Use Of Mobility Aids Research Articles

Life Satisfaction in Persons with Late Effects of Polio

To assess satisfaction with life as a whole and with ten domains of life satisfaction in Swedish persons with late effects of polio, to describe the relationship with sex, age, marital status, use of mobility aids and self-perceived needs of instrumental support, and to compare the level of life satisfaction with a Swedish reference sample. A cross-sectional study of 160 persons with verified late effects of polio answered a postal questionnaire including the Life Satisfaction Questionnaire (LiSat-11). A majority were to some degree satisfied with life as a whole and with all the ten domains of life satisfaction. Satisfaction with life as whole was not related to any of the sociodemographic or disability related factors and these factors had few relations to the ten domains of life satisfaction. The respondents were significantly less satisfied with life as a whole and with vocation, leisure, sexual life, activities of daily living, and somatic and psychological health compared to the Swedish reference sample, but were significantly more satisfied with economy and contacts with friends. Men and women with late effects of polio, regardless of age, marital status or disability, can experience a reduced life satisfaction. This emphasises the need to identify potential gaps between these persons’ aspirations and achievements in life and carry out appropriate rehabilitation interventions to enhance their life satisfaction.

Influence of Environment and Mobility Aid on Talking Pedometer Accuracy in Adults with Visual Impairment

BACKGROUND: Given the efficacy of pedometer-based programs to improve physical activity and health status in various clinical sub-populations, implementation of similar programs for persons with vision loss should be considered. Due to alterations in the gait patterns of persons with vision loss, factors such as environmental familiarity and mobility aids may influence results of pedometer validation trials. PURPOSE: The purpose of this study was to establish validity evidence for the Centrios talking pedometer relative to walking environment and mobility aid use in adults with vision loss. METHODS: Fifteen adults with legal blindness (10 females; age = 38 ± 14 years; BMI = 26.5 ± 4.2 kg·m2) completed two walking sessions over an unfamiliar, quarter-mile walking course while wearing a pedometer at the right and left hip. Walking speed, pedometer-determined step counts, and actual step counts were recorded during the first session, which represented walking in an unfamiliar environment. Following the completion of additional walking trials over the same route, outcome measures were reassessed during a second walking session over the course, which reflected walking in a "familiar environment." To obtain validity evidence for the talking pedometer, absolute percent error (APE) was calculated between actual and pedometer-determined steps. Paired t-tests were used to assess differences in APE relative to mounting position (right hip vs. left hip; mobility aid side vs. non-mobility aid side) across unfamiliar and familiar walking trials. RESULTS: The Centrios pedometer accurately reported step counts during unfamiliar (average speed = 3.2 mph) and familiar (average speed = 3.7 mph) walking trials when mounted at the hip opposite the user's mobility aid (APE = 3.1% and 2.4%, respectively), but was less accurate on the mobility aid side during unfamiliar and familiar walking (APE = 9.2% and 6.3%, respectively). Paired t-tests revealed no significant differences (p >.05) in APE relative to mounting position and familiarity with the environment. CONCLUSIONS: During walking in familiar and unfamiliar settings, the Centrios talking pedometer provides an accurate step count in adults with visual impairment when mounted at the hip opposite of the user's mobility aid.

Demographics and Trends in Wheeled Mobility Equipment Use and Accessibility in the Community

ABSTRACT This article presents a profile of household-resident U.S. adults using wheeled mobility equipment (WME) in 2005, trends in WME use from 1990 to 2005, and data on accessibility features and problems from 1994–97. Data were obtained from the Survey of Income and Program Participation (SIPP) and the National Health Interview Survey on Disability (NHIS-D). Compared to the general population, WME users are more likely to be older, female, and in poor health. Forty-four percent are working-aged, with twice the rate of poverty of the general population, and only 17% are employed. Mobility difficulty is the most significant predictor of WME use, but gender, race, poverty, and educational attainment are also significant predictors. From 1990–2005, WME use grew 5% per year, while mobility difficulty declined among the elderly and remained steady among working-age persons. This contrast suggests a reduction in unmet need for WME. In 1994–97, more than half of WME users had difficulty entering or exiting their homes, and one-third had accessibility problems outside their homes. Usage of home modification was low, with substantial unmet need. Regular national data collection on the use of WME and other mobility aids, their financing, and accessibility issues is warranted.

