Standard Measure Of Disability Research Articles

Adolescent childbirth and mobility disability among women ages 15–49: an analysis of population health surveys from 14 low-income and middle-income countries

ObjectivesAdolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This...

Adolescent Childbirth and Mobility Disability Among Women Ages 15-49: An Analysis of Population Health Surveys from 14 Low- and Middle-Income Countries

Background: Adolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low- and middle-income countries. Methods: Population health surveys from 2013-2018 containing mobility disability measures among ever-pregnant women ages 15-49 were analyzed (14 countries). Covariates included current age, urban/rural residence, education, and household wealth. Poisson regression models were used to estimate prevalence ratios (PR) of mobility disability among women who first gave birth during adolescence (19 years or younger) and in adult life (ages 20 to 45 years) in each country and across the whole sample. Countries were also analyzed according to the use of standard and non-standard mobility disability measures. Findings: Prevalence of adolescent childbirth (17·5%-66·2%) and mobility disability (0·32%-21·45%) varied widely across countries. Adolescent childbirth was significantly (p<0·05) associated with greater mobility disability in 6 of 8 countries utilizing standard disability measures. Among the 6 countries that did not use standard disability measures, none showed a statistically significant association between adolescent childbirth and mobility disability. Considering the whole sample and adjusting for all covariates, women who gave birth during adolescence had greater prevalence of mobility disability (Pooled PR 1·19, 95%CI 1·06-1·31). Interpretation: This analysis suggests a moderate and consistent association of adolescent childbearing with subsequent mobility disability. Adolescent childbearing appears to contribute to lasting negative effects on women’s mobility. Funding: Fogarty International Center: 5R21TW010466-02 Declaration of Interest: None to declare. Ethical Approval: Ethical approval statement: For this study, we conducted secondary data analysis of fully de-identified public use data sets. As such, our research does not fall within the regulatory definition of research involving human subjects and does not require ethical approval.

Measuring Disability in Consumers of mental health services - psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in Ghana.

The World Health Disability Assessment Scale (WHODAS-2.0) has widely been accepted as the standard measure of disability. However, psychometric testing is mostly performed in developed countries. This paper aims to assess the psychometric properties (reliability, validity) of the WHODAS-2.0 among consumers of mental health services in Ghana. Two translators (expert in English language and Akan language) performed forward and backward translation of the WHODAS-2.0 from English language to Ghanaian language (Twi). A total of 510 consumers of mental health services were recruited consecutively to complete the WHODAS-2.0 using RedCAP. Confirmatory factor analysis was used to analyse the data. All domains in the 6-factor solutions had excellent internal consistency (ω=0.90-0.98), sufficient convergent validity and had satisfactory discriminant validity except for domain on participation. The CFA model confirmed that the data had a good model fit, CFI=0.97, TLI=0.96, RMESA=0.05, RMR=0.03; NFI=0.94; χ2 =1243.8, df=529, P<0.001. Although the WHODAS 2.0 had satisfactory psychometric properties and was thus considered to be a reliable and valid measure for assessing disability and level of functioning in consumers of mental health services, researchers and clinicians should re-consider items within the participation domain. Also, practitioners are encouraged to integrate the WHODAS-2.0 into the collection of data on clinical outcomes, as well as, collecting data on government social protection intervention programmes for consumers.

Validity of the Global Activity Limitation Indicator (GALI) to evaluate severity of disability.

Our aim was to estimate the validity of the Global Activity Limitation Indicator (GALI) when measuring the severity level of disability. Data came from 153 residents of Spain, who requested an evaluation of their degree of disability. We compared disability classifications (severe vs. non-severe) from GALI against those from the 36-item questionnaire WHODAS 2.0, the current gold standard measure of disability. The sensitivity of GALI to detect severe disability was 58.3% [95% confidence interval (CI):43.2-72.4], and the specificity was 84.8% (95% CI: 76.4-91.0). Thus, the validity of GALI to accurately categorize the degree of severity of an individual's disability is not high, this in great part due to its limited sensitivity.

