WHO Disability Research Articles

Measuring health and disability of Ukrainian cadets – translation and cross-cultural adaptation of the WHODAS 2.0

IntroductionThe WHODAS 2.0 questionnaire is used internationally to assess disability. The goal was to perform a cross�cultural adaptation and validation of the Ukrainian version of the WHODAS 2.0, and examine the tool’s efficacy, particularly for screening studies.MethodsThe participants of the study were cadets (<i>n</i> = 256, age = 18–21 years). This study used the Ukrainian versions of the WHO Disability Assessment Schedule 2.0 (36 items, self-administered, WHODAS) and the Medical Outcomes Study: 36-Item Short Form Survey (MOS SF-36). The WHODAS was translated according to the WHO protocol. The level of disability, quality of life, and complaints of injuries and pain during training were assessed.ResultsThe WHODAS was translated into Ukrainian. The overall score of the WHODAS questionnaire correlates with the values of the MOS SF-36 questionnaire scales. Numerous negative, moderate or significant correlations were found between virtually all MOS SF-36 questionnaire scales and WHODAS domains. The strength and number of correlations in the study group were lower than in populations with significant health disorders. The level of vitality, fatigue, and low efficiency were critical for the respondents.ConclusionsThe Ukrainian version of the 36-item WHODAS questionnaire is easy to use and is suitable for use in the form of interviews to assess the health, functioning, and disability of the general population. This tool will contribute to the more effec�tive clinical practice of clinical professionals, in particular in rehabilitation, and will enable the integration of research results related to the assessment of the level of disability at the national and international levels.

Guided digital health intervention for depression in Lebanon: randomised trial

BackgroundMost people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access...

Factor Structure of an ICF-Based Measure of Activity and Participations for Adults in Taiwan's Disability Eligibility Determination System.

To assess activity and participation for adults in Taiwan's Disability Eligibility Determination System (DEDS), we developed a measure, the Functioning Disability Evaluation Scale—Adult version (FUNDES-Adult), based on the 36-item interviewer-administered version of the WHO Disability Assessment Schedule 2.0. The purpose of this study was to examine the factor structures of performance and capability dimensions of the FUNDES-Adult. This study followed a methodology research design to investigate the construct validity of the two dimensions of the FUNDES-Adult. Two samples were randomly stratified from the databank of adults with disabilities to examine structural validity by the exploratory factor analysis (EFA) (n = 8,730, mean age of 52.9 ± 16.81) and the confirmatory factor analysis (CFA) (n = 500, mean age of 54.3 ± 16.81). The results demonstrated that the EFA yielded 5-factor structures for both performance dimension (73.5% variance explained) and capability dimension (75.9% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (GFI, NFI, CFI, and TLI ≥ 0.95, RMSEA < 0.09). The results of this study provide evidence that the FUNDES-Adult has acceptable structural validity for use in Taiwan's DEDS. Utility of the FUNDES-Adult in rehabilitation, employment, welfare, and long-term care services needs further study.

Physical activity and sedentary behavior trajectories and their associations with quality of life, disability, and all-cause mortality

BackgroundPhysical activity (PA) and sedentary behavior (SB) are not stable conditions but change over time and among individuals, and both could have deleterious effects on health-related outcomes among older adults. This study aimed to identify the longitudinal trajectories of PA and SB and estimate their association with quality of life, disability, and all-cause mortality in a national sample of older Mexican adults.MethodsData comes from three waves of the WHO Study on global AGEing and adult health (SAGE) in Mexico (2009, 2014, 2017). In total, 3209 older adults ages 50 and above were included. PA and SB were determined by using the Global Physical Activity Questionnaire (GPAQ). Disability was measured using the WHO Disability Assessment Schedule (WHODAS 2.0), quality of life using the WHOQOL (WHO Quality of Life) instrument, and all-cause mortality using a verbal autopsy. We used growth mixture modeling (GMM) to investigate the longitudinal trajectories of PA and SB. Three-level linear mixed effect models were used to estimate the associations of PA and SB with quality of life and disability and the Cox model for the association with all-cause mortality.ResultsThree longitudinal trajectories of PA and SB were found: low-PA-decreasers, moderate-PA-decreasers, and high-PA-decreasers for PA; and low-maintainers, steep-decreasers, and steep-increasers for SB. Decreased quality of life, increased disability, and all-cause mortality were all consistently associated with worse PA and SB trajectories.ConclusionsOur results highlight the need for health policies and prevention strategies that promote PA and limit SB in middle-aged adults. Further studies should consider these activities/behaviors as exposures that vary throughout life and work to identify vulnerable groups of older adults for whom physical activation interventions and programs would be most impactful.

Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study

BackgroundPreoperative frailty may predispose patients to poorer outcomes in cardiac surgery; however, there are limited data concerning how preoperative frailty predicts patient-centred outcomes, such as patient-reported disability. Our objective was to evaluate the association between preoperative frailty and postoperative disability. MethodsPatients were prospectively evaluated using the Comprehensive Assessment of Frailty score, separating patients into frail and non-frail cohorts. Disability levels were quantified using the WHO Disability Assessment Schedule (WHODAS) 2.0 in percentage of the maximum disability score, with disability defined as a value ≥25%. ResultsFrail patients had increased median [inter-quartile range] disability scores of 31 [16–45]% preoperatively, 29 [9–54]% at 1 month, and 15 [3–31]% at 3 months postoperatively, compared with disability scores in non-frail patients of 10 [5–17]%, 17 [6–29]%, and 2.1 [0–12.0]%, respectively. Preoperative frailty was associated with a reduced likelihood of patients being free of disability and alive at 3 months; adjusted odds ratio 0.51 (for age, European System for Cardiac Operative Risk Evaluation II, and WHODAS 2.0: 12-Part Questionnaire score); P=0.045. The trajectory of disability scores, assessed in percentage change from the preoperative baseline, showed non-frail patients had increased disability burden at 1 month, whereas frail patients had reduced disability burden (+4.2% vs –2.1%; P=0.04). Although the disability burden decreased for both groups at 3 months, this was most marked for frail patients (–6.3% vs –10.4%; P=0.02). ConclusionsDisability burden in frail patients improves continuously postoperatively, whereas in non-frail patients, it worsens at 1 month before improving at 3 months postoperatively. This positive trajectory of patient-centred outcomes in frail patients should be considered in preoperative decision-making.

Neurological and Mental Health Symptoms Associated with Post-COVID-19 Disability in a Sample of Patients Discharged from a COVID-19 Ward: A Secondary Analysis.

Recent studies suggest that COVID-19 survivors may experience long-term health consequences: in particular, neurological and mental health symptoms might be associated with long-term negative outcomes. This study is a secondary analysis of a larger cohort study and aims to determine the extent to which neurological and mental health sequelae are associated with survivors’ disability. Participants include COVID-19 survivors, with no pre-morbid brain conditions, who were discharged from the COVID-19 Unit of the ASST Spedali Civili Hospital between February and April 2020. At an average of 3.5 months after discharge, they were submitted to a neurological examination and completed the WHO Disability Assessment Schedule (WHODAS-12), the Hospital Anxiety and Depression Score, the Pittsburgh Sleep Quality Index and the Montreal Cognitive Assessment. Multivariable regression analysis was carried out to analyze variables that explain WHODAS-12 variation. In total, 83 patients (63 males, average age 66.9, 95% CI: 64.2–69.7) were enrolled; average WHODAS-12 was 13.2 (95% CI: 9.7–16.6). Cognitive dysfunction, anxiety, fatigue, and hyposmia/hypogeusia explained 28.8% of WHODAS-12 variation. These findings underline the importance and need for longitudinal follow-up assessments after recovery from COVID-19 and suggest the need for early rehabilitation of residual symptoms to enhance patients’ functioning.

Improving physical function of patients following intensive care unit admission (EMPRESS): protocol of a randomised controlled feasibility trial

IntroductionPhysical rehabilitation delivered early following admission to the intensive care unit (ICU) has the potential to improve short-term and long-term outcomes. The use of supine cycling together with other rehabilitation...

Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis

IntroductionThe World Health Organization’s (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common...

Effectiveness of a brief group behavioral intervention for common mental disorders in Syrian refugees in Jordan: A randomized controlled trial.

