WHO Disability Assessment Research Articles

Effect of prehabilitation-related DIETary protein intake on Quality of Recovery after elective cardiac surgery (DIETQoR) study: protocol of a randomised controlled trial

IntroductionProtein malnutrition is associated with higher risks of postoperative complications, mortality, prolonged postoperative stays in hospital, slower physical and mental recovery after surgery and lower subsequent health-related quality of life....

Usability and feasibility of a digital cognitive screening tool measuring older adults’ early postoperative neurocognitive recovery: a protocol for a pilot study

IntroductionDelayed neurocognitive recovery, also identified as early postoperative cognitive decline (POCD), is a common complication after surgery, with advanced age being the most important risk factor. As the geriatric population...

Somatic symptoms in schizophrenia: Association with socio-demographic and clinical characteristics, disability and quality of life.

There is lack of research on somatic symptoms in schizophrenia. We aimed at finding prevalence and types of somatic symptoms in patients with schizophrenia and assessed their association with socio-demographic and clinical characteristics. We assessed somatic symptoms using Patient Health Questionnaire-15 (PHQ-15) in 93 patients with schizophrenia diagnosed on ICD10-DCR. Scale for Assessment of Positive Symptoms and Scale for Assessment of Negative Symptoms, WHO Disability Assessment Schedule 2.0, WHO Quality of Life (BREF) Hindi version and Liverpool University Neuroleptic Side-Effect Rating Scale were used to assess psychopathology, disability, quality of life and side effects. Significant somatic symptoms (n ≥5 on PHQ-15) were present in 62 (67.7%) patients with schizophrenia. Forty three (69.4%) had mild (n = 5-9 on PHQ-15), 17 (27.4%) had moderate (n = 10-14 on PHQ-15), and only 2 (3.2%) had severe (n = ≥15 on PHQ -15) somatic symptoms. Mean somatic symptoms score on PHQ-15 was 7.28 (± 3.83); 96.8% reported feeling tired, 76.3% had constipation or diarrhoea, 67.7% trouble in sleeping, 61.3% nausea or indigestion, 52.7% back pain and 51.6% headache. Patients with somatic symptoms were older in age, had longer duration of illness and treatment, and had more negative symptoms. They had higher disability and poor quality of life especially in physical domain. Somatic symptoms are common in patients with schizophrenia and are associated with chronicity, refractoriness and negative symptoms, significant disability and poor quality of life. Thus during routine clinical practice, somatic symptoms should be assessed and managed in these patients.

Outcomes of a Residential Program After Successful Graduation: A Pilot Quality Improvement Study

Residential treatment is an effective way to provide care to individuals who struggle with core life skills, have a mental illness, and/or have trouble adhering to treatment plans. The environment of residential care offers alternatives to typical treatment methods and a network of support to help foster independence. This pilot study assesses the impact of one residential care program from the perspective of those who were successfully discharged. The WHO Disability Assessment Schedule 2.0, the Outcome Rating Scale, and a homelessness screening tool were used to gather data from a small sample (N = 6) of former residents who completed the program. Results indicated that half of the discharges remained at stable functioning throughout the study duration, while the other half had difficulties in multiple domains of functioning. Insights obtained about instability following discharge will inform future research on quality of care with progress data collected throughout a client’s stay.

Exploring Personal Recovery in Schizophrenia: The Role of Mentalization.

Recovery is a broadly debated concept in the field of psychiatry research and in schizophrenia. Our study aims to understand the correlation between personal recovery from schizophrenia and factors such as mentalization, disability, quality of life, and antipsychotic side effects; Methods: Participants with schizophrenia (according to DSM-5 criteria) were consecutively recruited from the Psychiatry Unit of the University of Catania, Italy. Participants were assessed with the Recovery Assessment Scale (RAS), the Multidimensional Mentalizing Questionnaire (MMQ), the brief version of the WHO Disability Assessment Schedule (WHO-DAS), the EuroQoL-5 dimensions-5 levels, the Insight Orientation Scale (IOS) and the Glasgow Antipsychotic Side Effect Scale (GASS); Results: 81 patients were included. Our findings showed a positive correlation between RAS total scores and MMQ scores, especially in "good mentalizing" subdomains. IOS scores also had a positive association with RAS and MMQ scores. In contrast, poor mentalizing abilities negatively correlated with WHO-DAS 2.0 scores. While antipsychotic side effects influenced functioning, they did not impact perceived recovery. Conclusions: The study's results identified potential predictors of personal recovery from schizophrenia. These findings could contribute to creating tailored interventions to facilitate the recovery process.

