Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Muscle Strength, Lumbar Curve, Fear of Movement and Functional Disability among Patients with Lumbar Disc Herniation: A Review

Introduction: Lumbar disc herniation (LDH) refers to the rupture of the fibrous annulus of the intervertebral discs. Lumbar curvature may lead to the occurrence of lumbar disc degeneration. Fear of movement may worsen their disc herniation and cause further pain and injury. LDH conditions impact the individuals’ quality of life, to explore the relationship between lumbar curve, muscle strength, fear of movement and functional disability among patients with LDH. Methods: An electronic search was conducted on PubMed, Medline, Science Direct, Springerlink, Google Scholar and a hand search from reference lists was reviewed. Publications were included in human studies, patients 25 - 85 years of age, original studies and published in English language journals from January 2002 to December 2023. Result: In total, 64 articles were researched through the online search engines, and 9 papers were found through manual searches of reference lists. As a result, a total of 11 articles were included for the purpose of this review. The comprehensive analysis revealed the presence of eight cross-sectional studies, two retrospective studies and one experimental study. A minimum of 25 participants and a maximum of 360 participants were included. Ten studies included both genders, only one studies included healthy adults and patients with LDH but these studies didn’t mention gender. Results showed that the factors influencing LDH can be categorized into non-modifiable factors, such as gender, age, height or others. Modifiable factors included increased BMI, DM, smoking, alcohol, employment status, lifestyle and health problems or psychology. Conclusion: Females with greater VASC may be at risk of LDH. The lumbar extensor muscles indicated a localized disc herniation or nerve root pathology in patients with LDH. The fear of movement may lead to psychological consequences and reduce functional disability among patients with LDH.

Organized physical activity and sedentary behaviors in children and adolescents with autism spectrum disorder,cerebral palsy,and intellectual disability

BACKGROUND There is little data on physical activity(PA),organized PA(OPA),and sedentary behaviors in autism spectrum disorders(ASD)and other neurodevelopmental disorders in developing countries.AIM To examine OPA,non-OPA,and sedentary behaviors and their associated factors in children and adolescents with ASD,cerebral palsy(CP),and intellectual disability(ID).METHODS A total of 1020 children and adolescents with ASD,CP,and ID were assessed regarding the child and family information as well as the Children’s Leisure Activities Study Survey.RESULTS The results showed that the OPA level was significantly lower than non-OPA in all groups.Furthermore,the OPA level was significantly lower in the CP group compared to ASD and ID groups(P<0.001).Also,moderate(P<0.001),vigorous(P<0.05),and total(P<0.001)physical activity levels were significantly different between all three groups,with the values being higher in the ASD group compared to the other two.The mean of the total sedentary behavior duration in the ASD group(1819.4 min/week,SD:1680)was significantly lower than in the CP group(2687 min/week,SD:2673)(P=0.007)but not ID group(2176 min/week,SD:2168.9)(P=0.525).CONCLUSION Our findings remark on the participation rate of PA,OPA,and sedentary behaviors of children and adolescents with ASD,CP,and ID in a developing country.In contrast,the need for developing standards of PA/OPA participation in neurodevelopmental disorders is discussed.

Burden of disability in type 2 diabetes mellitus and the moderating effects of physical activity

The growing diabetic epidemic has created a substantial burden,not only on the people with diabetes but also on society at large.This mini-review discussed the limitations and patterns of disability in type 2 diabetes mellitus and put forward a case for the moderating effects of physical activity(PA)in the management of diabetes.The limitations and impairments associated with diabetes include vascular,neurological,cardiac,and renal impairments.Moreover,individuals participate less in their daily lives and in their instrumental activities of daily living,which negatively impacts the quality of life of individuals with diabetes.This often leads to a loss of quality of life due to disabilities,resulting in an increased rate of disability-adjusted life years among people with type 2 diabetes mellitus.Moreover,there are psychosocial sequelae of diabetes mellitus.This necessitates looking for moderating factors that may reduce the burden of the disease.PA has been shown to be one of the factors that can mitigate these burdens.PA does this in several ways,including through the benefits it confers,such as a reduction of hemoglobin A1c,a reduction of excess fat in the liver and pancreas,and the reduction of cardiovascular risk factors,all of which favorably affect glycemic parameters.Specifically,PA regulates or moderates diabetes disability through two mechanisms:The regulation of glucolipid metabolism disorders and the optimization of body mass index and systemic conditions.Therefore,efforts should be directed at PA uptake through identified strategies.This will not only prevent diabetes or diabetes complications but will reduce its burden.

