COVID-19: Factors Predicting Depressive Symptoms in People Aging With Long-Term Physical Disabilities.

The mental health impact of the COVID-19 pandemic may be greater than that of the viral infection. This impact is likely greater for disadvantaged groups such as people with long-term physical disabilities (PwLTPD). This cross-sectional study used a multiple linear regression model to examine factors associated with depressive symptoms and to understand their relative importance during the onset of the COVID-19 pandemic. The model explained 58% of the variance in depressive symptoms. Anxiety was the most important predictor, accounting for 8% of variance. Higher levels of anxiety, loneliness, and financial stress; prior diagnosis of depression; and non-Black race predicted a higher level of depressive symptoms in PwLTPD during the onset of the COVID-19 pandemic. Occupational therapy practitioners should strategically acknowledge predictors of depression that cannot be modified and actively address those that can be modified through evidence-based interventions to improve depressive symptoms in PwLTPD.

Sociodemographic Differences in Respondent Preferences for Survey Formats: Sampling Bias and Potential Threats to External Validity.

Objective: To explore sampling bias as a result of survey format selection by examining associations between characteristics of people aging with long-term physical disability (PAwLTPD) and their preferences for phone or web-based survey format. Design: A cross-sectional study using a secondary data analysis approach. Setting: Data were from an ongoing longitudinal cohort study conducted in the community. Participants: Convenience sampling was used. PAwLTPD who participated in year 2 of the longitudinal cohort study were included. Inclusion criteria were age 45-65 years, English speaking, and self-reported onset of a physical disability at least 5 years prior to study recruitment. Two participants completed the survey using both phone and web formats and were thus excluded; 387 participants (N=387) were included in the analysis. Interventions: Not applicable. Main Outcome Measures: Choice of survey format and demographics (age, sex, race and ethnicity, marital status, living arrangement, socioeconomic status) were collected in addition to self-rated physical health. Results: Participants were on average 58.2±5.6 years old. A total of 33% were male, and 62% were White. Approximately 40% of participants completed phone surveys. The phone survey group was significantly older (t=-4.76, P<.001) and had lower education (U=11133, z=-6.65, P<.001) and lower self-rated physical health (U=15420, z=-2.38, P=.017) than the web survey group. Participants who were White (χ2=60.69; df=1; P<.001; odds ratio [OR], 0.18) or were in a long-term relationship were less likely to choose phone surveys (χ2=42.20; df=1; P<.001; OR, 0.21). Those who earned $10,008 or less annually (χ2=53.90; df=1; P<.001; OR, 5.22) or who lived alone (χ2=36.26; df=1; P<.001; OR, 3.64) were more likely to choose phone surveys. Participants with paid work (χ2=16.81, df=1, P<.001) tended to select web-based surveys, while those on disability leave (χ2=9.61, df=1, P<.01) were more likely to choose phone surveys. Conclusions: Sociodemographics are associated with survey format choice in PAwLTPD. Findings largely support the existing understanding of digital literacy but also provide insight into the potential occurrence of sampling bias when multiple survey format options are not offered. These findings have implications for investigators who aim to reach a more representative sample of people with disabilities.

A protocol for Removing Environmental Barriers to Independent Living (REBIL): An adapted evidence-based occupational therapy intervention to increase community participation for individuals aging with long-term physical disabilities.

Background: People aging with long-term physical disabilities (PAwLTPD) are living longer and experiencing the challenges of aging, including the onset of secondary and age-related health conditions. PAwLTPD are at high risk of falls, fall injuries, diminished functional abilities, and compromised participation. However, no available programs support PAwLTPD to participate safely at home and in the community. The proposed study is to examine the feasibility and efficacy of an adapted intervention: Removing Environmental Barriers to Independent Living (REBIL). Method/Design: A single-blinded randomized controlled trial (RCT) will be conducted. Participants who are 45-65 years old; self-report difficulty with ≥2 daily activities; have had a physical disability for ≥5 years; and live within 60 miles of the research lab are eligible. All participants will receive an initial in-home evaluation before randomization. The treatment group will receive REBIL (total five visits), which is tailored. The waitlist control group will be offered the same intervention after 6-month follow-up. Expected outcomes are high acceptability, fidelity, and adherence; low safety risk; improved community participation and daily activities performance; and fewer environmental barriers and fall hazards. Discussion: Findings will serve as preliminary evidence for occupational therapy community practice. Outcomes will also inform future large, pragmatic trials. Trial Registration: ClinicalTrials.gov identifier NCT04589988.