WHO Disability Assessment Schedule Research Articles

Maladaptive facet trait profiles and psychopathology: a person-centered assessment approach

Person-centered approaches in personality allow greater understanding of how different subpopulations with specific personality profiles are linked with relevant outcomes. Studies under the Five Factor Model agree on the observation of a Resilient, an Undercontrolled and an Overcontrolled profile. However, studies using maladaptive traits are much more limited. The present research identify personality profiles based on the 25 maladaptative facet and examined the relationships with personality dysfunctioning, internalizing and externalizing symptoms.A mixed sample composed of community adults (n = 742) and patients (n = 312) completed the Personality Inventory for DSM-5 Short Form, the Inventory of Depression and Anxiety Symptoms-II, Externalizing Spectrum Inventory–Brief From, the 12 items Spanish version of the WHO Disability Assessment Schedule II and Level of Personality Functioning Scale-Brief Form 2.0. Latent profile analysis was performed on PID-5-SF score. The scores on internalizing, externalizing and functioning were compared across the profiles.Four profiles emerged: Resilient, Undercontrolled, Overcontrolled, and Ordinary type. The Overcontrolled and Undercontrolled types showed higher scores on pathology scales. While the Overcontrolled profile appeared more related to internalizing symptoms and impairment in self-functioning, the Undercontrolled profile was more linked to higher scores on externalizing symptoms and interpersonal dysfunctioning.

9 Cross-cultural comparison of cognitive functioning as a predictor of disability in older adults in an Indian and U.S. Sample

Objective:There is a well-established relationship in the literature between cognitive impairment and functional disability, such that, increased cognitive impairment is associated with diminished capacity to perform daily activities independently. However, there has been limited research on the relationship between cognitive impairment and daily functioning in older adults from an Indian population, or differences between Indian and U.S samples. The relationship may differ across these two populations due to their unique cultures. For example, India and the United States have significantly different social systems and family structures, with different emphases placed on the community as compared to the individual. Therefore, the role that older adults play or the support they receive within the family and society differs between the two countries and could significantly impact the relationship between cognitive ability and functional disability. The primary objective of this study is to further explore the similarities and differences in this relationship across cross-cultural populations. We hypothesized that individuals across both samples with lower cognitive functioning will have increased disability. Furthermore, we propose that the relationship between cognitive functioning and functional disability will be stronger in the U.S sample as compared to the Indian sample.Participants and Methods:Community-dwelling older adults were sampled through local senior centers and by convenience sampling in the United State and India, respectively (N = 40 and 36, respectively). All participants were administered the Montreal Cognitive Assessment (MoCA) to evaluate cognitive ability. Functional status was assessed using the Activities of Daily Living section of the OARS multidimensional functional questionnaire and the World Health Organization Disability Assessment Schedule (WHODAS).Results:A significant association between cognitive functioning and functional disability was demonstrated in the combined sample, i.e., the MoCA was correlated with OARS (r[70] = .42, p < .001) and the WHODAS (r[59] = -.32, p = .009). However, when comparing samples, significant differences in associations between the MoCA and functional measures were noted in the Indian and U.S. samples: In the Indian sample, the MoCA was not significantly correlated with either the WHODAS (r[38] = -.28, p = .09) or the OARS (r[39] = .17, p = .31). Comparatively, in the United States, the MoCA was correlated with the OARS (r[32] = .51, p = .002) and the WHODAS (r[26] = -.40, p = .04).Conclusions:These results, in keeping with most previous studies done in the U.S. point to a robust relationship between cognition and functional disability in the U.S sample. However, this association is substantially diminished in the Indian sample. One possible reason maybe, greater support available to older Indians may mitigate the negative effect of cognitive impairment on adaptive function. A major limitation of this study is the small sample size. Additionally, due to vast cultural differences that exist across India, the sample collected from an urban well-education population will likely not generalize to the larger country. Future research from larger and more diverse samples across the country will likely provide more valuable insight.

Examining the health and functioning status of medical laboratory professionals in Ontario, Canada: an exploratory study during the COVID-19 pandemic

ObjectivesThis study aims to explore the overall and specific aspects of the functioning of medical laboratory professionals (MLPs) in Ontario, Canada during the COVID-19 pandemic.DesignA cross-sectional analysis where a questionnaire...

52 Internalizing Psychopathology is Highly Related to Subjective Cognitive Impairment and the Discrepancy Between Objective and Subjective Cognitive Impairment: A Preliminary Cross-Sectional Study.

