Biopsychosocial Research Articles

Functionality and Quality of Life Within the Speech-Language Pathology Assessment Context: Analysis From the Structural Equation Modeling Perspective.

Quality of life and functionality are relevant in an approach based on the biopsychosocial model. Therefore, the objective of this study was to assess the influence of clinical, sociodemographic, and functionality aspects on the quality of life of children and adolescents undergoing speech-language evaluation. Cross-sectional analytical observational study conducted with 84 Brazilian children and adolescents. The Brazilian Economic Classification Criteria and the Pediatric Quality of Life Inventory 4.0™ were applied, and data were collected on sex, complaints, SPL diagnostic hypothesis, as well as on the Body Functions, Activities and Participation, and Environmental Factors components of the International Classification of Functioning, Disability and Health (ICF). Factor analysis and structural equation modeling were used for data analysis, with a 5% significance level applied to the final models. Male sex and clinical-care variables had a direct and negative influence on functionality in the first two models (p < 0.05). Activities and Participation had a positive direct effect on self-reported quality of life (p = 0.031; β = 0.282) and parent/caregiver-reported quality of life (p = 0.003; β = 0.387). Parent-reported quality of life was negatively influenced by complaints of oro-facial motricity alterations, while self-reported quality of life was positively influenced by the diagnostic hypothesis of speech disorders. The results show that sex and clinical-care complaints negatively influenced functionality, while Activities and Participation positively influenced quality of life. The use of structural equation modeling proved to be an important strategy for analyzing ICF and quality of life in SLP practice.

Case study on the applicability of the international classification of functioning, disability, and health in a patient with mitochondrial myopathy treated in the rehabilitation service

Background: Mitochondrial myopathies are rare neuromuscular diseases characterized by heterogeneous symptoms and severity. They affect multiple organs, including the brain, peripheral nervous system, muscles, kidneys, and liver. Objective: To illustrate how the application of the International Classification of Functioning, Disability, and Health (ICF) can help in managing a patient with mitochondrial myopathy in a rehabilitation setting. Methods: We present the case of a 26-year-old male diagnosed with a neuromuscular disease at age 12, exhibiting bilateral eyelid ptosis, dysphonia, dysphagia, and motor disorders. The patient underwent a thorough physical evaluation and various scales. The ICF model was employed to document and quantify deficits using a standardized template and numerical qualifiers. Results: Priority treatment areas included reeducation of postural and gait patterns, improving aerobic capacity through physical therapy, and managing pain via myofascial infiltration. Post-treatment, significant improvements were observed, although persistent challenges in participation domains, such as mobility in urban environments and employment, remained. Conclusions: This case study highlights the utility of the ICF framework in structuring rehabilitation plans, setting clear objectives, and evaluating outcomes for patients with rare diseases like mitochondrial myopathy. The ICF facilitates standardized assessment and comparison across different pathologies, promoting an integrative biopsychosocial model in rehabilitation.

Unhelpful Information About Low Back and Neck Pain on Physiotherapist's Websites.

The internet is increasingly used as a primary source of information for patients with musculoskeletal pain. Private physiotherapy practices provide informative content on low back pain (LBP) and neck pain (NP) on their websites, but the extent to which this information is biopsychosocial, guidelines-consistent, and fear-inducing is unknown. The aim of this study was to analyse the information on websites of private physiotherapy practices in the Netherlands about LBP and NP regarding consistency with the guidelines and the biopsychosocial model and to explore the use of fear-inducing language. The content of all existing Dutch private physiotherapy practice websites was examined in a cross sectional study design. Content analysis was based on predetermined criteria of the biopsychosocial model and evidence-based guidelines. Descriptive statistics were applied. After removing duplicates and sites without information, 834 (10%) of 8707 websites remained. Information about LBP was found on 449 (54%) websites and 295 (35%) websites informed about NP. A majority of websites (LBP: n = 287, 64%; NP: n = 174, 59%) were biomedically oriented. Treatment advice was given 1855 times on n = 560 (67%) websites. Most of the recommended interventions were inconsistent with or not mentioned in the guidelines. Fear-inducing language was provided n = 1624 (69%) times. The majority of the information on the Dutch private physiotherapy websites was biomedical and not in line with the current guidelines and fear-inducing. This study revealed that the majority of private physiotherapy practice websites that provide information on LBP and NP are inconsistent with the biopsychosocial model and current guidelines. This information has a negative impact on patients' knowledge, attitudes, beliefs, and expectations, potentially affecting treatment outcomes. Consequently, most physiotherapy practice websites are unreliable sources of information on LBP and NP for patients. There is an urgent need to implement strategies to make websites reliable and helpful sources of information.

