Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis

Long-term health conditions and UK labour market outcomes during the COVID-19 pandemic

BACKGROUND

Long-term health conditions can affect labour market outcomes. COVID-19 may have increased labour market inequalities, e.g. due to restricted opportunities for clinically vulnerable people. Evaluating COVID-19's impact could help target support.

AIM

To quantify the effect of several long-term conditions on UK labour market outcomes during the COVID-19 pandemic and compare them to pre-pandemic outcomes.

METHODS

The Understanding Society COVID-19 survey collected responses from around 20,000 UK residents in nine waves from April 2020-September 2021. Participants employed in January/February 2020 with a variety of long-term conditions were matched with people without the condition but with similar baseline characteristics. Models estimated probability of employment, hours worked and earnings. We compared these results with results from a two-year pre-pandemic period. We also modelled probability of furlough and home-working frequency during COVID-19.

RESULTS

Most conditions (asthma, arthritis, emotional/nervous/psychiatric problems, vascular/pulmonary/liver conditions, epilepsy) were associated with reduced employment probability and/or hours worked during COVID-19, but not pre-pandemic. Furlough was more likely for people with pulmonary conditions. People with arthritis and cancer were slower to return to in-person working. Few effects were seen for earnings.

CONCLUSION

COVID-19 had a disproportionate impact on people with long-term conditions' labour market outcomes.

Gender Diversity, Disability, and Well-Being: Impact of Delayed and Foregone Care Because of COVID-19

Purpose: This study explored the impact of delayed and foregone care due to COVID-19 on well-being among disabled and gender diverse adults. Methods: Using data from the 2021 National Survey on Health and Disability and logistic regression modeling we assessed the impact of delayed or foregone care due to COVID-19 on well-being among disabled people (n = 1638), with comparisons between cisgender (n = 1538) and gender diverse (n = 100) people with disabilities. We report odds ratios (OR) and confidence intervals (CI). Results: Disabled people reported high rates of delayed (79.36%) and foregone (67.83%) care and subsequent negative effects on well-being (72.07%). Gender diverse disabled people were over four times more likely to have delayed any care (OR 4.45, 95% CI 1.86-10.77) and three times more likely to have foregone any care (OR 3.14, 95% CI 1.71-5.79) due to COVID-19 compared to cisgender disabled people. They were three times more likely to report any negative impact on their health and well-being because of delayed and foregone care (OR 2.78, 95% CI 1.43-5.39). Conclusion: The COVID-19 pandemic affected the health care utilization of disabled people, resulting in high rates of delayed care, foregone care, and negative impacts on well-being. These effects were intensified at the intersection of disability and marginalized gender identity, with gender diverse disabled people having higher odds of delayed and foregone care and negative effects on well-being, including physical health, mental health, pain levels, and overall level of functioning.

"We're stronger as a family": Family experiences and relationships in an adapted physical activity camp

Adapted recreation programs involving the entire family may offer ways to enhance relationships in families with a child living with a disability because they enable participating together in new and potentially empowering experiences. This study examined family members' perspectives on their lived experiences with their relationships within their family and how they perceived they were affected by their participation in an adapted summer camp for families with a child living with a disability. We conducted a collective case study with five families who participated in a week-long camp. A focus group was conducted with each family and analyzed using reflexive thematic analysis. Participation in the camp impacted family relationships by reducing isolation for mothers; alleviating stress and anxiety which helped families bond; providing shared experience which led to mutual understanding, communication, and support; improving independence and confidence of the child living with a disability; facilitating sibling bonding and parent comfort with giving siblings more responsibility; and enhancing families' confidence to participate in family activities beyond the camp. These findings elucidate how participation in this type of program can impact relationships in families that include a child living with a disability and inform future program design.

COVID-19 pandemic among adults with intellectual disabilities: Implementing a social model of disability in crisis and trauma situations

A growing body of evidence has attested to the higher impact of COVID-19 on individuals with intellectual disabilities (IDs) than on members of the general population during the pandemic, mainly showing their higher vulnerability. However, we believe it is important to better understand how their situation interacts with the specific circumstances of the pandemic. In this article we discuss recent findings regarding individuals with IDs through the lens of two theories - the social disability model and the ecological model of trauma and recovery - and propose an integration, namely a social model of disability in crisis and trauma situations. Such a model allows for a wider perspective on understanding the way people living with disabilities (PLWDs) cope in these situations, integrating the individual aspects of coping with the social and environmental ones.

Impact of COVID-19 Pandemic on People with Locomotor Disability in North India: A Cross-Sectional Analysis

OBJECTIVE

To assess, analyse, and infer the impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with locomotor disability in North India.

METHODS

Patients with locomotor disabilities who met the inclusion criteria received a questionnaire that had already undergone testing and validation. It covered topics highlighting the effect of the pandemic on general health, financial burden, psychological and mental health, social life and behaviour, disability and comorbidity management, transportation, and healthcare accessibility during the pandemic. In order to gauge the pandemic's effects on the population of people with locomotor disabilities, the answers to the questions were collected and analyzed.

RESULTS

The COVID-19 pandemic has adversely affected people living with locomotor disability, ranging from loss of wages and financial crisis to anxiety, depression and lack of sleep. People with disabilities had limited reach to health and community services that were vital for them, including basic life and functional needs, besides risks of mistreatment and other psychological consequences.

CONCLUSION

This analysis suggests that the root cause of pandemic disparities is the lack of disability-inclusive planning and, more significantly, the pre-existing socioeconomic disparities and challenges that disabled people have been experiencing for a long time. We suggest that unambiguous public health and policy responses should be incorporated, and health, social participation, and socioeconomic disparity causes for disabled people should be addressed in tandem.

Prevalence of Unmet Rehabilitation Needs Among Canadians Living With Long-term Conditions or Disabilities During the First Wave of the COVID-19 Pandemic

OBJECTIVE

We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic.

DESIGN

Cross-sectional survey.

SETTING

Individuals residing in Canada during the first wave of the COVID-19 pandemic.

PARTICIPANTS

Eligible participants were Canadians living with long-term conditions or disabilities, 15 years or older living in 1 of the 10 provinces or 3 territories (n=13,487).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

We defined unmet rehabilitation needs as those who reported needing rehabilitation (ie, physiotherapy/massage therapy/chiropractic, speech, or occupational therapy, counseling services, support groups) but did not receive it because of the COVID-19 pandemic. We calculated the national, age, gender, and province/territory-specific prevalence and 95% confidence interval of unmet rehabilitation needs.

RESULTS

During the first wave of the pandemic, the prevalence of unmet rehabilitation needs among Canadians with long-term conditions or disabilities was 49.3% (95% confidence interval [CI]; 48.3, 50.3]). The age-specific prevalence was higher among individuals 15-49 years old (55.6%; 95% CI [54.2, 57.1]) than those 50 years and older (46.0%; 95% CI [44.5, 47.4]). Females (53.7%; 95% CI [52.6, 54.9]) had higher unmet needs than males (44.1%; 95% CI [42.3, 45.9]). Unmet rehabilitation needs varied across provinces and territories.

CONCLUSIONS

In this sample, almost 50% of Canadians living with long-term conditions or disabilities had unmet rehabilitation needs during the first wave of the COVID-19 pandemic. This suggests that a significant gap between the needs for and delivery of rehabilitation care existed during the early phase of the pandemic.

The experiences and impact of the COVID-19 pandemic on young carers: practice implications and planning for future health emergencies

BACKGROUND

Young carers are children or young people aged up to 25 years old who undertake unpaid caring responsibilities for a friend or family member. Young carers faced significant challenges brought on by the COVID-19 pandemic. We explored the impact of the pandemic and associated restrictions on mental health, wellbeing and access to support in young carers in the United Kingdom (UK) to understand how to improve services, as well as support this population in future health emergencies.

METHOD

We conducted 22 qualitative semi-structured interviews from May to November 2021 with 14 young carers and eight staff working in organisations that supported them. Interviews took place remotely over video or telephone call and explored participant experiences of the pandemic and its impact on their health, wellbeing and caring responsibilities. We used reflexive thematic analysis to analyse interview transcripts.

