-
Disability and Rehabilitation Oct 2022The aim of this systematic review was to identify models of community disability, rehabilitation and lifestyle service delivery in non-metropolitan areas of Australia,...
PURPOSE
The aim of this systematic review was to identify models of community disability, rehabilitation and lifestyle service delivery in non-metropolitan areas of Australia, and to describe these models through an Integrated People-Centred Health Services (IPCHS) lens.
MATERIALS AND METHODS
We identified peer-reviewed studies published between 2000 and June 2021 that met the following criteria: described or evaluated a community service delivery model, intervention or program in regional, rural or remote Australia; provided for people with a disability or a potentially disabling health condition. A scoring rubric was developed covering the five IPCHS strategies.
RESULTS
Nineteen studies were included in the review. We identified a range of service delivery models providing support to people with a range of disabilities or conditions. We report evidence of the use of the IPCHS strategies in ways relevant to the local context.
DISCUSSION
Several strengths emerged, with many services tailored to individual need, and significant community engagement. Innovative rural service delivery approaches were also identified. Key areas requiring action included improved coordination or integration within and across professions and sectors. There was limited evidence of co-production of solutions or participatory governance. While people-centred approaches show promise to improve community-based services, large-scale fundamental change is required.IMPLICATIONS FOR REHABILITATIONCommunity-based disability and rehabilitation services in rural and remote Australia performed well at delivering tailored care and engaging in community consultation.These services must urgently implement strategies to enhance community ownership of solutions and participatory governance.Services must place a greater focus on explicit strategies to integrate and coordinate across services and professions, and to create an enabling environment, to deliver people-centred care.The World Health Organisation Integrated People-Centred Health Services framework provides an important roadmap to improving service delivery in rural and remote Australian communities.
Topics: Australia; Delivery of Health Care; Disabled Persons; Humans; Life Style; Rural Health Services; Rural Population
PubMed: 34433373
DOI: 10.1080/09638288.2021.1962992 -
Occupational Therapy International Mar 2012Occupational therapists have recognized the benefits that service dogs can provide people with disabilities. There are many anecdotal publications extolling the benefits... (Review)
Review
Occupational therapists have recognized the benefits that service dogs can provide people with disabilities. There are many anecdotal publications extolling the benefits of working with service dogs, but few rigorous studies exist to provide the evidence of the usefulness of this type of assistive technology option. This systematic review evaluates the published research that supports the use of service dogs for people with mobility-related physical disabilities. Articles were identified by computerized search of PubMed, CINAHL, PsycINFO, OT Seeker, the Cochrane Database of Systematic Reviews, SportDiscus, Education Research Complete, Public Administration Abstracts, Web of Knowledge and Academic Search Premier databases with no date range specified. The keywords used in the search included disabled persons, assistance dogs or service dogs and mobility impairments. The reference lists of the research papers were checked as was the personal citation database of the lead author. Twelve studies met the inclusion criteria and whereas the findings are promising, they are inconclusive and limited because of the level of evidence, which included one Level I, six Level III, four Level IV and one Level V. All of the studies reviewed had research design quality concerns including small participant sizes, poor descriptions of the interventions, outcome measures with minimal psychometrics and lack of power calculations. Findings indicated three major themes including social/participation, functional and psychological outcomes; all of which are areas in the occupational therapy scope of practice. Occupational therapists may play a critical role in referral, assessment, assisting clients and consulting with training organizations before, during and after the service dog placement process. In order for health care professionals to have confidence in recommending this type of assistive technology, the evidence to support such decisions must be strengthened.
Topics: Animals; Disabled Persons; Dogs; Evidence-Based Practice; Humans; Mobility Limitation; Occupational Therapy; Social Participation
PubMed: 21858889
DOI: 10.1002/oti.323 -
International Journal of Environmental... Dec 2022This article reviews the peer-reviewed and grey literature published from January 1985 to November 2022 that has quantitatively evaluated the effects of personalized... (Review)
Review
This article reviews the peer-reviewed and grey literature published from January 1985 to November 2022 that has quantitatively evaluated the effects of personalized budgets for people with disabilities (PwDs), in terms of a range of benefit and cost outcomes. Benefit metrics of interest comprised measures of well-being, service satisfaction and use, quality of life, health, and unmet needs. A search was conducted using the PsycINFO, MEDLINE, CINAHL, ASSIA, and Social Care Online databases. Based on inclusion criteria and a quality assessment using the Downs and Black Checklist, a final count of 23 studies were identified for in-depth review. Given the heterogeneous nature of the studies, a narrative synthesis, rather than a formal meta-analysis, was undertaken. Taking the relatively scarce and often methodologically limited evidence base at face value, the findings suggest that-overall-personalized budget users tend to benefit in terms of well-being and service satisfaction outcomes, with the exception of mixed effects for people with mental health conditions. Only a minority of studies have investigated the cost-effectiveness or costs-only of personalized budgets, finding mixed results. Two out of the three cost-effectiveness studies find personal budgets to be more cost-effective than alternative options, meaning that the possibly higher costs of personalized budgets may be more than outweighed by additional benefits. Some evidence looking at service use and/or costs only also points to significant reductions in certain service use areas, which at least hints at the potential that personalized budgeting may-in some cases-entail reduced costs. Further research is needed to explore the generalizability of these conclusions and to better capture and understand the factors driving the observed heterogeneity in some of the results.