Sexual dysfunction after colorectal and anal cancer-treatment in nurse-led sexological clinics.

Sexual dysfunction after colorectal and anal cancer is common but rarely identified and treated, although effective treatment options do exist. Therefore, we recently established nurse-led clinics for the treatment of sexual dysfunction after pelvic organ cancer at two Danish university hospitals. The aim of this paper is to present patients' clinical characteristics, the treatments offered and improvements in sexual function recorded. In this cohort study, colorectal and anal cancer patients were referred to the clinics at any time point after their cancer treatment. Specialized treating nurses identified and registered organic sexual disorders and psychological concerns at the first visit, and initiated treatments. Treatments were algorithm-based and rooted in a biopsychosocial approach. Patient-reported outcome measures were completed at baseline and 3 months after discharge. Among 127 referred patients, 78% were men. The mean age was 60.6 years (SD 10.4 years) and the women were a mean 7.3 years younger than the men (p = 0.001). Eighty per cent were rectal cancer patients. The most prevalent disorder was erectile dysfunction in men (95%) and dyspareunia in women (71%). Psychological concerns were registered in 53% of men and 54% of women. Pharmacological treatments, mainly phosphodiesterase-5 inhibitors, were prescribed to 87% of men, and local oestrogens were prescribed to 54% of women. Instructions in the use of sexual aids were given to 22% of men and 42% of women. Furthermore, sexual counselling/therapy was offered to 44% of men and 92% of women to address sexuality related psychological problems. Three months after discharge, a clinically relevant improvement of ≥1 point was found in 68% of patients in at least one of three single items measuring 'Meaningful sex life', 'Sexual needs met' and 'Overall rating of sex life' on a five-point Likert-scale. At nurse-led clinics, specialized nurses can effectively identify and treat sexual problems in patients with sexual dysfunction following colorectal/anal cancer. Organic dysfunctions were prevalent, and psychological problems characterized most patients. This highlights that treatment needs to be multidisciplinary and that patients benefit from specialized care.

Prevalence and Factors Associated With Depression and Depressive Symptoms Among Chinese Older Persons: An Integrative Review.

China is the country with the largest population of older persons. Depression is the most common mental health issue among older adults, a trend expected to increase as societies continue to age. With the global increase in depression and depressive symptoms among this demographic, the resulting disease burden poses a significant challenge to health and social care systems in China. To map, summarise and examine the empirical literature on the prevalence and factors associated with depression and depressive symptoms in Chinese older adults, an integrative literature review was conducted informed by the guidelines of Whittemore and Knafl. The literature search encompassed EMBASE, SCOPUS, CINAHL, Web of Science, PubMed, PsycINFO, SocINDEX, China National Knowledge Infrastructure Database and Wanfang Database. The review included 65 studies, 29 in English and 36 in Chinese. The reported prevalence of depression or depressive symptoms in Chinese older adults was 3.78%-84.3%. Based on the biopsychosocial model, the associated factors were clustered as follows: biological factors (physical health, disability, drug effects, gender, age, diets, physical activities), psychological factors (self-esteem, coping skills, trauma, emotions, beliefs, hobbies, lifestyle) and social factors (family relationships, peers, family circumstances, school, residential areas, social support, social structure). This review synthesised research on depression among older adults in China, highlighting varying prevalence across diverse geographical locations. Given the high prevalence among certain older Chinese cohorts, the early identification and assessment of the factors associated with depression is essential to reducing disease burden. The use of the biopsychosocial model provided a theoretical lens to examine depression in this population in an integrative and holistic way. Thus, furthering understanding of the factors that require close consideration in future research and practice innovations on depression in older persons.