RESULTS

We identified four overarching themes pertaining to the impact of the pandemic and associated restrictions on mental health, wellbeing and access to support in young carers in the UK: (1) challenges in protecting loved ones from the virus, (2) changes to and loss of routine, (3) reduced access to pre-pandemic informal and formal support structures and (4) better understanding of inner resilience and goals. Many participants struggled with their mental health and wellbeing as a result of pandemic related restrictions which impacted on support structures for themselves and the individual they cared for. However, positive impacts pertained to additional support provided by local authority and third sector organisations.

CONCLUSIONS

Our findings highlight some of the changes that affected young carers during the COVID-19 pandemic. The impact of changes to routine and a reduction in pre-pandemic support were the greatest concerns reported by participants in this study. The additional support provided by local authority and third sector organisations during social restrictions suggests such organisations could play a greater role in supporting this population going forward and that schools and Governments may wish to put in additional strategies and provisions to protect young carers in the future.

Disability inclusion in African health systems' responses during COVID-19: A scoping review

Background

People with disabilities often experience poorer access to healthcare because of multiple barriers even in non-crisis times, especially more so in low- and middle-income countries. The coronavirus disease 2019 (COVID-19) pandemic significantly constrained health systems, thus exacerbating access barriers. African health system responses to, and considerations made for people with disabilities during the pandemic have not been adequately examined to inform future inclusive practices during emergent and non-emergent periods.

Objectives

This review aimed to explore disability considerations and accommodations included by African governments in their health systems' responses during the COVID-19 pandemic.

Method

A scoping review was carried out of peer-reviewed published articles on the Web of Science, Academic Search Premier, MEDLINE, Africa-Wide Info, and CINAHL databases. A desktop search of African government websites for COVID-19 country plans and reports was also conducted. Deductive thematic analysis of included texts was performed to identify disability inclusiveness in the health responses.

Results

Ten peer-reviewed articles and three COVID-19 country plans or reports were included in the review. Data reflected a general finding that included countries that failed to effectively consider and include the healthcare needs of persons with disabilities during the pandemic.

Conclusion

Poor inclusion of persons with disabilities was effected in healthcare systems' responses during COVID-19 in Africa.

Contribution

This article contributed insights about gaps in healthcare systems' responses and highlighted development foci that could improve systems towards greater inclusivity of persons with disabilities' health needs in low- and middle-income countries.

Quality of Life in Adolescents and Young Adults with Cleft Lip and Palate with and Without Speech Therapy During COVID-19

OBJECTIVE

Cleft-related speech concerns can affect the quality of life (QOL) in patients with cleft lip and palate (CLP). During the coronavirus disease 2019 (COVID-19), in-person speech therapy (ST) was restricted due to fear of getting infected. This study aimed to compare QOL in patients with CLP with and without ST during the pandemic.

DESIGN

Cross-sectional Study.

SETTING

CLP team at Tehran University of Medical Sciences (TUMS).

PATIENTS/PARTICIPANTS

Thirty-six CLP subjects with a mean age of 17.33 ± 4 years participated in two groups, including with and without ST. Fifteen subjects had cleft palate only (CPO) and others had CLP.

INTERVENTIONS

ST group received at least 10 ST sessions, and group without ST didn't receive ST during COVID-19.

MAIN OUTCOME MEASURE(S)

A virtual link of demographic and QOL adolescent cleft (QoLAdoCleft) questionnaires were sent to fill out. Results were extracted and transferred to SPSS.

RESULTS

Total and subscales' scores of QoLAdoCleft were lower in ST group than without ST but differences between them weren't statistically significant (P > .05). Furthermore, according to cleft type, there weren't any statistically significant differences in total, physical, and social subscales of QoLAdoCleft (P > .05); however, psychological subscale in CLP had a higher significant score than CPO (P < .05).

CONCLUSIONS

QOL was weak in all patients with CLP, and receiving/not receiving ST couldn't make noticeable differences between them. It seems; COVID-19 pandemic can have an adverse effect on these results. Also, subjects with CLP had weaker psychological than CPO due to negative psychosocial feedback related to Orofacial deformities received from society.

Pre- and Post-COVID-19 Outcomes for Israelis With Intellectual and Developmental Disabilities in the Community

This study is among the first pre-post examinations to explore differences in subjective well-being, adaptive and maladaptive behavior, close relationships, community integration, family members' satisfaction with residential and community living settings, and family contact before and after the COVID-19 outbreak. Participants demonstrated better life satisfaction and adaptive behavior before COVID-19 than after COVID-19. Participants reported closer relationships with family members and peers before COVID-19 and closer relationships with staff members after COVID-19. The findings reveal mixed, although mostly negative, effects of the pandemic on people with intellectual and developmental disabilities in the community in Israel, in accord with extant comparative research.

Telehealth Utilization During the COVID-19 Pandemic Among People With Functional Disabilities in the U.S.: A Preliminary Analysis of National Health Interview Survey 2020 Data

Introduction

Telehealth has been widely promoted and adopted at multiple levels in the U.S. healthcare system during the COVID-19 pandemic. However, this rapid expansion of telehealth services may have further exacerbated health inequities among marginalized groups.

Methods

Using the 2020 National Health Interview Survey, this study compared patterns of telehealth use between people with functional disabilities and people without disabilities during the first year of the pandemic.

Results

In the multivariable-adjusted logistic regression models, respondents with moderate disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.25, 95% CI=1.03, 1.52) and telehealth use, pandemic related (OR=1.43, 95% CI=1.28, 1.60) than people without disabilities. Similarly, respondents with severe disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.46, 95% CI=1.07, 2.00) and telehealth use, pandemic related (OR=2.06, 95% CI=1.72, 2.46). In addition, telehealth use varied by the number of limitations and disability type.

Conclusions

People with functional disabilities were more likely to report telehealth use than people without disabilities. Furthermore, these associations strengthened with increasing disability severity and number of limitations while varying by disability type. Additional studies are warranted to explore ways of providing patient-centered telehealth to responsively meet various healthcare needs of people with functional disabilities and improve their health outcomes.

Impact of the COVID-19 pandemic on community-based brain injury associations across Canada: a cross-sectional survey study

Background

The COVID-19 pandemic created new difficulties for people living with brain injury, their families, and caregivers while amplifying the challenges of community-based associations that support them. We aimed to understand the effects of the pandemic on clients who live with brain injury, as well as on the provision of community brain injury services/programs in Canada.

Methods

Online cross-sectional survey conducted in January 2022. Representatives of brain injury associations across Canada completed the 31 open- and closed-ended questions about meeting clients' needs, addressing public health guidelines, and sustaining the association. Data were analyzed using descriptive statistics (close-ended questions) and qualitative content analysis (open-ended questions).

Results

Of the 45 key representatives from associations in Pacific/Western (40%), Central (56%), and Atlantic Canada (4%), the majority were paid executive directors (67%). Participants reported that the most frequent psychosocial challenges experienced by their clients during the pandemic were social isolation (98%), loneliness (96%), and anxiety (93%). To alleviate these challenges, associations implemented wellness checks and psychosocial support. Most respondents (91%) affirmed that clients faced multiple technological barriers, such as a lack of technological knowledge and financial resources for devices and/or internet. In the open-ended questions, twenty-nine (64%) associations reported providing clients with devices, technology training, and assistance. Regarding public health measures, thirty (67%) respondents reported that clients had challenges understanding and/or following public health guidelines. Forty-two associations (93%) provided tailored information to help clients understand and comply with public health measures. Although associations (67%) received pandemic-related funding from the Canadian government they still struggled with the association's sustainability. Thirty-four (76%) lost funding or financial resources that prevented them from delivering programs or required the use of reserve funds to continue to do so. Only 56% reported receiving sufficient funding to address additional COVID-19-related expenses.

Conclusion

Although the pandemic added further challenges to the sustainability of brain injury associations across Canada, they quickly adapted services/programs to respond to the increasing and varied needs of clients, while complying with protective measures. To ensure community associations' survival it is essential to aptly recognize the vital role played by these associations within the brain injury care continuum.

Deepening Depression in Women Balancing Work-Life Responsibilities and Caregiving during the COVID-19 Pandemic: Findings from Gender-Specific Face-to-Face Street Interviews Conducted in Italy

PURPOSE

This study investigated the impact of the COVID-19 pandemic on mental health, quality of life, and family functioning in a sample of the general female population, exploring difficulties encountered in managing family and work responsibilities and burden of care when taking care of a loved one. This study was, moreover, aimed at investigating factors capable of influencing severe depressive symptomatology in the context of socio-demographics, traumatic events, individual vulnerability, and family functioning.

