北京市智力残疾人康复需求分析

目的调查北京市智力残疾人的康复需求情况。方法以第二次全国残疾人抽样调查中北京市738名智力残疾人为研究对象,调查其康复现状与需求。结果63.69%的智力残疾人需要社区和家庭服务,73.31%需要康复训练与服务;智力残疾人的医疗服务需求能基本得到满足,但康复训练需求远高于得到的服务,辅助器具需求很低,就业安置需求较高。结论应建立智力残疾人个案管理系统,多途径地满足不同年龄和残疾程度智力残疾人的康复需求。     

智力残疾人康复需求与康复服务发展状况Logistic回归分析研究

目的探讨智力残疾人的康复需求特点与康复服务发展状况及其影响因素。方法以250654名智力残疾人省级康复需求与康复服务实名制数据为样本数据,统计分析智力残疾人的康复需求特点和康复服务发展状况,Logistic回归分析其相关因素。结果在智力残疾人的康复需求报告中,报告率从高到低依次为护理47.8%、药物37.2%、功能训练26.1%、辅助器具19.8%和手术1.3%。智力残疾人报告获得的康复服务从高到低依次为护理43.5%、药物29.3%、功能训练27.2%、辅助器具19.6%和手术0.8%。根据Logistic回归模型发现,年龄和残疾等级对智力残疾人康复需求的报告与获得康复服务的概率存在显著影响(P<0.001)。结论智力残疾人康复需求主要表现为护理、药物和康复训练。接受的康复服务与康复需求具有相同的结构。由于智力残疾人功能的复杂性,重度或极重度残疾人更强调护理照料服务,轻度残疾人则需要功能训练。发展针对智力残疾人的康复服务,应该根据其智力功能和社会适应行为特点,开发康复服务项目,提供个别化的精准康复服务。     

智力残疾人康复需求与康复服务发展状况研究

目的探讨智力残疾人的康复需求与康复服务发展状况,为开展智力残疾人精准康复服务工作提供支持。方法采用河南省2016年度全国残疾人基本服务状况和需求实名制专项调查数据,对其中167,872名智力残疾人,从医疗服务与救助、辅助器具和康复训练3个方面进行分析。结果 56.4%智力残疾人有康复需求,且不同年龄、户口性质和残疾等级的智力残疾人,康复需求有非常高度显著差异(χ2 976.42, P 0.001)。受人口统计学变量、家庭经济状况、交通状况、对相关知识和信息的了解等因素影响,仅有19.0%智力残疾人获得康复服务。结论智力残疾人康复服务需求大,康复服务覆盖率低。要加大对智力残疾人康复服务的供给,制定精准康复服务实施方案,提高智力残疾人康复服务质量。     

智力残疾人的职业康复:理论架构、方法与服务

目的构建智力残疾职业康复的理论和服务框架,为提升智力残疾人的体面就业提供依据。方法根据ICF,分析智力残疾人的就业障碍,并以此为基础提出智力残疾职业康复的内容和流程。结果根据ICF框架,智力残疾人的就业障碍包括主要功能障碍、就业相关功能障碍和就业环境三个方面。智力残疾的职业康复主要涉及职业评估、职业咨询、职业技能开发与培训、职业指导、支持与协助服务,以及职业发展环境分析等。职业康复的主要流程有评估就业障碍与职业能力、确定就业模式与目标、制定和执行个别化职业康复计划以及追踪服务等。结论需要根据ICF发展结构化和个别化的针对智力残疾的职业康复架构与服务方法体系。     

基于ICF的智力残疾个别化服务与支持方案设计研究

目的基于ICF的功能和残疾理论与方法,分析智力残疾人的服务与支持需求,建立结构化和标准化的个别化服务支持系统方案。方法采用ICF的理论与方法对智力残疾个别化服务方案的过程进行分析,从智力功能与适应性行为和个体的服务需求入手,构建结构化、标准化的个别化服务支持方案。结果基于ICF的功能与残疾架构,对智力残疾人的功能与服务需求进行系统分析,构建涉及智力残疾人的功能诊断、服务需求报告以及个别化服务支持过程的结构化、标准化服务支持方案。结论运用ICF可以对智力残疾人的功能进行系统分析,对服务与支持需求进行结构化报告,从而构建针对个体功能特点和服务需求的结构化、个别化的智力残疾服务与支持方案,以促进智力残疾人的整体康复。     

