Health Organization Disability Assessment Schedule Research Articles

Mental contrasting and implementation of physical activity intentions in Ugandan primary care patients with mental health problems: A real-world intervention involving support partners

This study explored the efficacy of lay health worker (LHW)-led physical activity (PA) counselling for primary care patients with mental health problems (PCMH) and their support partners. Forty-nine (41♀, median age=47, interquartile range=22) PCMH and 49 support partners [9♀, 31(9)years] participated in once weekly counselling based on the mental contrasting and implementation of intentions framework for 8 weeks. All participants completed the Simple Physical Activity Questionnaire (SIMPAQ) and World Health Organization Disability Assessment Schedule 2 (WHODAS 2), while PCMH completed the Multidimensional Scale for Perceived Social Support (MSPSS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Alcohol Use Disorders Identification Test (AUDIT) pre- and immediately post-intervention. In PCMH significant (P<0.001) increases in walking, exercising and incidental PA (SIMPAQ) levels, reductions in depressive (PHQ-9) and anxiety (GAD-7) symptoms and improvements in mobility and participation (WHODAS 2) were observed. Perceived support from significant others (MSPSS) significantly increased. In support partners, a significant reduction in time spent sedentary, increase in incidental PA (SIMPAQ) and improvement in the perception of getting alone with others (WHODAS 2) was seen. Our study demonstrates that LHW-led PA counselling is beneficial for PCMH and their support partners. Randomized controlled trials are warranted to confirm these positive findings.

Disability Profile and Accessibility Limitations among Persons with Physical Disability in Nigeria

Purpose: To evaluate disability profile and accessibility limitations among Persons Living with Disabilities (PLWDs) in Nigeria. Methods: 61 PLWDs (44 men, 17 women) consented for this study. World Health Organization Disability Assessment Schedule 2.0, Facilitators and Barriers Survey for People with Mobility Limitations version 2, Barthel Index, and Medical Expenditure Panel Survey Questionnaires were used to obtain data on physical disability profile, level of access barriers, activities of daily living and quality of access to health care respectively. A proforma was used to collect information on socio-demographic characteristics. Data were analyzed using descriptive and inferential statistics. Alpha level set at p&lt; 0.05. Results: Prevalence of mobility, visual and hearing impairments were 60.7%, 21.3% and 6.6% respectively, There was a 11.5% rate of functional limitation while mild difficulty with ‘cognition’ and ‘life activities’ were reported among 96.7% and 65.6% of the respondents. 24.6% of the respondents had partial mobility dependence. There was low quality of access to health care (67.2%), high access barrier to home environment (73.8%) and transportation (93.4%). Conclusion: The PLWDs have high mobility impairment and face barriers in accessing healthcare, transportation and environment.

Functional Consequences after Road Traffic Injuries: the Preliminary Results from PERSIAN Traffic Cohort (PTC)

Background: Injuries are one of the important causes of death in the world. Today, it is needed to consider long-term functional consequences, after decreasing mortality rates and improving the recovery of injured patients. Objectives: The purpose of this study was to describe the functional outcomes of road traffic injuries and their predictors six month after hospital discharge based on the preliminary results from PTC. Methods: A cross-sectional study based on PERSIAN Traffic Health and Safety Cohort Study was performed. Data were collected using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with six domains (cognition, mobility, self-care, getting along with others, life activities, and participation), filled in by 180 injured adults (age >18 years) at six-month follow-up after hospital discharge during October 2019. These patients hospitalized after road crash in two referral trauma centers, from 23 September 2018 through 20 March 2019. Results: The majority of participants were men (82.7%) (Mean (SD) age =38.8 (16.7)). The mean score of WHODAS 2.0 was 17.8) SD=9.1).The highest score was estimated for the self-care dimension 3.3 (SD=1.8) and the lowest score for the Getting along with others 2.4 (SD=1.2). Age, gender, physiotherapy, injury localization including head and face, spinal cord, and upper extremity were predictors of WHODAS 2.0 score in various dimensions (p<0.05). Conclusions: The current study identified some functioning disabilities among patients sustaining road traffic injuries. It was evident from the results that a proportion of patients don’t recover six months after the injury and suffer disability especially in self-care, mobility, and life activities, which potentially prevent them from returning to normality. In addition, Age, gender, physiotherapy, injury localization were related to WHODAS 2.0 scores. These results highlight the importance of a comprehensive understanding of the long-term impact of injury on an individual.

