A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
A mobility disability is a type of physical disability that affects a person’s movement and dexterity. People with mobility disabilities may use assistive devices or mobility aids such as wheelchairs, walkers, crutches, or prosthetics. Previous studies have shown that people with mobility disabilities were disproportionately affected by the Coronavirus pandemic that began in March 2020, both by the virus itself and by pandemic safety measures that were put into effect to control its spread. Social distancing and lockdown measures limited access to health services and facilities, as well as the social supports needed to fully participate and live independently in the community of their choosing.
In a recent NIDILRR-funded study, researchers wanted to examine the impact of the pandemic on the lived experiences of people with mobility disabilities. Researchers also wanted to find out how the pandemic and related public health policies affected the physical and mental health of people with mobility disabilities, and their access to health care and everyday health needs such as medications and medical supplies.
Researchers at the Rehabilitation Research and Training Center on Promoting Interventions for Community Living (RRTC/PICL) surveyed 39 people with mobility disabilities who were enrolled in a larger study on community participation about their experiences during the pandemic. Participants were 18 years or older with an average age of about 53 and were living independently in a community. Participants were mostly female, white, and unmarried. Participants answered questions about how the coronavirus and public health measures such as social distancing affected their access to medical providers, health services, transportation, medical supplies, medications, and mental health services, as well as how the pandemic affected their physical and mental health. Participants could answer whether their condition remained unchanged, worsened, improved, or was not applicable. Those who answered that their condition improved or worsened had the opportunity to provide details about how the pandemic affected that aspect of their life.
Overall, the results show that many participants experienced worsened access to health services, medications, and medical supplies, and changes to their physical and mental health, and they cited a variety of reasons for what they experienced.
- Access to medical providers: 60.5% of participants said their access to medical providers worsened during the pandemic. Reasons included canceled services, closed offices, or staff layoffs resulting in limited appointment availability.
- Access to health services: 48.6% of participants said their access to specific health services such as elective surgeries and dental care worsened during the pandemic. Reasons included office closures, staffing shortages, and personal decisions to put off care to avoid exposure to the coronavirus.
- Access to transportation: 42.1% of participants said their access to transportation worsened during the pandemic. Reasons included transit services cancellations that resulted in some participants having to find facilities that were within walking distance for their health needs, skipping appointments, or skipping prescription pick-ups.
- Access to medical supplies: 23.5% of participants described worsened access to medical supplies, from general medical supplies like masks and gloves to specialized equipment like tubing for nebulizers and parts for wheelchairs. Reasons included closure of health facilities, insurance delays, or avoiding visiting providers to pick up or exchange their equipment because of perceived risk.
- Access to medications: 18.9% of participants expressed worsened access to medications during the pandemic. Reasons included office closures, prescription delays, telecommunication access, and supply shortages.
- Access to mental health services: 47.4% of participants had worsened access to mental health services. Reasons included difficulty finding providers who were willing to take on new patients during the pandemic, limited in-person appointments, discomfort with teletherapy or fear of being overheard during teletherapy sessions, and poor internet connection as a barrier to accessing online therapy and counseling sessions.
- Changes in physical health: 40.5% of participants experienced worsened physical health. Reasons included inactivity and related weight gain contributing to increased pain. On the other hand, some participants reported improved physical health due to having more free time to focus on their health.
- Changes in mental health: 48.6% of participants experienced worsened mental health. Reasons included not leaving the home, increased anxiety over the pandemic, and the lack of social interactions. However, some participants reported positive experiences, such as having time and space for introspection and refocus.
The authors noted that, in every health topic area, at least some participants reported decreased access to health facilities, supplies, and services during the pandemic and negative changes to their physical and mental health. While telehealth services and prescription deliveries were helpful for some participants to fill the gap in services, barriers such as inflexible policies around in-person and telehealth services, reduced staffing and closed facilities, and limited access to reliable telecommunications and transportation reduced participants’ access to necessary services and supports. Many of these barriers were not due directly to the virus, but resulted from the social safety measures put in place to prevent the spread of the COVID infection.
According to the authors, the results from this study highlight the importance of including the needs of people with disabilities when creating health policies and emergency response plans. Pandemic policies such as office closures and appointment cancellations may have put individuals with mobility disabilities at risk for poor health due to delayed treatment, missed therapy, or assistive devices in need of repair or replacement. They suggested that creating health policies with flexibility for telehealth and prescription delivery may alleviate some barriers experienced during public health emergencies like the pandemic. Telehealth may provide a way to continue care for some, but in-person care may still be an important service to consider. The authors pointed out that people with disabilities are less likely to have reliable access to the internet, and some services, such as physical therapy, may not be compatible with telemedicine. Emergency preparedness planners should consider the everyday health needs of people with disabilities when deciding upon facility closures, stockpiles of medical supplies, and the availability of service providers.
To Learn More:
The Pacific ADA Regional Center offers a collection of resources on health care and the Americans with Disabilities Act (ADA), as well as a regular webcast series on the topic.
Throughout the COVID-19 pandemic, the NIDILRR grantee community development many resources for health care providers, community entities, and individuals with disabilities to facilitate access to care including:
- COVID-19, Health care, and the ADA (webinar)
- Creating Rural Community Outreach Materials Related to COVID-19 and Disability (practice guidelines)
- Frequently Asked Questions about Spinal Cord Injury and COVID (factsheet)
- Managing your Wellness During the COVID-19 Outbreak (resource collection)
- Rationing of Medical Care and Protecting the Rights of People with Disabilities (webcast)
These and more resources are indexed in NARIC’s COVID-19 Special Collection.
To Learn More About this Study:
Goddard, K.S., Schulz, J., Nzuki, I., Hall, J.P. (2022). Examining the impacts of the coronavirus pandemic and social distancing on the health of people with mobility disabilities. Frontiers in Public Health. This article is available from the NARIC collection under Accession Number J88593 and in full text from the publisher.