Self-Perceived Quality of Life of People With Physical Disabilities and Labour Force Participation

Effect evaluation of a vocational rehabilitation program for young adults with chronic physical conditions at risk for unemployment: A controlled clinical trial

BACKGROUND

The work participation of young adults with chronic physical conditions lag behind compared to healthy age-mates. 'At Work' is a vocational rehabilitation intervention provided by occupational therapists, that supports them for entering the competitive labour market after graduating post-secondary education.

AIM

To evaluate the effects of 'At Work' on self-efficacy, work-ability and employment status as compared to usual care.

MATERIALS AND METHODS

In total, 88 young adults were included in a multicentre controlled trial; 49 entered 'At Work', 39 received usual care. GEE-analyses were applied.

RESULTS

Scores on all outcome measures substantially improved over time in the intervention group, but no significant effects were found as compared to the control group. The effect on general self-efficacy showed a positive trend in favour of the intervention group.

CONCLUSIONS AND SIGNIFICANCE

Unlike previous study results pointing to positive outcomes of At Work', the current study did not support the effectiveness of this program on work-related self-efficacy, work-ability and paid employment, as compared to usual care. Yet, we did find an indication for positive intervention effect on general self-efficacy, which is known to be an important capacity to achieve social participation.

Long Term Physical Activity Improves Quality of Life Perception, Healthy Nutrition, and Daily Life Management in Elderly: A Randomized Controlled Trial

Physical activity (PA) is a key element in the management of successful aging. The aim of this paper was to show the effects of PA on the quality of life perception, nutritional status, and daily life management of 178 older adults (aged 63.87 ± 8.17) randomly assigned to an Experimental Group (EG), which performed moderate-to-high intensity aerobic and strengthening training, and a Control Group (CG) which performed low-impact PA, assessed after 6, 12, and 24 months. The Short-Form Health Survey (SF-36), Mini Nutritional Assessment (MNA), and Physical Activity Scale for the Elderly (PASE) were used for the study. In the SF-36 assessment, EG showed a good quality of life perception maintained after 24 months, while CG showed a worsening in the same period (p = 0.018). The EG reported a significant better nutritional status as compared to pre-intervention assessment (p = 0.003) and to CG (p < 0.001). Regarding the PASE, the EG showed a higher level of weekly activities than the CG after 24 months (p = 0.011), while the CG showed a worsening after 12 months (p = 0.008). The prolonged engagement in moderate-to high-intensity PA allowed the maintenance of a good quality of life perception, a good level of nutritional status, and daily life activities.

The "Own" and the "Wise" Revisited: Physical Disability, Stigma, and Mental Health among Couples

Utilizing data from a cross-sectional community survey of 455 heterosexual couples in which at least one partner has a physical disability, we examine the associations between stigma and psychological distress for both partners. We also assess whether these associations are moderated by gender. Findings from an actor-partner interdependence model analysis reveal that personally experienced stigma and vicarious stigma experiences have additive effects on psychological distress, but only among women. We discuss how these findings extend a relational understanding of stigma and its effects and implications for research and practice.

Gender differences in the association between functional limitation and depressive symptoms: the salience of food insecurity

The present study evaluated gender differences in the associations of functional limitation with food insecurity and depressive symptoms. Using data from 3,624 respondents ages 18to 80 years from two pooled cross-sectional cycles (2011-2012 and 2013-2014) of the National Health and Nutrition Examination Survey (NHANES), a structural equation model was estimated to assess gender differences in the association between physical limitation and food insecurity, and whether indicators of economic resources mediated an observed interaction. Results demonstrate that food insecurity accounted for about one-tenthof the association between functional limitation and depressive symptoms. Furthermore, these associations were more pronounced among women and were not explained by variation in economic resources. Food insecurity thus appears to be an indicator of psychological adversity among people with functional limitations, especially women, independent of other indicators of economic resources and hardship. Health promotion and social programs should address food insecurity as a unique dimension of adversity in efforts to improve health and well-being.

Entering the labor market: increased employment rates of young adults with chronic physical conditions after a vocational rehabilitation program

PURPOSE

Employment of young adults with chronic physical conditions entering the labor market after finishing post-secondary education remains behind compared to typically developing peers. The aim of this study is to evaluate changes in their paid employment levels after following a vocational rehabilitation intervention ('At Work').

MATERIALS AND METHODS

Participants aged between 16 and 27 years (n = 90) were recruited via rehabilitation physicians and a jobcoach agency and participated in a vocational rehabilitation program. Cochran's Q and McNemar tests served to test the development of intervention participants' paid employment over time. Chi-square tests were used to compare intervention participants' paid employment level with national reference data selected on age and having a self-reported chronic physical condition.