Topics: Humans; Budgets; Cost-Benefit Analysis; Disabled Persons; Mental Disorders; Quality of Life
PubMed: 36498302
DOI: 10.3390/ijerph192316225 -
Public Health Sep 2020Smoking has negative consequences on occupational health. The current meta-analysis was conducted with the aim to pool the studies about smoking and increased disability... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Smoking has negative consequences on occupational health. The current meta-analysis was conducted with the aim to pool the studies about smoking and increased disability pension.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
Articles were found in the scientific literature using keywords, and searching was limited to prospective cohort studies that had been published before August 2018. Based on the inclusion and exclusion criteria, 23 prospective cohort studies were selected. The analyses were carried out on the basis of the random-effects method. Subgroup analysis was also carried out. Finally, the bias of publication was examined using Begg's test, the Egger test, the trim-and-fill method, and the funnel plot.
RESULTS
Twenty-three studies were included. The results showed a positive association between smoking and disability pension, with a risk ratio (RR) of 1.41 and 95% confidence interval (95% CI) of 1.30-1.53 (P < 0.001). In men, the RR was equal to 1.48 and 95% CI was equal to 1.30-1.68 (P < 0.001). In women, the RR was equal to 1.23 and 95% CI was equal to 1.09-1.37 (P = 0.001). In current smokers, the RR was equal to 1.41 and 95% CI was equal to 1.26-1.57 (P < 0.001). In former smokers, the RR was equal to 1.16 and 95% CI was equal to 1.05-1.29 (P = 0.003). Qualitative evaluation showed that the studies had a low level of selection bias, data collection bias, and withdrawal and dropout bias.
CONCLUSIONS
Smoking is a risk factor for increasing disability pension, and men are at higher risk of disability pension. In addition, both current and former smokers are in high risk of disability pension. Overall, it can be concluded that smoking is a risk factor for occupational health.
Topics: Disabled Persons; Humans; Pensions; Prospective Studies; Risk Factors; Smoking
PubMed: 32882482
DOI: 10.1016/j.puhe.2020.04.013 -
BMC Geriatrics Jan 2014The choice of measure for use as a primary outcome in geriatric research is contingent upon the construct of interest and evidence for its psychometric properties. The... (Review)
Review
BACKGROUND
The choice of measure for use as a primary outcome in geriatric research is contingent upon the construct of interest and evidence for its psychometric properties. The Late-Life Function and Disability Instrument (LLFDI) has been widely used to assess functional limitations and disability in studies with older adults. The primary aim of this systematic review was to evaluate the current available evidence for the psychometric properties of the LLFDI.
METHODS
Published studies of any design reporting results based on administration of the original version of the LLFDI in community-dwelling older adults were identified after searches of 9 electronic databases. Data related to construct validity (convergent/divergent and known-groups validity), test-retest reliability and sensitivity to change were extracted. Effect sizes were calculated for within-group changes and summarized graphically.
RESULTS
Seventy-one studies including 17,301 older adults met inclusion criteria. Data supporting the convergent/divergent and known-groups validity for both the Function and Disability components were extracted from 30 and 18 studies, respectively. High test-retest reliability was found for the Function component, while results for the Disability component were more variable. Sensitivity to change of the LLFDI was confirmed based on findings from 25 studies. The basic lower extremity subscale and overall summary score of the Function component and limitation dimension of the Disability component were associated with the strongest relative effect sizes.
CONCLUSIONS
There is extensive evidence to support the construct validity and sensitivity to change of the LLFDI among various clinical populations of community-dwelling older adults. Further work is needed on predictive validity and values for clinically important change. Findings from this review can be used to guide the selection of the most appropriate LLFDI subscale for use an outcome measure in geriatric research and practice.
