Chronic health conditions and their impact on the labor market. A cross-country comparison in Europe.

Objectives: To estimate the effect of having a chronic disease on the weekly working hours and the associated monetary losses. Design: Longitudinal data Survey of Health, Aging and Retirement (SHARE) in Europe. We analyzed 7 waves from 9 countries in Europe. A total of 80.672 observations. Setting: Participants who have their regular domicile in the respective SHARE country were interviewed face-to-face. Participants: Data from individuals aged between 50 and 65 years old in European countries were collected over seven years. A person was excluded from the survey if incarcerated, hospitalized or out of the country during the entire survey period, unable to speak the country's language(s) or moved to an unknown address. Interventions: Not applicable. Main outcome measurements: We applied a difference-in-differences with multiple time periods approach to estimate the effect of having a chronic condition on the number of working hours per week. We monetized the estimated productivity losses using the legal minimum wage in each country. Results: Persons with a chronic condition consistently reduced their weekly working hours compared to their healthy counterparts in the same country. This effect was more pronounced for men (6,78 hours per week or 352 hours per year) than women (3,97 hours per week or 206 hours per year). Persons with stroke, vascular, and lung disease showed the highest impact. On average, the reduced working hours represent about USD 12,80 billion annually in productivity losses in our sample. Conclusion: Having a chronic condition leads to people decreasing their working hours, which has significant economic losses. More severe health conditions showed the highest effects. This trend is observed in all the analyzed countries, highlighting the relevance of health and social systems to go beyond mortality and morbidity and the need to incorporate functioning in their target goals.

Rehabilitation delivery models to foster healthy ageing-a scoping review.

Introduction: Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. Methods: We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Results: Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Conclusions: Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.

Evidence-based recommendations for the rehabilitation and management of the ageing population with spinal cord injury: a systematic review of clinical practice guidelines.

INTRODUCTION: The intersection of ageing and spinal cord injury (SCI) is of global concern. Two scenarios have been described: 1) "SCI with ageing," an increase in the average age of SCI onset, and 2) "ageing with SCI," an increase in post-injury life expectancy. These scenarios entail complex health care and rehabilitation needs due to the accumulation of comorbidities, ageing-related and SCI-induced physiological changes, and post-SCI secondary health conditions. We systematically reviewed Clinical Practice Guidelines (CPGs) with the objective of identifying the extent to which SCI CPGs include recommendations for the rehabilitation and management of people who are "ageing with SCI" or who have acquired an "SCI with ageing". We termed these as "ageing-related recommendations". We also aimed to describe them and identify gaps. EVIDENCE ACQUISITION: We searched PubMed (NCBI), CINAHL Complete (EBSCOhost) and Embase (Elsevier) for relevant CPGs between 28 December 2022 and 5 January 2023. Included CPGs were evidence-based and had at least one ageing-related recommendation for SCI rehabilitation and management. We used the two core sets of the International Classification of Functioning, Disability and Health (ICF) to identify gaps. EVIDENCE SYNTHESIS: Only 16 (30%) of the 52 identified CPGs included ageing-related recommendations. Most were recent US or European publications and lacked specific chapters on ageing. These CPGs included 40 ageing-related recommendations, mostly "strong" but based on "low" to "very low" quality of evidence. The overall quality of the development process was low and did not consider the values and preferences of stakeholders and patients. Common topics included cardiovascular, bone, metabolic, bowel, bladder, and skin health. The recommendations could be linked to 30 ICF categories which represented only 18% of the ICF categories included in the comprehensive versions of two ICF Core Sets. Key gaps were found in mobility, interpersonal interactions, and relationships, neuromusculoskeletal and movement-related, mental, sensory and pain functions. CONCLUSIONS: There is a notable lack of high-quality ageing-related recommendations for SCI management and rehabilitation. Future research should prioritize the generation of high-quality evidence to develop age-sensitive CPGs. Future SCI CPGs need to address the complex challenges at the interface of ageing and SCI, considering patient and stakeholder preferences.

Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review.

INTRODUCTION: Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. AIMS: The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature. METHODOLOGY: A scoping review was conducted using the Arksey and O'Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010-2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. RESULTS: The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and response plans. CONCLUSION: Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of available evidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.

The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study.

BACKGROUND: Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. OBJECTIVE: The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. METHODS: Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. RESULTS: In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. CONCLUSIONS: Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.

Revisiting functioning recovery in persons with spinal cord injury undergoing first rehabilitation: Trajectory and network analysis of a Swiss cohort study.

