Different Levels Of Disability Research Articles

"I Have Faith in God That I Will Get Better"-The Multidimensional Perceptions and Expectations of Patients With Chronic Shoulder Pain: A Qualitative Analysis of Common Sense.

This descriptive qualitative study aimed to gain insights into the expectations of individuals with chronic shoulder pain and to investigate how different levels of disability may influence their beliefs and expectations regarding improvement. This qualitative study utilized the Common Sense Model as its theoretical framework. Conducted within a public physical therapy clinic, individuals with chronic shoulder pain who were awaiting the initiation of the treatment were included. Participants, female and male (aged 30-69years), were purposefully sampled. Thirty participants, categorized into 2 groups based on the Shoulder Pain and Disability Index (SPADI) scores, underwent semi-structured interviews. Group 1, lower SPADI scores (0-60), had 10 participants, and Group 2, higher SPADI scores (61-100), had 20 participants. Thematic analysis and inductive coding were employed to analyze the interviews. Common themes emerged in both groups: the use of medical terms for understanding the diagnosis and the multidimensional impact of pain. The last 2 themes differed between groups. Notable differences included Group 1's focus on resources for pain relief and positive expectations with physical therapy, while Group 2 emphasized rest, religion as a resource for pain relief, and God's role in improvement. These findings highlight the complexity of beliefs and expectations among patients with chronic shoulder pain. Individuals with greater disability often incorporated religious beliefs into their coping strategies, but they held lower recovery expectations and reported negative treatment experiences. These insights have implications for tailoring patient-centered care approaches. This study underscores the need for health care providers to consider the multidimensionality of recovery expectations, which can significantly influence patient outcomes. Clinicians can reflect on this knowledge to optimize treatment strategies and improve patient prognosis.

Disability Moderates Dual Task Walking Performance and Neural Efficiency in Older Adults With Multiple Sclerosis.

Mobility and cognitive impairment are prevalent and co-occurring in older adults with multiple sclerosis (OAMS), yet there is limited research concerning the role of disability status in the cognitive control of gait among OAMS. We investigated the levels of prefrontal cortex (PFC) activation, using oxygenated hemoglobin (HbO2), during cognitively-demanding tasks in OAMS with lower and higher disability using functional near-infrared spectroscopy (fNIRS) to: (1) identify PFC activation differences in single task walk and cognitively-demanding tasks in OAMS with different levels of disability; and (2) evaluate if disability may moderate practice-related changes in neural efficiency in OAMS. We gathered data from OAMS with lower (n = 51, age = 65 ± 4 years) or higher disability (n = 48, age = 65 ± 5 years), using a cutoff of 3 or more, in the Patient Determined Disease Steps, for higher disability, under 3 different conditions (single-task walk, Single-Task-Alpha, and Dual-Task-Walk [DTW]) administered over 3 counterbalanced, repeated trials. OAMS who had a lower disability level exhibited decreased PFC activation levels during Single-Task-Walk (STW) and larger increases in PFC activation levels, when going from STW to a cognitively-demanding task, such as a DTW, than those with higher disability. OAMS with a lower disability level exhibited greater declines in PFC activation levels with additional within session practice than those with a higher disability level. These findings suggest that disability moderates brain adaptability to cognitively-demanding tasks and demonstrate the potential for fNIRS-derived outcome measures to complement neurorehabilitation outcomes.

Interest in Telerehabilitation Among Patients with Mild to Severe Multiple Sclerosis: Results of the Czech Republic.

