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ANNEX 2: Physical and Complex Disabilities Client Group R&D Priorities: Priority 5: Mechanisms of disablement and handicap

  • Last modified date:
    15 August 2002

Priority 5: Mechanisms of disablement and handicap

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Importance

Disablement and handicap are brought about by physical and psychological changes in the disabled person, and by society's response to them. The interaction between these mechanisms are complex and better evaluation would help to ensure that resources are deployed in a way that most effectively minimises disablement and handicap. There is a paucity of research on the effectiveness and cost-effectiveness of interventions to reduce disability and handicap. Primary prevention, such as reduction in childhood accidents, and secondary prevention are both important in reducing burden on disabled people and their families and on the NHS. Secondary prevention must address not only the prevention of unnecessary physical disabilities but the prevention or amelioration of cognitive and psycho-social disabilities.

The way society views people with disabilities can compound their condition. Removing adverse social and environmental factors would, in many cases, create greater benefits than attempts to reverse physical impairments. Cost-benefit analysis of different approaches - such as alleviation of restricted mobility and access - needs to be systematically undertaken.

This research area also encompasses the development of better outcome measures and targets. Effective intervention can only be judged by the use of adequate outcome measures. There are a large number of measures of impairment. But, few have been properly validated or offer comprehensive measures of disablement and handicap which encompass physical, psychological and social functions. Very few adequate scales exist to measure outcome in terms of quality of life. There is a need to develop expertise, both to evaluate existing scales and to develop new measures.

Examples of Research and Development Objectives

  1. Identification of critical thresholds in progressive disabilities, such as the inability to transfer from one caring environment to another or to live independently.
  2. Identification of a hierarchy of skill acquisition and skill retention as a guide to treatment.
  3. Testing the effectiveness of measures used to prevent deformity in children and adults
  4. Evaluation of ways of delivering information to disabled people and of how the provision of such information affects the way the client copes with disability and handicap.
  5. Evaluation of measures to promote continence.
  6. Evaluation of the disabling effects of NHS environments, including the behaviour of NHS management and clinical staff.

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