-
International Journal of Environmental... Jul 2022The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention... (Review)
Review
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
Topics: Autism Spectrum Disorder; Child; Developmental Disabilities; Disabled Persons; Humans; Intellectual Disability; Psychometrics
PubMed: 35886552
DOI: 10.3390/ijerph19148701 -
Diabetes Research and Clinical Practice Dec 2023Living with a diabetes-related foot ulcer has significant lifestyle impacts. Whilst often considered a last resort, amputation can overcome the burden of ulcer... (Review)
Review
Living with a diabetes-related foot ulcer has significant lifestyle impacts. Whilst often considered a last resort, amputation can overcome the burden of ulcer management, for an improved quality of life. However, limited research has been conducted to understand how the decision to amputate is made for people with a chronic ulcer when amputation is not required as a medical emergency. Therefore, the aim was to identify and map key concepts in the literature which describe the decision-making for diabetes-related amputations. This review followed Arksey and O'Malley's PRISMA scoping review framework. Five electronic databases and grey literature were searched for papers which described clinical reasoning and/or decision-making processes for diabetes-related amputation. Data were extracted and mapped to corresponding domains of the World Health Organisation's International Classification of functioning, Disability and Health (ICF) framework. Ninety-four papers were included. Personal factors including emotional wellbeing, quality of life, and treatment goals are key considerations for an elective amputation. It is important to consider an individual's lifestyle and personal circumstances, as well as the pathology when deciding between amputation or conservative management. This highlights the importance of a holistic and shared decision-making process for amputation which includes assessment of a person's lifestyle and function.
Topics: Humans; Quality of Life; Ulcer; Amputation, Surgical; Diabetic Foot; Lower Extremity; Diabetes Mellitus
PubMed: 37981124
DOI: 10.1016/j.diabres.2023.111015 -
Public Health Sep 2023To undertake a systematic review and meta-analysis to estimate the relative risk of COVID-19-related mortality among people with disabilities compared to people without... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To undertake a systematic review and meta-analysis to estimate the relative risk of COVID-19-related mortality among people with disabilities compared to people without disabilities.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
We systematically searched four databases from March 1, 2020, to August 15, 2022. We included prospective studies with a baseline assessment of disability and a longitudinal assessment of the COVID-19-related mortality. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We undertook random-effects meta-analyses to calculate pooled adjusted hazard ratios for COVID-19-related mortality for people with disabilities, also disaggregated by disability type and study setting.
RESULTS
We identified 2596 articles throughout the electronic data search, and 56 studies were included in the review. Most (73%) had a moderate risk of bias. The pooled adjusted effect estimate for COVID-19-related mortality in people with disabilities compared to those without was 2.7 (95% confidence interval [CI]: 2.4-3.2). Heterogeneity between the studies was high (τ = 0.28, I = 97%). Effect estimates were highest for population-based samples (3.3, 95% CI: 2.7-3.9), compared to hospital settings (2.1, 95% CI: 1.7-2.7). Risk was not elevated among people with disabilities in care home settings (1.6, 95% CI: 0.7-3.5). Disaggregation by disability type showed that people with intellectual disabilities were at the highest relative risk of COVID-19 mortality.
DISCUSSION
Risk of COVID-19 mortality is elevated among people with disabilities, especially people with intellectual disabilities. Efforts are needed to collect better routine data on disability and to include people with disabilities in the pandemic response for COVID-19.
Topics: Humans; COVID-19; Intellectual Disability; Prospective Studies; Disabled Persons; Bias
PubMed: 37541064
DOI: 10.1016/j.puhe.2023.06.032 -
Interactive Journal of Medical Research Feb 2022This review focused on how sexual consent ability was determined, managed, and enhanced in people with cognitive disabilities, with the aim of better understanding the... (Review)
Review
BACKGROUND
This review focused on how sexual consent ability was determined, managed, and enhanced in people with cognitive disabilities, with the aim of better understanding the recurring themes influencing the design and implementation of these approaches. If a person's consensual ability becomes compromised, owing to either an early or late-onset cognitive disability, the formal systems involved must establish plans to balance the individual's rights and restrictions on sexual expression. This review identified these plans, focusing on how they promoted the intimacy rights of the individual.
OBJECTIVE
This study aims to identify approaches that determine sexual consent ability in people with cognitive disabilities, identify the means of managing and enhancing sexual consent ability in people with cognitive disabilities, and note the recurring themes that influence how these approaches and management systems are designed and implemented.