Information about an individual's functioning and its longitudinal development is key to informing clinical rehabilitation. However, the description and understanding of the detailed longitudinal course of functioning, i.e., functioning trajectories, is rare in the current SCI literature. The aim of this study was to re-estimate previously identified functioning trajectories of individuals with spinal cord injury (SCI) undergoing initial rehabilitation in Switzerland using trajectory analysis, and to identify highly influential functioning domains that could become trajectory-specific targets for clinical interventions using network analysis. The study was based on data from the Swiss SCI Cohort Study and included individuals with SCI (N = 1099) who completed their rehabilitation in one of four collaborating centers between May 2013 and March 2022. For the trajectory analysis, functioning was operationalized using the total sum score of the Spinal Cord Independence Measure version III (SICM III), which was assessed at up to four time points (T1-T4) during rehabilitation. For the network analysis, individual SCIM III items were used to operationalize relevant functioning problems at T1 (admission) and T4 (discharge). The re-estimation of trajectory analysis confirmed the previously identified mean functioning trajectory classes of stable high functioning (N = 239; 21.75%), early (N = 33; 3.00%), moderate (N = 753; 68.52%), and slow (N = 74; 6.73%) functioning improvement. The network analysis revealed highly connected functioning problems at T1 for the moderate functioning improvement class, including "Feeding", "Dressing upper body", and "Dressing lower body", "Mobility in bed", and "Use of toilet". These functioning domains might indicate potential trajectory-specific targets for clinical interventions. This study has increased our knowledge about functioning trajectories of individuals with SCI undergoing initial rehabilitation in Switzerland and its findings may inform discussions about the application and use of functioning trajectories in clinical practice. Due to the exploratory nature of this study, further research is needed to confirm the findings presented.

Integrating rehabilitation into health systems: A comparative study of nine middle-income countries using WHO's Systematic Assessment of Rehabilitation Situation (STARS).

BACKGROUND AND OBJECTIVE: The need for rehabilitation is growing due to health and demographic trends, especially the rise of non-communicable diseases and the rapid ageing of the global population. However, the extent to which rehabilitation is integrated into health systems is mostly unclear. Our objective is to describe and compare the nature and extent of integration of rehabilitation within health systems across nine middle-income countries using available Systematic Assessment of Rehabilitation Situation (STARS) reports. METHODS: Cross-country comparative study with variable-oriented design using available rehabilitation health system assessment reports from nine middle income countries. FINDINGS: The integration of rehabilitation into health systems is limited across countries. Governance and financing for rehabilitation are mostly established within health ministries but weakly so, while health information systems are characterized by no available data or data that is insufficient or not routinely generated. The overall numbers of rehabilitation workforce per capita are low, with frequent reports of workforce challenges. In most countries the availability of longer-stay, high-intensity rehabilitation is extremely low, the availability of rehabilitation in tertiary hospitals is modest and in government supported primary care its almost non-existent. Multiple concerns about rehabilitation quality arose but the lack of empirical data hinders formal appraisal. CONCLUSION: The study sheds light on the limited integration of rehabilitation in health systems and common areas of difficulty and challenge across nine middle income countries. All countries were found to have a basis on which to strengthen rehabilitation and there were often multiple areas within each health system building block that required action in order to improve the situation. Findings can inform governments, regional and global agencies to support future efforts to strengthen rehabilitation. Additionally, our study demonstrates the value of STARS reports for health policy and systems research and can serve as a model for further comparative studies.

Rehabilitation in primary care for an ageing population: a secondary analysis from a scoping review of rehabilitation delivery models.

