Explaining the disability paradox: a cross-sectional analysis of the Swiss general population

BMC Public Health

Research Article

Jerome Bickenbach¹  Gerold Stucki¹  Jan D Reinhardt¹  Bernd Fellinghauer² 

[1] Swiss Paraplegic Research (SPF), Guido A. Zäch Str. 4, 6207, Nottwil, Switzerland;Department of Health Sciences and Health Policy, University of Lucerne and SPF, Frohburgstr. 3, 4466, Lucerne, Switzerland;Swiss Paraplegic Research (SPF), Guido A. Zäch Str. 4, 6207, Nottwil, Switzerland;Seminar für Statistik, ETH Zurich, Rämistr. 101, 8092, Zurich, Switzerland;

关键词: Disability;    Human functioning;    Perceived health;    Impairment;    ICF;    Graphical models;    Activity limitation;    Participation restriction;   

DOI  :  10.1186/1471-2458-12-655

 received in 2012-01-16, accepted in 2012-07-03,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundDisability can be broken down into difficulties in different components of functioning such as impairments and limitations in activities and participation (A&P). Previous studies have produced the seemingly surprising result that persons with severe impairments tend to report high quality of life (QoL) including perceived health regardless of their condition; the so-called “disability paradox”. We aim to study the role of contextual factors (i.e. the personal and environmental situation) in explaining the disability paradox.MethodsThe Swiss Health Survey provides information on the perceived health of 18,760 participants from the general population. We construct a conditional independence graph applying random forests and stability selection in order to represent the structure of impairment, A&P limitation, contextual factors, and perceived health.ResultsWe find that impairment and A&P limitations are not directly related but only via a cluster of contextual factors. Similarly, impairment and perceived health are not directly related. On the other hand, perceived health is directly connected with A&P limitations. We hypothesize that contextual factors have a moderating and/or mediating effect on the relationship of impairment, A&P limitations, and perceived health.ConclusionThe disability paradox seems to dissolve when contextual factors are put into consideration. Contextual factors may be responsible for some persons with impairments developing A&P limitations and others not. In turn, persons with impairments may only then perceive bad health when they experience A&P limitation. Political interventions at the level of the environment may reduce the number of persons who perceive bad health.

【 授权许可】

Unknown   
© Fellinghauer et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.