Disability models in geriatrics: comprehensive rather than competing models should be promoted

The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA)

OBJECTIVE

To report on the feasibility and psychometric properties in terms of homogeneity and construct validity of a newly developed handicap questionnaire focusing on person-perceived handicaps: the Impact on Participation and Autonomy (IPA).

DESIGN

Cross-sectional. SETTING, subjects and outcome measure: One hundred consecutive individuals from the outpatient clinic of the department of rehabilitation of an academic hospital administered the new questionnaire IPA.

RESULTS

The results show good homogeneity and construct validity of the IPA. Factor analysis showed that the scale consists of four factors, explaining 68% of the total variance: social relationships, autonomy in self-care, mobility and leisure, and family role. Homogeneity of the four subscales was considered good, Cronbach's alpha ranged from 0.84 (family role) to 0.87 (social relationships). Feasibility in terms of the number of missing values and administration time needed was satisfactory.

CONCLUSION

The first results suggest that the IPA promises to be a useful handicap questionnaire. Further research is needed to establish test-retest reliability, convergent validity and responsiveness to change.

Service development to meet the needs of 'people with communication disabilities' in developing countries

PURPOSE

In spite of the catastrophic consequences of impaired communication skills on the quality of human life, development of services for people with communication disabilities have low priority in health care and rehabilitation. Nowhere is this more apparent than in developing countries. The low coverage levels of the limited services which do exist in these countries, indicate a need to develop new and innovative service structures. It is to this end, given the limited literature available, that this review looks mainly at articles of a descriptive nature based on clinical experience. The review seeks to identify ideology which could be used to under-pin alternative service delivery and structures.

METHOD

Three collections of literature relevant to the topic under discussion are identified, one collection relates to impairment categories, one to disability perspectives and one to speech and language therapy provision. It is recognized that all three collections are needed to form a basis for innovative change, but this review aims to examine the latter collection only, referring the reader to items in the other collections, when relevant.

RESULTS

The information reviewed is analysed for recurring themes and the results are seen to concur with many of the disability perspectives expressed in present day literature.

Correlates of subjective well-being in stroke patients

BACKGROUND AND PURPOSE

Data on survival and functioning after stroke needs to be supplemented by measures emphasizing the patients' subjective perception. We studied (1) subjective well-being (SWB) as a latent variable in a common-factor model with four items, (2) the reliability of these four items, and (3) variables related to SWB in stroke patients.

METHODS

Data on all stroke patients (n=1417) and a random subsample of stroke-free individuals of similar age (n=1439) were collected from the Nord-Trøndelag Health Survey, a cross-sectional study of 74977 persons. Based on a two-sample factor analysis model, scores of SWB were calculated, and variables explaining SWB were studied in a regression model.

RESULTS

Four items were a priori believed to measure SWB as a latent variable ("satisfaction," "strength," "calmness," and "cheerfulness"). This was confirmed by factor analysis. The reliability of these items (the proportion of the variance of the items that can be explained by the common factor) was between .42 and .53. Regression analyses showed a significant effect of having had a stroke, gender (lower SWB in men), age (increasing SWB with increasing age), perceived general health, nervousness, loneliness, sleep problems, social support, and use of analgesics. There was no statistical interaction between these variables and having had a stroke.

CONCLUSIONS

Higher SWB after stroke relates to female gender, older age, good general and mental health, and a firm social network.