智力残疾人的健康状况与健康服务研究

目的探讨智力残疾人的健康状况、影响因素与健康服务发展状况,为发展智力残疾人的健康服务提供循证支持。方法基于ICF功能和残疾的理论与方法分析智力残疾人主要功能障碍,运用流行病学方法分析智力残疾人的主要疾病、功能障碍表现、致病和致残因素。结果美国智力残疾现患率约为1.1%,中国为0.75%。智力残疾人主要健康问题为超重、肥胖、营养不良、口腔问题、消化系统疾病等;主要功能障碍有认知障碍、孤独症谱系障碍、视觉或听觉障碍、学习障碍、运动障碍、广泛性发育障碍等;因智力残疾导致的继发性障碍会加重在概念技能、社会技能和实用技能等方面的障碍程度。生物学和环境两方面的因素是智力残疾人致病和致残的主要健康风险因素。结论现代健康服务要关注智力残疾人的健康状况与健康行为的特殊性,提升智力残疾人的健康服务能力,提高智力残疾人健康水平。     

河北省智力残疾及服务需求状况分析

目的研究河北省智力残疾及服务需求满足状况。方法以第二次全国残疾人抽样调查河北省资料为依据,对智力残疾现患率、智力残疾等级、智力残疾的致残原因、智力残疾人的服务需求以及服务需求满足程度进行分析。结果智力残疾率农村明显高于城市(χ2=364.24, P<0.01);以三、四级智力残疾为主(χ2=221.16, P<0.01);智力残疾的主要致残原因为遗传性疾病和脑疾病;智力残疾人的服务需求满足程度较低。结论河北省农村智力残疾现患率高于城镇,智力残疾人以轻度、中度为多,智力残疾人的服务需求满足程度低。     

重庆市智力残疾人康复情况分析

目的：了解重庆市智力残疾人的康复状况及其主要需求。方法：以重庆市第二次全国残疾人抽样调查确定的401例智力残疾人为研究对象,按智力残疾的分级进行评定,包括残疾人基本情况、致残原因、康复形式、康复内容、曾接受服务及主要需求等。结果：智力残疾人主要康复形式为社区和家庭服务,主要康复内容为康复训练与服务;主要需求是贫困救助与扶持。结论：加强社区医疗机构建设,提高社区医疗机构的医疗质量及康复训练与服务,是改善智力残疾人生存质量、减少残疾人数的重要手段。     

成年智力残疾人生活质量调查

目的考察成年智力残疾人的生活质量实际现状、内在期望和支持程度。方法以北京市成年智力残疾人、家长和亲友、基层康复工作者394人为研究对象，完成生活质量调查。结果成年智力残疾人本人对生活质量的主观期望显著高于所得到的支持和实际现状；家长及亲友对生活质量的主观期望显著高于成年智力残疾人本人、基层康复者。结论充分考虑残疾人的内在期望和要求，以支持的方式提高成年智力残疾人生活质量，是实现“人人享有康复服务”有效途径。     

发挥技术资源中心优势 注重网络职能

抽样调查显示 ,吉林省现有肢体残疾人 2 0 .7万 ,智力残疾人 5 4万 ,其中 0%D 7岁的智力残疾儿童 6 .1万 ,0— 7岁聋儿 0 .9万。为了使这些残疾人能得到系统康复训练 ,根据《中国残疾人事业“九五”计划纲要》要求 ,我省于 1997年成立了吉林省残疾人康复服务指导中心 ,内设社区指导部 ,负责指导全省残疾人康复服务指导机构及社区家庭的系统康复训练工作。几年来 ,省残疾人康复服务指导中心主要对以下几方面的工作进行了探索 :1督导各级残疾人康复服务指导机构的建立 ,完善以省中心为龙头的康复服务网络建立各级康复服务指导机构 ,完善康复…     

Research participation by people with intellectual disability and mental health issues: An examination of the processes of consent

Balancing the demands of research and ethics is always challenging, and even more so when recruiting vulnerable groups. Within the context of current legislation and international human rights declarations, it is strongly advocated that research can and must be undertaken with all recipients of health‐care services. Research in the field of intellectual disability presents particular challenges in regards to consenting processes. This paper is a reflective overview and analysis of the complex processes undertaken, and events that occurred in gaining informed consent from people with intellectual disability to participate in a study exploring their experiences of being an inpatient in mental health hospitals within Aotearoa/New Zealand. A framework based on capacity, information, and voluntariness is presented, with excerpts from the field provided to explore consenting processes. The practical implications of the processes utilized are then discussed in order to stimulate debate regarding clearer and enhanced methods of gaining informed consent from people with intellectual disability.     

