Health Organization Disability Assessment Schedule Research Articles

Effect of real-time remote-based cardiac rehabilitation on subjective satisfaction and objective performance during the coronavirus disease 2019 pandemic

Abstract Background Real-time remote-based cardiac rehabilitation (CR) programmes improve exercise capacity. However, satisfaction and performance improvements after remote-based CR remain unclear. In addition to physical function, subjective satisfaction and objective performance may be adversely affected during the coronavirus disease 2019 pandemic. Purpose This study aimed to compare the effectiveness of real-time remote-based CR versus hospital-based CR in improving physical function, subjective satisfaction, and objective performance (i.e., activity limitations and participation restrictions). Methods We conducted a quasi-randomised controlled trial and recruited 38 patients with cardiovascular disease (CVD). The patients participated in 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. We assessed the participants at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for objective performance, and peak oxygen uptake (peak VO2) using the cardiopulmonary exercise test, for physical function. We evaluated individual results by measuring baseline to post-CR changes (i.e., delta [Δ]) (paired t-test) and then compared the remote and hospital-based CR programmes (unpaired t-test). Results Sixteen patients (72.2±10.4 years) completed remote-based CR and fifteen patients (77.3±4.8 years) completed hospital-based CR. Seven patients were excluded owing to other health complications (n=2) and inability to attend hospital based-CR (n=5). In the remote-based CR group, the peak VO2 (before: 12.0±2.7 mL min–1 kg–1; after: 14.9±3.9 mL min–1 kg–1; p<0.05) and the WHOQOL-BREF score (before: 77.4±12.8 points; after: 93.9±12.9 points; p<0.001) were significantly higher, whereas the WHODAS 2.0 score was significantly lower (before: 19.9±13.2 points; after: 11.3±6.8 points; p<0.05) after rehabilitation than at baseline. The post-CR physical function differed significantly between the two groups (Δpeak VO2, remote: 2.8±3.0 mL min–1 kg–1; hospital: 0.84±1.8 mL min–1 kg–1; p<0.05). The post-CR change in the WHOQOL-BREF score was not significantly different between the groups. The post-CR change in the WHODAS 2.0 score was significantly lower in the remote-based CR group than in the hospital-based CR group. (ΔWHODAS 2.0 score, remote: –8.56±14.2 points; hospital: 2.14±7.6 points; p<0.01). Conclusions Remote-based CR significantly improved physical function and objective performance in patients with CVD. Remote-based CR could be an effective treatment for stable patients who are unable to visit the hospital during the coronavirus disease 2019 pandemic. In the future, risk stratification according to severity of illness is needed. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Sanei Medicis company.

Be Patient: Prolonged Extracorporeal Membrane Oxygenation Support Including Full System Switch With Favorable Outcome

Despite tremendous advances in treatment, acute respiratory distress syndrome (ARDS) remains a disease with high mortality (42-48%). Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is often used as a last treatment option, which poses complex problems for the treatment team, especially with prolonged ECMO support. We report an interesting case of a 40-year-old female patient who developed influenza pneumonia leading to ARDS and subsequently requiring ECMO. Due to severe clotting complications, a prolonged ECMO run time with numerous filter changes was required. After a total of 56 days of ECMO therapy, the patient was successfully weaned. Fortunately, further in the course of treatment, complete recovery with restitutio ad integrum was achieved. A distinguishing feature of this case report is the description of a complete ECMO system change and the concurrent use of two ECMO systems for the same patient. Additionally, we provide data on the patient's current health-related quality of life as measured using the World Health Organization Disability Assessment Schedule 2.0.

물질사용장애 환자와 정신병 환자에서 관찰된 기능손상과 심리적 고통의 비교

Objectives: The purpose of this study was to compare the functional disability and psychological distress, observed in patents with substance use disorder (SUD) and psychosis. Methods: As a multicenter study, 17 patients with SUD and 49 patients with psychosis, participated in this study. All participants were assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) as well as the Kessler Psychological Distress Scale (K10). Results: In patients with SUD, functional disability was observed in approximately 8.5%. In the WHODAS total and all sub-scales scores, patients with SUD showed less severe functional impairment, compared to patients with psychosis. However, psychological distress was more severe in patients with SUD, and was at a very high level. This study confirmed that the psychological distress of patients with SUD, had a significant correlation with functional disability of cognition, interacting with others, and participation. Conclusion: In this study, patients with SUD were identified with distinct clinical features, compared to patients with psychosis.

