Women with Disabilities

Women with disabilities face substantial barriers to obtaining health care services. They are more likely than nondisabled women to smoke cigarettes, to be obese or overweight, to be physically inactive, and to report depressive symptoms, anxiety, and fears. Women with disabilities are often stigmatized as being asexual and experience higher rates of domestic partner and in-home abuse. Physical, communication, and attitudinal barriers within the health care system may prevent women with disabilities from receiving the care they need. This module discusses the definition of disability, prevalence and demographics of disability among US women, health conditions and risk factors, and general considerations in caring for women with disabilities. Selected health issues in caring for women with disabilities, including reproductive and parental rights, menstruation and fertility, contraception, preconception counseling, and menopause, are also discussed. Tables review components of the International Classification of Functioning, Health and Disability, examples of disability definitions, disability indicators using National Health Interview Survey data, health conditions causing chronic mobility disability for women ages 18 to 49, comorbid health conditions reported among women with and without disability, mental health conditions reported by women with and without disability, examples of women’s experiences with inaccessible medical equipment, examples of communication accommodations, and accessible labeling of prescription drug containers. Figures include the International Classification of Functioning, Health and Disability model of disability and graphs showing the percentage of women with basic action difficulties (BADs); with one or more BADs; with complex action limitations; with BADs by racial and ethnic groups; with indicated level of education and income among women with and without BADs; with indicated level of self-reported overall health among women with BADs; by smoking status among women with and without BADs; in body mass index category among women with and without BADs; with indicated physical activity level among women with and without BADs; with indicated heath care service use and lacking health insurance among women with and without BADs; and receiving Pap smears, mammography screening, and colon cancer screening among women with and without BADs. This review contains 12 highly rendered figures, 9 tables, and 86 references.

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million.1 Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths.2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs).4,5 Notwithstanding the substantial progress in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke,6 the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care1; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery. Because there remains a …

Incorporating a Client-Centered Approach to Audiologic Rehabilitation

Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update

This systematic review aimed to confirm the effectiveness of hand therapy programmes using the International Classification of Functioning, Disability and Health framework for each of the three phases of the wound healing process in adults with burns. A systematic review was conducted to determine the efficacy of different hand therapy programmes in the management of burnt hands. Two independent reviewers conducted a literature search using the PubMed and Cumulative Index to Nursing and Allied Health Literature databases for original articles reporting effectiveness of hand therapy programmes for adults with burns. Only randomized and non-randomized controlled trials were selected using the Mixed Methods Appraisal Tool. Demographic and clinical data including medical history, burn depth, and hand therapy programme were extracted. Outcome measures were reviewed based on the International Classification of Functioning, Disability and Health framework for acute, convalescence, and chronic phases of rehabilitation. Sixteen articles and 15 hand therapy programmes were identified, which included studies showing improvements in different parameters in the framework. In the acute and convalescence phases, improvements were found in health condition, body functions and structures, activities, and participation. In the chronic phase, improvements were shown only in body functions and structures. Environmental factors in the framework were not reported for all the phases. This review demonstrated the efficacy of hand therapy programmes in adults with burns in terms of the health condition, body function, activities, and participation during acute and convalescence phases but only the body function in the chronic phase.

ObjectiveTo conduct a comprehensive survey on disability to determine the prevalence and distribution of cause-specific disability among residents of the Manikganj district in Bangladesh.MethodsThe survey was conducted in Manikganj, a...

60 - Randomized Phase 2 Study of Guadecitabine in Patients with HMA-Naive Higher Risk Myelodysplastic Syndromes (MDS) or Chronic Myelomonocytic Leukemia (CMML)