The physical environment as a fall risk factor in older adults: Systematic review and meta‐analysis of cross‐sectional and cohort studies

Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. Eight databases (1985-2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97-1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03-1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59-2.71) and institutional (OR = 1.77; 95% CI: 1.66-1.89) settings. Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.

Patterns of mobility aid use among working-age persons with multiple sclerosis living in the community in the United States

Background Difficulty walking is the most visible sign of disability among persons with multiple sclerosis (MS). However, little is known about mobility aid use by persons with MS living in the community. Objectives To explore perceptions of mobility problems related to MS and patterns of mobility aid use by persons with MS residing in communities across the United States. Methods We conducted a 30-minute telephone survey in mid-2007 with 703 community-dwelling, working-age adults who self-reported having MS. We identified potential survey respondents using membership lists of the National Multiple Sclerosis Society, oversampling individuals living in zip codes with relatively high poverty rates. All analyses, including calculation of simple percentages, used sampling weights to produce population estimates. The overall response rate was 73.4%. Survey questions asked basic information about all mobility aids used by respondents and details about up to two different aids. We used multivariable polychotomous logistic regression to predict use of various mobility aids accounting for demographic and disease characteristics. Results In questions about the previous 2 weeks, needing to concentrate on walking because of MS was the most common problem cited (weighted percent = 79.3%), followed by MS making standing more difficult (69.9%), increased effort needed to walk (59.0%), and needing to hold onto furniture, walls, or someone's arm when walking indoors every day (40.0%). Among the 703 respondents, 434 (weighted percent = 60.5%) reported using at least one mobility aid; the majority of these individuals reported using more than one type of aid. Manual wheelchairs were the most common mobility aid (63.4%), followed by canes (56.7%), power wheelchairs (36.7%), and scooters (32.2%). Among those using three or more different types of mobility aids, the large majority used manual wheelchairs (88.2%), followed by canes (65.4%). Persons who are married or living with partners were much less likely to use powered equipment than those who were never married (adjusted odds ratio [AOR] = 0.32; 95% CI: 0.13–0.82). Women were much less likely than men to use powered equipment (AOR = 0.40; 95% CI: 0.21–0.75). Conclusion The vast majority of persons with MS who use at least one mobility aid own more than one type and about half own three or more different types of mobility aids. Persons with MS appear to “mix and match” different devices to suit their specific mobility needs. Given restrictive health insurance coverage policies for mobility aids, these findings raise questions about how persons acquire and pay for higher-technology mobility aids.

Perspectives on use of mobility aids in a diverse population of seniors: Implications for intervention

Background Many older adults who might benefit from using mobility aids do not or will not use them. Studies show that attitudes and beliefs strongly affect the decision to use mobility aids. Despite the growing diversity of the population, no prior studies have compared attitudes towards and beliefs about mobility aids by race and ethnicity. Objective This study aimed to explore whether and how attitudes towards and beliefs about mobility aid use vary by race and ethnicity. Methods We conducted 12 focus groups with 61 community dwelling persons age 65+ years from three groups: white, non-Hispanic black, and Hispanic. Data were coded and compared across groups. Results For all groups, perceived benefits of mobility devices in maintaining independence and control produced positive attitudes. However, the association of mobility aid use with aging and physical decline contributed to stigmatizing attitudes. Black and Hispanic participants expressed apprehension about using unsafe or inappropriate secondhand equipment, heightened concerns about mobility aid users becoming subjects of negative biases, and a preference for fashionable aids. Hispanic participants expressed a preference for human assistance. Participants of all groups perceived physicians as influencing their decisions to use aids. Conclusion Social pressures and perceived stigma deter mobility aid use, particularly in minority populations. Greater physician involvement, positive peer models, and affordable, safe, visually appealing devices would promote greater acceptance of mobility aids.

