Methods: We conducted 17 in-depth interviews (11 females, six males) with youth with disabilities aged 15–34 (mean age 26). We analyzed our data using an interpretive, qualitative, and thematic approach.
Results: Our results showed the timing of when youth disclosed their disability to their employer depended on disability type and severity, comfort level, type of job, and industry. Youth’s strategies and reasons for disclosure included advocating for their needs, being knowledgeable about workplace rights, and accommodation solutions. Facilitators for disclosure included job preparation, self-confidence, and self-advocacy skills, and having an inclusive work environment. Challenges to disability disclosure included the fear of stigma and discrimination, lack of employer’s knowledge about disability and accommodations, negative past experiences of disclosing, and not disclosing on your own terms.
Conclusions: Our findings highlight that youth encounter several challenges and barriers to disclosing their condition and requesting workplace accommodations. The timing and process for disclosing is complex and further work is needed to help support youth with disclosing their condition.
- Implications for rehabilitation
Clinicians, educators, and employers should emphasize the importance of mentoring and leadership programs to give youth the confidence and self-advocacy skills needed to disclose and ask for accommodations in the workplace.
Clinicians should advocate for the inclusion of youth with disabilities in the workforce and educate employers on the importance of doing so.
Youth with disabilities need more opportunities for employment training and particularly how to disclose their disability and request workplace accommodations.
Design: Prospective cohort study using participants from a randomized controlled trial (RCT) designed to study the effect of exercise during pregnancy on pregnancy related diseases.
Setting: St. Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital, April 2007 to December 2009.
Subjects: Healthy pregnant women.
Main outcome measures: Self-reported sick leave due to LPP in late pregnancy (gestation week 32–36).
Results: In total, 532/716 (74%) women reported LPP at 32–36 weeks of pregnancy, and 197/716 (28%) reported sick leave due to LPP. Not receiving job adjustments when needed (Odds ratio, OR with 95% confidence interval, CI, was 3.0 (1.7–5.4)) and having any pain in the pelvic girdle versus no pain (OR 2.7 (1.3–5.6), OR 2.7 (1.4–5.2) and OR 2.2 (1.04–4.8)) for anterior, posterior and combined anterior and posterior pain in the pelvis respectively, were associated with sick leave due to LPP in late pregnancy. Also higher disability, sick listed due to LPP at inclusion and lower education, were significant explanatory variables. There was a trend of reduced risk for sick leave due to LPP when allocated to the exercise group in the original RCT (OR 0.7 (0.4–1.0)).
Conclusion: Facilitating job adjustments when required might keep more pregnant women in employment. Furthermore, pain locations in pelvic area, disability, lower education and being sick listed due to LPP in mid pregnancy are important risk factors for sick leave in late pregnancy.
- Key points
Current awareness:
More than half of pregnant women are on sick leave during pregnancy and the most frequently reported cause is lumbopelvic pain.
This paper adds:
Inability to make job adjustments, pain locations in pelvic area, disability and lower education level were the most important risk factors for sick leave in late pregnancy. Facilitating early job adjustment might be a precaution to keep more pregnant women in work. Allocation to an exercise group tended to reduce the risk of sick leave in late pregnancy.Registration number: Clinical trial gov (NCT 00476567).
Materials and methods: Studies reporting isolated lumbar extension strength changes were examined for inclusion criteria including: (1) participants with chronic low back pain, (2) intervention?≥?four?weeks including isolated lumbar extension exercise, (3) outcome measures including isolated lumbar extension strength, pain (Visual Analogue Scale), and disability (Oswestry Disability Index). Six studies encompassing 281 participants were included. Correlations among change in isolated lumbar extension strength, pain, and disability. Participants were grouped as “met” or “not met” based on minimal clinically important changes and between groups comparisons conducted.
