Self-reported Disability Research Articles

Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness

Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions. To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI. This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020. Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks. The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue. A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education. In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies. ClinicalTrials.gov Identifier: NCT02161133.

Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain.

Chronic pain is associated with abnormal cortical excitability and increased pain intensity. Research investigating the potential for transcranial direct current stimulation (tDCS) to modulate motor cortex excitability and reduce pain in individuals with chronic lower back pain (CLBP) yield mixed results. The present randomised, placebo-controlled study examined the impact of anodal-tDCS over left-dorsolateral prefrontal cortex (left-DLPFC) on motor cortex excitability and pain in those with CLBP. Nineteen participants with CLBP (Mage = 53.16 years, SDage = 14.80 years) received 20-min of sham or anodal tDCS, twice weekly, for 4 weeks. Short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed using paired-pulse Transcranial Magnetic Stimulation prior to and immediately following the tDCS intervention. Linear Mixed Models revealed no significant effect of tDCS group or time, on SICI or ICF. The interactions between tDCS group and time on SICI and ICF only approached significance. Bayesian analyses revealed the anodal-tDCS group demonstrated higher ICF and SICI following the intervention compared to the sham-tDCS group. The anodal-tDCS group also demonstrated a reduction in pain intensity and self-reported disability compared to the sham-tDCS group. These findings provide preliminary support for anodal-tDCS over left-DLPFC to modulate cortical excitability and reduce pain in CLBP.

Eight Week Telewellness Program Improves Nutrition Knowledge Among People with Physical Disabilities

<h3>Research Objectives</h3> To evaluate the effectiveness of an eight-week telewellness program for improvements in nutrition knowledge among people with physical disabilities. <h3>Design</h3> Retrospective study of people with disabilities who participated in the Mindfulness, Exercise, and Nutrition to Optimize Resilience (MENTOR) Program from January-December 2021. <h3>Setting</h3> Virtual telewellness program. <h3>Participants</h3> Adults (n=89) ages 22-77 yrs. (mean 52.1±14.4) with a self-reported physical disability with 67.4% using an assistive device for ambulation (n=60). <h3>Interventions</h3> Eight-week, synchronous telewellness program using a commercial platform (Healthie) with built-in Zoom videoconferencing software. Participants attended weekly group classes in mindfulness, exercise, nutrition, and health coaching. A Registered Dietitian led the nutrition classes and offered optional nutrition counseling. <h3>Main Outcome Measures</h3> Participants completed the General Nutrition Knowledge Questionnaire- Revised (GNKQ-R) via the Healthie platform before and after the program. The GNKQ-R consists of four knowledge domains (Dietary Recommendations, Food Groups, Healthy Food Choices, & Diet, Disease and Weight Management) with a total composite score of 0-88 with higher scores indicating higher knowledge. The hypothesis for this retrospective analysis was that participants' GNKQ-R scores would increase as a result of the MENTOR program. Differences between pre and post total score and sub-scores were assessed using general linear models and reported as mean±standard error. <h3>Results</h3> Pre-intervention total scores ranged from 8-79 and post-intervention total scores ranged from 14-81. Post-intervention scores improved on total GNKQ-R (58.4±1.6 vs. 64.4±1.2 p< 0.001) and the four knowledge domains (Dietary Recommendations: 12.3±.0.3 vs. 13.4±0.2, p< 0.001; Food Groups: 23.1±0.8 vs. 26.5±0.6, p< 0.001; Healthy Food Choices 9.0 ± 0.3 vs. 9.7±0.4, p=0.01; Diet, Disease, and Weight Management 14.0±0.4 vs 15.0±0.4, p=0.007). <h3>Conclusions</h3> A comprehensive eight-week telewellness program (MENTOR) resulted in statistically significant improvements in nutrition knowledge among people with disabilities. Future research is examining MENTOR's effects on adoption of healthy food choices and dietary behaviors over the long term. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