BACKGROUND: The world population is ageing rapidly. Rehabilitation is one of the most effective health strategies for improving the health and functioning of older persons. An understanding of the current provision of rehabilitation services in primary care (PC) is needed to optimise access to rehabilitation for an ageing population. The objectives of this scoping review are a) to describe how rehabilitation services are currently offered in PC to older persons, and b) to explore age-related differences in the type of rehabilitation services provided. METHODS: We conducted a secondary analysis of a scoping review examining rehabilitation models for older persons, with a focus on PC. Medline and Embase (2015-2022) were searched to identify studies published in English on rehabilitation services for people aged 50 + . Two authors independently screened records and extracted data using the World Health Organization (WHO)'s operational framework, the Primary Health Care Systems (PRIMASYS) approach and the WHO paper on rehabilitation in PC. Data synthesis included quantitative and qualitative analysis. RESULTS: We synthesised data from 96 studies, 88.6% conducted in high-income countries (HICs), with 31,956 participants and identified five models for delivering rehabilitation to older persons in PC: community, home, telerehabilitation, outpatient and eldercare. Nurses, physiotherapists, and occupational therapists were the most common providers, with task-shifting reported in 15.6% of studies. The most common interventions were assessment of functioning, rehabilitation coordination, therapeutic exercise, psychological interventions, and self-management education. Environmental adaptations and assistive technology were rarely reported. CONCLUSIONS: We described how rehabilitation services are currently provided in PC and explored age-related differences in the type of rehabilitation services received. PC can play a key role in assessing functioning and coordinating the rehabilitation process and is also well-placed to deliver rehabilitation interventions. By understanding models of rehabilitation service delivery in PC, stakeholders can work towards developing more comprehensive and accessible services that meet the diverse needs of an ageing population. Our findings, which highlight the role of rehabilitation in healthy ageing, are a valuable resource for informing policy, practice and future research in the context of the United Nations Decade of Healthy Ageing, the Rehab2030 initiative and the recently adopted WHA resolution on strengthening rehabilitation in health systems, but the conclusions can only be applied to HICs and more studies are needed that reflect the reality in low- and middle-income countries.

Relevance and use of health policy, health systems and health services research for strengthening rehabilitation in real-life settings: methodological considerations.

Research on health policy, systems, and services (HPSSR) has seen significant growth in recent decades and received increasing attention in the field of rehabilitation. This growth is driven by the imperative to effectively address real-life challenges in complex healthcare settings. A recent resolution on 'Strengthening rehabilitation in health systems' adopted by the World Health Assembly emphasizes the need to support societal health goals related to rehabilitation, particularly to promote high-quality rehabilitation research, including HPSSR. This conceptual paper, discussed with the participants in the 5th Cochrane Rehabilitation Methodological Meeting held in Milan on September 2023, outlines study designs at diverse levels at which HPSSR studies can be conducted: the macro, meso, and micro levels. It categorizes research questions into four types: those framed from the perspective of policies, healthcare delivery organizations or systems, defined patient or provider populations, and important data sources or research methods. Illustrative examples of appropriate methodologies are provided for each type of research question, demonstrating the potential of HPSSR in shaping policies, improving healthcare delivery, and addressing patient and provider perspectives. The paper concludes by discussing the applicability, usefulness, and implementation of HPSSR findings, and the importance of knowledge translation strategies, drawing insights from implementation science. The goal is to facilitate the integration of research findings into everyday clinical practice to bridge the gap between research and practice in rehabilitation.

Qualitative methodological approaches involving participants with intellectual disabilities: Scoping review of literature exploring death and dying.

BACKGROUND: A paucity of qualitative research on sensitive topics that focuses on participants with intellectual disabilities leaves their views unexplored. This scoping review mainly aimed to provide an overview of qualitative data collection methods used in research involving participants with intellectual disabilities to explore death and dying. METHOD: A scoping review of primary research and methodological papers published between January 2008 and March 2022 was conducted. The PRISMA-ScR checklist was followed. RESULTS: We identified 25 articles utilising four data collection methods: interviews, focus groups, the Nominal Group Technique, and participant observation. Data collection trends were identified, including accommodations for participants with intellectual disabilities, visual media used as a facilitator, and reporting of distress protocols. Most participants had mild to moderate intellectual disabilities. CONCLUSIONS: The included studies demonstrate a flexible approach that relies on the use of multiple methods. Future research must adequately report study characteristics to ensure transparency and reliability.

Improving Access to and Coverage of Rehabilitation Services through the Implementation of Rehabilitation in Primary Health Care: A Case Study from Chile.

The demand for rehabilitation services (RS) is increasing worldwide, particularly in low-and middle-income countries (LMICs), where up to 50% of people currently don't have access to the RS they need. This case report describes how Chile integrated rehabilitation into primary health care (PHC) to improve access, coverage, and equity. The report draws on the first-hand experiences of two Ministry of Health (MoH) officials involved in transitioning from specialized to PHC-centered rehabilitation. The cornerstone of Chile's strategy is the Comprehensive Rehabilitation in PHC Program (RehabPHC), launched in 2007. It has three main service delivery strategies: Community Rehabilitation Rooms (CRRs), Integrative Rehabilitation Rooms (IRRs) linked to Family Health Centers (CESFAM), and Rural Rehabilitation Teams (RRTs) that provide mobile rehabilitation in remote areas. RehabPHC revolutionized the delivery, organization, and financing of rehabilitation. Rehabilitation coverage increased from 12 CRRs in 2007 to 307 in 2022, available in 52.6% of CESFAMs. Key to this progress was strong leadership and financial commitment from the MoH to ensure a sustainable, PHC-centered national rehabilitation system. Essential to planning was collecting and continuously monitoring data on rehabilitation needs and RehabPHC service indicators, which promoted evidence-based resource allocation. A dedicated policy was also critical, defining development pathways and coordination mechanisms for rehabilitation financing, advocacy, data collection, and monitoring. Chile's experience underscores the importance of strong governance, financial commitment, and evidence-based planning in integrating rehabilitation into PHC. As such, it provides a valuable blueprint for countries facing similar challenges.