Topics: Activities of Daily Living; Aged, 80 and over; Disability Evaluation; Disabled Persons; Geriatric Assessment; Humans; Psychometrics
PubMed: 24476510
DOI: 10.1186/1471-2318-14-12 -
American Journal of Physical Medicine &... Jun 2012Negative healthcare provider attitudes toward patients with physical disabilities may challenge the delivery of quality care to patients. The objective of this study was... (Comparative Study)
Comparative Study Review
OBJECTIVE
Negative healthcare provider attitudes toward patients with physical disabilities may challenge the delivery of quality care to patients. The objective of this study was to systematically review published studies examining the attitudes of healthcare students and professionals toward patients with physical disabilities.
DESIGN
In October 2011, we searched four electronic databases using the OVID platform. In addition, we screened citation lists. Independent reviewers completed the selection of articles and data abstraction by triplicate review using standardized and pilot tested forms. They resolved disagreements by discussion or with the help of an additional reviewer when necessary. Articles were included if they examined healthcare professionals' and students' attitudes toward patients with physical disabilities. We did not perform a meta-analysis because of the variation in instruments used and variables examined. We used a qualitative approach to identifying and reporting common findings across the studies.
RESULTS
Results indicate that healthcare students and professionals have favorable attitudes toward persons with physical disabilities. More experience with persons with physical disabilities, both professionally and socially, was associated with more favorable attitudes. In addition, female healthcare students and professionals were found to have more positive attitudes toward patients with physical disabilities than do their male colleagues. Limited evidence exists examining the influence of age, race or ethnicity, and rank of student or professional on attitudes toward patients with physical disabilities. Finally, it was found that healthcare students and professionals reported overall more favorable attitudes than did individuals in non-healthcare professions.
CONCLUSIONS
Overall, healthcare students' and professionals' attitudes toward persons with physical disabilities were favorable. However, some studies revealed the possibility that some healthcare providers demonstrate fear and anxiety with the challenge of caring for a patient with physical disabilities. Some of the factors associated with providers' attitudes toward patients with physical disabilities are potentially modifiable (e.g., experience) and could be the target of educational interventions to ameliorate this fear and facilitate higher quality care.
Topics: Attitude of Health Personnel; Delivery of Health Care; Disability Evaluation; Disabled Persons; Education, Medical; Education, Nursing; Female; Health Personnel; Humans; Male; Quality of Health Care; Students, Health Occupations; United States
PubMed: 22596075
DOI: 10.1097/PHM.0b013e3182555ea4 -
Obesity Reviews : An Official Journal... Nov 2008Disability pensions incur huge societal costs in many countries. In Sweden, the three greatest drivers of such productivity losses are musculo-skeletal, circulatory and... (Review)
Review
Disability pensions incur huge societal costs in many countries. In Sweden, the three greatest drivers of such productivity losses are musculo-skeletal, circulatory and psychiatric disorders, all closely associated with weight status. We identified 16 studies investigating the body mass index (BMI)-disability pension relation. In cross-sectional studies, a significantly greater proportion of obese compared with normal weight subjects were disability pensioners. In longitudinal studies, a J-shaped relation with BMI was generally found in both men and women of various ages. Different definitions of obesity status complicated interpretation, as several studies mixed the underweight and normal weight, which appear to have different disability pension risks. In middle-aged men, relative risks were elevated for circulatory causes only for the overweight and obese, while associations for mental disorders were similar in the underweight and overweight but much higher in the obese. In both sexes, monotonic increases and decreases were seen for circulatory and respiratory causes respectively. In intervention studies, reduced disability pension incidence and increased gainful employment were reported after surgery. In summary, BMI was significantly associated with disability pension, but the direction of causality may vary with underlying cause. Interventions had positive productivity effects in the morbidly obese, but whether this holds for the overweight remains to be proven.
Topics: Body Mass Index; Cross-Sectional Studies; Disabled Persons; Employment; Female; Humans; Longitudinal Studies; Male; Obesity; Pensions
PubMed: 18518906
DOI: 10.1111/j.1467-789X.2008.00502.x -
Social Science & Medicine (1982) Jul 2022In many settler-colonial countries, Indigenous people do not access disability services at rates commensurate with disability prevalence. Existing research suggests that... (Review)
Review
In many settler-colonial countries, Indigenous people do not access disability services at rates commensurate with disability prevalence. Existing research suggests that services often do not reflect Indigenous values and social practices, impacting on accessibility. Furthermore, disability services have historically been implicated in processes of colonisation. There is an urgent need to decolonise disability services. Understanding Indigenous knowledge and experience of disability is a necessary step towards achieving this. We systematically reviewed the disability conceptualisations, practices and experiences of First Nations peoples of Australia. Twelve studies met inclusion criteria. There was a consensus among these studies that Western constructs of disability do not resonate with many First Nations people across Australia. The studies reported that many First Nations people conceptualise most disabilities as unremarkable conditions that reflect the normal range of human diversity, although some conditions may be associated with social stigma. Inclusive attitudes and practices of caregiving in First Nations families facilitate the participation of First Nations people with disabilities in family and community life. However, ableism and racism in broader society combine to exclude many First Nations peoples with disabilities from public spaces and from labour markets. Disability services regularly fail to reflect First Nations values and social practices, and can lead to further disempowerment and marginalisation due to diagnostic processes; displacement from country and communities; gendered discrimination; and poor relationships with service providers. We argue that intersectional experiences of colonialism, racism, ableism and sexism, particularly in disability services, can lead to the marginalisation of First Nations participants and families. The decolonisation of disability services requires services to embrace diverse First Nations values and practices associated with human capability, social participation and caregiving. Decolonising disability services also necessitates First Nations control of the governance of disability services and reform across service, organisational, systemic and conceptual levels.