Assessment tools of disability status after stroke

Stroke is the second leading cause of death worldwide. The global incidence of stroke has increased in recent years, although low and middle-income countries have been heavily affected. Because of the complicated and diversified physical and emotional disruption, stroke survivors are likely to face a variety of difficulties in daily life activities. Because of the wide impact of a stroke on all body structures and functions, there is no gold standard instrument to evaluate impairment and all elements of recovery after a stroke, and there is no single scale that can capture all the effects of a stroke. The International Classification of Impairments, Disability, and Handicaps (ICIDH) categorized the consequences of the diseases into three categories: impairment, disability, and handicap. Using the biopsychosocial model in 2001 WHO defines and classifies disability by using International Classification of Functioning Disability and Health (ICF). The ICF divides the impairment into three categories: body function and structure, activity, and participation. This article aims to review the most important tools that are reliable and valid in assessing the disability left after a stroke: The National Institute of Health Stroke Scale (NIHSS), Barthel index (BI), The modified Rankin scale (mRS), Instrumental activities of daily living (IADL), Glasgow outcome scale (GOS), The Functional Independence Measure (FIM), The World Health Organization Disability Assessment Schedule (WHODAS 2.0). The WHODAS 2.0 questionnaire is validated in several countries and it would be useful to be validated, also, in our country.

ASSOCIATION BETWEEN FUNCTIONAL CAPACITY AND HANDGRIP STRENGTH IN PEOPLE WITH DIABETES MELLITUS

Objective: to investigate the association between handgrip strength and functional capacity in people with diabetes. Method: observational cross-sectional study with 168 participants seen at an outpatient clinic in Curitiba, Brazil, in 2019. Clinical, sociodemographic, and socioeconomic data were collected, and the following protocols were applied: World Health Organization Disability Assessment Schedule; Timed Up and Go; and dynamometry. For the analysis, multiple linear regression models were adjusted for the dependent variables related to functional capacity. Results: we observed mild disability, borderline functional mobility, and higher correlation between functional mobility scale and handgrip strength (r=-0.384; p < 0.01). Handgrip strength with other covariates explained less than 30% of the functional variability. Conclusion: these results contribute to the problem-solving of clinical practice in that they show that muscle strength and functional capacity should be considered in the evaluation of the patient in combination, making it clearer and more comprehensive.

Validation of the Chinese version of the Somatic Symptom Scale-8 in patients from tertiary hospitals in China.

ObjectiveTo validate the Chinese language version of the Somatic Symptom Scale-8 (SSS-8) in a sample of outpatients attending tertiary hospitals in China.Materials and methodsA Chinese language version of the SSS-8 was completed by outpatients (n = 699) from psychosomatic medicine, gastroenterology/neurology, and traditional Chinese medicine clinics of nine tertiary hospitals between September 2016 and January 2018 to test the reliability. The Patient Health Questionnaire-15 (PHQ-15), the Somatic Symptom Disorder–B Criteria Scale (SSD-12), the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder-7 (GAD-7) scale, the Medical Outcome Study 12-item Short Form Health Survey (SF-12) and the World Health Organization Disability Assessment Schedule (WHO DAS 2.0) were rated to test construct validity. The criterion validity was tested by using the Semi-structured Clinical Interview for DSM-5 (Research Version) (SCID-5-RV) for somatic symptom disorder (SSD) as the diagnostic gold standard to explore the optimal cutoff score of the SSS-8.ResultsThe average age of the recruited participants was 43.08 (±14.47). 61.4% of them were female. The internal consistency derived from the sample was acceptable (Cronbach α = 0.78). Confirmatory factor analyses resulted in the replication of a three-factor model (cardiopulmonary symptoms, pain symptoms, gastrointestinal and fatigue symptoms) (comparative fit index = 0.95, Tucker-Lewis index = 0.92, root mean square error of approximation = 0.10, 90% confidence interval = 0.08–0.12). The SSS-8 sum score was highly associated with PHQ-15 (r = 0.74, p < 0.001), SSD-12 (r = 0.64, p < 0.001), GAD-7 (r = 0.59, p < 0.001), and PHQ-9 (r = 0.69, p < 0.001). The patients with more severe symptoms showed worse quality of life and disability The optimal cutoff score of SSS-8 was 9 (sensitivity = 0.67, specificity = 0.68).ConclusionOur preliminary assessment suggests that the Chinese language version of the SSS-8 has reliability and validity sufficient to warrant testing further in research and clinical settings.

