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Banda A, Naaldenberg J, Timen A, van Eeghen A, Leusink G, Cuypers M. Cancer risks related to intellectual disabilities: A systematic review. Cancer Med 2024; 13:e7210. [PMID: 38686623 PMCID: PMC11058689 DOI: 10.1002/cam4.7210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND People with intellectual disabilities (ID) face barriers in cancer care contributing to poorer oncological outcomes. Yet, understanding cancer risks in the ID population remains incomplete. AIM To provide an overview of cancer incidence and cancer risk assessments in the entire ID population as well as within ID-related disorders. METHODS This systematic review examined cancer risk in the entire ID population and ID-related disorders. We systematically searched PubMed (MEDLINE) and EMBASE for literature from January 1, 2000 to July 15, 2022 using a search strategy combining terms related to cancer, incidence, and ID. RESULTS We found 55 articles assessing cancer risks in the ID population at large groups or in subgroups with ID-related syndromes, indicating that overall cancer risk in the ID population is lower or comparable with that of the general population, while specific disorders (e.g., Down's syndrome) and certain genetic mutations may elevate the risk for particular cancers. DISCUSSION The heterogeneity within the ID population challenges precise cancer risk assessment at the population level. Nonetheless, within certain subgroups, such as individuals with specific ID-related disorders or certain genetic mutations, a more distinct pattern of varying cancer risks compared to the general population becomes apparent. CONCLUSION More awareness, and personalized approach in cancer screening within the ID population is necessary.
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Affiliation(s)
- Amina Banda
- Department of Primary and Community CareRadboud university medical centreNijmegenthe Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community CareRadboud university medical centreNijmegenthe Netherlands
| | - Aura Timen
- Department of Primary and Community CareRadboud university medical centreNijmegenthe Netherlands
| | - Agnies van Eeghen
- Emma Children's HospitalAmsterdam University Medical CentersAmsterdamthe Netherlands
- 'S Heeren LooAmersfoortthe Netherlands
| | - Geraline Leusink
- Department of Primary and Community CareRadboud university medical centreNijmegenthe Netherlands
| | - Maarten Cuypers
- Department of Primary and Community CareRadboud university medical centreNijmegenthe Netherlands
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Barak S, Dunsky A. Long-term outdoor recreation program for adults with intellectual disabilities: Feasibility and effects. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1113-1123. [PMID: 37357316 DOI: 10.1111/jar.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND While people with intellectual disabilities tend to refrain from physical activity, outdoor physical activity programs increase motivation to engage in physical activity. METHOD Eighty adults with intellectual disabilities participated in a 12-month outdoor physical activity program. Attendance was used to assess feasibility. Aerobic capacity (6-min walk test), lower extremity endurance (30-s chair stand), and mobility (timed up and go) were assessed at three-time points: before, during, and after the program. Six interviews were also conducted with six staff members and participants. RESULTS The physical activity program was feasible, with all six groups completing the year-long activity. The six-minute walk and timed-up-and-go tests improved significantly. The qualitative analysis indicates the program's strengths (instructors' qualities and programs' social component) and weaknesses (dependency on weather and bureaucracy). CONCLUSION Among adults with intellectual disabilities, a long-term outdoor physical activity program is feasible as a means for increasing aerobic capacity and improving mobility ability.
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Affiliation(s)
- Sharon Barak
- Faculty of Health Science, Department of Nursing, Ariel University, Ariel, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Ayelet Dunsky
- School of Human Movement and Sport Sciences, The Levinsky-Wingate Academic College, Netanya, Israel
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Laxton P, Patterson F, Healy S. Factors Related to Physical Activity in Adults With Intellectual Disabilities in Group Home Settings: A Systematic Literature Review. Adapt Phys Activ Q 2023; 40:347-377. [PMID: 36543174 DOI: 10.1123/apaq.2022-0064] [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: 04/13/2022] [Revised: 08/30/2022] [Accepted: 09/28/2022] [Indexed: 12/24/2022] Open
Abstract
This systematic review of literature aimed to synthesize the multilevel factors related to physical activity (PA) among adults (age 18-65) with intellectual disability living in group homes. Keyword searches were used to identify articles from electronic databases, resulting in the inclusion of 10 articles for full-text review. Data were extracted relating to study and sample characteristics and study findings. Methodological quality of the studies was also evaluated. Factors related to PA in group homes were identified at all levels of the social-ecological model. Intrapersonal factors (e.g., health and functional status, attitude to PA), interpersonal factors (e.g., staff attitude, encouragement for PA, and coparticipation in PA), and organizational factors (e.g., program offerings, staff education, and staff-client ratios) were prominent findings in the reviewed studies. The findings support a social-ecological approach for PA promotion in group homes that target intrapersonal, interpersonal, and organizational factors.
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Affiliation(s)
- Paige Laxton
- College of Health Sciences, University of Delaware, Newark, DE,USA
| | - Freda Patterson
- College of Health Sciences, University of Delaware, Newark, DE,USA
| | - Sean Healy
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin,Ireland
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Salomon C, Bellamy J, Evans E, Reid R, Hsu M, Teasdale S, Trollor J. 'Get Healthy!' physical activity and healthy eating intervention for adults with intellectual disability: results from the feasibility pilot. Pilot Feasibility Stud 2023; 9:48. [PMID: 36949532 PMCID: PMC10032022 DOI: 10.1186/s40814-023-01267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND People with intellectual disabilities (ID) experience high rates of lifestyle related morbidities, in part due to lack of access to tailored health promotion programmes. This study aimed to assess the feasibility and preliminary efficacy of a tailored healthy lifestyle intervention, Get Healthy! METHODS Get Healthy! is a 12-week physical activity and healthy eating programme designed to address lifestyle-related risks for adults with mild-moderate ID. The feasibility pilot was designed to assess subjective participant experience and programme feasibility across: recruitment and screening, retention, session attendance and engagement, adverse events, and practicality and reliability of outcome procedures. Exploratory programme efficacy was assessed across the following measures: anthropometry (body mass index, weight, waist circumference), cardiovascular fitness, physical strength, dietary intake, healthy literacy, and quality of life. RESULTS Six participants with moderate ID and two carer participants completed the feasibility trial, representing a 100% retention rate. Qualitative data indicated the programme was well received. Participants with ID attended 75% of sessions offered and displayed a high level of engagement in sessions attended (91% mean engagement score). While most data collection procedures were feasible to implement, several measures were either not feasible for our participants, or required a higher level of support to implement than was provided in the existing trial protocol. Participants with ID displayed decreases in mean waist circumference between baseline and endpoint (95% CI: - 3.20, - 0.17 cm) and some improvements in measures of cardiovascular fitness and physical strength. No changes in weight, body mass index, or objectively measured knowledge of nutrition and exercise or quality of life were detected from baseline to programme endpoint. Dietary intake results were mixed. DISCUSSION The Get Healthy! programme was feasible to implement and well received by participants with moderate ID and their carers. Exploratory efficacy data indicates the programme has potential to positively impact important cardiometabolic risk factors such as waist circumference, cardiovascular fitness, and physical strength. Several of the proposed data collection instruments will require modification or replacement prior to use in a sufficiently powered efficacy trial. TRIAL REGISTRATION ACTRN: ACTRN12618000349246. Registered March 8th 2018-retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374497 UTN: U1111-1209-3132.
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Affiliation(s)
- Carmela Salomon
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
| | - Jessica Bellamy
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
- School of Medical, Indigenous & Health Sciences, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, 2522, Australia
| | - Elizabeth Evans
- Council for Intellectual Disability, 418A Elizabeth St, Surry Hills, NSW, 2010, Australia
| | - Renae Reid
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
| | - Michelle Hsu
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, 2006, Australia
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, 26 Llandaff Street Bondi Junction, Sydney, 2022, Australia
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Kensington, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia.