Psychometric Properties of the World Health Organization Disability Assessment Scale 2.0 among Iranian Cancer Patients

Background: The WHODAS-2 is a disability assessment tool built according to the conceptual framework of the international classification of functioning, disability, and health. This tool is a standard measure of disability dedicated to six specific domains. The aim of this study was to examine the psychometric properties of the World Health Organization Disability Assessment Scale 2.0 among Iranian cancer patients. Method: This study included cancer patients who referred to the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran. For this purpose, we enrolled 320 patients and asked them to complete the questionnaires. Cronbach’s α assessed the internal consistency. Pearson’s correlation coefficient evaluated the divergent and convergent validity and correlation of WHODAS 2.0 with EORTC QLQ-C30, difficulty of emotion regulation, and co-rumination scales. Moreover, we assessed constructive validity by confirmatory factor analysis using smart PLS software. Result: The results showed that Cronbach’s α was 0.91 for the questionnaire and higher than 0.75 for all domains. Furthermore, there was a significant correlation among the WHODAS 2.0 with Cancer EORTC QLQ-C30 (r = 0.85), DERS (r = 0.78), and co-rumination scales (r = 0.71). Conclusion: The version of the WHODAS 2.0 instrument had suitable psychometric properties in the sample of cancer patients. Therefore, it can be used in different populations and samples of cancer patients.

Prevalence and Severity of Child Impairment in a US Sample of Child Maltreatment Investigations.

Although there is agreement that childhood disability is both a risk and result of maltreatment, the extent of disability in the child welfare system remains unclear. Our objective is to determine the prevalence and severity of child impairment in a national sample of child abuse and neglect investigations in the United States. We used data from the National Survey of Child and Adolescent Well-Being II, a study of 2644 children older than 3 years who were subjects of child abuse and neglect investigations. Groups of children were identified by latent profile analysis using continuous standardized measures of intelligence, emotional or behavioral impairments, adaptive behaviors, and social skills. Whether the child remained in home or was removed to foster care after an investigation, 3 classes of children were identified: (1) slightly over one-tenth were in an intellectual disability subgroup characterized by marked intellectual impairments alongside delays in daily living functioning, (2) over one-third were in an emotional or behavioral impairment subgroup characterized by both frequent and severe internalizing and externalizing behaviors, and (3) slightly over half were in a typically developing subgroup. When using standardized measures of disability, nearly half of the children investigated by child protection in the United States are not typically developing. These findings suggest that those working for the child welfare system need to be attentive to the complex needs of children with intellectual disabilities and emotional or behavioral impairments and their families, many of whom are under significant stress.

Impact of Handedness on Disability After Unilateral Upper-Extremity Peripheral Nerve Disorder.

Background: Impairment of the dominant hand should lead to greater disability than impairment of the nondominant hand, but few studies have tested this directly, especially in the domain of upper-extremity peripheral nerve disorder. The aim of this study was to identify the association between hand dominance and standardized measures of disability and health status after upper-extremity peripheral nerve disorder. Methods: An existing database was reanalyzed to identify the relationship between affected-side (dominant vs nondominant) on individuals with unilateral upper-extremity peripheral nerve disorder (N = 400). Primary measure of disability was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: We found no differences in standardized measures of disability or health status between patients with affected dominant hand and patients with an affected nondominant hand. However, a post hoc exploratory analysis revealed that patients with an affected dominant hand reported substantially reduced ability to perform 2 activities in the DASH questionnaire: "write" and "turn a key." Conclusions: Following unilateral upper-extremity peripheral nerve disorder, impairment of the dominant hand (compared with impairment of the nondominant hand) is associated with reduced ability to perform specific activities, but this reduced ability is not reflected in standardized measures of disability and health status. To adequately identify disability following unilateral impairment of the dominant hand with the DASH, individual items must be used instead of the total score. New or alternative measures are also recommended.

WHODAS 2.0 as a Measure of Severity of Illness: Results of a FLDA Analysis.

WHODAS 2.0 is the standard measure of disability promoted by World Health Organization whereas Clinical Global Impression (CGI) is a widely used scale for determining severity of mental illness. Although a close relationship between these two scales would be expected, there are no relevant studies on the topic. In this study, we explore if WHODAS 2.0 can be used for identifying severity of illness measured by CGI using the Fisher Linear Discriminant Analysis (FLDA) and for identifying which individual items of WHODAS 2.0 best predict CGI scores given by clinicians. One hundred and twenty-two patients were assessed with WHODAS 2.0 and CGI during three months in outpatient mental health facilities of four hospitals of Madrid, Spain. Compared with the traditional correction of WHODAS 2.0, FLDA improves accuracy in near 15%, and so, with FLDA WHODAS 2.0 classifying correctly 59.0% of the patients. Furthermore, FLDA identifies item 6.6 (illness effect on personal finances) and item 4.5 (damaged sexual life) as the most important items for clinicians to score the severity of illness.

