Functional Limitations and Disability

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Effects of resistance training on self-reported disability in older adults with functional limitations or disability – a systematic review and meta-analysis

Effects of resistance training on self-reported disability in older adults with functional limitations or disability – a systematic review and meta-analysis

Objectives: To assess: i) whether and to what extent RT interventions have an effect on self-reported disability in older adults ( ≥ 65 years) with functional limitations or disability; and ii) whether the effects on self-reported disability are associated with changes in objective measures of muscle strength and functional capacity across studies. Methods: PubMed, Embase, Web of Science, CINAHL and SPORTDiscus electronic databases were searched in June 2018. Randomized controlled trials reporting effects of RT on self-reported disability/function in ≥ 65 year-old adults with defined, functional limitations or self-reported disability were eligible. Data on self-reported disability/function were pooled by calculating adjusted standardized mean differences (SMD) using Hedges ’ g. Likewise, effect sizes for three secondary outcomes: knee extensor muscle strength; gait capacity; and lower body functional capacity were calculated and fit as covariates in separate meta-regressions with self-reported disability as the dependent factor. Results: Fourteen RCTs were eligible for the primary meta-analysis on self-reported disability. The total number of participants was 651 (intervention n = 354; control n = 297). A significant moderate positive effect of RT was found (SMD: 0.59, 95% CI: 0.253 to 0.925, p = 0.001). Between-study heterogeneity was present (I 2 statistic = 75,1%, p < 0.001). RT effects on objective measures of lower body functional capacity were significantly associated with effects on self-reported disability (Adj. R 2 = 99%, p = 0.002, n = 12 studies), whereas no significant associations with gait capacity or knee extensor strength were found.
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Projecting Health Outcomes for Portuguese Ageing Population: Challenges and Opportunities

Projecting Health Outcomes for Portuguese Ageing Population: Challenges and Opportunities

Functional limitations and disability—Respondents of the 4th NHS were asked if they have any difficulty or a complete inability in performing a set of tasks. From these questions, three groups of limitations were consi- dered: 1) functional limitations, 2) disabilities in activities of daily living (ADL) and 3) disabilities in instru- mental ADL. In the first group, we included the questions related to mobility and to specific physical functional limitations. These included being bedridden or being unable to: go outside the home, walk at least 200 meters or being wheelchair-bound, walk up and down a twelve-step staircase without resting, get into and out of bed, sit- ting down and getting up from a chair, bend down and lift an object from the floor or grab a small object, alone and without difficulty. In this group, we also considered being unable to listen to a TV or radio show in a rea- sonable volume, being unable to see in order to recognize a friend at 4 meters of distance or having difficulties with speaking. In the second group, we included the disabilities that show dependence of the individual on oth- ers, with need for assistance in daily life. These included being unable to go to the bathroom and use it, get dress and undressed, have bath, wash hands and face or feed him/herself alone, without difficulty. The third group in- cluded the disabilities affecting a broader range of activities: being unable to use public transport, to go shop- ping, to do the housekeeping or to prepare food alone, without difficulty. Each group was considered in the form of a binary variable (1 if at least one of the limitations is present and 0, otherwise).
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Functional Disability and School Activity Limitations in 41 300 School-Age Children: Relationship to Medical Impairments

Functional Disability and School Activity Limitations in 41 300 School-Age Children: Relationship to Medical Impairments

Methods. The 1994 and 1995 National Health Inter- view Survey and Disability Interview Supplement sam- ples provide International Classification of Diseases, Ninth Revision medical impairment codes for children with functional limitations or school activity limitations in a nationally representative US sample. Functional lim- itations were distributed as follows: mobility 12.4/1000 (95% confidence interval [CI]: 11.1–13.6), self-care 8.8/ 1000 (95% CI: 7.7–9.8), communication 52.9/1000 (95% CI: 50.2–55.5), and learning 104.6/1000 (95% CI: 100.7–108.4). Functional disability status was classified as 4.1% mild, 5.9% major, and 1.9% multiple. School activity limita- tions included 4.1% needing or receiving special educa- tion, 0.7% unable to attend, and 0.9% limited attendance. We categorized International Classification of Diseases, Ninth Revision impairment codes reported in conjunc- tion with medical usage as physical disorders (n ⴝ 1251; eg, leukemia, diabetes), asthma (n ⴝ 916), neurodevelop- mental disorders (n ⴝ 802; eg, cerebral palsy, epilepsy, mental retardation, autism, blindness, deafness), and learning-behavior disorders (n ⴝ 806; eg, attention-defi- cit/hyperactivity disorder, learning disability, anxiety) for children with functional or school activity limita- tions. Of children with multiple functional disabilities, 29.9% had neurodevelopmental disorders, 27.1% had learning-behavior disorders, 18.1% had physical disor- ders, 4.2% had asthma, and 20.8% did not have an iden- tified medical impairment because they had not received medical services in the past year. Among children requir- ing special education, physical disorders accounted for 9.4%, neurodevelopmental disorders for 16.7%, learning and behavior disorders for 17%, asthma for 3.4%, and 53.4% did not have an identified medical impairment because they had not received medical services in the past year.
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Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI)

Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI)

To summarize, in none of the 9 studies included, there was evidence of a failing validity. The concurrent validity was evaluated in 4 studies. The two national concurrent validation studies indicated a dose-response effect by GALI severity level on the association with other health status measures with a somewhat weaker association re- lated to the mental well-being score.The two inter- national studies did not consider the GALI severity level. They concluded that the odds of reporting participation restriction were higher in subjects with self-reported or observed functional limitations. The strength of the as- sociation varied more strongly between the countries using the EHIS compared to the SHARE survey. The dif- ference in homogeneity can in part be explained by the variation in the implementation of the EHIS, including different wording across countries [33]. International comparability of data submitted to Eurostat, including those on GALI is hampered as EU regulations does not include guidelines on the exact formulation of the ques- tions within one and between surveys [20] nor on the data collection mode increasing the likelihood for differ- ential total survey errors [30]. This under-valorizes the substantial efforts done by Eurostat to harmonize instru- ments in surveys [49]. Differences in accounting for the institutionalized population may further have affected the heterogeneity in the size of the association of the GALI with other health measures [50]. Although, with- out focus on validity, a recent study, using the 2013 Da- nish Health and Morbidity survey and 31 health-related indicators, corroborates the concurrent validity describ- ing a trend towards poorer health and wellbeing in sub- jects with more participation restriction as well as a
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Development and validation of an index of musculoskeletal functional limitations

Development and validation of an index of musculoskeletal functional limitations

Musculoskeletal problems have received less attention as potential correlates of a wide range of health outcomes in subjects with chronic diseases. We define musculoskeletal limitations as functionally limiting problems involving bones, joints, cartilage, soft tissues and other muscu- loskeletal structures. Examples include various forms of arthritis, tendonitis, bursitis, fracture, and regional musc- uloskeletal pain (low back, neck, shoulder, foot, knee, etc). While musculoskeletal problems are among the lead- ing sources of disability, particularly in the elderly [10- 21], there has been little work to date on measuring the number of limiting musculoskeletal problems and using such measures as covariates in studies of chronic disease outcomes. Several scales measure functional status, a key outcome in patients with musculoskeletal conditions. But these scales do not attempt to capture the number of lim- iting musculoskeletal problems per se [22-24]. A single summary musculoskeletal limitations index score would provide an analytically efficient approach to accounting for this important domain. The index score could serve as a covariate to reflect the effect of musculoskeletal prob- lems and attendant limitations on salient health out- comes.
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Progressive disability in elderly population among tribals of Telangana: a cross sectional study

Progressive disability in elderly population among tribals of Telangana: a cross sectional study

Disability is not a binary condition, but a multi-faceted, multi domain functional limitation. From this study it is evident that disability related functional limitations like mobility and performing house hold activities are more impaired in elderly tribal population than other limita- tions like cognition, self-care, getting along with people and social participation. Women comparatively reported higher disability across most domains of disability. Also it was evident that disability related functional limita- tions are highly progressive, however gender variation was not statistically significant. Similar studies reported similar results of higher functional disability in women [25]; higher effect of disability on mobility domain [26]; and a higher prevalence of hypertension [27]. Similarly, results also highlight the fact that even elderly people in tribals suffer from similar issues contrary to certain assumptions that functional disabilities are uncommon, because of their unique socio cultural life style [28]. A detailed primary evaluation of disability domains among significant numbers (i.e. 506 elderly people from 1349 households) of elderly population living in scattered tribal habitats, and hard to reach setting of Khammam District in Telangana are the strength of this study. Limitations include: (1) not assessing for simultaneous clinical disability for comparison; and (2) non- inclusion of elderly people who may be hospitalized or living in old age homes that could have led to under estimation.
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Reliability and validity of the Mizo-version of neck disability index for non-specific neck pain in the rural North-East Indian population

Reliability and validity of the Mizo-version of neck disability index for non-specific neck pain in the rural North-East Indian population