The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study

BackgroundThere are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months.MethodsIn a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM.ResultsOf 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, − 0.19 [− 0.28 to − 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty.ConclusionsAt six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning.Clinical trial registrationNCT04401254 May 26, 2020.

Limitations on Participation and Their Relation to Social Determinants of Health Among Occupational Therapists and Occupational Therapy Students During Coronavirus Lockdown.

For the first time in recent history, people worldwide have faced severe restrictions in occupations because of the measures adopted by governments to contain the coronavirus disease 2019 (COVID-19) crisis. To determine the limitations on participation of occupational therapists and occupational therapy students during "lockdown" and their impact on social determinants of health. A cross-sectional, descriptive study conducted via an online survey. A total of 488 occupational therapists and occupational therapy students in North America, South America, and Europe. Outcomes and Measures: A questionnaire consisting of the World Health Organization Disability Assessment Schedule 2.0 of the International Classification of Functioning, Disability and Health and items developed to assess the impact of lockdown on daily life was emailed to occupational therapy professional associations, organizations, and universities between April and June 2020. It was available in English, Spanish, and Portuguese and metall the parameters listed in the Declaration of Helsinki. The roles and routines of people across the developed world have been affected by lockdown measures. The study shows marked differences between participants in the domains of getting along and life activities, as well as influence on the environment. Moreover, South American participants experienced these difficulties to a greater extent than European participants. This study quantifies the limitations in the participation of occupational therapists and occupational therapy students and the relationship of occupation to social determinants of health. What This Article Adds: The results of this research corroborate the relationship between health and occupation and highlight elements, such as the environment and context, that are important in occupational therapy. Therapists' ability to analyze occupation in relation to contextual and cultural factors will benefit clients.

Rasch Model Analysis of the Indonesian Version of World Health Organization Disability Assessment Schedule (WHODAS 2.0)

Rasch Model Analysis of the Indonesian Version of World Health Organization Disability Assessment Schedule (WHODAS 2.0)

Exploratory and confirmatory factor analysis of the 12-item Arabic World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a screening tool for Syrian refugees

Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees. Aims The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention. Method A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0. Results The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P &lt; 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution. Conclusions The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.

Prevalence and associated factors of disability in patients with chronic pain: An observational study.

The primary treatment goal of patients experiencing chronic pain has shifted from pain reduction to functional status improvement. However, the prevalence of disability and its associated factors in patients with chronic pain remain unknown.Individuals aged ≥50 years who visited the Pain Center at Nara Medical University with chronic pain from June 2019 to May 2020 were eligible for enrollment. Patients were asked to complete the Japanese version of the 12-item World Health Organization Disability Assessment Schedule 2.0. Patient demographics, pain intensity, level of catastrophizing, anxiety, depression, and exercise habits were assessed. Multivariate logistic regression analysis was used to identify the factors associated with disability.Of the 551 patients with a median age of 73 years, 51.5% experienced disability. Fixed factors such as age (odds ratio [OR], 1.03; 95% confidence interval [CI] 1.01–1.06, P = .002) and lumbar and lower limb pain (OR, 3.10; 95% CI, 1.83–5.24, P < .001) and some modifiable factors, including anxiety (OR, 2.06; 95% CI, 1.06–3.98, P = .03), depression (OR, 3.62; 95% CI, 1.92–6.82, P < .001), pain catastrophizer (OR, 2.94; 95% CI, 1.88–4.61, P < .001), numeric rating scale at the most painful site (OR, 1.29; 95% CI, 1.18–1.42, P < .001), exercise habits (walking (OR, 0.52; 95% CI, 0.33–0.83, P = .006) and working out (OR, 0.58; 95% CI, 0.34–0.99, P = .046), were found to be independently associated with disability.This cross-sectional study revealed a high prevalence of disability in patients with chronic pain and identified the factors associated with disability.

