Associations between COVID-19 incidence, weight status, and social participation restrictions in the U.S.: evidence from the national population, cross-sectional study.

BACKGROUND: To explore the associations between coronavirus infection incidence and weight status and social participation restrictions among community-dwelling adults in the United States. METHODS: We analyzed data from the 2021 National Health Interview Survey (NHIS), which included a representative sample of 29,394 individuals (Coronavirus disease 2019 (COVID-19): 3,205) and a weighted total of 252,461,316 individuals (COVID-19: 31,697,404), considering the complex sampling design used in the survey. RESULTS: Age, race/ethnicity, education level, family income index, body mass index (BMI), and smoking status were significantly associated with COVID-19 infection. Weight status was significantly correlated with social participation restrictions and strongly associated with COVID-19 infection, particularly among individuals who were overweight or obese. CONCLUSION: Weight status was shown to be associated not only with social participation restrictions but also with COVID-19 infection among U.S. adults. Understanding the complex interplay between weight status, social participation, and COVID-19 is crucial for developing effective preventive measures and promoting overall well-being in the community population.

Trends in physical functioning in acute lymphoblastic leukemia and non-Hodgkin lymphoma survivors across three decades.

PURPOSE: The impact of changes in therapy for childhood acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL) on the prevalence of physical performance limitations and participation restrictions among survivors is unknown. We aimed to describe the prevalence of reduced function among ALL and NHL survivors by treatment era. METHODS: Participants included survivors of childhood ALL and NHL, and a cohort of their siblings, participating in the Childhood Cancer Survivor Study (CCSS). Physical function was measured using questionnaire. The prevalence of reduced function was compared to siblings using generalized estimating equations, overall and stratified by treatment decade. Associations between organ system-specific chronic conditions (CTCAE v4.03) and function were also evaluated. RESULTS: Among 6511 survivors (mean age 25.9 years (standard deviation 6.5)) and 4127 siblings, risk of performance limitations (15.2% vs. 12.5%, prevalence ratio [PR] = 1.5, 95%CI = 1.3-1.6), restrictions in personal care (2.0% vs. 0.6%, PR = 3.1, 95% CI = 2.0-4.8), routine activities (5.5% vs. 1.6%, PR = 3.6, 95% CI = 2.7-4.8), and work/school attendance (8.8% vs. 2.1%, PR = 4.5, 95% CI = 3.6-5.7) was increased in survivors vs. siblings. The prevalence of survivors reporting reduced function did not decrease between the 1970s and 1990s. The presence of neurological and cardiovascular conditions was associated with reduced function regardless of treatment decade. CONCLUSIONS: Despite changes in therapy, the prevalence of poor physical function remained constant between the 1970s and 1990s. The CCSS clinical trial registration number is NCT01120353 (registered May 6, 2010). IMPLICATIONS FOR CANCER SURVIVORS: Our findings support screening for reduced physical function so that early interventions to improve physical performance and mitigate chronic disease can be initiated.

Post-coronavirus disease 2019 functional impairments, limitations, and restrictions: A prospective cohort study based on the international classification of functioning, disability, and health.

Background: Current knowledge regarding coronavirus disease 2019 (COVID-19) is constantly evolving, and the long-term functional impairments, limitations, and restrictions have not yet been well established. Objective: to evaluate the impact of post-COVID condition on the human functioning through the International Classification of Functioning, Disability and Health (ICF) classification. Methods: This is a prospective cohort study with 53 individuals with post-COVID condition at 3 time points: 0 to 3 (baseline), 3 to 6, and 6-12 months (follow-up). Outcomes were organized in dichotomous variable: No impairment (0); presence of impairment (≥1) in body function, structure, activities, and participation domains according to the ICF checklist. Chi-square test was used to determine the differences of 3 time points, and association with persistent symptoms. Results: A statistically significant difference was observed between the periods, with greater disabilities at 6-12 than at 0-3 months in mental, sensory, pain, and movement-related functions; cardiovascular, immunological, and respiratory systems. In terms of activity and participation, a greater limitation at 6-12 months was observed than at 0-3 months in learning and applying knowledge, general tasks, and mobility. In the domain of interpersonal interactions and relationships, there was a statistically significant difference between the 6-12 and 3-6 months groups. Associations between COVID-19 symptoms and ICF components at the first follow-up were: anosmia and dysgeusia with weight maintenance, fatigue and irritability with pain, brain fog with watching and listening, walking difficulty with pain, and headache with pain, watching, and listening. At the second follow-up were: anosmia and dysgeusia with energy and drive functions, attention, memory, and emotional functions; dizziness with watching and listening; fatigue with emotional function, pain, undertaking multiple tasks, lifting and carrying objects, and driving; irritability with energy and drive, emotional function, undertaking multiple tasks, lifting and carrying objects, and walking; walking difficulty with energy and driving, emotional function, respiration, muscle power, cardiovascular system, undertaking multiple tasks, lifting and carrying objects, and walking; and headache with emotional function, watching, and listening. Conclusions: Individuals with COVID-19 persistent symptoms showed impairments in structure and function, activity limitations, and participation restrictions during the 1-year follow-up period.

