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Riobóo-Lois B, Frieiro P, González-Rodríguez R, Verde-Diego C. Personal assistance, independent living, and people with disabilities: An international systematic review (2013-2023). Disabil Health J 2024; 17:101630. [PMID: 38679543 DOI: 10.1016/j.dhjo.2024.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/03/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The article discusses the contribution of personal assistance for the independent living of people with disabilities. This right is evolving at different speeds internationally, presents controversial aspects, and is under continuous debate. OBJECTIVE To synthesize the evidence relating to the promotion of self-determination and independent living through personal assistance. METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search for relevant literature published was conducted during March 2023 across nine databases. The findings of the included studies were coded and analyzed via inductive content analysis. RESULTS 26 articles were included, mostly qualitative, from four different continents. The analysis revealed six different key themes. The social framework highlighted the influence of international agreements and disability activism on cultural shifts in understanding disability. Secondly, healthy relationships and life or service expectations were emphasized. Key agents included users, personal assistants, family members, service providers, and other professionals. Personal assistants' work context explored ethical dilemmas, training, and working rights. Decision-making about personal assistance involved factors like lack of information, access requirements, and funding. Lastly, the implications underscored the positive impact of personal assistance on independent living, while identifying threats, and best practices for improvement. CONCLUSION This systematic review was the first to explore the promotion of independent living of people with disabilities through personal assistance schemes and highlights the need for governments to prioritize and coordinate efforts to ensure access for all, emphasizing the ethical imperative to progress toward social justice.
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Affiliation(s)
- Breogán Riobóo-Lois
- Universidade de Vigo, Grupo de Estudos en Traballo Social: Investigación e Transferencia (GETS-IT), Facultade de Educación e Traballo Social (2-2-3), Rúa do Doutor Temes s/n, Campus das Lagoas, 32004, Ourense, Spain; Social Work Studies Group: Research and Transfer (GETS-IT), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro - Bloque Técnico - Planta 2, Estrada Clara Campoamor nº 341, 36312, Vigo, Spain.
| | - Paula Frieiro
- Social Work Studies Group: Research and Transfer (GETS-IT), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro - Bloque Técnico - Planta 2, Estrada Clara Campoamor nº 341, 36312, Vigo, Spain; Universidade de Santiago de Compostela, University School of Social Work, Praza da Inmaculada, 5, 15704, Santiago de Compostela, Spain.
| | - Rubén González-Rodríguez
- Universidade de Vigo, Grupo de Estudos en Traballo Social: Investigación e Transferencia (GETS-IT), Facultade de Educación e Traballo Social (2-2-3), Rúa do Doutor Temes s/n, Campus das Lagoas, 32004, Ourense, Spain; Social Work Studies Group: Research and Transfer (GETS-IT), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro - Bloque Técnico - Planta 2, Estrada Clara Campoamor nº 341, 36312, Vigo, Spain.
| | - Carmen Verde-Diego
- Universidade de Vigo, Grupo de Estudos en Traballo Social: Investigación e Transferencia (GETS-IT), Facultade de Educación e Traballo Social (2-2-3), Rúa do Doutor Temes s/n, Campus das Lagoas, 32004, Ourense, Spain; Social Work Studies Group: Research and Transfer (GETS-IT), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro - Bloque Técnico - Planta 2, Estrada Clara Campoamor nº 341, 36312, Vigo, Spain.
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von Granitz H, Sonnander K, Winblad U. Tracing the refinement of policy tools for disability rights: a content analysis of how the granting process of state-funded personal assistance in Sweden is aligned with the LSS Act. Disabil Rehabil 2024:1-10. [PMID: 38950573 DOI: 10.1080/09638288.2024.2362954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/29/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE According to the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (The LSS Act), personal assistance (PA) aims to enhance good living conditions for people with disability. The Act is operationalised by a policy tool, an instruction developed and refined by the Swedish Social Insurance Agency (SSIA) to grant PA. The study explores how this instruction is aligned with the LSS rationale and goals. MATERIAL AND METHOD Qualitative content analysis was applied on the material i.e., a government bill preceding the LSS Act and the policy tool, i.e., the SSIA instruction, versions 1994 and 2019. RESULTS The result shows that the instruction has deviated from the LSS Act over time, by decreasing users' access to community life, a shift towards health care activities, lack of support for the PA user, increased control and service-granting criteria. CONCLUSION This paper emphasises that the selection of policy tools goes beyond mere pragmatism, as they are subject to refinement procedures that have significant impacts over time. The deviations observed in fulfilling the objectives of the LSS Act highlights the importance of ongoing adjustments to policy tools to align with the original policy goals in order to promote disability rights.
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Affiliation(s)
- Heléne von Granitz
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Karin Sonnander
- Disability and Habilitation, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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Grue J. The double bind of social legitimacy: On disability, the sick role, and invisible work. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:78-94. [PMID: 37394774 DOI: 10.1111/1467-9566.13692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
During the last few decades, the human rights paradigm has shifted the normative status of disabled people, providing, in principle, the right to full and equal participation. Particularly in neoliberal economies, however, participation in work life is a major constraint on social legitimacy, creating a predicament for people who cannot adhere to the ideal of the 'productive member of society'. In this article, I explore this predicament at the intersection of disability studies and the sociology of health and illness, reviewing literature and discussing key concepts. I argue that in neoliberal societies, two distinct and largely incompatible pathways to social legitimacy depend, respectively, on (a) a version of the classical sick role and (b) a more recently constituted able-disabled role. Of these, the first pathway has mainly been explored and critiqued in the sociology of health and illness, while the second features mainly in disability studies. However, both pathways can be understood (1) as ableist mechanisms for maintaining adherence to values of productivity and by (2) imposing on disabled people an unequal burden of invisible work-a key feature of ableism, driving inequality both within the group of disabled people and for the group as a whole.