Results: Isolated lumbar extension strength and Visual Analogue Scale pooled analysis showed significant weak to moderate correlations (r?=??0.391 to ?0.539, all p?<?0.001). Isolated lumbar extension strength and Oswestry Disability Index pooled analysis showed significant weak correlations (r?=??0.349 to ?0.470, all p?<?0.001). For pain and disability, isolated lumbar extension strength changes were greater for those “met” compared with those “not met” (p?<?0.001–0.008).
Conclusions: Improvements in isolated lumbar extension strength may be related to positive and meaningful clinical outcomes. As many other performance outcomes and clinical outcomes are not related, isolated lumbar extension strength change may be a mechanism of action affecting symptom improvement.
- Implications for Rehabilitation
Chronic low back pain is often associated with deconditioning of the lumbar extensor musculature.
Isolated lumbar extension exercise has been shown to condition this musculature and also reduce pain and disability.
This study shows significant correlations between increases in isolated lumbar extension strength and reductions in pain and disability.
Strengthening of the lumbar extensor musculature could be considered an important target for exercise interventions.
Method: Ten databases were searched. Websites of organizations active in disability and children issues were also searched.
Results: Forty-eight studies met our inclusion criteria (11 qualitative, 29 quantitative, and 8 mixed-methods). The findings indicate that the impact of environmental risk factors on development might be ameliorated by providing disability-screening services, community-based interventions, targeted, and inclusive basic services. The review also identifies key barriers to supporting these children as stigma and discrimination. Key enablers include religious support and community education.
Conclusions: Comprehensive interventions from screening services to inclusive basic services are needed and collaboration from related stakeholders, also utilization of local resources is vital.
- Implications for Rehabilitation
Environmental risk factors threaten development of young children with disabilities in developing countries.
Screening services, community-based interventions, targeted and inclusive basic services are needed to address environmental risk factors.
Religious support and community education are key in addressing stigma and discrimination in developing countries.
Methods: Randomized controlled trials investigating the effects of walking alone compared to exercise and to exercise with added walking on adults with chronic low back pain were identified using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials (CENTRAL), PsychINFO, and SPORT DiscusTM databases. Two reviewers independently selected the studies and extracted the results. Study quality was assessed using the PEDro scale and the clinical relevance of each outcome measure was evaluated.
Results: Meta-analysis of five randomized controlled trials meeting inclusion criteria was performed. The effectiveness of walking and exercise at short-, mid-, and long-term follow-ups appeared statistically similar. Adding walking to exercise did not induce any further statistical improvement, at short-term.
Conclusions: Pain, disability, quality of life and fear-avoidance similarly improve by walking or exercise in chronic low back pain. Walking may be considered as an alternative to other physical activity. Further studies with larger samples, different walking dosages, and different walking types should be conducted.
- Implications for Rehabilitation
Walking is commonly recommended as an activity in chronic low back pain.
Pain, disability, and fear-avoidance similarly improve by walking or exercise.
Adding walking to exercise does not induce greater improvement in the short-term.
Walking may be a less-expensive alternative to physical exercise in chronic low back pain.
Methods: An electronic search was conducted from 1987 to 24 October 2017. Studies were included if they met the following criteria: (1) full text, peer reviewed, and written in English, (2) original research, (3) diagnosed concussion or mild traumatic brain injury, (4) described the evaluation of an intervention, (5) the outcome was a concussion impairment, and (6) the mean/median age was under 19. Quality assessment using the Down’s and Black criteria was conducted.
Results: Twenty-six studies published between 2001 and 2017 were identified. Interventions included rest, active rehabilitation, exercise, vestibular, oculomotor, cervicospinal therapy, education, early intervention, telephone counselling, mobile health application, Web-based Self-Management program, multimodal physical therapy, cognitive behavioural therapy, transcranial direct current stimulation, and acupuncture. The quality assessments ranged from poor to good.
Conclusions: The literature describing interventions following concussion in children is scarce. While both positive and negative results were obtained, there were methodological concerns in most studies limiting the ability to draw conclusions. Interventions incorporating aerobic exercise show promise as a concussion management strategy.
- Implications for rehabilitation
Few studies have examined rehabilitation interventions for youth following concussion.