Relation of environmental factors with activity limitations and participation restrictions in older adults with diabetes mellitus over time: an international classification of functioning framework perspective.

BACKGROUND: Activity limitations and participation restrictions were observed in patients with diabetes, which may impact their quality of life. Environmental factors such as seasonal effects, resources and perceived stress may play important role in activity limitations and participation restrictions. In this study, a variant of International Classification of Functioning (ICF) model was used to clarify the associations of function/structure factors, personal factors and environmental factors with activity limitations and participation restrictions. METHODS: This was a longitudinal design with 1 year follow-up. The Mini-Mental State Examination (MMSE), Geriatric Depression Scale- short form, Perceived Stress Scale, and Instrumental Activities of Daily Living assessments were measured at 3-month intervals for long-term follow-up in 110 patients with diabetes aged ≥ 65 years. RESULTS: Hierarchical linear regression models revealed that age (p = 0.001), perceived health status, MMSE scores (p < 0.01), and positive perceived stress (p < 0.001) were predictors of activity limitations (adjusted R2 = 53%). GDS-S (p < 0.05) and positive perceived stress (p < 0.01) were predictors of participation restrictions (adjusted R2 = 30%). Generalized estimating equation analysis indicated that seasonal effects, age, perceived health status, MMSE predicted the changes of slopes in activity limitations. Seasonal effects and GDS-S were predictors of the changes of slopes for participation restrictions (all p < 0.001). CONCLUSIONS: The ICF can be used to identify the risk factors for activity limitations and participation restrictions in older adults with diabetes. Practitioners should provide individualized interventions with consideration of these risk factors.

"My role as a parent, to me, it has narrowed" the impact of early inflammatory arthritis on parenting roles: a qualitative study.

PURPOSE: To explore the impact of early inflammatory arthritis on participation in parenting roles. MATERIALS AND METHODS: Twenty-four individuals (20 female) aged between 32 and 62 years with early inflammatory arthritis (<2 years duration) and who were parents of dependent children (≤21 years) were interviewed. A qualitative description study design was used, and thematic analysis methodologies were employed in the data analysis. RESULTS: Parenting roles were significantly impacted in early disease and extensive parenting restrictions were identified regardless of age and gender. Physical symptoms hampered "everyday mammy activities." Parent-child interactions were altered by the emotional impact of early arthritis including low mood and irritability. Participants emphasised remorse at the negative impact of their arthritis on their children's childhood. Parent-role identity and parents' perception of how they were viewed by their children were negatively impacted by early disease with considerable self-imposed pressure to shield children from the consequences of arthritis. A forced "role switch" requiring relinquishing of some parenting tasks was identified as an unwanted burden associated with inflammatory arthritis. CONCLUSION: Inflammatory arthritis has a negative impact on parenting which is present from disease onset. Understanding factors which influence parenting with arthritis is important to identify appropriate healthcare interventions.Implications for rehabilitationAn early diagnosis of inflammatory arthritis is synonymous with considerable challenges in performing parenting tasks and activities which are present despite early medical management and drug therapy.Physical and psychosocial sequelae of early inflammatory arthritis result in restrictions in the execution of parenting activities and are accompanied by a forced "role switch".The disease impact on parenting differs in early and established inflammatory arthritis and requires distinct healthcare approaches and interventions to adequately address the needs.Parent role identity and perceived lack of control are intrinsically linked to the degree of perceived negative impact on parenting and these factors should be considered in the design and evaluation of appropriate healthcare interventions for this population.

A multidisciplinary-led early arthritis service to manage client-identified participation restrictions in early inflammatory arthritis: A qualitative study of service user and staff perspectives.

