Chronic Illness Scale Research Articles

The Function of Occupational Activity for Health as Perceived by Chronically Ill People.

Existing studies confirm the benefits of employment for chronically ill persons’ health, but few studies so far have delved into how they themselves perceive employment in relation to their health. There is also a paucity of information about individual factors influencing the formation of their perceptions. This study sought to determine differences between chronically ill persons with and without jobs regarding their perceptions of the function of employment for the physical, mental and social dimensions of health, as well as how their occupational activity or inactivity moderates the associations between the perception of work as health beneficial or health adverse and selected individual characteristics, such as self-efficacy, acceptance of illness, actualisation of self, and psychosocial problems. The study involved 80 adults with chronic illnesses and was conducted using the following psychological tools: the WH Scale, the Generalized Self-Efficacy Scale, the Acceptance of Illness Scale, the Actualization of Self Scale and the Psychosocial Problems of Persons with Chronic Illness Scale. It has been found that the way in which chronically ill persons perceive the function of employment for health is unrelated to whether or not they have a job, and that occupational activity moderates associations between the sense of self-efficacy and the perception of work as benefitting health.

The Relationship Between Adaptation to Disease and Self-care Agency Levels in Patients With Multiple Sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an inflammatory and demyelinating disorder of the central nervous system. The patients with MS have some difficulties in physical, social, and psychological functions. This study was carried out to determine the relationship between the adaptation levels of patients with MS to the disease and their self-care agency levels. METHODS: This study used a descriptive design and was carried out in a university hospital's neurology clinic and outpatient clinic between July 2019 and March 2020. The sample size was determined as 258 using the known universe sampling method. Data were collected using the "Adaptation to Chronic Illness Scale," the "Self-Care Agency Scale," and a "Patient Identification Form." Spearmen correlation analysis was used to evaluate the data. RESULTS: The mean age of the patients participating in the study was 41.36 (0.74) years, 74% of them had MS for more than 3 years, 58% had their last attack more than a year ago, and 27% had balance problems. The adaptation levels of patients to the disease (76.79 [0.57]) and their self-care agency (88.42 [1.34]) were slightly higher than the moderate level. A moderate-level, significant, and positive correlation was found between the adaptation level of the patients to the chronic illness and their self-care agency levels (r = 0.310, P = .000). CONCLUSION: It was concluded that there was a moderate-level, significant, and positive correlation between the patients' level of adaptation to MS disease and the level of their self-care agency. We recommend the provision of supportive professional training to patients with MS on their disease.

Living with chronic illness scale in Parkinson's disease: Longitudinal metric properties and meaningful change

AimTo analyze the responsiveness and interpretability of the Living with Chronic Illness Scale in patients with Parkinson's disease (LW-CI-PD). MethodsLongitudinal, international study, with a convenience sample of 153 PD Spanish and Latin-American patients assessed at baseline and one year later. The LW-CI-PD and other clinical measures were applied. For responsiveness, Wilcoxon-Mann-Whitney test of differences, correlation of change between rating scales, standard error of difference, relative change, Cohen's effect size and standardized response mean of LW-CI-PD were computed. The minimally clinical important difference was calculated using anchor- (applying the Patient Global Impression of Severity) and distribution-based methods. A triangulation of interpretability indexes was performed to determine the range of the minimally clinical important difference values. ResultsThe LW-CI-PD scored 65.7 (11.7, range: 33–101) at baseline, and 68.6 (10.3, range: 33–102) one year later (p < 0.001). Change in LW-CI-PD correlated −0.26 with change in psychosocial status, 0.18 with change in motor function and −0.15 with change in social support. Responsiveness statistics were: relative change = 4.5%; effect size = 0.25; standardized response mean = 0.46. Using PGI-S as anchor, 29 patients worsened, and the value of minimally clinical important difference for worsening in LW-CI-PD total score was 4.7. Minimally clinical important difference values using distribution-based methods were between 4.5 (1 standard error of measurement) and 10.4 (10% of total score), with a mean of 6.9. ConclusionsOur study suggest the LW-CI-PD is responsive to changes over time. The use of different methods for calculating the minimally clinical important difference allows to determine a range of the real change for the LW-CI-PD.