Results: The internal consistency determined by Cronbach alpha, and the Intraclass Correlation Coefficient (ICC) using the test-retest reliability showed a good and an excellent reliability respectively (α=0.82, ICC=0.97, 95% CI= 0.95-0.98). Construct validity was determined between the variables-Numerical Pain Rating Scale (NPRS) and NDI by Pearson’s correlation coefficient and found to have a good correlation r=0.89 and significant difference at p<0.001. Conclusions: The study results concluded the Mizo version of NDI to be easy to understand, reliable and valid instrument for measuring disability and functional limitations of daily activities in non-specific neck pain in the Mizo speaking population.
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In defense of madness: the problem of disability

In defense of madness: the problem of disability

It will help at this point to recall the problem that led us here. It was borne out of the need to arbitrate between the medical and social views on the origin of the limitations associated with variations in function. Advocates of the medical model consider most of the limitations to be unconditional, i.e., intrinsic to the dysfunction/impairment/variation itself. Given the prior anal- ysis, we have a different way of understanding this claim. When we witness a person struggling to achieve some complex goal, we may refer this back to some dysfunction in his or her abilities. Now, we can see that the limit drawn by our reference to dysfunction is a normative and not a natural limit. Hence, when we say that a dysfunction (or an impairment or variation) is intrinsically disabling, we need also to give an account of the norms, values, and contexts by which we were driven to make this claim, and to come to terms with that being the basis of our judgment. The importance of remain- ing cognizant of this point is that in its absence we would not even occasion the need to perhaps examine those norms, values, and contexts and see if they can be modified in such a way that would reflect positively on that per- son’s ability to function and thrive in society through various sorts of adjust- ments. This would act as a bulwark against the gratuitous individualization of the difficulties others face, and the powerful tendency to medicalize their predicament instead of coming to terms with the social solutions that can be put in place, bearing in mind that that is what the activists are asking for.
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Literature Review on the Needs of Families and Carers of People with Learning Disabilities Aikaterini Samioti, Efstratios Papanis, Panagiotis Giavrimis

Literature Review on the Needs of Families and Carers of People with Learning Disabilities Aikaterini Samioti, Efstratios Papanis, Panagiotis Giavrimis

Carers of people with learning disabilities highlight the significant difficulties they have to confront during their caring role (Social Policy Research Unit, 2007). The additional financial costs of bringing up and caring for a person with severe disability have been estimated as twice as much compared to the carers of non- disabled children (JFR Findings, 2001). The additional costs cannot be confined only to the early years of parenting since over the life course, parents and carers of people with learning disabilities would encounter a number of unexpected situations and financial challenges that will require new coping strategies to be found (Todd & Shearn, 1996a). An additional burden for carers of people with learning disabilities is the fact that their employment levels are greatly reduced (Shearn & Todd, 1997). In a different study, Shearn and Todd (2000) presented the perspectives of mothers of children with learning disabilities with respect to their employment. The mothers who participated in the study encountered unusual time demands and felt that their employment opportunities were restricted by social attitudes towards parents of children with disabilities. Different studies have tested the psychological cost of the employment of parents – carers of people with learning disabilities (Todd & Shearn, 1996b; Stephens, Franks & Atienza, 1997).
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The determination and measurement of functional disability in rheumatoid arthritis

The determination and measurement of functional disability in rheumatoid arthritis

In many instances in rheumatology, we are forced to accept the variables we can observe rather than the underlying concepts we wish to measure. We do not have good measures for the latent variable functional ability, so we are forced to accept surrogates like HAQ score or functional scores from the Medical Outcomes Study Short Form 36 [3,4] or Arthritis Impact Measurement Scales [5]. When we accept surrogates, we introduce substantial error because these measures are only approximate mea- sures of function or disability. The HAQ, for example, can be quite abnormal in individuals with little apparent func- tional loss, and can be normal in individuals with substan- tial and obvious dysfunction [2]. Because of the problems in ascertaining a latent outcome, researchers often prefer- entially measure observed outcomes such as work disabil- ity [6–10], joint replacement surgery [11], income [12], or death [13–16]. Yet these outcomes also have their prob- lems because they often take too long to occur, because they may not apply to all patients, and because they do not touch on the day-to-day substance of RA.
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Surgical management of presbyopia

Surgical management of presbyopia

Since certain limitations and complications still persist in excimer laser correction, it is imperative to proceed with a complete ophthalmologic examination, including visual acuity assessment, refraction, intraocular pressure, and fundoscopic examination, as well as corneal thickness and corneal topography assessment. Assessment of biomechanical properties of cornea may be helpful but it is still under investigation. Thin cornea and/or abnormalities on topography, such as keratoconus, may prevent the refractive error correction. Complications such as haze and postoperative pain in PRK, as well as complications regarding the flap, diffuse lamellar keratite, corneal ectasia and dry eye in LASIK correction may occur. LASIK and PRK for myopia and hyperopia have shown reasonable safety, efficacy, and predictability profiles in the presbyopic age group. 14,28
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Outcome measures in brain injury rehabilitation : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