BACKGROUND: The impact of inflammatory arthritis (IA) on occupational performance and on participation in meaningful life roles is recognised. However, limited research has explored how clinical services support broader life impact and participation restrictions associated with early disease as part of routine healthcare. This exploratory study was undertaken to describe how a novel multidisciplinary-led early arthritis service approach addresses client-identified participation restrictions in early IA. METHODS: Qualitative Description (QD) approaches were used to explore perspectives of staff and clients of these multidisciplinary-led early arthritis services in Ireland. Data were gathered using focus groups with staff, and individual semi-structured interviews with clients. Transcripts were analysed using thematic analysis. RESULTS: Fifteen staff working in these services participated in the focus groups and 43 clients with IA participated in interviews (female n = 31); diagnosis duration ranged from 5 to 24 months. Participants described how the multidisciplinary-led service had a clear remit to address participation alongside traditional symptom management and provided automatic, immediate access to interventions focussed on identification and management of participation restrictions experienced in early disease. The service model utilised a delivery approach that allowed for ease of early access to a full multidisciplinary team and prolonged support. The most significant feature of the service approach was 'the centrality of the client' which influenced a person-centred approach to identification of needs and priorities for interventions. CONCLUSION: Findings indicate the role and value of this innovative multidisciplinary approach in addressing client-identified participation restrictions in routine clinical practice that is positively regarded by clients and staff.

'You don't want to be seen as a burden' experiences of working with early inflammatory arthritis: a qualitative study.

PURPOSE: To describe the impact of early inflammatory arthritis on work participation. MATERIALS AND METHODS: Thirty individuals (24 women) of working age (age 18-69 years) with inflammatory arthritis (<2 years duration) who were in paid employment or fulltime education were interviewed using qualitative description methodology. Data was analysed using thematic analysis. RESULTS: Half of participants (n = 15) reported work disability within the first two-years of diagnosis. Five descriptive themes were identified that explained the early impact of IA on participation in paid employment. These themes were: (i) altered capacity for work; (ii) work comes first; (iii) the invisible burden; (iv) the disclosure effect; and (v) a reconstructed work future. CONCLUSION: The scale of early work disability appears to be higher than previously understood. Although early medical intervention has improved disease management, significant work-based restrictions requiring intervention remain. Internalised and invisible work-related anxieties present early in the disease and need to be acknowledged and addressed by healthcare providers.IMPLICATIONS FOR REHABILITATIONEarly inflammatory arthritis causes significant challenges in work ability, and early work-based participation restrictions are present despite early use of drug therapy.Assessment of the client's subjective experience, including understanding the invisible burden, is an important aspect in determining the types of work interventions required.Disclosure of diagnosis in the work environment is associated with anxiety and fear, however, disclosure is influential in supporting capacity to retain work participation and should be included in work interventions.Routine healthcare should include early interventions to address work-based restrictions and supporting work retention to avoid work disability.

After 55 Years of Neurorehabilitation, What Is the Plan?

Neurological disorders often cause severe long-term disabilities with substantial activity limitations and participation restrictions such as community integration, family functioning, employment, social interaction and participation. Increasing understanding of brain functioning has opened new perspectives for more integrative interventions, boosting the intrinsic central nervous system neuroplastic capabilities in order to achieve efficient behavioral restitution. Neurorehabilitation must take into account the many aspects of the individual through a comprehensive analysis of actual and potential cognitive, behavioral, emotional and physical skills, while increasing awareness and understanding of the new self of the person being dealt with. The exclusive adoption by the rehabilitator of objective functional measures often overlooks the values and goals of the disabled person. Indeed, each individual has their own rhythm, unique life history and personality construct. In this challenging context, it is essential to deepen the assessment through subjective measures, which more adequately reflect the patient's perspective in order to shape genuinely tailored instead of standardized neurorehabilitation approaches. In this overly complex panorama, where confounding and prognostic factors also strongly influence potential functional recovery, the healthcare community needs to rethink neurorehabilitation formats.

Associations among quality of life, activities, and participation in elderly residents with joint contractures in long-term care facilities: a cross-sectional study.

