Factors impacting the household and recreation participation of older adults living in the community

Abstract

Purpose: To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults. Methods: A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression. Results: There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p?<?0.001, p?<?0.001). For recreational participation, higher levels of depression were associated with restricted participation (p?<?0.001). Conclusion: Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail.

• Implications for Rehabilitation

• Depression is significantly correlated with the level of participation in daily activities for older adults.

• Health professionals need to screen for depression when working with older adults.

     

Health disparities among workers and nonworkers with functional limitations: implications for improving employment in the United States

Purpose: The aim of this study was to compare workers and nonworkers who reported mild, moderate, and severe/complete functional limitations to identify disparities in 19 health and social indicators. Method: Using the International Classification of Functioning, Disability and Health as our conceptual framework, we analyzed data from the combined 2000–2008 National Health Interview Survey, comparing workers and nonworkers by severity of functional limitations, as measured by the FL12 Scale of Functional Limitation Severity. Results: Only 9.5% of people reporting moderate/severe functional limitations worked. Although not without exception, not working and severity of functional limitation were associated with poorer health outcomes, with nonworkers reporting severe/complete limitations having least optimal health. Prevalence of chronic conditions was associated with level of functional limitation severity, with the strongest associations among nonworkers. Conclusions: By focusing exclusively on people with functional limitations, we were better able to examine factors contributing to health and participation of workers and nonworkers. People who worked and had moderate or severe/complete limitations often did so while reporting poor health. With improved access to health care, health promotion activities, and other support systems, the quality of life and likelihood of work participation of people with greater functional limitations might also be improved.

Implications for Rehabilitation

• Improving access to health care, health promotion activities, and other support systems may increase the quality of life and likelihood of work participation of people with moderate or severe/complete limitations.

• Specifically addressing health behaviors among workers and nonworkers with moderate and severe/complete functional limitations in the course of rehabilitation may improve both work participation and job retention.

• Workers and nonworkers with mild, moderate, and severe/complete activity limitations exhibit different patterns of health and participation requiring carefully crafted intervention strategies

• Consistent management of chronic health conditions and chronic pain may improve the likelihood of work participation and retention in the workforce among adults with moderate and severe/complete functional limitations.

     

Participation in life situations by persons with systemic sclerosis

Abstract

Purpose: To measure the frequency of participation in life situations. Methods: A sample of 83 persons with systemic sclerosis (SSc) completed questionnaires regarding the presence and severity of disease symptoms, disability [the Health Assessment Questionnaire (HAQ)], depression [the Center for Epidemiologic Studies Depression Scale (CES-D)], and participation [the Adelaide Activities Profile (AAP)]. On the AAP, individuals rate the frequency of participation in four domains: domestic chores, household maintenance, service to others and social activities. Results: Participants were predominantly female, married, educated, white, and had diffuse SSc. Mean age was 53.7 years and mean disease duration was 9.9 years. On the AAP, participation was significantly more frequent for domestic chores than for household maintenance, service to others, and social activities. More fatigue (p?<?0.05), disability (p?<?0.001), and fatigue (p?<?0.05) resulted in lower total AAP scores. More fatigue, pain, severe gastrointestinal symptoms, and depression related to lower household maintenance scores, while the presence of ulcers and more disability and depression were associated with lower domestic chores scores. Conclusions: Participation in life situations in persons with SSc is related to higher disability, depression, and severity of disease symptoms. Interventions to address the disability, depression and symptoms may increase participation.

• Implications for Rehabilitation

• People with systemic sclerosis (SSc) have restrictions in participation including domestic chores, household maintenance, service to others compared to a normative sample.

• For practitioners, these findings show the need to assess participation in addition to impairments and activity limitations in persons with SSc.

• The Adelaide Activities Profile could be used to measure participation.

• Our findings also suggest that interventions addressing fatigue, disability and depression, may improve participation.

     

Quality of life of patients with Duchenne muscular dystrophy: from adolescence to young men

Purpose: This study investigated quality of life (QOL) in adolescent and young men with Duchenne muscular dystrophy (DMD).

Methods: Health-related QOL and global QOL were assessed with the Short Form 36 (SF-36) and World Health Organization Quality of Life-BREF (WHOQOL-BREF). Associations between functional status and QOL were assessed.

Results: All domains of the SF-36 were below Taiwan norms (effect size: ?14.2 to ?0.5), especially Physical Function, Role Physical, and Social Function. Three of the four domains of the WHOQOL-BREF were below Taiwan norms (effect size: ?2.0 to ?0.7). The Physical Function of the SF-36 was moderately correlated with functional status (mobility, basic activities of daily living, and arm function). The Social Function of the SF-36 and Social Relationships of the WHOQOL-BREF were also moderately correlated with functional status (impairment, basic activities of daily living, and arm function).

