Health Organization Disability Assessment Schedule Research Articles

Evaluation of the Relationship between Disability and Disease Severity, Cognitive Functions, and Insight in Patients with Schizophrenia.

: This study aims to examine the clinical characteristics, cognitive functions, and levels of insight, which are thought to be related to disability in schizophrenia patients, and to determine which variable will guide the clinician to predict the disability. : Participants were 102 individuals with schizophrenia aged 18-60. All participants completed the social functioning scale and the Beck cognitive insight scale. To determine the severity of disability, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scale was conducted. Positive and negative syndrome scale, Calgary depression scale for schizophrenia, trail making tests and Stroop test were performed. : The regression analysis indicated that high income, increased education level, and fewer hospitalization variables had significant negative effects (p ＜ 0.05) on the WHODAS overall score, explaining 20.8% of the variance. The duration of trail-making test form A, PANSS total score, and Stroop 3 duration variables had significant positive effects (p ＜ 0.05) on the WHODAS score, explaining 49.3% of the total variance. Increased levels of education, higher income, and higher cognitive insight were found to be associated with less disability. Increased severity of disease and some deterioration in the mental field were found to be related to high disability. : In this research, the predictors of disability in individuals with schizophrenia, level of education, and income are among the predictors of disability, and disease severity seems to be more related to the impairment of cognitive functions. Interventions and treatments that support the psychosocial functionality should be planned rather than symptom-oriented treatment approaches.

Assessing the Effectiveness of Rehabilitation Interventions through the World Health Organization Disability Assessment Schedule 2.0 on Disability-A Systematic Review.

(1) Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a tool designed to measure disability in accordance with the International Classification of Functioning, Disability and Health. Measuring disability is becoming increasingly important due to its high prevalence, which continues to rise. Rehabilitation interventions can reduce disability and enhance functioning. (2) Objective: The present study aims to assess the impact of rehabilitation interventions on reducing disability, as measured by the WHODAS 2.0 questionnaire. It also seeks to identify which specific rehabilitation interventions are more effective and to explore other disability assessment questionnaires. (3) Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a systematic review, with the protocol registered with the identifier CRD42023495309, focused on "WHODAS" and "rehabilitation" using PubMed and Web of Science electronic databases. (4) Results: We identified 18 articles from various regions encompassing patients with various health conditions, related to stroke, the cardiovascular system (cardiovascular disease, chronic heart failure), the pulmonary system (chronic obstructive pulmonary disease), the neurologic system (Parkinson's disease, cerebral palsy, neurodegenerative disease), the musculoskeletal system (orthopaedic surgery), cancer, and chronic pain, and among frail elderly. These patients have received a wide range of rehabilitation interventions: from conventional therapy to virtual reality, robot-assisted arm training, exergaming, and telerehabilitation. (5) Discussion and Conclusions: A wide range of rehabilitation techniques can effectively improve disability with various comorbidities, offering numerous benefits. The WHODAS 2.0 questionnaire proves to be an efficient and reliable tool for measuring disability, and scores have a tendency to decrease after rehabilitation.

Challenges of Measuring Self-Reported Exposure to Occupational Biomechanical Risk Factors Amongst People with Low Literacy Engaged in Manual Labour: Findings from a Cross-Cultural Adaptation and Psychometric Investigation in an African Population with Chronic Low Back Pain