Functioning of patients with post-COVID syndrome — preliminary data

Introduction: Post-COVID syndrome is a common finding during the first year after SARS-CoV-2 infection affecting the daily living of many patients. The aim of this study was to assess the functioning of patients with post-COVID syndrome. Material and methods: A self-reported questionnaire — the Functioning in Chronic Illness Scale (FCIS) — was applied in 79 (30 women, 49 men) patients (mean age of 62.7 ± 13.6 years), suffering from post- COVID syndrome 5.8 ± 2.3 months after discharge from hospital. Results: The mean FCIS score was 86.2 ± 12.8 points, corresponding to medium functioning level. The mean score in the first, second and third subscale was 27.0 ± 6.4; 27.5 ± 3.7; and 31.7 ± 4.3 points respectively. Better functioning was observed in men vs women: the FCIS score 88.59 ± 10.95 vs 82.20 ± 14.71; p = 0.02 and in the youngest patients: first ( &lt; 59 years) vs second (59–67 years) vs third tercile ( &gt; 67 years): FCIS score 92.76 ± 14.84 vs 83.15 ± 11.64 vs 83.07 ± 9.68; p = 0.01). The amount of time from COVID-19-related hospitalisation did not affect the FCIS score. Conclusion: Symptoms of post-COVID syndrome influencing patients’ functioning persist within the first year regardless of the time elapsing from the disease. Men and younger patients demonstrate better functioning abilities.

Dahili servislerde yatan hastaların kronik hastalıklara uyumunun sağlıklı yaşam biçimi davranışları üzerine etkisi

Purpose: This descriptive study investigated the effects of chronic illness adaptation on the healthy lifestyle behaviours of patients in internal services.&#x0D; Materials and Methods: The research was conducted with 104 inpatients at the Bingöl State Hospital. No sampling method was used in the study. A descriptive information form was utilised to record the patients’ sociodemographic characteristics. The Adaptation to Chronic Illness Scale (ACIS) and the Healthy Lifestyle Behavior Scale-II (HLBS-II) were used to collect the data on their adaptation and behaviour levels. &#x0D; Results: The patients’ total mean ACIS score was 84.99±12.45, meaning that their adaptation to chronic illness was above average. Moreover, since their total mean HLBS-II score was 130.27±24.50, their adaptation to healthy lifestyle behaviours was moderate. The patients’ adaptation to chronic illness positively affected their healthy lifestyle behaviours (B=1.045), and this result was statistically significant.&#x0D; Conclusion: Chronic illness adaptation positively influenced healthy lifestyle behaviours.

Living with Chronic Illness Scale: International validation through the classic test theory and Rasch analysis among Spanish-speaking populations with long-term conditions.

BackgroundThe Living with Chronic Illness (LW‐CI) Scale is a comprehensive patient‐reported outcome measure that evaluates the complex process of living with long‐term conditions.ObjectiveThis study aimed to analyse the psychometric properties of the LW‐CI scale according to the classic test theory and the Rasch model among individuals living with different long‐term conditions.DesignThis was an observational, international and cross‐sectional study.MethodsA total of 2753 people from six Spanish‐speaking countries living with type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, Parkinson's disease, hypertension and osteoarthritis were included. The acceptability, internal consistency and validity of the LW‐CI scale were analysed using the classical test theory, and fit to the model, unidimensionality, person separation index, item local independency and differential item functioning were analysed using the Rasch model.ResultsCronbach's α for the LW‐CI scale was .91, and correlation values for all domains of the LW‐CI scale ranged from .62 to .68, except for Domain 1, which showed correlation coefficients less than .30. The LW‐CI domains showed a good fit to the Rasch model, with unidimensionality, item local independency and moderate reliability providing scores in a true interval scale. Except for two items, the LW‐CI scale was free from bias by long‐term condition type.DiscussionAfter some adjustments, the LW‐CI scale is a reliable and valid measure showing a good fit to the Rasch model and is ready for use in research and clinical practice. Future implementation studies are suggested.Patient and Public ContributionPatient and public involvement was conducted before this validation study ‐ in the pilot study phase.