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Barriers and enablers to the implementation of healthy lifestyle interventions for people with disability living in supported accommodation: A systematic review using the consolidated framework for implementation research. Disabil Health J 2023; 16:101442. [PMID: 36740546 DOI: 10.1016/j.dhjo.2023.101442] [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: 09/08/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND People with disability living in supported accommodation often experience significant health disparities, despite the availability of additional support. Healthy lifestyle interventions have been identified as one key health promotion strategy. Implementation science offers an opportunity to explore the factors that influence the efficacy and sustainability of these interventions, yet its application in this context has been underutilized. OBJECTIVE This systematic review synthesized the barriers and enablers to the implementation of healthy lifestyle interventions delivered to people with disability living in supported accommodation settings. METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search for relevant literature published between January 2011 and November 2021 was conducted across six databases. The findings of included studies were coded and analyzed according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) via deductive content analysis. RESULTS Five studies were included, and their findings were mapped to 21 out of 38 constructs under the CFIR. Interventions from each study delivered health promotion education and training to staff and/or people with disability. The most prominent determinants that influenced implementation success included an intervention's relevance and its flexibility to adapt to the needs of people with disability, alongside organizational resourcing, and stakeholder endorsement in supporting implementation. CONCLUSIONS The CFIR provided a systematic approach to explore the implementation of healthy lifestyle interventions. However, further research that is grounded in and guided by implementation science theories is warranted. Despite the scarcity of literature, several compelling, yet preliminary recommendations were drawn from the findings.
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Zwack CC, McDonald R, Tursunalieva A, Lambert GW, Lambert EA. Exploration of diet, physical activity, health knowledge and the cardiometabolic profile of young adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:517-532. [PMID: 35137997 PMCID: PMC9303213 DOI: 10.1111/jir.12917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Young adults with intellectual disability (ID) are experiencing early mortality, and it is suggested that they are living with undiagnosed cardiovascular and metabolic risk factors (hereafter referred to as cardiometabolic). METHODS We investigated the association between modifiable risk factors and cardiometabolic health profile in adults with ID aged 18-45 years through clinical evaluation of traditional cardiometabolic parameters, and assessment of physical activity levels, diet and associated health knowledge. RESULTS We found that young adults with ID have an increased obesity (mean body mass index; ID group: 32.9 ± 8.6 vs. control group: 26.2 ± 5.5, P = 0.001), are engaging in less physical activity than the age-matched general population (total activity minutes per week; ID group: 172.2 ± 148.9 vs. control group: 416.4 ± 277.1, P < 0.001), and overall have unhealthier diets. Additionally, knowledge about nutrition and physical activity appears to be an important predictor of cardiometabolic risk in this population. If young people with ID are to improve their cardiometabolic health to reduce morbidity and early mortality, we need to further explore how to consistently apply health messaging to get lasting behavioural change in this population.
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Affiliation(s)
- C. C. Zwack
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
- School of Health SciencesUniversity of SydneyNew South WalesAustralia
| | - R. McDonald
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| | - A. Tursunalieva
- Department of Econometrics and Business StatisticsMonash UniversityClaytonVictoriaAustralia
| | - G. W. Lambert
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| | - E. A. Lambert
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
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Walsh S, Hegarty J, Lehane E, Farrell D, Taggart L, Kelly L, Sahm L, Corrigan M, Caples M, Martin AM, Tabirca S, Corrigan MA, O'Mahony M. Determining the need for a breast cancer awareness educational intervention for women with mild/moderate levels of intellectual disability: A qualitative descriptive study. Eur J Cancer Care (Engl) 2022; 31:e13590. [PMID: 35393746 PMCID: PMC9539590 DOI: 10.1111/ecc.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/11/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Following a review of the existing body of literature, this study aimed to explore the need for a breast cancer awareness intervention specifically targeted at women with mild/moderate levels of intellectual disability (ID) and provide perspectives on the preferred processes and content underpinning an intervention. METHODS A qualitative, descriptive design using semi-structured, individual (n = 5) and focus group (n = 5) interviews were used to engage with a non-probability, purposive sample of key stakeholders (n = 25) including women with mild/moderate levels of ID, caregivers and healthcare professionals. Data were analysed using qualitative content analysis. RESULTS Findings highlighted that an educational intervention should focus on breast awareness as opposed to breast cancer awareness. Additionally, findings identified that a combined breast awareness and healthy living intervention could be effective. However, the intervention needs to have a multimodal, hands-on, person-centred approach to learning which is underpinned by theory. Furthermore, integrating the caregivers and healthcare professionals into the intervention is recommended. CONCLUSION Findings from this study provide a foundation for developing and implementing a theoretically underpinned, multimodal, breast awareness and healthy living educational intervention for women with mild/moderate levels of ID.
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Affiliation(s)
- Susan Walsh
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Josephine Hegarty
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Elaine Lehane
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Dawn Farrell
- Department of Nursing and Healthcare Sciences, Institute of Technology Tralee, Tralee, Ireland
| | - Laurence Taggart
- Institute of Nursing and Health, Ulster University, Jordanstown, UK
| | - Louise Kelly
- Department of Academic Surgery, Cork Breast Research Centre-Cork University Hospital, Cork, Ireland
| | - Laura Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Maria Caples
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Anne Marie Martin
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Sabin Tabirca
- Department of Computer Science, University College Cork, Cork, Ireland
| | - Mark A Corrigan
- Department of Academic Surgery, Cork Breast Research Centre-Cork University Hospital, Cork, Ireland
| | - Mairin O'Mahony
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
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Vlot-van Anrooij K, Naaldenberg J, Hilgenkamp TIM, Overwijk A, van der Velden K, Leusink GL. Gaining actionable knowledge to improve local health-promoting capacities in long-term care support settings for people with intellectual disabilities. PATIENT EDUCATION AND COUNSELING 2022; 105:407-415. [PMID: 34045091 DOI: 10.1016/j.pec.2021.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/29/2021] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE People with intellectual disabilities (ID) are largely dependent on their environment to live healthily and, in this, ID-support organizations play a vital role. An environmental asset mapping tool for ID-support settings has been developed. This study aims to provide insight into whether or not the tool can provide a comprehensive view on assets in the system and actionable knowledge to improve health-promoting capacities in ID-support settings. METHODS Fifty-seven users from four setting completed the tool on availability, user satisfaction, and dreams regarding social, physical, organizational, and financial assets. RESULTS The findings provide a comprehensive view of available assets. Together with user satisfaction and dreams for improvements, they provide actionable knowledge for improving the health-promoting capacities of the settings, including: (1) how use of available assets can be improved, (2) the type of assets that should be enriched, and (3) the assets that can be added to the system. CONCLUSION The asset mapping tool provides a comprehensive view on assets in the system and actionable knowledge to improve health-promoting capacities in ID-support settings. PRACTICE IMPLICATIONS ID-support organizations can use the tool to generate actionable bottom-up knowledge for priority setting and implementing interventions to improve their health-promoting capacities.
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Affiliation(s)
- Kristel Vlot-van Anrooij
- Department of Primary and Community Care, Intellectual Disabilities and Health, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands.
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Intellectual Disabilities and Health, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Thessa I M Hilgenkamp
- Department of Physical Therapy, University of Nevada, Las Vegas, USA; Department of General Practice, Intellectual Disability Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Annelies Overwijk
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, The Netherlands; Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Intellectual Disabilities and Health, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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Dean S, Marshall J, Whelan E, Watson J, Zorbas C, Cameron AJ. A Systematic Review of Health Promotion Programs to Improve Nutrition for People with Intellectual Disability. Curr Nutr Rep 2021; 10:255-266. [PMID: 34893970 DOI: 10.1007/s13668-021-00382-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To investigate the type and effectiveness of health promotion programs designed to improve nutrition for people with intellectual disability. This review also sought to highlight gaps in the evidence by mapping interventions to the socio-ecological model. RECENT FINDINGS To date, reviews on health promotion programs for people with intellectual disability have focused on individualised weight management interventions and behaviour change techniques. No reviews have focused solely on nutrition or considered a broader range of interventions and policies targeted beyond the individual. This review found that health promotion interventions to date were predominantly at the individual level of the socio-ecological model and of varying effectiveness. Of the non-individually focused interventions, those targeting the physical environment or considering multiple socio-ecological levels achieved the greatest improvements in nutrition outcomes. Nutrition and obesity prevention research and policy need to include intellectual disability as part of equity considerations, while intellectual disability policy needs to consider the broader food environment.
