AIMS: This study investigates the association in women between conditions during childhood and adolescence and alcohol dependence or abuse in adulthood on the one hand, and disability pensions and long-term sickness absence on the other. METHODS: A stratified population-based sample of women in Göteborg was interviewed. For analyses in this study the following variables were selected from the interview protocol: childhood and adolescence, education, employment, social class, self-rated physical health and alcohol dependence or abuse (ADA), with diagnoses assessed according to DSM-III-R. Information on disability pension and sickness absence was obtained from the local Social Insurance Office. RESULTS: Unfavourable conditions during childhood and adolescence and school difficulties as well as early deviant behaviours predicted disability pension and long-term sickness absence in adulthood. For most risk factors ADA could explain only a minor part of the odds ratios found in crude and age-adjusted analyses. CONCLUSION: It is concluded that conditions early in life are predictors in women of disability pension and long-term incapacity to work. There are similarities in the pattern of early risk factors for later alcohol dependence or abuse and for disability pension/long-term sickness absence.
To investigate if a pending application for disability pension had an influence on the applicant's purchase of medical drugs, with a particular focus on musculoskeletal disorders and the use of painkillers.
We performed a registry-based follow-up study including 12,020 applicants for disability pension in a Danish county from 1995 to 2000 and linked this information to a database of drug prescriptions. Purchase of drug was calculated for the 6-month period just before the decision and for the 6-month period 2 years later. Changes in a 2-year time period were estimated by differences in purchase rates. Furthermore, the proportion of applicants with an increased purchase of drugs and the proportion of applicants who ceased buying drugs were estimated. The results were stratified by diagnosis and result of application (awarded/rejected). The analyses were furthermore restricted to musculoskeletal disorders and the use of painkillers.
At baseline 81% had a purchase and after the 2-year time period 11% ceased buying prescribed drugs. Half of all applicants increased the purchase of drugs. For musculoskeletal disorders one third had an increased purchase rate of painkillers while one fourth ceased purchase of drugs with variations in different diagnostic subgroups. The major changes of drug purchase after a pending application for disability pension are probably ascribed to characteristics of the diseases underlying the disability.
One hundred fifty-nine subacute low back work-injured patients completed a full medical assessment at baseline. A full repeat examination was performed 3 months later, when return-to-work status was determined.
To determine the prognostic value of a comprehensive medical assessment for the prediction of return-to-work status.
A systematic review of the work disability prediction literature of low back trouble prognosis revealed that no high-quality studies included a full medical history and physical examination in the design. The results of studies included in the systematic review were equivocal with respect to predictive usefulness of medical variables.
Participants completed medical history questionnaires and then were clinically examined by one of six experienced examiners (three physicians and three physiotherapists). Return-to-work status was measured 3 months later, and predictive validity was evaluated using logistic regression modeling.
Medical variables (, medical history subscales, physical examination subscales, and lumbar range-of-motion tests) showed modest correct classification rates varying between 61.6% and 69.1% for participants.
Comprehensive medical assessments play a crucial role in the early identification of serious pathology after low back trouble. We were unable to identify, however, any medical evaluation variables that would account for significant proportions of variance in return to work. The weight of evidence obtained in this study suggests that injured workers' subjective interpretations and appraisals may be more powerful predictors of the course of postinjury recovery than exclusively medical assessments.
The need for a national database on persons with disabilities was articulated in early 1980 when members of the Canadian government conducted a nationwide consultation to establish the issues facing persons with disabilities in Canada. This paper will describe the development of this database and show how the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and the international community played an important role in the successful creation of a database which has been used to improve the quality of life for Canadians with disabilities. The Canadian database on disability issues now includes information from three major surveys: the 1983/84 Canadian Health and Disability Survey (CHDS '83), the 1986/87 Health and Activity Limitation Survey (HALS '86) and the 1991/92 Health and Activity Limitation Survey (HALS '91).
Change in patient concerns following total knee arthroplasty described with the International Classification of Functioning, Disability and Health: a repeated measures design.