Characteristics of disability pensioners returning to work: an interview study among individuals with musculoskeletal disorders

Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on 'resting disability pension'.

Method. Qualitative analyses of interviews with 17 individuals going back to work.

Results. Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality.

Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.     

Learned helplessness and responses to nerve blocks in chronic low back pain patients

In a double-blind study, 67 chronic low back pain patients received 4 lumbar sympathetic nerve blocks, two given with bupivacaine and two given with saline. It was hypothesized that patients showing evidence of 'learned helplessness,' as measured by dependence on habit-forming medications for the pain, low activity levels, and elevated MMPI scores on Hypochondriasis, Depression and Hysteria would show the least reduction in subjective pain intensity following injections with both bupivacaine and saline. It also was hypothesized that placebo responses would be greatest in patients who had a high educational level, were divorced, and had no pending disability claims. Responses 30 min following nerve blocks failed to correlate with these variables. However, decreases in subjective pain intensity 24 h following both types of nerve blocks were greater in patients who showed low levels of pain behavior, who were divorced, and who had no pending disability claims. Decreased pain 24 h following saline injections was significantly related to low scores on the Lie, Defensiveness, Hypochondriasis, and Hysteria scales of the MMPI and to reduced subjective pain intensity following a 6 week comprehensive outpatient pain rehabilitation program. It was concluded that chronic pain patients who are fixed in their focus on pain, high in pain-related behaviors, and low in responsibilities are less likely to respond favorably to nerve blocks and that medical treatment for them needs to be paired with therapies designed to reduce their helplessness.     

Reporting about disability evaluation in European countries

Abstract

Purpose: To compare the official requirements of the content of disability evaluation for social insurance across Europe and to explore how the International Classification of Functioning, Disability and Health is currently applied, using the rights and obligations of people with disabilities towards society as frame of reference. Methods: Survey. We used a semi-structured questionnaire to interview members of the European Union of Medicine in Assurance and Social Security (EUMASS), who are central medical advisors in social insurance systems in their country. We performed two email follow-up rounds to complete and verify responses. Results: Fifteen respondents from 15 countries participated. In all countries, medical examiners are required to report about a claimant’s working capacity and prognosis. In 14 countries, medical reports ought to contain information about socio-medical history and feasible interventions to improve the claimant’s health status. The format of medical reporting on working capacity varies widely (free text, semi- and fully structured reports). One country makes a reference to the ICF in their reports on working capacity, others consider doing so. Conclusion: Official requirements on medical reporting about disability in social insurance across Europe follow the frame of four features: work capacity, socio-medical history, feasibility of intervention and prognosis of disability. There is an increasing trend to make formal or informal reference to the ICF in the reports about working capacity. The four features and the ICF may provide common references across countries to describe disability evaluation, facilitating national and international research.

• Implications for Rehabilitation

• Reporting about disability in social insurance in different countries is about work capacity, social medical history, feasibility of intervention and prognosis of disability.

• Formats of reporting on work capacity vary among countries, from free text to semi-structured report forms to fully structured and scaled report forms of working capacity.

• The ICF could serve as a reference for describing work capacity, provided the ICF contains all necessary categories.

     

Characteristics of disability pensioners returning to work: An interview study among individuals with musculoskeletal disorders

Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on ‘resting disability pension’.

Method. Qualitative analyses of interviews with 17 individuals going back to work.

Results. Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality.

Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.     