Conclusion: The adolescent and young men with DMD had poor health-related and global QOL. Poor QOL was related to both physical condition and social health. We suggest that rehabilitation programs focus on using assistive devices to facilitate arm function and encouraging participation in social activities to improve the QOL of patients with DMD.

• Implications for rehabilitation

• Duchenne muscular dystrophy (DMD) is a progressive muscle weakness disease that not only impacts physical health but also leads to poor quality of life in many domains.

• A valuable rehabilitation goal for patients with DMD is to encourage participation in social activities. Medical care and educational programs should plan a formal transition processes for patients with DMD from pediatric to adult care to maximum their quality of life.

• Arm function is associated with many domains of global quality of life, so a key element in improving quality of life may be to improve arm function.

     

Use of complementary and alternative medicine among US adults with and without functional limitations

Purpose. This study characterizes the use of complementary and alternative medicine (CAM) among adults with and without functional limitations. We also examine the reasons for using CAM and for disclosing its use to conventional medical professionals. Methods. Data were obtained from the 2007 adult CAM supplement and components of the National Health Interview Survey (n?=?20,710). Results. Adults with functional limitations used CAM more frequently than those without (48.7% vs. 35.4%; p?<?0.001). Adults with functional limitations used mind–body therapies the most (27.4%) and alternative medical systems the least (4.8%). Relaxation techniques were the most common therapy used by adults with functional limitations, and they used it more often than those without limitations (24.6% vs. 13.7%; P?<?0.001). More than half of the adults with functional limitations (51.3%) discussed CAM use with conventional medical professionals, compared with 37.9% of adults without limitations (p?<?0.001). The main reason for CAM use was general wellness/disease prevention among adults with and without functional limitations (59.8% vs. 63.1%; P?=?0.051). Conclusions. CAM use among adults with functional limitations is high. Health practitioners should screen for and discuss the safety and efficacy of CAM when providing health care.

Implications for Rehabilitation

• Complementary and alternative medicine (CAM) is often used for overall health, disease prevention, and to supplement conventional medical treatment.

• While most adults used CAM on the recommendation of friends and family, one-third of adults with functional limitations (FLs) reported CAM use recommended by a health care provider.

• This study found that ~50% of adults with FLs discussed their CAM use with a health care provider.

• Open discussion of CAM use and its safety and efficacy is vital.

     

Adapted Tango improves aspects of participation in older adults versus individuals with Parkinson’s disease

Purpose: Our aims were to determine (1) the impact of aging versus combined aging and disease on participation and (2) participation before and after a 12-week, Adapted Tango dance intervention (AT) in older adults with and without Parkinson’s disease (PD).

Methods: Participant responses to open and closed-ended questions on the Impact on Participation and Autonomy questionnaire (IPA) were recorded before, one-week-after, and three-months after 20 lessons of AT. Twenty-five older individuals with PD and 63 older adults without PD were initially enrolled and assessed, and 44 older adults and 22 individuals with PD finished the program with post-testing.

Results: Thematic analysis revealed major themes of difficulty with mobility, transportation and financial management, feelings of being forced to limit activities, and interest in work or volunteering for both groups at baseline and post-test. At post-test, additional emphasis on resilience in the face of challenges was noted. No differences were noted between groups on the IPA subscales at baseline. Quantitative analysis with a 2 (group)?×?3 (time) MANOVA revealed a main effect of time (p?p?p?=?0.073), and Family Role (p?=?0.057).

Conclusions: Adapted Tango improved aspects of participation for these cohorts of older adults with and without PD.

• Implications for Rehabilitation

• Both Parkinson’s disease and neurotypical aging can negatively impact participation in life’s activities in older adults.

• Adapted Tango is an alternative therapy that has improved quality of life and mobility in people with PD and older adults.

• Quantitative data show that Adapted Tango may improve some aspects of participation for older adults with and without PD.

• Open-ended responses reveal aging and combined aging and disease-related issues have a lasting impact upon participation.

     

Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

Purpose: The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation.

Method: The ADL intervention was early and pre-prosthetic; it was focused on six self-care activities. Fifty-two adults with LLA, who required assistance in self-care, were included. Functional independence (Barthel) was assessed at baseline and after intervention (T2). Successful intervention was defined as independent performance of all self-care activities.