The Effect of Preoperative Disability, Cognitive Impairment, Frailty and Opioid Use on Acute Postoperative Pain in Older Patients Undergoing Surgery A Prospective Cohort Study

Globally, life expectancy is increasing, leading to more surgeries being performed in older patients. Postoperative pain is associated with complications after surgery. The aim of this study is to explore potential age-related risk factors for acute postoperative pain in older patients undergoing surgery. This was a prospective, single-center study. Patients ≥65 years, with and without disability, as defined by the WHO Disability Assessment Schedule 2.0, undergoing elective surgery, were compared. Primary outcome was the postoperative pain (ie, numeric rating scale (NRS) score) on the first postoperative day. Secondary outcomes were postoperative pain and pain trajectories in patients with and without mild cognitive impairment (MCI), frailty, preoperative opioid use, and new-onset disability after surgery. Between February 2019 and July 2020, 155 patients were enrolled. On the first day after surgery, postoperative pain did not differ between patients with and without disability. NRS scores differed between patients with-, and without MCI on the first (P = .01), and second postoperative day (P < .01). Patients who used opioids before surgery reported higher median NRS score on the first (P < .001) and second (P < .01) postoperative day. Out of a total of 1816 NRS scores, 2 pain clusters were identified. Acute postoperative pain did not differ between patients with or without preoperative disability and frailty in older patients undergoing surgery. Reduced postoperative pain in older patients with MCI warrants further investigation. The PIANO study (Comparison of Postoperative NeurocognitiveFunction in Older Adult Patients with and without Diabetes Mellitus) was registered with www.clinicaltrialregister.nl (search term: Which can predict memory problems after surgery better; blood sugar levels or memory before surgery?). PerspectiveThis study explored risk factors for acute postoperative pain in older patients. No differences in postoperative pain were observed in patients with or without preexistent disability or frailty, however, patients with mild cognitive impairment experienced reduced pain. We suggest to simplify pain assessment in this group and take functional recovery into account.

The Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) is reliable and valid for chronic stroke survivors

ABSTRACT Background Stroke is the leading cause of disability worldwide. Assessing stroke’s impact on patients’ daily activities and social participation can provide important complementary information to their rehabilitation process. However, no previous study had been conducted on the psychometric properties of the Brazilian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the stroke population. Objectives This study aimed to examine the internal consistency, test-retest and inter-rater reliability, convergent validity and floor/ceiling effect of the Brazilian version of the WHODAS 2.0 in individuals after chronic stroke. Methods Two examiners interviewed 53 chronic stroke individuals who responded to the Brazilian 36-item version of the WHODAS 2.0 three times to analyze test-retest and inter-rater reliabilities. Floor/ceiling effects were calculated as relative frequencies of the lowest or the highest possible WHODAS 2.0 scores. Participants also responded to the Stroke Impact Scale 3.0 (SIS 3.0) and the Functional Independence Measure (FIM) to analyze convergent validity. Results The internal consistency analyses for domains of WHODAS showed a strong correlation among the items of each domain (0.76–0.91) except for the “getting along” domain, which presented a moderate correlation (ρ = 0,62). Total scores of WHODAS 2.0 showed satisfactory internal consistency (α = 0.93), good inter-rater reliability (ICC = 0.85), excellent test-retest reliability (ICC = 0.92) and no significant floor/ceiling effect. Convergent validity indicated moderate to strong correlations (ρ=-0.51 to ρ=-0.88; p < 0.001), with the highest values associated with the correlation with the SIS scale. Conclusions The Brazilian version of the WHODAS 2.0 instrument presented evidence of reliability and validity for chronic post-stroke individuals.

Psychotherapy for Chronic In- and Outpatients with Common Mental Disorders: The “Choose Change” Effectiveness Trial

Introduction: Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions. Objective: The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient). Methods: The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]). Results: Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes. Conclusions: Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings. Trial registration: This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.