BackgroundCommon mental disorders are frequently experienced by refugees. This study evaluates the impact of a brief, lay provider delivered group-based psychological intervention [Group Problem Management Plus (gPM+)] on the mental health of refugees in a camp, as well as on parenting behavior and children’s mental health.Methods and findingsIn this single-blind, parallel, randomized controlled trial, 410 adult Syrian refugees (300 females, 110 males) in Azraq Refugee Camp (Jordan) were identified through screening of psychological distress (≥16 on the Kessler Psychological Distress Scale) and impaired functioning (≥17 on the WHO Disability Assessment Schedule). Participants were randomly allocated to gPM+ or enhanced usual care (EUC) involving referral information for psychosocial services on a 1:1 ratio. Participants were aware of treatment allocation, but assessors were blinded to treatment condition. Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL; depression and anxiety scales) assessed at baseline, 6 weeks, and 3 months follow-up as the primary outcome time point. It was hypothesized that gPM+ would result in greater reductions of scores on the HSCL than EUC. Secondary outcomes were disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behavior, and children’s mental health. Between October 15, 2019 and March 2, 2020, 624 refugees were screened for eligibility, 462 (74.0%) screened positive, of whom 204 were assigned to gPM+ and 206 to EUC. There were 168 (82.4%) participants in gPM+ and 189 (91.7%) in EUC assessed at follow-up. Intent-to-treat analyses indicated that at follow-up, participants in gPM+ showed greater reduction on HSCL depression scale than those receiving EUC (mean difference, 3.69 [95% CI 1.90 to 5.48], p = .001; effect size, 0.40). There was no difference between conditions in anxiety (mean difference −0.56, 95% CI −2.09 to 0.96; p = .47; effect size, −0.03). Relative to EUC, participants in gPM+ had greater reductions in severity of personally identified problems (mean difference 0.88, 95% CI 0.07 to 1.69; p = .03), and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < .001). There were no significant differences between conditions for changes in PTSD, disability, grief, prodromal symptoms, or childhood mental health outcomes. Mediation analysis indicated the change in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE .07; 95% CI .003 to .274) and internalizing (β = 0.08, SE .05; 95% CI .003 to 0.19) problems in children. No adverse events were attributable to the interventions or the trial. Major limitations included only one-quarter of participants being male, and measures of personally identified problems, grief, prodromal psychotic symptoms, inconsistent parenting behavior, and children’s mental health have not been validated with Syrians.ConclusionsIn camp-based Syrian refugees, a brief group behavioral intervention led to reduced depressive symptoms, personally identified problems, and disciplinary parenting compared to usual care, and this may have indirect benefits for refugees’ children. The limited capacity of the intervention to reduce PTSD, disability, or children’s psychological problems points to the need for development of more effective treatments for refugees in camp settings.Trial registrationProspectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619001386123.

Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): results of a 12-month cluster-randomised controlled trial

SummaryBackgroundCommunity-based rehabilitation (CBR) is recommended to address the social and clinical needs of people with schizophrenia in resource-poor settings. We evaluated the effectiveness of CBR at reducing disability at 12 months in people with schizophrenia who had disabling illness after having had the opportunity to access facility-based care for 6 monthsMethodsThis cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Eligible clusters were subdistricts in Sodo district that had not participated in the pilot study. Available subdistricts were randomised (in a 1:1 ratio) to either the intervention group (CBR plus facility-based care) or to the control group (facility-based care alone). An optimisation procedure (accounting for the subdistrict mean WHO Disability Assessment Schedule (WHODAS) score and the potential number of participants per subdistrict) was applied for each of the eight health facilities in the district. An independent statistician, masked to the intervention or control label, used a computer programme to randomly choose the allocation sequence from the set of optimal ones. We recruited adults with disabling illness as a result of schizophrenia. The subdistricts were eligible for inclusion if they included participants that met the eligibility criteria. Researchers recruiting and assessing participants were masked to allocation status. Facility-based care was a task-shared model of mental health care integrated within primary care. CBR was delivered by lay workers over a 12-month period, comprising of home visits (psychoeducation, adherence support, family intervention, and crisis management) and community mobilisation. The primary outcome was disability, measured with the proxy-rated 36-item WHODAS score at 12 months. The subdistricts that had primary outcome data available were included in the primary analysis. This study is registered with ClinicalTrials.gov, NCT02160249.FindingsEnrolment took place between Sept 16, 2015 and Mar 11, 2016. 54 subdistricts were randomised (27 to the CBR plus facility-based care group and 27 to the facility-based care group). After exclusion of subdistricts without eligible participants, we enrolled 79 participants (66% men and 34% women) from 24 subdistricts assigned to CBR plus facility-based care and 87 participants (59% men and 41% women) from 24 subdistricts assigned to facility-based care only. The primary analysis included 149 (90%) participants in 46 subdistricts (73 participants in 22 subdistricts in the CBR plus facility-based care group and 76 participants in 24 subdistricts in the facility-based care group). At 12 months, the mean WHODAS scores were 46·1 (SD 23·3) in the facility-based care group and 40·6 (22·5) in the CBR plus facility-based care group, indicating a favourable intervention effect (adjusted mean difference −8·13 [95% CI −15·85 to −0·40]; p=0·039; effect size 0·35). Four (5%) CBR plus facility-based care group participants and nine (10%) facility-based care group participants had one or more serious adverse events (death, suicide attempt, and hospitalisation).InterpretationCBR delivered by lay workers combined with task-shared facility-based care, was effective in reducing disability among people with schizophrenia. The RISE study CBR model is particularly relevant to low-income countries with few mental health specialists.FundingWellcome Trust.