Effect of Virtual Reality Combined with Modified Constraint-Induced Movement Therapy on Chronic Stroke Survivors

<h3>Research Objectives</h3> To evaluate the effect of virtual reality combined with modified constraint-induced movement therapy-based upper limb training on chronic stroke survivors. <h3>Design</h3> Intervention. Randomized control trial, baseline two and four-week intervention. <h3>Setting</h3> In the Hospital setting outpatients. <h3>Participants</h3> Twenty-six patients both males and females with chronic stroke for more than 6 months and dysfunction in the upper limb were included in the study. The age range between 20 to 45 years was included. Convenient sampling is used for the selection procedure. <h3>Interventions</h3> Virtual reality Group: Treatment for 20 min 3 sessions per week for 4 weeks along with the conventional therapy. The VR protocol included using a VR headset and the games. In the Rally ball game, balls approaching the player from multiple angles are hit from a chair. The Reflex Ridge game involves hitting, and grasping obstacles while sitting in a chair. The patient played each game for 10-mins per session. Conventional therapy includes passive stretching, repetitive task-specific activities, passive, active-assisted and active ROM exercises. Virtual reality combined with m-CIMT Group: Treatment for 20 min 3 sessions per week for 4 weeks along with the conventional therapy. The unaffected hand of the participant was restrained and then the same VR treatment (as above) was given to the participants. <h3>Main Outcome Measures</h3> Wolf motor function test, DASH Questionnaire, Modified Ashworth Scale, and Box & Block test. <h3>Results</h3> The treatment group significantly improved from the control group. Repeated measure ANOVA showed significant improvement for all the outcome measures (p< 0.005) within the 2 groups. The Independent t-test shows a significant difference in Gross motor function, patient self-report disability, and manual dexterity of upper limb (p< 0.005) and no significant difference in spasticity for MAS (p>0.005) between the groups. <h3>Conclusions</h3> Both treatment approaches in the control and Treatment groups are effective in managing motor functional status, spasticity level of the upper extremity, disability level, and manual proficiency of the upper extremity. Except for spasticity, both treatment approaches were found equally effective. <h3>Author(s) Disclosures</h3> There is no conflict of interest

Association Between Inter-Recti Distance and Impaired Abdominal Core Function in Post-Partum Women With Diastasis Recti Abdominis.

Background and Aim: The definition and management of Diastasis Recti Abdominis (DRA) is under debate. This study aimed to understand the correlation between the post-partum inter-recti distance (IRD) and functional impairments associated with core instability, with the hypothesis that IRD could serve as a proxy for core instability symptoms and constitute a tool in decision-making for DRA treatment. Material and Methods: A cohort of post-partum women with abdominal core instability symptoms combined with DRA were studied. The size of IRD was measured with ultrasonography and cross-sectionally analysed against functional impairments registered with the self-report Disability Rating Index (DRI), which grades the ability to perform 12 different daily activities. Results: A total of 224 women were included in the study. In univariable analysis, IRD was associated with impairment of the activities running (p = 0.007), heavy work (p = 0.036) and exercise/sports (p = 0.047), but not with dressing, walking, sitting for long periods, standing bent over a sink, carrying a suitcase, making a bed, light manual labour or heavy lifting. No significant correlations were seen in the multivariable analysis when adjustments were made for BMI and parity. Conclusion: IRD and post-partum functional impairments had no significant correlation in multivariable analysis. The post-partum core instability condition is complex and probably associated with more factors than solely the IRD. The IRD alone does not seem to be a sufficient proxy for decision-making regarding optimal treatment. A more complete instrument to assess the post-partum abdominal core is warranted.