The Use of Mobility Devices Among Institutionalized Older Adults

The purpose of this article is to examine the demographic, health, and social characteristics of mobility device users in long-term care settings. Data were used from a recently institutionalized sample of older adults from the Canadian Study of Health and Aging. Multinomial logistic regression was used to examine the factors associated with the use of different mobility devices (cane, walker, or wheelchair). Over 70% used mobility aids (over 50% used a wheelchair). Mobility limitations were strongly associated with the use of mobility devices. However, among those with mobility limitations, educational resources reduced the odds of wheelchair use. Consistent with findings from the community setting, need factors are strongly associated with the use of mobility aids in institutions. However, socioeconomic resources may provide older adults with alternate ways to manage mobility limitations in institutional settings.

Corrigenda

HaemophiliaVolume 14, Issue 3 p. 670-670 Free Access Corrigenda This article corrects the following: Secondary prophylaxis with recombinant activated factor VII improves health-related quality of life of haemophilia patients with inhibitors W. K. HOOTS, L. S. EBBESEN, B. A. KONKLE, G. K.-H. AUERSWALD, H. R. ROBERTS, J. WEATHERALL, J.-M. FERRAN, R. C. R. LJUNG, , Volume 14Issue 3Haemophilia pages: 466-475 First Published online: February 12, 2008 First published: 28 April 2008 https://doi.org/10.1111/j.1365-2516.2008.01770_1.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the below article [1], the corrected text under the section “HRQoL” should read as: Prophylaxis with rFVIIa more than halved the proportion of days in hospital attributable to bleeding versus on-demand therapy during the pre-prophylaxis period (P = 0.0026; Fig. 1a). The median number of days of bleeding-related hospitalization decreased from 9.5 to 1.5 days in 3 months. There were non-significant trends towards the effect of rFVIIa prophylaxis being maintained during the post-prophylaxis period, with median hospitalization rates of 9%, 2% and 6% during the pre-prophylaxis, prophylaxis and post-prophylaxis periods, respectively. The proportion of days absent from school or work (Fig. 1b) was also significantly less (P = 0.0127) during rFVIIa prophylaxis than the pre-prophylaxis period (means respectively are 16.7% versus 38.7%). The median number (rates) of absentee days from school/work decreased from 18.5 days (33%) during the pre-prophylaxis period to 4.5 days (8%) with rFVIIa prophylaxis and 8.5 days (20%) during post-prophylaxis. Overall use of mobility aids remained unchanged throughout the trial, with patients requiring mobility aids on 28.3%, 27.5% and 26.2% of days in the pre-prophylaxis, prophylaxis and post-prophylaxis periods, respectively. References 1 Hoots WK, Ebbesen LS, Konkle BA, et al. Secondary prophylaxis with recombinant activated factor VII improves health-related quality of life of haemophilia patients with inhibitors. Haemophilia 2008; 14: 466– 75. 2 Neeta S, Nupur G, Shikha S, Deepika D, Suneeta M. Corpus luteal hemorrhage: an unusual manifestation of congenital factor XIII deficiency. Haemophilia 2008; 14: 667– 8. Volume14, Issue3May 2008Pages 670-670 ReferencesRelatedInformation

Perceived participation in life situations in persons with late effects of polio

To investigate how persons with late effects of polio perceive their participation and problems with participation in life situations and to determine the association between perceived problems with participation and sex, age, marital status, use of mobility aids and access to instrumental support. Cross-sectional. A total of 160 persons with prior polio 6-30 months after an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme. All subjects answered the Swedish version of the Impact on Participation and Autonomy Questionnaire. A majority of the respondents perceived their participation as sufficient in most activities and 65% of the respondents perceived no severe problems with participation. The remaining 35% perceived 1-6 severe problems with participation. All 5 domains of participation were positively correlated with the 9 items for problem experience. Most restrictions in participation were reported in the domains of Family role, Autonomy outdoors, and Work and education. Insufficient instrumental support was most strongly associated with the perception of severe problems with participation. Rehabilitation programmes for persons with late effects of polio need to focus on areas of participation that are perceived as a problem by these persons and to promote access to a supportive environment to enhance their participation.