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Affiliation(s)
- Sarah Dean
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Josephine Marshall
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Erin Whelan
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Jo Watson
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, 3220, Australia
| | - Christina Zorbas
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia
| | - Adrian J Cameron
- Faculty of Health, School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, 3220, Australia.
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Liu Q, Adami HO, Reichenberg A, Kolevzon A, Fang F, Sandin S. Cancer risk in individuals with intellectual disability in Sweden: A population-based cohort study. PLoS Med 2021; 18:e1003840. [PMID: 34673770 PMCID: PMC8568154 DOI: 10.1371/journal.pmed.1003840] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 11/04/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND A knowledge gap exists about the risk of cancer in individuals with intellectual disability (ID). The primary aim of this study was to estimate the cancer risk among individuals with ID compared to individuals without ID. METHODS AND FINDINGS We conducted a population-based cohort study of all children live-born in Sweden between 1974 and 2013 and whose mothers were born in a Nordic country. All individuals were followed from birth until cancer diagnosis, emigration, death, or 31 December 2016 (up to age 43 years), whichever came first. Incident cancers were identified from the Swedish Cancer Register. We fitted Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) as measures of cancer risk in relation to ID after adjusting for several potential confounders. We analyzed ID by severity, as well as idiopathic ID and syndromic ID separately. We performed a sibling comparison to investigate familial confounding. The study cohort included a total of 3,531,305 individuals, including 27,956 (0.8%) individuals diagnosed with ID. Compared with the reference group (individuals without ID and without a full sibling with ID), individuals with ID were in general more likely to be male. The median follow-up time was 8.9 and 23.0 years for individuals with ID and individuals without ID, respectively. A total of 188 cancer cases were identified among individuals with ID (incidence rate [IR], 62 per 1,000 person-years), and 24,960 among individuals in the reference group (IR, 31 per 1,000 person-years). A statistically significantly increased risk was observed for any cancer (HR 1.57, 95% CI 1.35-1.82; P < 0.001), as well as for several cancer types, including cancers of the esophagus (HR 28.4, 95% CI 6.2-130.6; P < 0.001), stomach (HR 6.1, 95% CI 1.5-24.9; P = 0.013), small intestine (HR 12.0, 95% CI 2.9-50.1; P < 0.001), colon (HR 2.0, 95% CI 1.0-4.1; P = 0.045), pancreas (HR 6.0, 95% CI 1.5-24.8; P = 0.013), uterus (HR 11.7, 95% CI 1.5-90.7; P = 0.019), kidney (HR 4.4, 95% CI 2.0-9.8; P < 0.001), central nervous system (HR 2.7, 95% CI 2.0-3.7; P < 0.001), and other or unspecified sites (HR 4.8, 95% CI 1.8-12.9; P = 0.002), as well as acute lymphoid leukemia (HR 2.4, 95% CI 1.3-4.4; P = 0.003) and acute myeloid leukemia (HR 3.0, 95% CI 1.4-6.4; P = 0.004). Cancer risk was not modified by ID severity or sex but was higher for syndromic ID. The sibling comparison showed little support for familial confounding. The main study limitations were the limited statistical power for the analyses of specific cancer types, and the potential for underestimation of the studied associations (e.g., due to potential underdetection or delayed diagnosis of cancer among individuals with ID). CONCLUSIONS In this study, we found that individuals with ID showed an increased risk of any cancer, as well as of several specific cancer types. These findings suggest that extended surveillance and early intervention for cancer among individuals with ID are warranted.
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Affiliation(s)
- Qianwei Liu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Abraham Reichenberg
- Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, New York, United States of America
- Seaver Autism Center for Research and Treatment, Ichan School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Alexander Kolevzon
- Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, New York, United States of America
- Seaver Autism Center for Research and Treatment, Ichan School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, New York, United States of America
- Seaver Autism Center for Research and Treatment, Ichan School of Medicine at Mount Sinai, New York, New York, United States of America
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Salse-Batán J, Suárez-Iglesias D, Sanchez-Lastra MA, Ayán Pérez C. Aquatic exercise for people with intellectual disabilities: findings from a systematic review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 69:134-146. [PMID: 37025330 PMCID: PMC10071967 DOI: 10.1080/20473869.2021.1924033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/26/2021] [Accepted: 04/23/2021] [Indexed: 06/19/2023]
Abstract
Background: There is a need for promoting exercise practice among people with intellectual disabilities (ID). Aquatic exercise (AE) could be a viable option in this regard. Objective: To identify and critically analyze the best available evidence concerning the effects of AE in the physical and mental health of people with ID. Methods: A systematic review of randomized controlled trials (RCTs) and comparative studies was performed after searching within several databases up to March 2021. Results: A total of 4 RCTs and 3 comparative studies were found. Their methodological quality ranged from high to low. Aquatic interventions had positive effects on cardiorespiratory, muscular fitness and balance. Mixed effects were seen on parameters related to obesity and cognition. Scant information regarding feasibility and intervention fidelity was provided. In general, interventions details were not discussed in deep. Conclusion: Preliminary evidence shows that aquatic exercise can be prescribed to people with ID in order to improve their physical health. The impact of aquatic exercise on motor skills, cognitive function and mental health remains unclear. Further research on this topic should provide a detailed description of the interventions carried out, including information on the feasibility and intervention fidelity.
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Affiliation(s)
| | - David Suárez-Iglesias
- VALFIS Research Group, Institute of Biomedicine (IBIOMED), Faculty of Physical Activity and Sports Sciences, University of León, León, Spain
| | | | - Carlos Ayán Pérez
- Departamento de Didácticas Especiais, Universidade de Vigo, Well-Move Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
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12
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Vlot-van Anrooij K, Naaldenberg J, Hilgenkamp TIM, Vaandrager L, van der Velden K, Leusink GL. Towards healthy settings for people with intellectual disabilities. Health Promot Int 2021; 35:661-670. [PMID: 31243433 PMCID: PMC7414853 DOI: 10.1093/heapro/daz054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
People with intellectual disabilities (ID) depend on their environment for support to live healthily. The characteristics of healthy settings for people with ID are unknown. This study aims to conceptualize healthy settings for people with ID by conducting an international and multidisciplinary concept mapping study. As theoretical framework the settings approach, an ecological model with a whole system focus toward health promotion, was used. The integrative mixed-methods approach of this study involved concept mapping with researchers specialized in healthcare for people with ID and researchers specialized in healthy settings. The 41 participants generated statements that were later sorted and rated. Findings encompass 13 clusters relating to the social environment, the physical environment and societal preconditions. Specific factors of healthy settings for people with ID include: (i) universal design of the physical environment, (ii) the role of care professionals in the social environment to empower people with ID, (iii) possibilities for care providers to contribute to a health-promoting setting and (iv) preconditions that allow people to engage in society. These factors can be used in strategies to apply the approach in practice and give directions to put in place policies on developing enabling environments and decreasing health inequities.
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Affiliation(s)
- Kristel Vlot-van Anrooij
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Corresponding author. E-mail:
| | - J Naaldenberg
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - T I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - L Vaandrager
- Department of Social Sciences, Health and Society, Wageningen University, PO Box 8130, 6706 KN Wageningen, The Netherlands
| | - K van der Velden
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - G L Leusink
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Powers B, Patterson F, Palmiere K, Healy S. "I sit all of the time": Health-related time-use among adults with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 108:103817. [PMID: 33338775 DOI: 10.1016/j.ridd.2020.103817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Adults diagnosed with intellectual disabilities (ID) are more likely to have cardiometabolic risk factors, including low physical activity (PA), high sedentary behavior (SB), and poor sleep. While these behaviors have typically been studied in isolation, emerging frameworks propose a more integrated approach to the study of these behaviors, asserting that the relative proportion of time spent in each of the health-related time-use behaviors (i.e. PA, SB and sleep) across the 24 -h period is a more powerful determinant of the incidence and progression of disease. This approach has yet to be considered for adults with ID. The purpose of this study was to explore how adults with ID and their formal caregivers (i.e. employed caregivers) perceived their health-related time-use, including the factors that influence their time-use. METHOD Five focus groups were conducted with twelve adults with ID and ten formal-caregivers. Consistent with an interpretive paradigm, this study employed an interpretative phenomenological analysis (IPA) methodology. RESULTS Three interrelated themes were identified: (1) Caregivers as gatekeepers to healthy time-use; (2) Places to move; and (3) Daily movement. The themes captured the participants' perspectives of interpersonal and environmental factors that influence health-related time-use, and how these factors were common to engagement in at least on health-related time-use behavior. CONCLUSIONS Interpersonal factors, including caregivers support and modeling-behaviors, and community factors, in the form of local, accessible, affordable spaces to be active, were identified as the most pertinent factors in determining PA, SB and sleep behaviors. Moreover, adults with ID and caregivers perceived health-related time-use behaviors to be interrelated. Further investigation in this area will ultimately inform the development of pilot interventions that support caregivers as gatekeepers and provide access to health-promoting environments to engage adults with ID in healthy levels of PA, SB, and sleep.