BACKGROUND: Joint contractures and degenerative osteoarthritis are the most common joint diseases in the elderly population, can lead to limited mobility in elderly individuals, can exacerbate symptoms such as pain, stiffness, and disability, and can interfere with social participation and quality of life, thus affecting mental health. However, relevant studies on this topic are very limited. This study describes the associations of joint contracture categories and sites in elderly residents in long-term care facilities with their quality of life, activities, and participation. METHODS: Elderly individuals with joint contractures who were residents in long-term care facilities were recruited. The World Health Organization (WHO) Quality of Life and the WHO Disability Assessment Schedule 2.0 were used to survey the participants. Correlations, multiple linear regressions, and multiple analyses of variance, with joint contractures as the response variable, were used in the statistical analysis. RESULTS: The final statistical analysis included 232 participants. The explanatory power of contracture sites on activities and participation had a moderate strength of association (η2 = .113). Compared with elderly residents with joint contractures and osteoarthritis isolated to the upper limbs, those with joint contractures and osteoarthritis in both the upper and lower limbs had significantly worse activity and participation limitations. No significant differences in activity and participation were found between elderly residents with joint contractures affecting only the upper limbs and those with joint contractures affecting only the lower limbs (F1,226 = 2.604 and F1,226 = 0.674, nonsignificant). Osteoarthritis had the greatest impact on activity limitations and participation restrictions among elderly residents with joint contractures affecting both the upper and lower limbs (F1,226 = 6.251, p = .014). CONCLUSIONS: Elderly residents in long-term care facilities belonging to minority groups, with a history of stroke, and with osteoarthritis are at a high risk of developing activity limitations and participation restrictions. Moreover, compared with other contraction sites, regardless of osteoarthritis, joint contractures affecting both the upper and lower limbs were associated with the greatest activity limitations and participation restrictions. TRIAL REGISTRATION: This study has been registered in the Chinese Clinical Trial Registry, registration number and date: ChiCTR2000039889 (13/11/2020).

Audiometric profiles and patterns of benefit: a data-driven analysis of subjective hearing difficulties and handicaps.

OBJECTIVE: Hearing rehabilitation attempts to compensate for auditory dysfunction, reduce hearing difficulties and minimise participation restrictions that can lead to social isolation. However, there is no systematic approach to assess the quality of the intervention at an individual level that might help to evaluate the need of further hearing rehabilitation in the hearing care clinic. DESIGN: A data-driven analysis on subjective data reflecting hearing disabilities and handicap was chosen to explore "benefit patterns" as a result of rehabilitation in different audiometric groups. The method was based on (1) dimensionality reduction; (2) stratification; (3) archetypal analysis; (4) clustering; (5) item importance estimation. STUDY SAMPLE: 572 hearing-aid users completed questionnaires of hearing difficulties (speech, spatial and qualities hearing scale; SSQ) and hearing handicap (HHQ). RESULTS: The data-driven approach revealed four benefit profiles that were different for each audiometric group. The groups with low degree of high-frequency hearing loss (HLHF) showed a priority for rehabilitating hearing handicaps, whereas the groups with HLHF > 50 dB HL showed a priority for improvements in speech understanding. CONCLUSIONS: The patterns of benefit and the stratification approach might guide the clinical intervention strategy and improve the efficacy and quality of service in the hearing care clinic.

Impact of non-pharmacological interventions on activity limitations and participation restrictions in older breast cancer survivors: A scoping review.

Cancer-related disability is a complex problem for older breast cancer survivors. One aspect of cancer-related disability is a survivor's inability to complete meaningful daily activities and engage in life roles, referred to as activity limitations and participation restrictions respectively. There is a limited understanding of how interventions influence activity limitations and participation restrictions in this population. A scoping review was undertaken to identify and characterize nonpharmacological interventions developed to address activity limitations and participation restrictions. A systematic search of electronic databases (Ovid Medline, Embase, EBSCO CINAHL, and Ovid PsycINFO) was conducted in April 2020 and updated October 2020. Eleven studies met inclusion criteria. Most frequently observed delivery features were in-person and one-on-one format. Six interventions incorporated telehealth delivery components. Interventions were often complex and varied in content. Exercise and behavioral strategies were among the most frequently used active ingredients. Activity limitations and participation restrictions were often secondary outcomes, and measures of these outcomes were varied in content and assessment method. Study samples were not representative of the current population of older adult breast cancer survivors. Future intervention research should clarify intervention delivery, content, and dose, prioritize comprehensive measurement of activity limitations and participation restrictions, as well as recruit and involve representative study samples to enhance generalizability of findings.

Examining the consequences of tinnitus using the multidimensional perspective.

