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Archives of Physical Medicine and... May 2022To investigate social determinants of health (SDoH) interventions on individual health outcomes, population health, and cost for persons in the United States over age 18... (Review)
Review
OBJECTIVE
To investigate social determinants of health (SDoH) interventions on individual health outcomes, population health, and cost for persons in the United States over age 18 living with disabilities and receiving long-term services and supports (LTSS) in noninstitutional settings.
DATA SOURCES
A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted of literature from PubMed, PsycINFO, REHABDATA, and Web of Science Core Collection published between January 1997 and July 2020.
STUDY SELECTION
Search terms were based on the primary SDoH domains identified by the Centers for Medicare and Medicaid's Accountable Health Communities Model. A total of 5082 abstracts were screened based on identification criteria of persons age 18 and above living in non-institutional, community-based settings receiving LTSS.
DATA EXTRACTION
During Level 2 review, articles were reviewed based on population focus, type of LTSS (personal assistance services, home care, adult day care, home modification, durable medical equipment, community transition services, caregiver supports and/or prevention services related to home- and community-based care), SDoH intervention and association with health outcomes, population health and/or cost. A total of 1037 abstracts underwent Level 2 review, yielding 131 publications or 1.3% for full review.
DATA SYNTHESIS
Studies (n=33) designed a priori to test outcomes of interventions were rated according to Grading Recommendations Assessment Development and Evaluation (GRADE) criteria. Qualifying articles that did not include interventions (n=98) were included in our summary of the literature but were not assessed by GRADE.
CONCLUSIONS
The preponderance of research surrounding SDoH and health outcomes has focused on older adults living with disabilities, and most interventions scored low or very low using GRADE criteria. Evidence is limited to the extent SDoH interventions are measured against outcomes for persons of all ages living with disabilities. Robust evaluation of models that feature SDoH interventions in partnership with community-based organizations is recommended as home and community-based care infrastructure expands in response to the American Rescue Plan Act of 2021.
Topics: Adolescent; Aged; Disabled Persons; Home Care Services; Humans; Medicare; Social Determinants of Health; United States
PubMed: 34756446
DOI: 10.1016/j.apmr.2021.06.021 -
Pain Sep 2019Hypersensitivity due to central pain mechanisms can influence recovery and lead to worse clinical outcomes, but the ability of quantitative sensory testing (QST), an... (Meta-Analysis)
Meta-Analysis Review
Hypersensitivity due to central pain mechanisms can influence recovery and lead to worse clinical outcomes, but the ability of quantitative sensory testing (QST), an index of sensitisation, to predict outcomes in chronic musculoskeletal disorders remains unclear. We systematically reviewed the evidence for ability of QST to predict pain, disability, and negative affect using searches of CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, and PubMed databases up to April 2018. Title screening, data extraction, and methodological quality assessments were performed independently by 2 reviewers. Associations were reported between baseline QST and outcomes using adjusted (β) and unadjusted (r) correlations. Of the 37 eligible studies (n = 3860 participants), 32 were prospective cohort studies and 5 randomised controlled trials. Pain was an outcome in 30 studies, disability in 11, and negative affect in 3. Meta-analysis revealed that baseline QST predicted musculoskeletal pain (mean r = 0.31, 95% confidence interval [CI]: 0.23-0.38, n = 1057 participants) and disability (mean r = 0.30, 95% CI: 0.19-0.40, n = 290 participants). Baseline modalities quantifying central mechanisms such as temporal summation and conditioned pain modulation were associated with follow-up pain (temporal summation: mean r = 0.37, 95% CI: 0.17-0.54; conditioned pain modulation: mean r = 0.36, 95% CI: 0.20-0.50), whereas baseline mechanical threshold modalities were predictive of follow-up disability (mean r = 0.25, 95% CI: 0.03-0.45). Quantitative sensory testing indices of pain hypersensitivity might help develop targeted interventions aiming to improve outcomes across a range of musculoskeletal conditions.
Topics: Affect; Disabled Persons; Humans; Musculoskeletal Pain; Pain Measurement; Pain Threshold; Prognosis; Prospective Studies; Randomized Controlled Trials as Topic
PubMed: 31045746
DOI: 10.1097/j.pain.0000000000001590 -
European Spine Journal : Official... Jul 2022Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically review the influence of pain-related threat beliefs or disability on trunk kinematic or postural control in LBP.