Glaucoma and Mobility Performance: The Salisbury Eye Evaluation Project

To determine the impact of glaucoma on mobility in a population-based cohort. Population-based observational study. Persons examined as part of a population-based eye disease study. Subjects performed a series of tasks, including walking an obstacle course, climbing stairs, performing tandem stands, and walking a 4-meter course. Persons with glaucoma were compared with those without glaucoma to identify differences in mobility. Speed to complete an obstacle course, number of bumps, ability to perform tandem stands, and walking and stair climbing speed. One thousand two hundred fifty subjects participated in the study. In an analysis adjusting for age, race, and gender, walking speed through the obstacle course was 2.4 m/minute slower for persons with bilateral glaucoma, and these individuals experienced 1.65 times the number of bumps when compared with persons without glaucoma (P<0.05 for both). None of the associations was statistically significant comparing persons with unilateral glaucoma with normals. This association remained after adjusting for other potentially confounding factors including visual acuity (VA), body mass index, height, Mini-Mental State Examination score, grip strength, arthritis, depressive symptoms, comorbidities, and use of mobility aids. Additional analyses indicate that visual field loss drives this association. Bilateral glaucoma reduces mobility performance as measured in multiple ways in this population-based study of community-dwelling individuals. Persons with bilateral glaucoma completed the walking course more slowly and had more bumps even after adjusting for use of a mobility aid, comorbidities, and VA. After adjusting for all other factors, persons with bilateral glaucoma walked on average 2.4 m less per minute through the course than those without glaucoma.

Secondary Prophylaxis with rFVIIa Improves Quality of Life of Hemophilia Patients with Inhibitors and Frequent Bleeds.

Introduction: Patients with hemophilia and neutralizing antibodies (inhibitors) against exogenous factor VIII or factor IX characteristically have impaired joint function and more hospitalizations compared with those without inhibitors. We investigated the impact of secondary prophylaxis with activated recombinant factor VII (rFVIIa) on quality of life (QoL) and health-related quality of life (HRQL) in patients with congenital hemophilia A or B with inhibitors and high requirements for on-demand therapy.Methods: In a prospective, randomized, double-blind, uncontrolled trial, 22 patients (inhibitor titer >2 BU/mL; and ≥4 bleeds/month) received secondary prophylaxis with rFVIIa (90 or 270 μg/kg) once daily. This was preceded by a 3-month observation (baseline) period and followed by a 3-month post-treatment follow-up period in which patients were treated on-demand for their bleeds. QoL was evaluated by hospitalizations related to bleeds, days unable to attend/absence from school or work, or days requiring mobility aids. HRQL was assessed with the EuroQoL (EQ-5D), a 5-dimensional measure of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with 3 levels (no problem; some or moderate problems; and extreme problems/impossible to do).Results: The clinically relevant reductions in bleed frequency observed with rFVIIa 90 or 270 μg/kg during prophylaxis (45% and 59%; p<0.0001 for both) compared with on-demand therapy during the observation period (baseline) were maintained during the 3-month follow-up period and were associated with improvements in QoL. The proportion of days during prophylaxis where patients were unable to attend/absent from school/work was significantly less than at baseline (16.7% vs 38.7%; p=0.0127, in a post-hoc analysis of the two treatment arms combined) and a significantly lower percentage of days was spent in hospital (5.9% vs 13.5%; p=0.0026 [post-hoc analysis]). During the post-treatment period, there were non-significant trends towards this effect being maintained (28.1% days absent from school/work, and 10.3% days spent in hospital). Overall use of mobility aids during prophylaxis and during the post-treatment period remained unchanged from that at baseline (post-hoc analysis). With EQ-5D, 2 of the measures (pain and mobility) showed trends towards improvement over time. Fewer patients tended to have pain and mobility problems during prophylaxis and during the post-treatment period.Conclusion: Prior to entry, patients enrolled in this trial bled frequently and overall had significant joint disease. Clinically relevant reductions in the number of bleeds observed during prophylaxis with rFVIIa compared with conventional on-demand therapy were associated with considerable improvements in QoL, reflected in a variety of important measures. Our results support the concept that secondary prophylaxis with rFVIIa in patients with severe hemophilia A or B with inhibitors and frequent bleeds improves the QoL of these disabled patients.

Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention

balancing reactions that involve rapid stepping or reaching movements are critical for preventing falls. These compensatory reactions are much more rapid than volitional limb movements and can be very effective in decelerating the centre-of-mass motion induced by sudden unpredictable balance perturbation; however, age-related deterioration in the neural, sensory and/or musculoskeletal systems may impede the ability to execute these reactions effectively. this paper summarises recent research regarding age-related changes in compensatory stepping and reaching reactions and the practical implications of these findings for fall prevention programmes. even healthy older adults experience pronounced difficulties. For stepping reactions, the main problems pertain to control of lateral stability--arresting the lateral body motion that occurs during forward and backward steps, and controlling lateral foot movement so as to avoid collision with the stance limb during lateral steps. Older adults appear to be more reliant on arm reactions than young adults but are less able to execute reach-to-grasp reactions rapidly. it is important for clinicians to assess compensatory stepping and reaching, in order to identify individuals who are at risk of falling and to pinpoint specific control problems to target for balance or strength training or other intervention. More effective use of stepping and reaching reactions can be promoted through improved design and appropriate use of sensory aids, mobility aids, footwear, handrails and grab-bars. It is particularly important to address the problems associated with the control of lateral stability because it is the lateral falls that are most likely to result in hip fracture.

Falls and the elderly: Is there any difference in the developing world?: A cross-sectional study from Turkey

The phenomenon of falls is not well studied in developing world. However, being aware of possible correlates for falls specific to different populations and trying to eliminate these factors is very important to prevent falls. This study investigated occurrence and correlates of falls among elderly in a developing country, Turkey. A total of 2322 patients aged 65 years and over presented to outpatient clinics of a reference hospital were included in this cross-sectional study. All patients had a complete comprehensive geriatric assessment and questioned for fall history. Correlates for falls were analyzed by using logistic regression. The mean age of participants was 71.8 years; 63.5% were female and 28.5% were found to have fallen within one year. Female sex, visual problems, auditory problems, use of mobility aids, mobility problems and depression were the only independent correlates for falls. Although the cross-sectional design of this study may not prove the causal role of the risk indicators, the size of the study group as well as the large number of possible correlates examined enriches the study. The results from this cross-sectional study form a basis for further prospective study on falls in the Turkish elderly population.

Mobility aids and transport possibilities 10–45 years after spinal cord injury

A cross-sectional survey with retrospective data. Follow-up information on the use of mobility aids and transportation possibilities in a chronic traumatic spinal cord injury (SCI) population. Clinic for Para- and Tetraplegia at Rigshospitalet, University hospital, Denmark (CPT). The uptake area is East Denmark with a population of 2.5 million inhabitants. Survey on date of birth, gender, time of SCI, cause of SCI, neurological level and functional classification from medical files were combined with information concerning mobility aids and transport possibilities at the time of follow-up from a mailed questionnaire. Individuals with traumatic SCI before 1 January 1991 were still in regular follow-up at CPT, and with sufficient medical record. A total of 279 were included, out of which 236 answered the questionnaire. Of the 193 men and 43 women injured from 1956 to 1990 the response rate was 84.6%. Age at the time of follow-up was 50.5 years in mean, and follow-up time was 24.1 years in mean. In all, 126 were paraplegic and 110 tetraplegic. Responders and nonresponders were comparable. In all, 3.4% used no special mobility aids at all. In total, 49 used crutches or rolling walkers and 26 lower extremities bracing, but mostly in combination with a wheelchair. Standing frame and stand-up wheelchair were used by men only. Manual wheelchair was used by 83.5% and electrical wheelchair by 27%, and the latter more by the tetraplegics. In all, 9.3% had neither a manual nor an electrical wheelchair. Overall, 86.4% had a passenger van or another car. Women used a car less often. Passenger vans were more often used by tetraplegics. Nearly all SCI participants had mobility aids of some sort, and 90.7% had either a manual or an electrical wheelchair or both. Most had a passenger van or another type of car for transportation. These facilities are important for the individuals to obtain an independent living.

