Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which ...clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation.
To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation.
We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions.
Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability.
Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information.
We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation.
There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.
Increased invasive bloodstream infections caused by multidrug resistant Shigella sonnei were noted in Vancouver, British Columbia, Canada, during 2021-2023. Whole-genome sequencing revealed clonal ...transmission of genotype 3.6.1.1.2 (CipR.MSM5) among persons experiencing homelessness. Improvements in identifying Shigella species, expanding treatment options for multidrug resistant infections, and developing public health partnerships are needed.
Physically disabled persons continue to be discriminated, excluded and neglected based on design of structures and their location. This hampers equitable access to services and disproportionately ...affect them during a pandemic. This study aimed to evaluate physical access barriers to COVID-19 vaccines among persons with physical disabilities during the COVID-19 pandemic, (March 2020 to March 2022) in Ugenya Sub-county, Siaya County in Western Kenya.
The study design was cross-sectional. 108 physically disabled participants were selected using systematic sampling technique. Data was collected using structured questionnaires.
Vaccination location (χ
= 95.480, p = 0.001), access to the vaccination room (χ
= 84.098, p = 0.001) and mobility impaired (χ
16.168, p = 0.001) had statistically significant associations with uptake of COVID-19 vaccine. Income levels, belief in existence of COVID-19, information from mass media and being married increased the odds of becoming vaccinated (AOR = 1.5, 95% CI 0.7-3.4), (AOR = 1.8, 95% CI 0.8-4.0) (AOR = 2.5, 95% CI 1.5-4.2) and (AOR = 2.2, 95% CI 1.3-3.9) respectively. The binary logistic regression analysis showed that transport cost and age (p = 0.001) had statistically significant associations with COVID-19 vaccine access and uptake. Those who had difficulty in movement and speaking found uptake of COVID-19 vaccine hard (p = 0.001).
Marital status, information from reliable sources, belief in existence of COVID-19 were associated with access to and uptake of COVID-19 vaccine. Additionally, nonpayment of transport cost increased the odds of becoming vaccinated. Therefore, mobile health teams should be put in place to reach the physically disabled who are hard-to-leave home. Additionally, reimbursement of amount spent on transportation can be adopted to boost access to healthcare services by the physically disabled persons.
Study objective Transgender, transsexual, or transitioned (trans) people have reported avoiding medical care because of negative experiences or fear of such experiences. The extent of trans-specific ...negative emergency department (ED) experiences, and of ED avoidance, has not been documented. Methods The Trans PULSE Project conducted a survey of trans people in Ontario, Canada (n=433) in 2009 to 2010, using respondent-driven sampling, a tracked network-based method for studying hidden populations. Weighted frequencies and bootstrapped 95% confidence intervals (CIs) were estimated for the trans population in Ontario and for the subgroup (n=167) reporting ED use in their felt gender. Results Four hundred eight participants completed the ED experience items. Trans people were young (34% aged 16 to 24 years and only 10% >55 years); approximately half were female-to-male and half male-to-female. Medically supervised hormones were used by 37% (95% CI 30% to 46%), and 27% (95% CI 20% to 35%) had at least 1 transition-related surgery. Past-year ED need was reported by 33% (95% CI 26% to 40%) of trans Ontarians, though only 71% (95% CI 40% to 91%) of those with self-reported need indicated that they were able to obtain care. An estimated 21% (95% CI 14% to 25%) reported ever avoiding ED care because of a perception that their trans status would negatively affect such an encounter. Trans-specific negative ED experiences were reported by 52% (95% CI 34% to 72%) of users presenting in their felt gender. Conclusion This first exploratory analysis of ED avoidance, utilization, and experiences by trans persons documented ED avoidance and possible unmet need for emergency care among trans Ontarians. Additional research, including validation of measures, is needed.
Summary Background With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention ...strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013. Methods We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). Findings Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval UI 0·86–0·94) to 1·45 million (1·38–1·54); YLLs from 31·0 million (29·6–32·6) to 41·6 million (39·1–44·7); YLDs from 0·65 million (0·45–0·89) to 0·87 million (0·61–1·18); and DALYs from 31·7 million (30·2–33·3) to 42·5 million (39·9–45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990. Interpretation Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health. Funding Bill & Melinda Gates Foundation.