Validation of the Brazilian version of WHODAS 2.0 for individuals with temporomandibular disorders

ABSTRACT This study aims to validate the Brazilian version of World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with temporomandibular disorders (TMD), assessing its psychometric properties, including internal consistency, construct validity, and discriminant validity. In total, 100 female and male patients with TMD were included. Participants were assessed based on the Research Diagnostic Criteria for TMD (RDC/TMD). For statistical analyses, McDonald’s omega coefficient was used to assess internal consistency; Spearman correlation, for construct validity; Kruskal-Wallis test and multiple comparisons (Dunn method), for discriminant validity. The results of internal consistency for the WHODAS 2.0 domains ranged from 0.70 to 0.94. The WHODAS 2.0 showed a moderate and significant correlation with the disability points of the RDC/TMD and with the WHOQOL-BREF domains. In the discriminant validity, significant differences were found in all domains of WHODAS 2.0 between grade 0 and grade III, between grade I and grade III, and between grade II and grade III from the chronic pain grading of the RDC/TMD. The results demonstrate that the instrument is reliable and valid for measuring the functioning of individuals with TMD, presenting acceptable psychometric properties for internal consistency, as well as for construct validity and discriminant validity.

Individual and population level estimates of work loss and related economic costs due to mental and substance use disorders in Metropolitan São Paulo, Brazil

BackgroundWe estimate work loss and economic costs due to mental and substance use disorders in the economically active population of the São Paulo Metropolitan Area, Brazil. MethodsThe São Paulo Megacity Mental Health Survey assessed a population-based sample of 3,007 economically active residents using the Composite International Diagnostic Interview 3.0 and the World Health Organization Disability Assessment Schedule 2 to investigate, respectively, 12-month psychiatric disorders, work performance, and economic costs. ResultsAbsenteeism over the past 12 months was reported by 12.6%, and presenteeism by 14.7% (qualitative loss) and 13.1% (quantitative loss). Having any mental disorder was associated with 17.6 days of absenteeism and 37.7 days of reduced-qualitative and/or quantitative functioning. Fourteen mental disorders were significantly associated with work loss, with odds ratios ranging from 2.3 for adult separation anxiety to 40.4 for oppositional defiant disorder. At a population-level, oppositional defiant disorder, panic disorder, attention deficit disorder, and dysthymia contributed to the largest costs. The total annual economic costs were USD $83.2 billion/year, representing 6.1% of Brazil's Gross Domestic Product in 2007. LimitationsDiagnosis of mental disorders was based on self-reported symptoms. Work loss assessment was restricted to 30 days before the interview and may not fully represents the annual real experience and symptoms of the respondents which would lead to an overestimation of the burden. ConclusionsMental disorders impose a great negative impact on work performance and functioning, with a consequent high economic burden, pointing to the need of implementing cost-effective interventions to prevent work loss.

Perceived Support for Recovery and Level of Functioning Among People With Severe Mental Illness in Central and Eastern Europe: An Observational Study.

Background: Many people with severe mental illness experience limitations in personal and social functioning. Care delivered in a person's community that addresses needs and preferences and focuses on clinical and personal recovery can contribute to addressing the adverse impacts of severe mental illness. In Central and Eastern Europe, mental health care systems are transitioning from institutional-based care toward community-based care. The aim of this study is to document the level of functioning and perceived support for recovery in a large population of service users with severe mental illness in Central and Eastern Europe, and to explore associations between perceived support for recovery and the degree of functional limitations.Methods: The implementation of community mental health teams was conducted in five mental health centers in five countries in Central and Eastern Europe. The present study is based on trial data at baseline among service users across the five centers. Baseline data included sociodemographic, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for functional limitations, and the Recovery Support (INSPIRE) tool for perceived staff support toward recovery. We hypothesized that service users reporting higher levels of perceived support for their recovery would indicate lower levels of functional limitation.Results: Across all centers, the greatest functional limitations were related to participation in society (43.8%), followed by daily life activities (33.3%), and in education or work (35.6%). Service users (N = 931) indicated that they were satisfied overall with the support received from their mental health care provider for their social recovery (72.5%) and that they valued their relationship with their providers (80.3%). Service users who perceived the support they received from their provider as valuable (b = −0.10, p = 0.001) and who reported to have a meaningful relationship with them (b = −0.13, p = 0.003) had a lower degree of functional limitation.Conclusion: As hypothesized, the higher the degree of perceived mental health support from providers, the lower the score in functional limitations. The introduction of the community-based care services that increase contact with service users and consider needs and which incorporate recovery-oriented principles, may improve clinical recovery and functional outcomes of service users with severe mental illness.