METHODS
A systematic literature review was performed using EBSCOhost (Social Gerontology, CINAHL Plus, MEDLINE, and SocINDEX), Embase, PsyInfo, and Scopus to locate reports on terms expanded on sexual consent and cognitive disability.
RESULTS
In all, 47 articles were identified, featuring assessment practices, legal case studies, and clinical standards for managing sexual consent capacity in people with cognitive disabilities. A total of 8 studies (5/8, 63% qualitative and 3/8, 38% quantitative) were included out of the 47 articles identified. Approaches for determining sexual consent included functional capacity and person-centered, integrated, and contextual approaches. Management of sexual consent ability included education, attitude, and advanced directives and support networks. The recurring themes that influenced these approaches included the 3 legal criteria of consent, American Bar Association and American Psychological Association Model, Lichtenberg and Strzepek Instrument, Ames and Samowitz Instrument, Lyden approach, Mental Capacity Act of 2005, and Vancouver Coastal Health Authority of 2009.
CONCLUSIONS
Determining sexual consent takes a holistic approach, with individuals judged in terms of their adaptive abilities, capacities, and human rights. The attitudes of those using this holistic approach need to be balanced; otherwise, the sexual rights of assessed people could be moved either in favor or against them. The ideal outcome, after person-centered considerations of those living with cognitive disabilities includes the people themselves being involved in the process of personalizing these approaches used to facilitate healthy intimate relationships.
PubMed: 35119371
DOI: 10.2196/28137 -
Midwifery Apr 2022Women with physical disabilities face multiple barriers in accessing safe, respectful and acceptable healthcare. As the number of women with physical disabilities... (Review)
Review
OBJECTIVE
Women with physical disabilities face multiple barriers in accessing safe, respectful and acceptable healthcare. As the number of women with physical disabilities becoming pregnant rises, ensuring their access to acceptable and high-quality maternity care becomes increasingly important. This review aimed to explore the most recent evidence regarding access to, and experiences of, maternity care for women with physical disabilities in high-income countries.
DESIGN
A scoping review was undertaken as guided by the Preferred Reporting Items for Systematic Reviews extension for scoping reviews (PRISMA-ScR). A systematic search of five online databases identified relevant articles published in English from 2000 to 2020. Reference lists of included studies were also screened, and quality was appraised using the Joanna Briggs Institute Checklists. A thematic synthesis was undertaken to develop descriptive and analytical themes.
FINDINGS
After screening, 27 articles from eight high-income countries were included. All articles were identified as having moderate or high methodological rigour in the quality appraisal. Women with physical disabilities reported numerous barriers in accessing maternity care and described predominantly mixed and negative experiences of care. These findings were grouped under three major themes: women with physical disabilities want a "normal" pregnancy experience; the need to strengthen maternity provider's disability knowledge and skills; and promoting enabling environments for improved access to, and experiences of, maternity care.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE
This review found that for women with physical disabilities access to, and experiences of, maternity care is suboptimal. Improving maternity providers disability knowledge and awareness, increasing the availability of support services for women, and increasing person-centred care through organisational policies and provider training may help to address the inequities women with disabilities face in accessing high-quality maternity care.
Topics: Disabled Persons; Female; Health Services Accessibility; Humans; Maternal Health Services; Obstetrics; Pregnancy; Quality of Health Care
PubMed: 35158123
DOI: 10.1016/j.midw.2022.103273 -
Translational Sports Medicine 2022Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss... (Review)
Review
BACKGROUND
Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies.
METHODS
All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included.
RESULTS
Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect.
CONCLUSIONS
Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.
PubMed: 38655170
DOI: 10.1155/2022/8791398 -
Developmental Medicine and Child... Apr 2022To determine the proportion of adults with cerebral palsy (CP) using health services and frequency of use, and to explore experiences and perceptions of health services... (Review)
Review
AIM
To determine the proportion of adults with cerebral palsy (CP) using health services and frequency of use, and to explore experiences and perceptions of health services for this population.
METHOD
A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology. Five databases were searched to September 2020. Observational and qualitative studies were included. Two reviewers screened titles, abstracts, and full texts; extracted data; and assessed the quality of included studies. Separate meta-analyses were used to pool the proportion of adults using each service and frequency of use. A meta-aggregation approach was used to synthesize qualitative data. Quantitative and qualitative findings were integrated using the Andersen and Newman Model of health care utilization.
