Luc Noreau

Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap.

OBJECTIVES To present a conceptual model of disablement adapted from the WHO model and to conduct a pilot study with a measurement tool (LIFE-H) of the concepts of life habits and handicap situations. DESIGN Content validity and test-retest reliability study. SETTING General community. PARTICIPANTS A panel of 12 experts of rehabilitation for the process of content validity and 49 individuals with spinal cord disorders (adults and children) for the reliability study. OUTCOMES MEASURES a persons life habits (activities of daily living and social roles). RESULTS The LIFE-H questionnaire was designed to assess the handicap situations observed in daily life of individuals with disability. The experts concluded that the LIFE-H items covered most of a persons life habits (ADL and social roles) and that it could be used to determine the appearance of handicap situations. The LIFE-H total score showed a good level of reliability for the children and the adult samples (ICC = 0.73 and 0.74, respectively). Taken individually, a majority of life habit categories have shown a moderate to high reliability level (ICC > or = 0.50) while a few life habit categories such as the interpersonal relationship or nutrition showed a lower reliability level. CONCLUSION The development of LIFE-H allows fulfillment of the need to determine the disruptions in life habits of persons with disabilities.

Secondary impairments after spinal cord injury: a population-based study.

ObjectiveTo determine the prevalence of secondary impairments among individuals with long-standing spinal cord injury in Quebec and the potential relationships between these impairments and several variables. DesignA review of 2200 medical files was conducted to determine the target population; 976 patients were selected randomly and mailed questionnaires. The results were based on 482 individuals with spinal cord injury who returned the completed questionnaire. The questionnaire included 14 subsections, such as sociodemographic, medical, psychosocial, and environmental information. The medical section, including the type and level of lesion and the presence of secondary impairments, was analyzed. ResultsUrinary tract infection, spasticity, and hypotension were the most frequently reported secondary impairments, regardless of the severity of injury. Relationships between the prevalence of secondary impairments and the duration of injury, as well as perceived health status, were observed. ConclusionsThis is the first study to describe secondary impairments after long-standing spinal cord injury in Quebec. Patients with spinal cord injury still present a high prevalence of secondary impairments many years after their rehabilitation, despite preventive education or medical follow-up visits. Further studies are required to determine the specific impact that these impairments have on the patients’ social role and their quality-of-life.

Older Adults, Chronic Disease and Leisure-Time Physical Activity

Background: Participating in regular physical activity is an important part of healthy aging. There is an increased risk for inactivity associated with aging and the risk becomes greater for adults who have a chronic disease. However, there is limited information on current physical activity levels for older adults and even less for those with chronic diseases. Objective: Our primary objective was to determine the proportion of older adults who achieved a recommended amount of weekly physical activity (≥1,000 kcal/week). The secondary objectives were to identify variables associated with meeting guideline leisure-time physical activity (LTPA), and to describe the type of physical activities that respondents reported across different chronic diseases. Methods: In this study we used the Canadian Community Health Survey Cycle 1.1 (2000/2001) to report LTPA for adults aged 65 years and older. This was a population-based self-report telephone survey. We used univariate logistic regression to provide odds ratios to determine differences in activity and the likelihood of meeting guideline recommendations. Results: For adults over 65 years of age with no chronic diseases, 30% reported meeting guideline LTPA, while only 23% met the recommendations if they had one or more chronic diseases. Factors associated with achieving the guideline amount of physical activity included a higher level of education, higherincome and moderate alcohol consumption. Likelihood for not achieving the recommended level of LTPA included low BMI, pain and the presence of mobility and dexterity problems. Walking, gardening and home exercises were the three most frequent types of reported physical activities. Conclusion: This study provides the most recent evidence to suggest that older Canadians are not active enough and this is accentuated if a chronic disease is present. It is important to develop community-based programs to facilitate LTPA, in particular for older people with a chronic disease.