15-item Roland-Morris Disability Questionnaire (RMDQ-15): structural and criterion validity on patients with chronic low back pain

BackgroundThe Roland-Morris Disability Questionnaire (RMDQ) is one of the most used instruments to measure self-reported disability in patients with low back pain, however, the uncertainty on which version to use may lead to inadequate disability measurement and consequently, improper management of patients with chronic low back pain.ObjectiveTo propose a short version of the RMDQ, compare it with the other short versions presented by the specialized literature, and identify the best internal structure of the RMDQ for the Brazilian population.MethodsThis is a cross-sectional study in which we used confirmatory factor analysis to identify the best structure of the RMDQ. We assessed 545 participants, most of which were women, aged ≥ 30 years old, single, with mean low back pain intensity ~ 5 points, and mean pain chronicity ~ 72 months. We used lavaan and semPlot packages, with implementation of a tetrachoric matrix and the robust diagonally weighted least squares extraction method. We also used fit indices chi-square/degree of freedom, comparative fit index, Tucker-Lewis index, root mean square error of approximation, and standardized root mean squared residual. For the comparison between models, we considered the structure with the lowest values of the Akaike information criterion and Bayesian information criterion. In addition, we assessed criterion validity via Spearman’s correlation coefficient to correlate the long and short versions. In this study, the 15-item structure was created through the use of modification indices to identify redundant items (9 items were excluded).ResultsRMDQ structure with one domain and 15 items and the structure with two domains and 16 items showed all fit indices with adequate values, but the one-dimensional version showed the lowest Akaike information criterion and Bayesian information criterion values. Regarding criterion validity, correlation between the RMDQ with 24 items and 15 items is adequate (rho = 0.954, p < 0.001).ConclusionThe RMDQ-15 is a short version of the RMDQ instrument with the most adequate internal structure and satisfactorily correlated with the long version of the instrument.

Association of Ankle Sprain Frequency With Body Mass and Self-Reported Function: A Pooled Multisite Analysis.

Ankle sprains result in pain and disability. While factors such as body mass and prior injury contribute to subsequent injury, the association of the number of ankle sprains on body anthropometrics and self-reported function are unclear in this population. Therefore, the purpose of this investigation was to assess differences in anthropometric measurements and self-reported function between the number of ankle sprains utilizing a large, pooled data set. Cross-sectional. Data were pooled from 14 studies (total N = 412) collected by the Chronic Ankle Instability Outcomes Network. Participants were categorized by the number of self-reported sprains. Anthropometric data and self-reported function were compared between those who reported a single versus >1 ankle sprain as well as among groups of those who had 1, 2, 3, 4, and ≥5 ankle sprains, respectively. Those who had >1 ankle sprain had higher mass (P = .001, d = 0.33) and body mass index (P = .002, d = 0.32) and lower Foot and Ankle Ability Measure-Activities of Daily Living (P < .001, r = .22), Foot and Ankle Ability Measure-Sport (P < .001, r = .33), and Cumberland Ankle Instability Tool (P < .001, r = .34) scores compared to the single ankle sprain group. Those who had a single ankle sprain weighed less than those who reported ≥5 sprains (P = .008, d = 0.42) and had a lower body mass index than those who reported 2 sprains (P = .031, d = 0.45). Some individuals with a history of multiple ankle sprains had higher body mass and self-reported disability compared to those with a single sprain, factors that are likely interrelated. Due to the potential for long-term health concerns associated with ankle sprains, clinicians should incorporate patient education and interventions that promote physical activity, healthy dietary intake, and optimize function as part of comprehensive patient-centered care.

Impact of resilience, social support, and personality traits in patients with neuroinflammatory diseases during the COVID-19 pandemic