Disability to Admit as a Change of Life after a Road Crash: Estimates and Related Factors in Benin for Prevention

Background: Disability is an underestimated issue in public health, with road crashes as leading cause. In Africa, motorcyclists disproportionately bear the burden of road crash injuries, including disability. To contribute to decision-making for disability prevention, this study aims to determine the prevalence and factors associated with disability at 12 months among motorcyclists involved in road crashes in Benin. Methods: This is a prospective, cross-sectional, analytical study based on 12-month follow-up data from a cohort of road crash victims set up in five hospitals in Benin. Data were collected from November 2020 to January 2021. Sample used for this analysis size was 297 motorcyclists. Disability was assessed using the Washington Group on Disabilities Statistics question set. Logistic regression analysis was used to identify risk factors for disability in victims 12 months after the crash. Results: The prevalence of disability was 12.5% 95% CI (9.2 - 16.7). Disability occurrence was associated with being over 45 years old (OR = 3.1;95% CI = 1.5 - 6.6), severity of initial injury (OR = 3.3;95% CI = 1.5 - 7.3) and hospitalisation of the victim (OR = 6.9;95% CI = 2.0 - 24). Conclusion: Age over 45 years, severity of initial injuries and hospitalisation of the victim were risk factors for the occurrence of disability among motorcyclists who were victims of road crashes in Benin. User awareness, law enforcement, holistic and early management of road crash victims could contribute to reducing the prevalence of disability among victims in Benin.

Research on the Integrated Development of Disability Services in the Greater Bay Area From the Perspective of Media Functions

As the main window for the public to understand the outside world,mass media has an undeniable influence on economic and social development.The way in which the media reports on issues related to people with disabilities not only affects the voice of the disabled community,which determines the public image of the“disappearing”disabled community,but also affects the public awareness and recognition of the disability cause.To further explore the current status of mainstream media’s coverage of the disability cause,this article combines relevant concepts from media function theory and analyzes reports related to the integrated development of the disability cause in the Guangdong-Hong Kong-Macao Greater Bay Area by using the examples of the Zhuhai Special Zone Daily,Southern Metropolis Daily,and Shenzhen Special Zone Daily since the release of the Development Plan Outline for the Guangdong-Hong Kong-Macao Greater Bay Area in 2019.The results show that the“Integrated Development of the Disability Cause in the Bay Area”presented in the reports has the characteristics of service-oriented and cooperation-based,which is in line with the overall trend of the development of China’s disability cause.However,due to factors such as a small overall quantity of related reports,a relatively single style of reporting and information sources,and a strong promotional tone,there still exists a certain difference between the“media reality”and objective reality constructed by these reports.Therefore,this article suggests that institutional media should fully strengthen their coverage of relevant topics,while enhancing the timeliness and readability of reports by enriching various reporting elements.By further enhancing the effectiveness of reporting and communication,the integrated development of the disability cause in the Bay Area can be effectively promoted.

Towards Smart, Sustainable, Accessible and Inclusive City for Persons with Disability by Taking into Account Checklists Tools

The main characteristics of potential smart cities in the future, smart citizens, smart energy, smart buildings, smart mobility, smart technology, smart healthcare, smart infrastructure, smart governance and education, and finally smart security are the aspects of smart cities. In the smart city, smart accessible infrastructure creates an inclusive environment for people with disabilities, in which they can integrate into the community and enjoy their civil, cultural, political, social and economic rights and entitlements. The aim of this study is to integrate disabled people into society so that they can actively participate in society and lead to a normal life. An integrated approach is needed to ensure that people with disabilities are not left alone. A combination of mainstreaming and targeted action is required for all interventions. People with disabilities have the same basic needs as everyone else: health protection and treatment, basic services, housing and income. Targeted intervention measures need to complement disability mainstreaming by addressing specific needs identified by general responses, including such interventions need not add materially to the overall cost, especially if the requirements of the maximum number of users are considered in the initial planning. This paper recommends how we can use an appropriate design checklist as a guide for our initial architectural concept and smart city planning to facilities reasonably accessible for people with disabilities in private and public buildings, making our cities smarter and more inclusive and helping to improve the quality of life for all people, especially people with disabilities.