Background: Research in telerehabilitation (TR) in neurology tends to focus on patients with low to moderate disability. For neurology patients with severe mobility limitations, TR can help to enable rehabilitation for people whose mobility limitations make it difficult for them to access rehabilitation facilities. The aim of this study is to evaluate the interest of people with neurological disability caused by multiple sclerosis (MS) in TR services. Methods: This electronic survey targeted individuals with MS, specifically those with a higher level of disability. Results: A total of 355 patients with MS (155 with severe disabilities) participated in this study. There was no difference in interest in rehabilitation between people with mild-to-moderate and severe disabilities (p = 0.1258, confidence interval [CI] = 95%). However, we found a higher interest in upper limb exercises (p = 0.0006, CI = 95%) and balance training (p = 0.0000, CI = 95%) among people with higher disability. Conclusion: The results of this study may help to improve the planning and targeting of TR interventions, where a different focus of intervention is appropriate for patients with different levels of disability. This may enable TR to be maximally tailored to patient capabilities and current greatest limitations. For example, for people with severe disabilities, it is appropriate to focus on training the upper limb function to maintain self-sufficiency and implement interventions to prevent falls.

A Review: Sign Language Converter Using Hand Gloves

Most people in the world are not able to communicate with other people because of different levels of disabilities caused by work accidents or some diseases. They are facing a lot of problems while communicating. They use sign language to communicate with normal people. But there is a communication barrier between normal and mute people while communicating. Therefore, the paper proposes a smart glove to convert sign language into voice. This system consists of a flex sensor, accelerometer and touch sensor attached to the gloves. These are used to sense the different gestures made by the mute people and couple the analogy voltage to the Arduino. After that, it is converted into speech using the speaker. So, this system helps mute people to communicate with normal people. Key Words: Flex sensor, Bluetooth, Accelerometer

Sex-related differential item functioning of neck disability index

Purpose To investigate if the responses to the Neck Disability Index (NDI) may produce some differential item functioning (DIF) comparing men and women. Materials and methods Register-based study among patients undergoing cervical surgery. Item response theory (IRT) analysis including a model for detecting a DIF. Results Of 338 patients, 171 (51%) were women and 167 (49%) were men. The mean age was 54.0 years. For most of the items, the average level of disability in a studied sample was associated with the middle point of the scale. The ability to distinguish people with different levels of disability was high or perfect for seven out of 10 items. While the DIF could be seen for all 10 items, only three items demonstrated statistically significant DIF – “pain intensity”, “headaches” and “recreation”. While the other seven items did not show statistically significant DIFs, better discrimination (steeper curves) for women could be graphically observed for “personal care”, “lifting”, “work”, “driving” and “sleeping”. Conclusions It seemed that the NDI may behave differently depending on the sex of respondents. Several items of the NDI may be more precise and more sensitive when detecting restrictions in functioning among women compared to men. This finding should be taken into account when using the NDI in research and clinical practice. Implications for Rehabilitation While the Neck Disability Index have been found to be a reliable and valid scale, potential differences in its properties across different sexes have mostly remained uninvestigated. This study showed that the Neck Disability Index may behave differently depending on the sex of respondents. Several items of the Neck Disability Index were more precise and sensitive when detecting restrictions in functioning among women compared to men. This difference should be taken into account when using the NDI in research and clinical practice.

Time-Based and Path-Based Analysis of Upper-Limb Movements during Activities of Daily Living.

Patients after stroke need to re-learn functional movements required for independent living throughout the rehabilitation process. In the study, we used a wearable sensory system for monitoring the movement of the upper limbs while performing activities of daily living. We implemented time-based and path-based segmentation of movement trajectories and muscle activity to quantify the activities of the unaffected and the affected upper limbs. While time-based segmentation splits the trajectory in quants of equal duration, path-based segmentation isolates completed movements. We analyzed the hand movement path and forearm muscle activity and introduced a bimanual movement parameter, which enables differentiation between unimanual and bimanual activities. The approach was validated in a study that included a healthy subject and seven patients after stroke with different levels of disabilities. Path-based segmentation provides a more detailed and comprehensive evaluation of upper limb activities, while time-based segmentation is more suitable for real-time assessment and providing feedback to patients. Bimanual movement parameter effectively differentiates between different levels of upper limb involvement and is a clear indicator of the activity of the affected limb relative to the unaffected limb.

