Swiss Paraplegic Research, Guido A, Zäch Str. 4, 6207 Nottwil, Switzerland.
BMC Public Health. 2012 Aug 15;12:655. doi: 10.1186/1471-2458-12-655.
Disability can be broken down into difficulties in different components of functioning such as impairments and limitations in activities and participation (A&P). Previous studies have produced the seemingly surprising result that persons with severe impairments tend to report high quality of life (QoL) including perceived health regardless of their condition; the so-called "disability paradox". We aim to study the role of contextual factors (i.e. the personal and environmental situation) in explaining the disability paradox.
The Swiss Health Survey provides information on the perceived health of 18,760 participants from the general population. We construct a conditional independence graph applying random forests and stability selection in order to represent the structure of impairment, A&P limitation, contextual factors, and perceived health.
We find that impairment and A&P limitations are not directly related but only via a cluster of contextual factors. Similarly, impairment and perceived health are not directly related. On the other hand, perceived health is directly connected with A&P limitations. We hypothesize that contextual factors have a moderating and/or mediating effect on the relationship of impairment, A&P limitations, and perceived health.
The disability paradox seems to dissolve when contextual factors are put into consideration. Contextual factors may be responsible for some persons with impairments developing A&P limitations and others not. In turn, persons with impairments may only then perceive bad health when they experience A&P limitation. Political interventions at the level of the environment may reduce the number of persons who perceive bad health.
残疾可细分为功能不同组成部分的困难，如损伤和活动及参与的限制（A&P）。先前的研究产生了一个看似令人惊讶的结果，即尽管状况不佳，严重损伤的人往往报告较高的生活质量（QoL），包括感知健康；即所谓的“残疾悖论”。我们旨在研究环境因素（即个人和环境状况）在解释残疾悖论中的作用。
瑞士健康调查提供了来自普通人群的 18760 名参与者感知健康的信息。我们应用随机森林和稳定性选择构建条件独立性图，以表示损伤、A&P 限制、环境因素和感知健康的结构。
我们发现损伤和 A&P 限制不是直接相关的，而是通过一组环境因素间接相关的。同样，损伤和感知健康也没有直接关系。另一方面，感知健康与 A&P 限制直接相关。我们假设环境因素对损伤、A&P 限制和感知健康的关系具有调节和/或中介作用。
当考虑环境因素时，残疾悖论似乎就消解了。环境因素可能导致一些有损伤的人出现 A&P 限制，而另一些人则没有。反过来，当有损伤的人经历 A&P 限制时，他们可能才会感知到健康状况不佳。环境层面的政治干预可能会减少感知健康状况不佳的人数。