RESULTS

Paid employment level of the intervention cohort significantly increased from 10.0% at baseline to 42.4% at 2-years follow-up (p < 0.001). At 2-years follow-up, their employment rates approached the employment rates of national reference data (42.4% versus 52.9%, p = 0.17).

CONCLUSION

Starting from a disadvantaged position, the paid employment rate of the intervention cohort substantially increased over time, approaching the employment rate of reference data. 'At Work' seems to be appropriate for supporting this specific group who face obstacles to enter the labor market, to find competitive employment.IMPLICATIONS FOR REHABILITATION'At Work' is a vocational rehabilitation intervention for young adults with chronic physical conditions who experience problems with finding and maintaining competitive employment after finishing post-secondary education.The 'At Work' intervention entails a combination of group sessions and individual coaching sessions based on the supported employment methodology.Paid employment rates of the intervention cohort substantially increased on the short- and long term, and approached employment rates of reference data of persons with chronic physical conditions.The 'At Work' intervention seems appropriate to support young adults with chronic physical conditions who experience barriers for work participation, to enter the labor market and find competitive and sustainable employment.

Measuring Quality of Life Loss in Litigation

This article discusses measuring quality of life (QOL) loss in litigation. Case examples are provided. The complexity challenge in QOL assessment is more easily addressed since the advent of computer adaptive testing, which is used by physicians and rehabilitationists in the administration of psychometric instruments to determine QOL loss. It is now possible to write algorithms to capture QOL data through text-mining. If QOL domains and their factors could be accessed through text-mining, it would make for an extraordinary opportunity for much needed doctoral level research in QOL issues for injured workers in workers' compensation programs.

A National Study of Veterans Treatment Court Participants: Who Benefits and Who Recidivates

Although there are now over 400 veterans treatment courts (VTCs) in the country, there have been few studies on participant outcomes in functional domains. Using national data on 7931 veterans in the Veterans Affairs (VA) Veterans Justice Outreach program across 115 VA sites who entered a VTC from 2011 to 2015, we examined the housing, employment, income, and criminal justice outcomes of VTC participants; and identified veteran characteristics predictive of outcomes. VTC participants spent an average of nearly a year in the program and 14% experienced a new incarceration. From program admission to exit, 10% more participants were in their own housing, 12% more were receiving VA benefits, but only 1% more were employed. Controlling for background characteristics, a history of incarceration predicted poor criminal justice, housing, and employment outcomes. Participants with property offenses or probation/parole violations and those with substance use disorders were more likely to experience a new incarceration. Participants with more mental health problems were more likely to be receiving VA benefits and less likely to be employed at program exit. Together, these findings highlight the importance of proper substance abuse treatment as well as employment services for VTC participants so that they can benefit from the diversion process.

A vocational rehabilitation intervention for young adults with physical disabilities: participants' perception of beneficial attributes

BACKGROUND

Finding and maintaining employment is a major challenge for young adults with physical disabilities and their work participation rate is lower than that of healthy peers. This paper is about a program that supports work participation amongst young adults with chronic physical disabilities. The study aims to explore their experienced barriers and facilitators for finding and maintaining employment after starting this program, the participant-perceived beneficial attributes of the program and participants' recommendations for additional intervention components.

METHODS

Semi-structured interviews (n = 19) were held with former intervention participations. Interviews were recorded and transcribed ad verbatim. Themes were derived using the phenomenological approach.

RESULTS

Physical functions and capacities, supervisor's attitude, self-esteem and self-efficacy and openness and assertiveness were experienced barriers and facilitators for finding and maintaining employment. Improvement of self-promoting skills and disclosure skills through job interview-training, increased self-esteem or self-efficacy through peer-support, a suitable job through job placement, improvement of work ability through arrangement of adjusted work conditions and change of supervisor's attitude through education provided to the supervisor were perceived as beneficial attributes of the intervention. Respondents recommended to incorporate assertiveness and openness skills training into future intervention programs.

CONCLUSIONS

The findings suggest that programs supporting work participation should be designed to provide challenging, real-world experiential opportunities that provide young adults with physical disabilities with new insights, self-efficacy and life skills. Also, such programs should facilitate context centered learning. Former intervention participants, therefore, evaluated job-interview training, sharing learning and social experiences with peers, job placement, arrangement of adjusted work conditions and education as beneficial attributes of the 'At Work' program. In addition, they recommended, to incorporate more training on assertiveness and disclosure. We advise professionals to include these beneficial attributes in similar interventions in other contexts.