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Affiliation(s)
- Brittany Powers
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Freda Patterson
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Katherine Palmiere
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sean Healy
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE, United States.
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14
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Vlot‐van Anrooij K, Koks‐Leensen MCJ, van der Cruijsen A, Jansen H, van der Velden K, Leusink G, Hilgenkamp TIM, Naaldenberg J. How can care settings for people with intellectual disabilities embed health promotion? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1489-1499. [PMID: 32627935 PMCID: PMC7689850 DOI: 10.1111/jar.12776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/07/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with intellectual disabilities (ID) depend on their environment to live healthily. Asset-based health promotion enhances a settings' health-promoting capacity starting with identifying protective or promotive factors that sustain health. METHOD This inclusive mixed-methods study used group sessions to generate and rank ideas on assets supporting healthy nutrition and physical activity in Dutch intellectual disability care settings. Participants included people with moderate intellectual disabilities and family and care professionals of people with severe/profound intellectual disabilities. RESULTS Fifty-one participants identified 185 assets in group sessions. They include the following: (i) the social network and ways "people" can support, (ii) assets in/around "places," and person-environment fit, and (iii) "preconditions": health care, prevention, budget, and policy. CONCLUSION This inclusive research provides a user perspective on assets in the living environment supporting healthy living. This gives insight in contextual factors needed for development and sustainable embedment of health promotion in the systems of intellectual disability support settings.
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Affiliation(s)
- Kristel Vlot‐van Anrooij
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Monique C. J. Koks‐Leensen
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Anneke van der Cruijsen
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Henk Jansen
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Koos van der Velden
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Geraline Leusink
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Thessa I. M. Hilgenkamp
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical CenterRotterdamThe Netherlands
- Department of Physical TherapyUniversity of NevadaLas VegasNVUSA
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
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15
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Miniera F, Berardi A, Panuccio F, Valente D, Tofani M, Galeoto G. Measuring Environmental Barriers: Validation and Cultural Adaptation of the Italian Version of the Craig Hospital Inventory of Environmental Factors (CHIEF) Scale. Occup Ther Health Care 2020; 34:373-385. [PMID: 33078967 DOI: 10.1080/07380577.2020.1834174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 06/11/2023]
Abstract
The study aimed to validate an Italian translation of the Craig Hospital Inventory of Environmental Factors (CHIEF) environmental assessment tool. The CHIEF scale was administered throughout Italy to 506 individuals who did not present with serious and/or disabling diseases. The results show an excellent interrelation between CHIEF scale items and the subscales. Furthermore, our analysis demonstrates that following repeated administration to the same participants, the instrument maintains excellent stability of each subscale for the frequency, magnitude, and impact of the barriers. This study demonstrates that the Italian version of the CHIEF scale is reliable for measuring environmental barriers. The findings show that the scale is suitable for the clinical and research fields to broaden our knowledge about this relevant yet poorly studied field.
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Affiliation(s)
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCSS Neuromed, Pozzilli, Italy
| | - Marco Tofani
- Neurorehabilitation Unit, Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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16
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Kuijken NMJ, Naaldenberg J, Anrooij KVV, Sanden MWGNVD, van Schrojenstein HMJ, Valk LD, Leusink GL. Integrating Health Promotion in the Everyday Life of People With Intellectual Disability-The Extent to Which Current Initiatives Take Context Into Account. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:170-179. [PMID: 32240052 DOI: 10.1352/1934-9556-58.2.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Taking the dynamics of everyday life into account is important for health behavior change. Surveys were conducted to gain insight into available health promoting physical activity and nutrition initiatives in the everyday life of people with intellectual disability (ID). Researchers considered characteristics of the initiatives and the attention they give to resources and hindering factors of healthy living for people with ID. The 47 initiatives mostly focused on physical activity and consisted of regularly organized, stand-alone activities. Care professionals, rather than health professionals, were involved. Organizational resources and hindering factors received relatively little attention. Health promotion for people with ID could benefit from incorporating health behavior into routines of daily living, focusing more attention on organizational resources, and improving the collaboration between health professionals and care professionals.
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Affiliation(s)
- Noortje M J Kuijken
- Noortje M. J. Kuijken, Jenneken Naaldenberg, Kristel Vlot-van Anrooij, Maria W. G. Nijhuis-van der Sanden, Henny M. J. van Schrojenstein Lantman-de Valk, and Geraline L. Leusink, Radboud University Medical Center
| | - Jenneken Naaldenberg
- Noortje M. J. Kuijken, Jenneken Naaldenberg, Kristel Vlot-van Anrooij, Maria W. G. Nijhuis-van der Sanden, Henny M. J. van Schrojenstein Lantman-de Valk, and Geraline L. Leusink, Radboud University Medical Center
| | - Kristel Vlot-van Anrooij
- Noortje M. J. Kuijken, Jenneken Naaldenberg, Kristel Vlot-van Anrooij, Maria W. G. Nijhuis-van der Sanden, Henny M. J. van Schrojenstein Lantman-de Valk, and Geraline L. Leusink, Radboud University Medical Center
| | - Maria W G Nijhuis-van der Sanden
- Noortje M. J. Kuijken, Jenneken Naaldenberg, Kristel Vlot-van Anrooij, Maria W. G. Nijhuis-van der Sanden, Henny M. J. van Schrojenstein Lantman-de Valk, and Geraline L. Leusink, Radboud University Medical Center
| | - Henny M J van Schrojenstein
- Noortje M. J. Kuijken, Jenneken Naaldenberg, Kristel Vlot-van Anrooij, Maria W. G. Nijhuis-van der Sanden, Henny M. J. van Schrojenstein Lantman-de Valk, and Geraline L. Leusink, Radboud University Medical Center
| | - Lantman-de Valk
- Noortje M. J. Kuijken, Jenneken Naaldenberg, Kristel Vlot-van Anrooij, Maria W. G. Nijhuis-van der Sanden, Henny M. J. van Schrojenstein Lantman-de Valk, and Geraline L. Leusink, Radboud University Medical Center
| | - Geraline L Leusink
- Noortje M. J. Kuijken, Jenneken Naaldenberg, Kristel Vlot-van Anrooij, Maria W. G. Nijhuis-van der Sanden, Henny M. J. van Schrojenstein Lantman-de Valk, and Geraline L. Leusink, Radboud University Medical Center
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17
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Tyrer F, Ling S, Bhaumik S, Gangadharan SK, Khunti K, Gray LJ, Dunkley AJ. Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:287-295. [PMID: 31976599 DOI: 10.1111/jir.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 10/01/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND As people with intellectual disabilities (ID) are now living longer, they are more at risk of developing non-communicable diseases, including type 2 diabetes mellitus. However, understanding of factors associated with diabetes for targeted management and prevention strategies is limited. This study aimed to investigate prevalence of diabetes in adults (aged ≥18 years) with ID and its relationship with demographic, lifestyle, independence and health factors. METHOD This was a cross-sectional analysis of interview data from 1091 adults with ID from the Leicestershire Learning Disability Register from 1 January 2010 to 31 December 2016. Logistic regression models were used to identify factors associated with diabetes in the study population. RESULTS The study population did not have healthy lifestyles: just under half reported having lower physical activity levels than people without ID of a similar age; one-quarter consumed fizzy drinks daily; and 20% consumed five or more fruit and/or vegetables per day. Prevalence of carer/self-reported diabetes was 7.3% (95% confidence interval 5.9-9.0). After adjustment, diabetes was positively associated with South Asian ethnicity (P = 0.03) and older age groups (P < 0.001). Diabetes was less common in people living with family members (P = 0.02). We did not find a relationship between any of the lifestyle, independence and health factors investigated. CONCLUSIONS A significant proportion of people with ID are living with diabetes. Diabetes management and prevention strategies should be tailored to individuals' complex needs and include consideration of lifestyle choices. Such strategies may want to focus on adults of South Asian ethnicity and people living in residential homes where prevalence appears to be higher.
