Disparities in Unmet Health Service Needs Among People with Disabilities in China

Background Extensive research has explored disparities in access to health care between people with and without disabilities, but much less is understood about disparities and associated factors within the disabled population. Objective The aim of this study was to examine differences in the prevalence of unmet health care needs by residential status (hukou status) and disability type among people with disabilities. Methods Our data were from the National Survey on Basic Services and Needs of Persons with Disabilities, a large-scale, register-based survey conducted by the China Disabled Persons’ Federation in 2019. The analysis sample included a nationally representative sample of 9,642,112 adults (16+) with disabilities. Associated factors were obtained from both individual-level and community-level. Cross-sectional multivariable logistic regression analyses were conducted to compare people with different residential status and different types of disabilities on unmet medical, care, rehabilitation and accessibility needs. Results The estimated prevalence of unmet medical, care, rehabilitation need and accessibility need are 15.4%, 10.2%, 45.6% and 13.7%, respectively. Rural hukou was associated with an important 13%-40% increase in unmet healthcare needs for people with disabilities in China. These rural-urban disparities in unmet health service needs can be partly explained by community-level factors, including access to facilities, social participation, and health professionals. Disparities across type of disability were smaller, but on average people with multiple disabilities appeared to have the highest rates of unmet care, medical and accessibility needs whereas those with physical disability had the highest unmet rehabilitation need. Conclusions Differences by residential status and impairment type were evident in all types of unmet health service needs. Targeted policy designs that meet the needs for justice and equality of people with disabilities are advisable. Public health and policy efforts are required to improve access to health service and meet the needs of people with disabilities, especially in rural practices and for particular disability groups.

Is Physical Rehabilitation Need Associated With the Rehabilitation Workforce Supply? An Ecological Study Across 35 High-Income Countries

Background: To determine whether population-adjusted rates of physical rehabilitation need (ie, disability-related epidemiological data) are associated with the workforce supply (ie, combined rates of practicing physical therapists (PTs) and occupational therapists (OTs) per 10 000 population) across high-income countries (HICs), adjusted for socio-demographic and economic covariates. Methods: This is a cross-national ecological study. Hierarchical, multiple linear regressions analyzed current international data across 35 HICs using: current PTs and OTs supply data obtained from the international professional federations (outcome variable); needs data obtained from the Global Burden of Disease 2017 (GBD 2017); and finally relevant socio-demographic variables and supply-side covariates extracted from the World Bank, GBD 2017, the supply data sources, and the Global Health Expenditure Database. Results: The PTs and OTs per capita varied greatly across the 35 HICs, differing by as much as 40-fold. Denmark had the greatest supply per capita. Physical rehabilitation need was not a significant, independent predictor of workforce supply regardless of the multiple regression model used (P >.10). In the final model, after Bonferroni correction, 3 covariates were significant, independent predictors of the supply variable: gross national income (GNI) per capita and the current health expenditure in % of gross domestic product (GDP) were positive factors for workforce supply, while population size was a negative factor (all P <.01). Conclusion: PT and OT workforce supply is highly variable across HICs. This variability is not accounted for by an indicator of population need but rather by financial indicators and population size.

Rehabilitation need for migrant populations: physiotherapy treatment of the PostTraumatic Stress Disorder and chronic pain from torture results

The migration phenomenon in recent years is assuming considerable proportions, so it is necessary to consider the need for health of migrant populations. The present work investigates, in particular, the rehabilitation need of the migrant populations. From the analysis of the literature about the incidence and prevalence of the diseases, two conditions of physiotherapy interest come to light: Post Traumatic Stress Disorder (PTSD) and the rehabilitation from torture outcomes. The analysis of the literature was carried out on the most important databases: PubMed, Scopus and PEDro. In PTSD relaxation techniques like BBAT appear to be essential. In chronic pain from torture, manual therapy, progressive exercises, balance training are recommended. Unfortunately, the rehabilitative intervention in no study is well clarified in terms of duration, frequency and type of exercise, so repeatability is definitely invalidated and the effectiveness of it continues to be uncertain.

Employed Vocational Rehabilitation Applicants with Visual Disabilities: Factors Associated with Timely Service Delivery

Introduction: Employed applicants for vocational rehabilitation need timely services to improve the likelihood of their successful job retention or career advancement. Little research exists that examines timeliness of services among employed applicants, particularly for applicants with visual disabilities. This study investigated time from vocational rehabilitation application to a signed Individualized Plan for Emplolyment (IPE) for employed applicants with visual disabilities. Method: The sample of 5,096 competitively employed vocational rehabilitation applicants from the FY2015 RSA-911 report was combined with survey responses from 51 vocational rehabilitation agencies about services to persons with visual disabilities. Multilevel modeling was used to examine effects of state-level and individual-level characteristics and cross-level interactions on the length of waiting time from vocational rehabilitation application to signed IPE. Results: The time from application to IPE was shorter for employed applicants with visual disabilities who received services from separate vocational rehabilitation agencies compared to that of combined vocational rehabilitation agencies. Employed vocational rehabilitation applicants with visual disabilities waited longer if they were younger, non-White, or received disability benefits. Official job-retention policies in state vocational rehabilitation agencies appeared to reduce the delay of IPE implementation for persons with secondary disabilities, for applicants who received disability benefits, and for persons who worked more hours per week. Discussion: Additional research to determine how vocational rehabilitation can provide services to employed persons as soon as possible after application is indicated, particularly for persons applying to combined agencies. Implications for practitioners: Vocational rehabilitation providers should explore ways to expedite service delivery, particularly for persons who are younger, non-White, or receiving disability benefits. Implementing official vocational rehabilitation policies for addressing job-retention and career-advancement cases may be one avenue to expedite services to some employed applicants.

Joint Pressure, Volume and Alignment in Development of AOA: Indications for Orthobiologics and Surgeons

To fix and prevent, not ‘manage’ Osteoarthritis OA in the lower limb, should be the collective ‘Holy Grail’ with or without Orthobiologics OB. Lateral Ankle Sprain LAS, Chronic Ankle Instability CAI and Ankle Osteoarthritis AOA create asymmetry which alters the biomechanics of the entire lower limb, so by better addressing AOA, we can probably do more than just impact the multi-billion dollar annual costs of AOA. It would seem we have advanced, if not futuristic Surgical techniques and Orthobiologic technology, so what is missing? The short answer is Medical Intent MI. Devices and methods used in rehabilitation need MI intent to enable and stimulate repair. The world is changing and Morals Ethics and the human costs, are being counted. CTE concussion is just the tip of the iceberg for cumulative trauma injuries, in cost and prevalence, and class actions seek to defend and enforce people’s rights to safety, either in the workplace, as in professional sport, or in medical outcomes. The significant yet hidden role of the subtalar joint as a ‘Safety Valve’ was first noted by Albert Ferguson in 1972, yet today the contradictions in rehabilitation and injury prevention devices that restrict the STJ, remain commonplace. It is also necessary to consider what has changed inside the synovial capsule before and after lateral ligament injury, such as pressure, joint alignment and space, so we can better understand and design for restoration of homeostasis. This paper will examine factors, causes and interventions that may be inadvertently restricting or preventing Orthobiologics effectiveness in the human ankle from a Translational Medicine perspective and an engineering bias.