PurposeOccupational biomechanical factors are implicated in the aetiology and progression of low back pain (LBP). This study cross-culturally adapted and psychometrically investigated the Occupational Risk Factor Questionnaire (ORFQ) in a low literate Nigerian Igbo population with chronic LBP.MethodsForward and back translation of the original ORFQ by clinical and non-clinical translators was followed by an expert committee review. The adapted ORFQ was pre-tested amongst rural Nigerian adults with chronic LBP using cognitive think-aloud interviewing. Internal consistency (Cronbach’s alpha) and test–retest reliability (unweighted and linear weighted k statistic for item-by-item agreement, and intra-class correlation coefficient—ICC) were investigated amongst 50 rural and urban Nigerian dwellers with chronic LBP. Spearman’s correlation and regression analyses were conducted with the Igbo-ORFQ, and measures of disability [World Health Organisation Disability Assessment Schedule (WHODAS 2.0), Roland Morris Disability Questionnaire (RMDQ), Back performance scale (BPS)], pain intensity [Eleven-point box scale (BS-11)] and social support [Multidimensional Scale of Perceived Social Support (MSPSS)], to test construct validity with 200 rural Nigerian dwellers with chronic LBP.ResultsCross-cultural adaptation highlighted difficulty conceptualising and concretising exposure to biomechanical risk factors. Item-by-item agreement, internal consistency (α = 0.84) and intraclass correlation coefficient (ICC = 0.83) were good. Some unexpected direction of associations between the biomechanical components of the Igbo-ORFQ, and disability, pain intensity, and social support prohibits establishment of construct validity.ConclusionProspective studies comparing the Igbo-ORFQ to other measures of exposure to occupational biomechanical risk factors are required to establish the construct validity of the Igbo-ORFQ.

Disability and emotional symptoms in women with lipedema: A comparison with overweight/obese women.

Lipedema is characterized by the painful abnormal deposition of adipose tissue in the lower limbs and is often misdiagnosed as obesity. Considering the numerous bothersome physical symptoms of lipedema, women with lipedema may have greater disability and emotional problems than women with lifestyle-induced obesity. Our study aims to assess disability, anxiety and depression symptoms in women with lipedema compared to women with overweight/obesity. Women with lipedema (n = 45, with a mean age of 41 years) and women who are overweight/obese (n = 43, with a mean age of 44.95 years) were asked to complete the following questionnaires: The World Health Organization Disability Assessment Schedule (WHO-DAS II), Beck's Depression Inventory - II (BDI-II), and The Hospital Anxiety and Depression Scale (HADS). Despite the higher BMI in the overweight/obesity group, the group with lipedema was more disabled in numerous domains of the WHO-DAS II questionnaire, including Life activities - domestic, work and school responsibilities and Participation in society When the influence of BMI was adjusted, a difference in the domain of Mobility was also present. The study groups did not differ in anxiety and depression symptoms. We showed that behavioral impairment was the main factor affecting functioning in women with lipedema. Emotional symptoms did not differentiate the study groups. Leg volumes and adipose tissue pain intensity were associated with greater disability in women with lipedema, and should be considered in managing women with this condition and in future research estimating the effectiveness of lipedema treatment.

Self-stigma, religiosity, and perceived social support in people with recent-onset psychosis in the Islamic Republic of Iran: Associations with symptom severity and psychosocial functioning.

Most evidence on psychosocial factors in recent-onset psychosis comes from high-income countries in Europe, Australia, Canada and the USA, while these factors are likely to differ under varying sociocultural and economic circumstances. In this study, we aimed to investigate associations of self-stigma, religiosity and perceived social support with symptom severity and psychosocial functioning in an Iranian cohort of people with recent-onset psychosis (i.e. illness duration of <2 years). We used baseline data of 361 participants (N = 286 [74%] male, mean age = 34 years [Standard Deviation = 10.0]) from the Iranian Azeri Recent-onset Acute Phase Psychosis Survey (ARAS). We included assessments of self-stigma (Internalized Stigma of Mental Illness, ISMI), religiosity (based on Stark & Glock), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS), symptom severity (Positive And Negative Syndrome Scale, PANSS) and psychosocial functioning (clinician-rated Global Assessment of Functioning Scale, GAF, and self-reported World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0). Descriptive analyses were employed to characterize the study sample. Covariate-adjusted ordinal and multivariable linear regression analyses were performed to investigate cross-sectional associations of baseline ISMI, religiosity and MSPSS with concurrent PANSS, GAF and WHODAS 2.0. Higher self-stigma was associated with poorer self-reported functioning (B = 0.375 [95% Confidence Interval (CI): 0.186, 0.564]) and more severe concurrent symptoms (B = 0.436 [95% CI: 0.275, 0.597]). Being more religious was associated with poorer clinician-rated functioning (OR = 0.967 [95% CI: 0.944, 0.991]), but with less severe symptoms (B = -0.258 [95% CI: -0.427, -0.088]). Stronger social support was associated with poorer clinician-rated (OR = 0.956 [95% CI: 0.935, 0.978]) and self-reported functioning (B = 0.337 [95% CI: 0.168, 0.507]). This study shows that self-stigma, religiosity and perceived social support were associated with symptom severity and clinician-rated as well as self-reported psychosocial functioning in an Iranian cohort of people with recent-onset psychosis. The findings extend previous evidence on these psychosocial factors to one of the largest countries in the Middle East, and suggest that it may be worthwhile to develop strategies aimed at tackling stigma around psychosis and integrate the role of religiosity and social support in mental ill-health prevention and therapy.

Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea

Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea

Correlation between neuroimaging, neurological phenotype, and functional outcomes in Wilson's disease.

Wilson's disease (WD) is associated with a variety of movement disorders and progressive neurological dysfunction. The aim of this study was to correlate baseline brain magnetic resonance imaging (MRI) features with clinical phenotype and long-term outcomes in chronically treated WD patients. Patients were retrospectively selected from an institutional database. Two experienced neuroradiologists reviewed baseline brain MRI. Functional assessment was performed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scale, and disease severity was classified using the Global Assessment Scale for Wilson's Disease (GASWD). Of 27 patients selected, 14 were female (51.9%), with a mean (standard deviation [SD]) age at onset of 19.5 (7.1) years. Neurological symptoms developed in 22 patients (81.5%), with hyperkinetic symptoms being the most common (70.4%). Baseline brain MRI showed abnormal findings in 18 cases (66.7%), including T2 hyperintensities in 59.3% and atrophy in 29.6%. After a mean (SD) follow-up of 20.9 (11.0) years, WD patients had a mean score of 19.2 (10.2) on WHODAS 2.0 and 6.4 (5.7) on GASWD. The presence of hyperkinetic symptoms correlated with putaminal T2 hyperintensities (p = 0.003), putaminal T2 hypointensities (p = 0.009), and mesencephalic T2 hyperintensities (p = 0.009). Increased functional disability was associated with brain atrophy (p = 0.007), diffusion abnormalities (p = 0.013), and burden of T2 hyperintensities (p = 0.002). A stepwise regression model identified atrophy as a predictor of increased WHODAS 2.0 (p = 0.023) and GASWD (p = 0.007) scores. Atrophy and, to a lesser extent, deep T2 hyperintensity are associated with functional disability and disease severity in long-term follow-up of WD patients.

Measuring the psychosocial wellbeing of Rohingya mothers in Cox’s Bazar, Bangladesh: Psychometric properties of an MHPSS assessment battery

Background Psychosocial research in humanitarian settings has been historically dominated by a focus on distress and disorder. As such, there is a need to establish the validity of instruments for a broad range of psychosocial outcomes, particularly among highly affected and under-represented populations. The current study describes the adaptation and testing of multiple psychosocial instruments among displaced Rohingya mothers in Bangladesh. Methods We used baseline data from 600 mothers of malnourished children aged 2 and under enrolled in an intervention study in Cox’s Bazar, Bangladesh. Instruments assessed distress (items from the International Depression Symptom Scale [IDSS] and Kessler-6 [K-6]); functional impairment (World Health Organization Disability Assessment Schedule [WHODAS]); subjective wellbeing (global Satisfaction With Life [SWL] and Personal Wellbeing Index [PWI]; and, coping (items from the Brief COPE and locally developed coping items). Instruments were piloted and refined, then used for data collection by Bangladeshi-Rohingya interviewer pairs. We conducted exploratory factor analysis, evaluated internal consistency, examined construct validity through correlation with other scales, and used regression models to explore demographic factors associated with psychosocial health. Results Both the WHODAS and coping items fit 2-factor models; other scales were unidimensional. Cronbach’s alphas ranged from .76 to .90 for the refined scales. With the exception of coping, scale correlations supported construct validity; separate measures of the same construct were highly correlated, distress and impairment were moderately correlated, and both were inversely correlated with wellbeing. Correlates of poorer psychosocial health included relative socioeconomic disadvantage, current pregnancy, and being unmarried. Conclusions Most of the standard psychosocial assessment tools performed adequately, but they did not appear to fully capture local experiences and included items of little local relevance. Findings highlight the need for further mixed methods research to develop a rich battery of instruments with cross-cultural validity, particularly for positive outcomes such as coping which was particularly challenging to assess.