METHOD

The sampling method used in this research was non-probability sampling. The survey took place during a Hospital Open Weekend (8-10 October 2021) organized by the National Gender Observatory on Women's Health "Fondazione Onda" on the occasion of the World Mental Health Day.

RESULTS

A total of 211 women were interviewed (mean age = 35.6, 53% living alone, more than 15% with financial difficulties, 47% exposed to the 2009 L'Aquila earthquake). More than 50% of the sample reported a higher complexity in managing their lives during the COVID-19 pandemic compared to their previous routine, with no statistically significant differences between working women and non-workers, although the latter obtained higher scores for depressive symptomatology and poorer quality of life. Compared to non-caregivers, female caregivers (22.3%) in charge of the care of loved ones affected by physical (10.9%) or psychiatric disabilities (11.4%) complained of a poorer quality of life, especially in general health perception (p = 0.002), physical function (p = 0.011), role limitations related to physical problems (p = 0.017), bodily pain (p = 0.015), mental health (p = 0.004), and social functioning (p = 0.007). Women caring for people affected by mental disorders seemed to experience a more significant worsening in vitality (p = 0.003) and social functioning (p = 0.005). Approximately 20% of the total sample reported severe depressive symptomatology. Previous access to mental health services (O.R. 10.923; p = 0.000), a low level of education (O.R. 5.410; p = 0.021), and difficulties in management of everyday lives during the COVID-19 pandemic (O.R. 3.598; p = 0.045) were found to be the main variables predictive of severe depressive psychopathology. Old age, good problem-solving skills, and ability to pursue personal goals were identified as protective factors.

CONCLUSIONS

The COVID-19 pandemic underlined the need for support amongst emotionally vulnerable women with pre-existing mental health conditions, partly reflecting the cumulative effects of traumas.

Communication to promote and support physical distancing for COVID-19 prevention and control

BACKGROUND

This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.

OBJECTIVES

To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.

SECONDARY OBJECTIVE

to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.

SEARCH METHODS

We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).

SELECTION CRITERIA

Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.

DATA COLLECTION AND ANALYSIS

Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.

MAIN RESULTS

This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.

AUTHORS' CONCLUSIONS

Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.

Physiotherapists' experiences on assisting physiotherapy users during the COVID-19 pandemic with lockdown measures in Spain

BACKGROUND

Physiotherapists had faced a new healthcare scenario characterised by the restrictions caused by the COVID-19 pandemic.

PURPOSE

To explore the impact of the COVID-19 pandemic on the physiotherapy profession from the perspective of physiotherapists working in the public and private sectors.

METHODS

Qualitative study based on semi-structured personal interviews with 16 physiotherapists working in public, private, or public-private partnership sectors in Spain. The data were collected between March and June 2020. Inductive qualitative content analysis was performed.

RESULTS

The participants (13 women, 3 men; aged 24-44 years) had professional experience in diverse healthcare settings (primary, hospital, home, consultations, insurance companies, associations). Five categories were identified: (1) the impact of lockdown on the health of physiotherapy users; (2) managing the demand for physiotherapy services during lockdown; (3) introducing protocols and protective measures in physiotherapy consultations; (4) changes in therapeutic approaches; and (5) future expectations in the physiotherapy care model. Physiotherapists perceived that lockdown caused a decline in the functionality of people with chronic conditions, together with a reduction in the physiotherapy services. Difficulties in prioritising users considered urgent became evident, and the inclusion of prophylactic measures affected treatment duration differently depending on the care setting and the pandemic prompted the use of telerehabilitation.

DISCUSSION

The pandemic affected the functional status of chronic physiotherapy users and made treatment time, quality of care and triage protocols visible. In physiotherapy, technological barriers need to be solved, such as digital literacy, families without resources, situations of dependency and cultural barriers.

Impact of COVID-19 on Utilisation of Funds by People With Disabilities: Lessons Drawn From the Australian National Disability Insurance Scheme

BACKGROUND

COVID-19 pandemic has affected everyone, especially people with disabilities (PwD). While there has been qualitative research on the impact of the pandemic on PwD in Australia, little quantitative evidence has been produced on the magnitude of this impact.

METHODS

A range of descriptive analytic methods are employed on the data merged from the National Disability Insurance Scheme (NDIS) and COVID-19 data on national, state, and regional levels to compare the expenditure of the NDIS participants who are in pandemic-affected regions and time periods with those that are not. Regression analysis is also performed to estimate the participants' utilisation of funds using explanatory variables drawn from the NDIS, COVID-19, and lockdown policy information.

RESULTS

Our analysis reveals that: (1) the pandemic reduced expenditure of the NDIS participants by approximately A$ 31.2 million, equal to 8.85% of the total expenditure over five quarters for the state of Victoria (VIC) alone; (2) the contractions in expenditure lasted for up to two quarters during the pandemic; (3) the reductions in expenditure were largely associated with the limited mobility imposed via lockdowns compared to the impaired access to services; and (4) the spread of COVID-19 that led to restrictions on mobility of people had a bearing on utilisation of funds by NDIS participants in the subsequent quarter.

CONCLUSION

COVID-19 has affected the expenditure of the PwD in Australia. We overlaid the NDIS data on the COVID-19 outbreaks to estimate the impact of the pandemic on expenditure and utilisation rate of the funds allocated to the NDIS participants. Our findings point to potential policy interventions to mitigate some of the adverse consequences of similar nationwide emergencies.

Influences on reproductive decision-making among forcibly displaced women resettling in high-income countries: a scoping review and thematic analysis

BACKGROUND

Forced displacement impacts the health, rights and safety of women, which is further compounded by gender inequality. In particular, this has consequences for forcibly displaced women's reproductive health once resettled in a new country. To ensure the reproductive health and rights of forcibly displaced women during and after resettlement, there must be careful consideration of their reproductive decision-making taking into account the context and environment of the host country.

AIM

This scoping review aimed to explore the influences on reproductive decision-making among forcibly displaced women resettling in high-income countries.

METHOD

A scoping review was conducted following the PRISMA-ScR for reporting. EBSCO was used to search databases covering global health, health policy, psychology, sociology, and philosophy for articles published from 1 January 2012 to 27 April 2022. Data extracted from each article included author(s), year of publication, publication type, aims/objectives, study design, sampling method, data collection or eligibility criteria, study population (i.e., sample size and characteristics), migration status, country(ies) of origin, host country(ies), key findings and limitations. Two independent reviewers screened all articles against eligibility criteria using Covidence. Data charting and thematic analysis were performed independently by one reviewer.

FINDINGS

Nineteen articles published between 2013 and 2022 mostly conducted in the United States (36.8%) and Australia (21.1%), with the majority reporting on qualitative findings (68.4%), and women from a wide array of countries and cultures (most commonly African countries) were included. Influences on women's reproductive decision-making related to the contexts before displacement, during displacement, and after arrival, with influences on women's reproductive decision-making identified specific to the context. The influences before displacement included conflict; religious beliefs; socio-cultural gendered expectations; and external control over reproductive autonomy. During displacement influences included paternalism and access to education. Influences after arrival included pressure, restriction, coercion; knowledge and misconceptions; patriarchal power dynamics; and seeking empowerment. An adapted socio-ecological model was developed to interpret the findings.

CONCLUSION

This review highlights the complexity and nuances within forcibly displaced women's experiences which influence their reproductive decision-making. Further research may review the evidence base to provide guidance for healthcare professionals and health policies aimed at empowering women to make autonomous reproductive decisions; develop training for healthcare professionals to prevent pressure, restriction and coercion of women's reproductive autonomy; and inform development of policy that takes an intersectional approach to women's health rights and gender equality.