Community Participation: Challenges for People with Disabilities Living in Oaxaca, Mexico, and New Mexico, United States

The use of wheelchairs or other mobility aids often limits the community participation of people with disabilities because of architectural barriers present in buildings. Although this has been recognized as a global problem, little research has been done to document accessibility standards on an international level. This study reports results from a survey using the Americans With Disabilities Act Accessibility Guidelines Checklist for Buildings and Facilities to measure the differences in levels of accessibility in Albuquerque, New Mexico, United States, and Oaxaca, Oaxaca, Mexico. Investigators surveyed four building types (stores, restaurants, churches, and government buildings or public museums) in both geographic locations to determine whether each building was accessible. The findings showed that buildings in Albuquerque were significantly ( p &lt; .0001) more accessible than buildings in Oaxaca on all measurement items and across all four building types. However, many buildings in Albuquerque were not fully accessible.

Extensible Endoprostheses for Bone Tumors of the Proximal Femur in Children

Between 1983 and 1996, nine children were treated with extensible endoprosthetic replacements of the proximal femur after resection of primary bone tumors. Four patients died of their disease. The remaining five patients were observed for an average follow-up period of 7.6 years. In these five patients, the authors performed an average of 10.2 operations per patient, including five lengthenings and a mean total extension of 69.7 mm per patient. Acetabular loosening and hip dislocations were the most frequent complications. Only two patients have not had a revision or a major complication. Despite this, four children are alive with a functioning lower limb and a mean Musculoskeletal Tumor Society functional score of 77.6%. Extensible endoprosthesis of the proximal femur is a viable alternative to hip disarticulation and in selected children offers an opportunity for near-normal development of the lower limb by allowing equalization of limb length and the ability to walk without the use of mobility aids.

Upper-limb pain in long-term poliomyelitis.

Late functional deterioration is common in long-term poliomyelitis patients. While upper-limb pain in individual functional regions is common, its overall prevalence and pattern in long-term poliomyelitis is poorly documented. To assess the nature of upper-limb pain in these patients and examine its association with dependence on mobility aids (and therefore upper limb 'overuse'). Questionnaire-based survey of patients attending a specialist unit. Questionnaires were sent to 139 patients with known long-term poliomyelitis (mean 49.8 years post polio), attending the Lane Fox Unit out-patient clinic at St Thomas' Hospital between January 1998 and December 1998. There were questions on the nature of the patient's acute illness, limb involvement at initial infection ('polio-affected' limbs), the site and onset of upper-limb pain, hand dominance, previous injuries and surgery, and the use of mobility aids. Limbs that had sustained an injury or undergone surgery, at or preceding onset of upper-limb pain, were excluded from analysis. Among 103 valid replies, the prevalence of upper limb pain was 64%. Mobility aids were used by 74%, and were associated with an increased risk of upper-limb pain, while 'polio-affected' limbs were at reduced risk. These data support 'overuse' due to greater mobility aid dependence as a cause of increasing upper-limb pain in long-term poliomyelitis.