METHOD
Eight electronic databases were searched from January 1990 to July 1, 2020. Meta-analysis using random-effect model was performed for 18 studies on the association between pain-related threat beliefs or disability and lumbar range of motion. Pearson r correlations were used as the effect size.
RESULT
Negative correlations were observed between lumbar range of motion (ROM) and pain-related threat beliefs (r = - 0.31, p < 0.01, 95% CI: - 0.39, - 0.24) and disability (r = - 0.24, p < 0.01, 95% CI: - 0.40, - 0.21). Nonsignificant correlations were reported between pain-related threat beliefs and center of pressure parameters during static standing in 75% of the studies. In 33% of the studies, moderate negative correlations between disability and postural control were observed.
CONCLUSION
Motor behaviors are influenced by several factors, and therefore, the relatively weak associations observed between reduced lumbar ROM with higher pain-related threat beliefs and perceived disability, and postural control with disability are to be expected. This could aid clinicians in the assessment and planning rehabilitation interventions.
LEVEL OF EVIDENCE I
Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
Topics: Cross-Sectional Studies; Disabled Persons; Humans; Low Back Pain; Postural Balance; Torso
PubMed: 35583666
DOI: 10.1007/s00586-022-07261-4 -
European Journal of Pain (London,... Feb 2023Traumatic injuries are amongst the leading causes of death and disability in the world across all age groups. This systematic review aimed to (1) describe the role of... (Review)
Review
BACKGROUND AND OBJECTIVE
Traumatic injuries are amongst the leading causes of death and disability in the world across all age groups. This systematic review aimed to (1) describe the role of post-traumatic stress symptoms (PTSS) on the development of chronic pain and/or pain-related disability following musculoskeletal trauma and (2) report pain and or pain-related disability by injury severity/type.
DATABASE AND DATA TREATMENT
Electronic databases were searched, from inception to 31 November 2021 and updated on 10 May 2022, to identify studies in which: participants were adults aged ≥16 years sustaining any traumatic event that resulted in one or more musculoskeletal injuries; an outcome measure of PTSS was used within 3 months of a traumatic event; the presence of pain and/or pain-related disability was recorded at a follow-up of 3 months or more. Two reviewers independently screened papers and assessed the quality of included studies.
RESULTS
Eight studies were included. Owing to between-study heterogeneity, the results were synthesized using a narrative approach. Five studies investigated the relationship between PTSS and pain. Participants with PTSS were more likely to develop persistent pain for at least 12 months post-injury. Six studies assessed the relationship between PTSS and pain-related disability. The results suggest that patients with PTSS had significantly higher disability levels for at least 12 months post-injury.
CONCLUSION
Findings from this comprehensive systematic review support a clear relationship between PTSS post-injury and future pain/disability, with the potential importance of certain PTSS clusters (hyper-arousal and numbing).
SIGNIFICANCE
The findings of this systematic review indicate an association between PTSS reported within 3 months of a traumatic musculoskeletal injury and the development of longer-term pain and disability. The PTSS clusters of 'hyper-arousal' and 'numbing' appear to be of particular importance in this relationship.
PROSPERO REGISTRATION NUMBER
CRD42021285243.
Topics: Adult; Humans; Stress Disorders, Post-Traumatic; Chronic Pain; Musculoskeletal Pain; Disabled Persons
PubMed: 36317593
DOI: 10.1002/ejp.2048 -
PLoS Neglected Tropical Diseases Aug 2021The number of new leprosy cases is declining globally, but the disability caused by leprosy remains an important disease burden. The chance of disability is increased by...
BACKGROUND
The number of new leprosy cases is declining globally, but the disability caused by leprosy remains an important disease burden. The chance of disability is increased by delayed case detection. This review focusses on the individual and community determinants of delayed leprosy case detection.
METHODS
This study was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The study protocol is registered in PROSPERO (code: CRD42020189274). To identify determinants of delayed detection, data was collected from five electronic databases: Embase.com, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library.
RESULTS
We included 27 papers from 4315 records assessed. They originated in twelve countries, had been published between January 1, 2000, and January 31, 2021, and described the factors related to delayed leprosy case detection, the duration of the delayed case, and the percentage of Grade 2 Disability (G2D). The median delay in detection ranged from 12 to 36 months, the mean delay ranged from 11.5 to 64.1 months, and the percentage of G2D ranged from 5.6 to 43.2%. Health-service-seeking behavior was the most common factor associated with delayed detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge. The most common socioeconomic factors were living in a rural area, performing agricultural labor, and being unemployed. Stigma was the most common social and community factor.