PERSIAN Traffic Safety and Health Cohort: a study protocol on postcrash mental and physical health consequences

BackgroundCohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health...

Longitudinal trajectories of intrinsic capacity and their association with quality of life and disability

ObjectivesIntrinsic capacity (IC) is a key concept within the World Health Organization's (WHO) healthy aging model. The systematic assessment of IC could provide a better understanding of the functional trajectories of individuals. Our aims were to identify the longitudinal trajectories of IC and estimate their association with quality of life and disability. Study designThe study data comes from the three waves of the WHO Study on global AGEing and adult health (SAGE) in Mexico (2009, 2014, 2017). In total, 2735 adults aged 50 years or more were included. An IC score was constructed using item response theory. We used growth mixture modeling (GMM) to investigate the longitudinal trajectories of IC. Three-level linear mixed effect models were used to estimate the associations of IC with quality of life and disability. Main outcome measuresDisability was measured using the WHO Disability Assessment Schedule (WHODAS 2.0) and quality of life using the WHOQOL (WHO Quality of Life) instrument. ResultsThree classes were identified: low baseline IC with a steeply decreasing trajectory, medium baseline IC with a slightly decreasing trajectory, and high baseline IC with a moderately increasing trajectory. The class with the better trajectory (higher baseline IC score and a moderately increasing pattern) exhibited higher quality-of-life scores and lower disability scores. ConclusionsThe findings show that older Mexican adults exhibit different IC trajectories, and that these may be associated with quality of life and disability. Results highlight the need for health policies and strategies to maintain intrinsic capacity and to promote primary prevention.

Correlation between functional disability and quality of life among rural elderly in Anhui province, China: a cross-sectional study

ObjectiveWe aimed to explore the correlation between functional disability and quality of life (QoL). And exploring the interaction of functional disability, basic demographic characteristics and health-related information on QoL among the rural elderly in Anhui Province.MethodsThis study used multi-stage stratified cluster sampling in rural Anhui Province from January to July 2018 to conduct a cross-sectional survey of older adults who met the inclusion criteria. The Five-Dimensional European Quality Of Health Scale (EQ-5D) and the WHO Disability Assessment Schedule (WHODAS2.0) scale were used to evaluate the QoL and functional disability, and the basic demographic characteristics of the survey subjects were also collected. Using binary logistic and Classification and regression tree model (CART) models to analyze the data, explore the relationship between functional disability and QoL in the elderly.ResultsA total of 3491 older adults were included in the survey, and 3336 completed the entire survey, with an effective response rate of 95.56%. After adjusting for covariables, those who had limited in dimension of mobility (AOR=2.243, 95%CI: 1.743-2.885), getting along (AOR=1.615, 95%CI: 1.173-2.226), life activities (AOR=2.494, 95%CI:1.928-3.226), and social participation (AOR=2.218, 95%CI: 1.656-2.971) had a lower QoL. However, the dimension of cognition (AOR=0.477, 95%CI: 0.372-0.613) is a protective factor for QoL. Additionally, we also observe that 96.3% of those who were unemployed and limited in both mobility and life activities dimensions had a lower QoL, but among those who were robust in both mobility and social participation dimensions and not suffer from chronic diseases, 56.3% had a higher QoL.ConclusionsOur findings indicate that special attention should be paid to the elderly who are unemployed, have limited in cognition, getting along, social participation, mobility, life activities and cognition robust to improve their QoL. This research is of great significance for formulating targeted strategies and measures to improve the QoL for rural elderly.

