Elizabeth M Badley

University of Toronto, Toronto, Ontario, Canada

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Publications (193)708.06 Total impact

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    ABSTRACT: The International Classification of Functioning, Disability and Health (ICF) published in 2001 describes the consequences of health conditions with three components of impairments in body structures or functions, activity limitations and participation restrictions. Two of the new features of the conceptual model were the possibility of feedback effects between each ICF component and the introduction of contextual factors conceptualized as moderators of the relationship between the components. The aim of this longitudinal study is to provide empirical evidence of these two kinds of effect. Structural equation modeling was used to analyze data from a French population-based cohort of 548 patients with knee osteoarthritis recruited between April 2007 and March 2009 and followed for three years. Indicators of the body structure and function, activity and participation components of the ICF were derived from self-administered standardized instruments. The measurement model revealed four separate factors for body structures impairments, body functions impairments, activity limitations and participation restrictions. The classic sequence from body impairments to participation restrictions through activity limitations was found at each assessment time. Longitudinal study of the ICF component relationships showed a feedback pathway indicating that the level of participation restrictions at baseline was predictive of activity limitations three years later. Finally, the moderating role of personal (age, sex, mental health, etc.) and environmental factors (family relationships, mobility device use, etc.) was investigated. Three contextual factors (sex, family relationships and walking stick use) were found to be moderators for the relationship between the body impairments and the activity limitations components. Mental health was found to be a mediating factor of the effect of activity limitations on participation restrictions.
    Social Science [?] Medicine 05/2015; 135. DOI:10.1016/j.socscimed.2015.05.007
  • Osteoarthritis and Cartilage 04/2015; 23:A48. DOI:10.1016/j.joca.2015.02.105
  • Osteoarthritis and Cartilage 04/2015; 23:A186. DOI:10.1016/j.joca.2015.02.964
  • Osteoarthritis and Cartilage 04/2015; 23:A322. DOI:10.1016/j.joca.2015.02.584
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    ABSTRACT: To examine work absenteeism, job disruptions and perceived productivity loss and factors associated with each outcome in young adults living with systemic lupus erythematosus (SLE) and juvenile arthritis (JA). One hundred and forty three young adults, ages 18 to 30 years, with SLE (54.5%) and JA (45.5%) completed an online survey of work experiences. Demographic, health (e.g., fatigue, disease activity), psychosocial (e.g., independence, social support) and work context (e.g., career satisfaction, job control, self-disclosure) information were collected. Participants were asked about absenteeism, job disruptions and perceived productivity loss in the last six months. Log-Poisson regression analyses examined factors associated with work outcomes. A majority of participants were employed (59%) and reported a well-managed health condition. Employed respondents were satisfied with their career progress and indicated moderate job control. Over forty percent of participants reported absenteeism, job disruptions and productivity loss. Greater job control and self-disclosure, and less social support were related to a higher likelihood of absenteeism; more disease activity was related to a greater likelihood of reporting job disruptions; lower fatigue and higher job control was associated with a reduced likelihood of a productivity loss. Young adult respondents with rheumatic disease experienced challenges with employment including absenteeism, job disruptions and productivity loss. While related to greater absenteeism, job control could play a role in a young person's ability to manage their health condition and sustain productive employment. Greater attention should also be paid to understanding health factors, and social support in early work experiences. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
    04/2015; DOI:10.1002/acr.22601
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    ABSTRACT: ContextBaby boomers are commonly believed to be healthier than the previous generation. Using self-rated health (SRH) as an indicator of health status, this study examines the effects of age, period, and birth cohort on the trajectory of health across 4 generations: World War II (born between 1935 and 1944), older baby boomers (born between 1945 and 1954), younger baby boomers (born between 1955 and 1964), and Generation X (born between 1965 and 1974).Methods We analyzed Canada’s longitudinal National Population Health Survey 1994-2010 (n = 8,570 at baseline), using multilevel growth models to estimate the age trajectory of SRH by cohort, accounting for period and incorporating the influence of changes in education, household income, smoking status, and body mass index (BMI) on SRH over time.FindingsSRH worsened with increasing age in all cohorts. Cohort differences in SRH were modest (p = 0.034), but there was a significant period effect (p = 0.002). We found marked cohort effects for increasing education, income, and BMI, and decreasing smoking from the youngest to the oldest cohorts, which were much reduced (education and smoking) or removed (income and BMI) once period was taken into account. At the population level, multivariable analysis showed the benefits of increasing education and income and declines in smoking on the trajectory of improving SRH were almost counterbalanced by the effects of increasing BMI (obesity).Conclusions We found no evidence to support the expectation that baby boomers will age more or less healthily than previous cohorts did. We also found that increasing BMI has likely undermined improvements in health that might have otherwise occurred, with possible implications for the need for health care. Period effects had a more profound effect than birth cohort effects. This suggests that interventions to improve health, such as reducing obesity, can be targeted to the entire, or a major portion of the, population and need not single out particular birth cohorts.