Streamlined EDSS for use in multiple sclerosis clinical practice: Development and cross-sectional comparison to EDSS

Background: The Expanded Disability Status Scale (EDSS) is the standard measure of disability in multiple sclerosis clinical trials. The EDSS has limited application in the clinical setting due to required completion time and scoring complexity. Systematically recording an objective, simplified, less time-intensive, and neurologist-derived disability score would be beneficial for patient care. Objective: To develop and validate a streamlined version of the Expanded Disability Status Scale (sEDSS) for clinical monitoring. Methods: The EDSS was modified by eliminating maneuvers with no impact on function, consolidating redundancies, and simplifying scoring. This sEDSS was refined and preliminarily validated using a pilot cohort of 102 patients. Subsequently, the sEDSS was retrospectively validated using 968 patients from the CombiRx trial. We evaluated correlation and agreement between each functional system as well as the overall sEDSS and EDSS. Results: The sEDSS correlated strongly with the EDSS, both overall (Spearman’s rho = 0.93) and for each functional system (Spearman’s rho 0.65–0.97). Correlation was slightly lower for functional systems where scoring was modified for consolidation and simplification. Conclusion: The sEDSS had strong agreement and correlation with the existing EDSS and can provide a useful measure of disability in clinical practice.

Long-term functional outcome of trigger finger

Purpose: The purpose of this study was to explore the long-term functional outcomes of trigger finger (TF) as perceived by the patient.Methods: Three study groups were included in the study: prolonged follow up TF group (at least 1-year post-treatment) (PF-TF), patients with acute TF and a control group. The first group was recruited retrospectively and included all patients who were diagnosed with TF in one orthopedic clinic and were contacted by phone, 109 agreed to participate. The acute TF and healthy controls participated in a previous controlled study. The Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) and numeric pain scale (NPS) were the main outcome measures.Results: Both TF groups reported significantly higher levels of disability, particularly in activities requiring strength and more severe pain in comparison with the control group. The acute TF group reported significantly higher levels of disability and pain than the PF-TF group. Seventy-two percent of acute TF group reported moderate to severe pain, in comparison with 37% of the PF-TF group.Conclusion: According to these data, substantial long-term disability and pain persist in both the acute and chronic settings.Implications for rehabilitationRecovery from TF may be a prolonged process and a long term follow up should be considered in clinical practice.The present study found that TF leads to significant disability, therefore, activity and participation should be addressed in practice.Assessment of TF interventions should include outcomes that address the client's perspective using standardized measures of disability, such as the QuickDASH.

JS03-03 - Prevalence and Impact of Common Mental Disorders: International Similarities & Differences. Results of the Who World Mental Health (WMH) Surveys Initiative

Introduction A number of studies have shown that there is international variation in the prevalence of common mental disorders. Several factors have been suggested to explain such differences. Methodological challenges to comparability include: differences in settings, samples, assessment methods, and reporting practices. Also, cultural differences have been pointed out as possible cause of differential recognition and reporting of mental health issues. There is still uncertainty about the degree of international variation in the prevalence of mental disorders, and the lack of comparability of results is still an issue.Objectives We assessed the prevalence and impact of mental disorders in the WHO World Mental Health (WMH) Survey Initiative, using common survey, assessment and reporting methods.Methods The WMH surveys were completed in 24 countries from Africa, the Americas, Asia, Europe, the Middle-East and the Pacific. Representative samples of the adult, non-institutionalizes population were interviewed face-to-face, with the aim of estimating the prevalence, burden and unmet need for treatment of common mental disorders. The Composite International Diagnostic Interview (CIDI, 3.0) was used in all surveys to assess mental health status. Common mental disorders assessed included: anxiety, mood, disruptive behaviour, and substance disorders. Several standard measures of disability, both generic and disorder-specific, and role impairment were administered.Results Results show that the mental disorders are commonly occurring in all participating countries. The inter-quartile range (IQR: 25th–75th percentiles) of lifetime DSM-IV disorder prevalence estimates (combining anxiety, mood, disruptive behaviour, and substance disorders) is 18.1–31.1%. The IQR of 12 month prevalence estimates is 9.8–19.1%. Prevalence estimates of 12-month Serious Mental Illness (SMI) are 4–6.8% in half of the countries, 2.3–3.6% in one-fourth and 0.8–1.9% in one-fourth. Possible causes of international variation will be addressed. Analysis of age-of-onset reports shows that many mental disorders begin in childhood-adolescence and have significant adverse effects on subsequent role transitions. Mental disorders are found in the WMH data to be associated with high levels of role impairment.Conclusions Despite this burden, the majority of mental disorders go untreated. Although these results suggest that expansion of treatment could be cost-effective form both the employer perspective and the societal perspective, treatment effectiveness trials are needed to confirm this suspicion. The WMH results regarding impairments are being used to target several of these interventions.Additional information about the WMH Surveys Initiative and the funing of the project can be found at: http://www.hcp.med.harvard.edu/wmh/