Cutoff for Benchmark Disability Using World Health Organization Disability Assessment Schedule 2.0: A Community-Based Cross-Sectional Study from Rural South India.

India uses the Indian Disability Evaluation and Assessment Scale (IDEAS) for quantifying disability due to mental illness. The cutoff score for benchmark disability is 7. India has adopted International Classification of Functioning and Health (ICF) and thereby is a signatory to use World Health Organization Disability Assessment Schedule (WHODAS). Cutoff for benchmark disability in WHODAS in a community-based sample is lacking. The study was conducted in Jagaluru Taluk, Davanagere District, Karnataka. It is a part of an ongoing research funded by Indian Council of Medical Research. Frequency, percentages, mean, standard deviations, mode, median, Receiver Operating Characteristic Curve were used in analyzing the data. The study included 184 persons with severe mental illness with mean age of 47 and average duration of illness (DOI) of 11 years. They had mild disability (5.99) in IDEAS. The corresponding cutoff score in WHODAS, as compared to IDEAS, when the influence of DOI is removed was 24. A shift from IDEAS to WHODAS is feasible. With the undue influence of DOI removed, both hospital and community-based samples show the score of 24 as cutoff.

Assessment of compliance and relapse in patients with schizophrenia before and after the onset of COVID-19 pandemic

Objective The aim of this study was to assess the frequency and correlates of relapse among patients with schizophrenia during the COVID-19 pandemic. Methods This retrospective study included 90 adults who met DSM-IV criteria for schizophrenia. The participants were evaluated using Positive and Negative Syndrome Scale (PANSS), Compliance Rating Scale (CRS) and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0) before and after the onset of COVID-19 pandemic. Results The mean score of CRS was decreased after the onset of COVID-19 pandemic compared to before COVID 19 ( p < 0.001). The mean total score of PANSS scale and the mean positive subscale (P) score had increased after the onset of COVID-19 pandemic compared to before COVID 19 ( p < 0.001). Following up the news about COVID-19 regularly and decreased level of family support after the pandemic onset were associated with lower CRS scores and higher PANSS scores. In addition, the presence of infection or death with COVID-19 among family members and lower CRS scores were associated with higher scores on PANSS positive subscale. Conclusions The relapse rate had increased among patients with schizophrenia during COVID-19 pandemic. Non-compliance with medications and lack of family support were the main correlates of relapse in schizophrenia. Key Points Patients with schizophrenia are at high risk for relapse during Covid-19 pandemic. Non-compliance with medications, lack of family support, COVID-19-related illness or death of family members and following the news of the pandemic are correlates of relapse in patients with schizophrenia. Psychoeducation, availability of medications and mental health services and family support may help to prevent relapse in patients with schizophrenia during pandemics. Prospective studies are needed to confirm the findings of this study.

Validating the 12-item proxy-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in young children with chronic physical illness in Canada