The Evolution of Disability during the Last Years in Romania and EU Member States

Purpose: People with disabilities represent a major objective, a global public health issue. This disadvantaged category needs protection and integration into society by implementing an improved legislative framework. The effectiveness of the policy making, consolidating the benefit programs and enhancing equity of the social insurance system represent the key of The Governments strategy. Methods: The paper highlights comparable data and research related to disability and social insurance system from Romania and other Member States of the European Union. Internationally, a proper measurement of disability may lead to a successful removal of barriers which increase the vulnerability of people with disability. Results: According to official data, in Romania the number of disabled people decreased gradually one year to another (in the last 5 years). In the EU Member States, musculoskeletal disorders leading to disability were one of the most common compared to Romania where it ranked last. From the point of view of the share in the total number of people with disabilities, according to the degree of disability, both in the EU Member States and in Romania, the number of moderately disabled people was double, respectively triple compared to the number of those with severe disability. Conclusion: The Romania Government promotes social-professional integration of people with disabilities, being responsible for the guidance, vocational counselling and employment. In accordance with our law, “any person with disabilities, fit and included in the labor market in Romania is entitled to a reasonable accommodation of the workplace.”

Associations between cardiac arrhythmia,incident disability in activities of daily living and physical performance:the ILSA study

Background Cardiac arrhythmias are common conditions in older people.Unfortunately,there is limited literature on associations between cardiac arrhythmias and physical performance or disability.We therefore aimed to prospectively investigate associations between cardiac arrhythmias and changes in disability and physical performance during 8 years of follow-up,using data from the Italian Longitudinal Study on Aging(ILSA).Methods Cardiac arrhythmias diagnosis was posed through a screening phase,confirmed by a physician.The onset of disability in activities of daily living(ADL)and the changes in several physical performance tests during follow-up were considered as outcomes.Fully-adjusted and propensity-score Cox Proportional Hazard models and mixed models were used for exploring associations between cardiac arrhythmia and the outcomes of interest.Results The prevalence of cardiac arrhythmia at baseline was 23.3%.People reporting cardiac arrhythmia at the baseline were significantly older,more frequently male,smokers and reported a higher presence of all medical conditions investigated(hypertension,heart failure,angina,myocardial infarction,diabetes,stroke),but no difference in dementia,Parkinsonism,cognitive or mood disorder.Cardiac arrhythmia at baseline was significantly associated with the incidence of disability in ADL(HR=1.23;95%:CI:1.01–1.50;P=0.0478 in propensity score analyses;HR=1.28;95%CI:1.01–1.61;P=0.0401 in fully adjusted models).Cardiac arrhythmia at baseline was also associated with a significant worsening in balance test(P=0.0436).Conclusions The presence of cardiac arrhythmia at baseline was associated with a significant higher risk of disability and of worsening in some physical performance tests,particularly those relating to balance.Screening and frequently assessing physical performance in older people affected by cardiac arrhythmia can be important to prevent a loss of physical performance,with further,potential,complications of medical management.

Association between facet joint osteoarthritis and the Oswestry Disability Index

AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years.The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens AG,Erlangen,Germany) using a dedicated receive only spine coil.After initial blinding,each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging.In total 2364 facet joints were graded.Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI.The index is scored from 0 to 100 and interpreted as follows:0%-20%,minimaldisability; 20%-40%,moderate disability; 40%-60%,severe disability; 60%-80%,crippled; 80%-100%,patients are bedbound.Spearman’s coefficient of rank correlation was used for statistical analysis,with significance set at P 【 0.05.RESULTS:In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals.FJOA was present in 97%(L4/L5) and 98%(L5/S1).At level L4/5(left/right) 17/15(2.9%/2.5%) were described as grade 0,146/147(24.7%/24.9%) as grade 1,290/302(49.1%/51.1%) as grade 2 and 138/127(23.4%/21.5%) as grade 3.At level L5/S1(left/right) 10/11(1.7%/1.9%) were described as grade 0,136/136(23.0%/23.0%) as grade 1,318/325(53.8%/55.0%) as grade 2 and 127/119(21.5%/20.1%) as grade 3.Regarding the ODI scores,patients’ disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%.The majority of patients(48.39%) had moderate functional disability(21%-40%).There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1.A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION:The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain.Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.

Does ethnicity and education influence preoperative disability and expectations in patients undergoing total knee arthroplasty?