Measuring social participation: reliability of the LIFE-H in older adults with disabilities

Purpose: Much more attention should be paid to instruments documenting social participation as this area is increasingly considered a pivotal outcome of a successful rehabilitation. The purpose of this study was to document the reliability of a participation measure, the Assessment of Life Habits (LIFE-H), in older adults with functional limitations. Methods: Eighty-four individuals with physical disabilities living in three different environments were assessed twice with the LIFE-H, an instrument that documents the quality of social participation by assessing a persons performance in daily activities and social roles (life habits). Results: The intraclass correlation coefficients (ICC) computed for intrarater reliability exceeded 0.75 for seven out of the 10 life habits categories. For interrater reliability, the total score and daily activities subscore are highly reliable (ICC ⩽ 0.89), and the social roles subscore is moderately reliable (ICC = 0.64). ‘Personal care’ is the category with the highest ICC, and for five other categories ICCs are moderate to high (< 0.60). Conclusion: LIFE-H is a valuable addition to instruments that mostly emphasize the concepts of function or functional independence. It is particularly meaningful to evaluate the participation of older adults in significant social role domains such as recreation and community life. It may be considered among the instruments having the best fit with the ICF definition of participation (the persons involvement in a life situation) and a majority of its related domains.

Spinal Cord Injury, Exercise and Quality of Life

SummaryThe ultimate goal of comprehensive rehabilitation in individuals with spinal cord injury (SCI) has shifted over time from an extension of their life expectancy to attainment of an optimal level of independent living and quality of life. After World War II, the important influence of sport and exercise upon the course of rehabilitation following SCI was recognised. Nonetheless, 5 decades later, there remains a lack of understanding of how an exercise programme can contribute to an improvement of quality of life among individuals with SCI. In future, attention should be directed toward avoidance of secondary impairments, disabilities and handicaps. The World Health Organization model of disablement provides a suitable framework for addressing this issue.The most common benefits of exercise are biological in nature. They target a reduction in secondary impairments (loss of cardiorespiratory, and muscular function, metabolic alterations and systemic dysfunctions). This in turn could minimise the development of disabilities and the appearance of such handicaps as loss of mobility, physical dependence and poor social integration. A lack of physical fitness for specific tasks can be a serious obstacle to autonomy following SCI. In a very short period of time, physical deconditioning can significantly decrease quality of life in individuals with SCI, ultimately placing them in a state of complete dependency.Quality of life is closely associated with independent living and, increasingly, it is a key outcome when measuring the success of rehabilitation. Consequently, research designs that examine the impact of exercise upon individuals with disabilities should not only include objective outcome measures, but also subjective measures relating to life-satisfaction and quality of life.

Predictors of long-term participation after stroke.

Purpose: (1) To explore factors that predict long-term participation after stroke (2 – 4 years after discharge from rehabilitation), and (2) to determine factors that predict both short- and long-term participation. Methods: Biopsychosocial data of people who had had a stroke were measured at discharge from an intensive rehabilitation unit using valid instruments. Six months later (n = 102) as well as 2 – 4 years later (n = 66), social participation of the survivors was measured in their living environments. Participation was estimated with the Assessment of Life Habits (LIFE-H), which includes 12 categories of daily activities and social roles. Results: From mutivariate regression analyses, the best predictors of long-term participation after stroke appear to be age, comorbidity, motor coordination, upper extremity ability and affect. Age, comorbidity, affect and lower extremity coordination are the best predictors of participation after stroke at both measurement times. Conclusions: With the exception of age, these factors may be positively modified and thus warrant special attention in rehabilitation interventions.

Comparison of three methods to assess muscular strength in individuals with spinal cord injury

The aim of the project was to compare three methods for measuring muscle strength in individuals with SCI: the manual muscle test (MMT), the hand-held myometry and the isokinetic dynamometry (Cybex). Thirty-eight (38) subjects, 31 men and seven women (age range=14–63; lesion from C5 to L3) were included in this project. Muscle strength assessment of upper limbs was performed at admittance and discharge using MMT and myometry for the left and right side, and using Cybex dynamometer for the stronger side. The testing sessions were at least a day apart and performed by a single evaluator (trained physiotherapist). Significant and non-significant differences of myometry mean strength values were observed between consecutive levels of MMT. However, the range of myometry scores within each MMT grade led to significant overlaps between two adjacent MMT grades of each muscle group. Variables correlations were observed between the strength values measured by MMT and myometry with paraplegia (0.26⩽r⩽0.67) and tetraplegia (0.50⩽r⩽0.95). Similar results were observed when compared MMT and Cybex with the stronger side.  Moderate to strong correlations were observed between the strength values measured by myometry and Cybex with paraplegia (0.70⩽r⩽0.90) and tetraplegia (0.57⩽r⩽0.96). These results suggest that the MMT method does not seem to be sufficiently sensitive to assess muscle strength, at least for grade 4 and higher and to detect small or moderate increases of strength over the course of rehabilitation. Since outcome measures is an important issue in rehabilitation, objective measurements of strength should be used in clinical settings. Considering cost and assessment time, the myometry technique seems to be highly valuable.