Research ranging from rest to exercise highlights the uncertainty of the field.
Low quality research limits the generalizability of results.
The use of physical activity appears to be an emerging area of interest.
Individualised, aerobic exercise should be used as part of clinical management.
Purpose: To map the evidence on physical activity and cognition in HIV.
Methods: We searched five databases using terms related to physical activity and HIV. Two authors independently reviewed titles and abstracts for studies that addressed physical activity/exercise and cognition in people with HIV. Authors reviewed full texts to identify articles that met our inclusion criteria. One author extracted the data, then we collated the results and summarized the characteristics of included studies.
Results: Sixteen studies from high-income countries were included; eight were interventional (five randomized controlled trials and three pre-post single group observational studies) and eight were non-interventional studies. The interventional studies included aerobic, resistive, and Tai Chi exercise for 8?weeks to 12?months in duration. Two of eight interventional studies found exercise to benefit self-reported cognition. All eight non-interventional studies showed a positive relationship between physical activity and cognitive function.
Conclusions: Results of this study suggest that physical activity may preserve or improve cognition in people living with HIV.
- Implications for Rehabilitation
Physical activity may play a role in preserving or improving cognition in the human immunodeficiency virus population.
Exercise should be prescribed for people with human immunodeficiency virus based on the stage of infection.
Rehabilitation professionals should follow current exercise guidelines when prescribing exercise for people living with human immunodeficiency virus.
Methods: Fifty three persons with multiple sclerosis who were enrolled in an exercise trial took part in semi-structured interviews regarding personal interpretations of physical activity, exercise, and sedentary behaviours.
Results: Forty three percent of participants indicated a consistent understanding of physical activity, 42% of participants indicated a consistent understanding of exercise, and 83% of participants indicated a consistent understanding of sedentary behaviour with the standard definitions. There was evidence of definitional ambiguity (i.e., 57, 58, and 11% of the sample for physical activity, exercise, and sedentary behaviour, respectively); 6% of the sample inconsistently defined sedentary behaviour with standard definitions. Some participants described physical activity in a manner that more closely aligned with exercise and confused sedentary behaviour with exercise or sleeping/napping.
Conclusions: Results highlight the need to provide and utilise consistent definitions for accurate understanding, proper evaluation and communication of physical activity, exercise, and sedentary behaviours among persons with multiple sclerosis.
Practice implications: The application of consistent definitions may minimise ambiguity, alleviate the equivocality of findings in the literature, and translate into improved communication about these behaviours in multiple sclerosis.
- Implications for Rehabilitation
The symptoms of multiple sclerosis can be managed through participation in physical activity and exercise.
Persons with multiple sclerosis are not engaging in sufficient levels of physical activity and exercise for health benefits.
Rehabilitation professionals should use established definitions of physical activity, exercise, and sedentary behaviours when communicating about these behaviours among persons with multiple sclerosis.
Method: The sample included 157 children of both genders, between 7 and 16?years of age (M?=?11.03, SD =2.59). The Activities Questionnaire, which consists of: social, leisure, recreational activities, and friendship, was used in the research.
Results: Participants with intellectual disability participated in a significantly larger number of all assessed activities than their peers with autistic spectrum disorders. There were no statistically significant differences in the frequency of participation in observed activities among the three groups of participants. Participants with intellectual disability were more independent than participants with autistic spectrum disorders in social and leisure activities, and needed less parental support in leisure activities. Participants with intellectual disability and autistic spectrum disorders had friendly relationships mainly with peers with disabilities. The influence of gender was detected in certain activities in all three groups of participants.
Conclusions: Participants with disability participate in social, leisure and recreational activities less than their typically developing peers. The activities in which they participate are mainly stereotypical, highly structured, and take place in the presence of parents.
- IMPLICATIONS FOR REHABILITATION
Forming a richer network of support services which would be oriented towards organizing social, leisure and recreational activities of persons with disabilities in the community.
It is necessary to improve support programs which would focus on strengthening the competencies and resources of parents.