Outcome measures in brain injury rehabilitation : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

As well as the Functional Independence Measure FIM and Functional Assessment Measure FAM, these measures included the Disability Rating Scale DRS, the Community Integration Questionnaire[r]

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Assessment of Quality Of Life and Functional Disability among Hemophilia A Patients

Assessment of Quality Of Life and Functional Disability among Hemophilia A Patients

102 patients of hemophilia A of age > 5 years and on clotting factor concentrate treatment (on- demand protocol) were included in the study. QOL was assessed with SF-36 questionnaire which includes 36 questions measuring physical and mental health with respect to eight health domains. Functional evaluation was done by World Federation of Hemophilia (WFH) approved Gilbert scoring system. Pearson Correlation explored the association between age of diagnosis, functional disability and QOL.

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<p>Functional Disability and Its Determinants in Ecuadorian Patients with Rheumatoid Arthritis</p>

<p>Functional Disability and Its Determinants in Ecuadorian Patients with Rheumatoid Arthritis</p>

Table 2 shows the comparison between patients with and without disabilities. We found a statistically signi fi cant rela- tionship between disability and female sex (p=0.018), age (p=0.020), presence of extra-articular manifestations (p=0.008), myalgias (p<0.001), xerostomia (p=0.023), fever (p<0.001), fatigue (p<0.001), presence of comorbidities (p<0.001), number of comorbidities (p<0.001), depression (p<0.001), hypertension (p=0.001), diabetes (p=0.030) and gastric disease (p<0.001). As for markers of disease activity, functional disability was associated with ESR (p<0.001), CRP (p<0.001), TJC (p<0.001), SJC (p<0.001), VAS of pain (p<0.001) and DAS-28 (p<0.001). In addition, patients with disability had a lower employment rate (26.7%) compared to those without disability (45.5%, p=0.001). Likewise, patients with disability reported greater sexual impairment (19%) com- pared to patients without disability (10.3%, p=0.022). No statistically signi fi cant associations were found between dis- ability and duration of the disease (p=0.058), RF positivity (p=0.441), smoking (p=0.463), Raynaud phenomenon (p=0.728), xerophthalmia (p=0.069), weight loss (p=0.149), hypothyroidism (p=0.827), dyslipidemia (p=0.355) or any treatment.
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Low back pain: what determines functional outcome at six months? An observational study

Low back pain: what determines functional outcome at six months? An observational study

The selection of instruments to be included in the questionnaire (Additional file 1) was based on several considerations. Firstly, the areas identified in previous studies to have prognostic value. Secondly, the question- naires with validity and reliability and with established use in these areas. Thirdly, a set of instruments which covered the main aspects of each domain, which com- plemented each other, without significant redundancy or overlap. The choice of instruments was informed by an international group of back pain researchers who recommended a standard battery of outcome measures to represent the multiple dimensions of outcome in the field of back pain [24]. The domains described included pain symptoms, back related function, generic well- being and disability. These authors anticipated that the instruments would evolve with time and that the core instrument would be sufficiently brief to allow investiga- tors to add other measures to the battery dependent on their research interest. In this study, this core data set was expanded to provide greater breadth and depth which included adding measures of somatisation and depression.
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Assessing function in patients undergoing joint replacement: a study protocol for a cohort study

Assessing function in patients undergoing joint replacement: a study protocol for a cohort study

Patients were excluded from the study if they lacked the capacity to provide informed consent. This was assessed by the research nurse in accordance with guidance from the integrated research application system, which is re- sponsible for providing ethical approval in the UK, and the Mental Capacity Act of 2005 [25]. This decision was made by a research nurse if the patient met one of the following criteria: 1.) they could not understand the in- formation relevant to the decision to participate 2.) they were unable to retain the information about the study 3.) they were unable to use or weigh that information as part of the decision-making process 4.) they were unable to communicate their decision about participation (whether by talking, using sign language or any other means). Another exclusion criterion was severe functional limita- tions such that the participant was unable to walk as this would prevent the participant from being able to attempt any of the functional tests which would make it impos- sible to collect essential data. This was assessed in the discussion between the research nurse and the potential participant about what participation would involve and was always a mutual decision by the researcher and the patient. Being unable to complete questionnaires in the English language was also an exclusion criterion because not all the validated questionnaires have been translated into other languages.
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Neurodevelopmental Disability Through 11 Years of Age in Children Born Before 26 Weeks of Gestation