Background and ObjectiveThe COVID-19 pandemic negatively impacted the well-being of persons with neuroinflammatory diseases (pwNID). Identifying factors that influence the response to challenging conditions could guide supportive care. Methods2185 pwNID and 1079 healthy controls (HCs) from five US centers completed an online survey regarding the effects of the COVID-19 pandemic on physical and psychological well-being. Survey instruments included resilience (Connor-Davidson Resilience Scale, CD-RISC), loneliness (UCLA Loneliness Scale), social support (modified social support survey, MSSS-5), personality traits (NEO-Five Factor Inventory, NEO-FFI), and disability (Patient-Determined Disability Steps (PDDS). Step-wise regression models and mediation analyses assessed whether the level of self-reported resilience, size of the social support, and specific personality traits (study predictors) were associated with self-reported disability and/or loneliness (study outcomes). ResultsThe response rate varied significantly between the questionnaires. While, all pwNID completed the demographic questionnaire, 78.8% completed the loneliness questionnaire and 49.7% completed the NEO-FFI. Based on 787 responses, greater neuroticism (standardized β = 0.312, p < 0.001), less social support (standardized β = -0.242, p < 0.001), lower extraversion (standardized β = -0.083, p=0.017), lower agreeableness (standardized β = -0.119, p < 0.001), and lower resilience (standardized β = -0.125, p = 0.002) were associated with the feeling of loneliness. Social support and resilience modestly but significantly mediated the association between personality traits and loneliness. Older age (standardized β = 0.165, p < 0.001) and lower conscientiousness (standardized β = -0.094, p = 0.007) were associated with worse disability (higher PDDS scores). There were no differences in outcomes between pwNID and HCs. ConclusionGreater social support potentially attenuates the association between neuroticism and the feeling of loneliness in pwNID during the COVID-19 pandemic. Assessment of personality traits may identify pwNID that are in greater need of social support and guide targeted interventions.

Prevalence of chronic non-specific low back pain among caregivers of stroke survivors in Kano, Nigeria and factors associated with it: A cross-sectional study.

PurposeLow back pain (LBP) may have a specific or non-specific cause such as abnormal posture or repetitive tasks. For instance, lifting and transferring patients during caregiving for stroke survivors may predispose the caregivers to LBP.ObjectivesThe aim of this study is to determine the prevalence of chronic non-specific LBP and factors associated with it in caregivers of stroke survivors.MethodThe research design used is cross-sectional study design. Participants of the study were caregivers of stroke survivors in Kano, Nigeria who were at least 18 years old. They were included if they had at least one-month experience with caregiving for at least 1 h per day. Presence of LBP and level of disability were assessed using participants' self-report and Rolland Morris Low Back Pain Disability Questionnaire respectively. The data collected was analyzed using descriptive, Chi-square statistics and Binary Logistics Regression.ResultThree hundred caregivers with mean age, 33.24 ± 10.32 years in which 207 and 93 were males and females respectively, participated in the study. The results showed that, there was a high prevalence (64.7%) of LBP among the caregivers. The prevalence was significantly associated with gender (p < 0.001), age (p = 0.029), occupation (p < 0.001) and duration of caregiving (p < 0.001) of the study participants. In addition, the result of the regression model showed that, being a female (p = 0.001), a civil servant (p = 0.031), a trader (p = 0.013), and a complete caregiver (0.001); and caregiving for a duration of 5 h or more per day (p = 0.024) are significant predictors of having LBP. Similarly, level of disability due to the presence of LBP among the study participants was significantly associated with gender (p < 0.001), occupation (p < 0.001), duration of caregiving (p = 0.025), and the nature of the caregiving (p < 0.001).ConclusionInformal caregiving for stroke survivors may result in developing chronic non-specific LBP, especially among females, Civil servants, traders, complete caregivers and those with long duration of caregiving. This can add an additional burden on the family in terms of cost of care, result in reduced quality of caregiving and cause psychological stress. Thus, it is important the health of the caregivers of stroke survivors is considered during stroke rehabilitation.