The improvement of formal and informal support should provide a wider network, and better and more frequent social relationships between persons with and without disabilities.
Materials and methods: Longitudinal data analysis of self-report surveys completed by 541 middle-aged community-dwelling participants with long-term physical disability from baseline to 5-year follow-up.
Results: 97% of participants endorsed one or more stressful life events (M?=?8.2, SD =?4.9), all of whom endorsed at least one life stressor with a negative impact. Reporting more life stressors and having lower resilience were significantly associated with developing more depressive symptoms. Interaction analyses indicated that women developed more depressive symptoms as negative impact increased than men.
Conclusions: Findings suggest that middle-aged individuals with physical disability experience a range of life stressors, many with negative impact. Women are at higher risk of depressive symptoms than men. Resilience may buffer against negative impact of life stressors on development of depressive symptoms. Targeted intervention to increase resilience, especially in women, may decrease risk of depression in persons aging with disability.
- Implications for Rehabilitation
Middle-age adults living with physical disability experience a number of aging- and disability-associated stressors that can have a negative impact and contribute to depression.
Women aging with disability who experience more negative impact from life stressors may be more vulnerable to developing depression.
Providing interventions that enhance resilience when faced with life stressors could prevent development of depression.
Methods: Semi-structured interviews informed by organismic valuing theory of growth through adversity were conducted with 14 elite paratriathletes (eight male, six female). To increase the likelihood that participants had experienced posttraumatic growth, a short form of the Posttraumatic Growth Inventory was completed prior to interview participation. Interview data were analyzed using directed content analysis.
Results: Although the initial response to disability was largely negative, paratriathlon experiences were reported to be a mechanism through which growth was facilitated. In particular, participants suggested that social, competence, empowerment, and identity development processes were instrumental in facilitating posttraumatic growth.
Conclusions: Analysis identified themes largely consistent with the main tenets of organismic valuing theory of growth through adversity, supporting its utility in understanding response to a traumatic event and subsequent growth. These findings also suggest that para sport may be an efficacious means for promoting posttraumatic growth, especially for individuals with severe initial reactions to their disability. Lastly, findings suggest that fostering perceptions of competence, autonomy, and social connection may promote posttraumatic growth.
- Implications for Rehabilitation
Acquiring a physical disability may have a detrimental impact on the satisfaction of an individual’s fundamental psychological needs.
In order to foster posttraumatic growth, the para sport environment should allow for participants to feel competent, autonomous, and to have meaningful interactions with fellow athletes and coaches.
Para sport may be particularly beneficial for individuals with previous sporting backgrounds and for those with severe initial reactions to their disability.
Design: A prospective cohort study.
Setting: The cardiac ward at Aarhus University Hospital, Denmark.
Intervention: A socially differentiated CR intervention in addition to the standard CR program.
Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N?=?379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network.
Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status.
Results: No significant long-term effect of the intervention was found.
Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
- Key points
The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors.
Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking.
General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
Method: A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters.
Results: Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II–IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n?=?3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n?=?2, all Evidence Level II) and Physical Fitness Training (n?=?4, Evidence Level II–V). Weak positive evidence was available for Modified Sport (n?=?3, Evidence Level IV–V) and Non-Immersive Virtual Reality (n?=?12, Evidence Level II–V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n?=?4, all Evidence Level II).
Interpretation: Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP.
- Implications for rehabilitation
Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy.
Gross Motor Activity Training is the most common and effective intervention.
Practice variability is essential to improve gross motor function.
Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.
Method: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines.
Results: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin “ultra”, beyond, to “habilitare”, make fit. The resulting term, “ultrabilitate”, commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning.
Conclusions: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas.
- Implications for rehabilitation
Despite significant progress, rehabilitation limits some people with disabilities.
Modern health systems still benchmark therapy for rehabilitation against “normal” or species-typical standards to aid recovery.
“Ultrabilitation”, meaning “beyond fitness”, promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery.
Biological, social and technological conditions are needed to support ultrabilitation.
Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth.
Methods: An internet-based study was conducted to identify and select relevant documents and websites containing information about the national approach to promote disability sports and physical activities in the Netherlands and Canada.
Results: Both governments promote high performance sports in similar ways, but use different strategies to promote recreational sports and physical activities. The Dutch approach is characterized by using time-limited programs focusing on enhancement of sports infrastructure and inter-sector collaboration in which municipalities have key roles. The Canadian government promotes recreational sports in disabled populations by supporting programs via bilateral agreements with provinces and territories. Furthermore, the level of integration of disability sports into mainstream sports differs between countries.
Conclusions: The findings of this study may inspire policy makers from different countries to learn from one another’s policies in order to optimize national approaches to promote disability sports and PA on all levels.
- Implications for rehabilitation
It is recommended for policy makers of national governments to develop and implement policy programs that promote sports and physical activities among people with disabilities because of its potential impact on functioning, participation, quality of life, and health.
Insight into national approaches to promote sport and physical activities is relevant for rehabilitation practice to understand ongoing opportunities for people with disabilities to stay physically active after rehabilitation through participation in home and/or community-based sport and physical activities.
It seems worthwhile to integrate activities to promote sport and physical activities in rehabilitation in such a way that it fits with the current governmental approach.
It is recommended to set up international collaborations to develop and share knowledge about effective and sustainable national approaches to promote sports and physical activities among people with disabilities.
Methods: This paper aims to describe coaching in early physiotherapy intervention, taking the specific coaching approach of the family-centered program “COPing with and CAring for infants with special needs” (COPCA) as a case in point.
Results: The theoretical underpinnings of coaching in COPCA, including a meta-model, family-centered practice, the Neuronal Group Selection Theory and the goal-oriented coaching approach, are discussed. Next, the translation of theory into practical ingredients for coaching of families of a child with special needs is presented. The latter includes the appreciation of family autonomy and attitudes, and the creativity to ask specific questions to support the families in making their own decisions to promote their child’s development during daily care-giving routines.
Conclusion: It is concluded that the approach of coaching is demanding for both families and pediatric physiotherapists. It requires an active role of the family members in the intervention process and for therapists that they incorporate the attitude of a coach that largely differs from the attitude of the traditional therapist. For families and pediatric physiotherapists appreciating these changes in attitude, COPCA’s coaching offers a promising form of early intervention.
- Implications for rehabilitation
We recommend the implementation of the promising approach of goal-oriented and solution-focused coaching in pediatric rehabilitation and/or early intervention.
We recommend applying coaching methods that are based on explicit theoretical background and clinical knowledge.
We recommend formal training in coaching before professionals apply coaching in pediatric rehabilitation and/or early intervention.
Purpose: Review of the literature on joint hypermobility and EDS hypermobility-type concerning psychological factors linked to pain chronicity and disability.
Methods: A comprehensive search was performed using scientific online databases and references lists, encompassing publications reporting quantitative and qualitative research as well as unpublished literature.
Results: Despite scarce research, psychological factors associated with EDS hypermobility-type that potentially affect pain chronicity and disability were identified. These are cognitive problems and attention to body sensations, negative emotions, and unhealthy patterns of activity (hypo/hyperactivity).
Conclusions: As in other chronic pain conditions, these aspects should be more explored in EDS hypermobility-type, and integrated into chronic pain prevention and management programs.
- Implications for Rehabilitation
Clinicians should be aware that joint hypermobility may be associated with other health problems, and in its presence suspect a heritable disorder of connective tissue such as the Ehlers–Danlos syndrome (EDS) hypermobility-type, in which chronic pain is one of the most frequent and invalidating symptoms.
It is necessary to explore the psychosocial functioning of patients as part of the overall chronic pain management in the EDS hypermobility-type, especially when they do not respond to biomedical approaches as psychological factors may be operating against rehabilitation.
Further research on the psychological factors linked to pain chronicity and disability in the EDS hypermobility-type is needed.