Sociodemographic and clinical determinants of the functioning of patients with coronary artery disease

Introduction: Chronic diseases affect many aspects of patients’ lives in various ways, including physical activity, emotional and spiritual sphere as well as social functioning. Aim: The study aimed to identify factors that determine the functioning of people with CAD, based on the original self-reported questionnaire. Methods: A single-centre, prospective, observational cohort study was carried out in 202 consecutive patients hospitalized due to CAD. The study assessed their functioning in chronic disease using the comprehensive tool: The Functioning in Chronic Illness Scale. Results: Most of the respondents (44.55%) showed a medium level of functioning in CAD [79 &lt; result &lt; 94 points]. Economic status (average) was an independent factor contributing to better functioning in the disease. Treatment time (1–5 years), marital status (widow/widower) and prior PTCA treatment were independent risk factors for worse FCIS scores. The independent factors determining the negative impact of the disease on the patient were: previous invasive treatment (PTCA and/or CABG) and age ( &gt; 65 years), while the independent determinants of the belief that the course of the disease can be modified were: sex (male) and duration of the disease ( &lt; 1 year). Conclusions: The study identifies independent factors affecting the functioning of patients with CAD. FCIS questionnaire comprehensively measures patients’ beliefs about the disease. Effective assessment of the quality of the patient’s functioning in the disease may be useful in more individualized therapeutic management.

Validation of living with chronic illness scale in a type 2 diabetes mellitus population

BackgroundWorldwide, type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases and one of those producing greatest impact on patients’ day-to-day quality of life. Our study aim is to validate the “Living with Chronic Illness Scale” for a Spanish-speaking T2DM population.MethodsIn this observational, international, cross-sectional study, 582 persons with T2DM were recruited in primary care and outpatient hospital consultations, in Spain and Colombia, during the period from May 2018 to June 2019. The properties analysed were feasibility/acceptability, internal consistency, reliability, precision and (structural) content-construct validity including confirmatory factor analysis. The COSMIN checklist was used to assess the methodological/psychometric quality of the instrument.ResultsThe scale had an adequate internal consistency and test retest reliability (Cronbach’s alpha = 0.90; intraclass correlation coefficient = 0.96, respectively). In addition, the instrument is precise (standard error of measurement = 3.34, with values < ½SD = 8.52) and correlates positively with social support (DUFSS) (rs = 0.56), quality of life (WHOQOL-BREF) (rs = 0.51–0.30) and ssatisfaction with life (SLS-6) (rs = 0.50–0.38). The original 26-items version of the scale did not support totally the confirmatory factor analysis. The COSMIN checklist is favourable for all the properties analysed, although weaknesses are detected for structural validity.ConclusionsThe LW-CI-T2DM is a valid, reliable and accurate instrument for use in clinical practice to determine how a person’s life is affected by the presence of diabetes. This instrument correlates well with the associated constructs of social support, quality of life and satisfaction. Additional research is needed to determine how well the questionnaire structure performs when robust factor analysis methods are applied.

International psychometric validation of the Living with Chronic Illness Scale in Spanish-speaking patients with chronic obstructive pulmonary disease

ObjectivesTo validate the Living with Chronic Illness (LW-CI) Scale in patients with chronic obstructive pulmonary disease (COPD).DesignObservational, cross-sectional validation study with retest. Acceptability, reliability, precision and construct validity were tested.SettingThe...

Psychometric Validation of the Living with Chronic Illness Scale in Patients with Chronic Heart Failure.

It is necessary to develop self-reported instruments that evaluate the process of living with chronic heart failure (HF) holistically. The Living with Chronic Illness Scale—HF (LW-CI-HF) is the only available tool to evaluate how patients are living with HF. The aim is to analyse the psychometric properties of the LW-CI scale in the HF population. An international, cross-sectional validation study was carried out in 603 patients living with HF from Spain and Colombia. The variables measured were living with HF, perceived social support, satisfaction with life, quality of life and global impression of severity. The LW-CI-HF scale presented good data quality and acceptability. All domains showed high internal consistency with Cronbach’s alpha coefficient ≥ 0.7. The intraclass correlation coefficient for the total score was satisfactory (0.9) in test–retest reliability. The LW-CI-HF correlated 0.7 with social support and quality of life measures. Standard error of measurement was 6.5 for total scale. The LW-CI-HF scale is feasible, reliable and valid. However, results should be taken with caution in order to be used in clinical practice to evaluate the complex process of living with HF. Further research is proposed.

The impact of an Education-Based Intervention Program (EBIP) on dyspnea and chronic self-care management among chronic obstructive pulmonary disease patients. A randomized controlled study.