Views on the impact of the COVID-19 pandemic on health in people with Down syndrome from diverse backgrounds

Down syndrome (DS) has a unique medical and psychological profile. To date, few studies have asked individuals with DS about their views of health, and fewer have explored the impact of COVID-19 on the health of individuals with DS and their families. We used a mixed methods approach including two studies on the health of individuals with DS and their parents conducted during the COVID-19 pandemic: (1) eight virtual focus groups, comprised of 20 parents and 8 individuals with DS to obtain participants' views of health, and (2) a 20-item questionnaire on health care experience of patients with DS who are African American or come from primarily Spanish-speaking homes. Focus group transcripts were coded using a hybrid inductive/deductive framework and thematically analyzed using the Framework Method. This questionnaire included questions regarding the impact of COVID-19 on caregivers and their loved ones with DS; responses to these questions were summarized using descriptive statistics. Individuals with DS discussed the impact of the COVID-19 pandemic on their physical and social health including masking, online learning, and online communication with friends and family. Parents of individuals with DS discussed how the COVID-19 pandemic negatively impacted their child's physical, social, and mental health, as a result of virtual schooling and decreased socialization. There were unexpected positives of the pandemic such as improved hygiene and eased scheduling with telehealth visits. Caregivers noted COVID-19 impacted their own anxiety, employment, and other domains that have potential ripple effects on the health of their children. The COVID-19 pandemic had a pervasive impact on the mental health and wellness of caregivers as well as the physical, social, and mental health of individuals with DS.

Care coordination of children with neurodevelopmental disabilities and medical complexity during the COVID-19 pandemic: Caregiver experiences

BACKGROUND

The COVID-19 pandemic and subsequent public health restrictions created significant challenges for children with neurodevelopmental disabilities with medical complexity and their caregivers including restrictions in care coordination for children and their families. Care coordination enhances families' skills in accessing and coordinating medical, education and disability care across sectors and systems.

OBJECTIVE

This study examined the implications of pandemic restrictions on care coordination from caregiver perspectives. These experiences can inform emergency preparedness planning and recovery strategies.

METHOD

A qualitative descriptive design was utilized to explore and describe the experience of caregivers of children with neurodevelopmental disabilities and medical complexity. Nineteen caregivers were interviewed about their experience with care coordination during the pandemic.

FINDINGS

Caregiver experiences of care coordination during the pandemic highlighted the importance of care coordination during a public health emergency. Two themes emerged: (1) disruptions to care coordination from initial COVID-19 restrictions leading to lack of access to supports and services, increasing level of need, and impacts of disruption for caregivers and children; and (2) adaptation and responsiveness to COVID-19 restrictions by advocating for families and managing uncertainties.

RECOMMENDATIONS

Recommendations include recognition of care coordination as a protective factor, designation as an essential service and sustained or increased funding for care coordination during emergencies. Families should be engaged in identifying care needs during care coordination, including during public health emergencies.

Quality of Physical Activity Participation Among Adults with Disabilities Through Pandemic Restriction

Background. Physical activity (PA) is essential for maintaining well-being in adults with disabilities. This population experienced reduced PA during the COVID-19 pandemic; yet, the impact on quality of PA participation remains unclear. Purpose. This secondary analysis explored how pandemic restrictions impacted six experiential dimensions of quality of PA participation among adults with disabilities. Methods. An exploratory sequential mixed-methods design, including semi-structured interviews (n  =  10) and self-reported surveys (n  =  61), was conducted in May-2020 and February-2021. Quality of PA participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Participants included community-dwelling adults over 19 years of age (mean 59.2  ±  14.0 years) living with stroke, spinal cord injury, or other physical disabilities. Findings. Directed content analysis identified three themes related to adjusting PA participation for restrictions, motivation barriers, and valuing social support. These themes highlighted five factors, such as resilience, as potential quantitative predictors of quality of PA participation. While paired correlations with MeEAP scores were observed, these factors were not statistically predictive in multiple regression analysis (adjusted R² = -0.14, F(10,50)  =  0.92, p  =  .53). Implications. The interplay between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality of PA participation was complex, with an emphasized role for mental health, in adults with disabilities.

Evolution of rehabilitation services in response to a global pandemic: reflection on opportunities and challenges ahead

The rapidly evolving COVID-19 public health emergency has disrupted and challenged traditional healthcare, rehabilitation services, and treatment delivery worldwide. This perspective paper aimed to unite experiences and perspectives from an international group of rehabilitation providers while reflecting on the lessons learned from the challenges and opportunities raised during the COVID-19 pandemic. We discuss the global appreciation for rehabilitation services and changes in access to healthcare, including virtual, home-based rehabilitation, and long-term care rehabilitation. We illustrate lessons learned by highlighting successful rehabilitation approaches from the US, Belgium, and Japan.

Creating a better post-pandemic future for adolescents with disabilities

Adolescents with disabilities must have their needs prioritised in recovery and future pandemic responses to improve health, educational, and social outcomes, argue Sarah Baird and colleagues

Types and Sources of Social Support Accessible to University Students with Disabilities in Saudi Arabia during the COVID-19 Pandemic

University students with disabilities face an increased risk of experiencing negative implications in educational, psychological, and social spheres during the COVID-19 pandemic. This study aimed at assessing various dimensions of social support and its sources during the COVID-19 pandemic that availed university students with disabilities. This cross-sectional descriptive study collected data from 53 university students with disabilities. We administered the Social Support Scale (SSC) to assess five dimensions: informational, emotional, esteem, social integration and tangible support, and access to social support from four sources: family, friends, teachers, and colleagues. Multiple regression analysis showed that university students with disabilities mainly relied upon their friends for informational support (β = 0.64; p < 0.001), emotional support (β = 0.52; p < 0.001), and social integration support (β = 0.57; p < 0.001). Family members (β = 0.406; p < 0.01) and colleagues (β = 0.36; p < 0.01) provided esteem support to students with disabilities. Support from teachers demonstrated an association with informational support (β = 0.24; p < 0.05). The findings from the current study suggest that students with disabilities primarily sought informational, emotional, and social integration support from their peers. Although teachers were the primary source of informational support, emotional and esteem support were not found to be significantly associated with them. These findings necessitate exploring the underlying factors and how to enhance them during unusual circumstances such as online distance education and social distancing.

People With Functional Disability and Access to Health Care During the COVID-19 Pandemic: A US Population-based Study

INTRODUCTION

The COVID-19 pandemic and nationwide restriction measures have disrupted health care delivery and access for the general population. There is limited evidence about access to care issues (delayed and forgone care) due to the pandemic among people with disability (PWD).

METHODS

This study used the 2020 National Health Interview Survey data. Disability status was defined by disability severity (moderate and severe disability), type, and the number of disabling limitations. Descriptive analysis and multivariate logistic regression (adjusted for sociodemographic and health-related characteristics) were conducted to estimate delayed/forgone care (yes/no) between PWD and people without disability (PWoD).

RESULTS

Among 17,528 US adults, 40.7% reported living with disability. A higher proportion of respondents with severe and moderate disability reported delaying care than PWoD (severe=33.2%; moderate=27.5%; PWoD=20.0%, P <0.001). The same was true for forgone medical care (severe=26.6%; moderate=19.0%; PWoD=12.2%, P <0.001). Respondents with a moderate disability {delayed [odds ratio (OR)=1.33, 95% confidence interval (CI)=1.19, 1.49]; forgone [OR=1.46, 95% CI=1.28, 1.67]} and a severe disability [delayed (OR=1.52, 95% CI=1.27, 1.83); forgone (OR=1.84, 95% CI=1.49, 2.27)] were more likely to report delayed medical care and forgone medical care compared with PWoD. These findings were consistent across the models using disability type and the number of limitations.

CONCLUSIONS

PWD were more likely to experience COVID-19-related delays in or forgone medical care compared with PWoD. The more severe and higher frequency of disabling limitations were associated with higher degrees of delayed and forgone medical care. Policymakers need to develop disability-inclusive responses to public health emergencies and postpandemic care provision among PWD.

Needs of an uninsured equity-deserving minority patient cohort with physical disabilities during the first wave of the COVID-19 pandemic

Background

Patients with disabilities and those from diverse equity-deserving backgrounds have been disproportionately affected by the SARS COV-2 ("COVID-19") pandemic.

Objective

To describe the significant needs and social determinants of health that affected a group of uninsured patients (from equity-deserving groups) with rehabilitation diagnoses during the early months of the COVID-19 pandemic.

Design

Retrospective cohort study utilizing a telephone-based needs assessment from April to October, 2020.

Setting

Free interdisciplinary rehabilitation clinic serving patients with physical disabilities from equity-deserving minority backgrounds.

Participants

51 uninsured, diverse patients with spinal cord injuries, brain injuries, amputations, strokes, and other diagnoses requiring interdisciplinary rehabilitation care.

Methods

Using a non-structured approach, telephone-based needs assessments were collected monthly. Reported needs were summarized into themes and the frequencies of each theme were recorded.