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Affiliation(s)
- F Tyrer
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S Ling
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - S Bhaumik
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S K Gangadharan
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
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18
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House A, Bryant L, Russell AM, Wright-Hughes A, Graham L, Walwyn R, Wright JM, Hulme C, O'Dwyer JL, Latchford G, Meer S, Birtwistle JC, Stansfield A, Ajjan R, Farrin A. Managing with Learning Disability and Diabetes: OK-Diabetes - a case-finding study and feasibility randomised controlled trial. Health Technol Assess 2019; 22:1-328. [PMID: 29845932 DOI: 10.3310/hta22260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obesity and type 2 diabetes are common in adults with a learning disability. It is not known if the principles of self-management can be applied in this population. OBJECTIVES To develop and evaluate a case-finding method and undertake an observational study of adults with a learning disability and type 2 diabetes, to develop a standardised supported self-management (SSM) intervention and measure of adherence and to undertake a feasibility randomised controlled trial (RCT) of SSM versus treatment as usual (TAU). DESIGN Observational study and an individually randomised feasibility RCT. SETTING Three cities in West Yorkshire, UK. PARTICIPANTS In the observational study: adults aged > 18 years with a mild or moderate learning disability, who have type 2 diabetes that is not being treated with insulin and who are living in the community. Participants had mental capacity to consent to research and to the intervention. In the RCT participants had glycated haemoglobin (HbA1c) levels of > 6.5% (48 mmol/mol), a body mass index (BMI) of > 25 kg/m2 or self-reported physical activity below national guideline levels. INTERVENTIONS Standardised SSM. TAU supported by an easy-read booklet. MAIN OUTCOME MEASURES (1) The number of eligible participants identified and sources of referral; (2) current living and support arrangements; (3) current health state, including level of HbA1c, BMI and waist circumference, blood pressure and lipids; (4) mood, preferences for change; (5) recruitment and retention in RCT; (6) implementation and adherence to the intervention; (7) completeness of data collection and values for candidate primary outcomes; and (8) qualitative data on participant experience of the research process and intervention. RESULTS In the observational study we identified 147 eligible consenting participants. The mean age was 54.4 years. In total, 130 out of 147 (88%) named a key supporter, with 113 supporters (77%) being involved in diabetes management. The mean HbA1c level was 54.5 mmol/mol [standard deviation (SD) 14.8 mmol/mol; 7.1%, SD 1.4%]. The BMI of 65% of participants was > 30 kg/m2 and of 21% was > 40 kg/m2. Many participants reported low mood, dissatisfaction with lifestyle and diabetes management and an interest in change. Non-response rates were high (45/147, 31%) for medical data requested from the primary care team. In the RCT, 82 participants were randomised. The mean baseline HbA1c level was 56 mmol/mol (SD 16.5 mmol/mol; 7.3%, SD 1.5%) and the mean BMI was 34 kg/m2 (SD 7.6 kg/m2). All SSM sessions were completed by 35 out of 41 participants. The adherence measure was obtained in 37 out of 41 participants. The follow-up HbA1c level and BMI was obtained for 75 out of 82 (91%) and 77 out of 82 (94%) participants, respectively. Most participants reported a positive experience of the intervention. A low response rate and difficulty understanding the EuroQol-5 Dimensions were challenges in obtaining data for an economic analysis. LIMITATIONS We recruited from only 60% of eligible general practices, and 90% of participants were on a general practice learning disability register, which meant that we did not recruit many participants from the wider population with milder learning disability. CONCLUSIONS A definitive RCT is feasible and would need to recruit 194 participants per arm. The main barrier is the resource-intensive nature of recruitment. Future research is needed into the effectiveness of obesity treatments in this population, particularly estimating the longer-term outcomes that are important for health benefit. Research is also needed into improving ways of assessing quality of life in adults with a learning disability. TRIAL REGISTRATION Current Controlled Trials ISRCTN41897033. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 26. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise Bryant
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amy M Russell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Liz Graham
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John L O'Dwyer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Ramzi Ajjan
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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19
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Steenbergen HA, de Jong BI, Fleuren MAH, van der Schans CP, Waninge A. Examining determinants of lifestyle interventions targeting persons with intellectual disabilities supported by healthcare organizations: Usability of the Measurement Instrument for Determinants of Innovations. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:913-931. [PMID: 30950177 DOI: 10.1111/jar.12583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to complex processes of implementation of innovations aimed at persons with intellectual disabilities in healthcare organizations, lifestyle interventions are not used as intended or not used at all. In order to provide insight into determinants influencing this implementation, this study aims to ascertain if the Measurement Instrument for Determinants of Innovations (MIDI) is useful for objectively evaluating implementation. METHOD With semi-structured interviews, data concerning determinants of implementation of lifestyle interventions were aggregated. These data were compared to the determinants questioned in the MIDI. Adaptations to the MIDI were made in consultation with the author of the MIDI. RESULTS All determinants of the MIDI, except for that concerning legislation and regulations, were represented in the interview data. Determinants not represented in the MIDI were the level of intellectual disabilities, suitability of materials and physical environment, multi-levelness of interventions and several persons who could be involved in the intervention, such as direct support persons (DSPs), a therapist or family, and the communication between these involved persons. CONCLUSION The present authors suggested making adjustments to existing questions of the MIDI in order to improve usability for deployment in organizations that provide care to persons with intellectual disabilities. The adjustments need to be tested with other interventions.
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Affiliation(s)
- Henderika A Steenbergen
- Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Brenda I de Jong
- Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Margot A H Fleuren
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cees P van der Schans
- Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Aly Waninge
- Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
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20
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Nau T, Nolan G, Smith BJ. Enhancing Engagement With Socially Disadvantaged Older People in Organized Physical Activity Programs. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 39:257-267. [PMID: 30638424 DOI: 10.1177/0272684x18821301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Participation in physical activity (PA) is low among older adults in developed nations and even lower among several socially disadvantaged groups. This study aimed to identify the actions that can be taken in the promotion, design, and implementation of organized PA programs to improve engagement with socially disadvantaged and underrepresented older people. Research design and methods: Semistructured interviews were conducted with 30 community service providers and 5 focus groups with 42 older participants in existing PA programs. Data were analyzed thematically, and the PRECEDE-PROCEED model for program planning was used to broadly categorize themes. Results: Helpful strategies for addressing predisposing factors such as social anxiety and lack of confidence included user-centered program design and sensitive, informative messaging and promotion. Key enabling strategies were transport assistance and minimizing fees. Facilitating gentle entry to groups and fostering inclusion and safety were identified as valuable reinforcing strategies. Providers regarded organizational networks as beneficial for facilitating referral and addressing resource constraints. Discussion and implications: A multifactorial approach addressing a range of predisposing, reinforcing, and enabling factors is likely to be necessary to enhance engagement in organized PA by socially disadvantaged and underrepresented older people. Key factors relate to creating a positive sociocultural environment, identifying activities of interest, and enhancing ease of access.
