Disabilities

Knee osteoarthritis (KOA) is a leading cause of disability in older adults, characterized by persistent pain and reduced physical function. Beyond localized joint pathology, many individuals with knee osteoarthritis experience multisite pain and live with multiple comorbidities, reflecting a heterogeneous and multifactorial pain condition. Prognostic models based primarily on biomedical variables have shown limited ability to explain long-term outcomes, partly due to insufficient integration of pain chronicity, comorbidity count and psychosocial determinants such as treatment expectations and pain self-efficacy. While exercise and education are commonly recommended as primary non-surgical treatments, people often respond to them very differently. This study protocol describes a secondary longitudinal observational analysis of data from the EPIPHA-KNEE two-arm, multicentre randomized controlled trial. The primary outcomes will be knee OA pain intensity and physical function, assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire at baseline, 3, 6 and 12 months. Baseline prognostic factors will include pain duration, pain distribution, comorbidity count and patient expectations, including treatment expectations and pain self-efficacy. Linear mixed-effects models will be used to examine longitudinal associations between these predictors and pain and function trajectories, with particular emphasis on predictor-by-time interactions to characterize differential patterns of change over time. The planned analyses aim to improve understanding of how clinical characteristics and expectancy-related factors jointly shape 12-month pain and physical function trajectories in older adults with knee osteoarthritis receiving education and exercise-based care, thereby informing prognostic stratification within non-surgical management.

In recent decades, technological advances have fostered new therapeutic approaches for children with neurodevelopmental disorders, particularly Autism Spectrum Disorder. Educational robotics has emerged as a promising resource for acquiring social skills, recognizing emotions, and developing theory of mind. However, there is still a need to understand which dimensions are most susceptible to this specific intervention and how its impact differs based on individual profiles. This study analyzes the effect of a therapeutic intervention based on Educational Robotics on Social Skills, Emotional Recognition, and Theory of Mind in two students diagnosed with Autism Spectrum Disorder. The intervention was structured in seven sessions using the ANDY^® kit. Tests from the NEPSY-II battery and an observational rubric of Social Skills recorded session by session were applied. Both participants showed significant improvements in Social Skills, especially in rules of courtesy, nonverbal communication, and conversational interaction. Regarding Emotional Recognition, one participant improved in identifying highly affective emotions, while the other showed more modest progress. Theory of Mind showed progress in only one of the participants. Adherence was high, although a slight decrease in motivation was identified in the last sessions. These results suggest that Educational Robotics, when applied within a structured therapeutic framework, can effectively foster socioemotional development in children with Neurodevelopmental Disorders. However, variability across domains highlights the importance of tailoring interventions to individual profiles and complementing them with strategies that support the transfer of learning to natural contexts.

Access to health care is a fundamental human right established in various legal frameworks worldwide. However, increasing evidence indicates that individuals with physical disabilities in rural Ethiopia continue to face barriers and disparities in accessing health care, leading to unmet needs and worsening health. Guided by Critical Disability Theory and Intersectionality Theory, this instrumental case study explored the barriers to accessing primary health care (PHC) for adults with physical disabilities in rural Ethiopia and examined how disability intersects with poverty, gender, and rurality to shape exclusion. Following purposeful sampling, we conducted 14 interviews and one focus group discussion (n = 7) with adults with physical disabilities, supplemented by PHC facility infrastructure observation. Using reflexive thematic analysis, we identified intersecting barriers across four domains: physical and environmental barriers, socioeconomic marginalization, socio-cultural stigma and attitudinal barriers, and systemic weaknesses in health service delivery. This revealed that disability-related barriers are rooted in structural ableism and intersecting inequities, underscoring the urgent need for inclusive policies and disability-inclusive practices. Such practices include enforcing accessibility standards, expanding community-based health insurance to cover disability-specific needs, supporting transportation, and providing disability-specific training for health professionals. Implementing these practices is essential to advancing disability rights and ensuring equitable health access in Ethiopia.