Results

From the total number of concerns, medical issues were reported with the highest frequency (46%), followed by equipment needs (30%) and mental health concerns (30%). Other frequently mentioned needs centered around themes of rent, employment, and supplies. Rent and employment were more frequently cited in earlier months, and equipment problems were more frequently cited in later months. A minority of patients reported they had no needs, some of whom had acquired insurance.

Conclusions

Our objective was to describe the needs of a racially and ethnically diverse set of uninsured individuals with physical disabilities seen at a specialized interdisciplinary rehabilitation pro bono clinic during the early months of COVID-19. Medical issues, equipment needs, and mental health concerns were the top three needs. To optimally serve them, care providers must be aware of current and future needs for their underserved patients, especially if future lockdowns occur.

Understanding the Early Impacts of the COVID-19 Pandemic on Brain Injury Associations Across Canada: A Qualitative Study

The COVID-19 pandemic has increased challenges for people living with brain injury and community associations to support this vulnerable population. This study aimed to gain an in-depth understanding of the challenges faced by brain injury survivors during the first year of the pandemic and how community brain injury associations adapted their services to respond to these needs. Findings from seven focus-group with 31 representatives of Canadian brain injury associations revealed 4 main themes: (1) Addressing evolving client needs; (2) Keeping clients safe; (3) Challenges and opportunities navigating the digital world; and (4) Sustaining brain injury associations in the face of uncertainties and disruptions. To comply with public health measures, associations reported pivoting their service delivery online, despite recognizing the difficulties this could create for many brain injury survivors in accessing and using technology. Our findings also highlight concrete directions for not-profit organizations providing instrumental help with activities, acting as a liaison and interpreter of public health guidelines, and in connecting with clients using technology while handling potential cognitive and technological challenges. Addressing these issues has the potential to protect people living with brain injury and community associations from external threats, like pandemics, in the future.

Varieties of 'new normal': Employment experiences among youth with and without disabilities during the reopening stages of the COVID-19 pandemic

BACKGROUND

Working and volunteering in the reopening stages of the COVID-19 pandemic has looked different depending on the location, employment sector and nature of the job. Although researchers have begun exploring the impacts on adults, little is known about what the transition to a 'new normal' in the reopening stages has been like for youth, especially those with disabilities.

OBJECTIVE

To explore and compare the experiences and perspectives of youth with and without disabilities who were working, volunteering or seeking work during the re-opening stages of the COVID-19 pandemic in Canada.

METHODS

We used a qualitative design involving semi-structured interviews with 16 youth (seven with a disability, nine without), aged 15-29 (mean 22 years). Thematic analysis was used to analyze the data.

RESULTS

Five main themes were identified: (1) Mixed views on being onsite in the reopening stages; (2) Mixed views on remaining remote; (3) Hybrid model as the best of both worlds; (4) Mixed views on COVID-19 workplace safety in the reopening stages; and (5) Hopes, dreams and advice for the future. Apart from the first main theme, there were more similarities than differences between youth with and without disabilities.

CONCLUSION

Our study highlights that youth encountered various work and volunteer arrangements during the reopening stages of the pandemic, and the personal preferences for particular models depend largely on their employment sector. The areas of agreement among youth highlight some longer-term impacts of the pandemic shutdowns and point to the need for greater mental health and career supports.

Changes in essential care in individuals with spinal cord injury during the COVID-19 pandemic

STUDY DESIGN

Cross-sectional, observational study.

OBJECTIVES

To determine whether changes in essential care during the COVID-19 pandemic impacted satisfaction with activities, participation, and relationships among individuals with spinal cord injury (SCI).

SETTING

Data were collected online between December 31, 2020 and February 14, 2021 among community dwelling adults with SCI (N = 123).

METHODS

The primary outcome variables were satisfaction with the ability to complete activities of daily living (ADLs) (mobility, dressing, feeding, and toileting), as well as satisfaction with participation in household and recreational activities, and satisfaction with relationships among friends, family, and with the status of one's relationship measured with the International Spinal Cord Injury Data Sets Activities and Participation Basic Data Set. Primary predictors were age, gender, time since injury, completeness of injury, injury level, access to mental health, access to medications, access to medical supplies, and access to personal care assistants (PCAs).

RESULTS

Impact on access to mental health and impact on access to supplies were the most common factors affecting satisfaction with activities, participation, and relationships for individuals with SCI during the COVID-19 pandemic. Impact on access to PCAs/homecare was also found to impact certain outcomes including feeding and participation in household activities.

CONCLUSIONS

Future supply chain disruptions from pandemics or natural disasters could have wide-reaching effects for individuals with SCIs. Thus, further research and advocacy is needed to improve mental health care planning and supply chain access during subsequent natural disasters.

Describing adolescents with disabilities' experiences of COVID-19 and other humanitarian emergencies in low- and middle-income countries: a scoping review

BACKGROUND

The COVID-19 pandemic and other humanitarian emergencies exacerbate pre-existing inequalities faced by people with disabilities. They experience worse access to health, education, and social services, and increased violence in comparison with people without disabilities. Adolescents with disabilities are amongst those most severely affected in these situations. Using participatory research methods with adolescents can be more effective than other methods but may be challenging in such emergency contexts.

OBJECTIVES

We conducted a scoping review to: 1) describe the literature and methods used in peer-reviewed and grey literature on adolescents (aged ten to nineteen) with disabilities' experience of COVID-19 and other humanitarian emergencies in low- and middle-income countries, and 2) identify research gaps and make recommendations for future research.

METHODS

The review followed a protocol developed using PRISMA guidelines and the Arksey and O'Malley framework. We searched grey and peer-reviewed literature between 2011 and 2021.

RESULTS

Thirty studies were included. Twelve were peer-reviewed, and of those seven used participatory methods. Humanitarian emergencies had adverse effects on adolescents with disabilities across health, education, livelihoods, social protection, and community participation domains. Surprisingly few studies collected data directly with adolescents with disabilities. Twenty-three studies combined data from non-disabled children, caregivers, and disabled adults which made it challenging to understand adolescents with disabilities' unique experience.

CONCLUSIONS

Our review highlights both the scarcity of literature and the importance of conducting research with adolescents with disabilities in humanitarian contexts. Despite challenges, our review shows that it has been possible to conduct research with adolescents with disabilities to explore their experiences of humanitarian emergencies, and that these experiences were different from those of non-disabled adolescents. There is a need to disaggregate findings and support the implementation and reporting of rigorous research methods. Capacity development through partnerships between non-governmental organisations and researchers may improve reporting of methods.

Factors Influencing Access to Health Services among Chronically Ill Older Adults with Physical Disabilities in the Era of the COVID-19 Outbreak

Chronically ill older adults with physical disabilities frequently face difficulties in their daily lives and require essential health service access, especially in the COVID-19 context. This study aimed to examine the association between social support, perception of benefits due to disability and access to health services among chronically ill older adults with physical disabilities during this crisis in Thailand. A total of 276 chronically ill older adults with physical disabilities were included in this cross-sectional study. Self-reported questionnaires were assessed through multi-stage random sampling. Correlations between the independent variables and health service access were examined using multiple regression analysis. Of the respondents, 159 were female (59.6%). Most participants perceived benefits (58.8%) and access to health services (56.2%) at good levels, while social support was at a moderate level (47.9%). Stepwise multiple regression analysis showed that social support (β = 0.351), perception of benefits (β = 0.257) and age (β = 0.167) were positively correlated with health service access. The findings are relevant for health care providers and multi-professional teams, who should enhance older adults' social support and perception of benefits to improve their access to health services, particularly among chronically ill older adults with physical disabilities, in the era of COVID-19.

Self-advocates with Down syndrome research the lived experiences of COVID-19 lockdowns in Aotearoa New Zealand

BACKGROUND

Individuals with Down syndrome are particularly vulnerable to COVID-19 because they are recognised as significantly immunocompromised. Yet their voices regarding their lived experiences of pandemic lockdowns have not been sought or heard.

AIM

This study aims to describe the lived experiences of people with Down syndrome during the pandemic lockdowns in Aotearoa New Zealand to add evidence in order to inform systemic advocacy.

METHOD

A mixed-methods approach positioned within an inclusive research paradigm was used, in which a group of self-advocates with Down syndrome co-designed a structured interview schedule and conducted 40 face-to-face interviews. Key themes were identified by using content analysis.