By drawing on the experience of trans people who are affected by physical disability, chronic illness and mental illness, this is the definitive guide on providing best practise in approaches to ...health and care policy. Suggesting solutions to areas where understanding and care provision is poor, Kermode gives advice on topics such as transitioning with a disability, sex-specific service provision and fertility and reproduction. The book also examines how health and care professionals can adapt to cater for transgender and non-binary people's needs and can support those who must use health services due to their condition.
Abstract
Objective: Age-related hearing loss is an increasingly important public health problem affecting approximately 40% of 55-74 year olds. The primary clinical management intervention for people ...with hearing loss is hearing aids, however, the majority (80%) of adults aged 55-74 years who would benefit from a hearing aid, do not use them. Furthermore, many people given a hearing aid do not wear it. The aim was to collate the available evidence as to the potential reasons for non-use of hearing aids among people who have been fitted with at least one. Design: Data were gathered via the use of a scoping study. Study sample: A comprehensive search strategy identified 10 articles reporting reasons for non-use of hearing aids. Results: A number of reasons were given, including hearing aid value, fit and comfort and maintenance of the hearing aid, attitude, device factors, financial reasons, psycho-social/situational factors, healthcare professionals attitudes, ear problems, and appearance. Conclusions: The most important issues were around hearing aid value, i.e. the hearing aid not providing enough benefit, and comfort related to wearing the hearing aid. Identifying factors that affect hearing aid usage are necessary for devising appropriate rehabilitation strategies to ensure greater use of hearing aids.
Three studies (N = 990) assessed the statistical reliability of two methods of determining gender identity that can capture transgender spectrum identities (i.e., current gender identities different ...from birth-assigned gender categories). Study 1 evaluated a single question with four response options (female, male, transgender, other) on university students. The missing data rate was higher than the valid response rates for transgender and other options using this method. Study 2 evaluated a method of asking two separate questions (i.e., one for current identity and another for birth-assigned category), with response options specific to each. Results showed no missing data and two times the transgender spectrum response rate compared to Study 1. Study 3 showed that the two-question method also worked in community samples, producing near-zero missing data. The two-question method also identified cisgender identities (same birth-assigned and current gender identity), making it a dynamic and desirable measurement tool for the social and medical sciences.
Purpose: Individuals with physical disabilities are among the most inactive population in society, arguably due to the lack of suitable environments to exercise. The gym is a space dedicated to ...improving physical fitness in a controlled environment with specialized equipment and qualified instructors. The feasibility of using this space to promote health to this population, however, is yet to be established.
Method: Over an 18-month period, 21 people with physical disabilities were interviewed regarding their experiences in the gym. Data were collected using semi-structured interviews, transcribed verbatim, and subject to thematic analysis.
Results: Four broad themes were identified: (1) experiencing enhanced well-ness, (2) perceived conflict between gym values and disability, (3) influence of a previous gym identity, and (4) experiences of psycho-emotional disablism.
Conclusions: Participants were perceived to experience a variety of health benefits; however, they also experienced many barriers such as not aligning to the cultural norms of the gym, limited interpretations of health, oppressive messages from the built environment, and negative relational interactions. While there is potential for the gym to be used as a place to promote health, more must be done to foster an inclusive atmosphere in this space.
Implications for Research
The gym may be a viable place to promote health enhancing behaviors to this population as participants perceived physical, social, and psychological improvements through exercising in this space.
Barriers such as not aligning to cultural norms of the gym, psycho-emotional disablism, and a lack of representation in the gym were perceived to hinder exercise participation.
Gyms should consider funding instructors to go on courses teaching them how to train an individual with a disability, and also consider employing instructors with a disability to mediate the socio-cultural barriers perceived to exist in the gym.
Men and women's past identity as gym users had different ramifications regarding their adoption of exercise after disability, therefore, professionals working in this field should be cognizant of this when designing and delivering exercise programs during and after rehabilitation.
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