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Affiliation(s)
- Tracy Nau
- 1 Sydney School of Public Health, University of Sydney, Australia
| | | | - Ben J Smith
- 1 Sydney School of Public Health, University of Sydney, Australia.,3 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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21
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Sandjojo J, Gebhardt WA, Zedlitz AM, Hoekman J, den Haan JA, Evers AW. Promoting Independence of People with Intellectual Disabilities: A Focus Group Study Perspectives from People with Intellectual Disabilities, Legal Representatives, and Support Staff. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Janice Sandjojo
- Leiden University; Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden The Netherlands
- Leiden University; Leiden Institute for Brain and Cognition (LIBC); Leiden The Netherlands
- Raamwerk, Noordwijkerhout; The Netherlands
| | - Winifred A. Gebhardt
- Leiden University; Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden The Netherlands
- Leiden University; Leiden Institute for Brain and Cognition (LIBC); Leiden The Netherlands
| | - Aglaia M.E.E. Zedlitz
- Leiden University; Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden The Netherlands
- Leiden University; Leiden Institute for Brain and Cognition (LIBC); Leiden The Netherlands
| | - Joop Hoekman
- Leiden University; Institute of Education and Child Studies, Clinical Child and Adolescent Studies; Leiden The Netherlands
| | | | - Andrea W.M. Evers
- Leiden University; Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden The Netherlands
- Leiden University; Leiden Institute for Brain and Cognition (LIBC); Leiden The Netherlands
- Leiden University Medical Center; Department of Psychiatry; Leiden The Netherlands
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22
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Elinder LS, Sundblom E, Zeebari Z, Bergström H. Effect and Process Evaluation of a Structural Health Intervention in Community Residences for Adults With Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Elinor Sundblom
- Department of Public Health Sciences; Karolinska Institutet; Solna Sweden
| | - Zangin Zeebari
- Department of Public Health Sciences; Karolinska Institutet; Solna Sweden
| | - Helena Bergström
- Department of Public Health Sciences; Karolinska Institutet; Solna Sweden
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Salomon C, Bellamy J, Evans E, Reid R, Hsu M, Teasdale S, Trollor J. 'Get Healthy!' A physical activity and nutrition program for older adults with intellectual disability: pilot study protocol. Pilot Feasibility Stud 2018; 4:144. [PMID: 30151237 PMCID: PMC6109457 DOI: 10.1186/s40814-018-0333-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/12/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older adults with intellectual disability have high rates of lifestyle-related illness yet remain poorly engaged in physical activity and nutrition interventions. There is a need to clarify what types of healthy lifestyle interventions are feasible and effective to implement in this population and how outcome measures can best be tracked. This paper describes the pilot feasibility study protocol for implementing a 12-week physical activity and healthy eating program, 'Get Healthy!' with older adults with intellectual disability. METHODS The primary study aims are to assess the feasibility of implementing and monitoring the 'Get Healthy!' program with adults with mild to moderate intellectual disability, aged 40 years and over, and their carers. Secondary study aims are to assess the impact of the intervention across the following parametres: body mass index, waist circumference, cardiovascular fitness, physical activity (amount and intensity) and sedentary behaviours, resting blood pressure, functional strength/capacity, dietary intake (energy intake, food group consumption and diet quality), dietary and physical activity knowledge, and quality of life. Between 8 and 10 participants in total will be recruited into the 12-week program that will be run in metropolitan NSW, Australia. A combination of objective and subjective measures will be used to assess program feasibility and impact at set timepoints (baseline, mid and end-program). DISCUSSION Results from the feasibility pilot will be used to refine the study methodology and 'Get Healthy!' program content for future use in a sufficiently powered trial. Findings may be of interest to a broad range of disability and allied health workers engaged in supporting and monitoring healthy lifestyle change in adults with intellectual disability. TRIAL REGISTRATION ACTRN: ACTRN12618000349246. Registered March 8, 2018- Retrospectively registered, UTN: U1111-1209-3132.
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Affiliation(s)
- Carmela Salomon
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
| | - Jessica Bellamy
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
- Department of Exercise Physiology, School of Medical Sciences, Wallace Wurth Level 2, UNSW Sydney, Sydney, 2052 Australia
| | - Elizabeth Evans
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
| | - Renae Reid
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
| | - Michelle Hsu
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, 2006 Australia
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, 26 Llandaff Street, Bondi Junction, 2022 Australia
- School of Psychiatry, UNSW, Hospital Road, Randwick, 2013 Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
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Williams F, Kouimtsidis C, Baldacchino A. Alcohol use disorders in people with intellectual disability. BJPSYCH ADVANCES 2018. [DOI: 10.1192/bja.2017.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThis article initially highlights that although the prevalence of alcohol use disorders in people with intellectual disability (PWID) appears to be low, it is a significant issue. This group can be more vulnerable to the adverse effects of alcohol and it is likely that many PWID who have alcohol use disorders are not being identified. We go on to review the limited existing literature on treatment for PWID who have alcohol use disorders and the challenges in meeting the needs of this patient group. We explore how assessment and treatment of alcohol use disorders in this population can be and needs to be tailored to the needs of PWID on an individual basis. There is also discussion about the use of incapacity legislation to treat this group.LEARNING OBJECTIVES•Be aware that alcohol use disorders can be especially problematic for PWID, that such disorders can often go undetected and that adapted screening techniques may be needed to identify such problems•Understand the difficulties that this population has in accessing addiction services and that successful management of PWID who misuse alcohol is usually dependent on appropriate joint working between intellectual disability and addiction services•Be aware that PWID are not a homogeneous group, rather they vary widely in their abilities, necessitating interventions tailored to the individual, and that the use of compulsory measures to manage PWID who lack capacity regarding to their alcohol use should be done with cautionDECLARATION OF INTERESTNone.
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House A, Latchford G, Russell AM, Bryant L, Wright J, Graham E, Stansfield A, Ajjan R. Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability. Pilot Feasibility Stud 2018; 4:106. [PMID: 29862037 PMCID: PMC5975532 DOI: 10.1186/s40814-018-0291-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. METHODS In five steps, we:Clarified the principles of supported self-management as reported in the published literatureIdentified the barriers to effective self-management of type 2 diabetes in adults with a learning disabilityReviewed existing materials that aim to support self-management of diabetes for people with a learning disabilitySynthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to themImplemented and field tested the intervention. RESULTS The final intervention had four standardised components: (1) establishing the participant's daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals.Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions.Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. CONCLUSIONS The intervention was feasible to deliver and, as judged by participation and engagement, acceptable to participants and those who supported them. TRIAL REGISTRATION Current Controlled Trials ISRCTN41897033 (registered 21/01/2013).
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amy M. Russell
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Louise Bryant
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Elizabeth Graham
- Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | | | - Ramzi Ajjan
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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Bossink LWM, van der Putten AA, Vlaskamp C. Understanding low levels of physical activity in people with intellectual disabilities: A systematic review to identify barriers and facilitators. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 68:95-110. [PMID: 28750208 DOI: 10.1016/j.ridd.2017.06.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) undertake extremely low levels of physical activity. AIMS To enhance understanding concerning low levels of physical activity in people with ID, this study has three aims: (1) to identify barriers to and facilitators of physical activity in people with ID; (2) to examine differences in barriers and facilitators between levels of ID (mild, moderate, severe, and profound); (3) to examine differences in barriers and facilitators between various stakeholder groups. METHODS AND PROCEDURES A systematic search was performed using the following databases from the year 1990: MEDLINE, ERIC, and PsycINFO. The studies included were peer reviewed, available as full text, and written in English, addressing barriers to and facilitators of physical activity in people with ID. The quality of the studies was assessed using existing critical review forms. All studies were subjected to qualitative synthesis to identify and compare barriers and facilitators. OUTCOMES AND RESULTS In all, 24 studies were retrieved, describing 14 personal and 23 environmental barriers and/or facilitators. The quality of the studies varied, particularly for qualitative studies. Only two studies included people with severe or profound ID. Stakeholder groups tend to identify barriers outside their own responsibility. CONCLUSIONS AND IMPLICATIONS Results reveal a broad range of barriers and facilitators, but not for people with more severe ID. Further research should also examine these factors among stakeholders responsible for providing support.