CONCLUSIONS
Delayed leprosy case detection is clearly correlated with increased disability and should therefore be a priority of leprosy programs. Interventions should focus on determinants of delayed case detection such as health-service-seeking behavior, and should consider relevant individual, socioeconomic, and community factors, including stigmatization. Further study is required of the health service-related factors contributing to delay.
Topics: Delayed Diagnosis; Disabled Persons; Humans; Leprosy; Patient Acceptance of Health Care; Risk Factors; Social Stigma; Socioeconomic Factors; Time-to-Treatment
PubMed: 34383768
DOI: 10.1371/journal.pntd.0009651 -
Disability and Health Journal Jan 2022Sports participation has many physical and mental health benefits for individuals with a disability including improved functionality and reduced anxiety, yet a large... (Review)
Review
BACKGROUND
Sports participation has many physical and mental health benefits for individuals with a disability including improved functionality and reduced anxiety, yet a large proportion of individuals with a disability are inactive.
OBJECTIVE
To investigate the experiences and perceived health benefits of sport participation across four disability populations: children and adolescents, adults, elite athletes and veterans with a disability.
METHODS
A mixed-methods systematic review was conducted. Eligible studies had participants who were children, adults, elite athletes or veterans with a physical, visual or intellectual disability. Data were extracted using the Joanna Briggs Institute (JBI) tool and quality assessment involved the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Content, thematic and narrative synthesis techniques were used. Confidence in cumulative evidence was determined using GRADE-CERQual and Classes of Evidence.
RESULTS
Several positive aspects of sport participation were highlighted across all four populations, including socialisation opportunities, pure enjoyment, a sense of freedom and providing an arena to challenge stereotypes. The paucity of research within the 'veterans with a disability' group limited analysis of experiences and benefits of sport in this population.
CONCLUSIONS
This systematic review was the first to explore this phenomena, finding that overall sport is a beneficial experience for individuals with a disability. The positive aspects should be promoted when encouraging sport participation for children, adolescents, adults and elite athletes. More research is needed to explore these phenomena in veterans and to compare perceived benefits between populations to enable tailored promotion of sport.
Topics: Adolescent; Adult; Athletes; Child; Disabled Persons; Health Status; Humans; Mental Health; Sports
PubMed: 34238729
DOI: 10.1016/j.dhjo.2021.101164 -
International Journal of Environmental... Jun 2022The aim of this systematic review was to identify the main factors affecting the training process of para-athletes, as well as the barriers they encounter. For this... (Review)
Review
The aim of this systematic review was to identify the main factors affecting the training process of para-athletes, as well as the barriers they encounter. For this purpose, a systematic review was carried out in accordance with the PRISMA declaration guidelines, in which six databases were analysed (Web of Science, Scopus, SportDiscus, Pubmed, Eric, and PsycInfo). A total of 19 articles were selected for analysis after applying the inclusion criteria. The results show that the figures of the coach and families in the sporting and social contexts, respectively, had a relevant influence on the training process of para-athletes. Furthermore, in terms of psychological aspects, stress reduction, the importance of self-esteem, and motivation were highlighted. On the other hand, there are some barriers hindering the training and performance of athletes, which are related to the lack of financial support, lack of visibility in the media, and dependence on other people. These considerations can be of great help to coaches and competent institutions in the field (Paralympic committees, federations, etc.) in order to improve the training process and performance of para-athletes and to eliminate the barriers encountered by this group, promoting policies which facilitate access to sports for people with disabilities.
Topics: Athletes; Disabled Persons; Humans; Motivation; Para-Athletes; Sports
PubMed: 35742492
DOI: 10.3390/ijerph19127242 -
Research in Developmental Disabilities May 2023Psychological flexibility, a popular concept in clinical psychology, is still evolving in the context of studying parents of children with disabilities. This study... (Review)
Review
PURPOSE
Psychological flexibility, a popular concept in clinical psychology, is still evolving in the context of studying parents of children with disabilities. This study systematically reviewed the literature on the psychological flexibility of parents of children with disabilities to identify contributions of the literature and make recommendations for practice and future study.