Could an increased risk of obstructive sleep apnoea be one of the determinants associated with disability in individuals with cardiovascular and cerebrovascular diseases?

To investigate a possible association between the risk of obstructive sleep apnoea (OSA) and disability in individuals with cardiovascular or cerebrovascular diseases. Cross-sectional study was conducted with 373 individuals (313 with cardiovascular or cerebrovascular diseases and 60 healthy). Disability was assessed by the 12-item World Health Organization Disability Assessment Schedule (WHODAS), and the risk of OSA was assessed by STOP-BANG. Anxiety and depression symptoms, daytime sleepiness, and cognition were assessed by the Hospital Anxiety and Depression Scale (HADS), Epworth Sleepiness Scale (ESS), and Mini Mental State Examination (MMSE). Greater disability was found in individuals with intermediate or high risk of OSA, considering healthy individuals (p=0.03), or individuals diagnosed with arrhythmia (p<0.01) or coronary artery disease (p=0.04). A high risk of OSA and higher WHODAS scores was significant among women as well as between OSA risk categories (p<0.01). Cognitive deficit and level of education also showed differences between OSA risk categories. Age, depression, and sleepiness were also associated with the subjects' disability (p<0.01). Gamma regression model showed higher WHODAS scores in female, in those with intermediate and high risk of OSA, and in those with depressive symptoms and cognitive deficit. Age also showed a correlation with higher WHODAS scores. The presence of all investigated cardio and cerebrovascular diseases showed an increase in the WHODAS score, implying a greater disability compared to healthy individuals. Moderate and high risk of OSA is associated with disability, as well as gender, age, depressive symptoms, cognitive deficit, and cardiovascular diseases.

Prevalence and levels of disability post road traffic orthopaedic injuries in Rwanda.

Prolonged disability resulting from road traffic injuries (RTIs) contributes significantly to morbidity and disease burden. A good understanding of the prevalence and the level of disability of orthopaedic injuries in developing countries is crucial for improvement; however, such data are currently lacking in Rwanda. To determine the prevalence and levels of disability of 2 years post-road traffic orthopaedic injuries in Rwanda. A multicentre, cross-sectional study from five Rwandan referral hospitals of 368 adult RTI victims' sustained from accidents in 2019. Between 02 June 2022, and 31 August 2022, two years after the injury, participants completed the World Health Organization Disability Assessment Schedule (WHODAS 2.0) Questionnaire for the degree of impairment and the Upper Extremity Functional Scale and Lower-Extremity Functional Scale forms for limb functional evaluation. Descriptive, inferential statistics Chi-square and multinomial regression models were analysed using R Studio. The study's mean age of the RTOI victims was 37.5 (±11.26) years, with a sex ratio M: F:3: 1. The prevalence of disability following road traffic orthopedic injury (RTOI) after 2 years was 36.14%, with victims having WHODAS score > 25.0% and 36.31% were still unable to return to their usual activities. Age group, Severe Kampala Trauma Score and lack of rehabilitation contributed to disability. The most affected WHODAS domains were participation in society (33%) and life activities (28%). The prevalence and levels of disability because of RTOI in Rwanda are high, with mobility and participation in life being more affected than other WHODAS domains. Middle-aged and socio-economically underprivileged persons are the most affected. This study showed that a good rehabilitation approach and economic support for the RTI victims would decrease their disabilities in Rwanda.

