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Employment rates amongst disabled people reveal one of the most significant inequalities in the UK today: less than half (48%) of disabled people are in employment compared to 80% of the non-disabled population. Despite a record-breaking labour market, 4.6 million disabled people and people with long-term health conditions are out of work leaving individuals, and some large parts of communities, disconnected from the benefits that work brings. People who are unemployed have higher rates of mortality and a lower quality of life. This green paper sets out the nature of the problem and why change is needed by employers, the welfare system, health and care providers, and all of us. Proposed solutions are set out  and views requested. (Consultation now closed)

04101608 10/16 

The aim of this study was to estimate the prevalence of disability and compare the well-being and access to the community between people with and without disabilities. A population-based survey was undertaken in District 2 of Quezon City and in Ligao City. 60 clusters of 50 people aged 18 years and older were selected with probability proportion to size sampling from both locations. The Rapid Assessment of Disability (RAD) survey was used to identify people with disabilities based on their responses to activity limitations. The levels of well-being and access to the community for people with disabilities were compared with controls matched by age, gender, and cluster. Information on barriers to accessing the community was also collected.

Popul Health Metrics 14, 26 (2016)

DOI 10.1186/s12963-016-0096-y

This Campbell Collaboration systematic review assesses the effectiveness and cost-effectiveness of community-based rehabilitation (CBR) for people with physical and mental disabilities in low- and middle-income countries, and/or their family, their carers, and their community. This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical (stroke, arthritis, chronic obstructive pulmonary disease) and mental disabilities (schizophrenia, dementia, intellectual impairment). The authors conclude that the evidence on the effectiveness of CBR for people with disabilities in low- and middle-income countries suggests that CBR may be effective in improving the clinical outcomes and enhancing functioning and quality of life of the person with disabilities and his/her carer and recommend future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations

Campbell Systematic Reviews 2015:15

Cerebral palsy is the most prevalent health condition linked to childhood disability in Bangladesh, yet support and rehabilitation for this group is limited. Understanding the impact of cerebral palsy at family level is important forthe development of appropriate interventions.

Purpose: This study aims to explore the impact on the lives of caregivers of children with cerebral palsy.

Methods: The study used mixed methods. The PedsQLTMFamily Impact Questionnaire Module was administered to the main caregivers in 135 families with a child with cerebral palsy and 150 families that did not have a child with a disability, from the same villages. In-depth interviews and observations were undertaken with 10 families, and 2 focus group discussions were conducted with representatives from 14 parent/caregiver groups. The project was conducted from April 2011- April 2013. Data collection was from September 2011- Dec 2012.

Results: The mean overall and sub-scale PedsQLTM scores were significantly poorer (p<0.001) for caregivers of a child with cerebral palsy compared to scores from families that did not have a child with disability. Caregivers reported high levels of stress, anxiety, isolation, stigma, physical tiredness, and lack of time to complete everyday tasks. Knowledge and understanding about cerebral palsy was generally low.

Conclusion: This study demonstrates the particular vulnerability of families of children with disabilities in resource-limited settings. It reveals the extent of the impact on the caregivers. Interventions therefore need to be holistic, addressing the well-being and empowerment of caregivers as well as children.

Purpose: The attitudes of support staff towards people with intellectual disability can greatly impact upon an individual’s quality of life and level of social inclusion. However, there are few studies that examine how perceptions and beliefs have changed within one organisation over the past few decades; a period during which there have been major social and government policy changes including deinstitutionalisation, inclusive education and the introduction of the United Nations Convention on the Rights of Persons with Disabilities. In conjunction with a 25th anniversary review of a community-living project in rural Australia, the current research replicated a study from 1987 that examined attitudes of staff with respect to people with intellectual disability, and thematically compared the findings of the two questionnaires.

Method: In 1987, a purpose-designed questionnaire was developed and completed by 15 direct care staff. This 10-item tool asked for basic demographic information and for the participants’ perceptions of people with intellectual disability and their own work roles in the disability sector. This tool was replicated in 2013 and was again completed by 15 direct care staff from the same organisation.

Results: The thematic analysis indicated a number of differences between the 1987 and 2013 cohorts in regard to their attitudes. The wide acceptance of the rights of people with intellectual disability was one key change. There was an age separation found within the 2013 cohort, with older participants (> 50 years of age) more likely to display similar attitudes to the 1987 group than the younger participants (<30 years old). Dealing with the problem of ageing-related issues, something that was not obvious 25 years ago, was now considered of major importance. There was evidence that disability support was increasingly recognised as a valid career choice, with a substantial difference in motivation found between the two age groups. Across both cohorts, direct exposure to the realities of the job was seen to be the best training for new employees.