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Affiliation(s)
- Jan Grue
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway
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García-Rudolph A, Saurí J, Cegarra B, Opisso E, Tormos JM, Frey D, Madai VI, Bernabeu M. The impact of COVID-19 on home, social, and productivity integration of people with chronic traumatic brain injury or stroke living in the community. Medicine (Baltimore) 2022; 101:e28695. [PMID: 35212272 PMCID: PMC8878630 DOI: 10.1097/md.0000000000028695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022] Open
Abstract
Compare community integration of people with stroke or traumatic brain injury (TBI) living in the community before and during the coronavirus severe acute respiratory syndrome coronavirus 2 disease (COVID-19) when stratifying by injury: participants with stroke (G1) and with TBI (G2); by functional independence in activities of daily living: independent (G3) and dependent (G4); by age: participants younger than 54 (G5) and older than 54 (G6); and by gender: female (G7) and male (G8) participants.Prospective observational cohort studyIn-person follow-up visits (before COVID-19 outbreak) to a rehabilitation hospital in Spain and on-line during COVID-19.Community dwelling adults (≥18 years) with chronic stroke or TBI.Community integration questionnaire (CIQ) the total-CIQ as well as the subscale domains (ie, home-CIQ, social-CIQ, productivity CIQ) were compared before and during COVID-19 using the Wilcoxon ranked test or paired t test when appropriate reporting Cohen effect sizes (d). The functional independence measure was used to assess functional independence in activities of daily living.Two hundred four participants, 51.4% with stroke and 48.6% with TBI assessed on-line between June 2020 and April 2021 were compared to their own in-person assessments performed before COVID-19.When analyzing total-CIQ, G1 (d = -0.231), G2 (d = -0.240), G3 (d = -0.285), G5 (d = -0.276), G6 (d = -0.199), G7 (d = -0.245), and G8 (d = -0.210) significantly decreased their scores during COVID-19, meanwhile G4 was the only group with no significant differences before and during COVID-19.In productivity-CIQ, G1 (d = -0.197), G4 (d = -0.215), G6 (d = -0.300), and G8 (d = -0.210) significantly increased their scores, meanwhile no significant differences were observed in G2, G3, G5, and G7.In social-CIQ, all groups significantly decreased their scores: G1 (d = -0.348), G2 (d = -0.372), G3 (d = -0.437), G4 (d = -0.253), G5 (d = -0.394), G6 (d = -0.319), G7 (d = -0.355), and G8 (d = -0.365).In home-CIQ only G6 (d = -0.229) significantly decreased, no significant differences were observed in any of the other groups.The largest effect sizes were observed in total-CIQ for G3, in productivity-CIQ for G6, in social-CIQ for G3 and in home-CIQ for G6 (medium effect sizes).Stratifying participants by injury, functionality, age or gender allowed identifying specific CIQ subtotals where remote support may be provided addressing them.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Saurí
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Dietmar Frey
- Charité Lab for Artificial Intelligence in Medicine – CLAIM, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vince Istvan Madai
- Charité Lab for Artificial Intelligence in Medicine – CLAIM, Charité - Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Charité - Universitätsmedizin Berlin, Berlin, Germany
- School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, United Kingdom
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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von Granitz H, Sonnander K, Reine I, Winblad U. Do personal assistance activities promote participation in society for persons with disabilities in Sweden? A five-year longitudinal study. Disabil Rehabil 2021; 44:3973-3981. [PMID: 33721545 DOI: 10.1080/09638288.2021.1897691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore whether the personal assistance (PA) activities provided by the Swedish Act concerning Support and Service for Persons with Certain Functional Impairment in 2010 and 2015 promote participation in society according to Article 19 of the United Nations' Convention on the Rights of Persons with Disabilities (UNCRPD). METHODS Register data and data from two questionnaires were used (N = 2565). Descriptive statistics and chi-square (McNemar's test) were used to describe the basic features of the data. Mixed binominal logistic regression was used to examine correlation between gender and hours of PA between 2010 and 2015. RESULTS Despite an increase in the number of PA hours, more care activities and a reduction of most PA activities representing an active life were found. The result was especially evident for women, older people, and for a particular person category. CONCLUSIONS The results offer evidence of a shift to a medical model and indicate a risk of social exclusion due to fewer activities representing an active life. An increase on average of 16 h of PA over the period studied does not guarantee access to an active life and may indicate a marginal utility. The noted decline of PA for participation in society enhances the importance of monitoring content aspects to fulfil Article 19 of the UNCRPD.Implications for RehabilitationPersonal assistance (PA) in Sweden is a supportive measure for persons with disabilities; however, there are few studies to show whether PA activities are fulfilling disability rights of participation in society.The results show that PA activities are used more for medical care and home-based services over the five-year period.The study highlights the importance of monitoring aspects of content to ensure that the activities of PA comply with the policy objectives of the LSS legislation and Article 19 of the United Nations' Convention on the Rights of Persons with Disabilities (UNCRPD), i.e., full participation in society. Monitoring efforts should include individualised planning and follow-up, moreover, ensure compliance with social service capacity at PA providers.
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Affiliation(s)
- Heléne von Granitz
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Karin Sonnander
- Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden
| | - Ieva Reine
- Statistics Unit, Riga Stradins University, Riga, Latvia
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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