Effectiveness of Mindfulness-Based Cognitive Therapy on Pain Catastrophizing and Job Satisfaction of Employees with Migraine Headaches

Background and Objective: Migraine headache (MH) is a common disorder that is observed with severe pains at different levels of disability that can affect a person's performance. In this context, the present study was conducted to investigate the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on pain catastrophizing and job satisfaction of employees with MH. Materials and Methods: The present semi-experimental research was conducted based on a pretest-posttest design and a control group. The study's statistical population included all employees with MH in Tehran in 2020. The study sample included 30 patients with headaches who were selected using the available sampling method and randomly assigned to an experimental group and a control group. The required data were collected using pain catastrophizing and job satisfaction questionnaires. The experimental group received eight 90-minute sessions of MBCT, while the control group did not receive any intervention. Finally, the obtained data were analyzed by multivariate analysis of covariance. Results: The results of the present study showed that MBCT significantly reduced pain catastrophizing and increased job satisfaction among employees with MH (P<0.01). Conclusion: Based on the findings, it can be concluded that MBCT was able to reduce the catastrophizing of pain and increase the job satisfaction of employees. For this purpose, it is suggested to hold workshops and programs by psychologists and specialists for employees with MH.

Enhancing the work placement experience of students with disabilities

Work placement learning enhances self-efficacy and work readiness for students. However, students with disabilities often have a different experience with regard to work placements. With a growing number of people with disabilities in universities, it is essential to provide students who have disabilities with an inclusive learning and working environment. Expanding on previous studies that have explored industrial work placement in higher education across different levels of disabilities, this study is contextualised in Nigeria and adopts an integrative literature review approach to critically review and synthesise the literature on student experience, disability, work placement and higher education in the country. This process enables the development of a new theoretical framework and perspective for enhancing the work placement experience of students with disabilities. The study contributes to the existing knowledge regarding work experience, students with disabilities and student experiences in developing countries. It also has practical implications for stakeholders involved in work placements for students with disabilities.

Psychometric Comparisons of Three Depression Measures for Patients With Stroke.

Psychometric examinations for patients with stroke remain insufficient. The Center for Epidemiologic Studies Depression Scale (CES-D), Beck Depression Inventory-II (BDI-II), and Geriatric Depression Scale (GDS) are promising outcome measures. To examine and compare the reliability and validity of three depression measures in a sample of patients with stroke. Repeated-measures design. A hospital in southern Taiwan. Fifty-nine outpatients, who completed three depression measures. Cronbach's α and intraclass correlation coefficients (ICCs) were used to examine the internal consistency and test-retest reliability, respectively, of the three measures. An independent-samples t test was conducted to compare two groups of patients with different levels of disability to investigate discriminative validity. Pearson's rs were calculated among the three measures to examine concurrent validity. The three measures had good internal consistency (α = .85-.92) and sufficient test-retest reliability (ICC = .84-.91). The minimal detectable change (percentage of minimal detectable change) was 10.6 (63.3%), 13.5 (98.3%), and 5.8 (49.9%) for the CES-D, BDI-II, and GDS, respectively. There was a statistically significant difference between the two groups in CES-D score (p = .032) and no significant differences on the other two measures (p = .095-.187). The correlations among the three measures ranged from .79 to .89. All three depression measures had sound internal consistency, test-retest reliability, and concurrent validity in patients with stroke. What This Article Adds: Of the three measures, the CES-D had better discriminative validity, and the GDS demonstrated greater reliability and smaller random measurement error in patients with stroke.

The Preference-Based Multiple Sclerosis Index: an assessment of its psychometric properties and translation into Turkish