The Learning Rehabilitation System: Strengthening an intersectoral strategy to improve functioning of an ageing population.

Rehabilitation uses a person-centred approach that relies on dynamic case management and works across sectors, including social protection, labour, and education to improve individual functioning. Global population ageing means that more people will live with impairment in functioning. Responding to this growth in impairment will require countries to strengthen rehabilitation at all levels of their health systems as highlighted by the 2023 WHO Resolution on Rehabilitation. Efforts to strengthen rehabilitation can benefit from the concept of the Learning Health System, which implies a cyclical process of identifying issues, developing and implementing responses, monitoring the consequences of systems' change, and revising the response. However, we argue that it is not enough to simply adopt the notion of the Learning Health System for strengthening rehabilitation. We should rather think of a Learning Rehabilitation System. This is because rehabilitation is an intrinsically inter-sectoral strategy given its focus on people's functioning in their daily lives. Therefore, we believe that introducing the notion of the Learning Rehabilitation System is more than a terminological change; it is a fundamental programmatic shift that can contribute towards the goal of strengthening rehabilitation as an intersectoral strategy to improve functioning of an ageing population.

Translation and cross-cultural adaptation of the Model Disability Survey (MDS) for Brazil.

OBJECTIVE: This study has as objective the translation and cross-cultural adaptation of the Model Disability Survey (MDS), a World Health Organization instrument that provides comprehensive information on disability/functioning, for Brazil. METHODS: This is a cross-sectional methodological study, carried out through five stages - initial translation, synthesis of translations, reverse translation, review by a specialist committee, and pre-test -, considering properties such as semantic, idiomatic, experimental, and conceptual equivalence. Translators, researchers, a mediating team, health professionals, a methodologist and a language specialist were needed to pass through the stages. Statistical analysis was produced from absolute and relative frequencies, measures of central tendency and dispersion, normality tests and content validity index (CVI) > 0.80. RESULTS: The MDS has 474 items, which generated 1,896 analyzes of equivalence. Of these, 160 items had a CVI < 0.80 in at least one of the four types of equivalence and required adjustments. After adaptations and approval by the judges, the pre-final version went on to the pre-test with 30 participants from four regions of the Brazilian Northeast. Regarding this sample, 83.3% are women, single, with an average age of 33.7 years (SD 18.8), self-declared as black or brown, active workers, with technical education and living with three residents. Interviews lasted 123 minutes on average, where 127 health conditions were mentioned, and the most frequent cited were anxiety and back pain. Answers were analyzed and 63 items were cited as needing some adjustment, two of which were submitted for analysis by the committee because they presented a CVI < 0.80. The instrument, guide and presentation cards were adjusted after a new pre-test. CONCLUSIONS: The MDS was translated and cross-culturally adapted to Brazilian Portuguese and showed adequate content validity.

Mobile Health Self-management Support for Spinal Cord Injury: Systematic Literature Review.