Blood flow restriction added to usual care exercise in patients with early weight bearing restrictions after cartilage or meniscus repair in the knee joint: a feasibility study

PurposeBlood flow restriction – low load strength training (BFR-LLST) is theoretically superior to traditional heavy strength training when rehabilitating patients who cannot heavily load tissues following surgery. The main purpose of this study was to examine the feasibility of BFR-LLST added to usual care exercise early after cartilage or meniscus repair in the knee joint.MethodsWe included 42 patients with cartilage (n = 21) or meniscus repair (n = 21) of the knee joint. They attended 9 weeks of BFR-LLST added to a usual care exercise program at an outpatient rehabilitation center. Outcome measures were assessed at different time points from four (baseline) to 26 weeks postoperatively and included adherence, harms, knee joint and thigh pain, perceived exertion, thigh circumference (muscle size proxy), isometric knee-extension strength, self-reported disability and quality of life.ResultsOn average, patients with cartilage or meniscus repair completed > 84% of the total BFR-LLST supervised sessions. Thirty-eight patients reported 146 adverse events of which none were considered serious. No decrease in thigh circumference or exacerbation of knee joint or quadriceps muscle pain of the operated leg was found in either group during the intervention period.ConclusionsBFR-LLST added to usual care exercise initiated early after cartilage or meniscus repair seems feasible and may prevent disuse thigh muscle atrophy during a period of weight bearing restrictions. Harms were reported, but no serious adverse events were found. Our findings are promising but need replication using a RCT-design.Trial registrationNCT03371901, preprint (open access): https://www.medrxiv.org/content/10.1101/2022.03.31.22272398v1

Gadolinium-based contrast agent exposures and physical and cognitive disability in multiple sclerosis.

The clinical correlation of gadolinium-based contrast agents (GBCAs) has not been well studied in multiple sclerosis (MS). We investigated the extent to which the number of GBCA administrations relates to self-reported disability and performance measures. A cohort of MS patients was analyzed in this retrospective observational study. The main outcome was the association between the cumulative number of GBCA exposures (linear or macrocyclic GBCA), Patient-Determined Disease Steps (PDDS), and measures of physical and cognitive performance (walking speed test, manual dexterity test [MDT], and processing speed test [PST]). The analysis was performed first cross-sectionally and then longitudinally. The cross-sectional data included 1059 MS patients with a mean age of 44.0years (standard deviation=11.2). While the contrast ratio in globus pallidus weakly correlated with PDDS, MDT, and PST in a univariate correlational analysis (coefficients, 95% confidence interval [CI] = 0.11 [0.04, 0.18], 0.15 [0.08, 0.21], and -0.16 [-0.10, -0.23], respectively), the associations disappeared after covariate adjustment. A significant association was found between number of linear GBCA administrations and PDDS (coefficient [CI] = -0.131 [-0.196, -0.067]), and MDT associated with macrocyclic GBCA administrations (-0.385 [-0.616, -0.154]), but their signs indicated better outcomes in patients with greater GBCA exposures. The longitudinal data showed no significant detrimental effect of macrocyclic GBCA exposures. No detrimental effects were observed between GBCA exposure and self-reported disability and standardized objective measures of physical and cognitive performance. While several weak associations were found, they indicated benefit on these measures.

Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy.

The Affordable Care Act mandated data collection standards to identify people with disabilities in federal surveys to better understand and address health disparities within this population. Most federal surveys use six questions from the American Community Survey (ACS-6) to identify people with disabilities, whereas many international surveys use the six-item Washington Group Short Set (WG-SS). The National Survey on Health and Disability (NSHD), which focuses on working-age adults ages 18-64, uses both question sets and contains other disability questions. We compared ACS-6 and WG-SS responses with self-reported disability types. The ACS-6 and WG-SS failed to identify 20percent and 43percent, respectively, of respondents who reported disabilities in response to other NSHD questions (a broader WG-SS version missed 4.4percent of respondents). The ACS-6 and the WG-SS performed especially poorly in capturing respondents with psychiatric disabilities or chronic health conditions. Researchers and policy makers must augment or strengthen federal disability questions to improve the accuracy of disability prevalence counts, understanding of health disparities, and planning of appropriate services for a diverse and growing population.