Conclusions: The past 25 years have seen positive developments in both social acceptance and expectations for people with disabilities. Individuals are now viewed in a realistic but more positive light. As an exemplar of this change, concerns about individuals entering a consenting sexual relationship have changed dramatically, and what was once an issue of major concern is now no longer raised. While the training provided to staff has changed significantly over the past 25 years, on-the-job exposure to people with intellectual disability, combined with support from peers, is still perceived as vital for developing a quality support network.

Purpose: To assess the effects of Motor Imagery programme on upper extremity functional task performance and quality of life among stroke survivors.

Method: Thirty people who were diagnosed with stroke, were selected from the Department of Occupational Therapy, SVNIRTAR, Odisha, India, and consecutively assigned to control (n=15) and experimental (n=15) groups. The control group received conventional occupational therapy only, and the experimental group received conventional occupational therapy combined with Motor Imagery programme. Upper Extremity Motor Activity Log (UE-MAL) and Stroke Specific Quality Of Life Questionnaire (SSQOL) were used for assessment, before and after the intervention.

Results: The experimental group showed significant improvement compared to the control group (P<.004 & P<.001). The implication is that there is a good relationship between upper extremity functional task performance and quality of life (r= 0.928).

Conclusions: The Motor Imagery programme is a simple and very cost-effective treatment used in Occupational Therapy practice. It can be easily taught and learnt. The study concludes that Motor Imagery programme is effective in improving upper extremity functional task performance and quality of life among stroke survivors.

In this paper, the researchers develop a needs-based home-based rehabilitation programme for people living with HIV in order to improve their quality of life and functional ability. The study aims to  provide rehabilitation professionals and researchers with evidence that can be utilised to improve existing rehabilitation interventions for people living with HIV.

The paper outlines a randomised control trial to test the programme, to be conducted at a public hospital in KwaZulu-Natal, South Africa. The trial will assess the participants’ quality of life, perceived level of disability, functional ability and endurance

Trials 16:491

Background: The majority of individuals report a decline in health-related quality of life following a stroke. Quality of life and factors predicting quality of life could differ in individuals from lower income countries. The aim of this study was therefore to determine the quality of life and factors influencing quality of life of community-dwelling stroke patients living in low-income, peri-urban areas in the Western Cape, South Africa.

Method: An observational, longitudinal study was used to collect data from a conveniently selected sample of first-ever stroke patients. The Rivermead Motor Assessment Scale and the Barthel Index were used to determine functional outcome and the EQ-5D was used to collect information relating to quality of life at two months and six months poststroke. Descriptive and inferential statistics were used to analyse the data.

Results: The total sample of 100 participants consisted of 50% men and 50% women with a mean age of 61 and a standard deviation of 10.55 years. Six-month quality of life datawas analysed for 73 of the 100 participants. Of the 27 who were lost to follow-up, nine participants died, four withdrew from the study after baseline data was collected and eleven could not be followed up as they had either moved or no follow-up telephone numbers were available. A further three participants were excluded from the analysis of the EQ-5D as they were aphasic. Of these, approximately 35% had problems with mobility and self-care, whilst 42% had severe problems with everyday activities and 37.8% expressed having anxiety and depression. Quality of life at two months (p = 0.010) and urinary incontinence (p = 0.002) were significant predictors of quality of life at six months.

Conclusion: Health-related quality of life was decreased in the South African stroke sample. Functional ability and urinary incontinence were the factors affecting quality of life in the sample. These factors should be considered in the rehabilitation of stroke patients in these settings.

Habilitation and rehabilitation call for a paradigm shift from the traditional intervention programmes which focus on physical functioning to programmes that include aspects of physical, psychological and social wellbeing.

Purpose: To develop a quality of life instrument, using focus group discussions to assess the outcomes of interventions for school-going children with hearing loss.

Methods: Separate focus group discussions were held with children with hearing loss between 8 and 18 years of age, special educators and mothers. Focus group discussions were conducted separately for boys and girls. Each focus group had 8–10 participants. In-depth interviews were conducted with the heads of institutions and rehabilitation professionals. Fathers had to complete self-administered questionnaires. The focus group discussions were guided by topics and probes drawn from literature reviews, and were audio recorded, transcribed and analysed.

Results: Around 421 problem statements were classified under 7 themes: Educational implications; Social integration; Psycho-social wellbeing; Family relationships; Speech, language and communication; Leisure and recreation; and General functioning. Education and career aspirations were considered to be most important. The problem statements revealed that the primary focus of training was on improving academics. Integration and feeling comfortable with social situations were cited as limitations; as also, the preference for friendship with people of similar abilities. For the majority of children, leisure and recreation was limited to watching television. Parents and siblings were considered vital to their progress and achievements.

Conclusions: Multidimensional and varied perspectives of different stakeholders, especially family members, are necessary for a comprehensive analysis of the impact of hearing loss on the quality of life of school-going children.