Predicting the grade of disability 1 year after stroke following rehabilitation

The purpose of this study was to identify predictors of grades of disability at least 1 year after stroke rehabilitation therapy. We recruited stroke patients from the inpatient rehabilitation department of a university hospital. The degree of disability was graded using the disability evaluation at least 1 year after stroke onset. Functional ability was evaluated using the Functional Independence Measure instrument on admission, on discharge from the inpatient rehabilitation program, and at the 6-month follow-up visit after discharge. Major sociodemographic, medical, and rehabilitative factors were also collected during the hospitalization period. Of the 109 patients surveyed, 64 (58.7%) had severe or very severe grades of disability. The correlates of severe or very severe disability in logistic regression analyses were bilaterally affected (odds ratio, OR, 10.8), impaired orientation (OR, 3.6), and poorer functional ability at discharge (OR, 7.6). Based on the significant predictors identified, the logistic regression model correctly classified severe or very severe disability in 68.0% of subjects. The higher frequency of severe or very severe disability in this study may have been due to the relatively more severely affected stroke patient population in the inpatient rehabilitation service and the use of unique disability evaluation criteria. These results may provide information useful in planning continuous rehabilitation care and setting relevant socio-welfare policies for stroke victims.

Cross-national compartability of burden of disease estimates:the European disability weights project

Objective: To investigate the sources of cross-national variation in disability-adjusted life-years (DALYs) in the European Disability
Weights Project.

Methods: Disability weights for 15 disease stages were derived empirically in five countries by means of a standardized procedure and the cross-national differences in visual analogue scale (VAS) scores were analysed. For each country the burden of dementia in women, used as an illustrative example, was estimated in DALYs. An analysis was performed of the relative effects of cross-national variations in demography, epidemiology and disability weights on DALY estimates.

Findings: Cross-national comparison of VAS scores showed almost identical ranking orders. After standardization for population size and age structure of the populations, the DALY rates per 100 000 women ranged from 1050 in France to 1404 in the Netherlands. Because of uncertainties in the epidemiological data, the extent to which these differences reflected true variation between countries was difficult to estimate. The use of European rather than country-specific disability weights did not lead to a significant change in the burden of disease estimates for dementia.

Conclusions: Sound epidemiological data are the first requirement for burden of disease estimation and relevant between-countries comparisons. DALY estimates for dementia were relatively insensitive to differences in disability weights between European countries.

The relation between non-occupational physical activity and years lived with and without disability

OBJECTIVES: The effects of non-occupational physical activity were assessed on the number of years lived with and without disability between age 50 and 80 years. METHODS: Using the GLOBE study and the Longitudinal Study of Aging, multi-state life tables were constructed yielding the number of years with and without disability between age 50 and 80 years. To obtain life tables by level of physical activity (low, moderate, high), hazard ratios were derived for different physical activity levels per transition (non-disabled to disabled, non-disabled to death, disabled to non-disabled, disabled to death) adjusted for age, sex and confounders. RESULTS: Moderate, compared to low non-occupational physical activity reduced incidence of disability (HR 0.66, 95% CI 0.51 to 0.86), increased recovery (HR 1.95, 95% CI 1.32 to 2.87), and represents a gain of disability-free years and a loss of years with disability (male 3.1 and 1.2; female 4.0 and 2.8 years). Performing high levels of non-occupational physical activity further reduced incidence, and showed a higher gain in disability-free years (male 4.1; female 4.7), but a similar reduction in years with disability. CONCLUSION: Among 50-80-year-olds promoting physical activity is a fundamental factor to achieve healthy ageing.

Validation of a body-worn accelerometer to measure activity patterns in octogenarians

OBJECTIVE: To determine the validity of a triaxial body-worn accelerometer for detection of gait and postures in people aged >80 years. DESIGN: Participants performed a range of activities (sitting, lying, walking, standing) in both a controlled and a home setting while wearing the accelerometer. Activities in the controlled setting were performed in a scripted sequence. Activities in the home setting were performed in an unscripted manner. Analyzed accelerometer data were compared against video observation as the reference measure. SETTING: Independent-living and long-term-care retirement village. PARTICIPANTS: Older people (N=22; mean age ± SD, 88.1±5y) residing in long-term-care and independent-living retirement facilities. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The level of agreement between video observation and the accelerometer for the total duration of each activity, and second-by-second correspondence between video observation and the accelerometer for each activity. RESULTS: The median absolute percentage errors between video observation and the accelerometer were <1% for locomotion and lying. The absolute percentage errors were higher for sitting (median, -22.3%; interquartile range [IQR], -62.8% to 10.7%) and standing (median, 24.7%; IQR, -7.3% to 39.6%). A second-by-second analysis between video observation and the accelerometer found an overall agreement of ≥85% for all activities except standing (median, 56.1%; IQR, 34.8%-81.2%). CONCLUSIONS: This single-device accelerometer provides a valid measure of lying and locomotion in people aged >80 years. There is an error of approximately 25% when discriminating sitting from standing postures, which needs to be taken into account when monitoring longer-term habitual activity in this age group.