Results: There was a significant improvement in Barthel scores between baseline and T2 in toileting (p?p?p?p?p?=?0.025). The proportion of homes with an unmet need for adaptation decreased significantly in bathroom (p?=?0.008) and other internal areas (p?=?0.031). Intervention was successful for 61.5% of participants. In a multivariate model, age was significantly associated with successful intervention (OR 0.66, 95%CI 0.52–0.83).

Conclusions: A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies.

• Implications for Rehabilitation

• Because basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence.

• A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation.

• Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation.

• A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation.

     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

Performance and capacity-based measures of locomotion,compared to impairment-based measures,best predicted participation in individuals with hemiparesis due to stroke

Purpose: To determine the potential predictors of participation of individuals with post-stroke hemiparesis, taking into account modifiable variables of impairments, activity limitations, and environmental factors.

Methods: One hundred and nine individuals (58?±?12 years; 64 men) participated in this study. Outcomes included measures of impairments (depressive symptoms: Geriatric Depression Scale and motor-based impairments: finger-to-nose test, lower extremity (LE) motor coordination test, and handgrip strength, isometric strength of the LE muscles), activity (capacity: 10-meter walking speed test and Test d'Évaluation des Membres Supérieurs de Personnes Agées; performance: locomotion and manual abilities; environmental factors (Measure of the Quality of the Environment); and participation: Assessment of Life Habits (LIFE-H 3.1 Brazil)).

Results: Regression analyses revealed that the explanatory variables accounted for 59% and 49% of the variance in the LIFE-H 3.1 Brazil daily activity and social role sub-scales, respectively. Locomotion performance (R²?=?39%; p?R²?=?32%; p?Conclusions: Performance and capacity-based measures of locomotion showed to be the best predictors of participation. Additionally, depressive symptoms should not be underlooked.

• Implications for Rehabilitation

• Activity-related measures of locomotion showed to be the main predictors of participation in individuals with post-stroke hemiparesis, as assessed by the daily activity and social role sub-scales of the LIFE-H 3.1.

• The daily activity model was best predicted by measures of performance, whereas the social role sub-scale, by measures of capacity.

• Although small, the impact of depressive symptoms on participation should not be underlooked.

• Locomotion appeared to be essential for participation and increases in walking speed and locomotion ability should be the main goals for both professionals and individuals, when the aim is to increase participation.

     

Timed mobility: description of measurement,performance, and dimensionality among older adults

Purpose: To describe the measurement, performance, and dimensionality of five timed mobility activities completed by older adults.

Materials and methods: Cross-sectional observational study using correlational and factor analysis to examine the dimensionality of five timed mobility activities performed by 189 older adults in an outpatient setting.

Results: The times to complete supine-to-sit, five repetition sit-to-stand, 8 m comfortable gait, four step ascent, and four step descent were correlated significantly with one another (r?=?0.294–0.827, p?α?=?0.71) and loaded highly on a single factor (0.587–0.888).

Conclusion: The timed measurements of this study were easily obtained. They can be viewed as unidimensional and representative of a single construct of the international classification of functioning, disability, and health -timed mobility.

• Implications for rehabilitation

• For patients who are independent in mobility, timing offers a means of differentiating the performance of individual patients.

• As the times to complete five mobility activities are interrelated, mobility is supported as a rehabilitation construct and patients who are faster at one activity should be expected to be faster at another.

     

Impact of environmental factors in home rehabilitation – a qualitative study from the perspective of older persons using the International Classification of Functioning,Disability and Health to describe facilitators and barriers

Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

Implications for Rehabilitation

• Environmental factors can be considered as obstacles or facilitators depending on each unique individual’s need.

• In a relatively small sample, this study shows the importance of the impact of the social environment on activities and participation among older people receiving home rehabilitation.

• Using ICF “linking rules” to link environmental factors as facilitators or barriers reported by older people can identify potentially important areas in home rehabilitation service described in the ICF categories. This can facilitate to improve rehabilitation service for older people.

• Reveals health care professionals as one central environmental factor for older people’s rehabilitation.

     

A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy

Purpose: Swallowing dysfunction has been reported in Duchenne muscular dystrophy (DMD), but has not been studied in Becker muscular dystrophy (BMD). The aims of this study were to report the characteristics of swallowing dysfunction in BMD compared with DMD.

Materials and methods: The study participants were 18 patients with BMD and 18 patients with DMD. All the patients were examined using videofluorography during swallowing of 5?mL of fluid. The penetration–aspiration scale (P–A scale) and the videofluorographic dysphagia scale (VDS) were used to evaluate dysphagia.