Psychological assessment of individuals with Mal de Débarquement Syndrome.

To report on the psychological, personality, and behavioral profiles of individuals with persistent Mal de Débarquement Syndrome (MdDS). Individuals with MdDS who participated in neuromodulation clinical trials between May 2013 and June 2019 completed a series of standardized psychological questionnaires and underwent the Structural Clinical Interview for DSM-IV-TR (SCID) for specific psychiatric diagnoses. All data reported are from baseline assessments prior to any study interventions. Scores were compared to population norms for adult women. Complete datasets were available for 55 women. Mean age of onset of MdDS was 49.0 ± 11.9 years (range 22-69years) and median duration of illness of 22months (6months-20years). SCID results were as follows: healthy (48.1%), any lifetime Major Depressive Disorder (35.2%, 7.4% current); any lifetime history of anxiety disorder (11.1%); any lifetime substance use disorders (18.5%, 0% current). Compared to population norms, the MdDS group scored significantly higher on the Patient Health Questionnaire-9 depression scale and the Generalized Anxiety Disorder 7 (GAD-7) anxiety scale, but only the GAD-7 correlated with symptom severity. The NEO-Five Factor Inventory for personality, Positive and Negative Affect Schedule, Behavioral Inhibition System/Behavioral Activation System Scale, and the Empathy Quotient metrics did not correlate with duration of illness. Disability assessed by the 12-item World Health Organization Disability Assessment Schedule 2.0 was 25.7 ± 6.7, comparable to reports for concussion. Disability correlated with severity of depression, anxiety, neuroticism, and affect but not to severity of MdDS. Psychological profiles of MdDS relate to disability but not to duration of illness.

The association of depressive symptoms with disability among adults in China

BackgroundThe symptoms that patients with major depressive disorder (MDD) experience are the dominant contributing factors to its heavy disease burden. This study sought to identify key symptoms leading to disability in patients with MDD. MethodsSubjects consisted of patients who had a 12-month MDD diagnosis based on the China Mental Health Survey (CMHS). World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to assess the degree of disability. The associations between depressive symptoms and disability were analyzed using a linear regression and logistic regression with a complex sampling design. ResultsOf the 32,552 community residents, 655 patients were diagnosed with 12-month MDD. The disability rate due to MDD was 1.06% (95% CI: 0.85%–1.28%) among adults in Chinese community and 50.7% (95% CI: 44.3%–57.1%) among MDD patients. Depression was associated with all functional losses measured by the WHODAS. Feelings of worthlessness in life or inappropriate guilt, and psychomotor agitation or retardation were the key symptoms related to disability. Economic status, co-morbidity of physical diseases or anxiety disorders were correlates of disability scores. LimitationsThe disability rate might be underestimated due to the exclusion of MDD patients living in hospitals. The effect of treatments on disability was excluded. ConclusionsPsychological symptoms, not somatic symptoms, contribute to disability in MDD patients. Disability worsens when physical diseases or anxiety disorders are present. More attention could be paid to psychological symptoms, physical diseases, and anxiety disorders in MDD patients with disabilities.

Disability from chronic ear disease in Nepal assessed using the World Health Organization Disability Assessment Schedule 2.0 instrument.

