Qualitative case study on the disability acceptance experiences of soldiers with disabilities.

PURPOSE: This study comprehensively examines the disability acceptance experience of individuals who become disabled following accidents in the military after enlistment. METHODS: In-depth interviews and participative observation of two soldiers with disabilities are conducted. Data sources encompass the transcripts from these interviews, relevant news videos, and articles on the participants. A qualitative case study approach is applied to conduct both "within-case" and "cross-case" analyses. RESULTS: Although the two participants survived a crippling accidents, their military units did not actively attempt to resolve the accident. They grappled with despair and found it challenging to accept their new status as individuals with disability. Over time, they noticed changes in their personal relationships and started considering themselves burdens on their caregivers. However, despite encountering psychological challenges, which were marked by repeated setbacks and disappointments, the soldiers consistently made determined efforts to realize their objectives. Moreover, they strove to lead purposeful lives despite suffering the adversities caused by their disabilities. CONCLUSIONS: This study is the first in-depth examination of the disability acceptance experiences of soldiers with disability. The insights gleaned from our in-depth interviews will help formulate psychological and physical support systems for such individuals.

[Psychological dysfunctions and management of cerebral palsy patients]. / Dysfonctionnements et prise en charge psychologiques des patients cérébrolésés.

Cerebrospinal patients are victims of acquired brain lesions of multiple etiologies: head trauma, stroke, brain tumors, arteriovenous malformations, progressive degenerative diseases. Their care requires a combination of neurological, neuropsychological, psychiatric and psychopathological knowledge. Psychological follow-up of patients with cerebral palsy is one of the dimensions of their care.

Impact of the End PJ Paralysis interventions on patient health outcomes at the participating hospitals in Alberta, Canada.

PURPOSE: Multiple hospitals in Alberta implemented the End PJ Paralysis - a multicomponent inpatient ambulation initiative aimed at preventing the adverse physical and psychological effects patients experience due to low mobility during admission. To inform a scale-up strategy, this study assessed the impact of the initiative based on select process and outcome measures. MATERIALS AND METHODS: Clinical and administrative data were obtained from the hospital Discharge Abstract Database, Research Electronic Data Capture (Redcaps), and Reporting and Learning System for Patient Safety. The variables explored were length of stay, inpatient falls, discharge disposition, pressure injury, patient ambulation, and patient dressed rates. We then used the Interrupted Time Series design for impact analysis. RESULTS: The analysis included discharge abstracts for 32,884 patients and the results showed significant improvements in outcomes at the participating units. The length of stay and inpatient falls were reduced immediately by 1.8 days (B2=-1.80, p = 0.044, 95% CI [-3.54, -0.05]), and 2.2 events (B2=-2.22, p = 005, 95% CI [-3.75, -0.69]). The percentage of patients discharged home increased overtime (B2=.39, p=.006, 95% CI [.11, .66]). Mobilization and dressed rates also improved. CONCLUSIONS: The findings imply the interventions safely mitigated the risk of immobility-induced complications, including deconditioning and hospital-acquired disability.

Immobility during hospitalization is endemic in hospitals and, without intervention, presents a significant risk of physiological deconditioning and subsequent adverse health outcomes, such as functional decline and hospital-acquired disability.This study elevates the importance of preserving functional capacity and dignity of hospitalized patients by encouraging them to get up, dress in personal clothes, and move as much possible.Function-focused initiatives, that include intentional patient ambulation, have the potential to mitigate the risk of immobility-induced deconditioning and other adverse outcomes, such as falls and pressure injury, in older adults.In this study, we have demonstrated the End PJ Paralysis had a positive impact on patient ambulation, length of stay, inpatient falls, and discharge disposition.The study also informed a proposed transformational roadmap to strengthen rehabilitation in the provincial health system and spread the initiative to all the major hospitals to potentially benefit more patients.