Results: Swinyard functional ability stage was not significantly different between the BMD and DMD groups. Rate of aspiration, P–A scale score, and total VDS score did not differ across groups, but the VDS item score for laryngeal elevation was lower in the BMD group than in the DMD group (median scores 4.5 and 9, respectively; p?r?=?0.78, p?Conclusion: Patients with BMD have swallowing problems similar to those observed in patients with DMD when matched according to physical functional status. These patients should be evaluated and followed-up for the duration of their disease.

• Implications for rehabiliation

• Dysphagia is one of the most critical problems in patients with progressive neuromuscular disease but dysphagia in patients with Becker muscular dystrophy (BMD) was not well known.

• Eighteen patients with BMD and 18 patients with Duchenne muscular dystrophy were examined with videofluorography.

• Patients with BMD have swallowing problems similar to those observed in patients with DMD.

     

The functional exercise capacity and its correlates in obese treatment-seeking people with binge eating disorder: an exploratory study

Abstract

Purpose: The primary aim was to compare the functional exercise capacity between obese treatment-seeking people with and without binge eating disorder (BED) and non-obese controls. The secondary aim was to identify clinical variables including eating and physical activity behaviour, physical complaints, psychopathology and physical self-perception variables in obese people with BED that could explain the variability in functional exercise capacity. Methods: Forty people with BED were compared with 20 age-, gender- and body mass index (BMI)-matched obese persons without BED and 40 age and gender matched non-obese volunteers. A 6-minute walk test (6MWT), the Baecke physical activity questionnaire, the Symptom Checklist-90, the Physical Self-Perception Profile and the Eating Disorder Inventory were administered. Physical complaints before and after the 6MWT were also documented. Results: The distance achieved on the 6MWT was significantly lower in obese participants with BED (512.1?±?75.8?m versus 682.7?±?98.4, p?<?0.05) compared to non-obese controls. No significant differences were found between obese participants with and without BED. Participants with BED reported significantly (p?<?0.05) more musculoskeletal pain and fatigue after the walk test than obese and non-obese controls. A forward stepwise regression analysis demonstrated that sports participation and perceived physical strength explained 41.7% of the variance on the 6MWT in obese participants with BED. Conclusion: Physical activity participation, physical self-perception and perceived physical discomfort during walking should be considered when developing rehabilitation programs for obese people with BED.

• Implications for Rehabilitation

• Rehabilitation programmes in people with binge eating disorder should incorporate a functional exercise capacity assessment.

• Clinicians involved in the rehabilitation of people with binge eating disorder should consider depression and lower self-esteem as potential barriers.

• Clinicians should take into account the frequently observed physical discomfort when developing rehabilitation programmes for people with binge eating disorder.

     

Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders

Abstract

Purpose: The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder.

Methods: A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder.

Results: Veterans with (vs. without) post-traumatic stress disorder (n?=?896) reported lower social participation (40.2 vs. 43.9, p?<?0.0001). Multivariate analyses showed that longer duration of injury (OR?=?0.98, 95% CI: 0.97–1.00, p?=?0.04) and white race (OR?=?0.62, 95% CI: 0.38–1.01, p?=?0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR?=?1.43, 95% CI: 1.25–1.64, p?<?0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR?=?0.94, 95% CI: 0.90–0.98, p?=?0.003).

Conclusions: Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation.

• Implications for Rehabilitation

• Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences.

• Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder.

• Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation.

• These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.

     

Conceptual issues in the measurement of participation among wheeled mobility device users

Purpose. To review current measurement approaches to activity and participation among wheeled mobility users and suggest key factors researchers should consider as they continue to develop and refine both the concept of participation and its measurement.

Methods. Literature review and expert opinion.

Results. Four issues are reviewed:

1. Participation as a concept and as a key domain of the revised International Classification of Functioning, Disability and Health (ICF).

2. The ‘perspective’ of current participation self-reports as they reflect the underlying cultural values of autonomy and independence.

3. The lack of sensitivity in current participation measures to assistive technology.

4. The significance of the ICF qualifiers ‘capacity’ and ‘performance’ to the accurate assessment of activity and participation among wheeled mobility users.

Conclusions. The following suggestions are offered as researchers continue to develop increasingly sophisticated instruments and methods: (1) participation measures need to be device-specific; (2) measures ought to capture both ‘capacity’ and ‘performance’; (3) methods need to be sensitive to those factors that impact mobility device use over time; (4) methods need to be sensitive to the complexities of both the social and physical environment as they impact device use; and (5) measures need to reflect the impact of multiple mobility device use.     