Supervisors’ perceptions of organizational policies are associated with their likelihood to accommodate back-injured workers

Background Low back pain (LBP) is a major concern among North American workplaces and little is known regarding a supervisor’s decision to support job accommodation for workers with LBP. The extent to which supervisors are included in a company’s effort to institute disability management policies and practices and workplace safety climate are two factors that may influence a supervisor’s decision to accommodate workers with LBP. Objective Determine the association between supervisors’ perceptions of disability management policies, corporate safety culture and their likelihood of supporting job accommodations for workers with LBP. Methods We conducted a cross-sectional study of supervisors (N=796) recruited from a non-random, convenience sample of 19 Canadian and US employers. The outcome was supervisors’ likeliness to support job accommodation and the exposure was global work safety culture and disability management policies and practices. A multivariable generalized linear modelling strategy was used and final models for each exposure were obtained after assessing potential effect modifiers and confounders. Results In the study, 796 eligible supervisors from 19 employers participated. Disability management policies and practices were positively associated with supervisors’ likeliness to accommodate (β=0.19; 95% CI: 0.13; 0.24) while no significant association was found between corporate safety culture (β=??0.084; 95% CI: ?0.19; 0.027) and supervisors’ likeliness to accommodate. Conclusions Employers should ensure that proactive disability management policies and practices are clearly communicated to supervisors in order to improve job modification and return to work efforts.

• Implications for Rehabilitation

• Low back pain (LBP) is a major workplace concern and little is known regarding what factors are associated with a supervisor’s likelihood to support job accommodation for workers with LBP.

• The objective of this article was to determine the association between supervisors’ perceptions of disability management policies and practices, corporate safety culture and their likelihood of support job accommodations for workers with LBP.

• Results suggest that disability management policies and practices are positively associated with supervisors’ likelihood to accommodate while corporate safety culture is not.

• These results are important for employers as it suggests that employers should ensure that their disability management policies and practices are clearly communicated to supervisors in order to improve job accommodation and return to work efforts.

     

Researching disability: the way forward.

This paper critically examines the individualistic and medicalized assumptions underlying much research on disability. The OPCS surveys of disability, in particular, are examined. Based on the perceptions of disabled people and their organizations, and drawing on a series of seminars on disability research which took place in 1991, an alternative social view of disability is presented and applied to research. It is concluded that the assumptions underlying much disability research, especially when they are translated into practice, are oppressive to disabled people, and that participatory and emancipatory research needs to be developed in order to assist disabled people in their struggle for empowerment.     

Social Influences on Peer Judgments about Chronic Pain and Disability

Chronic pain is a leading cause of work absenteeism and disability compensation. Previous work demonstrates that patients with chronic illness often seek advice, such as whether or not to pursue disability benefits, from peers with similar health conditions. The current study examined the extent that social factors influence patients with chronic pain (“peers”) when making disability judgments and recommendations for other patients with chronic pain. Participants (N = 71) made pain-related and disability ratings for fictional vignette patients that varied in weight (normal vs obese), fault of accident, and physical work demands. Results of repeated measures analyses of variance indicated that participants rated patients with obesity, who were not at fault, and who held a physically demanding job as experiencing more severe pain symptoms and disability and were more likely to recommend they seek disability benefits. Participants who had applied for disability benefits themselves rated patients as more disabled than participants who had not applied for disability. These data suggest that patients with chronic pain are influenced by patient and contextual factors when making pain-related and disability judgments for peers. These judgments may impact patient decision making via peer support programs and online forums.PerspectiveThis study suggests that patients with chronic pain are influenced by patient weight, fault of accident, and physical work demands when making judgments about pain and disability for peers. Future studies should examine the extent such peer-to-peer recommendations influence actual disability-seeking behaviors for pain.     

Is self-efficacy and catastrophizing in pain-related disability mediated by control over pain and ability to decrease pain in whiplash-associated disorders?

Pain perception is influenced by several cognitive and behavioral factors of which some identified as mediators are important in pain management. We studied the mediating role of control over pain and ability to decrease pain in relation to functional self-efficacy, catastrophizing, and pain-related disability in patients with Whiplash-Associated Disorders, (WAD). Further, if the possible mediating impact differs over time from acute to three and 12 months after an accident, cross-sectional and prospective design was used, and 123 patients with WAD were included. Regression analyses were conducted to examine the mediating effect. The results showed that control over pain and ability to decrease pain were not mediators between self-efficacy, catastrophizing, and disability. Self-efficacy had a larger direct effect on pain-related disability compared to catastrophizing. Thus, healthcare staff should give priority to increase patients’ self-efficacy, decrease catastrophic thinking, and have least focus on control over pain or ability to decrease pain.