The effects of neuromuscular electrical stimulation on hospitalised adults: systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: Neuromuscular electrical stimulation (NMES) is a treatment to prevent or reverse acquired disability in hospitalised adults. We conducted a systematic review and meta-analysis of its effectiveness. METHOD: We searched MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health (CINAHL) and the Cochrane library. Inclusion criteria: randomised controlled trials of hospitalised adult patients comparing NMES to control or usual care. The primary outcome was muscle strength. Secondary outcomes were muscle size, function, hospital length of stay, molecular and cellular biomarkers, and adverse effects. We assessed risk of bias using the Cochrane risk-of-bias tool. We used Review Manager (RevMan) software for data extraction, critical appraisal and synthesis. We assessed certainty using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: A total of 42 papers were included involving 1,452 participants. Most studies had unclear or high risk of bias. NMES had a small effect on muscle strength (moderate certainty) (standardised mean difference (SMD) = 0.33; P < 0.00001), a moderate effect on muscle size (moderate certainty) (SMD = 0.66; P < 0.005), a small effect on walking performance (moderate certainty) (SMD = 0.48; P < 0.0001) and a small effect on functional mobility (low certainty) (SMD = 0.31; P < 0.05). There was a small and non-significant effect on health-related quality of life (very low certainty) (SMD = 0.35; P > 0.05). In total, 9% of participants reported undesirable experiences. The effects of NMES on length of hospital stay, and molecular and cellular biomarkers were unclear. CONCLUSIONS: NMES is a promising intervention component that might help to reduce or prevent hospital-acquired disability.

Association between Hospital-acquired Disability and Clinical Outcomes in Older Patients Who Underwent Cardiac Surgical.

OBJECTIVE: This study aimed to clarify the association between hospital-acquired disability (HAD) and prognosis in older patients who underwent cardiac surgery. METHODS: This single-center, retrospective, observational study included 141 patients aged ≥65 years who underwent cardiac surgery at our hospital from November 2016 to August 2021. The primary endpoint of this study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) within 2 years of hospital discharge. HAD was defined as a score of ≤5 on any one of the functional independence measure (FIM) subitems at discharge compared to preoperatively. RESULTS: MACCE was observed in 16.3%, and the incidence of MACCE was significantly higher in the HAD group than that in the non-HAD group (12.1 vs. 34.5%, log-rank, p = 0.003). HAD was also significantly associated with the MACCE (hazard ratio [HD]: 2.575, 95% confidence interval [CI]: 1.001-9.655, p = 0.046). The incidence rate of HAD was 20.6%, with age (odds ratio [OR]: 1.260, 95% CI: 1.080-1.470, p = 0.004), preoperative short physical performance battery (SPPB) score (OR: 0.462, 95% CI: 0.301-0.708, p <0.001), and postoperative delirium (OR: 6.660, 95% CI: 1.480-30.000, p = 0.014) identified as significant factors. CONCLUSION: HAD is an independent predictor of MACCE in older patients who underwent cardiac surgery.

Development and applicability of a risk assessment tool for hospital-acquired mobility impairment in ambulatory older adults.

BACKGROUND: Mobility loss is common in hospitalized older adults, and resources to prevent mobility impairment are finite. Our goal was to use routinely collected data to develop a risk assessment tool that identifies individuals at risk of losing the ability to walk during hospitalization on the first hospital day. Second, we determined if the tool could inform the use of mobility-preserving interventions. METHODS: We included patients admitted to a general medical service, aged ≥65 years, who walked occasionally or frequently on admission (Braden Scale Activity subset > = 3). Patients were considered to have a new mobility impairment if, at discharge, their ability to walk was severely limited or nonexistent or they were confined to bed (Braden Scale Activity subset <3). We used predictors available on the first hospital day to develop (2017-18 cohort) and validate (2019 cohort) a risk assessment tool. We determined the association between predicted risk and therapy use in the validation cohort to highlight the model's clinical utility. RESULTS: 5542 patients were included (median age 76 years, 48% women); 7.6% were discharged unable to walk. The model included 5 predictors: age, medication administrations, Glasgow Coma Scale verbal score, serum albumin, and urinary catheter presence. In the validation cohort, the model discriminated well (c-statistic 0.75) and was strongly associated with hospital-acquired mobility impairment (lowest decile 1%, highest decile 25%). In the validation cohort, therapy consultation ordering increased linearly with predicted risk; however, observed mobility impairment increased exponentially. CONCLUSION: The tool assesses the risk of mobility impairment in all ambulatory hospitalized older adults on the first hospital day. Further, it identifies at-risk older adults who may benefit from mobility interventions.

Relationship between instrumental activities of daily living decline during hospitalization and one-year mortality in elderly patients with heart failure: A multi-center prospective cohort study.