Population based intervention to change back pain beliefs and disability : three part evaluation

Objective To evaluate the effectiveness of a population based, state-wide public health intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and costs of compensation. Design Quasi-experimental, non-randomised, non-equivalent, before and after telephone surveys of the general population and postal surveys of general practitioners with an adjacent state as control group and descriptive analysis of claims database. Setting Two states in Australia Participants 4730 members of general population before and two and two and a half years after campaign started, in a ratio of2:1:1; 2556 general practitioners before and two years after campaign onset. Main outcome measures Back beliefs questionnaire, knowledge and attitude statements about back pain, incidence of workers' financial compensation claims for back problems, rate of days compensated, and medical payments for claims related to back pain and other claims. Results In the intervention state beliefs about back pain became more positive between successive surveys (mean improvement in questionnaire score 1.9 (95% confidence interval 1.3 to 2.5), P<0.001 and 3.2 (2.6 to 3.9), P < 0.001, between baseline and the second and third survey, respectively). Beliefs about back pain also improved among doctors. There was a clear decline in number of claims for back pain, rates of days compensated, and medical payments for claims for back pain over the duration of the campaign. Conclusions A population based strategy of provision of positive messages about back pain improves population and general practitioner beliefs about back pain and seems to influence medical management and reduce disability and workers' compensation costs related to back pain.

Evaluation of the Chinese version of the disability of the arm, shoulder and hand (DASH-HKPWH): cross-cultural adaptation process, internal consistency and reliability study

Abstract
The Disability of the Arm, Shoulder and Hand (DASH) was translated into Chinese by a physiotherapy team of the Prince of Wales Hospital, Hong Kong (DASH-HKPWH).

Objectives
This study evaluated the cross-cultural adaptation process, face validity, internal consistency and reliability of the DASH-HKPWH.

Method
Language officers and medical professionals from different fields were invited to translate and evaluate the face validity of the DASH-HKPWH. 88 patients were recruited to complete two DASH questionnaires on two occasions 1-2 weeks apart.

Results
Some adjustments were made to the translations based on the cultural and linguistic practice in Hong Kong. The face validity was satisfactory with a mean endorsement score of 3.2. The difference between the mean of DASH scores was not significant (t = −0.35, p = 0.73). The ICC (1,1) and Cronbach's alpha for the 30-item Disability/Symptom of the DASH-HKPWH was 0.77 and 0.94, respectively.

Conclusion
The translation was valid and reliable and acceptably equivalent to the original version. The questionnaire is suitable for measuring changes experienced by patients with any upper extremity disorders.

Depression in people with intellectual disability : an evaluation of a staff-administered treatment program

The prevalence of co-morbid depression in people with intellectual disability (ID) provides a strong rationale for the early identification and treatment of individuals at risk. The aim of this study was to evaluate a staff-administered group CBT program for the treatment of depression in people with mild ID. A sample of 13 staff employed at two community-based disability agencies were trained to deliver the program to 47 individuals with mild ID and symptoms of depression. A wait list control group comprised of 27 individuals subsequently completed the program. Compared to the control group, individuals who had participated in the treatment program showed lower depression scores, and fewer automatic negative thoughts. Furthermore, these changes were maintained at a 3-month follow-up. The results indicate that staff can be trained to deliver a CBT program within community settings that is effective in the reduction of depression symptomatology in people with mild ID.

The content validity of the behaviour support plan quality evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability

Background The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability.

Method A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics.

Results The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme.

Conclusions The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes.

Emerging trends in the use of drugs to manage the challenging behaviour of people with intellectual disability

Background Concerns about the pharmacological management of the behaviour of individuals with intellectual disability have resulted in the development of legislative and procedural controls.
Method This Australian study provided a comparison of 873 reported cases where drugs were administered to manage behaviour in March 2000, with 762 cases reported in March 1993. Drug use in individuals who remained medicated across time (n = 316: recurrent sample) was also compared with those who were reported only in 1993 (n = 329: limited sample).
Results A small decrease in the proportion of individuals who were reported to have received medication was evident over time (from 5% to 4.5% of total population). However, this was accompanied by an increase in drug diversity and interclass polypharmacy. An increase in antidepressant use was evident (from 7.4% to 13.8% of reported drugs), and there was a trend towards greater reporting of medication for acute behavioural problems and medication use with children. Greater use of antipsychotic drugs was evident in individuals who remained medicated across time compared with those who did not.
Conclusions The findings suggest the need for continuous research into practice. The fact that many individuals receive medication over long periods makes it incumbent on service providers to engage in regular, comprehensive and individualized review and evaluation of medication regimes.

