.23). Employment status remained relatively stable in adults with pediatric-onset SCI; however, changes in employment were associated with education, secondary health conditions and psychosocial well-being.

Modeling Secondary Health Conditions in Adults Aging With Physical Disability

To test a conceptual model of secondary health conditions, age, and function in persons aging with long-term physical disabilities. Surveys were collected from 1,862 adults with spinal cord injury, neuromuscular disease, multiple sclerosis, or post-polio syndrome. Structural equation modeling was used to build a model describing relationships among physical and psychosocial secondary health conditions, pain, functional impairments, chronic medical conditions, and age. In total, 12 individual symptom or function domains (latent factors) were identified, grouped into 5 broader factors. Increasing age was associated with greater rates of physical and health problems and poorer function, and showed curvilinear relationships with pain and psychosocial difficulties. These data support a biopsychosocial model of secondary health conditions in adults aging with physical disability and suggest a five-factor approach for conceptualizing secondary conditions and their impact. Results also emphasize the importance of age in symptom severity and impact.

Person factors and work environments of workers who use mobility devices.

Nearly 25% of people with mobility impairments and limitations who are of working age are employed, yet few studies have examined their perspectives on their jobs or work environments required to complete job tasks. The purpose of this study was to describe the factors that contribute to successful employment for those who use mobility devices. A convenience sample of 132 workers who use power wheelchairs, manual wheelchairs, canes, crutches or walkers. Participants completed an online version of the Mobility Device User Work Survey (MWS). A multivariate analysis and a two-step multiple linear regression analysis were used. Study participants had few secondary health conditions that influenced their work. Employee satisfactoriness to their employers was high. Accessibility of worksites was high. Assistive technologies were inexpensive, and personal assistance was used infrequently and usually was unpaid. Co-worker communications were very positive. Flexible work rules and supportive managers were highly valued. Job satisfaction positively correlated with accessibility, work tasks, co-worker communication and work support. The description of work environments of successfully employed mobility device users can provide some useful guidance to employers, vocational rehabilitation (VR) counselors and unemployed mobility device users to balance employee abilities and preferences with the needs of employers.

Secondary Health Conditions Associated With Spinal Cord Injury

Secondary Health Conditions Associated With Spinal Cord Injury

Incidence of Epilepsy in Adults with Cerebral Palsy and Secondary Health Outcomes: A Review and Proposed Feasibility Study

Cerebral palsy is one of the most common chronic childhood disorders, occurring in 2-2.5 of every 1000 live births; it is a persistent disorder of movement and posture caused by non-progressive lesions of the immature brain. Epilepsy is an important problem in children with cerebral palsy, with past studies showing an average incidence of epilepsy in about one-third in cases of cerebral palsy. Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate seizures, common in patients who have other factors (such as cerebral palsy) that are associated with a very high likelihood of a persistently lowered seizure threshold and therefore a high recurrence risk. A few studies were conducted in the past analyzing the correlation of cerebral palsy and epilepsy in children; however, no study has been conducted yet evaluating the evolution of cerebral palsy in the transition from childhood to adulthood, and how the incidence, prevalence and clinical course of epilepsy change in such a time lapse. Furthermore, no studies yet evaluated the classification of seizures in this adult population, their correlations to cerebral palsy and its degrees of severity, and associated secondary health conditions, causing epidemiological data to be lacking in that regard. This aim of this manuscript is to introduce to the reader the current evidence regarding epilepsy in adults with cerebral palsy, as well as present recommendations for future research.

Secondary health conditions in individuals with spinal cord injury: a sign of premature ageing?

Secondary health conditions in individuals with spinal cord injury: a sign of premature ageing?

Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review

Scoping review. To gain a better understanding of the prevalence, course and association with age of secondary health conditions in individuals with spinal cord injury (SCI). Seattle, Washington, USA. We performed searches of electronic databases for studies published from 1986-2011 that provided information regarding the prevalence, course or associations with age and duration of secondary health conditions in individuals with SCI. Ninety-two studies were included. The findings indicate that: (1) individuals with SCI experience a number of secondary health conditions, many of which occur at a higher rate in those with SCI than the normative population; (2) the most common conditions or symptoms are pain, bowel and bladder regulation problems, muscle spasms, fatigue, esophageal symptom and osteoporosis; (3) a number of conditions, including cardiovascular disease, diabetes, bone mineral density loss, fatigue and respiratory complications or infections, occur with higher frequency in older individuals or those with longer SCI duration, relative to younger individuals or those with shorter SCI duration; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in individuals aging with SCI. The findings support the conclusion that individuals with SCI show signs of 'premature aging' in different organ systems. Longitudinal research is needed to understand when problems are most likely to emerge, and to develop and test the efficacy of interventions to prevent these health conditions and their negative impact.