Neighborhood Vulnerability and Disability in First Episode of Psychosis: A Multilevel Study.

Objective: Neighborhood socioeconomic status seems to be related to functioning in patients with first episode of psychosis (FEP). The present study aimed to assess if neighborhood vulnerability and risk of social exclusion could predict functional outcomes in people with FEP after controlling for other key variables identified in previous literature.Methods: A total of 137 patients with FEP (DSM-IV-TR criteria) and 90 controls comprised the study sample from February 2013 to May 2019. Functioning was assessed with the WHO Disability Assessment Schedule. Neighborhood vulnerability was measured using a multidimensional socioeconomic deprivation index; data for the index were collected by the Madrid City Council and based on the participant's home address. Multilevel mixed-effects regression analyses were conducted to estimate the effects of neighborhood vulnerability on functioning.Results: Our results show that FEP patients could be more vulnerable to the effects of neighborhood-level characteristics than healthy controls (B = 1,570.173; z = 3.91; P < .001). In addition, our findings suggest that higher neighborhood vulnerability is related to greater functional disability in people with FEP, after controlling for other relevant confounders (B = 1,230.332; z = 2.59; P = .010).Conclusions: These results highlight the importance of incorporating contextual factors into assessment of patients with FEP, since psychosocial difficulties observed in these patients could be partially related to the quality of neighborhood social-related resources.

Physical activity and functional disability among older adults in Ghana: The moderating role of multi-morbidity.

Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults' care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries-many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO's Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana.

Convergent Validity of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire (PHQ-9) in Pregnant and Postpartum Women: Their Construct Correlations with Functional Disability

This study aimed to evaluate the convergent validity of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in Thai pregnant and postpartum women, using the 12-item WHO Disability Assessment Schedule (WHODAS) as the reference standard. Participants completed the EPDS, PHQ-9, and WHODAS during the third trimester of pregnancy (over 28 weeks in gestational age) and six weeks postpartum. The sample included 186 and 136 participants for the antenatal and postpartum data analyses, respectively. The antenatal and postpartum data showed moderate correlations between both the EPDS and the PHQ-9 scores and the WHODAS scores (Spearman's correlation coefficients = 0.53-0.66, p < 0.001). The EPDS and PHQ-9 were moderately accurate in distinguishing disability (WHODAS score ≥ 10) from non-disability (WHODAS score < 10) in pregnant and postpartum participants, but the area under the curve of the PHQ-9 receiver operating characteristic curves in postpartum participants was significantly larger than that of the EPDS, with a difference (95% CI; p-value) of 0.08 (0.16, 0.01; p = 0.044). In conclusion, the EPDS and PHQ-9 are valid for assessing PND-related disability in pregnant and postpartum women. The PHQ-9 may perform better than the EPDS in distinguishing disability from non-disability in postpartum women.

Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus

BackgroundThe mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited.ObjectiveTo examine the effectiveness of a peer-provided psychological intervention (Problem Management...

FUNCTIONAL OUTCOMES FOLLOWING HIGH- AND LOW-ENERGY LISFRANC INJURIES: A LARGE REGISTRY-BASED STUDY

Lisfranc injuries account for 0.2% of all fractures and have been linked to poorer functional outcomes, in particular resulting in post-traumatic arthritis, midfoot collapse and chronic pain. This study assesses the longitudinal functional outcomes in patients with low and high energy Lisfranc injuries treated both operatively and non-operatively.Patients above 16 years with Lisfranc injuries from January 2008 and December 2017 were identified through the Victorian Orthopaedic Trauma Outcomes (VOTOR) registry. Follow-up performed at 6, 12 and 24 months through telephone interviews with response rate of 86.1%, 84.2% and 76.2% respectively. Longitudinal functional outcome data using Global Outcome Assessment, EQ-5D-5L, numerical pain scale, Short-Form 12, the WHO Disability Assessment Schedule and return to work status were collected. Univariate analysis was performed and variables showing a significant difference between groups (p &lt; 0.25) were analysed with multivariable mixed effects regression model.745 patients included in this retrospective cohort study. At 24 months, both the operative and non-operative groups demonstrated similar functional outcomes trending towards an improvement. Mixed effect regression models for the EQ items for mobility (OR 1.80, CI 0.91 – 3.57), self-care (OR 1.95, 95% CI 1.09-3.49), usual activities (OR 1.10, 95% CI 0.99-1.03), pain (OR 1.07, 95% CI 0.61-1.89), anxiety (OR 1.29, 95% CI 0.72-2.34) and pain scale (OR 1.07, 95% CI 0.51 – 2.22) and return to work (OR 1.28, 95% CI 0.56-2.91) between groups were very similar and not statistically significantly different.We concluded that there was no statistically significant difference between operative and non-operative patients with low and high energy Lisfranc injuries. Current clinical practices in Lisfranc injury management are appropriate and not inadvertently causing any further harm to patients. Future research comparing fracture patterns, fixation types and corresponding functional outcomes can help determine gold standard Lisfranc injury management.