BACKGROUND: It remains unclear whether instrumental activities of daily living (IADL) decline during hospitalization is related to mortality rates. This study examined the relationship between IADL decline during hospitalization and the one-year mortality rate in elderly heart failure (HF) patients. METHODS: Five hundred seventy-six consecutive patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into groups based on changes in IADL during hospitalization: IADL maintained and IADL decline. IADL was assessed by the National Center for Geriatrics and Gerontology-Activities of Daily Living Scale (NCGG-ADL). IADL decline was defined as Δ NCGG-ADL ≤ -1 point. The primary outcome was one-year all-cause mortality rate after discharge. Outcomes were examined using the Kaplan-Meier method with the log-rank test and Cox proportional hazards models using the existing prognostic risk factors for HF. RESULTS: Of 576 patients, 20% (n = 113) had IADL decline during hospitalization, and 9.2% (n = 35) and 6.0% (n = 18) died of all-cause and cardiovascular disease within one year after discharge, respectively. The IADL-decline group had significantly higher one-year all-cause mortality rates after adjusting for risk factors (hazard ratio: 1.923, 95% confidence interval 1.085-3.409; P = 0.023). Among the IADL subcategories, outdoor activity items such as "go out by oneself," "take a bus or train," and "shop for necessities" were more likely to change from independent to dependent during hospitalization. CONCLUSION: IADL decline during hospitalization was associated with an increased all-cause mortality rate at one-year after discharge in elderly HF patients.

Physical Activity as Measured by Accelerometers Predicts Functional Improvement in Older Patients Undergoing Hospital Rehabilitation.

This prospective cohort study aimed to investigate the association between physical activity (PA) as measured using accelerometers, and functional improvement measured using a short physical performance battery in older patients undergoing rehabilitation. After admission to the rehabilitation hospital, patients were categorized into quartile groups based on their level of PA measured using accelerometers. The primary outcome was physical function measured using the short physical performance battery at hospital discharge. A total of 204 patients were included in the analysis. After adjusting for confounding factors, light-intensity PA (p < .001) and moderate-to-vigorous-intensity PA (p < .001) were associated with a short physical performance battery at hospital discharge. In conclusion, PA at admission is positively associated with functional improvement in older patients undergoing hospital rehabilitation.

Relationship Between Skeletal Muscle Quality and Hospital-Acquired Disability in Patients With Sepsis Admitted to the ICU: A Pilot Study.

Early risk assessment of functional decline in patients with sepsis is clinically challenging. Recently, there is increasing interest in the nonvolitional evaluation of skeletal muscle quality. OBJECTIVES: The aim of this study was to assess the relationship between skeletal muscle quality and functional decline after intensive care. DESIGN SETTING AND PARTICIPANTS: This pilot study was a single-center prospective observational study conducted from March 2021 to February 2022. We included consecutive patients with sepsis who were admitted to our ICU. MAIN OUTCOMES AND MEASURES: The primary outcome was hospital-acquired disability (HAD), which is defined as a decrease in the Barthel index score of at least 5 points from pre-hospital to hospital discharge. Muscle quality was assessed by: 1) muscle echogenicity with ultrasound and 2) phase angle (PhA) with bioelectrical impedance analysis, both of which were measured on ICU days less than 3, 3-5, 5-7, 7-10, and 10-14. We compared longitudinal changes in muscle echogenicity and PhA between the HAD and non-HAD groups using two-way repeated measures analysis of variance with mixed models. RESULTS: Among the 22 patients, 7 (31.8%) had HAD. Muscle echogenicity was higher in the HAD group than in the non-HAD group (p < 0.001); however, no interaction effects were found between the two groups (p = 0.189). PhA showed a main effect on each evaluation day in patients (p = 0.040) and a significant interaction effect between the groups, including an early decreased pattern in the HAD group (p = 0.036). CONCLUSIONS AND RELEVANCE: Higher muscle echogenicity and a decreased PhA pattern are related to HAD. Noninvasive assessment of muscle quality using ultrasound and bioelectrical impedance analysis may be useful in predicting the functional prognosis of patients with sepsis.

Dysphagia is an independent predictor of hospital-acquired disability in older patients with heart failure: a propensity score-matched analysis : Predictors of HAD in older HF patients.