Created Sick? Well, Not Exactly… Canadian Atheists Report Similar Levels of Impairment and Disability to the Religiously Affiliated

Religion/spirituality (R/S) is positively associated with a variety of health outcomes, although how R/S relates to the likelihood or severity of impairment or disability is understudied. Given the broad salutary effects of R/S, we tested if nonreligious groups (specifically atheists) were more likely to report impairment or were more likely to report greater disability. Using Canadian data (N ≥ 1,000) from the 2015 General Social Survey (Cycle 29), we compared atheists to Agnostics, Nones, Protestants, Catholics, Christian Orthodox, and Eastern Religion practitioners. The results indicated that Atheists were slightly more likely to report the presence of impairment and disability relative to Catholics, but these effects were in the trivial-to-small range. When exploring the severity of self-reported disability across religious groups, atheists did not differ from any other religious group. These results are intriguing as the broader R/S-health literature has suggested that greater secularism should be associated with a health penalty; however, we found limited evidence to support this. Although we cannot state that atheism is necessarily healthy, the results of the current study would suggest that atheism is certainly not unhealthy.

Disability and physical activity in people with chronic disease receiving physiotherapy. A prospective cohort study.

Chronic disease affects patients' disability and participation in activities of daily living. Longitudinal information on disability and physical activity is generally scarce in patients with chronic disease. The current study aimed to investigate if self-reported disability and physical activity changed in patients with chronic disease receiving physiotherapy. Furthermore, the aim was to assess if an improvement in self-reported disability was related to an increase in objectively measured physical activity and if an aggravation in self-reported disability was related to a decrease in physical activity. Seventy patients with either multiple sclerosis, Parkinson's disease, rheumatoid arthritis or stroke receiving free of charge physiotherapy were tested at baseline and 1 year later. Disability was measured with the self-reported modified Ranking Scale-9 Questionnaire and physical activity was objectively measured using tri-axial accelerometry. Neither self-reported disability nor physical activity changed among patients receiving 1 year of free of charge physiotherapy at group level. Furthermore, self-reported change of disability was not expressed with changes in objectively measured physical activity, indicating that the two measures represent two different constructs.

Perinatal Health Risks And Outcomes Among US Women With Self-Reported Disability, 2011-19.

Women with disabilities experience elevated risk for adverse pregnancy outcomes. Most studies have inferred disabilities from diagnosis codes, likely undercounting disabilities. We analyzed data, including self-reported disability status, from the National Survey of Family Growth for the period 2011-19. We compared respondents with and without disabilities on these characteristics: smoking during pregnancy, delayed prenatal care, preterm birth, and low birthweight. A total of 19.5percent of respondents who had given birth reported a disability, which is a much higher prevalence than estimates reported in US studies using diagnosis codes. Respondents with disabilities were twice as likely as those without disabilities to have smoked during pregnancy (19.0percent versus 8.9percent). They also had 24percent and 29percent higher risk for preterm birth and low birthweight, respectively. Our findings suggest that studies using diagnosis codes may represent only a small proportion of pregnancies among people with disabilities. Measurement and analysis of self-reported disability would facilitate better understanding of the full extent of disability-related disparities, per the Affordable Care Act.

Transition to endemic: acceptance of additional COVID-19 vaccine doses among Canadian adults in a national cross-sectional survey