Pain revolution in the public health system: Active coping strategies for chronic pain unit.

Chronic pain represents a global health challenge demanding a transition from traditional biomedical to patient-centered biopsychosocial models. This masterclass explores active coping strategies for effective chronic pain management within healthcare systems. It describes the Unit of Active Coping Strategies for Chronic Pain (UAAD - Unidad de Afrontamiento Activo para el Dolor) in Primary Care in Valladolid, Spain, as a successful example of implementing a biopsychosocial care model for treating chronic pain. To provide tools that allow the application of active coping strategies in the treatment of patients with chronic pain and how to implement the UAAD units in other healthcare systems. This masterclass describes the UAAD's innovative approach, starting with its comprehensive and personalized methodology. This includes a referral system, a thorough assessment encompassing biological, psychological, and social factors, and a functional categorization system. These elements guide personalized treatment plans delivered through group and individual programs grounded in therapeutic exercise and pain science education. Four key pillars are highlighted: clinical care, teaching, resource management, research and dissemination. Embracing this model empowers healthcare providers to address the growing burden of chronic pain. It also enables patients to take an active role in their recovery and self-management.

Ancient Era Hospitals “Asclepions” and their Heritage to the Day

Asclepios is the god of medicine and health in mythology. In ancient times, healing was sought in the worship of Asclepios. Ancient hospitals built in the name of Asclepios are called “Asclepion”. In ancient times, around three hundred and twenty Asclepions were built within the borders of Greece and Türkiye today. The most important of these ancient hospitals are located in Epidauros, Pergamon, Kos, Athens and Knidos. There was also a health center (an ancient hospital) in Allianoi. In this study, the most significant locations, architectural features, treatment methods, historical and cultural roles of the ancient hospitals among the Asclepions in Western Anatolia and Greece were investigated. When the treatment methods in Asclepions are examined, it is seen that holistic medical practices were applied with a biopsychosocial approach to the patients called guests. Diseases were not seen as one-dimensional but as the result of complex processes and negative environmental, social and psychological interactions. Patients were treated with respect as beings with mental, ethical, emotional, social, moral and natural characteristics. Centuries earlier in Asclepions, the first functional applications of hospital architecture and individual and holistic medical approaches are seen. We think that today's hospital architecture and treatment approaches have many features that can be learned from the heritage of ancient hospitals in history.

Perceptions of Monica Geller in Friends: A Pilot Study on Personality Frameworks and Parasocial Relationships

This pilot study investigated how viewers perceive Monica Geller’s personality using three evidence-based personality models: Big Five, HEXACO, and Cloninger’s Biopsychosocial Model. Additionally, it examined how these perceptions are associated to audiences’ engagement in parasocial relationships with this iconic character from the sitcom Friends. A sample of sixty-three participants assessed Monica’s personality by responding to the Big Five Inventory (BFI), the HEXACO-60, and the Temperament and Character Inventory (TCI-60). Participants also completed the Multidimensional Measure of Parasocial Relationships (MMPR). Personality scores were contextualized against U.S. population norms (NBFI = 711, NHEXACO = 1126, NTCI = 1948) and Pearson correlations were conducted to explore associations between personality traits and the Affective, Behavioral, Cognitive, and Decisional dimensions of parasocial engagement. Normative comparisons revealed Monica’s perceived Openness and Agreeableness in the Big Five and her Openness and Agreeableness in the HEXACO as significantly below average, while her Big Five Neuroticism and her HEXACO Conscientiousness were significantly above average. In the Biopsychosocial Model, Monica’s Persistence was significantly higher than population norms, while Cooperativeness was significantly lower. Big Five Agreeableness showed correlations across all parasocial engagement dimensions. HEXACO Emotionality was strongly linked to the Affective and Behavioral dimensions, while Honesty–Humility was associated with Cognitive parasocial engagement. In the Biopsychosocial Model, Reward Dependence and Cooperativeness were associated with Cognitive and Affective parasocial engagement, while Self-Directedness was linked to the Behavioral dimension. The Biopsychosocial Model offered the most comprehensive insights, capturing the multidimensional nature of viewer–character engagement. The Big Five and HEXACO models added valuable perspectives, particularly in explaining that traits associated with trust and kindness are linked to decision making. These findings emphasize the importance of integrating multiple personality frameworks to advance the understanding of parasocial relationship engagement, shedding light on the nuanced ways personality traits shape audience perceptions and relationships with media characters, with significant implications for media psychology and personality research. Limitations and avenues for future developments are discussed, building on the insights from this pilot study.