Measuring participation in children with disabilities using the Assessment of Life Habits

The objectives of this study were: (1) to examine the psychometric properties of the Assessment of Life Habits (LIFE‐H) for children; and (2) to draw a profile of the level of participation among children of 5 to 13 years of age with various impairments. The research team adapted the adult version of the LIFE‐H in order to render it more appropriate for the daily life experiences of children. Content validity was verified by an expert panel of 29 people, made up of parents, paediatric clinicians, and researchers. Reliability and construct validity of the LIFE‐H for children (interview‐administered form) was tested during an experiment that comprised three sessions of interviews with a group of 94 parents of children with disabilities (36 males, 58 females; mean age 8y 10mo [SD 2y 6 mo]; diagnostic groups: cerebral palsy, myelomeningocoele, sensory‐motor neuropathy, traumatic brain injury, and developmental delay). Overall, the LIFE‐H showed high intrarater reliability with intraclass correlation coefficient values of 0.78 or higher for 10 out of 11 categories. The correlations between the LIFE‐H and the tools used in pediatric rehabilitation varied, and categories with similar constructs generally led to higher correlations. The psychometric properties of the LIFE‐H are appropriate and its content allows a complete description of participation among children with disabilities.

Relationship of impairment and functional ability to habitual activity and fitness following spinal cord injury.

Associations between a physically active leisure, physical fitness, impairment and disability have been tested in 123 volunteers (73 with paraplegia and 50 with quadriplegia). Active physical leisure was assessed by the questionnaire of Godin and Shephard (Canadian Journal of Sports Sciences 10, 141-6 1985). Fitness measures included body mass index, peak oxygen intake on a wheelchair ergometer, and tests of muscle strength and endurance (peak isokinetic torque, average muscle power and total muscle work for shoulder flexion, shoulder adduction and elbow flexion at movement speeds of 60 degrees and 180 degrees s-1). Primary impairment was assessed by the ISMGF scale, and secondary impairment was judged from reported pressure scores, spasticity, and urinary infections over the previous 12 months. Scores for self-care and mobility were obtained using a modified Barthel Index. Physically active leisure and fitness were unrelated to secondary impairment. However, functional ability for a given primary impairment was significantly correlated with peak oxygen intake and the three indices of muscle strength, particularly in individuals with high level lesions. Associations between physical activity and functional ability were weaker, but tended in the same direction. Although longitudinal studies are needed to prove the causality of these relationships, the findings point towards a significant influence of fitness status upon functional ability. Rehabilitation teams should thus give a stronger emphasis to systematic exercise conditioning programmes when planning overall treatment following SCI.

Quality of life after spinal cord injury.

Quality of life (QOL) is an often-used but it remains an ill-understood concept in medicine. Literature suggests 3 important approaches to operationalize and measure QOL: Health-related quality of life (HRQOL), well-being, and QOL as a superordinate construct. To measure the various instruments of HRQOL (SF-36 and Sickness Impact Profile) and well-being (Satisfaction With Life Scale and Life Satisfaction Questionnaire LiSat) are used. Domains on which QOL of persons with SCI lag behind QOL of the general population are identified. Overall, this paper suggests: (1) that inspection of the QOL measure used in a particular study is necessary to identify the domains of QOL that are measured, (2) that most measures lack sufficient evidence of reliability and validity, and (3) that longitudinal studies starting in the early phase of rehabilitation are necessary to reveal the course and predictors of QOL of persons with SCI.