This study aims to compare the long-term results of continuous intrathecal baclofen therapy rehabilitation against those of conventional treatment for intractable spasticity in children with cerebral palsy using the International Classification of Functioning, Disability and Health of Children and Youth. This is a 5-yr single-center retrospective cohort study. The International Classification of Functioning, Disability and Health of Children and Youth data from 24 patients with cerebral palsy of Gross Motor Function Classification System levels IV-V (aged between 8 and 18 yrs) were retrospectively analyzed for 5 yrs. The results show different trends between the 12 patients who received continuous intrathecal baclofen therapy and the 12 who were excluded because of contraindications.The continuous intrathecal baclofen therapy group improved spasticity, pain, and body mass index z-scores over 12 mos and during the 5-yr follow-up with a continuous simple Baclofen administration at a maximum of 140 μg/d at a concentration of 2000 μg/mL. Continuous intrathecal baclofen therapy improves structure and function, autonomy, and participation in both short and long term. Overall, the continuous intrathecal baclofen therapy group, with its characteristics of initially greater pain and hypertonia, benefited significantly from the efficacy of intrathecal Baclofen treatment compared with the control group, which continued to receive conventional treatment.The International Classification of Functioning, Disability and Health of Children and Youth outcome measures demonstrated an interrelationship between spasticity and weakness and disease progression over childhood to adolescence.Follow-up will be vital for effective personalized treatment, quality of life, and research.Long-term International Classification of Functioning, Disability and Health of Children and Youth data collection is key to comparing treatment outcomes.

Introduction: The International Classification of Functioning, Disability and Health (ICF) is the first universally shared model and classification of functioning, disability and health. It can be used as an assessment instrument based on ICF-derived tools, such as the ICF Core Sets, as well as a reference for other outcome measures and health indicators. Aims: To present the results of the development of the Generic ICF Core Set and the results of the comparison of the Generic ICF Core Set and the six widely-used generic outcome measures: the SF-36, the NHP, the QL-I, the WHOQOL-BREF, the WHODASII and the EQ-5D. Results: The Generic ICF Core Set is a parsimonious set of ICF categories which defines the health and health-related domains to be taken into account to assess health from a comprehensive perspective. It contains all health and health-related domains that are addressed in the most widely-used outcome measures and health indicators. Conclusions: The consequent use of the Generic ICF Core Set enables the comparison of health information across health conditions and health-care contexts. It also enhances the international comparability of health and functioning and disability data and can ultimately contribute to the improvement of care and support for persons with disabilities and the elderly.

Objective: To identify the categories of the International Classification of Functioning, Disability and Health most suitable as outcome indicators in the transitional care for people with spinal cord injury in China.Methods: A three-round Delphi survey was conducted surveying 37 experts selected through purposive sampling. In the first round, each expert was required to suggest the most useful indicators in the transitional care for spinal cord injury patients. Categories of the International Classification of Functioning, Disability and Health were linked with the concepts extracted from the responses. In the second round, the experts were asked to make a yes/no judgment about the utility of those categories as outcome indicators and to rate their importance from 1 to 10. In the third round, the experts were asked to re-judge and re-rate the importance considering the second-round results.Results: Forty-one categories, seven personal factors, and three concepts not covered in the International Classification of Functioning, Disability and Health were identified. They generated agreement percentages over 80% in the third round. The means of the importance ratings ranged from 5.15 to 9.52.Conclusions: A set of categories and concepts was identified in the Delphi survey based on the International Classification of Functioning, Disability and Health. They provided a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.Implications for rehabilitationIn China, the people with spinal cord injury who live at home after discharge urgently need professional transitional care which can be extended from medical institutions to families.The categories and concepts identified by the Delphi survey based on the International Classification of Functioning, Disability and Health reflect the focuses in the transitional care of people with spinal cord injury in China.Those categories and concepts provide a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.

Purpose: We comprehensively evaluated cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health.Method: We surveyed 1967 patients receiving long-term inpatient psychiatric care. Patients were further categorized into an old long-stay group (n = 892, >5 years in hospitals) and a new long-stay group (n = 1075, 1–5 years in hospitals). We obtained responses for all the International Classification of Functioning, Disability, and Health items in domain b (Body Functions) and domain d (Activities and Participation). We estimated weighted means for each item using the propensity score to adjust for confounding factors.Results: Responses were received from 307 hospitals (response rate of hospitals: 25.5%). Cognitive and social functioning in the old long-stay group was more severely impaired than in the new long-stay group. No statistically significant differences were observed regarding the International Classification of Functioning, Disability, and Health items associated with basic activities of daily living between the two groups.Conclusion: Combined therapy consisting of cognitive remediation and rehabilitation on social functioning for this patient population should be started from the early stage of hospitalization. Non-restrictive, independent environments may also be optimal for this patient population.Implications for rehabilitationRehabilitation of cognitive and social functioning for patients requiring long-term inpatient psychiatric care should be started in the early stages of hospitalization.In psychiatric fields, the International Classification of Functioning, Disability, and Health checklist could facilitate individualized rehabilitation planning by allowing healthcare professionals to visually assess the comprehensive functioning of each patient using graphics such as radar charts.