Knowledge translation initiatives at the Transitional Pain Service: insights from healthcare provider outreach and patient education

Evidence-based treatment of chronic pain requires a multidisciplinary approach grounded in the biopsychosocial model. Implementing this approach within health systems relies on its acceptance by both healthcare providers and patients. While pioneering multidisciplinary pain clinics can serve as a model for implementation, a systematic effort is needed to share knowledge effectively and broadly. In the current paper we provide an overview of the knowledge translation initiatives undertaken at our Transitional Pain Service (TPS) at Toronto General Hospital, a state-of-the-art multidisciplinary pain program established in 2014 for patients at risk of developing chronic pain after surgery. The TPS team strives to enhance acceptance of this model of care among patients and providers, facilitate the establishment of similar clinics, and promote patient understanding of the integrated multidisciplinary pain care approach. Guided by the Knowledge to Action (KTA) framework, knowledge translation activities undertaken by our TPS team include clinician training, resources and outreach activities for providers, and patient education. Resource development was preceded by consultation and needs assessment among patients and providers and feedback from both groups was incorporated as part of the development process. The tailored resources were disseminated via the TPS clinic website and monitoring of online usage enables continuous evaluation of engagement. Barriers to engagement with the resources were examined through patient surveys and staff interviews. Based on these activities, we offer insights gained by our team throughout the knowledge translation process and provide recommendations for other clinical teams who wish to undertake similar initiatives.

Effect of biopsychosocial comprehensive chronic pain management physiotherapy practice protocol in patients with chronic musculoskeletal pain-a randomised control trial

Background: Chronic musculoskeletal pain (CMP) is a common condition treated by physiotherapists. Many existing treatments focus mainly on biomedical aspects, which have limited effectiveness and do not align with clinical practice guidelines that advocate for a biopsychosocial (BPS) approach. To address this issue, a new physiotherapy protocol has been developed that incorporates pain neurophysiological education, cognitive behaviour modification, and self-management strategies. This protocol will undergo clinical trial evaluation and has the potential to transform physiotherapy practices in line with these guidelines. Methods: A randomised, single-centre clinical trial will be carried out to compare the effect of a comprehensive CMP management (CCPM) which consists of 16 sessions weekly twice for 8 weeks neuroscience education program (4 sessions, 4 hrs) cognitive behaviour modification program (6 sessions, 6 hrs), self-management strategies (4 sessions, 4 hrs) and revision of the program (2 sessions, 2 hrs) along with usual care physiotherapy treatment for thrice weekly for 8 weeks, with standardised physiotherapy thrice weekly for 8 weeks as control group. The study aims to evaluate the effect of CCPM intervention on central sensitisation, as well as on fear avoidance, pain, disability, and pain self-efficacy The outcome variables will be measured at the beginning of the intervention and after 8 weeks. Discussions: The Physiotherapy practice must adopt a multi-dimensional pathway of treatment that considers all the bio-psychosocial factors during treatment sessions, rather than just following a bio-model pathway of management. Trial registration: CTRI/2023/05/053340 [Registered on: 31/05/2023]

Sociodemographic and Clinical Determinants of the Quality of Life of Moroccan People With Multiple Sclerosis.