Purpose To translate Preference-Based Multiple Sclerosis Index (PBMSI) into Turkish, investigate its psychometric properties and differences between its two scoring algorithms: PBMSI-Rating Scale (PBMSI-RS) and PBMSI-Standard Gamble (PBMSI-SG). Methods An expert committee supervised the translation process. Psychometric properties were evaluated in 104 people with multiple sclerosis. Exploratory common factor analysis was used to investigate structural validity. Convergent validity was assessed by formulating hypotheses about correlations between PBMSI and other HRQL measures, disability level, walking-related measures, and MS symptoms. Known-groups validity was assessed against different measures of disability and walking capacity. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC95%). Results Factor analysis revealed one factor (Eigenvalue = 2.46). PBMSI-RS and PBMSI-SG correlated significantly with other measures (p < .001). Both could differentiate between individuals with different levels of disability and walking capacity (p < .05, d ≥ 0.50). Relative test-retest reliability was moderate for PBMSI-RS (ICC = 0.75) and good for PBMSI-SG (ICC = 0.83). SEM and MDC95% values were 0.16 and 0.44 for PBMSI-RS and 0.10 and 0.28 for PBMSI-SG, respectively. Conclusion Turkish version of PBMSI has good psychometric properties to assess health-related quality of life in people with multiple sclerosis. PBMSI-SG should be preferred over PBMSI-RS. IMPLICATIONS FOR REHABILITATION Health-related quality of life is often used as a primary or secondary endpoint in multiple sclerosis research. The Preference-Based Multiple Sclerosis Index is the first preference-based health-related quality of life measure developed in multiple sclerosis using patient preferences. Preference-Based Multiple Sclerosis Index was translated to Turkish and demonstrated good psychometric properties, including structural, convergent, known-groups validity, internal consistency, and test-retest reliability. Professionals working in the field of multiple sclerosis research and rehabilitation may benefit from using the Preference-Based Multiple Sclerosis Index as it is a short and psychometrically robust instrument.

Changes in Gait Characteristics During and Immediately After the 6-Minute Walk Test in Persons With Multiple Sclerosis: A Systematic Review.

There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability. The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter. Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT. Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT. The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability. Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability. The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity.

Experiences of social isolation among patients with neuromyelitis optica spectrum disorder in China: A qualitative study

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory demyelinating disease of the central nervous system, which mainly involves the optic nerve and spinal cord and has high recurrence and disability rates. Patients with this condition are prone to social isolation, which has not been widely assessed. The purpose of this study was to investigate the experience of social isolation in patients with NMOSD. MethodsA qualitative descriptive approach was used to conduct in-depth, face-to-face, semi-structured interviews. Data were analyzed using thematic analysis. ResultsA total of 20 patients (19 females, 1 male) completed the interview. Patients ranged in age from 14 to 68 years, with disease duration from 1 month to 30 years and Expanded Disability Status Scale scores from 2.0 to 8.0; 60% of patients were unemployed. Four major themes were identified: (1) perception of social isolation, (2) reasons for isolation, (3) impacts of isolation, and (4) potential solutions. ConclusionsSocial isolation affects patients of all ages with different levels of disability and duration of NMOSD. Isolation occurs as a result of multiple interactions between physiological, cognitive-psychological, and environmental factors. The effects of social isolation mainly involve physical, psychological, and family-society aspects. Comprehensive interventions to improve social isolation should be carried out based on these multidimensional influencing factors.

Home- and Community-Based Services Use Patterns and Functional Improvement among Older Care Recipients in Taiwan

The new version of Taiwan’s 10-Year Long-Term Care Plan launched in 2016 aims to reinforce the integration of home- and community-based services (HCBS). The underlying HCBS use patterns and effectiveness of functional improvement among care recipients merit investigation. The purpose of the study was to examine the association of HCBS and changes in ADLs among care recipients with different levels of disabilities in Taiwan. We accessed the sub data of Taiwan’s Long-Term Care Services Management Online System. Samples were aged 65 and over and had completed records of baseline and reassessment information during 2018 (N = 4787). Latent class analysis and multivariate linear regression were applied to examine the relationship of HCBS and functional changes. Four HCBS subpatterns were found: home-based personal care services (home-based PS) (59.16%), home-based reablement services (home-based RS) (23.90%), home-based multiple services (home-based MS) (11.93 %), and community-based services (5.01%). In the cases with mild disabilities at baseline, recipients receiving home-based RS had higher probabilities of improving in ADLs among four HCBS subgroups (for example: β = 2.65, SE = 1.19 in comparison to home-based PS). Care recipients with moderate-to-severe disability at baseline, ADLs improvement was only found in home-based PS (β = 1.63, SE = 0.82 in comparison of home-based MS). In the cases with profound disabilities, home-based PS showed positive effects on ADLs improvement (β = 2.45, SE = 0.80 in ADLs, compared to home-based RS). The study suggested that HCBS subpatterns had different impacts on older adults with different disability levels.