This study aims to identify the relationship between dysphagia and developing hospital-acquired disability (HAD) in older patients with heart failure (HF). This single-center retrospective cohort study included 360 patients (median age, 84 years: 58.1% female, 41.9% male) who had undergone rehabilitation and were aged 65 years and older. Patients were divided into dysphagia and non-dysphagia groups and compared based on the Functional Oral Intake Scale score. HAD was defined as a decline in the Barthel Index score (indication of daily activity levels) at discharge relative to that before admission. The relationship between dysphagia and HAD was analyzed using bivariate analysis after adjusting for age, sex, body mass index, medical history, clinical and laboratory data, short physical performance battery (SPPB), and cognitive function at the start of rehabilitation, using propensity score matching. HAD was observed in 38.1% of the patients. Patients with dysphagia were significantly older, and had lower body mass index and physical and cognitive function than those without. After propensity score matching, the prevalence of HAD was significantly higher in the dysphagia group than in the non-dysphagia group (61.9% vs. 42.9%, P = 0.032). Dysphagia at the start of rehabilitation was an independent predictor of HAD. The results of this study may contribute to risk stratification of HAD.

"They treat you like a person, they ask you what you want": a grounded theory study of quality paid disability support for adults with acquired neurological disability.

PURPOSE: Adults with acquired neurological disability often require paid disability support to live an ordinary life. However, little is known about what facilitates quality support. This study aims to explore the lived experience of people with acquired neurological disability to develop an understanding of the factors that influence the quality of support. METHODS: Guided by constructivist grounded theory, in-depth qualitative interviews were conducted with 12 adults with acquired neurological disability. Data analysis followed an iterative process to develop themes and subthemes and explore relations between themes to build a model of quality support. RESULTS: Nine key factors emerged in the dyadic space, with the support worker recognising the person as an individual as foundational to quality support. Beyond the dyadic space, three broader contextual factors were identified as influential on the quality of support by mechanism of facilitating or constraining the person with disability's choice. Finally, the provision of quality support was characterised by the person feeling in control. CONCLUSIONS: Findings support the rights of people with disability to quality, individualised support, and a need for interventions to better prepare the disability workforce to deliver support in line with the needs and preferences of people with acquired neurological disability. IMPLICATIONS FOR REHABILITATIONTo provide quality support, disability support workers need to recognise the person with disability as an individual and the expert in their support needs and preferences.The quality of paid disability support is primarily determined by the way the person with disability and support worker work together in the dyadic space.Ensuring people with acquired neurological disability have authentic choice over their support arrangements and daily living is critical to facilitate quality support, and in turn help the person with disability to feel in control.

"Let the people you're supporting be how you learn": a grounded theory study on quality support from the perspective of disability support workers.

PURPOSE: Quality disability support is fundamental to the lives of many adults with acquired neurological disability. However, little is known about the factors that influence the quality of paid support. This study is part of a larger project to develop a holistic understanding of quality support, grounded in the experience of people with acquired neurological disability, close others, and disability support workers. The current study focuses on the support worker perspective. METHODS: Following constructivist grounded theory methodology, interviews were conducted with 12 support workers. Grounded theory analysis was followed to develop themes and subthemes and build a model of quality support. RESULTS: Five key themes, with fifteen subthemes emerged to depict factors influencing the quality of support. The five themes are: being the right person for the role, delivering quality support in practice, working well together, maintaining and improving quality support, and considering the broader context. Findings emphasise the importance of the support worker recognising the person as an individual and respecting their autonomy. CONCLUSIONS: Critical to quality support is centring the needs and preferences of people with disability, improving support worker working conditions and supporting people with disability and support workers to build effective, balanced working relationships.IMPLICATIONS FOR REHABILITATIONDelivering quality support in practice relies upon the support worker recognising, centring, and respecting the autonomy of the person with disability.To deliver quality support, support workers need to feel valued, be committed to the role and actively work to maintain and improve the quality of support provision.Quality support provision is facilitated by the support worker and the person with disability effectively balancing boundaries and friendship, and in turn building a quality working relationship.

Hospital-acquired disability in older heart failure patients decreases independence and increases difficulties in activities of daily living.