The quality of life (QOL) of people with multiple sclerosis (MS) is considerably poorer than the QOL of people with other chronic diseases. QOL management should not be restricted to only clinical aspects but also factors modifying QOL. The aim of this study was to identify the sociodemographic and clinical determinants of QOL in people with MS. A cross-sectional study conducted from 2022 to 2023 included 200 participants aged 18 and over recruited from the Hassan II University Medical Hospital in Fez, Morocco. QOL assessment was performed using the Arabic version of the Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire. Univariate analysis using Student t test, analysis of variance, and Pearson correlation was performed, followed by multiple linear regression analysis to determine the main factors associated with QOL. QOL was impaired in the physical health (PH) (48.51±22.08) and mental health (MH) (48.69±17.18) components of the MSQOL-54. Male sex, unemployment, and high scores on the Expanded Disability Status Scale (EDSS) were factors significantly associated with lower scores on both the PH and MH components. In contrast, later age at MS diagnosis and older age were significantly associated with worse PH and MH, respectively. EDSS score was a strong predictor of QOL (PH: β = -34.983; 95% CI, -39.64 to -30.31; MH: β = -23.383; 95% CI, -27.62 to -19.14). The results highlight the importance of sociodemographic and clinical determinants of QOL. Clinicians need to integrate a biopsychosocial approach into therapeutic education programs, considering the risk factors and specific needs of people with MS to optimize their QOL.

'A boy actually said I looked like a fire victim': Exploring the psychosocial impacts of psoriasis, eczema and acne amongst young women in the UK through thematic analysis.

Our knowledge of the psychosocial implications of skin conditions continues to broaden, as research identifies multiple psychological morbidities relating to psoriasis, eczema and acne. This includes findings of poor body image, as a result of the change in physical appearance to the skin. However, there is limited qualitative research in the UK that explores how young women with skin conditions experience unique psychosocial impacts, including body image issues. The present study explored the experiences of seven young women with psoriasis, eczema and acne. Four main themes were developed: Embarrassment over appearance related symptoms; An unrealistic female beauty standard; Change in appearance attacking personal identity; and Lack of support. The implications of these findings are discussed, including a call for a biopsychosocial approach to skin condition treatment, that prioritises the psychological and social well being of young female skin condition patients, as well as their physical health.

Психологические факторы здоровья у молодых и пожилых лиц

&lt;p&gt;The article examines the problem of preserving and maintaining human health from the standpoint of the biopsychosocial approach, the theory of functional systems by P.K. Anokhin, the theory of development and functioning of higher mental functions, as well as the concept of cerebral information fields and the psychological information fields of the brain formed on their basis. The empirical part of the article focuses on studying of psychological factors affecting the health of young and elderly people with mild cognitive impairment (MCI) in a calm and post-stress state. The study reveals the features of the negative impact of stress on psychological health in young and elderly people with MCI, as well as highlights the factors contributing to the deterioration or maintenance of psychological health in different age groups. It was found that in a stressful situation, elderly people with MCI have a more differentiated reaction to stress compared to young people, and indicators of self-esteem and cognitive functions remain at the same level, while young people in a stressful situation demonstrate an undifferentiated reaction leading to personal maladaptation, deterioration of cognitive functions and greater severity of negative emotions (anxiety, fear, aggression, depression). The data obtained indicate a greater ability of elderly people with MCI to regulate their psychological health, compared with younger people, due to the formed positive stable attitude towards maintaining health.&lt;/p&gt;

Going Beyond Medications for Chronic Pain: Exploring the Alternatives

Chronic pain is prevalent in the US and a major source of disability. Americans are familiar with, and often reliant on, pharmacologic interventions for analgesia. However, nonpharmacologic interventions can be equally effective in reducing pain and related impairment. The complex nature of chronic pain and the specific goal of reducing reliance on opioid analgesics, together, support utilizing a more comprehensive, biopsychosocial approach. Although this approach improves clinical outcomes in this population, ongoing barriers require additional research, along with continuing education, to generate equal support of alternative interventions for pain management. Policy changes and a systemic effort to improve current practices in pain management are critical to provide more comprehensive, interdisciplinary care for all people living with chronic pain.

Pain management in percutaneous nephrolithotomy - an approach rooted in pathophysiology.