Globally, South Asia has the highest proportion of disabling hearing loss. There is a paucity of data exploring the associated hearing loss and disability caused by chronic middle-ear disease in South Asia in the setting of surgical outreach. This study aimed to measure disability using the World Health Organization Disability Assessment Schedule 2.0 in patients undergoing ear surgery for chronic middle-ear disease in an ear hospital in Nepal. The World Health Organization Disability Assessment Schedule 2.0 was translated into Nepali and administered by interview to patients before ear surgery, and results were correlated with pre-operative audiograms. Out of a total of 106 patients with a mean age of 23 years, the mean World Health Organization Disability Assessment Schedule 2.0 score was 17.7, and the highest domain scores were for domain 6 'participation in society' at a score of 34. There was a positive correlation of World Health Organization Disability Assessment Schedule 2 score with hearing level (r = 0.46). Patients with ear disease in Nepal have had their disability measured using the World Health Organization Disability Assessment Schedule 2.0. Our study demonstrated a correlation between impaired hearing and disability in a surgical outreach context, which was an expected but not previously reported finding.

Does psychiatric comorbidity influences quality of life and disability among subjects with refractory focal epilepsy- a comparative cross-sectional study

Background: Refractory focal epilepsy is a disorder associated with a significant impact on quality of life and disability. Having comorbid psychiatric disorders among these subjects has been well documented. Recently studies have looked at how this impacts the quality of life and disability, but they are few in number. Methodology: Subjects were taken from the epilepsy clinic whom neurologist diagnosed as having refractory focal epilepsy. MINI International Neuropsychiatric Interview (MINI) was used to identify psychiatric comorbidity. Two groups of 25 subjects were made based on whether they had or did not have psychiatric comorbidities and further assessed with the World Health Organization Quality of Life (WHOQOL)-BREF for quality of life and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for disability. Results: Analysis of the two groups showed quality of life score lesser in the group with psychiatric comorbidities, which was significant (p<0.001). Similarly, the disability score was higher in the group with psychiatric comorbidities, which was significant (p<0.001). The quality of life was lowest in major depressive disorder (60.80±8.47) and disability was highest in psychosis (105.33±1.53). Conclusion: Psychiatric comorbidities in subjects with refractory focal epilepsy significantly impact the quality of life and disability. It is essential to have a good team approach, and liaison between neurology and psychiatry for early detection and treatment of such symptoms will decrease healthcare costs and improve quality of life.

Health and Disability Among Persons Experiencing Homelessness

This paper provides insight into the health disparities prevalent among people experiencing homelessness and the impact on daily activities using the International Classification of Functioning, Disability, and Health framework and the World Health Organization Disability Assessment Schedule 2.0. Persons experiencing homelessness reported that physical and psychological health conditions profoundly impacted daily functioning. The most impacted global domains included the emotional aspects of difficulties due to health problems, joining in community activities (Participation), moving and getting around (Mobility), and domestic responsibilities (Life activities).

Health-Related Quality of Life in Survivors of Severe COVID-19 of a University Hospital in Northern Portugal.

Long-term health impairments are often experienced among survivors of critical illness, which may have a negative impact on their quality of life. The aim of this study was to characterize COVID-19 survivors of critical illness and to evaluate health-related quality of life and disability following hospital discharge. This is a retrospective case-series study that included COVID-19 survivors admitted to the Intensive Care Medicine Department of a University Hospital. Follow-up evaluation was performed between the 30th and the 90th day after discharge. Quality of life was explored using the five-level version of the EQ-5D instrument (EQ-5D-5L) and functionality using the 12-question World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Forty-five survivors were enrolled, 28 (62.2%) men, median age 63.0 years. The EQ-5D-5L questionnaire showed moderate to extreme problems in some dimension in 29 patients (64.4%): mobility in six (13.3%), self-care in seven (13.3%), usual activities in 23 (51.1%), pain/discomfort in 14 (31.1%) and anxiety/depression in 17 (37.8%). When using the 12-question WHODAS 2.0 questionnaire, moderate to extreme disability was reported in some question in 37 patients (82.2%): 19 (42.2%) in standing for long periods, 18 (40.0%) in long-distance walking; 14 (31.1%) on taking care of household responsibilities and 17 (37.8%) in their day-to-day work; 23 (51.1%) felt emotionally affected by their health problems. Based on COVID-19 survivors-reported outcomes after critical illness, mobility, pain/discomfort, and anxiety/depression were the main problems that persisted one to three months after hospital discharge. An organized follow-up structure is crucial to improve health-related quality of life in critical COVID-19 survivors.