Corpus callosal diffusivity predicts motor impairment in relapsing–remitting multiple sclerosis: A TBSS and tractography study

Motor deficits in relapsing remitting multiple sclerosis (RRMS) patients are monitored using standard measures of disability that assess performance ranging from walking ability to hand function, thus reflecting involvement of a variety of motor pathways. We investigated the relative contributions of diffuse white matter damage and focal lesions using diffusion tensor imaging (DTI), in predicting future worsening of hand function in RRMS. The nine hole peg test (NHPT), a test of fine hand motor control, was used to measure baseline upper limb function in 16 controls and 25 RRMS patients, and then performed at follow-up on 22 of these patients at 6 and 12months. Tract-based spatial statistics (TBSS) were used across the whole brain as a non-hypothesis driven method for localizing white matter changes associated with motor deficits. Subsequently, we used probabilistic fiber tractography in the corticospinal tracts (CST) and the transcallosal hand motor (TCHM) fibers to assess the predictive power of diffusion metrics and/or functionally relevant visible lesion volumes on the decline of hand motor function over the next 12months. While fractional anisotropy (FA) and radial diffusivity (RD) of both pathways were strongly associated with NHPT performance at baseline, only RD of the TCHM fibers was predictive of NHPT decline over the next 12months. Neither total visible lesion load nor pathway specific lesion loads were indicative of NHPT performance or progression. The TCHM fibers may play an important role in modifying the effects of MS pathology on fine motor control, and RD in these fibers may be a sensitive biomarker for future disability.

Psychometric evaluation of the Northwick Park Dependency Scale

To examine the psychometric properties of the Northwick Park Dependency Scale (NPDS). Review of existing literature and psychometric analysis in relation to other standardized measures of disability in a large neurorehabilitation cohort. A regional post-acute specialist inpatient neurorehabilitation unit in London, UK. A total of 569 inpatients with complex neurological disabilities (350 males, 219 females; mean age 44.4 years). The NPDS, Barthel Index, Functional Independence and Functional Assessment measures. A database search found 5 studies that examined the psychometrics of the NPDS. These supported its validity and reliability. The present study added to these by evaluating the internal consistency, factor structure, discriminatory power and responsiveness to change during rehabilitation. The NPDS was found to have good internal consistency (α = 0.90), suggesting that it can reasonably be summed to a single total score. It discriminated among people with different levels of dependency and was responsive to change, particularly in the higher dependency groups. The NPDS is a psychometrically robust tool, providing a broader range of information on nursing needs than some other commonly-used disability measures. The Special Nursing Needs subscale provides clinically useful information, but its metric properties require further development, which is now underway.

Case-Control Cohort Study of Patients' Perceptions of Disability in Mastocytosis

BackgroundIndolent forms of mastocytosis account for more than 90% of all cases, but the types and type and severity of symptoms and their impact on the quality of life have not been well studied. We therefore performed a case-control cohort study to examine self-reported disability and impact of symptoms on the quality of life in patients with mastocytosis.Methodology/Principal FindingsIn 2004, 363 mastocytosis patients and 90 controls in France were asked to rate to their overall disability (OPA score) and the severity of 38 individual symptoms. The latter was used to calculate a composite score (AFIRMM score). Of the 363 respondents, 262 were part of an ongoing pathophysiological study so that the following data were available: World Health Organization classification, standard measures of physical and psychological disability, existence of the D816V KIT mutation, and serum tryptase level. The mean OPA and AFIRMM scores and the standard measures of disability indicated that most mastocytosis patients suffer from disabilities due to the disease. Surprisingly, the patient's measurable and perceived disabilities did not differ according to disease classification or presence or absence of the D816V KIT mutation or an elevated (≥20 ng/mL) serum tryptase level. Also, 32 of the 38 AFIRMM symptoms were more common in patients than controls, but there were not substantial differences according to disease classification, presence of the D816V mutation, or the serum tryptase level.ConclusionsOn the basis of these results and for the purposes of treatment, we propose that mastocytosis be first classified as aggressive or indolent and that indolent mastocytosis then be categorized according to the severity of patients' perceived symptoms and their impact on the quality of life. In addition, it appears that mastocytosis patients suffer from more symptoms and greater disability than previously thought, that mastocytosis may therefore be under-diagnosed, and that the symptoms of the indolent forms of mastocytosis might be due more to systemic release of mediators than mast cell burden.

