Focus on Secondary Condition Prevention: Defining Secondary Conditions for People with Disabilities

While there is agreement that secondary conditions can be debilitating, costly in terms of financial and social consequences, and potentially fatal in some circumstances, there is much debate within the disability community as to how to define secondary conditions. To set the stage for future columns dedicated to providing information and advice on how to reduce or prevent these conditions to improve quality of life for people with disabilities, this column will provide a framework within which to examine these issues.

A little over a month ago, Workshop on Disability in America: A New Look was published by the Institute of Medicine. In it, leading experts within the field of disability wrote about such topics as: (1) secondary conditions and disability; (2) impact of exercise on targeted secondary conditions; (3) secondary conditions with spinal cord injury; (4) depression as a secondary condition in people with disabilities; and (5) promoting health and preventing secondary conditions among adults with disabilities. This publication provides an excellent resource on the topic of secondary conditions, yet even within its pages lie differing opinions as to what constitutes a secondary condition.

Some views favor a narrow scope of identifying secondary conditions as primarily physiological in nature. Examples of these secondary conditions would include pressure sores, urinary tract infections, and deconditioning. Other, broader views of secondary condition definitions include environmental factors such as access to health services and structural barriers located within the environment that affect the health status of people with disabilities. Counter to this view is that environmental barriers actually represent issues of limited participation, not secondary conditions.

Those who argue for the narrower definition point out that when secondary conditions are thought of as expanding to include the larger issues of “disability,” this broad scope dilutes the larger need to promote access, modify attitudes, and increase societal participation. However, others point out that environmental barriers represent conditions affecting the health status of people with disabilities and therefore fall within a broad definition of secondary conditions. This broad definition is supported by the Healthy People 2010 Report (Chapter 6, Disability and Secondary Conditions), which lists secondary conditions as "medical, social, emotional, family, or community problems that a person with a primary disabling condition likely experiences."

What is needed is a clear way in which to define secondary conditions, which has not yet been determined based on differences within the literature. For example, some researchers include psychosocial factors such as 'feelings of being isolated' and 'problems getting around' in the definition of secondary conditions, whereas others adhere to a strictly body systems/structures [medical] definition. Some difficulties such as 'problems getting around' could be attributed to internal problems such as muscular atrophy and fatigue, or to environmental conditions such as difficulty accessing a transportation system. Missing from the literature is scientific evaluation of secondary conditions in ways that allow for evidence-based practice using tested prevention interventions. A universal definition of secondary conditions would contribute to this level of examination and would allow for comparison of results across studies and populations.

While both sides agree that environmental barriers are often the key to successful participation for all people with disabilities, there is disagreement as to where these barriers fit within the definitional framework of secondary conditions. Within the context of this column, I am choosing to adopt the broader definition of secondary conditions that embraces physiological, psychological, and environmental barriers as secondary conditions affecting the health status of people with disabilities. I look forward to sharing with you information and advice on ways to prevent or reduce the impact of secondary conditions using medical, behavioral, structural, and technological interventions that can work together to improve quality of life for people with disabilities.

I encourage you to contact me with suggestions for future column topics or to comment on this column. You can reach me, Dr. Jennifer L. Rowland, by e-mail at jenrow@uic.edu or (312) 523-4236.

Thank you for your feedback!
Thank you for the responses to last month’s column! I will address your questions and suggestions in future columns. I also welcome comments and responses from people with disabilities who have experienced, or who are experiencing, secondary conditions. If you have information about products or interventions that worked for you when preventing or treating secondary conditions, let me know and I will share that information with other readers so they may benefit from this knowledge.

This fact sheet was last updated on 04-07-2006.