RESULTS

Despite the difficulties associated with lockdowns and participants not receiving their usual supports and having to make significant adjustments, they remained positive, adapted well, and demonstrated a high level of resilience and adaptability.

CONCLUSIONS

The findings add to the limited research on the lived experiences of people with Down syndrome during pandemic lockdowns. This research has given them a voice to contribute to policy, government initiatives, and service providers; particularly on issues around support during lockdown and staying connected with others.

Narrative identity among people with disabilities in the United States during the Covid-19 pandemic: The interdependent self

This study examines narrative identity among a large, diverse sample of people with disabilities (PWDs) in the United States during the "second wave" of the Covid-19 pandemic (October-December 2020). The study relied on abductive analyses, combining a purely inductive phase of inquiry followed by two rounds of investigation that filtered inductive insights through three theoretical lenses: social-ecological theory, the theory of narrative identity, and perspectives from the interdisciplinary field of disability studies. The central result was the identification of a particular configuration of self, one that was demonstrably interdependent with both immediate interpersonal contexts and with broader cultural contexts. This interdependent self was interpreted in both positive and negative ways by PWDs. These findings invite future inquiry into commonplace conceptualizations of an independent self at the center of personality research and suggest that dominant conceptualizations of "the good life" may overly emphasize independence.

Adolescents with Neuropsychiatric Disorders during the COVID-19 Pandemic: Focus on Emotional Well-Being and Parental Stress

(1) Introduction: The aim of our research was to explore emotional/behavioral changes in adolescents with neuropsychiatric conditions during the COVID-19 pandemic, and parental stress levels through a standardized assessment, comparing the data collected before and during the first months of lockdown. Moreover, an additional goal was to detect a possible relationship between emotional/behavioural symptoms of adolescents and the stress levels of their parents. (2) Methods: We enrolled 178 Italian adolescents aged between 12-18 that were referred to the Child Neuropsychiatry Unit of the University Hospital of Salerno with different neuropsychiatric diagnoses. Two standardized questionnaires were provided to all parents for the assessment of parental stress (PSI-Parenting Stress Index-Short Form) and the emotional/behavioral problems of their children (Child Behaviour Check List). The data collected from questionnaires administered during the six months preceding the pandemic, as is our usual clinical practice, were compared to those recorded during the pandemic. (3) Results: The statistical comparison of PSI and CBCL scores before/during the pandemic showed a statistically significant increase in all subscales in the total sample. The correlation analysis highlighted a significant positive relationship between Parental Stress and Internalizing/Externalizing symptoms of adolescent patients. Age and gender did not significantly affect CBCL and PSI scores, while the type of diagnosis could affect behavioral symptoms and parental stress. (4) Conclusions: our study suggests that the lockdown and the containment measures adopted during the COVID-19 pandemic could have aggravated the emotional/behavioral symptoms of adolescents with neuropsychiatric disorders and the stress of their parents. Further studies should be conducted in order to monitor the evolution of these aspects over time.

A tale of two stories: COVID-19 and disability. A critical scoping review of the literature on the effects of the pandemic among athletes with disabilities and para-athletes

The still ongoing COVID-19 pandemic has dramatically impacted athletes, and, in particular, para-athletes and athletes with disabilities. However, there is no scholarly appraisal on this topic. Therefore, a critical scoping review of the literature was conducted. We were able to retrieve sixteen relevant studies. The sample size ranged from 4 to 183. Most studies were observational, cross-sectional, and questionnaire-based surveys, two studies were interventional, and two were longitudinal. One study was a technical feasibility study. Almost all studies were conducted as single-country studies, with the exception of one multi-country investigation. Five major topics/themes could be identified: namely, 1) impact of COVID-19-induced confinement on training and lifestyles in athletes with disabilities/para-athletes; 2) impact of COVID-19-induced confinement on mental health in athletes with disabilities/para-athletes; 3) impact of COVID-19-induced confinement on performance outcomes in athletes with disabilities/para-athletes; 4) risk of contracting COVID-19 among athletes with disabilities/para-athletes; and, finally, 5) impact of COVID-19 infection on athletes with disabilities/para-athletes. The scholarly literature assessed was highly heterogeneous, with contrasting findings, and various methodological limitations. Based on our considerations, we recommend that standardized, reliable tools should be utilized and new, specific questionnaires should be created, tested for reliability, and validated. High-quality, multi-center, cross-countries, longitudinal surveys should be conducted to overcome current shortcomings. Involving all relevant actors and stakeholders, including various national and international Paralympic Committees, as a few studies have done, is fundamental: community-led, participatory research can help identify gaps in the current knowledge about sports-related practices among the population of athletes with disabilities during an unprecedented period of measures undertaken that have significantly affected everyday life. Moreover, this could advance the field, by capturing the needs of para-athletes and athletes with disabilities and enabling the design of a truly "disability-inclusive response" to COVID-19 and similar future conditions/situations. Furthermore, follow-up studies on COVID-19-infected para-athletes and athletes with disabilities should be conducted. Evidence of long-term effects of COVID-19 is available only for able-bodied athletes, for whom cardiorespiratory residual alterations and mental health issues a long time after COVID-19 have been described.

Workplace accommodations during the COVID-19 pandemic: A scoping review of the impacts and implications for people with disabilities

BACKGROUND

The COVID-19 pandemic has led to widespread changes in the way people work. Some of these changes represent the same kinds of work modifications or adjustments that have often been requested as workplace accommodations, and which may improve labour market and employment outcomes for people with disabilities.

OBJECTIVE

The aim of this scoping review was to examine the literature on workplace accommodations in the pandemic and their impacts and implications for people with disabilities.

METHODS

Following a search of six international databases, articles were selected by two reviewers, and data were abstracted in accordance with scoping review methodology. A thematic analysis was used to report the relevant findings.

RESULTS

Thirty-seven articles met the inclusion criteria, and three main themes were identified: positive impacts of pandemic-related workplace accommodations on people with disabilities (e.g., improved accessibility, reduced stigma around workplace accommodations, rapid implementation of workplace accommodations, opportunities for advocacy); negative impacts (e.g., worsened physical and mental health, new accommodation needs); and action needed and recommendations (e.g., revisit legislation and policy on accommodations, ensure representation of people with disabilities). Overall, our review identified a mixed assessment of the impacts of pandemic-related accommodations on people with disabilities. However, there was a broader consensus regarding the importance of learning from the experiences of the pandemic to improve workplace accommodation policies in the future.

CONCLUSIONS

The pandemic may present opportunities for improving workplace accommodation policies, but our review also highlights the need for more research examining how workplace changes due to the COVID-19 pandemic have impacted people with disabilities.

Lessons learned from the impact of Covid-19 on the work of disability support organisations that support employers of social care personal assistants in England

Social care Personal Assistants (PAs) are directly employed by individuals to assist with activities of daily living such as help or support with personal care, shopping, household tasks and community participation. This option is encouraged by UK public funding. In England, disabled people's support organisations initially offered assistance with such arrangements, although numbers doing this have declined. The Covid-19 pandemic provided the opportunity to ask those remaining organisations providing support for PA employers about their activities during this time and the questions being posed to them by PA employers. This paper reports data from 15 interviews undertaken March-July 2021 with disability support organisation representatives. We identified one overarching theme 'Working to prevent and challenge marginalisation of PA employers', with three related subthemes: (1) Advocating for the voice of a forgotten group; (2) Needing to be proactive and (3) Adapting to new tasks and ways of working. Participant accounts focused on representing the needs of disabled people to the authorities and providing concise, timely and accurate information to PA employers, particularly around the use of public funds during Covid-19. Remote working amplified the digital-divide, resulting in these organisations working hard to ensure PA employers received important information about their support options. Befriending services and Covid-hubs were established by some organisations to reduce isolation and risks of poor mental health amongst PA employers. Many of the challenges facing PA employers existed pre-pandemic but were perceived to have been heightened during it, reflecting the value of and need for the work of these local support organisations. Our findings suggest areas where effective contingency planning drawn from closer collaboration between disability support organisations and central and local government might usefully be focussed. The potential for specific services or organisations to be commissioned to provide such support is discussed.