Associations between Predictors of PTSD and Psychosocial Functioning in Veterans: Results from a Longitudinal Assessment Study

Impairments in psychosocial functioning are common in veterans, especially in those with significant mental health symptoms. Although available treatments are aimed at alleviating these symptoms, impairments in psychosocial functioning do not appear to be fully addressed. To achieve rehabilitation and full societal participation, there is a need to identify longitudinal associations of both symptoms and functional outcomes which can be targeted in treatment. United States veterans (N=491) of the Iraq and Afghanistan wars were recruited as part of a longitudinal assessment study which examined predictors of postdeployment adjustment. Veterans were assessed at four timepoints over the course of a two-year period. A Bayesian multivariate multilevel model was used to estimate the association of predictors of PTSD (depression, alcohol use, suicidal ideation, and sleep) on psychosocial functioning as encompassed by quality of life (Quality of Life Scale (QLS)) and disability (World Health Organization Disability Assessment Schedule (WHODAS)) scores over time. As female veterans have unique environmental exposures and functional demands, interactions between predictors and gender were included in all models. There was significant overlap between predictors of PTSD and predictors of disability across domains and quality of life. Depressive symptoms and social support emerged as the strongest predictors of psychosocial functioning. Additionally, suicidality and alcohol use emerged as predictors of quality of life, but not disability. As expected, increases in PTSD symptoms predicted increased disability and decreased quality of life. The effect of depressive symptoms on quality of life was more pronounced for male veterans, and the effect of PTSD and alcohol use on quality of life was more pronounced for female veterans. Findings highlight various treatment targets which have the potential to improve symptoms of PTSD and functional outcomes. Findings highlight an opportunity to leverage intervention and prevention efforts focused on decreasing depression and increasing social support to improve trauma symptoms and maximize rehabilitation and functional recovery in veterans.

Impairments in psychological functioning in refugees and asylum seekers.

Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.

Structural Model of Personality Traits and Illness Perception with Functional Disability in Functional Somatic Syndromes in Patients with Coronary Artery Disease Based on the Mediating Role of Self-Care Behavior

Objective: Heart diseases, including coronary artery disease, are among the three main causes of death alongside cancer and stroke in most countries. The current study aimed to predict functional disability in functional somatic syndromes in patients with coronary artery disease based on personality traits and illness perception, considering the mediating role of self-care behavior. Methods and Materials: This study, with applied objectives and a correlational research design, was conducted using the structural equation modeling approach. The statistical population included all patients with coronary artery disease in the city of Amol in the year 2022, from which 250 individuals were purposefully selected. Data collection tools included the World Health Organization Disability Assessment Schedule (2014), the McCrae and Costa Personality Traits Questionnaire (1985), the Illness Perception Questionnaire (2006), and the Self-Care Questionnaire (2003). The statistical technique used was structural equation modeling with full latent variables. SPSS version 26, AMOS version 24, and R version 4.2.0 software were used for statistical data analysis. Findings: The results showed that all five personality dimensions, illness perception, and self-care significantly explain the variance in functional disability (P&lt;0.01). Additionally, the mediating role of self-care behavior was significant in the relationship between functional disability and four personality dimensions: extraversion, openness to experience, agreeableness, conscientiousness, and illness perception (P&lt;0.01). Conclusion: It can be concluded that functional disability in functional somatic syndromes in patients with coronary artery disease can be predicted based on their personality traits and illness perception, taking into account the mediating role of self-care behavior.

