The Use of Self-Reported Functional Limitation to Examine Pregnancy and Reproductive Health Experiences in a National Sample of Women.

Context: A lack of consensus in the literature examining reproductive health experiences of women with disability prevails, in part, due to various operational definitions of disability. Methods: Results from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) were utilized to assess reproductive health, disability, and demographic variables among women aged 20-44. Disability was assessed using the six functional limitation subgroups. Analyses included modified Poisson regression and negative binomial regression. Results: One hundred eighty-two (14%) women reported having any functional limitation. Women with at least one functional limitation (WWFL) were significantly more likely than women without a functional limitation (WWOFL) to have had a hysterectomy and had more cesarean deliveries. WWFL did not differ significantly from WWOFL in key pregnancy outcomes (ever been pregnant, number of pregnancies, or number of unsuccessful pregnancies). A high degree of overlap between mobility and self-care (66.1%), cognitive and independent living (61%), and mobility and independent living (37.4%) limitations was found. Conclusions: This work summarizes key reproductive health variables among US women of reproductive age and contextualizes disability experiences through subgroup and overlap analysis. Subgroup analysis results demonstrate the need for detailed operational definitions of disability to accurately capture experiences of women with different limitations, and overlap analysis indicates the interconnectedness of limitations among this group. Findings call for future exploration of reproductive health-related similarities and differences between WWD and women without disability, and employment of detailed operational definitions of disability.

Quality appraisal of systematic reviews of interventions for children with cerebral palsy reveals critically low confidence.

AIM: To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions. METHOD: A comprehensive search of 22 databases identified eligible systematic reviews with and without meta-analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) to appraise methodological quality. RESULTS: Eighty-three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR-2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR-2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. INTERPRETATION: Most of these systematic reviews are considered unreliable according to AMSTAR-2. Current recommendations for treating children with CP based on these flawed systematic reviews need re-evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high-level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper adds Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non-randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta-analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.

A systematic scoping study exploring opioid use across a variety of disability conditions.

BACKGROUND: Opioid use experiences among people with disability (PWD) as a group has not been clearly articulated in the current literature, despite links between pain and measures of disability. OBJECTIVE: To conduct a systematic search and scoping study examining the characteristics of current literature focused on opioid use among PWD. METHODS: Four databases were queried (i.e., Medline, PsycINFO, Embase, and CINAHL) for peer-reviewed, empirical, English-language, journal articles focused on long-term opioid use among PWD. Collected data points included: disability details (specific condition, onset of disability), opioid details (category of opioid use, and specified substance), study details, and design. RESULTS: A total of 196 articles were included, with 83.7% published since 2000 largely from the US. The majority of articles (70.4%) focused on the use of opioids as medical treatment, with fewer articles focusing on recreational opioid use or substance use disorders. The majority of included sources (73%) focused on opioid use in acquired conditions; neuropathic pain (21.9%) and attention deficit hyperactivity disorder (20.4%) were the most commonly studied. Differences were observed in the distribution of disability conditions across category of opioid use and study design classification; 73.5% were considered observational in design. CONCLUSIONS: The varied representation of disability conditions, and differences across opioid use category and study design classification point to a complicated relationship between opioid use and disability. The present research portfolio would benefit from research matching informational needs of a specific disability area or opioid use category to provide the evidence necessary to advance current knowledge and promote inclusion in national agendas.

Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis.

BACKGROUND: Despite possibly higher risk of severe outcomes from COVID-19 among people with intellectual and developmental disabilities (IDD), there has been limited reporting of COVID-19 trends for this population. OBJECTIVE: To compare COVID-19 trends among people with and without IDD, overall and stratified by age. METHODS: Data from the TriNetX COVID-19 Research Network platform was used to identify COVID-19 patients. Analysis focused on trends in comorbidities, number of cases, number of deaths, and case-fatality rate among patients with and without IDD who had a positive diagnosis for COVID-19 through May 14, 2020. RESULTS: People with IDD had higher prevalence of specific comorbidities associated with poorer COVID-19 outcomes. Distinct age-related differences in COVID-19 trends were present among those with IDD, with a higher concentration of COVID-19 cases at younger ages. In addition, while the overall case-fatality rate was similar for those with IDD (5.1%) and without IDD (5.4%), these rates differed by age: ages ≤17 - IDD 1.6%, without IDD <0.01%; ages 18-74 - IDD 4.5%, without IDD 2.7%; ages ≥75- IDD 21.1%, without IDD, 20.7%. CONCLUSIONS: Though of concern for all individuals, COVID-19 appears to present a greater risk to people with IDD, especially at younger ages. Future research should seek to document COVID-19 trends among people with IDD, with particular attention to age related trends.

A systematic search and technical review of online information pertaining to medical care for people with disability.

BACKGROUND: Little is known about the availability and technical quality of online information related to the medical care of people with disability, despite the potential of this information to alter clinical interactions and treatment decisions. OBJECTIVES: This review examines the utility of internet search engines for finding information related to medical care for people with disability, identifies common sources of this online information, and assesses the presence of technical attributes which allow for its critical evaluation. METHODS: Exhaustive systematic searches were conducted on two popular search engines (Google and Yahoo) using six search phrases. Resources were coded to categorize presenting organization, format, and technical quality. RESULTS: Only 8.9% of results included information related to medical care for people with disability. Analyzed resources were most often from non-profit organizations (31.7%) in website format (60.2%). The composite technical quality score for all included resources had a median and mode of three on a scale of six. CONCLUSIONS: Online information related to medical care for people with disability is not only difficult to locate, but has generally low technical quality. These findings have implications for health information professionals, patients, care providers, and information developers.

Developing a systematic search strategy related to people with disability: A brief report testing the utility of proposed disability search terms in a search about opioid use.

BACKGROUND: The varied use of the term "disability" in the scientific literature makes it challenging to conduct systematic reviews of health issues among people with disability. Utilizing general disability search terms has been suggested as an efficient way to ensure a broad capture of the literature related to disability. OBJECTIVES: This study evaluates the utility of general disability terms versus condition-specific terms, in the context of systematically searching for articles related to disability and other conditions or issues, in this case, opioid use. METHODS: Systematic searches were conducted using three databases. An initial search of articles mentioning opioids and disability was conducted employing the general search terms recommended by Walsh et al.1 The results were then compared to 16 condition-specific searches. The proportion of unique articles from each condition-specific search that overlapped with the general search was assessed. RESULTS: There was very little overlap between the articles captured using condition-specific search terms and the articles captured utilizing the general search terms. The highest amount of overlap was for spinal muscular atrophy at 33.3%, with the overall median proportion of overlap being 13.4% (mean = 15.7%; SD = 11.7%). CONCLUSIONS: With a systematic search for articles about disability associated with opioid use as an example, condition-specific search terms capture a large proportion of articles not identified using general disability search terms. Disability researchers should be aware of pitfalls using general terminology and the importance of using disability-specific search terms.