Patient- and proxy-perceptions on functioning after stroke rehabilitation using the 12-item WHODAS 2.0: a longitudinal cohort study

Purpose To analyse longitudinally patient- and proxy-perceptions on stroke survivors’(SSs’) functioning using the 12-item WHO Disability Assessment Schedule 2.0 (WHODAS) after subacute inpatient stroke rehabilitation. Methods Sixty-five SSs and their significant others(proxies) responded to WHODAS questionnaire at discharge and 9 to 50 months later. Self-WHODAS ratings were compared with corresponding proxy-perceptions and informal ratings on self-reported functional recovery. Results On average, SSs’ functioning improved after discharge, except according to self-WHODAS ratings of those with severe stroke. Individual changes were, however, notable. Association between time and change was statistically insignificant. SSs perceived greatest improvements in walking, household tasks, community life and working ability. The only items showing slight deterioration were emotions and relationships. In parallel, proxies rated all items except emotions and relationships improved. At discharge, proxies rated SSs’ functioning more impaired than SSs themselves, mostly regarding those with severe stroke. Still, inter-rater reliability was very strong and increased significantly with time (ICC 0.799 vs. 0.979 at follow-up). Ninety percent of SSs with improved functioning according to self-WHODAS reported better functioning also in the informal questionnaire. Conclusion WHODAS showed improvements in SSs’ functioning 9-50 months after discharge from subacute stroke rehabilitation. Improvements were in line with proxy-perception and self-reported functional recovery. IMPLICATIONS FOR REHABILITATION Stroke survivors’ functioning improved significantly during the 9-50 months follow-up after subacute inpatient stroke rehabilitation. Stroke survivors perceived slightly less difficulties in their functioning compared to evaluations by proxies. Strong correlation between patient- and proxy-perceptions on stroke survivors’ functioning strengthened from subacute to chronic phase of stroke recovery. The 12-item WHODAS 2.0 seems to be a valuable patient- and proxy-reported outcome measure to assess longitudinal changes in stroke survivors’ functioning after stroke.

Disability types, determinants and healthcare utilisation amongst Afghan adults: a secondary analysis of the Model Disability Survey of Afghanistan

ObjectivesThe needs of people with disability in Afghanistan are not well understood. We describe the characteristics, healthcare utilisation patterns, and experience of care among Afghan adults with moderate or severe...

Cognitive Behavioral Therapy untuk mengurangi perilaku melukai diri pada individu dengan gangguan depresi mayor

Depression is a mood disorder characterized by the absence of hope, prolonged sadness, excessive feelings of helplessness, inability to make decisions, inability to concentrate, loss of enthusiasm for life, feelings of tension and desire to end life or hurt oneself. The purpose of this study was to see whether self-harm behavior in depression could be reduced after giving cognitive behavioral therapy. The assessment was carried out using interviews, observation, WHO Disability Assessment Schedule (WHODAS), Depression Anxiety Stress Scales (DASS), Graphic tests (Draw a Person, BAUM, House Tree Person) and Thematic Apperception Test (TAT). The result shows that cognitive behavioral therapy is effective in reduce self-harm into positive copping mechanism behavior and can reduce negative thinking in people with depression.

Housing conditions and long-term care needs of older adults in Ghana: Evidence from the WHO SAGE Ghana Wave 1.