Health-related quality of life and associated factors among Onchocerciasis patients in southeast Nigeria: A cross-sectional comparative study.

IntroductionOnchocerciasis, a neglected tropical disease of public health importance, causes chronic morbidity and severe disability that may impact on health-related quality of life (HRQoL) of the infected people. This study assessed the HRQoL and associated factors among onchocerciasis patients in southeast Nigeria.MethodsThis was a community-based cross-sectional comparative study. Using a multistage sampling technique, 340 onchocerciasis patients were selected and matched for age and gender with the healthy population in the same neighbourhood. The respondents were interviewed using the short-form-36 (SF-36) questionnaire to determine their HRQoL. WHO Disability Assessment Schedule 2.0 tool (WHODAS 2.0) was used to assess disability in persons with onchocerciasis. Means were compared with independent student t-test while Chi-square test was used to compare proportions. Also, correlation analysis and logistic regression were used in the analyses.ResultsA significantly lower proportion of people living with onchocerciasis had a good quality of life when compared with the healthy subjects (69.4% vs 93.5%, p<0.001). Also, an inverse relationship was seen between disability and quality of life in the onchocerciasis group (r = -0.647, p<0.001). Predictors of poor quality of life among respondents with onchocerciasis were: respondents aged ≥48 years (AOR = 2.5, 95% CI: 1.4–5.0), those with some disability associated with onchocerciasis (AOR = 3.33, 95%CI: 1.4–5.0) and respondents who perceived themselves as a burden to people (AOR = 10, 95%CI: 2.5–20).ConclusionOnchocerciasis impacted negatively on HRQoL of persons with onchocerciasis when compared with the healthy population. The quality of life of persons affected with onchocerciasis reduces with increasing disability. There is the need to increase community awareness on onchocerciasis to ensure early diagnosis and prompt treatment as this will reduce disability among those affected with the disease thus enhancing their HRQoL.

Comparative effect of propofol and sevoflurane on chronic postsurgical pain and cognitive function after cardiac surgery in Chinese elderly patients: A preliminary clinical study

&#x0D; &#x0D; &#x0D; &#x0D; Purpose: To compare the effects of propofol and sevoflurane on chronic post-surgical pain and cognitive function after cardiac surgery in Chinese elderly patients.&#x0D; Methods: A total of 200 Chinese patients (aged &gt; 65 years) with confirmed diagnosis of severe chronic artery disease who underwent cardiac surgery were given either propofol or sevoflurane. The following efficacy variables were assessed in both treatment groups: pain using an 11-point NRS after surgery; cognitive function, using Severe Impairment Battery (SIB), Clinician Interview-Based Impression of Change (CIBIC), Mini Mental State Examination (MMSE) scale; as well as psychological well-being and disability, using K10 Psychological Distress Scale K-10 and WHO Disability Assessment Schedule (WHODAS) scale. Incidence of complications and duration of hospital stay were also compared.&#x0D; Results: Pain severity score was significantly lower in patients treated with propofol than in those who received sevoflurane (6.1 vs 8.4; p &lt; 0.05). Psychological well-being measured using K-10 score was similar in both groups (p &gt;0.05). Similarly, there were no meaningful differences in disability score between the two treatment groups (p &gt; 0.05). The severity of signs and symptoms of dementia were similar at baseline visit (p &gt;0.05). Propofol-treated patients had numerically greater relief in signs and symptoms of dementia/cognitive impairment, when compared to the Sevoflurane-treated patients (p &gt;0.05). However, incidence of complications (including adverse events) was comparable in both groups (p &gt; 0.05).&#x0D; Conclusion: Propofol produced significantly greater improvement in post-surgical pain and cognitive functions than sevoflurane after cardiac surgery in Chinese elderly patients.&#x0D; &#x0D; &#x0D; &#x0D;