Objectives:To evaluate the impact of dyspnea and chronic self-care management outcomes of an Education-Based Intervention Program (EBIP) compared to routine care.Methods:The population of the study consisted of self-care management scale of 61 patients diagnosed with chronic obstructive pulmonary disease (COPD) stage 2 and within one month after discharge. A total of 51 conforming patients were divided into experimental and control groups for a single-blind randomized trial. Data were collected using an introductory information form, the baseline dyspnea index (BDI), pulmonary function test (PFT), the self-care management process in chronic illness (SCMP-G) scale and body mass index (BMI). There were no addition interventions to the control group. The intervention group underwent a 3-month EBIP intervention that included education, house visits and follow-ups through phone calls between March 2019 and June 2019. The data were analyzed using Kolmogorov-Smirnov and Shapiro-Wilk tests, χ2, Mann Whitney U and Wilcoxon signed-rank tests. p<0.05 was statistically significant.Results:The study was completed with a total of 40 COPD patients. The effect of the EBIP training program on BDI, PFT, and SCMP-G scores in the intervention group was statistically proven (p<0.05). However, the differences between the groups in the BDI sub-dimension of functional impairment and PFT were not statistically significant (p>0.05).Conclusion:Providing patients with illness-related education through EBIP provided a partial improvement in dyspnea and a significant improvement in chronic care management among COPD patients.

Rasch analysis of the living with chronic illness scale in Parkinson\u2019s disease

BackgroundNeurologists play an essential role in facilitating the patient’s process of living with Parkinson’s disease (PD). The Living with Chronic Illness Scale-PD (LW-CI-PD) is a unique available clinical tool that evaluates how the patient is living with PD. The objective of the study was to analyse the LW-CI-PD properties according to the Rasch model.MethodsAn open, international, cross-sectional study was carried out in 324 patients with Parkinson’s disease from four Latin American countries and Spain. Psychometric properties of the LW-CI-PD were tested using Rasch analysis: fit to the Rasch model, item local independency, unidimensionality, reliability, and differential item functioning by age and gender.ResultsOriginal LW-CI-PD do not fit Rasch model. Modifications emerged included simplifying the response scale and deleting misfit items, the dimensions Acceptance, Coping and Integration showed a satisfactory fit to the Rasch model, with reliability indices greater than 0.70. The dimensions Self-management and Adjustment to the disease did not reach fit to the Rasch model.ConclusionSuggestions for improving the LW-CI-PD include a multidimensional and shorter scale with 12 items grouped in three subscales with a simpler response scheme. The final LW-CI-PD Scale version is a reliable scale, with good internal construct validity, that provides Rasch transformed results on linear metric scale.

Determination of adaptation levels and applications for fistulas care and protection to disease of patients with arteriovenous fistula

Introduction: The aim of this study was to the determinate adaptation to chronic disease and applications for arteriovenous fistula (AVF) care and protection of hemodialysis (HD) patients with an AVF, and to determine the relationships between adaptation and application.&#x0D; Methods: This research is a prospective, descriptive, and cross-sectional type of research. The universe of the study accounted for 180 patients who underwent HD. The research was completed with 114 patients. The research was conducted from July 2019 to September 2019, in two different dialysis centers in Osmaniye Province. The data were collected using The Patient Identification Form and Adaptation to Chronic Illness Scale. Mean ± Standard deviation, percentages, and independent samples t-test analysis were used.&#x0D; Results: When the scale scores of the patients participating in the study were evaluated, determined to level of total adaptation with chronic disease and physical adaptation was to above the average score (40.24 ± 5.99). Social adaptation (21.82 ± 6.39) and psychological adaptation (22.91 ± 5.39) levels can be said to be moderate. Individuals who exercised with the ball to mature the fistula, who was careful to dress and keep the area dry on the 1st day of the operation, who was careful not to apply lotion to the fistula area, and who complied with the fluid restriction were found to have higher levels of adaptation with the disease.&#x0D; Conclusion: It can be said that the patients who make the right application for fistula care and protection have in general adaptation levels can also be said to be high. The level of adaptation is effective for applications. The level of adaptation is effective on applications for AVF care and protection.