There is no published evidence of how patient concerns change during the first six weeks following total knee arthroplasty (TKA). An understanding of the recovery process from the patient's perspective will inform clinicians on how to best educate patients about their post-operative concerns. Our objectives were to (1) quantify the level of importance for each of 32 previously identified concerns pre-operatively, and across the first six weeks following primary TKA and, (2) convey this change in importance post-operatively using the components of the International Classification of Functioning, Disability and Health (ICF).
The objectives were achieved using a repeated measures design. Convenience sampling was used to recruit 54 consecutive patients undergoing primary TKA at a hospital in Ontario, Canada. Pre-operatively and at two, four and six weeks post-operatively subjects rated the level of importance for each of the 32 previously identified patient concerns
The importance rating of patient concerns in all four ICF components changed from before surgery to two weeks after surgery. Patient concerns in the Participation component became increasingly important after the first two weeks following surgery. Post-operatively from week two to week four, changes in importance ratings were also found in the Body Function and Activity components, but not in the Environmental Factors component.
Changes in patient concerns mirror their early recovery from TKA surgery. Consistent with this, Participation restrictions become increasingly important to patients after discharge from acute care suggesting that clinicians should think of managing patient expectations for return to societal roles early in post-operative rehabilitation.
Notes
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Classification of handicaps in 6-7-year-old mentally retarded children. Usefulness and inter-observer agreement of a child adapted handicap code of WHO's ICIDH.
This paper reports on the clinical use of a classification of handicaps in 6-7-year-old mentally retarded children. A child-adapted handicap code of WHO's ICIDH was used. It was easy to manage and added valuable information to the child's medical status and psychosocial evaluation. The inter-observer agreement was most satisfactory. The handicap dimension of 'social integration' ought to be regarded as 'social interaction' and needs to be specified further.
To determine efficiency and efficacy of publicly-funded inpatient stroke rehabilitation based on a Case-Mix Group Classification Model, and to analyse the usefulness of this decisional aid in the refinement of rehabilitation services delivery needed to optimize accessibility to inpatient rehabilitation services for individuals with stroke in a publicly-funded healthcare system.
Individuals with stroke (n=422) who received inpatient rehabilitation through the Montreal Rehabilitation Hospital Network were included in this retrospective study. Clinical (total, motor and cognitive-Functional Independence Measure (FIM) scores, percentage of discharge to community) and administrative outcomes (onset to rehabilitation interval, length of inpatient rehabilitation stay, length of stay efficiency) were measured.
Across Case-Mix Groups, mean onset to rehabilitation days varied between 16.2 (5.7) and 32.0 (19.4) days whereas the mean length of stay fluctuated between 27.5 (13) and 77.0 (27) days. Best total (41.6 (21.4)) and motor-FIM (38.9 (19.0)) gains were observed in most severely disabled cases (114) whereas the Case-Mix Group 103 presented the best cognitive-FIM gain (5.8 (4.0)). Optimal mean total, motor and cognitive-FIM efficiency rates, found in moderately disabled stroke patients, were 0.668 (0.434), 0.634 (0.377) and 0.15 (0.136), respectively. Majority of patients returned home following rehabilitation in all Case-Mix Groups (63.6% to 96.4%) except for groups 112 and 108.
Moderate to good length of stay efficiencies are observed among all Case-Mix Group following stroke rehabilitation. In fact, individuals with moderate disability present the best rate of recovery. Variations in length of stay efficiency suggest that the use of a Case-Mix Group Classification Model in stroke rehabilitation could represent an innovative approach, especially for program evaluation in publicly-funded and universal-access rehabilitation hospitals.
The Disability Tax Credit (DTC) Certification is an assessment tool used to provide Canadians with disability tax relief The International Classification of Functioning, Disability and Health (ICF) provides a universal framework for defining disability.
The purpose of this study was to evaluate the DTC and familiarize occupational therapists with the process of mapping measures to the ICF classification system.
Concepts within the DTC were identified and mapped to appropriate ICF codes (Cieza et al., 2005).
The DTC was linked to 45 unique ICF codes (16 Body Functions, 19 Activities and Participation, and 8 Environmental Factors).
The DTC encompasses various domains of the ICF; however, there is no consideration of Personal Factors, Body Structures, and key aspects of Activities and Participation. Refining the DTC to address these aspects will provide an opportunity for fair and just determinations for those who experience disability.