Generating comprehensive functioning and disability data worldwide: development process, data analyses strategy and reliability of the WHO and World Bank Model Disability Survey

BackgroundData on functioning and disability collected at population level is essential to complement mortality and morbidity, to estimate rehabilitation needs of countries and regions and to monitor the Convention on the Rights of Persons with Disabilities (CRPD) and the Sustainable Development Goals (SDGs). The objective of this paper is to briefly report the development process of the WHO Model Disability Survey, its data analysis strategy as well as its reliability and ability to measure low to high levels of functioning and disability across countries.MethodsThe development process is described in detail, and a secondary analysis using Rasch methods is conducted to report reliability and targeting using data from eight national and two regional implementations of the survey.ResultsThe currently available versions of the Model Disability Survey are presented. The survey has good to very good internal reliability and good targeting in all included countries.ConclusionThe participatory and evidence-based development, consideration of the expertise of stakeholders, the availability of previously developed ICF-based surveys, and WHO tools targeting functioning and disability are reflected in its good to very good psychometric properties. The survey has been implemented to date in Afghanistan, Cameroon, Chile, Costa Rica, India, Laos, Pakistan, Philippines, Sri Lanka, and Tajikistan, and is used to inform policy-making, to monitor the CRPD and SDGs and to plan the delivery of rehabilitation services.

Longitudinal functional status trajectories and its predictors among postpartum women with and without maternal morbidities in Northwest Ethiopia: a group based multi-trajectory modelling

IntroductionUnlike physiological recovery, return to full functional status following childbirth takes longer than 6 weeks (42 days) of the traditionally defined postnatal period, and women with maternal morbidity usually require...

Disability and its determinants among individuals with onchocerciasis in Southeast Nigeria: a cross-sectional study.

Introductionalthough onchocerciasis is rarely a life-threatening disease, it causes chronic morbidity which ultimately leads to disability due to late detection and treatment of the infected people. Disability in Onchocerciasis results in activity limitation and social exclusion of the affected individuals through stigma. This study aimed at assessing the level of disability and its determinants among persons with onchocerciasis.Methodsmulti-stage sampling technique was used to recruit 340 respondents from the randomly selected wards. Disability was assessed using WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) tool. Chi-square test and multivariate analysis using binary logistic regression were used to determine factors associated with disability. The level of statistical significance was determined by a p-value of < 0.05.Resultsthe highest proportion (35.6%) of the respondents was 55 years and above with a mean age of 46.8±17.5. About three-quarters (76.2%) of them had some form of disability and the disability domains mainly affected were participation in community activities (61.8%) and getting along with other people (54.1%) while the least affected were self-care (26.2%) and life activities including domestic responsibilities (45.0%). The Predictor of disability included being ≥48 years old, (AOR=0.2; 95%CI: 0.1-0.4).Conclusionmost people with onchocerciasis experience some form of disability and the major determinant for disability is being in the older age group. Thus, there is a need for stakeholders in the onchocerciasis control program to formulate and implement disability screening programs in the communities for early detection of onchocerciasis-associated disability, especially among the older age group.

Health-Related Quality of Life and Disability Among Older New Zealanders With Kidney Failure: A Prospective Study.