BACKGROUND: Tinnitus is one of the most frequent chronic conditions in adults with wide range of consequences. AIMS/OBJECTIVES: The aim of the current study was to determine the problems and life effects reported by individuals with tinnitus using the International Classification of Functioning, Disability and Health (ICF) framework. MATERIAL AND METHODS: The study used a cross-sectional survey design. A total of 344 individuals with tinnitus completed a series of questionnaires. The responses to open-ended questions were linked to ICF categories. RESULTS: Activity limitations and participation restrictions were most dominant consequence of tinnitus followed by effect on the body function with limited emphasis on the contextual factors. Frequently reported responses to body function involved emotional functions (b152), attention function (b140), and sleep functions (b134). Commonly reported responses to activity limitations and participation restrictions were recreation and leisure (d920), conversation (d350), communicating with-receiving-spoken messages (d310), listening (d115), and remunerative employment (d850). Sound intensity (e2500) and sound quality (e2501) were the frequently reported responses to environmental factors. Coping styles, past and present experiences, and lifestyle were the most frequently occurring personal factors. CONCLUSIONS AND SIGNIFICANCE: The study highlighted some key influencing factors of tinnitus in different ICF domains which can be helpful in rehabilitation planning.

The Voice Problem Impact Scales (VPIS).

INTRODUCTION: Patient-reported outcome measures (PROMs) are important for systematically assessing a person's perspectives and experiences with disease to inform clinical decision-making. However, PROMs can occasionally fail to capture subtle differences amongst subgroups. In response to this problem, the aim of the current study was to examine the convergent validity of four patient-reported voice activity and participation scales to better reflect and describe the impact of a voice problem in a patient's work, home, social and overall life. It was hypothesized that augmenting the validated PROM with a directed situational short instrument may enhance patient and clinician communication. This would allow for further description of individual areas of activity limitations or participation restrictions that are relevant to the patient, potentially informing therapeutic goals. METHODS: The Voice Problem Impact Scales (VPIS) were developed following the criteria outlined by Francis et al (2016). A retrospective chart review was completed for voice therapy treatment seeking patients at the USC Voice Center. Results from the Voice Handicap Index-10 (VHI-10) and VPIS scores were recorded at the time of the evaluation. Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) assessment was performed by an SLP with fellowship training in voice. RESULTS: Three hundred four charts were reviewed, and 198 met inclusion criteria. When considering all patients, VHI-10 scores were significantly correlated with each domain of the VPIS, including overall (R = 0.635, P < 0.001), work (R = 0.436, P < 0.001), social (R = 0.714, P < 0.001), and home (R = 0.637, P < 0.001). For females aged 18-39 and aged ≥60, the VHI-10 was correlated with all domains except work. CAPE-V score was significantly correlated with the social domain (R = 0.236, P = 0.001). Using the corrected significance level, it was not correlated with the overall (R = 0.165, P = 0.022), home (R = 0.197, P = 0.006), or work domains (R = 0.042, P = 0.567). The VHI-10 was not correlated with any of the VPIS domains for males aged 18-39, was correlated with all domains for males aged 40-59, and was correlated with all domains except work for males aged ≥60. Age was the only significant predictor of the work domain (ß = -4.631 P < 0.001), with a model fit of R2 = 0.101. CONCLUSIONS: Scores from each domain of the VPIS are significantly correlated with VHI-10 scores thus confirming the instrument's convergent validity. There are certain groups for which currently used questionnaires may underrepresent the impact of dysphonia on the patient's life. The VPIS represents a broad tool that might allow the patient to interpret each scale within their individual context and cultural background. The VPIS emphasizes the significance of the dysphonia on quality of life in four common environments. Using this instrument can augment questionnaires and initiate conversations between the provider and patient to determine the area(s) where voice impairment is most important enhancing shared decision-making on therapeutic goals for plan of care.

The impact of participation restrictions on everyday life in long-term colorectal cancer survivors in the EnCoRe study: A mixed-method study.