Identifying key environmental barriers experienced by persons with mild, moderate, or severe disability in Bankim Health District, Cameroon: a policy-targeted secondary analysis of data obtained with the World Bank and WHO model disability survey

BackgroundComprehensive data is key for evidence-informed policy aiming to improve the lives of persons experiencing different levels of disability. The objective of this paper was to identify the environmental barriers — including physical, social, attitudinal, and political barriers — that might become priorities for cross-cutting policies and policies tailored to the needs of persons experiencing severe disability in Cameroon.MethodsA secondary analysis of data obtained with the WHO Model Disability Survey was completed in the Bankim Health District (N = 559) using random forest regression to determine and compare the impact of the environmental factors on the experience of disability.ResultsThe physical environment had by far the highest influence on disability, with transportation, toilet of the dwelling, and the dwelling itself being the most important factors. Factors inside one’s own home (toilet of the dwelling, and the dwelling itself) were the most important for persons with moderate and severe disability, followed by attitudes of others and issues with accessing health care.ConclusionOur study provides country policy makers with evidence for setting priorities and for the development of evidence-informed policies for the Bankim Health District in Cameroon.

Multi-Sign Language Glove based Hand Talking System

Many people around the world suffer from losing the ability to talk and hear with different levels of disabilities, caused by either a car or a work accident or some diseases. After losing communication, these people cannot do normal functions of normal life. Along with the aforementioned disabilities, those people may also have psychological effects. This paper introduces a technique to realize multiple sign language translation using a sensors-based glove and an Android smartphone for speech impaired people to communicate normally with people. The design of the hand talking system (HTS) was implemented with a minimum possible number of sensors and a capable sewing controller (Lilypad). The proposed HTS includes flex sensors, Arduino, smartphone, and accelerometer. The HTS uses an Android application programmed to store multi-language in the SQLite database and enables the user to interact with the system. The system provides talking with a letter formed words, or using the most frequently used words in daily communication by hand gesture. The HTS has achieved high accuracy obtained for American Sign Language and Arabic Sing Language which are about 98.26% and 99.33% respectively with an average accuracy of 98.795 for both Sign Languages.

Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury

ObjectiveCognitive impairment is a key cause of disability after traumatic brain injury (TBI) but relationships with overall functioning in daily life are often modest. The aim is to examine cognition...

Effects of Teleassistance on the Quality of Life of People With Rare Neuromuscular Diseases According to Their Degree of Disability.

Rare neuromuscular diseases (RNMDs) are a group of pathologies characterized by a progressive loss of muscular strength, atrophy, fatigue, and other muscle-related symptoms, which affect quality of life (QoL) levels. The low prevalence, high geographical dispersion and disability of these individuals involve difficulties in accessing health and social care services. Teleassistance is presented as a useful tool to perform psychosocial interventions in these situations. The main aim of this research is to assess the effects of a teleassistance psychosocial program on the QoL levels of people with RNMDs who have different levels of disability. A sample of 73 participants was divided into an experimental group (n = 40), which participated in the intervention, and a control wait list group (n = 33). QoL was evaluated through the SIP and the SF-36, and disability through the WHO-DAS II. The participants with a moderate to severe level of disability were those who most benefited from the intervention. The results also revealed that the psychosocial teleassistance program was suitable to improve physical and psychosocial aspects of people suffering from a rare neuromuscular disease with a moderate level of disability, but just psychosocial aspects in those with a severe level of disability.