Effectiveness of treatment programmes for depression among adults with mild/moderate intellectual disability

Background The current study describes the development and evaluation of group treatment programme for people with mild/moderate intellectual disability (ID).
Methods A total of 34 participants (16 males, 18 females) completed the treatment programme and 15 participants (six males, nine females) comprised a control group.
Results Compared to the control group, the intervention group showed an improvement in levels of depression, positive feelings about the self, and lower levels of automatic negative thoughts after the intervention. These changes were maintained at 3-month follow-up.
Conclusions These results demonstrate that intervention programmes are effective for the treatment of depression among people with ID.

Colorectal cancer screening in Australia: an economic evaluation of a potential biennial screening program using faecal occult blood tests

Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder.  Methods: The annual equivalent costs and consequences of a   biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99–400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.

The measurement of subjective wellbeing in people with intellectual disability in Australia

The importance of measuring quality of life, and most particularly the personal wellbeing of people with intellectual disabilities (ID), is now recognized. The measurement of wellbeing is an important component of program evaluation and can assist in the identification and planning of individualized support needs. There remains, however, a need for further research in this area. This paper describes a new scale, the Personal Wellbeing Index Intellectual Disability Scales (PWI-ID), which has been shown to be valid and reliable. Data is presented regarding its use in the measurement of wellbeing in people with ID and the focus of discussion is on its advantages and limitations.

Experiences of disability consumer-directed care users in Australia : results from a longitudinal qualitative study

The rapidly growing body of literature suggests that Consumer-directed Care (CDC) has the potential to empower consumers and improve the flexibility and quality of care. However, reports highlighting quality and risk concerns associated with CDC focusing on a longer time frame have been few. This paper presents the findings from a qualitative longitudinal evaluation of an Australian CDC programme. Focusing on the period between 2003 and 2008, it reports on the experiences of 12 families caring for a dependent family member. It is based on two external evaluations completed 6 and 36 months after enrolment, and one internal evaluation completed 48 months after enrolment. The findings were triangulated with internal memos, reports and minutes of meetings, as well as with the theoretical literature. The study demonstrates that CDC harbours considerable benefits for people with disabilities and their carers. However, the study also suggests that, over time, carers may experience an increased sense of isolation and lack of support as a result of their involvement in the CDC programme. The paper argues that the development of safeguards addressing these weaknesses is crucial for the sustainability of CDC programmes in contexts where risk cannot be simply transferred onto consumers.

Meaning of home : a comparison of the meaning of home as identified by samples of Victorians with, and without, an intellectual disability

This phenomenological study of the meaning of home from the perspectives of people with and without an intellectual disability sought to identify, (a) any common ‘essence’ of meaning held by and, (b) the nature of any differences of perception between, the groups. Purposive samples of 18 people with an intellectual disability and 21 non-disabled people were surveyed using a semi-structured interview to ascertain their experiences of home and 'non-homes'. Inductive analysis of the data revealed a shared understanding of the meaning of home at a fundamental level. This shared meaning of home was found to comprise: the ability to exert control over an area; having a personalised space; feeling content with the living situation; a sense of familiarity with the setting; a set of behaviours and routines usually only enacted when at home; common names and uses for rooms; socialising at home with others; the importance of a positive social atmosphere in the home; and, recognition of places as non-homes because they lacked one or more of these attributes. Further analysis revealed the essence of home is its experience as the place where stress is most reduced or minimised for the individual. The study demonstrates that the concept of stress is superordinate to previously identified concepts considered fundamental to home such as privacy, control and non-homes. Major differences between the two samples were largely differences of degree with people who have an intellectual disability reporting the same fundamental attributes of home as people who do not have an intellectual disability, but in a less elaborated form. Principal among these differences of degree was the notion of control over the home and its derivative elements which encompassed the whole dwelling including its setting for people without an intellectual disability but was very restricted for people with an intellectual disability being largely confined to the person's bedroom. Socialising in or from the home was also very limited for people with an intellectual disability in comparison with that experienced by non-disabled informants with the former group conveying an impression of leading significantly socially isolated lives at home. The major implications of this study are related to the meaning of home per se, to residential service provision to people with an intellectual disability, and to future research.