Promoting equity in health emergencies through health systems strengthening: lessons learned from disability inclusion in the COVID-19 pandemic

Discriminatory health systems and inequalities in service provision inevitably create barriers for certain populations in a health emergency. Persons with disabilities have been disproportionately affected by the COVID-19 pandemic. They commonly experience three increased risks - of contracting the disease, of severe disease or death, and of new or worsening health conditions. These added risks occur due to a range of barriers in the health sector, including physical barriers that prevent access to health facilities and specific interventions; informational barriers that prevent access to health information and/or reduce health literacy; and attitudinal barriers which give rise to stigma and exclusion, all of which add to discrimination and inequality. Furthermore, national health emergency preparedness and planning may fail to consider the needs and priorities of persons with disabilities, in all their diversity, thus leaving them behind in responses. This commentary discusses the importance of inclusive health systems strengthening as a prerequisite for accessible and comprehensive health emergency preparedness and response plans that reach everyone. Lessons learned relating to disability inclusion in the COVID-19 pandemic can inform health systems strengthening in recovery efforts, addressing underlying barriers to access and inclusion, and in turn improving preparedness for future health emergencies.

Validation of a Scale on Society's Attitudes towards the Sexuality of Women with Intellectual Disabilities-Survey Study

BACKGROUND

The main aim of this study was to design and validate a questionnaire in Spanish to acknowledge the perception of the sexuality of women with intellectual disabilities. We sought to cover specific spheres of sexuality, such as sexual capacity, decision-making capacity, sexual disinhibition, and sexual education and quality of life.

METHODS

A questionnaire was developed based on a literature review. Validation was performed using content validation through a panel of experts; construct validation was performed using exploratory and confirmatory factorial analyses; reliability tests were also performed, using Cronbach's Alpha and the two-halves test.

RESULTS

Two-hundred forty-four participants pilot tested the initial 34-item questionnaire. After content validation and exploratory factorial analysis, the resulting 10-item questionnaire showed four domains, with Cronbach's Alpha values between 0.69 and 0.82. Confirmatory factorial analysis confirmed the domains, and the model's goodness-of-fit tests were adequate.

CONCLUSIONS

The final ten-item scale developed in this research proved to be a valid and reliable instrument, as it has good psychometric properties of both validity and reliability. Thus, researchers interested in investigating the social perception of the sexuality of women with intellectual disabilities can use this tool. Future research can extend the validity of this scale to other languages and settings.

Experiences of Organisations of (or That Serve) Persons with Disabilities during the COVID-19 Pandemic and National Lockdown Period in South Africa

Organisations have long played an effective role in advocating for and actioning crucial developmental and humanitarian functions around the world, often under challenging conditions, as well as servicing the health needs of persons with disabilities. This article reports on the experiences of organisations of (or that serve) persons with disabilities, hereafter called service providers, during the COVID-19 lockdown period in South Africa beginning 26 March 2020. Organisations participated in an online survey as well as virtual narrative interviews to voice out their experiences. Five major themes emerged: (1) difficulties in keeping the doors open; (2) continued care under lockdown; (3) restructuring of care (4) government systems and policies; and (5) reaching out to offer and receive support. The findings demonstrate that the South African government failed to ensure targeted support to organisations of persons with disabilities. A remarkable feature of the organisations we interviewed for this small study was their agility in responding creatively to the challenges they faced, despite the difficulties. There is a need for government support to include targeted efforts to support organisation of persons with disabilities during pandemics to avoid worsening service gaps.

Perceived impacts of COVID-19 on wellbeing among US working-age adults with ADL difficulty

BACKGROUND

The COVID-19 pandemic has disproportionately impacted people with disabilities. Working-age adults with ADL difficulty may face unique challenges and heightened health risks because of the pandemic. It is critical to better understand the impacts of COVID-19 on social, financial, physical, and mental wellbeing among people with disabilities to inform more inclusive pandemic response policies.

OBJECTIVE

This study compares perceived COVID-19 physical and mental health, social, and financial impacts for US working-age adults with and without ADL difficulty.

METHODS

We analyzed data from a national survey of US working-age adults (aged 18-64) conducted in February and March 2021 (N = 3697). We used logistic regression to compare perceived COVID-19-related impacts on physical and mental health, healthcare access, social relationships, and financial wellbeing among those with and without ADL difficulty.

RESULTS

Adults with ADL difficulty were more likely to report negative COVID-19 impacts for many but not all outcomes. Net of covariates, adults with ADL difficulty had significantly greater odds of reporting COVID-19 infection (OR = 2.1) and hospitalization (OR = 6.7), negative physical health impacts (OR = 2.0), and negative impacts on family relationships (OR = 1.6). However, they had significantly lower odds of losing a friend or family member to COVID-19 (OR = 0.7). There were no significant differences in perceived impacts on mental health, ability to see a doctor, relationships with friends, or financial wellbeing.

CONCLUSIONS

Working-age adults with ADL difficulty experienced disproportionate health and social harm due to the COVID-19 pandemic. To address these disparities, public health response efforts and social policies supporting pandemic recovery must include disability perspectives.

The differential impact of COVID-19 on mental health: Implications of ethnicity, sexual orientation, and disability status in the United States

The COVID-19 pandemic's effects on mental health interact with preexisting health risks and disparities to impact varying populations differently. This study explored the relationship between demographic variables (e.g., ethnicity, sexual orientation, and disability status), distress and mental health (e.g., depression, anxiety, somatic complaints, and pandemic distress), and vulnerability factors for COVID-19 (e.g., personal health vulnerabilities, community members' health vulnerabilities, and environmental exposure risks at work or home). An online cross-sectional study was conducted from 18 June to 17 July 2020, reflecting the impact of early phase COVID-19 pandemic and related shelter-in-place measures in the United States. Participants were adults residing in the United States (N = 594), with substantial subsamples (N ≥ 70) of American Indian, Asian American, African-American, and Hispanic and/or Latinx participants, as well as people with disabilities and sexual minorities. Outcomes measured were depression, hopelessness, somatic complaints, anxiety-related disorders, locus of control (LOC), and a novel measure of pandemic-related distress. Data were analyzed using analyses of covariance (ANCOVA), chi-square test, and correlation coefficients. Generally, younger individuals, and those with less financial power-across all identities-suffered more distress. When controlling for age, lower financial power was associated with higher scores on the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R; r = -0.21, p = < 0.001), Beck Hopelessness Scale (BHS; r = -0.17, p < 0.001), Patient Health Questionnaire-15 (PHQ-15; r = -0.09, p = 0.01), Screen for Child Anxiety Related Emotional Disorders for Adults Panic Disorder (SCARED-A PD; r = -0.14, p < 0.001), SCARED-A generalized anxiety disorder (GAD; r = -0.13, p = 0.002), SCARED-A obsessive-compulsive disorder (OCD; r = -0.08, p = 0.04), and the COVID-19 Pandemic Distress restriction/disconnection scale (C19PDS; r = -0.10, p = 0.009). In addition, disparities were found, in general, for marginalized identities by gender, sexual orientation, and disability status. Importantly, each ethnicity subsample showed a unique pattern of relationships between COVID-19 risk variables and mental health symptoms. The results support the hypothesis that any pandemic may amplify preexisting social and financial disparities. Overall, interventions at the clinical, governmental, or health equity level should take into consideration the needs of vulnerable groups.

Evaluation of the Impact of the First Wave of COVID-19 and Associated Lockdown Restrictions on Persons with Disabilities in 14 States of India

BACKGROUND

There is a paucity of data to assess the impact of the COVID-19 pandemic on persons with disabilities (PwDs) in India. About 27.4 million cases were reported as of 27 May 2021. The continuing pandemic in the form of subsequent waves is expected to have negative repercussions for the disabled globally, particularly in India, where access to health, rehabilitation, and social care services is very limited. Therefore, this study aimed to assess the impact of the COVID-19 pandemic and lockdown restrictions on PwDs in India.

OBJECTIVE

To determine the level of disruption due to COVID-19 and the associated countrywide lockdown restrictions on PwD in India during the first wave.

METHODS

Using a cross-sectional, mixed-methods approach, data were collected from a representative sample of 403 persons with disabilities in 14 states in India during the COVID-19 first wave at two different points in time (Lockdown and post-lockdown phase). Factors associated with the negative impact were examined using the Chi-square test for associations. The paired comparisons between 'lockdown' with the 'post-lockdown' phase are presented using McNemar's test and the marginal homogeneity test to compare the proportions. Additionally, a subsample of the participants in the survey was identified to participate in in-depth interviews and focus group discussions to gain in-depth insights on the study question and substantiate the quantitative findings. The framework approach was used to conduct a thematic analysis of the qualitative data.