AIM To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty.METHODS We prospectively included 829 patients undergoing primary unilateral total knee arthroplasty(TKA) from April 2013 to December 2014 at a single centre. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Patients were stratified based on ethnicity. Majority ethnicity was defined as born inthe study country and minority ethnicity was defined as born in any other country. Similarly, patients were stratified based on duration of education in groups defined as < 9 years, 9-12 years and > 12 years, respectively.RESULTS We found that 92.2% of patients were of majority ethnicity. We found that 24.5%, 44.8% and 30.8% of patients had an education of < 9 years, 9-12 years and > 12 years, respectively. The mean preoperative(preOP) oxford knee score(OKS) in the total population was 23.6. Patients of minority ethnicity had lower mean pre-OP OKS(18.6 vs 23.9, P < 0.001), higher pain levels(VAS 73.0 vs 58.7, P < 0.001), expected higher levels of post-OP pain(VAS 14.1 vs 6.1, P = 0.02) and of overall symptoms(VAS 16.6 vs 6.4, P = 0.006). Patients with > 12 years education had lower mean pre-OP OKS(21.5 vs 23.8 and 24.6, P < 0.001) and higher pre-OP VAS pain(65.4 vs 59.2 and 56.4, P < 0.001) compared to groups with shorter education. One year post-operative(post-OP) patients of minority ethnicity had lower mean OKS, higher pain and lower QoL. One year post-OP patients with > 12 years education reported higher pain compared to patients with shorter educations. However, the response-rate was low(44.6%), and therefore post-OP results were not considered to be significant.CONCLUSION Minority ethnicity and the duration of education influ-ence preoperative disability and expectation in patients undergoing TKA. This should be taken into account when patients are advised pre-operatively.

Measuring episodic abdominal pain and disability in suspected sphincter of Oddi dysfunction

AIM:To evaluate the reliability of an instrument that measures disability arising from episodic abdominal pain in patients with suspected sphincter of Oddi dysfunction(SOD).METHODS:Although several treatments have been utilized to reduce pain and associated disability,measurement tools have not been developed to reliably track outcomes.Two pilot studies were conducted to assess test-retest reliability of a newly developed instrument,the recurrent abdominal pain intensity and disability(RAPID) instrument.The RAPID score is a 90-d summation of days where productivity for various daily activities is reduced as a result of abdominal pain episodes,and is modeled after the migraine disability assessment instrument used to measure headache-related disability.RAPID was administered by telephone on 2 consecutive occasions in 2 consenting populations with suspected SOD:a pre-sphincterotomy population(Pilot Ⅰ,n = 55) and a post-sphincterotomy population(Pilot Ⅱ,n = 70).RESULTS:The average RAPID scores for Pilots Ⅰ and Ⅱ were:82 d(median:81.5 d,SD:64 d) and 48 d(median:0 d,SD:91 d),respectively.The concordance between the 2 assessments for both populations was very good:0.81 for the pre-sphincterotomy population and 0.95 for the post-sphincterotomy population.CONCLUSION:The described pilot studies suggest that RAPID is a reliable instrument for measuring disability resulting from abdominal pain in suspected SOD patients.

The association between socioeconomic status and visual disability among older adults in China

AIM: To investigate the association between socioeconomic status(SES) and visual disability(VD) among older Chinese adults. METHODS: We obtained data from the Second National Sample Survey on Disability, conducted in China in 2006. A total number of 192 375 older adults(aged≥65 y) were screened for suspected VD via interviews with trained examiners. Those who screened positively for VD were referred to ophthalmologists to obtain a final diagnosis. RESULTS: VD was prevalent among 7.29% of Chinese adults aged 65 and older, and was higher in rural areas(8.71%) than in urban areas(4.82%). After adjusting for SES indicators and covariates, we found that lesseducated older adults were more likely to suffer from VD, with an odds ratio(OR) of 2.50(95%CI: 2.26-2.82) for illiterates, compared with those who graduated from senior high school or above. Older adults who were in the lowest income quintile were more at risk of VD, with an OR of 1.81(95%CI: 1.68-2.95), compared with adults in the highest income quintile. In urban areas, when compared with adults who graduated from senior high school or above, those who did not continue their education after junior high school, primary school, or those who were illiterate, were more likely to suffer from VD, with an OR of 1.35(95%CI: 1.51-1.59), 1.84(95%CI: 1.60-2.12), and 2.63(95%CI: 2.27-3.04), respectively. Lower levels of income were statistically significant when associated with VD. In rural areas, adults who were illiterate had an OR of 2.21(95%CI:1.75-2.79) when compared to adults with senior high school or above education level. Per capita, household income remained significantly associated with VD. Older adults who were ≥85, female, single, and residing in rural areas were associated with higher risks of VD. CONCLUSION: Individual-level SES among the elderly, in the form of education and income, is associated with VD among elderly Chinese adults in both urban and rural areas; however, the association is stronger in rural areas. Further studies are still required to explore the mechanism behind the relationships.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

Prevalence and Years Lived with Disability for Dental Caries among Children Aged 0-14 Years in China, 1990-2016