AIMS: The aim of this study was to clarify whether worsening of independence in activities of daily living (ADL) and also difficulties in ADL are triggered by hospitalization in older patients with heart failure (HF) and whether difficulties in ADL can predict readmission for HF regardless of independence in ADL in these patients. METHODS AND RESULTS: We enrolled 241 HF patients in the present multi-institutional, prospective, observational study. The patients were divided according to age into the non-older patient group (<75 years, n = 137) and the older patient group (≥75 years, n = 104). The Katz index and the Performance Measure for Activities of Daily Living-8 (PMADL-8) were used to evaluate independence and difficulties in ADL, respectively. The endpoint of this study was rehospitalization for HF. Independence as indicated by the Katz index at discharge was significantly lower than that before admission only in the older patient group, and the value of the PMADL-8 at discharge was significantly higher than that before admission (P < 0.001). In all patients, after adjusting for the Katz index and other variables, PMADL-8 score was a significant predictor of rehospitalization for HF (hazard ratio 1.50; 95% confidence interval 1.07-2.13; P = 0.021). CONCLUSIONS: Worsening of both independence and difficulties in ADL was triggered by hospitalization in older HF patients, and difficulties in ADL were relevant factors for risk of rehospitalization regardless of independence in ADL. These findings indicate the importance of preventing not only decreased independence but also increased difficulties in ADL during and after hospitalization.

Strategies employed in coping with physical disabilities acquired during adulthood in rural South Africa.

Background: Society places people with physical disabilities acquired during adulthood in disadvantaged positions, especially when they cannot participate in activities like their non-disabled counterparts. The situation can be worse for individuals who acquire disabilities during adulthood, where they have to learn to cope with the adulthood-acquired physical disabilities. Objectives: This study aimed to identify the types of physical disabilities acquired during adulthood and their causes and explore how participants defined their disabilities and the coping strategies they used. Methods: The study used a phenomenological research design. Five adults (three women, two men) with adulthood-acquired disabilities were purposefully selected from a rural area in Limpopo, South Africa. Data were collected using semi-structured interviews. Thematic analysis was used to generate themes about coping strategies study participants used. Results: The results show four types of adulthood-acquired disabilities amongst the participants: visual impairment, paraplegia, weakened muscles which led to bilateral amputation, loss of function on both hands and legs. Participants' meanings of their physical adulthood-acquired disabilities ranged from a punishment, pain, not a bother, black magic, to results of doing wrong things to someone. In coming to terms with their adulthood-acquired disabilities, participants used problem- and emotion-focused strategies. Four themes from the participants' responses were spiritual support, social support, substance dependency, access to health and rehabilitation services. Conclusion: The study contributes to understanding the experiences of individuals who acquired disabilities in adulthood, how they define their disabilities and the divergent coping strategies they use. This study established that participants used problem-focused, positive emotion-focused and negative emotion-focused coping strategies.

Self-identified intervention priorities amongst women with road accident-acquired physical disabilities in South Africa.

Background: Acquiring a physical disability in adulthood necessitates a range of adjustments, with past research suggesting that some challenges encountered are unique to women. Moreover, several factors may complicate adjustment to an altered embodiment and difficulties in functioning after an accident, including insufficient rehabilitation and support services and problematic societal attitudes towards disability. In addition, women with disabilities are often excluded from health and social policy and programme development, an oversight that can result in support gaps. Objectives: This article presents the self-identified priority interventions of women with road accident-acquired physical disabilities in South Africa. Methods: We conducted interviews with 18 women with road accident-acquired physical disabilities. The participants were recruited via snowball sampling. Interviews were conducted by experienced interviewers, who were home language speakers of the participants' preferred language of communication. The interview recordings were transcribed, translated, and coded by trained, independent researchers. Results: Study participants identified three key areas of intervention requiring consideration in supportive intervention planning: the acute post-injury environment and healthcare infrastructure, transitional services and social inclusion interventions. These were identified as overlooked areas in which they required support to successfully adapt to limitations in functioning. Conclusion: To develop inclusive, accessible, and practical policy and programming for people with disabilities, exercises like those outlined in this research - eliciting intervention ideas from lived experience - should be conducted as they highlight actionable priorities for programming.

Factors that influence the quality of paid support for adults with acquired neurological disability: scoping review and thematic synthesis.

