This study established a fall prediction model for physically disabled people and investigated the differences between polio and no-polio disabled participants in demographic information, psychological status, musculoskeletal conditions, and mobility. The cause of physical disability, gender, disability grade, and FGA constituted the fall prediction model, which had reasonable sensitivity and specificity in the fall diagnosis. The history of disability was longer in the polio group than that in the no-polio group, but significantly more severe anxiety was found in no-polio disabled participants. Meanwhile, the incidence of musculoskeletal conditions in the polio group was significantly higher than that in the no-polio group. In the mobility tests, the polio group had relatively weak performance in TUG but they were more active in terms of physical activity. Furthermore, the Polio group not only had a higher rate of falls but also mainly recurrent falls.
The results of this study showed that indicators related to the severity of disability, rather than age 20, were important in the prediction of falls in middle-aged and elderly disabled people. Female participants in this model were more likely to fall, which may indicate the balance of female disabled people declines faster after middle age than the males 21, 22. In addition to the demographic indicators, FGA was entered in this model, suggesting that FGA can also be employed in the evaluation of the people with physical disabilities in addition to the elderly community dwellers 23. ROC curve further verified the effect of the model in fall prediction and provided the cut-off point for clinical reference. Previous studies have found that TUG had both good discriminant validity24, 25 and responsiveness 26 in disabled people 25. This study also showed that TUG test can effectively distinguish the mobility of the polio group and the no-polio group, but the effect in fall prediction was insignificant. The explanation was that as a quick screening tool, TUG only included three aspects of position transferring, walking, and turning, while fall evaluation of the disabled should take more circumstances into consideration 27.
Compared to psychological issues, health conditions in the musculoskeletal system had more negative impacts on activities of daily living 28. In this study, the five most frequently reported musculoskeletal conditions were contracture, short limb, pain, numbness, and scoliosis and almost all polio participants suffered from multiple musculoskeletal conditions. The findings identified the intervention targets which the healthcare provider should focus on to maximize their functional independence.
There were few studies on the stigma of people with physical disabilities. This study showed that both of the two groups had a low level of stigma. Due to the long history of disability, the participants were essentialized and had stable and positive self-evaluation 29. However, it should be noted that people with physical disabilities may hide their disability-related characteristics to reduce stigma30. For instance, disabled people may reduce their exposure to the public and refuse to use axillary crutches, wheelchairs, or other assistive devices, which usually led to motor function decline and social participation limitation. The positive rate of moderate anxiety was significantly higher in the no-polio group. A previous study demonstrated that moderate-to-vigorous physical activity was related to the reduction of anxiety symptoms 31 and anxiety also improved over time 32, as the no-polio group had a shorter history of disability with a less active lifestyle than the polio group in this study. In addition, the prevalence of depression was reported to be 13.5% among healthy people over 55 years old 33 and a survey of disabled people in England found that the positive rate of depression was 19.5% 34 which was similar to the overall positive rate of depression in this study. It was recommended that depressive symptoms should be taken into consideration when making policies related to senior adults35.
Clinical Implication
A rational fall prediction model was established in this study, where the cause of disability, gender, grade of disability, and functional gain assessment were the four significant indicators. The disabled people with a high risk of falling can be identified through roughly 10 minutes of screening and calculating. This study also showed the intervention targets for the musculoskeletal conditions in people with physical disabilities, such as contracture, short limb, scoliosis, numbness, and pain, especially in the polio group. Considering the high positive rates of anxiety and depression among the physically disabled, policymakers should take some low-cost and efficient interventions into account.