    Milbank Quarterly 03/2015; 93(1). DOI:10.1111/1468-0009.12105
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    ABSTRACT: Purpose:To determine the impact of lack of government insured routine eye examinations on the incidence of self-reported glaucoma, cataracts and vision loss. Methods:We analyzed data from the Canadian longitudinal National Population Health Survey (1994-2011). White respondents aged 65+ in 1994/1995 were included (n=2618). Three cohorts were established at baseline: those free of glaucoma, cataracts and vision loss (i.e. unable to see close or distance when wearing glasses or contact lenses). Incident cases were identified through self-reporting of these conditions during the follow-up period. Results:The incidence (per 1000 person-years) of glaucoma was lower in uninsured provinces (8.1, 95% confidence interval [CI] 5.5-10.7) than in insured provinces (12.8, 95% CI 10.5-15.1). The incidence of cataracts was also lower in the uninsured (67.2, 95% CI 55.7-78.6) versus insured provinces (75.7, 95% CI 69.2-82.2). The incidence of vision loss was higher in the uninsured (26.6, 95% CI 20.2-33.0) versus insured provinces (22.5, 95% CI 20.0-25.5). Adjusting for confounders, seniors in insured provinces had a 59% increased risk of glaucoma (incidence rate ratio [IRR] 1.59; 95% CI 1.07-2.37), a 13% greater risk of cataracts (IRR 1.13, 95% CI 0.93-1.37) and a 12% reduced risk of vision loss (IRR 0.88, 95% CI 0.67-1.16). Conclusions:Lack of government-funded routine eye examinations is associated with a reduced incidence of self-reported glaucoma and cataracts, likely due to reduced detection. Lack of insurance is also associated with a higher incidence of self-reported vision loss, likely due to poorer access to eye care and late treatment. Copyright © 2014 by Association for Research in Vision and Ophthalmology.
    Investigative Ophthalmology &amp Visual Science 12/2014; 55(12). DOI:10.1167/iovs.14-15361
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    ABSTRACT: Objectives: To explore the perceived consequences of knee symptoms on the lives of people aged 35-65 years who had diagnosed osteoarthritis (OA) or OA-like symptoms. Design: A qualitative study with six focus groups and 10 one-on-one interviews. Constructivist grounded theory guided data collection and analysis. Data were analysed using the constant comparative method. Setting: Toronto, Canada. Participants: 51 participants (median age 49; 61% female) who self-reported knee OA or reported knee pain, aching or stiffness on most days of the past month participated in the study. Results: The core finding, disruption and change, illustrates the range of perceived consequences of knee symptoms in peoples' lives. Participants described the consequences of symptoms on their physical activity (giving up high-level activities or changing how or how much they performed activities), social life (leisure, family and work) and emotional life. Knee symptoms also altered the way participants thought about their bodies and themselves. They reported that they had a new awareness of their knee and that they no longer trusted their knee. They also conveyed that their sense of self was altered. Conclusions: This study illuminates the significant and varied consequences that mild to moderate knee symptoms have on the lives of adults age 35-65 years. Findings highlight the need for clinicians to tailor advice and support to the individual's needs considering their symptoms, the consequences of symptoms on their lives and their personal context.