Neurodevelopmental Disability Through 11 Years of Age in Children Born Before 26 Weeks of Gestation

RESULTS: Using classmate data to determine reference ranges, seri- ous cognitive impairment (score of less than ⫺ 2 SD) was present in 40% of extremely preterm children and 1.3% of classmates (odds ratio [OR]: 50 [95% confidence interval (CI): 12–206]) at 11 years of age. Overall, 38 (17%) extremely preterm children had cerebral palsy; moder- ate or severe impairment of neuromotor function, vision, and hearing was present in 10%, 9%, and 2% of these children, respectively. Combining impairment across domains, 98 (45%) extremely preterm children had serious functional disability compared with 1% of the classmates (OR: 61 [95% CI: 15–253]); this was more common in boys than girls (OR: 1.8 [95% CI: 1.0 –3.1]) and in those born at 23 or 24 weeks’ gestation compared with those born at 25 weeks’ gestation (OR: 1.8 [95% CI: 1.0 –3.1]). The preva- lence of serious functional disability was 46% at 6 years of age and 45% at 11 years of age. Using multiple imputation to correct for selective dropout, it is estimated that 50% (95% CI: 44%–57%) of extremely preterm children are free of serious disability at 11 years of age.
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Supporting tertiary students with disabilities: Individualised and institution-level approaches in practice

Supporting tertiary students with disabilities: Individualised and institution-level approaches in practice

Students and staff invest considerable expertise and effort in identifying suitable reasonable adjustments and supports, yet sometimes they were unsuccessful. The barriers to using adjustments and supports identified by participants were predominantly physical or attitudinal, or they related to the ways in which disability supports were implemented. The physical barriers to using reasonable adjustments described by students and disability services staff included: situations in which the technology proved unsuitable for the intended use; equipment not arriving on time; students were not trained in using it; the provided equipment created other difficulties; or access to study resources was restricted. For instance, one student described being given a swivel chair, which then needed to be taken by the student to multiple classrooms on different levels of a building; another student spoke of significant physical restrictions in studying due to needing assistance to use the lifts and the login screens on computers.
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<p>Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery</p>

<p>Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery</p>

To determine baseline predictors of pain intensity tra- jectory class membership, univariate logistic regression analyses were conducted (Table 8). Signi fi cant factors associated with pain intensity trajectory group membership at the univariate level included: age, sex, PICU admission, surgery type, use of regional analgesia, cumulative 5-day opioid consumption, baseline functional disability, base- line symptoms of post-traumatic stress, baseline symptoms of depression, baseline pain-related anxiety and worry, baseline non-pain-related anxiety, and baseline parent pain fl exibility. Six variables (age, PICU admission, sur- gery type, use of regional analgesia, cumulative 5-day opioid consumption, and baseline parent pain fl exibility) were not signi fi cant when building the multivariable model (ie, every other factor individually accounted for more of the variance) and therefore we excluded them from the fi nal model. A multivariable logistic regression was conducted with the fi nal model shown in Table 9. The referent class was mild pain intensity. The fi nal model ( χ 2 (7, n = 208) = 36.659, p < 0.001, Nagelerke R 2 = 21.6%) included functional disability, cumulative 5-day opioid consumption, sex, general anxiety, pain-related anxiety and worry, symptoms of depression, and post- traumatic stress symptoms. Greater functional disability prior to surgery predicted a higher likelihood of being in the high pain intensity trajectory group (OR: 1.053, 95% CI: 1.019, 1.089, p = 0.002). In-hospital cumulative 5-day Table 5 Model Fit For Pain Intensity And Pain Unpleasantness
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Clinical profile and functional disability of patients with migraine.

Clinical profile and functional disability of patients with migraine.

Item‑wise frequency and percentage of functional disability were computed among episodic (n = 32), chronic (n = 28), and the total number (n = 60) of participants. The item‑wise mean scores obtained in questions 1 through 5 and the 2 supplementary questions are shown in Table 3. The group with CM had more missed more days from work/school (1.89 [95% confidence interval (CI), 0.8–2.9] vs. 0.69 [95% CI, 0.2–1.1]), had more days of reduced productivity at work/school (6.71 [95% CI, 3.5–9.9] vs. 1.91 [95% CI, 0.8–2.9]), missed more days of housework (4.57 [95% CI, 3.07–6.08] vs. 2.44 [95% CI,1.35–3.52]), reduced effectiveness in housework (9.43 [95% CI, 6.53–12.33] vs. 4.28 [95% CI, 2.63–5.94]),
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