Liz Adams Shaping Evidence Based Social Policy


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Liz Adams Shaping Evidence Based Social Policy

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