Quality of life for veterans with multiple sclerosis on disease-modifying agents: Relationship to disability

Our objective was to compare self-reported health-related quality of life (HRQOL) for U.S. veterans with multiple sclerosis (MS) on disease-modifying agents with provider reports of HRQOL from standard disability measures. We conducted a 3-year prospective observational study of 204 subjects who used interferon beta or glatiramer acetate and compared subjects' responses on the Veterans Short-Form 36 (VSF-36) (36-item short-form functional status assessment for veterans) with the Kurtzke Expanded Disability Status Scale (EDSS) and the Functional System (FS) scales, which are standard MS disability scales. EDSS and FS scores were significantly correlated with some VSF-36 domains (physical function [r = -0.57], role physical [r = -0.37], and physical component summary [r = -0.40]) and weakly correlated with other domains. HRQOL scores did not predict disability or compliance with therapy. We observed decrements in HRQOL at relatively low disability levels. HRQOL measures directly associated with physical function were correlated with standard MS disability scales. Researchers need to clarify the role of HRQOL in clinical outcomes assessment, as shown by the lack of outcome sensitivity and predictive value of the VSF-36.

Posttraumatic stress disorder among deliberate self‐poisoning patients

This study explored posttraumatic stress disorder (PTSD) among suicide attempters. Participants were 330 hospital-treated deliberate self-poisoning (DSP) patients. Twelve-month prevalence of PTSD and comorbid psychiatric disorders was determined using the Composite International Diagnostic Interview (CIDI-A). Standard disability measures and demographic information were also obtained. PTSD prevalence was 32% among women and 15% among men. The PTSD group had significantly higher levels of affective disorder, anxiety disorders other than PTSD, psychiatric disability, and service utilization than DSP patients without PTSD. Logistic regression modeling showed that PTSD was associated with the type of traumatic event, number of events, affective disorder, and anxiety disorder other than PTSD.

Clinical Application of Physiotherapy with a Cognitive?behavioural Approach in Low Back Pain

The aim of this study was to investigate the effects of an integrated physiotherapy and cognitive-behavioural programme for a patient with persistent low back pain and disability. Outcome as well as comparison to a physiotherapy exercise programme was made in a controlled single-case format. The participant was a 41-year-old woman with an 18-month history of low back pain and increasing disability. The assessment involved physical function and exercise performance, disability, self-efficacy, life satisfaction and coping strategies. There were considerable improvements in performance of exercises as well as in resumed everyday activities during the integrated programme, as compared to the exercise programme. There were also marked improvements in standardized measures of disability, functional self-efficacy, and life satisfaction. All results were maintained at the 1-year follow-up. The results suggest that clinical integration of physiotherapeutic and cognitive-behavioural interventions was more effective...

Interference between gait and cognitive tasks in a rehabilitating neurological population

OBJECTIVESTo quantify the extent of interference between gait and cognitive tasks after brain injury; to investigate whether such interference is common to various cognitive tasks, or confined to specific cognitive...

The Functional Limitations Profile may be a valid, reliable and sensitive measure of disability in multiple sclerosis.

This pilot study was designed to evaluate the usefulness of the Functional Limitations Profile (FLP), a validated interval measure of self-report of disability, in studies of multiple sclerosis (MS). It is compared with the standard measure of disability in MS, the Kurtzke Expanded Disability Status Scale (EDSS), and the Illness Severity Score (ISS), which is an interval score derived from the EDSS. Inherent problems of all measures are discussed. On two occasions separated by 6 months, 50 MS patients were assessed prospectively by a neurologist and a psychologist, using the above measures. Validity was reflected in correlation and in agreement between measures. The FLP Physical dimension correlated significantly with the EDSS for both visits (at visit 1: r = 0.77; at visit 2: r = 0.77). Agreement between the interval measures, FLP and ISS, was satisfactory (mean difference +0.18, SD 6.8). The reliability of FLP was assessed by comparing FLP Physical dimension scores in the 30 patients who had not changed clinically between visits (EDSS change < 1.0, ISS change < 3.8). For this unchanged group the mean difference was +0.56 (SD 6.2); the 95% confidence interval (CI) was -2.87 to +1.75. For sensitivity of the FLP the 20 MS patients who had clinically changed between visits were assessed (EDSS =/> 1.0, ISS =/> 3.8). For this changed group the mean difference was -8.0 (SD 9.21); 95% CI was -12.3 to -3.69. The FLP Physical dimension in this pilot study seems to be a valid, reliable and sensitive measure of MS disability. If confirmed by larger studies it would be useful in prospective clinical studies of treatments for MS.