Psychometric properties of Meaningful Activity Participation Assessment (MAPA) in chronic stroke survivors

ABSTRACT Background Meaningful Activity Participation Assessment (MAPA) is an appropriate tool for assessing both objective and subjective aspects of participation. Objectives This study aimed to investigate the psychometric properties of MAPA in chronic stroke survivors. Methods Translation of MAPA was done according to the standard protocol of forward-backward translation. One hundred and seven chronic stroke survivors participated in this study. In addition to the MAPA, they were assessed by Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies of Depression Scale (CES-D), Life Satisfaction Index-Z (LSI-Z), Purpose in Life Test-Short Form (PIL-SF), and 36-Item Short-Form Survey (SF-36). To investigate the test-retest reliability, 37 participants were reassessed by MAPA after two weeks. Reliability, construct and known-groups validity were evaluated for MAPA. Results The results showed an acceptable internal consistency (Cronbach’s α = 0.79) and good test-retest reliability (ICC = 0.92) of MAPA. A significant moderate to high correlation was found between the MAPA and PIL-SF, CES-D, LSI-Z, SWLS, and different subscales of SF-36 (r = 0.32–0.65). MAPA showed good ability to differentiate between young adults (age≤ 65 years) and older adults (age> 65 years) with chronic stroke (P = .005) as well as between chronic stroke survivors with different levels of disability (P < .001). Conclusions The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.

Kinect v2 based system for gait assessment of children with cerebral palsy in rehabilitation settings

Cerebral palsy (CP) describes a group of disorders of movement, posture and balance caused by a non-progressive brain injury in the immature brain. It is the most prevalent cause of chronic motor disability in childhood, and although two thirds of CP children are able to walk, they show gait limitations. In this context, rehabilitation therapy can improve muscle balance and gait. Previous studies showed the importance of gait analysis as part of multidisciplinary tools for effective rehabilitation treatment. However, the high cost and the infrastructure required for the implementation of commercial gait analysis systems as well as the time-consuming preparation procedures, limit the access to this service. A low cost, non-restrictive, portable and of simple operation and installation system was developed based on Kinect v2 sensor. This study aims to validate it for capturing and analysing gait parameters in children with cerebral palsy. Several gait parameters from eleven CP patients with different levels of disability classified as a function of the Gross Motor Function Classification System (GMFCS) from II to III were recorded while they walked on a flat surface. The Kinect-based gait analysis system was compared with video-recording that yielded the same results. These results show the potential of Kinect to analyse gait in frail patient populations unobtrusively and with very low cost. More importantly, regarding to spatial parameters, the Kinect system was useful even for the worst case of GMFCS III that show a large gait variability with abnormal patterns.

New applications for independent activities of daily living in measuring disability in multiple sclerosis

Background: Disability outcome measures in multiple sclerosis (MS) focus heavily on ambulation; however, limitations in performing everyday activities encompass another type of disability. Objectives: The aim of this study was to examine the ability of instrumental activities of daily living (IADL) scale to discriminate between different levels of disability and to predict disability progression. Methods: The North American Research Committee on Multiple Sclerosis (NARCOMS) registry fall 2006 semi-annual survey asked participants to complete the RAND-12, Performance Scales, Patient Determined Disease Steps (PDDS), and IADL questionnaires. We modeled the trajectory of disability change, using the PDDS, over 12 years. Analyses used linear and repeated measures regression methods. Results: Of respondents (n = 9931), 9559 (96%) completed the PDDS and IADL scale. Respondents were mostly female (76%), Caucasian (92%), and 52.3 (10.5) years old with moderate disability (median PDDS 4 (early cane)). Mean (SD) IADL total score was 20.5 (3.7). Discriminant ability of the IADL scale was higher than other measures considered at higher levels of disability. Adjusted longitudinal models showed that needing greater assistance on IADLs was independently predictive of trajectories of greater disability change. Conclusion: IADL scale had a greater ability to discriminate between higher disability levels than RAND-12 domains. The IADL scale may provide a useful and clinically relevant tool to measure disability in progressive MS populations.