RESULTS

About 60% of the PwDs found it difficult to access emergency medical services during the lockdown, and 4.6% post lockdown (p < 0.001). Likewise, 12% found it difficult to access rehabilitation services during the lockdown, and 5% post lockdown (p = 0.03). About 76% of respondents were apprehensive of the risk of infection during the lockdown, and this increased to 92% post lockdown (p < 0.001). Parents with children were significantly impacted due to lockdown in the areas of Medical (p = 0.007), Rehabilitation (p = 0.001), and Mental health services (p = 0.001). The results from the qualitative study supported these quantitative findings. PWDs felt that the lockdown restrictions had negatively impacted their productivity, social participation, and overall engagement in everyday activities. Access to medicines and rehabilitation services was felt to be extremely difficult and detrimental to the therapeutic benefits that were gained by them during the pre-pandemic time. None of the pandemic mitigation plans and services was specific or inclusive of PWDs.

CONCLUSIONS

COVID-19 and the associated lockdown restrictions have negatively impacted persons with disabilities during the first wave in India. It is critical to mainstream disability within the agenda for health and development with pragmatic, context-specific strategies and programs in the country.

Impacts on anxiety symptoms and alcohol consumption among people with disabilities and family caregivers in Latin America and the Caribbean during the first wave of the COVID-19 pandemic

Objectives

The aim of this study was to analyse associations between the COVID-19 pandemic, alcohol consumption and anxiety symptoms among people with self-reported disabilities and family caregivers in Latin America and the Caribbean.

Study design

Cross-sectional study with secondary data analysis of the ‘Alcohol Use during the COVID-19 pandemic in Latin America and the Caribbean’, a Web-based cross-sectional survey conducted by the Pan American Health Organisation between March and June 2020.

Methods

Descriptive analyses were conducted on the individual, social environment characteristics, COVID-19 infection, quarantine compliance, anxiety symptoms (measured by Generalized Anxiety Disorder Scale [GAD-7]) and change in frequency of heavy episodic drinking during the pandemic. Multinomial logistic regression was used to analyse associations among individuals with self-reported disabilities with anxiety symptoms and change in frequency of heavy episodic drinking during the pandemic.

Results

Family caregivers were more compliant with COVID-19 restrictive measures than individuals with and without disabilities. The majority of participants with disabilities did not change their drinking patterns during the pandemic (64.3%); however, 28.1% reported increased consumption. People with disabilities were 2.17 times more likely to have severe anxiety symptoms than no anxiety symptoms between March and June 2020 in Latin America and the Caribbean.

Conclusions

This study observed a higher prevalence of the maintenance of heavy episodic drinking behaviour during the early phase of the pandemic in people with disabilities and family caregivers than in people without self-reported disabilities in Latin America and the Caribbean. People with disabilities showed more severe anxiety symptoms than those without disabilities, highlighting the need to develop inclusive health and quality-of-life policies to mitigate the effects of the pandemic in this vulnerable population.

The impact of lockdown on young people with genetic neurodevelopmental disabilities: a study with the international participatory database GenIDA

BACKGROUND

Previous publications suggested that lockdown is likely to impact daily living issues of individuals with intellectual disabilities. The authors notably suspected an intensification of behavioural, eating and sleep problems.

METHODS

To test these hypotheses, we conducted an international online survey about the impact of COVID-19-associated first lockdown on people with genetic neurodevelopmental disorders. This survey was carried out using GenIDA, an international participatory database collecting medical information on genetic neurodevelopmental disorders. Patients' relatives took part in this online survey from 30/04/2020 to 09/06/2020. This survey adapted from GenIDA standard questionnaire requested information on diagnosis, lifestyle and was based on yes/no answers to questions regarding behaviour, diet, and sleep, in the 6-months period before lockdown and during lockdown. We also asked relatives to evaluate the intensity of these problems by severity level. Finally, relatives could freely comment in open fields on the medical and/or quality of life problems they had encountered during lockdown.

RESULTS

In total 199 participants-144 children and 45 adults-with neurodevelopmental disorders (intellectual disability (79.4%) and/or autism spectrum disorder (21.6%)) of various genetic origins, with near-equal male/female (96/103) contribution and originating mainly from Europe and Northern America, were included. The average lockdown duration at time of the survey was 57 days. We did not find differences in the frequency of behavioural, eating and sleep problems before and during lockdown. Moreover, there was no apparent difference in the intensity of eating and sleep disorders between both periods. However, for persons with behavioural problems at both periods, relatives reported an increase in aggressivity, self-aggressivity, depressiveness, stereotypies, and restricted interests during lockdown, all of which might be interpreted as consequences of a lack of stimulation or a reaction to unexpected changes in daily habits.

CONCLUSIONS

Our results support previous studies that suggest that the negative impact of lockdown does not depend on the intellectual disability per se but on the associated comorbidities such as behavioural disorders. This study addresses the need for prevention of behavioural disturbance in the vulnerable population with genetic neurodevelopmental disabilities.

COVID-19 Related Shifts in Social Interaction, Connection, and Cohesion Impact Psychosocial Health: Longitudinal Qualitative Findings from COVID-19 Treatment Trial Engaged Participants

While effective for slowing the transmission of SARS-CoV-2, public health measures, such as physical distancing and stay-at-home orders, have significantly shifted the way people interact and maintain social connections. To better understand how people sought social and psychological support amid the pandemic, we conducted a longitudinal qualitative evaluation of participants enrolled in a COVID-19 treatment trial (N = 30). All participants from the parent trial who consented to being contacted for future research studies were recruited electronically via email, and first-round virtual interviews were conducted between December 2020 and March 2021. Participants who participated in first-round interviews were contacted again, and follow-up interviews were conducted in January-February 2022. The results reported significant shifts in how participants connected to social support, including changes from physical to virtual modalities, and using different social networks for distinct purposes (i.e., Reddit/Facebook for information, WhatsApp for community connection). While having COVID-19, profound loneliness during isolation was described; yet, to mitigate effects, virtual support (i.e., emotional, knowledge-seeking) as well as in-person material support (e.g., groceries, snow-shoveling), were key. Public health efforts are needed to develop interventions that will improve the narratives about mental health challenges related to COVID-19 isolation, and to provide opportunities to share challenges in a supportive manner among social networks. Supporting social cohesion, despite the everchanging nature of COVID-19, will necessitate innovative multimodal strategies that learn from lived experiences across various stages of the pandemic.

A Survey of the Challenges Faced by Individuals with Disabilities and Unpaid Caregivers during the COVID-19 Pandemic

The COVID-19 pandemic negatively affected many individuals. In particular, it is likely that individuals with disabilities and unpaid caregivers were disproportionately affected, however, its exact impact is largely unknown. The primary objective of this work was to identify challenges faced by individuals with disabilities and unpaid caregivers. A secondary objective was to identify potential solutions to the major challenges experienced by both populations. Two surveys were administered online to individuals with disabilities and unpaid caregivers, respectively between September 2020 and January 2021. We used an inductive thematic analysis within an interpretivist paradigm to analyze survey responses. A total of 111 survey responses were collected amongst both surveys. Separate thematic maps were created for individuals with disabilities and unpaid caregivers, and maps were drawn to compare challenges. Potential solutions to mitigate the challenges experienced by both populations include revising financial assistance programs and improving awareness of support programs that are available.

Legal restrictions and mitigation strategies amongst a disabled population during COVID-19

The impact of physical disability on protective behaviors during COVID-19 has been little studied. This retrospective study compared the 699 the self-declared behaviors of 699 people with disabilities before and after the relaxation of COVID-19 restrictions in England. We found that people with disabilities in England showed high compliance with protective behaviors and mitigation strategies during a period of legal restrictions. Following the lifting of restrictions, respondents engaged in less social mixing, fewer distancing and hygiene behaviors and were less likely to use face coverings. Hierarchical regressions revealed that socio-economic status, age, and gender moderated protective behaviors: while those with higher socio-economic status were more relaxed with regard to hygiene and distancing behaviors, they were more cautious about mixing with others after the end of restrictions. Age, (male) gender, and being unvaccinated were positively associated with relaxation in the use of facemasks in public places, not needing a carer with fewer out-of-home visits. Taken together these findings suggest that the removal of restrictions had an unequal impact on the population of England, placing a disproportionate burden on some people with disabilities.