BACKGROUND: Self-management plays a critical role in maintaining and improving the health of persons with spinal cord injury (SCI). Despite their potential, existing mobile health (mHealth) self-management support (SMS) tools for SCI have not been comprehensively described in terms of their characteristics and approaches. It is important to have an overview of these tools to know how best to select, further develop, and improve them. OBJECTIVE: The objective of this systematic literature review was to identify mHealth SMS tools for SCI and summarize their characteristics and approaches to offering SMS. METHODS: A systematic review of the literature published between January 2010 and March 2022 was conducted across 8 bibliographic databases. The data synthesis was guided by the self-management task taxonomy by Corbin and Strauss, the self-management skill taxonomy by Lorig and Holman, and the Practical Reviews in Self-Management Support taxonomy. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards guided the reporting. RESULTS: A total of 24 publications reporting on 19 mHealth SMS tools for SCI were included. These tools were introduced from 2015 onward and used various mHealth technologies and multimedia formats to provide SMS using 9 methods identified by the Practical Reviews in Self-Management Support taxonomy (eg, social support and lifestyle advice and support). The identified tools focused on common SCI self-management areas (eg, bowel, bladder, and pain management) and overlooked areas such as sexual dysfunction problems and environmental problems, including barriers in the built environment. Most tools (12/19, 63%) unexpectedly supported a single self-management task instead of all 3 tasks (ie, medical, role, and emotional management), and emotional management tasks had very little support. All self-management skills (eg, problem-solving, decision-making, and action planning) had coverage, but a single tool addressed resource use. The identified mHealth SMS tools were similar in terms of number, introduction period, geographical distribution, and technical sophistication compared with SMS tools for other chronic conditions. CONCLUSIONS: This systematic literature review provides one of the first descriptions of mHealth SMS tools for SCI in terms of their characteristics and approaches to offering SMS. This study's findings highlight a need for increased coverage of key SMS for SCI components; adopting comparable usability, user experience, and accessibility evaluation methods; and related research to provide more detailed reporting. Future research should consider other data sources such as app stores and technology-centric bibliographic databases to complement this compilation by identifying other possibly overlooked mHealth SMS tools. A consideration of this study's findings is expected to support the selection, development, and improvement of mHealth SMS tools for SCI.

Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey.

BACKGROUND: As the European population with Spinal Cord Injury (SCI) is expected to become older, a better understanding of ageing with SCI using functioning, the health indicator used to model healthy ageing trajectories, is needed. We aimed to describe patterns of functioning in SCI by chronological age, age at injury and time since injury across eleven European countries using a common functioning metric, and to identify country-specific environmental determinants of functioning. METHODS: Data from 6'635 participants of the International Spinal Cord Injury Community Survey was used. The hierarchical version of Generalized Partial Credit Model, casted in a Bayesian framework, was used to create a common functioning metric and overall scores. For each country, linear regression was used to investigate associations between functioning, chronological age, age at SCI or time since injury for persons with para- and tetraplegia. Multiple linear regression and the proportional marginal variance decomposition technique were used to identify environmental determinants. RESULTS: In countries with representative samples older chronological age was consistently associated with a decline in functioning for paraplegia but not for tetraplegia. Age at injury and functioning level were associated, but patterns differed across countries. An association between time since injury and functioning was not observed in most countries, neither for paraplegia nor for tetraplegia. Problems with the accessibility of homes of friends and relatives, access to public places and long-distance transportation were consistently key determinants of functioning. CONCLUSIONS: Functioning is a key health indicator and the fundament of ageing research. Enhancing methods traditionally used to develop metrics with Bayesian approach, we were able to create a common metric of functioning with cardinal properties and to estimate overall scores comparable across countries. Focusing on functioning, our study complements epidemiological evidence on SCI-specific mortality and morbidity in Europe and identify initial targets for evidence-informed policy-making.

Development of an instrument for measuring the work functioning of persons with epilepsy in clinical settings.

OBJECTIVE: To describe the development process of the Work Functioning Assessment for Epilepsy (WOFAE), an instrument recently developed in Brazil for measuring the work functioning of persons with epilepsy (PwE) in clinical settings, and to evaluate to what extent this instrument is in line with existing generic and epilepsy-specific tools used to measure general and work functioning. METHODS: The development process included four phases: the content development, based on a literature review and using the International Classification of Functioning, Disability and Health (ICF) as a reference framework; a preliminary field test, conducted with 20 PwE; an expert consultation, applying the Delphi Method; and the mapping and content comparison of the WOFAE to other five functioning assessments, using the ICF linking rules. RESULTS: The WOFAE containing 46 items structured into eight domains was developed in an evidence-based and participatory process. It is broader in terms of body functions and environmental factors than the other functioning assessments. CONCLUSION: It is a useful tool to guide multidisciplinary interventions, measure clinical progress and assess disability for the granting of social benefits and retirement pensions of PwE. The future phases consist of revision and psychometric analyses of the instrument to ensure its validity and reliability.