PURPOSE: Theoretically, individualised funding schemes empower people with disability (PWD) to choose high quality support services in line with their needs and preferences. Given the importance of support, the aim of this scoping review was to understand the factors that influence the quality of paid disability support for adults with acquired neurological disability. METHODS: A comprehensive scoping review of the published literature from 2009-2019 was conducted on five databases: Medline, CINAHL, Embase, PsycINFO and Scopus. RESULTS: Of the 3391 records retrieved, 16 qualitative articles were eligible for review. Thematic synthesis of the findings revealed six key interrelated themes: (1) choice and control, (2) individualised support, (3) disability support worker (DSW) qualities, (4) DSW competence, (5) PWD - DSW relationship, and (6) accessing consistent support. The themes depict factors influencing the quality of paid disability support from the perspective of PWD, close others and DSWs. CONCLUSIONS: Although the evidence base is sparse, the factors identified were in line with international rights legislation and policy ideals. The findings can provide insights to PWD hiring and managing support, and facilitate the delivery of quality disability support. Further research is required to understand the interactions between the factors and how to optimise support in practice.Implications for rehabilitationThe quality of paid disability support is determined by a multitude of interrelated factors influenced by the disability support worker's qualities and competencies, the interaction between the person with disability and the disability support worker, as well as external contextual factors.Optimising choice and control for adults with acquired neurological disability and providing individualised support should be a significant focus for disability support workers.Training modules for disability support workers can be informed by five of the identified themes: (1) choice and control, (2) individualised support, (3) DSW qualities, (4) DSW competence and (5) the relationship between PWD and DSWs.

Strategies employed in coping with physical disabilities acquired during adulthood in rural South Africa

Society places people with physical disabilities acquired during adulthood in disadvantaged positions, especially when they cannot participate in activities like their non-disabled counterparts. The situation can be worse for individuals who acquire disabilities during adulthood, where they have to learn to cope with the adulthood-acquired physical disabilities. Objectives: This study aimed to identify the types of physical disabilities acquired during adulthood and their causes and explore how participants defined their disabilities and the coping strategies they used. Methods: The study used a phenomenological research design. Five adults (three women, two men) with adulthood-acquired disabilities were purposefully selected from a rural area in Limpopo, South Africa. Data were collected using semi-structured interviews. Thematic analysis was used to generate themes about coping strategies study participants used. Results: The results show four types of adulthood-acquired disabilities amongst the participants: visual impairment, paraplegia, weakened muscles which led to bilateral amputation, loss of function on both hands and legs. Participants' meanings of their physical adulthood-acquired disabilities ranged from a punishment, pain, not a bother, black magic, to results of doing wrong things to someone. In coming to terms with their adulthood-acquired disabilities, participants used problem- and emotion-focused strategies. Four themes from the participants' responses were spiritual support, social support, substance dependency, access to health and rehabilitation services. Conclusion: The study contributes to understanding the experiences of individuals who acquired disabilities in adulthood, how they define their disabilities and the divergent coping strategies they use. This study established that participants used problem-focused, positive emotion-focused and negative emotion-focused coping strategies.

Diferencias laborales entre personas con discapacidad adquirida y sobrevenida en edad adulta. Análisis secundario de la Encuesta Nacional de Discapacidad ­ ENEDIS 2012 / Labor differences between people with congenital and adulthood acquired disability. Secondary analysis of the National Disability Survey - ENEDIS 2012

Objetivo: Evaluar diferencias laborales entre personas con discapacidad adquirida y discapacidad sobrevenida en edad adulta. Material y Métodos: Estudio transversal analítico secundario de la Encuesta Nacional de Discapacidad (ENEDIS) 2012. Se incluyeron personas entre 14 y 65 años de edad, agrupándolas según discapacidad (adquirida, sobrevenida temprana, sobrevenida adulta). Se consideraron como resultados finales de interés: tener trabajo, ser trabajador dependiente o independiente, contar con contrato y tener ingresos superiores a la remuneración mínima vital. Se realizo análisis bivariados y múltiples considerando el muestreo complejo de los datos. Resultados: Se estudiaron a 16060 personas, 27,92 % presentaron discapacidad adquirida, 10,45 % sobrevenida temprana y 61,63 % sobrevenida adulta. Se encontró que aquellas con discapacidad sobrevenida adulta tenían una mayor frecuencia de: tener trabajo (34,93 vs 23,20 %, p < 0,001), contar con contrato (50,40 vs 27,74 %, p < 0,001) y tener mayores ingresos (18,18 vs 13,29 %, p=0,048), respecto a las personas con discapacidad adquirida. Al realizar el análisis de regresión múltiple, las diferencias del ingreso económico y tipo de contrato disminuyen (p<0,05), pero la probabilidad de tener trabajo en la discapacidad sobrevenida adulta se invierte de 51% más a 8% menos (p=0,057). Conclusiones: Las personas con discapacidad sobrevenida en edad adulta presentan más empleo e ingresos económicos que aquellas con discapacidad adquirida. Aparentemente esto no depende del tiempo de discapacidad (que es menor en la discapacidad sobrevenida adulta) sino principalmente a factores como edad, sexo, grado de instrucción, región de residencia y tipo de limitación.