Purpose This study investigated the psychometric properties of the 12-item proxy-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in young children with chronic physical illness in Canada. Materials and methods Data come from the Multimorbidity in Youth across the Life-course, a longitudinal study of Canadian youth with physical illnesses (n = 263). Baseline parent-reported data from children (2–9 years, n = 143) and adolescents (10–16 years, n = 117) were analyzed. Wilcoxon’s tests examined differences in WHODAS 2.0 scores between subgroups. Internal consistency was estimated, and confirmatory factor analysis modeled the WHODAS 2.0 factor structure. Regression modeling examined if the WHODAS 2.0 could discriminate between children with vs. without mental comorbidity. Results Differences were found between children and adolescents regarding self-care and getting along, and for the item on emotional affect. Inter-item correlations were similar between subgroups and internal consistency was strong for children (α = 0.90) and adolescents (α = 0.93). The factor structure of the WHODAS 2.0 was confirmed; parameter estimates were similar between subgroups. The association between mental comorbidity and disability did not differ by age – comorbidity was associated with greater disability (β = 5.87, p < 0.01). Conclusions The 12-item proxy-administered WHODAS 2.0 appears valid and reliable in young children with physical illness and can be used in this population. Implications for rehabilitation The 12-item proxy-administered WHODAS 2.0 has acceptable inter-item correlations and internal consistency in young Canadian children with chronic physical illness, and its factor structure is consistent with previous reports Expansion of its use in measuring disability in young children provides the opportunity to use the WHODAS 2.0 across the life-course, facilitating the interpretation of changes in disability over time or in response to treatment Additional research is needed to determine responsiveness to change and the minimal clinically important difference of the WHODAS 2.0 in this population

Measurement invariance of the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 across early and late adolescents in Canada

Purpose This study examined whether the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 demonstrated measurement invariance between young adolescents aged 10–16 years with a physical illness and older adolescents aged 15–19 years from the general population. Materials and methods Young adolescent data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117) and older adolescent data come from the Canadian Community Health Survey-Mental Health (n = 1851). Multiple-group confirmatory factor analysis was used to test measurement invariance. WHODAS 2.0 scores were compared across morbidity subgroups using multiple regression. Results Measurement invariance of the WHODAS 2.0 was demonstrated: (χ 2=635.2(144), p<.001; RMSEA = 0.059 (0.054, 0.064); CFI = 0.967; TLI = 0.970; and, SRMR = 0.068). Adjusting for data source, sex, race, immigrant status, and household income, WHODAS 2.0 scores were associated with morbidity status in a dose–response manner: physical illness only (B = 1.50, p<.001), mental illness only (B = 2.92, p<.001), and physical–mental comorbidity (B = 4.44, p<.001). Conclusions Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents – a group that previously demonstrated measurement invariance with an adult sample. The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course. IMPLICATIONS FOR REHABILITATION The 12-item self-administered WHODAS 2.0 is one of the most widely used measures of disability and functioning. Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents and adults in Canada. Researchers and health professionals can be confident that differences in 12-item self-administered WHODAS 2.0 scores are real and meaningful. The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course.

Agreement of the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in parents and youth with physical illness living in Canada

Purpose This study modelled the factor structure and tested for measurement invariance between youth and parent reports on the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0; estimated agreement between informants; and, examined moderators of youth-parent discrepancies. Materials and Methods Data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117). Multiple-group confirmatory factor analysis was used to test for measurement invariance and Wilcoxon signed-rank tests compared informant scores. Intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement plots were used to examine the youth-parent agreement. Results The WHODAS 2.0 demonstrated measurement invariance [χ 2 = 221.8(136), p < 0.01; RMSEA = 0.073 (0.055, 0.091); CFI = 0.962; and, SRMR = 0.078]. Youth typically reported more disability compared to parent proxies, with the exception of item Q5 (emotional). The agreement was low (ICC = 0.08–0.53). Youth sex moderated informant agreement such that more consistent agreement was seen for female youth (β = 0.54, p < .01) compared to male youth (β = 0.11, p = .29). Conclusions Youth and their parents interpret the construct of disability, as measured by the 12-item WHODAS 2.0, similarly. Thus, informant differences represent real differences that are not a consequence of error. Low parent-youth agreement reinforces the need for collecting multiple perspectives in the pediatric setting, especially for male youth. Implications for rehabilitation The WHODAS 2.0 is one of the most widely used measures of disability and functioning. Measurement invariance of the WHODAS 2.0 suggests that youth and parents interpret the construct of disability similarly. Parent-youth agreement was low and youth typically report more disability compared to parent proxies. More consistent agreement with parents was found for female youth compared to male youth.