BackgroundAdditional doses of COVID-19 vaccine have been proposed as solutions to waning immunity and decreased effectiveness of primary doses against infection with new SARS-CoV-2 variants. However, the effectiveness of additional vaccine doses relies on widespread population acceptance. We aimed to assess the acceptance of additional COVID-19 vaccine doses (third and annual doses) among Canadian adults and determine associated factors.MethodsWe conducted a national, cross-sectional online survey among Canadian adults from October 14 to November 12, 2021. Weighted multinomial logistic regression analyses were used to identify sociodemographic and health-related factors associated with third and annual dose acceptance and indecision, compared to refusal. We also assessed influences on vaccine decision-making, and preferences for future vaccine delivery.ResultsOf 6010 respondents, 70% reported they would accept a third dose, while 15.2% were undecided. For annual doses, 64% reported acceptance, while 17.5% were undecided. Factors associated with third dose acceptance and indecision were similar to those associated with annual dose acceptance and indecision. Previous COVID-19 vaccine receipt, no history of COVID-19 disease, intention to receive an influenza vaccine, and increasing age were strongly associated with both acceptance and indecision. Chronic illness was associated with higher odds of acceptance, while self-reported disability was associated with higher odds of being undecided. Higher education attainment and higher income were associated with higher odds of accepting additional doses. Minority first language was associated with being undecided about additional doses, while visible minority identity was associated with being undecided about a third dose and refusing an annual dose. All respondents reported government recommendations were an important influence on their decision-making and identified pharmacy-based delivery and drop-in appointments as desirable. Co-administration of COVID-19 and influenza vaccines was viewed positively by 75.5% of the dose 3 acceptance group, 12.3% of the undecided group, and 8.4% of the refusal group.ConclusionsTo increase acceptance, targeted interventions among visible minority and minority language populations, and those with a disability, are required. Offering vaccination at pharmacies and through drop-in appointments are important to facilitate uptake, while offering COVID-19/influenza vaccine co-administration may have little benefit among those undecided about additional doses.

Functional versus conventional strength and conditioning programs for back injury prevention in emergency responders.

Back pain and back-related injuries are common complaints among emergency responders. The purpose of this study was to compare the effectiveness of two strength and conditioning programs in improving back muscle characteristics and disabilities in emergency responders (firefighters/paramedics). Participants (n = 24) were randomized into two groups to complete 16 weeks of supervised exercise intervention: 1) Functional training used unilateral movements that mimicked the asymmetrical nature of emergency operations, 2) Conventional training performed bilaterally loaded exercises. Outcome measures were maximum isometric back extension strength, passive muscle stiffness, lumbar extensor fatigability, and revised Oswestry Low Back Pain Questionnaire. A mixed model Analysis of Variance with repeated measures was performed to compare the difference over time and between groups. While the training effects were similar between groups, both programs improved isometric back extension strength (+21.3% functional, +20.3% conventional, p < 0.001, ηp 2 = 0.625) and lumbar extensor muscle fatigability (+17.4% functional, +9.5% conventional, p = 0.009, ηp 2 = 0.191). Bilateral symmetry in muscle stiffness was improved as indicated by reduction in symmetry index (-7.1% functional, -11.8% conventional, p = 0.027, ηp 2 = 0.151). All self-reported pain and disability scores fell within the category of “minimum functional limitation” throughout the intervention and 6-month follow-up periods. For frontline firefighters and paramedics, both functional and conventional strength training are effective for improving back muscle characteristics.

Opioid Use Behaviors Among People With Disability in the United States: An Analysis of the National Survey on Drug Use and Health.

People with disability (PWD) often experience chronic pain, and opioid is widely used prescription medication. However, population-based evidence of opioid use behaviors among PWD is lacking. This study examined the prevalence of opioid use behaviors by sociodemographic and health-related characteristics among PWD compared with people without disability (PWoD). This cross-sectional study used data from 2015-2019 National Survey on Drug Use and Health. Three types of opioid use behaviors (any use, misuse, and use disorder) were defined and compared by disability status. Five self-reported disability types were measured, including hearing, vision, cognitive, mobility, and complex activity limitations. Complex survey design-adjusted descriptive and logistic regression models were used for statistical analysis. Of 201,376 respondents aged 18 years or older, 34.6% reported any opioid use, 4.2% opioid misuse, and 0.8% opioid use disorder. Compared with PWoD, PWD had higher prevalence of any opioid use (49.7% vs 30.7%), misuse (6.2% vs 3.7%), and use disorder (1.7% vs 0.8%). In adjusted analysis, PWD with mobility limitation (odds ratio [OR], 1.95; 95% confidence interval, 1.81-2.11) or multiple limitations (OR, 1.92; 95% CI, 1.83-2.02) were almost 2 times more likely to report any opioid use than PWoD. The likelihood of reporting any opioid use (ORs, 1.42-2.50), misuse (ORs, 1.24-2.41), and disorder (ORs, 1.38-2.54) increased as the number of limitations increased. People with vision, cognitive, or multiple limitations had higher rates of opioid misuse and disorder than PWoD. Development of more inclusive opioid abuse prevention strategies for PWD is warranted.