Objetive: To evaluate labor differences between people with congenital and adulthood acquired disability. Material and Methods: Secondary analytical cross-sectional study of the National Disability Survey (ENEDIS) - 2012. People between 14 and 65 years of age were included, grouping them according to their disability (congenital, early acquired, adulthood acquired). The final results of interest were considered: to have a job, being a dependent or independent worker, to have a contract and to have an income higher than the minimum living wage. Bivariate and multivariate analyzes were performed to evaluate the differences raised. Results: 16060 people were studied, 27,92% presented congenital disability, 10,45% early acquired and 61,63% adulthood acquired. It was found that those with adulthood acquired disability had a higher frequency of to have a job (34,93 vs 23,20 %, p <0,001), to have a contract (50,40 vs 27,74 %, p <0.001) and have income higher (18,18 vs 13,29 %, p = 0,048), with respect to people with congenital disability. When performing the multivariate analysis, the differences in economic income and type of contract decrease (p<0,05), but the probability of to have a job in adulthood acquired disability reverses from 51% more to 8% less (p = 0.057). Conclusions: People with adulthood acquired disability have more employment and income than those with congenital disability. Apparently this does not depend on the time of disability (which is less in adulthood acquired disability) but mainly to factors such as age, sex, level of education, region of residence and type of limitation

Clinical Characteristics of Older Heart Failure Patients With Hospital-Acquired Disability: A Preliminary, Single-Center, Observational Study.

BACKGROUND: This study investigated the clinical factors related to hospital-acquired disability (HAD) among 70 patients (median age, 78 years; interquartile range (IQR), 78 - 83) who were hospitalized for heart failure (HF) at Ayase Heart Hospital between December 2019 and October 2020. METHODS: HAD was defined as a ≥ 5-point decrease in Barthel Index (BI) scores from admission to discharge. Twenty-nine HF patients (41%) developed HAD after admission. RESULTS: Compared to the non-HAD group, the HAD group had higher Kihon Checklist scores (14 points (IQR, 11 - 17) vs. 9 points (IQR, 6 - 13); P < 0.01) and prevalence of multi-faceted frailty (90% vs. 29%; P < 0.01), a longer urinary-catheter-placement period (3 days (IQR, 1 - 5] vs. 1 day (IQR, 0 - 2), P < 0.05), less daily number of steps (457 steps (IQR, 301 - 997) vs. 1,692 steps (IQR, 1,227 - 2,418); P < 0.01), and moderate-intensity physical activity time (0 min (IQR, 0 - 2] vs. 1 min (IQR, 0 - 3); P < 0.05). CONCLUSION: In conclusion, lower physical function and general physical activity and longer urinary-catheter-placement are associated with HAD.

Prognostic impact of hospital-acquired disability in elderly patients with heart failure.

AIMS: Functional decline is associated with worse outcomes in patients with elderly heart failure (HF), but little is known about the prognostic impact of hospital-acquired disability (HAD) during hospital stay after acute HF. The present study examines the prognostic significance of HAD in the prediction of all-cause mortality in elderly patients who admitted for acute HF. METHODS AND RESULTS: This retrospective study was performed in 1941 elderly patients aged ≥65 years or older from the cardiovascular physiotherapy for acute HF patients in the Tokyo metropolitan area registry and excluded those who died in hospital. HAD was defined as any decline in the Barthel index (BI) before discharge compared with the BI within 1 month before hospital admission. The primary outcome of this study was all-cause death and HF readmission. A total of 565 (29%) deaths and 789 (41%) HF readmission occurred over a median follow-up period of 1.7 years. A total of 476 patients (25%) had HAD during hospital stay after acute HF. In multivariable analysis, HAD predicted all-cause death [hazard ratio (HR): 1.772; 95% confidence interval (CI): 1.450-2.167; P < 60; 0.001] and with risk of HF readmission (HR: 1.193; 95% CI: 1.005-1.416; P = 0.043) after adjusting for the Meta-analysis Global Group in Chronic Heart Failure risk score. CONCLUSIONS: Hospital-acquired disability is associated with an increased risk of all-cause death and readmission for HF in elderly patients with acute HF.