Background:Disability is prevalent in individuals with kidney failure and can contribute to significantly reduced quality of life and survival. In older individuals with kidney failure, disability can be caused by a combination of factors, including issues directly related to their kidney disease and/or treatment, including weakness, low energy, and low activity. Few studies have investigated health-related quality of life (HRQoL) as a possible predictor of disability among older individuals experiencing kidney failure.Objective:This study aimed to determine if patient-reported HRQoL, and/or other factors at baseline, predicts disability in people with kidney failure, aged ≥65 years, after 12 months of follow-up.Design:The DOS65+ study was an accelerated longitudinal cohort design comprising of both cross-sectional and longitudinal components. Participants were eligible if they were aged ≥65 years, had chronic kidney disease stage 5G (CKD 5G) (estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2), and had: commenced kidney replacement education, or were on an active conservative pathway, or were newly incident dialysis patients commencing dialysis therapy or prevalent on dialysis.Setting:Three New Zealand District Health Board (DHB) nephrology units (Counties Manukau, Hawke’s Bay, and Southern DHB) were involved in the study.Participants:Participants were eligible if they were aged ≥65 years, had CKD 5G (eGFR <15 ml/min/1.73 m2), and had: commenced kidney replacement education, or were on an active conservative pathway, or were newly incident dialysis patients commencing dialysis therapy or prevalent on dialysis.Measurements:Disability and HRQoL were measured by EQ-5D-3L, a WHO Disability Assessment Schedule (WHODAS) 2.0.Methods:Baseline and 12-month data from our longitudinal dialysis outcomes in older New Zealanders’ study were analyzed to determine if HRQoL at baseline predicted disability outcomes 12 months later.Results:Of the 223 participants at baseline, 157 participants completed a follow-up interview 12 months later. Individuals with “considerable disability” at baseline had a significantly (86%) higher risk of experiencing “considerable disability” at 12 months compared with those with “lesser/no disability” at baseline. Two thirds of those with ≥3 comorbidities were experiencing “considerable disability.” In addition, those with problems with EQ-5D-3L self-care, EQ-5D-3L usual activities, and EQ-5D-3L anxiety/depression reported higher rates of disability.Limitations:Selection bias is likely to have been an issue in this study as participants were excluded from the follow-up interview if they had an intercurrent illness requiring hospitalization within 2 weeks of the survey interview or if the treating nephrologist judged that the individual’s ability to take part was significantly impaired. Sample size meant there were a limited number of explanatory/confounding variables that could be investigated in the multivariable model.Conclusions:EQ-5D-3L mobility and self-care may be useful in predicting subsequent disability for individuals with CKD 5G. Although individuals with kidney failure often experience disability, previous studies have not clearly identified HRQoL or disability as predictors of later disability for individuals with kidney failure. Therefore, we would recommend the assessment of mobility and self-care, in conjunction with existing disabilities in the clinical review and pre-dialysis education of individuals with kidney failure as they approach the need for kidney replacement therapy.Trial registration: the Australian and New Zealand clinical trials registry: ACTRN12611000024943.

Naturalistic Study on the Effects of Electroconvulsive Therapy (ECT) on Depressive Symptoms.

The effectiveness of ECT under naturalistic conditions has not been well-studied. The current study aimed to 1) characterize a naturalistic sample of ECT patients; and 2) examine the long-term outcomes of ECT on depressive symptoms (Beck Depression Inventory-II; BDI-II) and functional disability symptoms (WHO Disability Assessment Schedule 2.0) in this sample. Participants were adults who received ECT for a major depressive episode at an ambulatory ECT clinic between September 2010 and November 2020. Clinical and cognitive assessments were completed at baseline (n = 100), mid-ECT (n = 94), 2-4 weeks post-ECT (n = 64), 6-months post-ECT (n = 34), and 12-months post-ECT (n = 19). At baseline, participants had severe levels of depressive symptoms (BDI-II: M = 41.0, SD = 9.4), and 62.9% screened positive for multiple psychiatric diagnoses on the MINI International Neuropsychiatric Interview. Depressive symptoms (F(4,49.1) = 49.92, P < 0.001) and disability symptoms (F(3,40.72) = 12.30, P < 0.001) improved significantly following ECT, and this was maintained at 12-months follow-up. Improvement in depressive symptoms trended towards significantly predicting reduction in disability symptoms from baseline to post-ECT, (F(1,56) = 3.67, P = 0.061). Although our clinical remission rate of 27% (BDI-II score 13 and 50% improvement) and overall response rate of 41.3% (50% improvement in BDI-II score) were lower than the rates reported in the extant RCT and community ECT literature, 36% of those treated with ECT were lost to follow-up and did not complete post-ECT rating scales. At baseline, remitters had significantly fewer psychiatric comorbidities, lower BDI-II scores, and lower disability symptoms than non-responders (P < 0.05). Participants were severely symptomatic and clinically complex. ECT was effective at reducing depressive symptoms and functional disability in this heterogeneous sample. Although a large amount of missing data may have distorted our calculated response/remission rates, it is also likely that clinical heterogeneity and severity contribute to lower-than-expected remission and response rates to ECT.