Research Progress in the Study of the World Health Organization Disability Assessment Schedule 2.0 for Perioperative Applications

Research Progress in the Study of the World Health Organization Disability Assessment Schedule 2.0 for Perioperative Applications

Pharmacotherapy guideline concordance for major depressive disorder and its link to functioning via symptom change

Abstract Introduction: Alleviation of symptom severity for major depressive disorder (MDD) is known to be associated with a lagged improvement of functioning. Pharmacotherapy guidelines support algorithms for MDD treatment. However, it is currently unclear whether concordance with guidelines influences functional recovery. A guideline concordance algorithm (GCA-8) was used to measure this pathway in a naturalistic clinical setting. Methods: Data from 1403 adults (67% female, 84% non-Hispanic/Latino White, mean age of 43 years) with nonpsychotic MDD from the Penn State Psychiatry Clinical Assessment and Rating Evaluation System registry (visits from 02/01/2015 to 04/13/2021) were evaluated. Multivariable linear regression measured associations between GCA-8 and World Health Organization Disability Assessment Schedule 2.0 (WHODAS) scores. Mediation by MDD symptom severity using the Patient Health Questionnaire depression module (PHQ-9) was also evaluated. Results: This study found a statistically significant improvement in WHODAS scores (functioning) between baseline and final measures (−2 points, P &lt; .001) within one year. A one standard deviation increase in the GCA-8 score was associated with a 0.48-point reduction in mean disability score (total effect; P = .02) with significant mediation by the change in MDD symptom severity (coefficient = −0.51, P &lt; .001) and a nonsignificant natural direct effect of the GCA-8 independent of PHQ-9 change (coefficient = −0.02, P = .92). Conclusions: Higher pharmacotherapy guideline concordance is associated with better functioning for MDD patients; this association likely occurs through improvement in MDD symptom severity rather than directly.

Interplay of Chronic Diseases, Disability, and Depression Among Saudi Arabian Patients: A Cross-sectional Analysis

Chronic diseases are a leading cause of disability and mental health issues globally, with significant implications for healthcare systems and patient well-being. In Saudi Arabia, the prevalence of chronic conditions is rising, but the comprehensive interplay between chronic diseases, disability, and depression remains underexplored. This study aims to examine the relationships between chronic diseases, disability, and depression among Saudi Arabian patients, providing insights that can inform healthcare policies and interventions to improve patient outcomes. A cross-sectional survey was conducted in Riyadh, Saudi Arabia, from March to May 2024. The study included 381 patients with one or more chronic diseases. Data were collected using standardized questionnaires that assessed the number of chronic diseases, level of disability (measured using the World Health Organization Disability Assessment Schedule), and depression (assessed using the Patient Health Questionnaire-9). Regression analysis was used to evaluate the factors contributing to depression and to establish the correlation between chronic diseases, disability, and depression. The analysis revealed a direct association between the number of chronic diseases and the level of disability experienced by the participants (P &lt; 0.01). Patients with multiple chronic conditions (P = 0.000; Beta = 0.456; 95% confidence interval = 0.272-0.422) reported higher levels of disability, significantly impacting their daily functioning. The Pearson correlation analysis revealed a significant positive correlation between the number of chronic illnesses and the severity of disability (P &lt; 0.01). Additionally, our study identified a significant correlation (P &lt; 0.05) between increased depression and higher levels of disability among participants. Patients with higher disability scores exhibited more severe depressive symptoms, indicating a compounded effect on mental health. This study provides critical insights into the significant impact of chronic diseases on disability and mental health among Saudi Arabian patients. The findings highlight the compounded challenges faced by patients with multiple chronic conditions and underscore the intertwined nature of physical and mental health. Addressing the complex interplay of sociodemographic and health-related factors can enable healthcare systems to better meet the needs of this vulnerable population, ultimately improving their quality of life and health outcomes.

Effectiveness of group problem management plus in distressed Syrian refugees in Türkiye: a randomized controlled trial.