Avaliação da incapacidade de indivíduos com diabetes mellitus: um estudo transversal com o WHODAS 2.0

ABSTRACT Diabetes mellitus (DM) causes several functional limitations, which can negatively affect the personal and professional life of individuals. This effect can lead to more complications and disabilities. This study aimed to analyze in which domains of the World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0) individuals with diabetes mellitus have the greatest disabilities. cross-sectional study was performed with 111 individuals with diabetes mellitus, of any type. A sociodemographic questionnaire and the WHODAS 2.0 with 36 questions were applied to assess individuals’ difficulties in the last 30 days. Most individuals were women (60.3%) and classified as independent in the community (90.1%). The highest prevalence was among retired individuals (35.1%). The mobility domain presented the highest impairment (48±23) whereas the life activities domain presented the lowest impairment (28±13). However, for all domains, the impairment was below 50 on a scale ranging from zero to 100. All individuals with diabetes mellitus showed some disability, but the greatest impairment was in the mobility domain.

A pilot randomized controlled clinical trial of dance practice for functionality in autistic children and adolescent with all levels of need support

ObjectiveThis study addressed dance practice intertwining communication, functional independence and social behavior in autistic children and adolescents with all levels of need support. DesignA pilot randomized clinical trial with seventy-two participants between 8 and 15 years old were assessed for eligibility. SettingTheater rehearsal room and mental health clinic. InterventionsDance group (n = 17) or control group (n = 19), 24 sessions, once a week, lasting 40 min. Main outcome measuresThe Autism Behavior Checklist (ABC), Autistic Screening Questionnaire (ASQ), Childhood Autism Rate Scale (CARS), Functional Independence Measure (FIM), and World Health Organization Disability Assessment Schedule (WHODAS, version 2.0, to assess mothers’ functioning) were applied at two time points: baseline and end-point. ResultsDifferences between dance and control groups were significant at post-intervention for communication (mean difference: 1.31; 99.8%CI: 0.29, 2.32, p < 0.001, d = 0.93); social cognition (mean difference: 1.01; 99.8%CI: 0.13, 1.89, p < 0.001, d = 0.82); autistic behavior (mean difference: 11.82; 99.8%CI: 17.33, −6.31, p < 0.001, d = 1.45). ConclusionsIn this preliminary study, the findings provide ways of communication and social interaction through dance practice by autistic children and adolescents with all levels of support needs. Research on neurodiversity is needed to understand its feasibility and the lifestyle appropriation.

Post-traumatic stress disorder (PTSD) after an earthquake experience: A cross-sectional survey of Wenchuan earthquake victims with physical disabilities 10 years later

BackgroundNatural disasters such as earthquakes are highly associated with post-traumatic stress disorder (PTSD). The Wenchuan earthquake in 2008 was the worst earthquake in the modern history of China, but the long-term prevalence of PTSD among earthquake victims, particularly those with disabilities, remains unknown. This study investigated the long-term effect of PTSD brought about by the Wenchuan earthquake, and its relationship with demographic factors. MethodsA total of 308 earthquake victims who suffered from physical disabilities resulting from the Wenchuan earthquake were recruited from three hospitals in Sichuan to participate in a 10-year cross-sectional survey. Outcome measures included the Impact of Event Scale–Revised, the World Health Organization Disability Assessment Schedule, and the European Quality of Life–5 Dimensions questionnaire. ResultsStatistically significant relationships were found between PTSD and gender, returning to old occupations, loss and/or severe injury of relatives and/or friends, pain, cognition, depression, and anxiety. Female gender, loss of relatives and friends, and a diagnosis of amputation or fracture were significant predictive factors for PTSD. The prevalence of PTSD for earthquake victims with physical disabilities 10 years later was 42.21%. Participation and engagement in daily life and community activities was negatively correlated with PTSD. ConclusionsEarthquake victims still presented with PTSD 10 years after the disaster, particularly among victims who had suffered permanent loss of body parts or other physical disabilities. Identification of the risk factors in victims should be implemented as early as possible to provide them with the best support for their mental wellbeing.