RESULTS
Fifty-seven studies (31 quantitative, 26 qualitative) of 14 300 adults with CP were included. The proportion of adults using services ranged from 7% (95% confidence interval [CI]: 2-13%) for urologists to 84% (95% CI: 78-90%) for general practitioners. Incidence of visits ranged from 67 (95% CI: 37-123) hospital admissions to 404 (95% CI: 175-934) general practitioner visits per 100 person-years. Qualitative themes highlighted issues regarding accessibility, caregivers' involvement, health workers' expertise, unmet ageing needs, transition, and health system challenges.
INTERPRETATION
Adults with CP used a wide range of health services but faced context-specific challenges in accessing required care. Appropriate service delivery models for adults with CP are required. This review emphasizes a need to develop an appropriate service model for adults with CP to meet their needs.
Topics: Adult; Cerebral Palsy; Health Personnel; Health Services; Humans; Patient Acceptance of Health Care; Qualitative Research
PubMed: 34705276
DOI: 10.1111/dmcn.15097 -
Health Technology Assessment... Nov 2021Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the...
BACKGROUND
Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective.
OBJECTIVE
The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability.
DESIGN
A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability.
RESULTS
Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child.
LIMITATIONS
Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias.
CONCLUSIONS
Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions.
FUTURE WORK
There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42018100572.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 25, No. 73. See the NIHR Journals Library website for further project information.
Topics: Adolescent; Child; Cost-Benefit Analysis; Cross-Sectional Studies; Humans; Parents; Surveys and Questionnaires; Technology Assessment, Biomedical
PubMed: 34866570
DOI: 10.3310/hta25730 -
Disability and Health Journal Jan 2024Livability is a concept commonly featured in health research to help shape public policy decisions and improve local place settings. Although widely used, it is a... (Review)
Review
BACKGROUND
Livability is a concept commonly featured in health research to help shape public policy decisions and improve local place settings. Although widely used, it is a contested concept known for its ambiguity and inconsistency of measurements. Other criticisms include the lack of equity perspectives and the underrepresentation of people with disabilities and inhabitants of non-metropolitan places.
OBJECTIVES
This review sought to identify the extent to which people with disabilities and non-metropolitan places are included in measurements of livability and to critically review and summarise i) livability definitions and uses, ii) livability places and populations, and iii) livability measurements.
METHODS
The scoping review followed Arksey and O'Malley's methodological framework and the PRISMA extension for scoping reviews. The data extraction used meta-aggregation techniques to evaluate findings. A standardised mixed methods appraisal tool was used, and a novel classification of measurements was created.
RESULTS
Seventy-seven articles were included, and 1955 measurements were extracted. The overarching findings were: i) livability is inconsistently defined and assessed by measuring the performance of related and independent domains, ii) the population sample or the studies' participants are often not disclosed, non-metropolitan settings are overlooked, and equity is not generally applied or operationalised in measurements, and iii) there is an extensive lack of measurements considering people with disabilities and diversity within disabilities.
CONCLUSIONS
The assumptions of homogeneity in study populations in livability measurement literature overlook inequities experienced by people with disabilities and inhabitants of non-metropolitan settings. This review suggests recommendations for future research to assess livability from perspectives inclusive of human diversity.
Topics: Humans; Disabled Persons; Health Equity
PubMed: 37722993
DOI: 10.1016/j.dhjo.2023.101521 -
F1000Research 2022Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. To...
Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. To assess the effectiveness of different aerobic exercises to reduce pain intensity and functional disability in patients with CLBP. A computer-aided search was performed to find Randomised Controlled Trials (RCTs) that evaluated the effectiveness of different aerobic exercises in CLBP. Articles published between January 2007 to December 2020 were included in the review. Quality assessment using the PEDro scale, extraction of relevant information, and evaluation of outcomes were done by two reviewers independently. A total of 17 studies were included that involved 1146 participants. Outcomes suggested that aerobic exercise combined with other interventions was more effective than aerobic exercise alone. Aerobic exercise with higher frequency (≥ 5 days/week) and longer duration (≥ 12 weeks) were effective to gain clinically significant (≥ 30%) improvements. Environment and using pedometer did not seem to influence the outcomes. Pain intensity and functional disability in CLBP patients can be minimized by prescribing aerobic exercise. However, to get better improvements, aerobic exercise should be done in combination with other interventions and at optimum frequency and duration. Further studies should emphasize examining the optimal doses and duration of different aerobic exercises.
Topics: Humans; Low Back Pain; Exercise Therapy; Pain Measurement; Exercise; Disabled Persons
PubMed: 37854288
DOI: 10.12688/f1000research.75440.2