Despite high levels of psychological distress, mental health service use among Syrian refugees in urban settings is low. To address the mental healthcare gap, the World Health Organization developed group problem management plus (gPM+), a scalable psychological intervention delivered by non-specialist peer facilitators. The study aimed to evaluate the effectiveness of gPM+ in reducing symptoms of depression and anxiety among Syrian refugees in Istanbul, Türkiye. A randomized controlled trial was conducted among 368 distressed (Kessler Psychological Distress Scale, K10 > 15) adult Syrian refugees with impaired functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16). Participants were recruited between August 2019 and September 2020 through a non-governmental organization providing services to refugees. Participants were randomly allocated to gPM+ and enhanced care as usual (gPM+/E-CAU) (184 participants) or E-CAU only (184 participants). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist (HSCL-25)) at 3-month follow-up. Secondary outcomes were post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5; PCL-5), functional impairment (WHODAS 2.0), and self-identified problems (psychological outcome profiles). Intent-to-treat analyses showed no significant effect of gPM+ on symptoms of anxiety, depression, PTSD and self-identified problems. Yet, there was a significant reduction in functional impairment in gPM+/E-CAU compared to E-CAU at 3-month follow-up (adjusted mean difference 1.66, 95 % CI 0.04, 3.27, p = 0.045, d = 0.19). Post-hoc subgroup analyses among participants with probable baseline depression or anxiety showed that there was a small but significant reduction in depression (adjusted mean difference -0.17, 95 % CI -0.32, -0.02, p = 0.028, d = 0.27) and anxiety (adjusted mean difference -0.21, 95 % CI -0.37, -0.05, p = 0.009, d = 0.30) symptoms comparing gPM+/E-CAU to E-CAU only at 1-week post assessment, but not at 3-month follow-up. There was a significant difference between conditions on functional impairment at 3-month follow-up, favouring gPM+/E-CAU condition (adjusted mean difference -1.98, 95 % CI -3.93, -0.02, p = 0.048, d = 0.26). In this study in an urban setting in Türkiye, gPM+ did not alleviate symptoms of depression and anxiety among Syrian refugees experiencing psychological distress and daily living difficulties. However, participants with higher distress at baseline seemed to benefit from gPM+, but treatment gains disappeared in the long term. Current findings highlight the potential benefit of tailored psychosocial interventions for highly distressed refugees in volatile low-resource settings.

Efficacy of telerehabilitation with digital and robotic tools for the continuity of care of people with chronic neurological disorders: The TELENEURO@REHAB protocol for a randomized controlled trial.

Chronic Neurological Disorders (CNDs) are among the leading causes of disability worldwide, and their contribution to the overall need for rehabilitation is increasing. Therefore, the identification of new digital solutions to ensure early and continuous care is mandatory. This protocol proposes to test the usability, acceptability, safety, and efficacy of Telerehabilitation (TR) protocols with digital and robotic tools in reducing the perceived level of disability in CNDs including Parkinson's Disease (PD), Multiple Sclerosis (MS), and post-stroke patients. This single-blinded, multi-site, randomized, two-treatment arms controlled clinical trial will involve PD (N = 30), MS (N = 30), and post-stroke (N = 30). Each participant will be randomized (1:1) to the experimental group (20 sessions of motor telerehabilitation with digital and robotic tools) or the active control group (20 home-based motor rehabilitation sessions according to the usual care treatment). Primary and secondary outcome measures will be obtained at the baseline (T0), post-intervention (T1, 5 weeks after baseline), and at follow-up (T2, 2 months after treatment). a multifaceted evaluation including quality of life, motor, and clinical/functional measures will be conducted at each time-point of assessment. The primary outcome measures will be the change in the perceived level of disability as measured by the World Health Organization Disability Assessment Schedule 2.0. The implementation of TR protocols will enable a more targeted and effective response to the growing need for rehabilitation linked to CNDs, ensuring accessibility to rehabilitation services from the initial stages of the disease.

