Vol. 90, No. 3, March 2010, pp. 324-325
DOI: 10.2522/ptj.2010.90.3.324
Editorials |
Improving the Evidence Base for Physical Therapy Disability Interventions
Disability is an emerging global issue, as reflected by the first joint World Health Organization (WHO)–World Bank Report on Disability, Rehabilitation, and Inclusion, scheduled to be released by WHO in 2010. Some estimates suggest that 10% of the world's population has some form of disability—but that figure excludes the families who are affected by a member's disability.1 According to 2005 US Census Bureau statistics, 54 million (18.7%) people in the United States have some level of disability.2 That number will grow significantly over the next 20 years as the baby-boom generation enters late life, when the risk of disability is greatest.
People with disabilities comprise the largest and arguably the most important health care consumer group in the United States; however, as the Institute of Medicine and others have warned,3,4 far too little progress has been made over the past 2 decades in removing obstacles that limit what many people with physical and cognitive impairments can achieve. Part of the challenge might be that disability is complex, multifactorial, and difficult to define. In addition, there is a persistent lack of evidence about strategies to reduce activity limitations and improve participation for people with disability, which hinders the development of sound policy and intervention options.
Despite the challenges, this is a time of great innovation: many technological developments provide the opportunity for new strategies and interventions to enhance participation in people with disability. New technologies have the potential to reduce environmental barriers, such as "smarter" homes and buildings that allow tasks to be performed with minimal human input and mobility and communication equipment that minimizes the impact of underlying impairments on function. The usual delivery of therapy services is enhanced by telerehabilitation, which facilitates training via the Web, telephone, or other technology over great distances. New social media are allowing more people with disabilities to connect with one another and support each other in real time in a way that was impossible before.
The field of physical therapy can be central to ensuring an optimal future for people with disability across the globe. As Jules Rothstein, Editor in Chief Emeritus, wrote in PTJ's 1994 special issue on Physical Disability:
We began, and I hope will always be seen as, professionals who seek to deal not just with pathologies and impairments, but also with the disabling consequences of diseases, trauma, and developmental anomalies. In essence we became an identifiable group not when we administered massages, heat, exercises, or electrical stimulation, but rather when we chose to collect a body of knowledge and clinical approaches that focused on eliminating disability, when we sought to bring meaningful function back into the lives of those who sought our services.5(p375)
There is a scarcity of available scientific evidence about the patterns of health conditions and the health care needs of people with disability and about effective interventions for prevention, treatment, and rehabilitation. In addition to the lack of evidence about what works to improve activity and participation of those with disabilities, there also is little evidence about the costs incurred. With the aim of helping to advance science and practice in these areas, PTJ invites original contributions to a special issue, to be published in late 2010/early 2011. Improving the Physical Therapy Evidence Base for Disability Intervention will capture the latest research, perspectives, and scholarship. We seek to aggregate and disseminate high-quality disability research on such topics as:
- What are the patterns of need for physical therapy in people with disabilities?
- What are the key physical therapy interventions that will improve levels of activity and participation for people with disabilities?
- What new interventions or technological developments have preliminary evidence of efficacy in improving participation in people with disability?
- What is the current state of understanding of the etiology, prevention, and treatment of secondary conditions for people with disability?
- Are physical therapy services, technological aids, and universal design features that promote good health and that maximize societal participation accessible to people with disability?
- Are there effective ways to reduce environmental barriers for people with disability?
- Are there important breakthroughs and advances in the conceptualization, definition, and measurement of disability?
- Are there special issues and needs for people aging with a disability compared to those who develop a disability as they age?
- What rehabilitation approaches have some evidence of efficacy when used in developing countries?
We encourage scientists conducting research relevant to the nexus of physical therapy and disability to contribute to building this crucial knowledge base. PTJ's special issue will provide a global forum for presenting authoritative empirical research, theoretical development and perspectives, clinical case studies, and related innovative developments.
Those interested in contributing to the special issue are asked to forward an outline of your proposed topic for consideration to disabilityevidence{at}apta.org.
References
- Mont D. Measuring disability prevalence. SP Discussion Paper No. 0706. Washington, DC: The World Bank; 2007.
- Brault M. Americans with disabilities: 2005. Current Population Reports. Washington, DC: US Census Bureau; 2008:3.
- Field M, Jette AM, eds; Committee on Disability in America. The Future of Disability in America. Washington, DC: The National Academies Press; 2007.
- Disability: beyond the medical model [editorial]. The Lancet. 2009;374:1793.
- Rothstein JM. Disability and our identity [editorial]. Phys Ther. 1994;74:375–378.
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