Improving function through primary care treatment of PTSD: The IMPACT study protocol

Despite the availability of effective psychological interventions for PTSD, access to and retention in these interventions remains problematic. Of note, the Veterans Health Administration (VHA) developed and implemented post-deployment health surveys that screen for PTSD in primary care (PC), but effective PC-based, psychological intervention treatment options have yet to be established. To address the literal physical gap between where the patients first present for care (i.e., primary care) and where they must go to receive first-line treatment for PTSD (i.e., specialty mental health), study investigators developed a 4–6 visit Prolonged Exposure for Primary Care (PE-PC) treatment that has shown efficacy in reduction of PTSD. To extend previous work to recovery-based mental health care, the Improving Function Through Primary Care Treatment of PTSD (IMPACT) study examined function as assessed by the World Health Organization Disability Assessment Schedule [WHODAS 2.0; (Axelsson, Lindsäter, Ljótsson, Andersson, & Hedman-Lagerlöf, 2017)]. Veterans presenting in VHA primary care mental health integration (PCMHI) clinics with PTSD or significant subsyndromal PTSD who met minimal inclusion and exclusion criteria were randomly assigned to PE-PC or treatment as usual (TAU). If proven effective in improving function, PE-PC would provide a new access point for high quality PTSD care and allow greater numbers of veterans to access effective PTSD treatment.Trial Registration: http://ClinicalTrials.gov: NCT03581981

The Consequences of Discontinuing a Home Care Service for Patients with Severe Mental Illness After the COVID-19 Pandemic.

Continuity of care has been considered, as a key component of the treatment process, especially after discharge from the hospital. Establishing treatment continuity is critical to achieving successful treatment outcomes. Roozbeh Home Care Program was developed to ensure the continuity of care in patients with severe mental illness. This study aims to investigate the consequences of discontinuing a home care service including; relapse, readmission, service satisfaction, severity and disability, in patients with severe mental illness in Iran. Forty-three patients who received home care service for more than 6 months were included. They were assessed 3 and 6 months after receiving the service; and 12 months after the program discontinuation. There was a significant difference between the hospitalization rate during (0.42 ± 0.64) and 1 year after the program's discontinuation (0.65 ± 1.46). The majority of the caregivers (70%) were highly satisfied with the home care services. Among the patients who received the homecare services, 40.4% were highly satisfied; and 21.2% were moderately satisfied. There was no significant difference between disability (as measured by World Health Organization Disability Assessment Schedule), clinical improvement (as measured by Clinical Global Impression-Improvement Scale), or severity of illness (as measured by Clinical Global Impression Severity of the Illness Scale) during and 1 year after program's discontinuation. During the time of receiving the service, hospitalization rate was reduced. Patients and caregivers were satisfied with the service. Providing psychiatric services at home should be considered as a solution to maintain the continuity of care.

Evaluating Post-Injury Functional Status among Patients Presenting for Emergency Care in Kigali, Rwanda

Despite high injury-related morbidity, approaches for evaluating post-injury functional status after emergency care are poorly characterized in resource-limited settings. This study evaluated the feasibility of standardized disability assessments among patients presenting with significant trauma to the Centre Hospitalier Universitaire de Kigali ED in Rwanda from January–June 2020. The functional status at 28-days post-injury was assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2), the Katz Activities of Daily Living (ADL) Scale, and self-reported functional state. The primary outcome was a descriptive profile of the disability status at 28-days post-injury. The WHODAS 2.0, Katz ADL Scale and patients’ self-perceived functional status was compared using Kendall’s rank correlation coefficient. Twenty-four patients were included. The most common injury mechanism was road traffic accident (70.8%); 58.3% of patients had traumatic brain injury. The self-perception questionnaire and the Katz ADL scale were strongly correlated with the WHODAS 2.0 scale; however, self-perception was not well correlated with the ADL scale. Post-injury morbidity was high and morbidity assessment was feasible, with a strong correlation between patients’ self-perceived functional status and the WHODAS-2 scale. Structured post-injury assessments may serve to inform the development of rehabilitation services in Rwanda, although larger studies are needed to inform such initiatives.

Food Insecurity and Functional Disability Among Older Adults in Ghana: The Role of Sex and Physical Activity.