The Relationship Between Fluid Control and Disease Adaptation Levels with Symptoms in Patients Undergoing Hemodialysis

Objectives: This study was performed with the goals of increasing quality of life and improving health condition in chronic renal failure patients undergoing haemodialysis treatments through increasing adaptation to fluid limitations, determining knowledge, behaviour, and attitudes regarding fluid control, guiding future studies by determining the physical, social, and psychological adaptation levels, and determining the relationship between symptoms with levels of fluid control and adaptation to the chronic disease. Methods: A prospective, descriptive, cross-sectional design was conducted. Ninety-five patients undergoing haemodialysis treatment were included in the study in a dialysis unit. The data were collected using The Patient Identification Form, The Dialysis Symptoms Index, Fluid Control in Haemodialysis Patients Scale and Adaptation to Chronic Illness Scale. Results: The most common symptoms were found to be respectively fatigue and decreases in energy 50.5% , bone and joint pain 41.1% , and difficulties remaining asleep 41.1% . The mean total ACIS score was found to be 81.61±8.93, mean total FCHPS score was found to be 49.88±4.88. An increase in the positive attitudes regarding fluid control was seen alongside an increase in general adaptation to the disease, where the fluid control levels of patients increased as their level of physical adaptation to the disease increased in a statistically significant level p

Self-reported questionnaires for a comprehensive assessment of patients after acute coronary syndrome

Effective patients’ preparation for discharge is expected to improve adherence to long-term treatment and functioning in chronic faze of coronary artery disease-ameliorating clinical outcome. This paper is aimed to introduce the strategy of comprehensive post-ACS in-hospital patients’ evaluation regarding readiness for hospital discharge, as well as a post-discharge assessment of adherence to pharmacological treatment and functioning in the chronic phase of the coronary artery. A system of diagnostic tools allowing assessment of patients during hospitalization and after discharge has been developed. The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) was designed for in-hospital evaluation, while the Adherence in Chronic Diseases Scale (ACDS) and the Functioning in Chronic Illness Scale (FCIS) for examination during follow-up visits. They are expected to reflect the effectiveness of different aspects of patient-medical staff collaboration. Use of questionnaires seems to be a method of choice for this purpose because of the simplicity, easiness of their application, and low cost. Self-reported questionnaires allow comprehensive in-hospital and post-discharge assessment of patients after ACS.

Escala de convivencia con un proceso crónico: estudio piloto en pacientes con enfermedades crónicas

ObjectiveTo present the pilot study of the Living with Chronic Illness Scale (EC-PC) in patients with diabetes mellitus type 2, chronic heart failure, chronic obstructive pulmonary disease and osteoarthritis. DesignObservational, cross-sectional and multicenter study. LocationTwo specialized hospitals in Navarre and Madrid. Participants64 patients with several chronic diseases, older than 18 years old, that go to primary health centre and/or outpatients. Patients with cognitive deterioration and/or psychiatric disorders were excluded. InterventionsEvaluations had an average duration of 15 minutes per patient. Main measurementsPatients completed the EC-PC and a questionnaire related to the scale. Feasibility/acceptability, internal consistency and construct validity was analyzed. ResultsFor the total sample, the EC-PC showed a good viability and acceptability, without missing data and with almost 100% of the computable data. Cronbach's alpha coefficient reached values between 0.64 and 0.76, and the homogeneity index was higher than 0.30 in all domains of the scale. The values of internal validity ranged between 0.04 and 0.30. No significant differences were found (p> 0.05) in the total score of the scale according to gender or the different pathologies. The patients described the scale as simple and useful. ConclusionsThe pilot study of the EC-PC in patients with different chronic illnesses showed that it is a brief, easy to use, reliable and valid measure. The EC-PC will serve to know in an individualized way, how the patient is living with his/her chronic process and to prevent possible negative aspects of the daily living with the disease.

Validation of the Functioning in Chronic Illness Scale (FCIS)

Diagnosis of deficient areas in the functioning of patient with chronic disease is necessary to undertake the adequate therapeutic actions. The aim of the study was to validate a new self-reported questionnaire for patients with chronic disease assessing the impact of the disease on the patient, the patient’s impact on the disease and the impact of the disease on patient’s attitudes. Results: The internal consistency of the questionnaire expressed by a-Cronbach coefficient = 0.855, indicates its high reliability and homogeneity. The set of 24 items fulfilled the assumption of factor analysis: the determinant of correlation matrix was 0.001, Kaiser-Mayer-Olkin (K-M-O) statistic was 0.843 and the Bartlett’ test of sphericity was statistically significant. The factor analysis was conducted using the principal component analysis with Varimax rotation. The scale and subscale levels were determined based on the percentiles scale. Conclusion: The validation procedure revealed that FCIS is a reliable and homogeneous tool to measure patient’s physical and mental functioning in the chronic illness. The set of items divided into 3 subscales allows evaluation of: the impact of the disease on the patient, the patient’s impact on the disease and the impact of the disease on the patient’s attitudes.