Validating the COVID Check-In: A co-produced online platform enabling integrated care for people with Long COVID

Introduction: ‘Long COVID’ describes the sustained and debilitating symptoms experienced by many people following acute COVID-19 infection. This study builds on previous work by Deakin University and the Western Health COVID-19 Recovery Collaboration (WHCOVRE). In this previous work, a team of 4 health researchers and 6 consumers with Long COVID co-designed the COVID Recovery (or DisCOVeRY) model of care. This model provides a framework for appropriate and effective care by providing an integrated pathway that incorporates existing community supports, tailored to individual consumer need. Consumers receive a comprehensive biopsychosocial assessment using a co-designed patient rated outcome measure (PROM) called the ‘COVID Check-In’ (CCI), the World Health Organisation Disability Assessment Schedule (WHODAS-36), EQ-5D and the 100-point Goal Attainment Scale (GAS). Assessment outcomes determine which clinical stream is offered – self-managed (DisCOVeRY-SM) or intensive rehabilitation (DisCOVeRY-IR).&#x0D; Aim: The aim of this project was to validate the automated component of DisCOVeRY-SM for people with Long COVID. Is the CCI a valid, reliable, relevant and accessible Patient Rated Outcome Measure (PROM) for people with Long COVID?&#x0D; Methods: A quantitative descriptive approach was adopted, providing a psychometric analysis of the validity of the CCI. The CCI was delivered using “Platform O”; a flexible online research tool developed at Deakin University to meet both end-user and researcher needs. The interactive content builder fully integrates with questionnaire applications, online video platforms, animated content, and third-party interactive applications. “Platform O” also includes engagement tools (e.g., star ratings, personalised reminders) and security features to support user testing, continuous quality improvement and communication between end-users and the project team.&#x0D; All Australians meeting the World Health Organisation case description of Long COVID aged over 18 years were eligible to participate. For divergent validity analysis, a separate sample of Australians diagnosed with chronic fatigue syndrome (CFS) aged over 18 years were also eligible to participate. Participants were invited to complete the comprehensive baseline assessment outcome measures only on a single occasion on Platform O. Brief ‘pop’ up questions about the comprehensiveness, relevance and comprehensibility of the CCI were included to evaluate content validity. Correlations between CCI scores, WHODAS-36, EQ-5D and the GAS assessed convergent validity. While Long COVID and chronic fatigue syndrome share some symptoms, they are distinctive syndromes whose differences were used to assess divergent validity.&#x0D; Results: The face and construct validity of the CCI was tested in a small sample (n=20) at Western Health. Further validation is currently underway (n=260 consumers) to ensure its quality prior to broader scale up of the DisCOVeRY-SM, and these results will be reported in this conference paper. &#x0D; Conclusion: The CCI is the first co-produced PROM for people with Long COVID, and specifically reflects their needs and priorities. Rigorous validation of this measure will support its broader dissemination both within and outside of Australia, to enable people with this syndrome to receive integrated, high quality and individually tailored care.

THE ASSOCIATION OF URINARY INCONTINENCE AND DISABILITY AMONG A DIVERSE SAMPLE OF MID-LIFE SWAN WOMEN

Abstract Few studies have examined the prospective association between urinary incontinence (UI) and disability in midlife women. We assessed associations between UI type, frequency and amount with reported disablity in a racially/ethnically diverse cohort of community dwelling midlife women. Data was from longitudinal analyses of questionnaires from the multi-center, prospective cohort Study of Women’s Health Across the Nation. We used multivariable ordinal logistic regression to examine if UI type, frequency and amount at the 13th follow-up were associated with the World Health Organization Disability Assessment Schedule (WHODAS) at the 15th follow-up (controlling for other factors, e.g. menopause status, body mass index, lifestyle and psychosocial factors) and disability at Follow-up 13. UI was associated with subsequent reports of disability in participants, particularly in the WHODAS domains of mobility, communication, and societal participation. Associations were strongest for mixed UI type compared to stress UI or urge UI, daily frequency of UI compared to monthly or weekly, and larger amounts of urine leakage compared to drops of leakage. UI appears had a strong association with multiple domains of disability in midlife women after two years of follow-up. It is important for clinicians to address UI earlier in symptom onset. Screening for mixed UI and UI that occurs more frequently and it larger amounts, more specifically, may yield better information regarding a patient’s future disability risk.