Clinical features of hereditary progressive arthro-ophthalmopathy (Stickler syndrome): A survey

Purpose: To define variations in the clinical manifestations of Stickler syndrome.Methods: A questionnaire was sent to 612 persons.Results: Of the 316 usable replies, 95% of persons had eye problems (retinal detachment occurred in 60% of patients, myopia in 90%, and blindness in 4%); 84% had problems with facial structures such as a flat face, small mandible, or cleft palate; 70%, hearing loss; and 90%, joint problems, primarily early joint pain from degenerative joint disease. Treatment included cryotherapy and laser therapy for retinal detachment, repair of cleft palate, use of hearing and mobility aids, and joint replacements.Conclusions: There are wide variations of symptoms and signs among affected persons, even within the same family. There are delays in diagnosis, lack of understanding among family members, denial about the risk of serious eye problems, and joint disease.

Mobility difficulties are not only a problem of old age.

Lower extremity mobility difficulties often result from common medical conditions and can disrupt both physical and emotional well-being. To assess the national prevalence of mobility difficulties among noninstitutionalized adults and to examine associations with demographic characteristics and other physical and mental health problems. Cross-sectional survey using the 1994-1995 National Health Interview Survey-Disability Supplement (NHIS-D). We constructed measures of minor, moderate, and major lower extremity mobility difficulties using questions about ability to walk, climb stairs, and stand, and use of mobility aids (e.g., canes, wheelchairs). Age and gender adjustment used direct standardization methods in Software for the Statistical Analysis of Correlated Data (SUDAAN). Noninstitutionalized, civilian U.S. residents aged 18 years and older. National Health Interview Survey sampling weights with SUDAAN provided nationally representative population estimates. An estimated 19 million people (10.1%) reported some mobility difficulty. The mean age of those with minor, moderate, or major difficulty ranged from 59 to 67 years. Of those reporting major difficulties, 32% said their problems began at aged 50 years or younger. Adjusted problem rates were higher among women (11.8%) than men (8.8%), and higher among African American (15.0%) than whites (10.0%). Persons with mobility difficulties were more likely to be poorly educated, living alone, impoverished, obese, and having problems conducting daily activities. Among persons with major mobility difficulties, 30.6% reported being frequently depressed or anxious, compared to 3.8% for persons without mobility difficulties. Reports of mobility difficulties are common, including among middle-aged adults. Associations with poor performance of daily activities, depression, anxiety, and poverty highlight the need for comprehensive care for persons with mobility problems.

Economic and Health-Related Quality of Life Considerations of New Therapies in Parkinson??s Disease

The progressive disability of Parkinson's disease results in substantial burdens for patients, their families and society in terms of increased health resource use, poorer quality of life, caregiver burden, disrupted family relationships, decreases in social and leisure activities, deteriorating emotional well-being, and direct and indirect costs of illness. Health-related quality of life (HR-QOL) measures have been used successfully in cross-sectional studies to identify and characterise these burdens; however, there is not yet substantial evidence that these instruments will be responsive to changes in patients over time and that the results will provide patients and health professionals with clinically meaningful information useful in making decisions about treatment strategies. The few studies documenting direct and indirect costs indicate increased use of ancillary health and community services, significant adaptations in home and transportation, increased use of mobility and self-care aids, and lack of access to appropriate healthcare providers. Patients with Parkinson's disease incur higher hospital expenses, have increased number of prescriptions, and experience earnings loss; the latter also applies to family caregivers. The choice, intensity and timing of therapy are determined by a variety of factors: presenting symptoms, age, employment status, comorbidity, cognitive impairment and level of functional impairment. Choices must be individually tailored to a patient's physical and personal needs. To be useful for patients with Parkinson's disease in clinical practice, clinicians should be able to use HR-QOL measures to identify appropriate medical interventions or socio-behavioural modifications to modify the HR-QOL deficits. However, while the interplay of interventions and clinical outcomes are often well understood, the effects of interventions on HR-QOL outcomes have not been studied extensively. Little research has been done that explicitly links the signs and symptoms of Parkinson's disease to the HR-QOL outcomes. The only Parkinson's disease cost-effectiveness study as yet performed indicated higher costs for patients receiving pramipexole than for those not taking the drug, but additional quality life-years were gained. Longer term effectiveness of many treatment strategies, and the usefulness of HR-QOL instruments to assess these treatments for individual patients over time, are critical areas for future research.