We examined the associations between food insecurity and functional disability among older adults in Ghana and, the roles of sex and physical activity on the relationship. A cross-sectional study design was employed. A total of 4446 older adults (50+ years of age) from the Study on Global Aging and Adult Health Ghana Wave 2, a countrywide study, was completed in2015. Logistic regression models were used to examine the associations between measures of food insecurity and functional disability using data from Study on Global Aging and Adult Health Ghana Wave 2. Functional disability was assessed using World Health Organization Disability Assessment Schedule 2.0 composed of 12 items in 6 domains of cognition, mobility, self-care, getting along, life activities, and participation in society. Food insecurity was assessed from 12-month food sufficiency and experience of hunger over the last 12months. Approximately 11% were identified as having functional disability. The prevalence of food insecurity was 23.8% for insufficient food intake and 18.3% for hunger. Adjusting for all variables, older adults who reported consuming insufficient food (OR 2.27; 95% CI 1.57, 3.28), and those who experienced hunger (OR 2.35; 95% CI 1.59, 3.46) had higher odds of functional disability, compared with those not reporting these issues. Sex differences modified the association between hunger and functional disability. Physical activity served as a protective factor (OR 0.60; 95% CI 0.38, 0.95) on the association implying that older adults who engaged in physical activity were 40% less likely to experience food insecurity-induced functional disability. Food insecurity is associated with functional disability among older adults. Results highlight the usefulness of tackling the social determinants of health and promoting financial/social security in older age in a changing Ghanaian society.

Community reintegration of people with traumatic brain injury in South Africa

ABSTRACT Background Traumatic brain injury (TBI) affects cognitive, behavioral and physical function, influencing community reintegration. Objectives To describe the level of community reintegration and the associated influencing factors post-TBI in South Africa. Methods A cross-sectional analysis of patients living with TBI was done, using the Community Integration Questionnaire (CIQ), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Quality of Life after Brain Injury Overall Score (QOLIBRI-OS). Results Of the 80 participants 54.0% presented with mild TBI. The median (IQR) score of the CIQ, WHODAS 2.0 and QOLIBRI-OS was 22 (7.5)/29, 31(18)/100 and 73 (45.5)/100. There was a moderate inverse relationship between the WHODAS 2.0 and CIQ scores (r = −0.68; p < 0.001) and a moderate positive correlation between the QOLIBRI-OS and CIQ scores (r = 0.54; p < 0.001). The WHODAS 2.0 scores also showed a strong inverse correlation with the QOLIBRI-OS scores (r = −0.76; p < 0.001). Conclusion The participants had high levels of functioning and low levels of disability, both of which were found to be in tandem with high CIQ scores and generally good quality of life. Post-TBI patients are capable of achieving good community integration provided they attain high levels of functioning.

Measuring disability in amyotrophic lateral sclerosis/motor neuron disease: the WHODAS 2.0-36, WHODAS 2.0-32, and WHODAS 2.0-12

Aim: To investigate whether the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) can provide interval level measurement of disability in Amyotrophic Lateral Sclerosis (ALS), allowing parametric analyses. Methods: Data on the WHODAS 12, 32, and 36-item versions, from 1120 patients studied at one or more time points, were fit to the Rasch model and comparisons made against ALSFRS-R, King’s staging, and mortality. Trajectory modeling was undertaken for a newly diagnosed (≤6 months) cohort of 454 individuals. Results: Total scores for WHODAS 32 and 36-item versions can be converted to interval level measurement suitable for individual clinical use, and the 12-item WHODAS total for group use. The 36-item version is shown to be equivalent to the 32-item version. Expected correlations were seen with King’s staging, ALSFRS-R, and EQ-5D-5L. Trajectory analysis of disability (WHODAS 2.0) showed three clearly demarcated groups with differences in King’s staging, depressive symptomatology and mortality, but not age. Conclusions: The WHODAS 2.0 is a brief patient reported outcome measure which can be used to measure disability in ALS. Provided the patient answers all 36 (32 if not working) items, the conversion table produces an interval level estimate for parametric analyses. The different trajectories demonstrated from diagnosis support the concept of a prodromal period, and suggest the WHODAS 2.0 could be used for surveillance of at risk populations, such as those with genetic predisposition.