Cold sensitivity and its association to functional disability following a major nerve trunk injury in the upper extremity-A national registry-based study.

AimsTo investigate self-reported cold sensitivity and functional disability after a repaired major nerve trunk injury in the upper extremity.MethodsWe identified 735 individuals with a major nerve trunk injury in the upper extremity, surgically treated with direct nerve repair or reconstructed with nerve autografts, in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity, and perceived disability were collected using two questionnaires (HQ-8 and QuickDASH) preoperatively, and at three and 12 months postoperatively.ResultsWe included 281 individuals, who had responded the questionnaires, where 197 (70%) were men (median age 34 [interquartile range 25–52] years) and 84 (30%) were women (median age 41 [25–55]). Cold sensitivity (scored 0–100) was the most prominent symptom 12 months postoperatively after an injured and repaired/reconstructed median (p<0.001) or ulnar (p<0.001) nerve, while individuals with a radial nerve injury showed milder symptoms. Concomitant injuries did not affect cold sensitivity scores. Individuals with ulnar nerve injuries scored higher in stiffness (p = 0.019), weakness (p<0.001) and ability to perform daily activities (p = 0.003) at 12 months postoperatively than median nerve injuries. Individuals with a median, ulnar or radial nerve injury with severe (>70) cold sensitivity had 25, 37 and 30 points higher QuickDASH scores, respectively (p<0.001), at 12 months postoperatively than individuals with mild (<30) cold sensitivity. There were no differences in QuickDASH score or cold sensitivity score at 12 months postoperatively between direct nerve repair or nerve reconstruction with nerve autografts. Neither age, nor sex, affected QuickDASH score at 12 months postoperatively.ConclusionCold sensitivity after surgery for a major nerve trunk injury in the upper extremity can be substantial with impaired ability to perform daily activities, where an ulnar nerve injury may have a worse outcome.

Translation, cross-cultural adaptation and validation of the Argentine version of the Pain Catastrophizing Scale in patients with chronic low back pain

IntroductionLow back pain (LBP) is the leading cause of years lived with disability worldwide. Higher levels of catastrophizing were found in patients with LBP and this variable is associated with self-reported disability. The Pain Catastrophizing Scale (PCS) is a self-report questionnaire that assesses catastrophizing in the presence of pain. Currently, an Argentine version of the PCS is not available. ObjectiveTo translate and cross-culturally adapt the PCS into Argentine Spanish and test the psychometric properties of the new version with chronic LBP patients. Study designStudy of diagnostic accuracy/assessment scale. MethodsThe study was carried out in three consecutive phases following the COSMIN guidelines: translation, cross-cultural adaptation and validation. We included Argentine residents over 18 years with chronic LBP. We used the PCS and the Global rating of change (GROC) to assess the psychometric properties. ResultsNo difficulties were present in the translation processes and the PCS-Arg was developed. The alfa Cronbach coefficient was 0.89. The standard error of measurement and the minimal detectable change were 5.4 and 15.1 points, respectively. In the explanatory factorial analysis 3 components were identified. For the construct validity, the correlation between the PCS-Arg and disability and pain were r = 0.35 and rho = 0.04, respectively. The mean PCS score was 29.9. The lowest and highest scores were 3 and 52 points, therefore, no roof or ceiling effects of the total score were observed. ConclusionThe PCS-Arg is a viable, reliable and valid tool for the assessment of catastrophizing in patients with chronic LBP.