The present study examined the association between housing conditions and long-term care needs of older adults in Ghana. We used data from 4,920 adults aged ≥50 years that participated in the World Health Organisation's (WHO) Study on adult health and AGEing Ghana Wave 1. Housing conditions were assessed with drinking water, sanitation, cooking conditions and building materials, and long-term care needs were based on WHO Disability Assessment Schedule 2.0. Multivariable logistic regressions modelled the effect of housing conditions on long-term care needs. After full adjustment for all available potential confounders, older adults living in households with unimproved cooking conditions had higher odds of reporting long-term care needs (OR = 6.87, 95%CI: 5.04-9.37) compared to those in improved cooking condition households. Moreover, those in households with unimproved housing materials (OR = 1.27, 95%CI: 1.01-1.72) and those in unimproved sanitation households (OR = 1.26, 95%CI: 1.05-1.54) were more likely to experience long-term care needs after respectively controlling for demographic and health-related covariates. Poor housing conditions are risk factors of long-term care needs in Ghana. Efforts to improve housing conditions may benefit older age functional abilities and unmet long-term care needs.

Quality of life and disability: a study on bipolar disorder patients in remission

Background: Throughout the world bipolar disorder is one of the leading causes of mental disability. But there are only few literature studies found on quality of life (QoL) and disability of patients with bipolar disorder. The study aims to assess inter-relationship between QoL and disability of patients with bipolar I disorder in remission and to assess the pathways of help seeking behaviors by the family members of bipolar I disorder patients.Methods: This study involves non-experimental research design with purposive sampling method. A total of 62 participants from clinical group (outpatient department of mental health institute (Centre of excellence), S. C. B. medical college) and 48 participants from matched healthy control group included. World health organization quality of life assessment (WHO-QoL) Bref Odia version and WHO disability assessment schedule (WHO DAS) 2.0 used.Results: Statistically significant differences (p&lt;0.05) were found in all the four domains of QoL. Statistically significant differences (p&lt;0.05) were found in cognition, mobility, life activity and participation in society domains of WHO DAS. There were significant negative correlations found in different domains of QoL and disability. A majority of family members consulted mental health professionals directly as the first modality of treatment.Conclusions: Both the QoL and mental disability burden are equally affected in chronic suffers of bipolar I disorder, which requires mental health intervention at earliest as possible.

Self-reported symptom severity, general health, and impairment in post-acute phases of COVID-19: retrospective cohort study of Swedish public employees

This study aimed to examine current symptom severity and general health in a sample of primarily non-hospitalized persons with polymerase chain reaction (PCR) confirmed COVID-19 in comparison to PCR negative controls. During the first quarter of 2021, we conducted an online survey among public employees in West Sweden, with a valid COVID-19 test result. The survey assessed past-month severity of 28 symptoms and signs, self-rated health, the WHO Disability Assessment Schedule (WHODAS) 2.0 and illness severity at the time of test. We linked participants’ responses to their SARS-CoV-2 PCR tests results. We compared COVID-19 positive and negative participants using univariable and multivariable regression analyses. Out of 56,221 invited, 14,222 (25.3%) responded, with a response rate of 50% among SARS-CoV-2 positive individuals. Analysis included 10,194 participants (86.4% women, mean age 45 years) who tested positive 4–12 weeks (N = 1425; subacute) and > 12 weeks (N = 1584; postcovid) prior to the survey, and 7185 PCR negative participants who did not believe that they had had COVID-19. Symptoms were highly prevalent in all groups, with worst symptoms in subacute phase participants, followed by postcovid phase and PCR negative participants. The most specific symptom for COVID-19 was loss of smell or taste. Both WHODAS 2.0 score and self-rated health were worst in subacute participants, and modestly worse in postcovid participants than in negative controls. Female gender, older age and acute illness severity had larger effects on self-rated health and WHODAS 2.0 score in PCR positive participants than in PCR negative. Studies with longer follow-up are needed to determine the long-term improvement after COVID-19.

HEART rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study

IntroductionLong COVID (LC), also known as post-COVID-19 syndrome, refers to symptoms persisting 12 weeks after COVID-19 infection. It affects up to one in seven people contracting the illness and causes...