International Classification of Function, Health and Disability provides a common framework and universal language for rehabilitation professionals across the globe. To identify problems in functioning and mobility relevant to persons with lower-limb amputation from an expert's point of view and quantify these problems using the International Classification of Function, Health and Disability. Qualitative study using electronic and paper surveys. Electronic or paper survey was done across six countries targeting clinicians involved in pre- and post-amputation care. Meaningful concepts were extracted from the responses and linked to suitable second-level and where applicable third-level International Classification of Function, Health and Disability categories. Categorical frequency analysis was completed for the combined data and for each location. A total of 183 experts from 6 different countries responded to the survey. A total of 2171 concepts were identified, 82% of which could be linked to a second-level International Classification of Function, Health and Disability category. The categorical frequency analysis revealed that the categories of walking, design and construction of buildings for public and private use and sensation of pain were the most frequently occurring concepts and was similar across the six countries. The International Classification of Function, Health and Disability can be utilised as a common framework for communication among clinicians involved in rehabilitation of persons with lower-limb amputation across the globe. The most important factors that were identified by experts in amputee rehabilitation working in different international locations were similar. The challenges faced by the clinicians involved in care of persons with lower extremity amputation vary across different parts of the world. The overarching goal for the clinician irrespective of the location is to improve mobility and quality of life of their clients. The International Classification of Function, Health and Disability provides a common language between the various stakeholders in amputee rehabilitation across the globe.

Objective: Linking the content of the Comprehensive Geriatric Assessment (CGA) of a reference center for the health of the elderly with the International Classification of Functioning, Disability and Health (ICF) and present its Basic Set of ICF codes. Method: The AGA were linked to the ICF by two specialists, trained according to the established linking rules. Agreement between the health professionals was determined based on Cohen's kappa index. Results: The agreement between the two health professionals was considered perfect for each ICF domain (k= 0.91; p<0.00; agreement= 93.32%). The AGA contained 419 items, 106 of which could not be linked to the ICF, as they were associated with health conditions or did not fit into any category. It was found that 313 were linked to the ICF domains and that 181 (60.13%) were related to body functions, 18 (5.98%) to body structures, 73 (24.258%) to activity and participation, 30 (9.97%) to environmental factors and 11 (3.51%) to personal factors. Conclusions: The ICF can be inserted in specific contexts of health services, making it feasible to link the ICF with forms prepared by the health services themselves. The correspondence between a geriatric assessment instrument and the ICF enhances case discussions, therapeutic plans and continued care. The dynamics of the care process standardized by the ICF can facilitate the expansion of care and the establishment of therapeutic goals that go beyond the context of the service and reach the family and social sphere.

P1-120 Influential factors of the development in infants and toddlers application of the “International Classification of Functioning, Disability and Health” framework

Epilepsy is a chronic neurological condition that impacts approximately 3.4 million people within the United States and over 50 million people worldwide. Adults reflect the largest, and fastest growing, cohort of individuals experiencing epilepsy onset. Epilepsy is characterized by unprovoked seizures resulting in loss of consciousness, involuntary movement, convulsions, confusion, and incontinence. Experiences with reoccurring seizures can result in challenges in socioemotional functioning, physical limitations, phycological distress, and stigma. Gaining seizure control, and obtaining seizure freedom, remains a priority for persons with epilepsy. A preeminent goal for persons with epilepsy is the engagement in behaviors and actions that culminate in the effective management of their health condition, otherwise known as epilepsy self-management. The purpose of this study was to evaluate the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) framework as a biopsychosocial model for predicting health self-management participation among people with adult-onset epilepsy. The contribution of each individual ICF construct, to epilepsy self-management, was evaluated utilizing hierarchical regression analysis. Findings from the study’s analysis suggest that environmental influences (i.e., diagnosis experience, social support, social stigma) and personal characteristics (i.e., self-stigma) accounted for 75% of variance in participation in health self-management. This study is novel in its use of the ICF model to evaluate the contribution of biopsychosocial factors to participation in health self-management among persons with adult-onset epilepsy.