Disability and Health Journal最新文献

Background: Survivors of stroke report low levels of community and social participation, even years after stroke. ENGAGE is a community-based intervention that merges social learning, guided problem solving, and supervised practice to collaboratively identify, generate, and apply solutions to challenges with community and social participation after stroke.

Objective: We examined the feasibility, acceptability, and safety of ENGAGE and characterized within group changes in community and social participation outcomes.

Methods: Community-dwelling survivors of stroke, occupational therapy providers, and occupational therapy scientists partnered to co-design the essential and structural elements of ENGAGE, as well as to evaluate ENGAGE using a multi-site single-arm community-based phase 2a clinical trial design. The 6-week ENGAGE program was co-facilitated by survivors of stroke acting as peer mentors and occupational therapy provider through in-person (Phase I, 12 sessions) or virtual web conference meetings (Phase II, 9 sessions). Feasibility was assessed through participant retention, engagement, acceptability, satisfaction, and safety. Within group change was assessed through the PROMIS Ability to Participation in Social Roles and Activities Scale.

Results: Of the 42 participants providing consent, 38 were eligible, and 30 started the intervention program. Retention in the ENGAGE program was 90 % (n = 27). Of these, 85 % engaged actively, 87 % indicated very high satisfaction, and 0 % reported injuries or injurious falls. Participants achieved a medium within group effect size of change in community and social participation (d = 0.38, 95 % CI = -0.11, 0.94).

Conclusions: ENGAGE appears to be a feasible and promising intervention to promote improvements in community and social participation in community-dwelling survivors of stroke.

Background: Photovoice enables participants to document their lived realities through photography, fostering self-expression and deeper reflection.

Objective: Leveraging these strengths, this study aimed to systematically review Photovoice research involving people with disabilities to explore the lived experiences with health-promoting behaviors.

Methods: A systematic literature review was conducted in July 2024 using multiple electronic databases, including PubMed, EMBASE, CINAHL, Cochrane, and Medline. The search process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Quality appraisal was performed using the Critical Appraisal Skills Program. Identified facilitators and barriers to health-promoting behaviors among individuals with disabilities were mapped onto the Socio-Ecological Model to provide a structured analysis.

Results: Ten studies met the inclusion criteria for this review. At individual level, nine facilitators and seven barriers were identified. The interpersonal level revealed three facilitators and two barriers, while the institutional level included two facilitators and one barrier. At the community level, four facilitators and four barriers were found. No relevant factors were identified at the policy level.

Conclusion: This study expands the existing literature on participatory research by systematically reviewing Photovoice studies that examine health-promoting behaviors among people with disabilities. By offering a comprehensive analysis of facilitators and barriers, this review enhances the understanding of lived experiences and informs future interventions aimed at fostering inclusive and supportive environments for health promotion.

Background: Long-term services and supports (LTSS) include various paid institutional and personal care, comprising nearly 28.3 % of Medicaid spending, with significant variability in home and community-based services (HCBS) eligibility across states.

Objective: To examine the impact of state of residence and HCBS spend on risk of institutional placement on a particularly vulnerable population, dual-eligible non-elderly adults with intellectual/developmental disabilities (IDD).

Methods: A retrospective cohort study was conducted to determine the hazard ratio of institutional placement based on Medicaid and Medicare data. We examined CMS Medicaid Analytic eXtract files with linked 2008-2012 Medicare data from California, Florida, New York, Ohio, and Pennsylvania. Eligible participants were 159,275 dual-eligible adults aged 18-to-64 years living in community settings who were continuously enrolled in Medicaid and had ICD-9 codes for ID in any inpatient, outpatient, or long-term encounter.

Results: Among study participants, 4.4 % (n = 6975) had an eventual institutional placement claim. Subjects with institutional placement were more likely to be older, female, sicker, and have more claims for acute, ambulatory, and short-term care. In both unadjusted and adjusted analysis, risk of institutional placement was highest among those living in Ohio (HR 1.86 [1.70-2.04], P < 0.0001) and California (HR 1.50 [1.37-1.64], P < 0.0001) compared to Florida. Risk was lower for every $10,000 increase in HCBS spend at baseline. Black, Hispanic, and Other subjects had lower risks than While subjects, CONCLUSIONS: Our findings suggest that continued investments in HCBS and better access may decrease reliance on costly institutional care for non-elderly disabled adults who may need long-term care for decades.

Background: Little is known about the longitudinal relationship between the prevalence of childhood medical conditions or disabilities (MCoD) lasting at least six months and associated excess healthcare costs to the public payer (Medicare).

Objective: To determine the additional federally funded Medicare costs for children who have a long-term medical condition or disability and to investigate whether these costs rise due to the recurring presence of the conditions over time.

Methods: This study utilised data from the nationally representative Longitudinal Study of Australian Children, comprising Birth (B) and Kindergarten (K) cohorts, involving 9,224 children. Based on Medicare data linkage, the analysis included 54,285 observations longitudinally. Generalised linear models with a log link and gamma distribution were employed to estimate the impact of childhood MCoD on Medicare costs over 14 years for the B cohort and 12 years for the K cohort. All models were adjusted for demographic, socioeconomic, and selected child medical characteristics.

Results: On average, children with long-term MCoD incurred excess Medicare costs ranging from A$494 to A$784 biennially, in the different age groups of 0-1 to 16-17 years, compared to children without such conditions. Nationally, this translates to an estimated total additional Medicare expenditure of A$313.0 million for a cohort of children from age 0-1 year to 16-17 years.

Conclusion: The findings highlight the significant excess public Medicare costs associated with childhood MCoD in Australia. These results will be beneficial for future cost-effectiveness analysis and for improving public health planning aimed at improving support for children with long-term medical conditions or disabilities.

Cerebral palsy (CP) is a lifelong condition that affects 1.5-3.4 per 1000 children worldwide. As they grow older, these children must transition from pediatric to adult healthcare services. This transition comes with stress and uncertainty for a population that is already at a higher risk of poor mental health. This paper discusses what is known about mental health in youth with CP and its impact on their transition within the medical system. It also uses a biopsycho-ecological framework to understand how transition impacts several domains of their life including family structure and social participation. Actionable guidance for medical providers and caregivers is given to promote a healthier transition process.

Background: Disability is experienced by approximately 1.3 billion individuals worldwide. Therefore, people with disabilities (PWD) are part of every physician's patient base, regardless of specialty. Specific educational programs are needed, as medical students and physicians still report discomfort in taking histories, performing clinical examinations and making differential diagnoses when dealing with PWD.

Objective: We hypothesized that participation in a one-week disability awareness training, including theoretical sessions, practical workshops with PWD, and 3-day immersive training courses, would significantly improve the quantitative and qualitative outcomes of medical students toward PWD.

Methods: We conducted a monocentric prospective mixed-methods study targeting 3rd year medical students, using quantitative measurements through repeated synchronous surveys, evaluating disability attitudes in health care (DAHC) scores and performed qualitative explorations through individual semidirected interviews, evaluating students' feelings and attitudes toward PWD.

Results: A total of 218 students (mean age: 21.1 ± 1.4 years) were included in the study. While 60 % of the participants reported no prior working experience with PWD, there was a significant improvement in paired-DAHC scores 3 months after the training (+1.32, p = 0.003). Improvements were predominantly observed in comfort levels during interaction and in discriminatory attitudes. This practical experience was positively reported in the semidirected interviews, in which a facilitated transition from unfamiliarity to informed empathy and knowledge was reported.

Conclusions: The implementation of disability awareness trainings in compulsory medical curricula should be prioritized to improve future physician's skills and attitudes when caring for PWD.