PURPOSE: Knowledge about long-term colorectal cancer (CRC) or treatment related health and functioning problems and on its impact on participation of CRC survivors in domestic life and in society is limited. We aimed to explore the nature and impact of cancer (treatment) related participation restrictions on everyday life of long-term CRC survivors, their current satisfaction with participation, and associations of health and functioning problems with participation satisfaction, using the International Classification of Functioning, Disability and Health (ICF) to comprehensively study participation. METHOD: Mixed-method study in 2-10 years post-diagnosis stage I-III CRC survivors (n = 151) from the cross-sectional part of the EnCoRe study. Participation restrictions were explored by semi-structured interviews in a subsample reporting participation restrictions (n = 10). Role functioning (SF36-Health Survey), fatigue (Checklist Individual Strength), and peripheral neuropathy symptoms (EORTC QLQ-CIPN20) were assessed in all participants and associations with self-reported participation satisfaction were analyzed by multivariable logistic regression models. RESULTS: 19% of CRC survivors reported dissatisfaction with participation. Participation restrictions were reported for interpersonal relationships, work/employment, and social/civic life. CRC survivors reporting better physical and emotional role functioning were significantly less likely to be dissatisfied with their participation, whereas survivors reporting higher levels of fatigue or more peripheral neuropathy symptoms were more likely to be dissatisfied with participation. CONCLUSIONS: Colorectal cancer (treatment) related health and functioning problems negatively impacts the ability of nearly 1 in 5 long-term CRC survivors to participate in everyday life situations and their satisfaction with participation. Follow-up care needs to be able to identify and address these problems.

Development of the Central Africa Daily Functioning Interference Scale for Dementia Diagnosis in Older Adults: The EPIDEMCA Study.

BACKGROUND: There are a few validated tools capable of assessing the dimensions essential for the diagnosis of dementia and cognitive disorders in sub-Saharan Africa. OBJECTIVES: Our aim was to develop an adapted tool, the Central African - Daily Functioning Interference (DFI) scale. METHODS: An initial 16-item scale of activity limitations and participation restrictions was completed by 301 participants with low cognitive performances to assess their level of DFI. A psychometric evaluation was performed using Item Response Theory. RESULTS: A unidimensional 10-item scale emerged with a reasonable coverage of DFI (thresholds range: -1.067 to 1.587) with good item discrimination properties (1.397-4.076) and a high reliability (Cronbach's al pha = 0.92). The cutoff for detecting 96% of those with dementia was with a latent score ≥0.035 that corresponds to the LAUNDRY limitation. CONCLUSIONS: These results provide valuable support for the reliability and internal validity of an operational 10-item scale for DFI assessment used in Central Africa for the diagnosis of dementia in the elderly.

Services, systems, and policies affecting mobility device users' community mobility: A scoping review: Services, systèmes et politiques influençant la mobilité dans la communauté des utilisateurs d'aides à la mobilité : examen de la portée.

BACKGROUND: Opportunities to travel from one place to another in the community, or community mobility, are especially important for mobility device users' ability to participate fully in society. However, contextual challenges to such mobility exist. PURPOSE: This study summarizes the literature on existing community mobility barriers and facilitators of mobility device users created by services, systems, and policies as defined by the International Classification of Functioning, Disability, and Health (ICF). METHOD: Arksey and O'Malley's approach for scoping studies was used for the review. The extraction chart was organized following the ICF, and frequency counts were used to report the data. FINDINGS: The findings suggest that certain factors, such as transportation, open-space planning, and architecture and construction, influence community mobility opportunities. However, little attention has been paid to services, systems, and policies in the research literature, limiting the knowledge on the subject. IMPLICATIONS: Further research is needed to examine the relationship between specific services, systems, and policies and mobility device users' mobility within their communities.

Assessment of breast cancer disability: agreement between expert assessment and patient reports.

OBJECTIVE: To estimate the extent of agreement between health professionals' (ClinRO) and patients' (PRO) ratings on disabilities associated with breast cancer (impairments, activity limitations and participation restrictions). DESIGN: Cross-sectional. METHODS: Health care professionals measured arm impairments, activity limitations and participation restrictions with the international classification of functioning (ICF) breast cancer core set. Participants filled five outcomes measures targeting health aspects of QOL that were previously mapped to the ICF. Agreement between ClinRO and PRO was estimated with quadratic Kappa. RESULTS: About 245 paired clinician and participant completed the outcomes measures. A total of 60 items mapped to 24 different ICF breast cancer core set codes, which provide 68 analyses for agreement. Impairment was better addressed with PROs (mostly poor and fair level of agreement); Activity limitations, both PROs and self-reported outcomes (SRO) (fair); participation restrictions, PROs (fair). CONCLUSION: Clinicians usually underestimate the symptoms and impairments of the patients, leading to a greater proportion of poor agreement. PRO's provide valuable information on impairments at the mental function level and pain. ClinRO's provide more valuable information on physically assessed impairments (oedema). Activity limitations and participation restrictions, excluding reporting the difficulty aspect of various life situations, can be either SRO or ObsRO. Implications for rehabilitation Impairments, activity limitation and participation restrictions are common sequelae of breast cancer treatment, which ultimately may affect the person's quality of life and should be investigated early on in the continuum of care. Clinicians should rely on the symptoms' reported by the patient regarding lymphedema and should identify the presence and severity of it. Patients inform best on the severity of pain, fatigue and mental distress experienced during and post-breast cancer treatment as clinicians tend to underestimate them. Clinicians and patients concur on presence and severity of activity limitations but not on difficulty, which can only be assessed from the patient's perspective.