Living with chronic illness scale: international validation of a new self-report measure in Parkinson's disease.

Understanding how a person lives with a chronic illness, such as Parkinson’s disease (PD), is necessary to provide individualized care and professionals role in person-centered care at clinical and community levels is paramount. The present study was aimed to analyze the psychometric properties of the Living with Chronic Illness-PD Scale (EC-PC) in a wide Spanish-speaking population with PD. International cross-sectional study with retest was carried out with 324 patients from four Latin American countries and Spain. Feasibility, acceptability, scaling assumptions, reliability, precision, and construct validity were tested. The study included 324 patients, with age (mean±s.d.) 66.67±10.68 years. None of the EC-PC items had missing values and all acceptability parameters fulfilled the standard criteria. Around two-third of the items (61.54%) met scaling assumptions standards. Concerning internal consistency, Cronbach’s alpha values were 0.68–0.88; item-total correlation was >0.30, except for two items; item homogeneity index was >0.30, and inter-item correlation values 0.14–0.76. Intraclass correlation coefficient for EC-PC stability was 0.76 and standard error of measurement (s.e.m.) for precision was 8.60 (for a EC-PC s.d.=18.57). EC-PC presented strong correlation with social support (rS=0.61) and moderate correlation with life satisfaction (rS=0.46). Weak and negligible correlations were found with the other scales. Internal validity correlations ranged from 0.46 to 0.78. EC-PC total scores were significantly different for each severity level based on Hoehn and Yahr and Clinical Impression of Severity Index, but not for Patient Global Impression of Severity. The EC-PC has satisfactory acceptability, reliability, precision, and validity to evaluate living with PD.

Estimating multiple morbidity disease burden among older persons: a convergent construct validity study to discriminate among six chronic illness measures, CCHS 2008/09.

BackgroundSince approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system.MethodsUsing the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use.ResultsOverall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6.ConclusionsTo properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.

Long-term effects of a rehabilitation program on the clinical outcomes, social functionality, and life quality of schizophrenic patients-a follow-up study

Objective: Schizophrenia is a severe brain disease which leads to progressive clinical, cognitive, social, and vocational deterioration. The results of a meta-analysis of studies from more than 100 years showed that the progress and outcomes of schizophrenia remain poor. However, evidence-based strategies combining pharmacological and psychosocial treatments have obtained promising results and increased expectations regarding the outcome of schizophrenia. This study examined the effects of a multimodal, psychosocial intervention program for schizophrenic patients at the end of the program and three years later. Methods: The study involved 60 patients between 18 and 65 years old who had been diagnosed with schizophrenia but had not participated in a multimodal, psychosocial intervention program. At the beginning of, end of, and three years after the six-month program, all patients were assessed with the Bakirkoy Rehabilitation Form for Patient with Chronic Mental Illness, Positive and Negative Syndrome Scale, Morisky’s Questions-Self-Report Measure of Adherence, Quality of Life Scale, Insight into the Three Components of the Evaluation Scale, Social Functioning Scale, and Disability Assessment Schedule. The three sets of measurements were compared to each other. Findings: In the end-of-program and third-year measurements, the severity of the symptoms had statistically and significantly decreased compared to measurements made before the program. As well, the frequency of hospitalizations decreased, while adherence to treatment, insight level, social functionality, and quality of life increased. Discussion: The structured psychosocial interventions used throughout the program were found to increase patients’ insight level and adherence to treatment, which resulted in decreased severity of symptoms and frequency of hospitalizations. Recovery from negative symptoms, which the literature shows to be the most important causes of decreased social and professional functionality, could explain the increase in the scale scores measuring social functionality and quality of life. Likely also contributing to this result was the intense use of techniques in such areas as independent living skills, interpersonal relations, daily life activities, and social affairs and behaviors. Results: The results of this study are important. They show that the applied program is effective and that its positive effects lasted three years after it ended. This program can serve as a model for the community mental health centers opening during the transition to and establishment of a community-based psychiatric system in Turkey.