Topics: Colonialism; Concept Formation; Disabled Persons; Humans; Indigenous Peoples; Population Groups
PubMed: 35617764
DOI: 10.1016/j.socscimed.2022.115047 -
Scandinavian Journal of Medicine &... Dec 2014Most people with physical disabilities do not participate in sports regularly, which could increase the chances of developing secondary health conditions. Therefore,... (Review)
Review
Most people with physical disabilities do not participate in sports regularly, which could increase the chances of developing secondary health conditions. Therefore, knowledge about barriers to and facilitators of sports participation is needed. Barriers and facilitators for people with physical disabilities other than amputation or spinal cord injuries (SCI) are unknown. The aim of this study was to provide an overview of the literature focusing on barriers to and facilitators of sports participation for all people with various physical disabilities. Four databases were searched using MeSH terms and free texts up to April 2012. The inclusion criteria were articles focusing on people with physical disabilities, sports and barriers and/or facilitators. The exclusion criteria were articles solely focusing on people with cognitive disabilities, sensory impairments or disabilities related to a recent organ transplant or similar condition. Fifty-two articles were included in this review, with 27 focusing on people with SCI. Personal barriers were disability and health; environmental barriers were lack of facilities, transport and difficulties with accessibility. Personal facilitators were fun and health, and the environmental facilitator was social contacts. Experiencing barriers to and facilitators of sports participation depends on age and type of disability and should be considered when advising people about sports. The extent of sports participation for people with physical disabilities also increases with the selection of the most appropriate sport.
Topics: Disabled Persons; Fatigue; Health Status; Humans; Motivation; Relaxation; Self Efficacy; Social Participation; Sports; Time Factors; Transportation
PubMed: 24730752
DOI: 10.1111/sms.12218 -
Journal of Back and Musculoskeletal... 2023Low back pain is one of the leading causes of disability globally, with a high economic and social burden. A decrease or imbalance in trunk strength has been associated... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Low back pain is one of the leading causes of disability globally, with a high economic and social burden. A decrease or imbalance in trunk strength has been associated with the occurrence of low back pain and its severity. Trunk strength training is helpful in the treatment of Non-specific low back pain (NSLBP) patients. However, we do not know the effects of trunk isokinetic training (IKT) on pain intensity, disability, and trunk strength.
OBJECTIVE
This systematic review aimed to determine the effects of trunk IKT in NSLBP patients on pain intensity, disability, and trunk flexor and extensor isokinetic strength.
METHODS
We searched PubMed, Web of Science, Scopus, CENTRAL, and PEDro, from January 2001 until March 2021 and updated to November 2022. Randomized controlled trials (RCTs) that investigated the effect of IKT in adult participants with NSLBP on pain intensity, disability, or isokinetic trunk strength were included. Mean difference (MD) and 95% confidence intervals (95% CI) were calculated for pain. Bias was assessed using the Cochrane risk of bias (RoB) tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULTS
Among 1750 retrieved articles, eight were included in this review. Meta-analysis comparing IKT (trunk isokinetic training, n= 134) with control groups (conventional exercises, n= 133) revealed that IKT decreases pain intensity (MD -1.50 (95% CI: -2.60; -0.39)) immediately post-intervention, and one month (MD -1.97 (95% CI: -2.92; -1.03)) and at six months follow-up (MD -2.48 (95% CI: -2.77; -2.19)), although with a very low to low quality according to the GRADE rating. Besides, IKT decreases disability and increases isokinetic trunk strength, but with scant evidence.
CONCLUSIONS
Trunk IKT could be a novel clinical tool for pain management in patients with NSLBP, although evidence is scarce. In addition, few RCTs exist for IKT on disability or trunk isokinetic strength in patients with NSLBP. Therefore, further research on this topic is needed.
Topics: Adult; Humans; Low Back Pain; Exercise Therapy; Resistance Training; Disabled Persons; Pain Measurement
PubMed: 37458013
DOI: 10.3233/BMR-220301