    BMJ Open 10/2014; 4(10):e006006. DOI:10.1136/bmjopen-2014-006006
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    ABSTRACT: Objective. To examine perceived independence, overprotection, and support, and their association with the employment participation of young adults with rheumatic disease. Methods. One hundred and forty-three young adults, ages 18 to 30 years, with systemic lupus erythematosus (54.5%) and juvenile arthritis (45.5%) completed a 30-min online questionnaire of their work and education experiences. Information collected was demographic, health (e.g., pain, fatigue, disease activity), work context (e.g., career satisfaction, helpfulness of job accommodation/benefits, and workplace activity limitations), and psychosocial (e.g., independence, social support, and overprotection). Log-Poisson regression analysis examined factors associated with employment status. Results. Over half of respondents were employed (59%) and 26% were enrolled in school. Respondents reported moderate to high perceptions of independence and social support. However, 27% reported that "quite a bit" to "a great deal" of overprotection characterized their relationships with those closest to them. At the bivariate level, employed participants and those indicating greater perceived independence reported greater social support and less overprotection. Multivariable analysis revealed that being employed was associated with older age, more job accommodations/benefits perceived as being helpful, and greater perceived independence. Conclusion. This is one of the first studies examining the employment of young adults with rheumatic diseases. Findings highlight the importance of psychosocial perceptions such as independence and overprotection, in addition to support related to working. Additional research is needed to better understand the role of those close to young adults with rheumatic diseases in supporting independence and encouraging employment.
    The Journal of Rheumatology 10/2014; 41(12). DOI:10.3899/jrheum.140419
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    ABSTRACT: Objective This multilevel study examines access to rheumatologists for all arthritis and inflammatory arthritis, taking into account geographic availability of rheumatologists, access to primary care physicians (PCPs), and population characteristics (e.g., socioeconomic status [SES]).Methods We analyzed data from the population (age ≥18 years) living in the 105 health planning areas in Ontario, Canada on visits to physicians for arthritis and musculoskeletal disorders. Using data from a survey of rheumatologists and Geographic Information System analysis, an index of geographic availability for rheumatologists was calculated, incorporating distance between the population and rheumatologist locations and the number of hours per week of rheumatologist care. Multilevel Poisson regression was used to examine factors associated with the rates of rheumatology visits for inflammatory arthritis and all arthritis.ResultsControlling for age and sex, the rheumatologist availability index was associated with visit rates for all arthritis, but not inflammatory arthritis. Patients living in areas with low access to PCPs or low SES were less likely to have office visits to rheumatologists for all arthritis and inflammatory arthritis.Conclusion Besides potential deficiencies in rheumatology provision, there may be access barriers to rheumatology services, particularly for populations with low access to PCPs or low SES. This is of special concern for patients with inflammatory arthritis for whom rheumatologist care is necessary. In developing models of care for arthritis, this study points to the need to pay attention to areas with low PCP resources and areas of low SES, as well as the location and amount of rheumatology services available.
    07/2014; 67(2). DOI:10.1002/acr.22413
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    ABSTRACT: Objective: While the prevalence of osteoarthritis (OA) increases with age, the first signs begin in the fourth or fifth decade. Little is known about how younger adults respond to OA. This paper explores how people age 35-65 years manage knee symptoms. Methods: Six focus groups were conducted with 41 participants (mean age 50.9 years; 63% female) who self-reported a diagnosis of OA or reported knee symptoms (i.e. pain, aching or stiffness) on most days of the past month. Purposive sampling was used, seeking variation in age and sex. The principles of constructivist grounded theory guided data collection and analysis. Data were analyzed using a constant comparative method. Results: Participants engaged in a process of proactively trying to find ways to control knee symptoms and disease progression. Their approach to management was not linear, but rather, a process that moved back and forth between searching for "solutions" and active management (ongoing use of strategies). During the process, participants consulted health care providers but often perceived that medical care offered limited options and guidance. Management was constructed as a "never-ending" process that entailed effort and personal resources. Conclusion: Participants were proactive in seeking ways to manage knee OA symptoms. There is a mismatch between participants' proactive approach and the reactive approach of the health care system that has focused on late stage disease. Programs and supports within the formal and informal health care system are required to enable people to successfully manage knee symptoms across the lifespan. © 2013 American College of Rheumatology.