Pain related to percutaneous nephrolithotomy (PCNL) is multifactorial and poorly elucidated. However, understanding the pathophysiology of pain can enable a practical approach to pain management, which can be tailored to each patient. A number of potential mechanisms underlie pain perception in PCNL, and these mechanisms can be leveraged at various points on the perioperative care pathway. These interventions provide opportunities for modulation of pain associated with PCNL but must take into account various technical, pharmacological and patient-related considerations. Technical considerations include the influence of percutaneous access, stone removal and drainage techniques. Pharmacological aspects include the use of various analgesics and anaesthesia approaches. Patient factors include consideration of the biopsychosocial model in pain experience to understand each individual's response to pain. By understanding the contemporary evidence surrounding the physiology of postoperative pain and identifying tangible intervention points, we can seek to mitigate postoperative pain in patients undergoing PCNL.

Breaking research silos to achieve equitable precision medicine in rheumatology.

Health disparities in rheumatic disease are well established and urgently need addressing. Obstacles to precision medicine equity span both the clinical and the research domains, with a focus placed on structural barriers limiting equitable health care access and inclusivity in research. Less articulated factors include the use of inaccurate population descriptors and the existence of research silos in rheumatology research, which creates a knowledge gap that precludes addressing the health disparities and fulfilling the goals of precision medicine to understand the 'full patient'. The biopsychosocial model is a research framework that intertwines layers of biological and environmental effects to understand disease. However, very limited rheumatology research bridges across molecular and epidemiological studies of environmental exposures, such as physical and social determinants of health. In this Review, we discuss clinical obstacles to health care equity, including access to health care and the use of inaccurate language when labelling population groups. We explore the goals and data needed for research under the biopsychosocial model. We describe results from a rheumatic disease literature search that highlights the paucity of studies investigating the molecular influences of systemic exposures. We conclude with a list of considerations and recommendations to help achieve equitable precision medicine.

Endometriosis management in a low/middle income country – Integration of a multidisciplinary medical team and patient social support group

Endometriosis is a chronic condition that causes significant pain, subfertility and impairs the quality of life of affected women and girls. There is no known cure and management is tailored to specific individual circumstances. International best practice recommendation advocates managing severe endometriosis within centres of excellence with multidisciplinary team (MDT) of specialists. This type of care should focus on the chronic disease and biopsychosocial models. We describe a first and unique endometriosis MDT that incorporates patient social support group in a low and middle income country.

Clarifying the characteristics of interprofessional rehabilitation programs for adults with chronic low back pain: A scoping review

Background Interprofessional rehabilitation programs are recommended by practice guidelines based on their effectiveness in improving health-related quality of life, pain, and function for people with chronic low back pain (CLBP). However, the most appropriate program characteristics are poorly described in the literature. Objective This scoping review aimed to synthesize the characteristics of interprofessional rehabilitation programs for people living with CLBP. Methods The scoping review was guided by the framework developed by Arksey and O'Malley, which has been further enhanced by the Joanna Briggs Institute (JBI). Electronic databases, including Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, PubMed, Web of Science, and Cochrane Library, were searched to identify relevant published studies. Results Out of 13370 articles identified through our search, seventy-nine studies fulfilled our eligibility criteria. In the majority of the studies (n = 75), interprofessional rehabilitation programs for people with CLBP consisted of two or more of the following interventions: physical activity and exercise (n = 68), education (n = 61), psychotherapy (n = 52), and vocational support/advice (n = 31). In a few studies describing the underlying theories, the biopsychosocial model, which emphasizes the need to address social, psychological, and physical components in the management of CLBP, was the most often cited theoretical framework. Conclusion There is substantial variation in how interprofessional rehabilitation programs for people with CLBP are conceptualized and evaluated. A detailed description of the intervention evaluated, and the underlying theoretical frameworks was also lacking in most studies. We recommend the use of a consistent term and components aligned with practice guidelines.

Impact of a Long-Term Home-Based Rehabilitation Program on Quality of Life, Balance, and Autonomy in Adults with Disabilities.

