[Regionalization of rehabilitation services. Survey of users of a Quebec center]. / La régionalisation des services de réadaptation. Ce qu'en pensent les usagers dans le centre et l'est du Québec.

OBJECTIVE: To understand the situation of and difficulties encountered by users of a supraregional rehabilitation institute when they are transferred from the institute to facilities in their own regions, and to discover how they address these difficulties. DESIGN: Qualitative descriptive study. SETTING: Regions in Quebec served by a physical rehabilitation institute (Institut de réadaptation en déficience physique de Québec). PARTICIPANTS: Thirty-nine people who used services at the institute and then sought rehabilitation in their own regions. METHOD: Telephone survey using a validated questionnaire with both open-ended and closed questions. MAIN FINDINGS: About 69% of users had difficulty obtaining adequate follow up in their regions; the regions lacked professionals with expertise; more efficient methods of communication are required; and physicians' role in providing continuity of care needs to be recognized. CONCLUSION: Providing continuity of care on a regional basis is a formidable challenge for the entire health and social services network, but ways of meeting this challenge are within reach.

[Psychometric properties of a psychological well-being test for people with physical impairments]. / Les qualités psychométriques d'un instrument de mesure du bien-être psychologique utilisé auprès des personnes ayant une déficience physique.

Measuring the psychological well-being of people with physical impairments could provide relevant information to occupational therapists. The aim of this study was to verify psychometric properties of a psychological well-being test called Test de personnalité PER (PER). This test was administered to two samples of people with physical impairments. Two time measurements were collected within a group of 36 individuals and one single measure within another group of 79 individuals. Comparisons between time measurements, between groups and with the normative group of the PER were performed in an attempt to verify the sensitivity, the capacity to discriminate between known groups, and the construct validity of the PER. One section of the Sickness Impact Profile measuring psychological well-being was administered to the same groups to verify the concurrent criterion validity of the PER. The results indicate that the PER has sufficient psychometric qualities.

Long-term consequences of spinal cord injury on social participation: the occurrence of handicap situations.

PURPOSE: Handicap situations in daily life of persons with Spinal Cord Injury (SCI) is rarely evaluated in spite of their impact on long-term health. The purpose of the present study was to identify the occurrence of potential handicap situations in individuals with SCI and to determine the potential associations between the level of social participation and some characteristics of the person. METHODS: Four hundred and eighty-two individuals completed a mailed questionnaire that comprised the 'assessment of life habits', a tool developed to assess social participation in persons with disabilities. RESULTS: Significant disruptions were particularly observed in home maintenance, participation in recreational and physical activities as well as in productive activities and the achievement of sexual relations. However, many individuals successfully achieved various social roles despite the presence of disabilities. No indications of a potential impact of premature ageing on the accomplishment of life habits were observed. CONCLUSIONS: The severity of injury seems to significantly increase the occurrence of handicap situations as the individuals with tetraplegia reported carrying out their life habits with much more difficulty or requiring more assistance than those with a less severe impairment.

Profile of handicap situations in children with cerebral palsy.

The purposes of this study were to establish a profile of handicap situations in children with cerebral palsy and to identify some variables associated with the occurrence of these situations. Ninety-eight children with a diagnosis of cerebral palsy (mean age +/- 1 SD, 10.5 +/- 3.5 years) were recruited on a voluntary basis. The Life Habits Assessment (LIFE-H, version 1.0) was used to measure the degree of accomplishment in 12 categories of life situations (activities of daily living and social roles). Significant disruptions in the accomplishment of all life habit categories were revealed. The highest disruptions were observed in the following categories: recreation, community, personal care, education, mobility, housing and nutrition. Disruption progressed significantly with increased severity of cerebral palsy. Impairment type, severity, speech and language disorders, and comprehension difficulties explained a high percentage of the total variance (> 60%) in the accomplishment of life habits. The results suggest that life habits related to school and social integration are greatly disturbed.

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 person's 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 person's 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.

Documenting environmental factors for preventing the handicap creation process: Quebec contributions relating to ICIDH and social participation of people with functional differences.

This article presents the conceptual origins and the usefulness of an holistic model, stressing the role of environmental determinants in the performance of day-to-day activities and the fulfilment of social roles by persons with disabilities. The Quebec Committee on ICIDH contribution to the development of knowledge on the clarification of the relationship of disabled individual-environment and the understanding of the handicap creation process in relation with ICIDH experimentations is presented. Finally, on the basis of anthropological social research conducted in Quebec, the article illustrates a methodology for environmental analysis of the handicap situations of disabled clients in rehabilitation and social integration support programmes.

[Implications of the diffusion of the International Classification of Handicaps on policies concerning handicapped persons]. / Les implications de la diffusion de la Classification internationale des handicaps sur les politiques concernant les personnes handicapées.

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) has had a considerable impact on perception of the consequences of disease, and of the modifications which these consequences can present. Ideally, ICIDH is at the same time a descriptive, an explanatory and an implementation too for health policy. Two examples of the conceptual and policy use of ICIDH are given: policy developments proposed to Member States of the Council of Europe; multisectoral development in Québec. Both these examples underline that the ICIDH not only deals with clarifying items, but is also a support to the development of responsible policies.