Use of accommodations for valued life activities: Prevalence and effects on disability scores

Abstract

Objective. To describe the prevalence of using 4 specific behavioral accommodations (assistive devices, personal assistance, limits on the amount or kind of activities, and taking more time to perform activities) in the performance of valued life activities (VLAs), and to examine the impact of accounting for these accommodations on VLA disability scores. Methods. Data were from a panel study of 467 individuals with rheumatoid arthritis (RA) interviewed annually by telephone. VLA disability was assessed using a 29-item scale, rating difficulty performing each activity and asking whether the 4 types of accommodations were used. An unadjusted difficulty score based solely on difficulty ratings was calculated, as well as 3 adjusted scores accounting for use of assistance or devices, use of assistance, devices, or limitations in activities, and use of all 4 accommodations. Results. Accommodations were widely used by individuals with RA to perform daily activities. Limits and more time were used for more activities than assistance and devices. Adjustment for accommodations produced substantial increases in disability scores (e.g., the mean total VLA difficulty score increased by 84% after adjustment for all 4 accommodations). Conclusion. The accommodations included on the Health Assessment Questionnaire, the most commonly used measure of functioning for RA, include only assistive devices and personal assistance, which were not the accommodations most frequently used in our sample. If assessments are intended to estimate total disease burden, they should include use of a broader range of accommodations to develop a more complete picture of how daily function is affected.

Arthritis restricts volunteer participation: Prevalence and correlates of volunteer status among adults with arthritis

“…For example, in a study examining behavioral modifications for valued life activities among people with rheumatoid arthritis (RA), 53% of participants reported limiting their amount of volunteering (39). The same pattern was found in a similar study of people with systemic lupus erythematosus (40).…”

“…As noted in these studies, the choice to spend more time on certain activities to accommodate effects of arthritis necessitates less time for other activities. Selection may force individuals to limit or give up valued activities, effectively contracting the scope of potential activities in which people participate (39).…”

Self-management strategies to support performance of daily activities in hand osteoarthritis

“…Use a clamp to hold the tube when squeezing (1) Cutting food (35) . Use knifes with ergonomic handles (24) . Use cheese cutters with ergonomic handles (5) .…”

“…Thereafter, the analyses were compared and discussed until agreement was reached (23). The final step consisted of comparing the derived strategies and categories with previous reporting of self-management in rheumatic diseases and, when feasible, wording was adjusted to enable comparison across studies (4,(11)(12)(13)(14)(15)(24)(25)(26). To explore what were the most common strategies, we calculated number of statements within each strategy in the total sample.…”

Development and validation of a short form of the valued life activities disability questionnaire for rheumatoid arthritis

“…The importance of assistive devices and personal assistance to functioning among individuals with RA is reflected by the assessment of accommodations in the HAQ. However, other behavioral accommodations to improve functioning or reduce disability, such as limiting activities or taking more time to perform them, may be more commonly used than assistive devices or personal assistance(6–10). Thus, there is a need for a measure that can address a wide range of functioning, and also address behavioral accommodations that are frequently adopted by individuals with RA to improve their function.…”