Rehabilitation is a critical process for enhancing functionality, independence, and quality of life in individuals with disabilities. Grounded in the biopsychosocial model, it addresses physical, emotional, and social dimensions through personalized, evidence-based interventions. By integrating standardized assessments and continuous evaluation, rehabilitation has the potential to promote recovery and support active participation in society. This study evaluated the impact of a long-term, multidisciplinary, home-based rehabilitation program on quality of life, balance, and functional autonomy in adults with neuromusculoskeletal disabilities. A total of 559 participants received individualized interventions from a team of physical therapists, occupational therapists, psychologists, and other health professionals. Functional independence, balance, depressive symptoms, and quality of life were assessed using the Barthel Index, Berg Balance Scale, Beck Depression Inventory, and SF-36 questionnaire, respectively. A longitudinal analysis comparing pre- and post-intervention outcomes revealed statistically significant improvements (p < 0.001) across all metrics. The Barthel Index median increased from 85 to 90 points, indicating greater functional independence, while the Berg Balance Scale improved from 39 to 47 points, reflecting reduced fall risk. Depressive symptoms decreased, with Beck Depression Inventory scores dropping from 12 to 9, and both physical and mental health components of the SF-36 showed marked enhancements. These findings demonstrate the program's effectiveness in addressing both physical and emotional needs, emphasizing the value of extended, personalized, home-based care in improving health, autonomy, and overall quality of life for individuals with disabilities. This study underscores the potential of multidisciplinary approaches to support long-term rehabilitation in diverse populations.

Assessing disability progression using the WHODAS 2.0 in multiple sclerosis: Investigating clinical and socio-demographic factors in a large longitudinal cohort study (TONiC-MS).

Identifying influences on disability accumulation in multiple sclerosis (MS), including modifiable factors other than the core features of disease itself, is vital for clinical care, but has often relied on instruments with acknowledged psychometric shortcomings. We model MS disability using the WHO Disability Assessment Schedule (WHODAS) 2.0, a validated measure based on the WHO's biopsychosocial model and sensitive to the breadth of disability-related domains important to people, to investigate the factors associated with its trajectory after diagnosis. In a model allowing individual trajectories to vary around the population mean, we analysed the WHODAS 2.0, transforming it from ordinal raw scores to interval latent estimates via the Rasch Measurement Model (operational range 0 (low) to 128 (high disability)), across up to 6 surveys, from time of diagnosis to 24 years hence, by 5210 adults with MS from the UK's Trajectories of Outcome in Neurological Conditions-MS (TONiC-MS) longitudinal cohort study. Whilst disability rose, on average, across the disease course, and was higher for people with progressive onset MS (mean difference (MD) 14.55, 95 % confidence interval (CI) 12.56, 16.54), there was considerable variability between people in both their level of disability at time of diagnosis (with the WHODAS 2.0 scores of 90 % of people with MS expected to lie between 1.63 to 61.90) and in their subsequent trajectories. We found higher education was associated with lower disability (MD -5.81, 95 % CI -7.46, -4.16) and also delayed disability progression. However, further analyses indicated that the effect of education may be partially-mediated by self-efficacy. Higher levels of self-efficacy were associated with lower disability, and this effect was greater for those with lower education. In addition, the WHODAS 2.0 is sensitive to facets affected by depression, including cognition and participation in community activities, and we found greater depression to be associated with higher disability (MD 7.98, 95 % CI 7.05, 8.91). Both a higher number of comorbidities, and smoking, were associated with greater disability, especially early in the disease course. Higher disability was also found in those: not in work (MD 15.42, 95 % CI 14.24, 16.59) and more fatigued (5.83, 95 % CI 5.46, 6.21 per 1SD increase on Neurological Fatigue Index MS). Our results also indicated within-individual variability was greatest in those recorded as relapsing remitting at study entry, compared to those recorded as having progressive MS. The interplay between self-efficacy, education and disability reinforces the importance of interventions seeking to enhance self-efficacy. Our results additionally support early monitoring and targeting of comorbidities and smoking, which could reduce disability progression. The associations of time-varying depression and fatigue with disability also offer important opportunities for treatment. Characterising disability progression via validated measures provides information, targets for health promotion and indicators of groups warranting closer monitoring.