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Affiliation(s)
- L W M Bossink
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, Netherlands.
| | - Annette Aj van der Putten
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, Netherlands
| | - Carla Vlaskamp
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, Netherlands
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O'Leary L, Taggart L, Cousins W. Healthy lifestyle behaviours for people with intellectual disabilities: An exploration of organizational barriers and enablers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:122-135. [DOI: 10.1111/jar.12396] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Lisa O'Leary
- Scottish Learning Disabilities Observatory, Academic Unit for Mental Health & Wellbeing; Gartnavel Royal Hospital, University of Glasgow; Glasgow UK
| | - Laurence Taggart
- Institute of Nursing and Health Research; School of Nursing, Ulster University, Jordanstown Campus; Newtownabbey Northern Ireland UK
| | - Wendy Cousins
- Institute of Nursing and Health Research; School of Nursing, Ulster University, Jordanstown Campus; Newtownabbey Northern Ireland UK
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Swerts C, Vandevelde S, VanDerNagel JEL, Vanderplasschen W, Claes C, De Maeyer J. Substance use among individuals with intellectual disabilities living independently in Flanders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 63:107-117. [PMID: 27061044 DOI: 10.1016/j.ridd.2016.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Over the past decades, there has been increased scientific and clinical interest in substance use among individuals with intellectual disabilities (ID). Despite raised interest and awareness in the topic, lack of supportive data on prevalence and risk factors highlights the need for ongoing research. The aims of this cross-sectional multicenter study were to examine the nature and extent of substance use in individuals with ID living independently, to investigate group differences in substance use and related problems, and to explore the role of substance-related knowledge and attitudes in substance use behaviors. METHOD Participants were 123 individuals with mild to moderate ID receiving support from independent living services. Data were gathered by means of a structured interview strategy (i.e. the Substance Use and Misuse in Intellectual Disability-Questionnaire; SumID-Q). RESULTS Findings revealed that rates of lifetime use of licit and illicit substances were higher than those found in earlier studies among individuals with ID and the general population. While cannabis use was the only illicit substance reported, current tobacco and alcohol use were shown to be highly prevalent (48%-45.5%). Rates for the latter were similar to earlier studies among community samples of individuals with ID. In contrast to our hypotheses, few group differences in substance use behaviors were observed. Male gender was associated with age of onset of alcohol and tobacco use and tobacco use-related problems, while younger age was found to be associated with lifetime use of cannabis. No evidence was found regarding the role of knowledge; however, smokers and alcohol users rated tobacco and alcohol use more positively. CONCLUSION This study demonstrated that individuals with ID living independently use a wide range of licit and illicit substances and present divergent levels and patterns of substance use. Notwithstanding the role of personal choice in substance use, more research is needed to better understand the nature and extent of substance use and related problems, as well as the role of substance-related knowledge and attitudes in individuals with ID.
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Affiliation(s)
- Chris Swerts
- University College Ghent, Faculty of Education, Health and Social Work, Department of Orthopedagogy-Special Education, Centre of Expertise E-QUAL, Valentin Vaerwyckweg 1, 9000 Ghent, Belgium.
| | - Stijn Vandevelde
- Ghent University, Department of Special Needs Education, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Joanneke E L VanDerNagel
- Tactus Addiction Treatment, Raiffeisenstraat 75, 7514 AM Enschede, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University Nijmegen, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands; Aveleijn, Grotestraat 260, 7622 GW Borne, The Netherlands
| | - Wouter Vanderplasschen
- Ghent University, Department of Special Needs Education, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Claudia Claes
- University College Ghent, Faculty of Education, Health and Social Work, Department of Orthopedagogy-Special Education, Centre of Expertise E-QUAL, Valentin Vaerwyckweg 1, 9000 Ghent, Belgium; Ghent University, Department of Special Needs Education, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Jessica De Maeyer
- University College Ghent, Faculty of Education, Health and Social Work, Department of Orthopedagogy-Special Education, Centre of Expertise E-QUAL, Valentin Vaerwyckweg 1, 9000 Ghent, Belgium
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Melville CA, Oppewal A, Schäfer Elinder L, Freiberger E, Guerra-Balic M, Hilgenkamp TIM, Einarsson I, Izquierdo-Gómez RH, Sansano-Nadal O, Rintala P, Cuesta-Vargas A, Giné-Garriga M. Definitions, measurement and prevalence of sedentary behaviour in adults with intellectual disabilities - A systematic review. Prev Med 2017; 97:62-71. [PMID: 28057512 DOI: 10.1016/j.ypmed.2016.12.052] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/28/2016] [Accepted: 12/30/2016] [Indexed: 11/17/2022]
Abstract
Supporting positive change in lifestyle behaviours is a priority in tackling the health inequalities experienced by adults with intellectual disabilities. In this systematic review, we examine the evidence on the definition, measurement and epidemiology of sedentary behaviour of adults with intellectual disabilities. A systematic literature search of PUBMED, EMBASE, MEDLINE and Google Scholar was performed to identify studies published from 1990 up to October 2015. Nineteen papers met the criteria for inclusion in the systematic review. Many researchers do not distinguish between insufficient physical activity and sedentary behaviour. None of the studies reported the reliability and validity of the methods used to measure sedentary behaviour. Sedentary time, assessed objectively, ranged from 522 to 643min/day: higher than in adults without intellectual disabilities. This first-ever review of sedentary behaviour and intellectual disabilities found that at present the evidence base is weak. Studies calibrating accelerometer data with criterion measures for sedentary behaviour are needed to determine specific cut-off points to measure sedentary behaviour in adults with intellectual disabilities. Researchers should also examine the reliability and validity of using proxy-report questionnaires to measure sedentary behaviour in this group. A better understanding of sedentary behaviour will inform the design of novel interventions to change lifestyle behaviours of adults with intellectual disabilities.
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Affiliation(s)
| | - Alyt Oppewal
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | - Ellen Freiberger
- Institute for Biomedicine of Ageing, FAU Erlangen-Nürnberg, Germany
| | - Myriam Guerra-Balic
- Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, Spain
| | - Thessa I M Hilgenkamp
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ingi Einarsson
- School of Science and Engineering, University of Reykjavik, Iceland
| | | | - Oriol Sansano-Nadal
- Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, Spain
| | - Pauli Rintala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Finland
| | | | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, Spain
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Willems M, Hilgenkamp TIM, Havik E, Waninge A, Melville CA. Use of behaviour change techniques in lifestyle change interventions for people with intellectual disabilities: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:256-268. [PMID: 28341236 DOI: 10.1016/j.ridd.2016.10.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/03/2016] [Accepted: 10/16/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) experience more health problems and have different lifestyle change needs, compared with the general population. AIMS To improve lifestyle change interventions for people with ID, this review examined how behaviour change techniques (BCTs) were applied in interventions aimed at physical activity, nutrition or physical activity and nutrition, and described their quality. METHODS AND PROCEDURES After a broad search and detailed selection process, 45 studies were included in the review. For coding BCTs, the CALO-RE taxonomy was used. To assess the quality of the interventions, the Physiotherapy Evidence Database (PEDro) scale was used. Extracted data included general study characteristics and intervention characteristics. OUTCOMES AND RESULTS All interventions used BCTs, although theory-driven BCTs were rarely used. The most frequently used BCTs were 'provide information on consequences of behaviour in general' and 'plan social support/social change'. Most studies were of low quality and a theoretical framework was often missing. CONCLUSION AND IMPLICATIONS This review shows that BCTs are frequently applied in lifestyle change interventions. To further improve effectiveness, these lifestyle change interventions could benefit from using a theoretical framework, a detailed intervention description and an appropriate and reliable intervention design which is tailored to people with ID.