MATERIALS AND METHODS
The systematic review was conducted according to the PRISMA guidelines and identified studies on the psychological flexibility of parents of children with disabilities using five electronic databases: PsychNet, PubMed, ERIC, Social Services Abstracts, and EBSCO. Twenty-six articles met the criteria and were included. A thematic analysis was conducted to extract major themes.
RESULTS
Three major themes emerged from the data: (1) psychological flexibility is associated with various aspects of mental health; (2) psychological flexibility is associated with parental functioning in caring for children with a disability; (3) acceptance and commitment therapy (ACT) based interventions effectively enhance the psychological flexibility of parents of children with disabilities.
CONCLUSIONS
The study concludes that psychological flexibility is extremely relevant to disability studies and should be further explored in relation to different parental well-being and functioning aspects. Professionals are encouraged to incorporate principles of acceptance and commitment therapy into their work with parents of children with disabilities.
Topics: Child; Humans; Disabled Children; Acceptance and Commitment Therapy; Parents; Mental Health; Stress, Psychological
PubMed: 36966545
DOI: 10.1016/j.ridd.2023.104490 -
BMC Medical Informatics and Decision... Jul 2021Low back pain is a leading cause of disability worldwide. Health literacy has been associated with pain intensity and pain control. However, there is a paucity of... (Review)
Review
BACKGROUND
Low back pain is a leading cause of disability worldwide. Health literacy has been associated with pain intensity and pain control. However, there is a paucity of evidence regarding this association. In the field of low back pain research, inconsistent reporting of outcomes has been highlighted. To address this issue a Core Outcome Set has been developed.
OBJECTIVES
The objectives of this scoping review were: (1) The health literacy measures currently employed for low back pain and the aspects of health literacy they include. (2) The low back pain health outcomes included in such work. (3) The extent to which these health outcomes reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain.
METHODS
The search included thirteen bibliographic databases, using medical subject heading terms for low back pain and health literacy, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The eligibility criteria were defined by the Joanna Briggs Institute PCC mnemonic. A thematic framework approach was used for analysis.
RESULTS
The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. Most health literacy measures focused on functional health literacy, with few assessing communicative and critical health literacy. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most of these outcome measures studied (36 out of 50) did not directly reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain.
CONCLUSIONS
To allow for comparison across findings and the development of a rigorous evidence base, future work should include the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. There is an urgent need to broaden the evidence-base to include regions where low back pain morbidity is high, but data is lacking. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components.
Topics: Disabled Persons; Health Literacy; Humans; Low Back Pain; Outcome Assessment, Health Care
PubMed: 34256742
DOI: 10.1186/s12911-021-01572-0 -
Dimensions of Critical Care Nursing :...Early mobilization (EM) is associated with reduced physical disability post-intensive care (PD PIC). Yet, contextual factors facilitate or impede delivery of EM in the... (Review)
Review
Patient-Level Barriers and Facilitators to Early Mobilization and the Relationship With Physical Disability Post-Intensive Care: Part 2 of an Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health.
BACKGROUND
Early mobilization (EM) is associated with reduced physical disability post-intensive care (PD PIC). Yet, contextual factors facilitate or impede delivery of EM in the intensive care unit (ICU). Only 45% of ICUs in the United States routinely practice EM despite its recognized benefits.
OBJECTIVES
To analyze the evidence on the relationship between critical care EM, PD PIC, and personal (patient-level) factors, using the theoretical lens of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF).
METHOD
The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the World Health Organization ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized.
RESULTS
Early mobilization delivery was influenced by personal factors. Deeper sedation level, the presence of delirium, higher patient acuity, the presence of medical devices, and patient weight were identified barriers to EM delivery. Patient engagement in EM was associated with improved delivery. Patients who enjoyed rehabilitation were more likely to demonstrate improvement in functional impairment than those who did not enjoy rehabilitation.
DISCUSSION
Early mobilization is associated with reduced PD PIC, yet numerous contextual factors affect the delivery of EM in the ICU. Further study of patient-level factors and EM must explore the relationship between patient engagement, baseline demographics, and functional status at ICU admission, patient-level considerations for decisions to mobilize, and EM in the ICU. This research is critical to improving the delivery of EM in the ICU and reducing PD PIC.
Topics: Critical Care; Disabled Persons; Early Ambulation; Humans; Intensive Care Units; World Health Organization
PubMed: 33792276
DOI: 10.1097/DCC.0000000000000470