Secondary health conditions in persons with spinal cord injury: A longitudinal study from one to five years post-discharge

To assess the occurrence of secondary health conditions and their potential risk factors in persons with spinal cord injury from 1 to 5 years after discharge from initial inpatient rehabilitation. Multicentre longitudinal study. A total of 139 wheelchair-dependent persons with spinal cord injury. The occurrence of secondary health conditions and their potential risk factors were assessed in a clinical interview with a rehabilitation physician at 1 and 5 years after discharge from inpatient rehabilitation and by a telephone interview 2 years after discharge. Self-report questionnaires were used for the assessment of musculoskeletal and neuropathic pain. Neuropathic pain (83.7-92.1%), musculoskeletal pain (62.3-87.1%) and urinary tract infection (56.5-58.9%) were the most frequently reported secondary health conditions. The occurrence of several secondary health conditions was higher among women and individuals with a complete lesion, tetraplegia, and with a higher body mass index. Secondary health conditions are common in the first years post-discharge following spinal cord injury, and their course seems to be relatively stable. These results emphasize the number of health issues that must be considered during post-injury care of persons with spinal cord injury living in the community, and the importance of a well-coordinated interdisciplinary approach from specialized rehabilitation centres.

Theoretical Risk and Prevention Model for Secondary Health Conditions and Mortality After SCI: 15 Years of Research

To successfully prevent secondary health conditions (SHCs) and promote longevity after spinal cord injury (SCI), we must first understand the risk factors precipitating their occurrence and develop strategies to address these risk factors. Conceptual models may aid in identifying the nature of SHCs and guide research, clinical practice, and the development of prevention strategies. Our purpose is to review and refine an existing theoretical risk and prevention model (TRPM) as a means of classifying risk and protective factors for SHCs and mortality after SCI and for identifying points of intervention. We describe conceptual work within the field of SCI research and SHCs, including a description of the TRPM, a review of research using the TRPM, and conceptual enhancements to the TRPM based on previous research. The enhanced TRPM directs research to the timing and chronicity of the SHCs and their relationship with overall health and physiologic decline. Future research should identify differences in the nature of SHCs, the extent to which they relate to risk and protective factors, and the degree to which they may be prevented with appropriate research-based strategies.

Secondary health conditions and spinal cord injury: an uphill battle in the journey of care

Purpose: To understand the journey of care in the prevention and management of secondary health conditions (SHCs) following spinal cord injury (SCI). Method: This was a case study design with ‘Ontario’ as the case. The Network Episode Model was used as the conceptual framework. Data sources included in depth interviews with persons with SCI, care providers, and policy and decision makers. Document analysis was also conducted on relevant materials and policies. Key informants were selected by purposeful sampling as well as snowball sampling to provide maximum variation. Data analysis was an iterative process and involved descriptive and interpretive analyses. A coding structure was developed based on the conceptual framework which allowed for free nodes when emerging ideas or themes were identified. Results: Twenty-eight individuals were interviewed (14 persons with SCI and 14 persons representing care providers, community advocacy organization representatives, system service delivery administrators and policy-makers). A major over-arching domain that emerged from the data was the concept of ‘fighting’. Eleven themes were identified: at the micro-individual level: (i) social isolation and system abandonment, (ii) funding and equitable care, (iii) bounded freedom and self-management; at the meso care provider level: (iv) gender and caregiving strain, (v) help versus disempowerment, (vi) holistic care-thinking outside the box, (vii) poor communication and coordination of care; and at the macro health system level: (viii) fight for access and availability, (ix) models of care tensions, (x) private versus public tensions and (xi) rigid rules and policies. Conclusions: Findings suggest that the journey is challenging and a persistent uphill struggle for persons with SCI, care providers, and community-based advocates. If we are to make significant gains in minimizing the incidence and severity of SHCs, we need to tailor efforts at the health system level.Implications for RehabilitationSecondary health conditions are problematic for individuals with a spinal cord injury (SCI).This study aimed to understand the journey of care in the prevention and management of secondary health conditions (SHCs) following SCI.Findings suggest that the journey is challenging and a persistent uphill struggle for persons with SCI, care providers, and community-based advocates.All stakeholders involved recognized the disparities in access to care and resources that exist within the system. We recommend that if we are to make significant gains in minimizing the incidence and severity of SHCs, we need to tailor efforts at the health system level.