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Affiliation(s)
- Mariël Willems
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanzehogeschool Groningen, P.O. Box 3109, 9701 DC Groningen, The Netherlands.
| | - Thessa I M Hilgenkamp
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Else Havik
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanzehogeschool Groningen, P.O. Box 3109, 9701 DC Groningen, The Netherlands
| | - Aly Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanzehogeschool Groningen, P.O. Box 3109, 9701 DC Groningen, The Netherlands
| | - Craig A Melville
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
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31
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Skorpen S, Nicolaisen M, Langballe EM. Hospitalisation in adults with intellectual disabilities compared with the general population in Norway. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:365-377. [PMID: 26915087 DOI: 10.1111/jir.12255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 10/16/2015] [Accepted: 12/02/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Previous studies have found that adults with intellectual disabilities (ID) are hospitalised more often than the general population (GP). This study investigates hospital discharge rates and main diagnostic causes for hospitalisation among administratively defined people with ID compared with the GP in Norway. METHOD Data from the Norwegian Labour and Welfare Service was combined with data from the Norwegian Patient Register (Ntotal = 1 764 072 and NID = 7573) for the period 2008-2011. Data from a Norwegian patient report generator and Statistics Norway are also analysed. RESULTS During the study period, 11% of people with ID and 11.5% of the GP were admitted to hospitals. The length of the average hospital stay was just over 4 days for both groups. Among those who were hospitalised, the majority were only admitted to hospital once during the study period: ID 66% and GP 70%. People with ID were admitted somewhat more often than people in the GP. Contrary to the GP, adults with ID were more frequently hospitalised at a younger age and less frequently at old age. The most common International Classification of Diseases diagnostic group for hospitalisation among people with ID is injury, poisoning and certain other consequences of external causes, whereas for the GP, it is diseases of the circulatory system. CONCLUSION This study finds that the proportion of people being hospitalised per year is statistically, but only slightly, different among adult people with ID and the GP. The results must be interpreted in light of the organisation of the health care system in Norway.
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Affiliation(s)
- S Skorpen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway
| | - M Nicolaisen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - E M Langballe
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Norway
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Kuijken NMJ, Naaldenberg J, Nijhuis-van der Sanden MW, van Schrojenstein-Lantman de Valk HMJ. Healthy living according to adults with intellectual disabilities: towards tailoring health promotion initiatives. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:228-241. [PMID: 26625732 DOI: 10.1111/jir.12243] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND A healthy lifestyle can prevent several health problems experienced by adults with intellectual disabilities (ID). For the development of effective and usable health promoting interventions for people with ID, the perspective of the intended audience should be taken into account. The aim of this qualitative study was to gain insight into the perspectives of people with mild to moderate ID on healthy living. METHOD Qualitative study. Five semi-structured focus groups were conducted with a total of 21 adults with mild to moderate ID in the Netherlands. Discussions focused on three main themes: (1) perceptions of own health, (2) what participants consider as healthy living and (3) factors experienced to be related to the ability to live healthily. Interviews were analysed thematically resulting in two main domains: (1) perceptions of what is healthy and unhealthy and (2) factors that participants experience to be related to their ability to live healthily. RESULTS For participants, healthy living entails more than healthy food and exercising: feeling healthy, happiness and level of independence are perceived as important as well. Factors experienced to relate to their ability to live healthily were (a lack of) motivation, support from others and environmental factors such as available health education, (a lack of) facilities and a(n) (dis)advantageous location of work or residence. CONCLUSIONS This qualitative study shows that adults with mild to moderate ID have a good understanding of what being healthy and living healthily constitute. As they face several difficulties in their attempts to live healthily, existing health promotion programmes for people with ID must be tailored to individual preferences and motivations and adapted for individual physical disabilities. Moreover, because of their dependency on others, tailoring should also be focused on the resources and hindering factors in their physical and social environment.
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Affiliation(s)
- N M J Kuijken
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - J Naaldenberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - M W Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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Feldman MA, Owen F, Andrews AE, Tahir M, Barber R, Griffiths D. Randomized Control Trial of the 3Rs Health Knowledge Training Program for Persons with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:278-88. [DOI: 10.1111/jar.12186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Maurice A. Feldman
- Centre for Applied Disability Studies; Brock University; St. Catharines ON Canada
| | - Frances Owen
- Department of Child and Youth Studies; Centre for Applied Disability Studies; Brock University; St. Catharines ON Canada
| | - Amy E. Andrews
- 3Rs Community-University Research Alliance; Community LivingWelland-Pelham; Welland ON Canada
| | - Munazza Tahir
- Centre for Applied Disability Studies; Brock University; St. Catharines ON Canada
| | - Rachel Barber
- Centre for Applied Disability Studies; Brock University; St. Catharines ON Canada
| | - Dorothy Griffiths
- Department of Child and Youth Studies; Centre for Applied Disability Studies; Brock University; St. Catharines ON Canada
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Hartman E, Smith J, Westendorp M, Visscher C. Development of physical fitness in children with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:439-449. [PMID: 24953003 DOI: 10.1111/jir.12142] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Few studies examined the development of physical fitness in children and youth with intellectual disabilities (ID), but the developmental patterns of physical fitness are largely unknown. The first aim was to examine physical fitness of primary school children with ID, aged 8-12, and compare the results with typically developing children in order to determine the performance level of children with ID. The second aim was to investigate the developmental trajectory of physical fitness in children with ID and the possible influence of gender and severity of cognitive impairment in a 4-year during longitudinal study. METHOD Seventy-three children with borderline or mild ID (51 boys, 22 girls; age range 8-11 in the year of enrolment) were measured annually on running speed, aerobic endurance (cardiovascular endurance), explosive strength, handgrip strength and trunk strength. Physical fitness scores of 515 typically developing children (266 boys, 249 girls; age range 8-12) were collected for reference values. RESULTS The results indicated statistically significant differences (with moderate to large Effect Sizes) between children with ID and typically developing children in all ages, favouring the typically developing children, and showed that the gap remained stable across the ages or decreased with increasing age. Multilevel models showed that the children with ID developed statistically significant on all items of physical fitness between age 8 and age 12. There was no statistically significant effect of gender on physical fitness, and the developmental trajectories were similar for boys and girls. For children with borderline and mild ID the developmental trajectories were parallel, but children with mild ID scored statistically significant worse on running speed, explosive strength and handgrip strength. CONCLUSIONS Despite statistically significant development of physical fitness in children with ID, their physical fitness levels should be stimulated. This should start already in young children (<8 years) and the children with the most severe cognitive impairments need special attention.
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Affiliation(s)
- E Hartman
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Spanos D, Hankey CR, Melville CA. The Effectiveness of a Weight Maintenance Intervention for Adults with Intellectual Disabilities and Obesity: A Single Stranded Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:317-29. [PMID: 25916495 DOI: 10.1111/jar.12181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5). MATERIALS AND METHODS Thirty-one participants who had completed the 16 week TAKE five weight loss intervention (Phase I) were invited to participate in a 12 month weight maintenance intervention (Phase II). Content included recommendations of the National Weight Control Registry. RESULTS Twenty-eight participants completed Phase II with 50.4% maintaining their weight (mean weight change -0.5 kg, SD 2.2), 28.7% gaining weight (mean weight gain 5.4 kg, SD 2.2) and 21.6% losing weight (mean weight loss -8.0 kg, SD 3.0) at 12 months. CONCLUSION Further research is justified to investigate the efficacy of weight loss maintenance interventions in adults with intellectual disability and obesity, using controlled study designs.
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Affiliation(s)
- Dimitrios Spanos
- Institute of Mental Health & Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Catherine R Hankey
- College of Medical, Veterinary and Medical and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Craig A Melville
- Institute of Mental Health & Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Blick RN, Saad AE, Goreczny AJ, Roman K, Sorensen CH. Effects of declared levels of physical activity on quality of life of individuals with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 37:223-229. [PMID: 25528082 DOI: 10.1016/j.ridd.2014.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/28/2014] [Indexed: 06/04/2023]
Abstract
Routine physical fitness improves health and psychosocial well-being of individuals with intellectual and developmental disabilities. The current study investigated impact of physical fitness on quality of life by comparing individuals who maintain a physically active lifestyle with those who do not report exercising. We assessed several indicators of quality of life, including inclusion and community participation; satisfaction with professional services, home life, and day activities; dignity, rights, and respect received from others; fear; choice and control; and family satisfaction. Our data suggested that individuals who regularly exercise reported having more frequent outings into the community than did their peers who reported exercising infrequently; regular exercisers were also more likely to live in intermediate care facilities (ICF) as opposed to living independently or with family members. We discuss possible reasons for this as well as ideas for future research needed to expand on this area.
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