    07/2014; 66(7). DOI:10.1002/acr.22278
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    Mayilee Canizares, Aileen M Davis, Elizabeth M Badley
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    ABSTRACT: Objective: To examine the impact of access to primary care physicians (PCPs), geographic availability of orthopaedic surgeons, socioeconomic status (SES), proportion of older population (>= 65 years) and proportion of rural population on orthopaedic surgeon office visits and orthopaedic surgery. Design: Population multilevel study. Setting: Ontario, Canada. Participants: Ontario residents 18 years or older who had visits to orthopaedic surgeons or an orthopaedic surgery for musculoskeletal disorders in 2007/2008. Primary and secondary outcomes: Office visits to orthopaedic surgeons and orthopaedic surgery. Results: Access to PCPs and the index of geographic availability of orthopaedic surgeons, but not SES, were significantly associated with orthopaedic surgeon office visits. There was a significant interaction between access to PCPs and orthopaedic surgeon geographic availability for the rate of office visits, with access to PCPs being more important in areas of low geographic availability of orthopaedic surgeons. After controlling for office visits with orthopaedic surgeons, the index of geographic availability of orthopaedic surgeons was no longer significantly associated with orthopaedic surgery. Conclusions: The findings suggest that, particularly, in areas with low access to PCPs or with fewer available orthopaedic surgeons, residents are less likely to have orthopaedic surgeon office visits and in turn are less likely to receive surgery. Efforts to address adequate access to orthopaedic surgery should also include improving and facilitating access to PCPs for referral, particularly in geographic areas with low orthopaedic surgeon availability.
    BMJ Open 07/2014; 4(7):e004472. DOI:10.1136/bmjopen-2013-004472
  • Elizabeth Badley
    BMJ (online) 04/2014; 348:g2804. DOI:10.1136/bmj.g2804
  • Osteoarthritis and Cartilage 04/2014; 22:S220-S221. DOI:10.1016/j.joca.2014.02.425
  • Osteoarthritis and Cartilage 04/2014; 22:S391. DOI:10.1016/j.joca.2014.02.729
  • Osteoarthritis and Cartilage 04/2014; 22:S202. DOI:10.1016/j.joca.2014.02.386
  • Osteoarthritis and Cartilage 04/2014; 22:S181. DOI:10.1016/j.joca.2014.02.340
  • Osteoarthritis and Cartilage 04/2014; 22:S205-S206. DOI:10.1016/j.joca.2014.02.394
  • Osteoarthritis and Cartilage 04/2014; 22:S181. DOI:10.1016/j.joca.2014.02.341
  • Osteoarthritis and Cartilage 04/2014; 22:S205. DOI:10.1016/j.joca.2014.02.393

Publication Stats

4k Citations
708.06 Total Impact Points


  • 1995–2015
    • University of Toronto
      • • Institute for Clinical Evaluative Sciences
      • • Institute of Health Policy, Management and Evaluation
      • • Department of Family and Community Medicine
      • • Faculty of Medicine
      Toronto, Ontario, Canada
  • 2001–2013
    • University Health Network
      • • Division of Healthcare and Outcomes Research
      • • Arthritis and Immune Disorder Research Center
      Toronto, Ontario, Canada
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 2009
    • Women's College Hospital
      Toronto, Ontario, Canada
  • 2008
    • North York General Hospital
      ノースヨーク, Ontario, Canada
  • 2007
    • University of British Columbia - Vancouver
      Vancouver, British Columbia, Canada
  • 2005–2007
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 2006
    • Leiden University Medical Centre
      • Department of Rheumatology
      Leiden, South Holland, Netherlands
    • University of Oslo
      Kristiania (historical), Oslo, Norway
  • 2004
    • University of South Carolina
      Columbia, South Carolina, United States
  • 2003
    • Sunnybrook Health Sciences Centre
      Toronto, Ontario, Canada
  • 2002
    • Population Health Research Institute
      Hamilton, Ontario, Canada
  • 1999
    • Mount Sinai Hospital, Toronto
      Toronto, Ontario, Canada
    • Arthritis Research Centre of Canada
      Richmond, British Columbia, Canada