[Participation restrictions in substance use disorders : Registration by screening and assessment instruments]. / Teilhabeeinschränkungen bei Suchterkrankungen : Erfassung durch Screening- und Assessment-Verfahren.

BACKGROUND: Substance use disorders can contribute to severe participation restrictions. Whether these participation restrictions are covered by assessment instruments that are frequently used in addiction treatment services is not known. The international Classification of Functioning, Disability and Health (ICF) provides a framework to compare the content of different assessments. OBJECTIVES: The aim of this study was to investigate whether assessments that are frequently used in German addiction treatment services, cover participation restrictions according to the ICF. MATERIALS AND METHODS: In the summer of 2015, we asked German addiction treatment services to participate in an online survey. Addiction treatment services were approached via the mailing lists of German associations of addiction treatment. Respondents were asked to indicate which assessments from a list of frequently used assessment instruments they were using in their treatment service. The most frequently used assessments were then linked to components of the ICF. RESULTS: A total of N = 177 addiction treatment services responded to the survey. Most of them offered long-term rehabilitation treatment (n = 97; 61 %) or counselling services (n = 44; 28 %). Twelve assessments were used by more than 10 % of the respondents. The analysis revealed a total of 491 so-called meaningful concepts that could be linked to components of the ICF. Of these, 95 (16 %) referred to the ICF component activity and participation. CONCLUSIONS: Frequently used assessments in addiction treatment services include contents of the ICF component activity and participation to a substantial degree. However, this does not mean by default that these assessments can be used to assess participation restriction in a meaningful way.

Life Balance and Stress in Adults With Medical Conditions or Obesity.

This cross-sectional research examined differences in life balance and perceived stress by body mass index (BMI) levels and self-reported medical conditions that limited physical activity. The sample consisted of 2,338 participants between the ages of 18 and 49 years who took the Life Balance Inventory, the Perceived Stress Scale, and provided demographic information including height and weight. Findings showed that individuals who were obese (BMI > 30.0) reported significantly lower life balance scores and higher stress scores than participants without obesity (p < .001). Also, individuals who had medical conditions that resulted in activity limitations reported significantly less life balance and more stress than individuals without medical conditions (p < .001). These findings highlight the importance of addressing activity participation as a means to promote health and wellness.

Impact evaluation and association with EuroQol 5D health-related utility values in Ménière's disease.

The study was aimed at evaluating the validity of impact measures among patients with Ménière's disease (MD) with outcome variables of EuroQol generic health-related quality of life (HRQoL) measures (i.e., EQ-5D) by using Visual Analogue Scale (VAS) and EQ-5D index values. 183 members (out of 200 contacted) of the Finish Ménière Association returned the questionnaires that they had filled out. Various open-ended and structured questionnaires focusing on diagnostic aspects of symptoms and impairment caused by the disease were used. For activity limitation and participation restriction, standardized questionnaires were used. Open-ended questions on impact of the disease were asked, and subsequently classified based on the WHO-ICF classification. The general HRQoL was evaluated with EQ-5D index value and EQ VAS instruments. Correlation and linear regression analyses were used to explore the association between HRQoL and other aspects. Based on the explanatory power of different models the disease specific semeionic model provides the most accurate prediction in EQ-5D index calculations (38 % of the variance explained). In EQ VAS scores, HRQoL is most accurately determined by participation restriction (53 % of the variance explained), but the worst prediction was in ICF-based limitations (8 % of the variance explained). Interestingly, attitude and personal trait explained the reduction of HRQoL somewhat better than ICF-based variables. Activity limitation and participation restrictions are significant components of MD, but are less frequently recognized as significant factors in self-evaluating the effect of MD on the quality of life. The current study results suggest that MD patients seem to have problem identifying factors causing activity limitation and participation restrictions and hence use the semiotic description focusing on complaints.