A-148 Executive Dysfunction in Late-Life Depression: Changes and Relationship to Treatment Response in a Clinical Trial

Abstract Objective Executive dysfunction is the core neurocognitive deficit associated with late-life depression (LLD). This study identified changes in executive functioning during a structured behavioural treatment for depression in older adults and ascertained if pre-treatment executive dysfunction predicted treatment response. Method We analyzed data from a large multisite randomized controlled trial of structured behavioral psychotherapies (PST and Engage) for unipolar depression in adults ≥60 years. Participants were diagnosed with major depressive disorder and had Mini-Mental State Examination [MMSE] ≥24. Cognitive measures included the Stroop test, digit span, Iowa Gambling Task (IGT), and Wisconsin Card Sorting Test (WCST). Treatment response outcomes included pre- to post-treatment changes on the Hamilton Depression Rating Scale (HAM-D) and World Health Organization Disability Assessment Schedule II (WHODAS-II). One-way analysis of variance (ANOVA) assessed pre- and post-treatment changes in executive functioning measures across 9 weeks of treatment for 95 participants with complete data. Multiple linear regression models tested whether baseline measures of executive functioning predicted treatment response in (a) HAM-D depression and (b) WHODAS disability scores. Results A one-way ANOVA revealed improvements on IGT performance (Total Money) between baseline and week 9 post-treatment (F(1,186) = 7.00, p &amp;lt; 0.01). No combination of baseline measures of executive functioning significantly predicted change in HAM-D or WHODAS scores across treatment (ps &amp;gt; 0.05). Conclusion Baseline executive functioning did not predict treatment response (change in depressive symptoms or disability ratings). That is, individuals improved on treatment outcomes regardless of baseline executive dysfunction. In addition, results suggest that these approaches may actually improve real-life decision-making.

Postdischarge Functional Capacity, Health-Related Quality of Life, Depression, Anxiety, and Post-traumatic Stress Disorder in Patients Receiving a Long-term Left Ventricular Assist Device

BackgroundThere is a paucity of data on depression, anxiety and post-traumatic stress disorder after left ventricular assist device (LVAD) implantation. We designed an observational study to integrate these with functional capacity and health-related quality of life (HR-QOL) in surviving LVAD patients. Methods and ResultsConsenting patients between 1 month and 9 years after LVAD implantation (n = 121) were screened for functional capacity (World Health Organization Disability Assessment Schedule 2.0 [WHODAS 2.0)]); HR-QOL (European Quality of Life [EQ-5D] and Visual Assessment Scales [EQ-VAS]), depression (Patient Health Questionnaire [PHQ-9], anxiety (Generalized Anxiety Disorder Scale [GAD-7]) and post-traumatic stress disorder (Impact of Event Scale Revised [IES-R]). Of the 94% of patients who consented, 34.7% reported impaired functional capacity (WHODAS 2.0 score of ≥25%), 23.1%–34.7% HR-QOL problems (domain EQ-5D of ≥3), 10.7% “poor health” (EQ-VAS of ≤40), 14.9% depression (PHQ-9 of >14), 11.7% suicidal ideation and 17.5% anxiety (GAD-7 of >10). Among these patients, 23.5% had a positive screen for post-traumatic stress disorder (IES-R of ≥24). An EQ-VAS of 80 or greater predicted good functional capacity (P < .001). ConclusionsOne-third of discharged LVAD patients reported impaired function, HR-QOL, and psychological issues. A standardized evaluation before and after LVAD implantation could facilitate psychologic prehabilitation, inform decision-making, and identify indications for mental health intervention.

Disability, Pain, and Wound-specific Concerns Self-reported by Patients at Risk of Limb Loss

There has been limited study of patient-reported outcomes (PROs) in patients at risk of limb loss. Our primary objective was to estimate the burden of disability in this patient population using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Secondary objectives were to determine whether the WHODAS 2.0 was clinically acceptable to these patients and the extent to which patient and wound characteristics, wound-specific concerns, and wound-related discomfort or distress predict their disability.