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SHAPING EVIDENCE-BASED SOCIAL POLICY FOR THE DISABLED: MAKING THE CASE FOR SPORT
TO IMPROVE HEALTH AND WELL-BEING
Liz Adams, MPH, VA Technology Assessment Program, BostonTed Fay, PhD, SUNY Cortland
Presented to:ISDPA Power of Sport Summit
June 10-12, 2010
Evaluation of sport from an individual & global public health perspective
Evidence-based social policy: myths &
realities
Evidence
Current policy trends
Recommendations for policy & research
Oh, the possibilities!!!
Objectives
“Public Health is defined as improvement of health through the organized efforts of society—social
interventions.” (Gray 1997)
Sport is an organized social intervention for health improvement
Physical activity through sport is an attainable & essential health behavior
A Public Health Perspective
Evidence
ValuesResources
Opinion-based Social Policy
Evidence
ValuesRESOURCES
Evidence-based Social Policy: What it is
Policy based on a systematic appraisal of the best available evidence in
the context of societal values & available
resources (Gray 1997)
Evidence = science & experiences
Policy makers must have the skills to find & assess the quality & applicability of available evidence
Policy shapers must be able to produce & present the evidence on which a decision change should be based
To Affect Evidence-based Social Policy
Impossible to practice
“Cookbook”
Restricted to RCTs & meta-analyses
Cost-cutting
Evidence-based Social Policy: What it isn’t
VALUE “Physical activity” for disabled = a major
public health priority
Sport orgs help promote social policies, healthy environments & behavior
Effective program development
Maximize community participation
Evidence-based Social Policy: Why we need it
Systematic/critical reviews published from 2000-present in English
Databases: Pubmed, EBSCO Rehabilitation and Sports Medicine Source, Cochrane Lib, Embase, Current Contents, Social Science/Science Citation Index, PsychInfo
Terms: “sport”, “exercise”, “physical activity”, “physical fitness”, “recreation” & “leisure”
All disabilities
All outcomes
What is the Evidence?
Psychological benefits of sport (non-sys review) Empowerment model:
◦ performance accomplishments & functional efficiency◦ perceived self-efficacy, self-concept & self-esteem◦ personality disorders, mood states & locus of control◦ activity level & social acceptance
Findings: “most psychological constructs expressed within the empowerment model are positively affected by physical activity in disabled people, when applied properly”◦ Multiple study design limitations
What is the Evidence? Hutzler 1993
Survey of sport disability, age & scientific discipline
Most frequent subjects = wheelchair users (58%), adults (90%), males (98%)
Most frequent outcomes= physiology (41%), psychology (29%)
Findings: Evidence base represented assessment of physiological responses to physical activity in adult males who used wheelchairs
What is the Evidence? Hutzler 1999
Physical activity & exercise, age ≥ 60 yrs
2 SR + 2 critical reviews: 11- 41 RCTs
Findings: Exercise enhances strength, aerobic capacity & function esp. walking, but unclear if exercise prevents or minimizes disability
◦ Multiple study design limitations
What is the Evidence? Keysor 2003
Physical activity in youth w/developmental disability, ages 0-20
3 SR, 1 RCT, 13 uncontrolled studies Findings:
◦ Strong evidence for group exercise, treadmill training, therapeutic riding/hippotherapy
◦ Lower evidence for adapted skiing, aquatic programs
◦ Positive outcomes: enjoyment, satisfaction or physical benefit
◦ Study limitations
What is the Evidence? Johnson 2009
Health promotion activities, age 18-65 80 studies: 32 RCTs, 16 NRCTs, 32 NR uncontrolled Disability groups w/ higher prevalence (20% stroke,
15% MS, 13% intellectual disability (Downs)) Interventions: 26% aerobic, 25% strength, 23%
combo Outcomes: 62.5% functional, 42% musculoskel.,
27% cardioresp., 26% mental Findings: Overall broad in scope, limited quality &
generalizability
What is the Evidence? Rimmer 2010
Sport & games in ↓ symptoms of PTSD (Lawrence 2010)
Policy interventions through sport orgs to promote healthy behavioral changes (Priest 2008)
Policy interventions through sport orgs for increasing participation in sport (Priest 2008)
Findings: 0 studies met inclusion criteria, largely anecdotal
What is the Evidence? Cochrane reviews
Evidence represents a narrow range of disabilities, interventions & relevant outcomes in studies of variable quality.
Benefits of regular physical activity confirmed in general pop but less clear in disabled pop
The effects of sport as a health intervention in the disabled have not been quantified in a meaningful way
Conclusions
Underpowered
Many disabilities under-represented
Randomization infrequent or impractical
Lack of valid disability outcome measurement tools
◦ impairment vs. disability
◦ relevance
Results not stratified by age, health status, functional level, cause of disability, setting & exposure
Poor reporting, no replication
Limitations
Lacks clear & consistent definition of sport
Lacks clear & consistent theoretical framework for eval disabled
◦ WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH) 1980
◦ WHO International Classification of Functioning, Disability and Health (ICF) 2001
What and why?
Limitations
Public Health is paying attention to sport
Population is aging
Lifestyle and “Real world” outcomes are valued
Policy makers want actionable findings
◦ Consider consequences of doing something + not doing something
Personalized vs. one-size-fits-all◦ Shifting from reactive to proactive
Current Public Health Policy Trends
It’s difficult to prove cause and effect without good evidence
◦ Integrative methodologies
Centralized data coordination
Define sport as a health intervention
Identify & use common theoretical framework
Policy and Research Recommendations
Prioritize disability groups
Innovative recruitment strategies targeted toward non-volunteers
Factors affecting participation in sport
Effects of assistive technologies
Policy and Research Recommendations