Translation and cross-cultural adaptation of the Model Disability Survey (MDS) for Brazil / Tradução e adaptação transcultural do Model Disability Survey (MDS) para o Brasil

ABSTRACT OBJECTIVE This study has as objective the translation and cross-cultural adaptation of the Model Disability Survey (MDS), a World Health Organization instrument that provides comprehensive information on disability/functioning, for Brazil. METHODS This is a cross-sectional methodological study, carried out through five stages - initial translation, synthesis of translations, reverse translation, review by a specialist committee, and pre-test -, considering properties such as semantic, idiomatic, experimental, and conceptual equivalence. Translators, researchers, a mediating team, health professionals, a methodologist and a language specialist were needed to pass through the stages. Statistical analysis was produced from absolute and relative frequencies, measures of central tendency and dispersion, normality tests and content validity index (CVI) > 0.80. RESULTS The MDS has 474 items, which generated 1,896 analyzes of equivalence. Of these, 160 items had a CVI < 0.80 in at least one of the four types of equivalence and required adjustments. After adaptations and approval by the judges, the pre-final version went on to the pre-test with 30 participants from four regions of the Brazilian Northeast. Regarding this sample, 83.3% are women, single, with an average age of 33.7 years (SD 18.8), self-declared as black or brown, active workers, with technical education and living with three residents. Interviews lasted 123 minutes on average, where 127 health conditions were mentioned, and the most frequent cited were anxiety and back pain. Answers were analyzed and 63 items were cited as needing some adjustment, two of which were submitted for analysis by the committee because they presented a CVI < 0.80. The instrument, guide and presentation cards were adjusted after a new pre-test. CONCLUSIONS The MDS was translated and cross-culturally adapted to Brazilian Portuguese and showed adequate content validity.

RESUMO OBJETIVO Traduzir e adaptar transculturalmente o Model Disability Survey (MDS), instrumento da Organização Mundial da Saúde que fornece informações abrangentes a respeito de deficiência/funcionalidade, para o Brasil. MÉTODOS Trata-se de um estudo metodológico de corte transversal, realizado por meio de cinco etapas - tradução inicial, síntese das traduções, retrotradução, revisão por comitê de especialistas e pré-teste -, considerando propriedades como equivalência semântica, idiomática, experimental e conceitual. Para realização das etapas foram necessários tradutores, pesquisadores, equipe mediadora, profissionais da saúde, metodologista e especialista em idiomas. A análise estatística foi produzida a partir de frequências absolutas e relativas, medidas de tendência central e dispersão, testes de normalidade e índice de validade de conteúdo (IVC) > 0,80. RESULTADOS O instrumento MDS apresenta 474 itens, o que gerou 1.896 análises de equivalências. Destes, 160 itens apresentaram IVC < 0,80 em pelo menos uma das quatro equivalências e necessitaram de ajustes. Após adequações e aprovação dos juízes, a versão pré-final seguiu para o pré-teste com 30 participantes, de quatro regiões do Nordeste brasileiro. Desta amostra, 83,3% são mulheres, solteiras, com idade média de 33,7 (DP 18,8) anos, autodeclaradas pretas ou pardas, trabalhadoras ativas, com escolaridade a partir do ensino técnico e que residiam com três moradores. O tempo médio das entrevistas foi de 123 minutos de duração. Foram mencionadas 127 condições de saúde, sendo as mais frequentes ansiedade e dores nas costas. As respostas foram analisadas e 63 itens foram citados como necessitando de algum ajuste, sendo dois destes encaminhados para análise pelo comitê por possuírem IVC < 0,80. O instrumento, manual e cartões de apresentação foram ajustados após um novo pré-teste. CONCLUSÕES O MDS foi traduzido e adaptado transculturalmente para o português brasileiro e apresentou adequada validade de conteúdo.

WHO Functioning and Disability Disaggregation (FDD11) tool: a reliable approach for disaggregating data by disability.

BACKGROUND: There is a global scarcity of good quality disability data, which has contributed to a lack of political will to address the challenges that persons with disabilities face. The current paper proposes a way forward to overcome this gap by demonstrating the psychometric properties of the World Health Organization Functioning and Disability Disaggregation Tool (FDD11) - a brief disability disaggregation instrument that countries can use. RESULTS: The study demonstrated that FDD11 is a valid and reliable tool. Unidimensionality of the scale produced by each calibration was supported by the factor analysis performed. The analysis indicated good fit of the items, and targeting of the items was deemed to be sufficient. The person separation index was 0.82, indicating good reliability of the final scale. CONCLUSION: FDD11 provides a good opportunity to researchers and governments to capture good quality disability data and to disaggregate existing data by disability. The tool can facilitate low- and middle-income countries in their efforts to develop evidenced-based policies to address any barriers faced by persons with disabilities, to monitor the implementation of the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals, and to take stock of the challenges that still remain.