Long-term functional outcome of patients with longitudinal radial deficiency: cross-sectional evaluation of function,activity and participation

Purpose: To evaluate all functional aspects of patients with longitudinal radial dysplasia and to clarify the relationship between body functions on the one hand and limitations in activity and participation on the other hand. Methods: Thirty-one arms of seventeen adult patients with longitudinal radial dysplasia were analysed. Body function was assessed by measuring grip and pinch strength and active range of motion (ROM) of the hand. Activities were measured using the “Sequential Occupational Dexterity Assessment “, to measure perceived restrictions in participation the “Impact on Participation and Autonomy questionnaire” was used. Relationships between severity of dysplasia, body function, participation and activity were determined. Results: Patients with a severe type scored significantly lower in body function scores than patients with a mild form. Patients with limited active finger joint motion performed worse on activities. We found no significant differences in activity and participation between mild or severe types and found no correlation in participation scores. Conclusion: Although considerable restrictions in joint mobility and strength were revealed, little or no limitations on the activity and participation level were found. Limitations in body functions hardly influenced capacity on activity level and did not influence participation in societal roles.

Implications for Rehabilitation

• People with LRD learn to accomplish many of the everyday tasks without great difficulty and do not report a low quality of participation in major life activities.

• Professionals working in rehabilitation medicine should focus on activity and participation rather than on body structure or functions. Therapy focused solely on increasing joint motion or strength does not lead to further improvement.

• For parents it will be reassuring to know that children with severe radial deficiencies can satisfactory fulfill social roles in later life.

     

The impact of falls prevention on participation in daily occupations of older adults following discharge: a systematic review and meta-analysis

Abstract

Purpose: To investigate the impact of falls intervention programmes on participation of older adults returning home to live, following discharge from hospital. Method: A systematic review of peer-reviewed articles and grey literature was completed. Limits were set for articles published in English, dated 1990–2012. Inclusion criteria included randomised control trials with older adults (≥65 years) that used an effective falls intervention and a participation measure, following discharge from hospital or emergency department. Two independent researchers assessed the studies for eligibility. Research risk of bias was evaluated using the PEDro scale (range 1–10). A meta-analysis of the selected articles was completed. Results: Five studies fulfilled the inclusion criteria and measured participation outcomes short-term (<six months post-discharge, n?=?488) and long-term (6–12 months post-discharge, n?=?571). The results indicated that falls interventions provided a positive improvement in patients’ participation level (p?=?0.042, p?=?0.026). However, the effect size was small at 0.20 and 0.21. Conclusions: The meta-analysis findings indicate that there is a causal association between falls interventions and participation in daily occupations with older adults post-discharge. Although the effect size was small, practice implications of this study suggest that participation needs to be considered in future falls prevention research.

• Implications for Rehabilitation

• Falls interventions for older adults following discharge home from hospital, increase participation in life situations to a small extent.

• Health professionals can include a focus on falls prevention programmes with older adults to promote participation.

     

Social participation in early and established rheumatoid arthritis patients

Purpose: The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients.

Method: Two samples of RA patients with early (n?=?97; age?=?53?±?12.3 years; disease duration?= 2.8?±?1.2 years; 76% women) and established (n?=?143; age?=?58?±?10.3 years; disease duration?= 16.1?±?3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere–Terpstra test. Results: Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group. Conclusions: The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA.

• Implications for Rehabilitation

• Supporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life.

• Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation.

     

Peer support need fulfillment among adults with spinal cord injury: relationships with participation,life satisfaction and individual characteristics

Purpose: To test the hypothesis among people with spinal cord injury (SCI) that greater fulfillment of peer support needs to be associated with greater participation and life satisfaction. A secondary objective was to identify characteristics of people in great need of SCI peer support. Method: The participants consisted of a population-based sample of 1549 adults with SCI. The participants completed a survey with questions on peer support, participation, life satisfaction and provided demographic and SCI-related information. A secondary analysis of cross-sectional survey data was conducted. A set of regression analyses tested the primary purpose and a partition analysis was conducted to examine the secondary objective. Results: In regression analyses, peer support need fulfillment was positively associated with autonomous-outdoors participation (p?p?p?p?Conclusions: The results provide some evidence that SCI peer support plays an important role in promoting participation and life satisfaction. Individuals with many SCI-related unmet needs are most likely to report a need for peer support.

• Implications for Rehabilitation

• The receipt of peer support after a spinal cord injury (SCI) is positively related to aspects of social participation and life satisfaction.

• Provision of peer support can play an important role in the SCI rehabilitation process.

• Education, injury-related characteristics, and the number of other unmet needs are factors that rehabilitation professionals can use to identify those in particular need of peer support.

• Rehabilitation professionals should encourage patients who have sustained an SCI, to participate in peer support programs.