The estimate of dental caries among Chinese children at the microscale level using standard methodology remains unclear. In this study, we assessed and analyzed the disease burden of childhood dental caries in China by extracting data from the Global Burden of Disease, Injuries, and Risk Factors Study 2016 （GBD 2016）. In 2016, the number of cases, prevalence, years lived with disability （YLD）, and age-standardized YLD rate of dental caries was 93.0 million, 43.0%, 32,200 person years, and 14.8 per 100,000, respectively. Across 33 provincial units, the disease burden was highest in Hubei （YLD rate 28.6 per 100,000）, lowest in Macao （9.1 per 100,000）, while geographical clustering was not observed. Compared with 1990, the prevalence in 2016 decreased from 46.8% to 43.0%, and the YLD rate decreased from 16.5 per 100,000 to 14.8 per 100,000. Given the slight decrease in dental caries burden, the prevalence and disease burden remained high among Chinese children. Strategies for addressing the spatial inequity of childhood dental caries require geographical targeting.

Prevalence of-and risk factors for work disability in Dutch patients with inflammatory bowel disease

AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD), and to assess risk factors associated with work disability.METHODS For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability(sick leave, partial and full disability) and long-term full work disability(> 80% work disability for > 2 years).RESULTS Prevalence of work disability was higher in Crohn's disease(CD)(29%) and ulcerative colitis(UC)(19%) patients compared to the general Dutch population(7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years,smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level(OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications(OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work disability.CONCLUSION The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.

Psychosocial Aspects of Disability

In this paper, we will address common psychological reactions to disability such as anxiety, depression, denial, and anger in the framework of a stage model. In addition, this paper will discuss specific societal aspects that can impact reaction and adjustment to disability. In this vein, we will examine the specific effects of societal attitudes and stigma upon individuals with disabilities. Strategies for changing attitudes and facilitating adjustment to disability will also be discussed.

The Future of Disability Policy and Vocational Rehabilitation in the United States

This article focuses on current and future disability public policy having potential implications for the Rehabilitation Act and vocational rehabilitation services in the United States. It explores several models of disability reflected in public policy, important historical legislation, and the relationship of the Workforce Investment Act (WIA) to the Rehabilitation Act. Competing issues and conflicts between the WIA and the state vocational rehabilitation agencies are discussed. A framework for analyzing disability policy is identified to project the future of disability policy, as well as, how these issues and conflicts may impact the survival of the rehabilitation profession.

Rehabilitation of shoulder paresis caused by herpes zoster according to the International Classification of Functioning, Disability and Health A case report

We describe the case of a 73-year-old man with left shoulder paresis caused by a herpes zoster infection of the left C5 dermatomes. The patient had been affected by pain for 10 days, a skin rash on his left shoulder and back for 5 days, and weakness of his left shoulder for 2 days before admission. Eiectromyography revealed denervation discharges from the left supraspinatus, infraspinatus and deltoid muscles, which was compatible with radiculopathy showing after zoster infection. The patient was examined in accordance with the International Classification of Functioning, Disability and Health, and treated with range-of-movement and strengthening exercises as well as activities of daily living and social participation. At 14 months after the onset of the condition, muscle strength had returned to normal. Electromyography revealed that motor unit action potentials were largely normal. These results indicate that the rehabilitation of paresis caused by herpes zoster can obtain positive results with suitable movement training.

The effect of hot intermittent cupping on pain,stiffness and disability of patients with knee osteoarthritis

Objective:The aim of this study was to investigate the effect of hot intermittent cupping on pain,stiffness and inability of patients with knee osteoarthritis(KO).Methods:The present study was a clinical trial,which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic.Based on permutation block method,the research units were divided into cupping therapy and control groups.For the cupping therapy group,four sessions of cupping therapy were performed every four days.To collect data,the form of demographic information,Visual Analogue Scale(VAS)and the Western Ontario and McMaster(WOMAC)osteoarthritis scale were used,and the data were analyzed by SPSS software v.16 using descriptive statistics and independent t-test,paired t-test,Chi-square test and Fishers exact test with a significance level of P<0.05.Results:Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous.Findings indicated that,based on VAS,the mean pain intensity in the left(P<0.001)and the right knees(P<0.001),as well as based on WOMAC,stiffness(P=0.006),pain intensity(P<0.001)and disability(P<0.001)in the cupping therapy group significantly decreased compared to the control group.Conclusion:Findings showed that hot intermittent cupping therapy reduced the pain intensity,stiffness and disability in patients with KO.