Objective:Eliciting perceived cognitive complaints is a routine part of a clinical neuropsychological evaluation, presumably because complaints are informative of underlying pathology. However, there is no strong empirical support that subjective cognitive impairment (SCI) is actually related to objective cognitive impairment as measured by neurocognitive tests. Instead, internalizing psychopathology is thought to predominately influence the endorsement of SCI. Specifically, individuals with greater symptoms of depression and anxiety, when accounting for comorbidities, have a higher disposition to overestimate their degree of cognitive impairment as compared to objective testing. Yet, there are few existing studies that have determined which factors influence both SCI and the discrepancy between subjective and objective cognitive impairment in general outpatient populations. The current study examined the relationship between subjective and objective cognitive impairment in a clinically diverse sample of outpatients. We additionally explored the associations between SCI and relevant intrapersonal factors including internalizing psychopathology, number of medical comorbidities, and demographics. Finally, we quantified the degree of discrepancy between subjective and objective impairment and examined this discrepancy in relation to the intrapersonal factors.Participants and Methods:The sample comprised 142 adult women and men (age range 18–79 years) seen in an outpatient neuropsychology clinic for a diverse range of referral questions. Scores on the cognition portion of the WHO Disability Assessment Schedule (WHODAS 2.0) were used to index SCI. A composite score from 14 measures across various domains of cognitive functioning served as an objective measure of cognitive functioning. Internalizing psychopathology was measured via a standardized composite of scores from screening measures of anxiety and depression. Medical comorbidities were indexed by the number of different ICD diagnostic categories documented in patients' medical records. Demographics included age, sex, race, and years of formal education. Objective-subjective discrepancy scores were computed by saving standardized residuals from a linear regression of neurocognitive test performance on the WHODAS 2.0 scores.Results:A hierarchical linear regression revealed that objective cognitive impairment was not significantly related to SCI (p > .05), explaining less than 2% of the variance in SCI ratings. Likewise, participants' demographics (age, sex, education, race) and number of comorbidities were not significantly related to their SCI ratings, explaining about 6% of the variance. However, participants' level of internalizing psychopathology was significantly associated with SCI (F[10, 131] = 4.99, p < .001), and explained approximately 20% of the variance in SCI ratings. Similarly, the degree of discrepancy between subjective and objective cognitive impairment was primarily influenced by internalizing psychopathology (F[9, 132] = 5.20, p < .001, R2 = 21%) and largely unrelated to demographics and number of comorbidities, which explained about 6% of the variance.Conclusions:These findings are consistent with prior research suggesting that SCI may be more indicative of the extent of internalizing psychopathology rather than actual cognitive impairment. Taken together, these results illuminate potential treatment and diagnostic implications associated with assessing perceived cognitive complaints during a neuropsychological evaluation.

Continuous Assessment of Function and Disability via Mobile Sensing: Real-World Data-Driven Feasibility Study.

Functional limitations are associated with poor clinical outcomes, higher mortality, and disability rates, especially in older adults. Continuous assessment of patients' functionality is important for clinical practice; however, traditional questionnaire-based assessment methods are very time-consuming and infrequently used. Mobile sensing offers a great range of sources that can assess function and disability daily. This work aims to prove the feasibility of an interpretable machine learning pipeline for predicting function and disability based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 outcomes of clinical outpatients, using passively collected digital biomarkers. One-month-long behavioral time-series data consisting of physical and digital activity descriptor variables were summarized using statistical measures (minimum, maximum, mean, median, SD, and IQR), creating 64 features that were used for prediction. We then applied a sequential feature selection to each WHODAS 2.0 domain (cognition, mobility, self-care, getting along, life activities, and participation) in order to find the most descriptive features for each domain. Finally, we predicted the WHODAS 2.0 functional domain scores using linear regression using the best feature subsets. We reported the mean absolute errors and the mean absolute percentage errors over 4 folds as goodness-of-fit statistics to evaluate the model and allow for between-domain performance comparison. Our machine learning-based models for predicting patients' WHODAS functionality scores per domain achieved an average (across the 6 domains) mean absolute percentage error of 19.5%, varying between 14.86% (self-care domain) and 27.21% (life activities domain). We found that 5-19 features were sufficient for each domain, and the most relevant being the distance traveled, time spent at home, time spent walking, exercise time, and vehicle time. Our findings show the feasibility of using machine learning-based methods to assess functional health solely from passively sensed mobile data. The feature selection step provides a set of interpretable features for each domain, ensuring better explainability to the models' decisions-an important aspect in clinical practice.

Self-report versus performance based executive functioning in people with psychotic disorders

BackgroundAlthough executive functioning is often measured using performance-based measures, these measures have their limits, and self-report measures may provide added value. Especially since these two types of measures often do not correlate with one another. It thus has been proposed they might measure different aspects of the same construct. To explore the differences between a performance-based measure of executive functioning and a self-report measure, we examined their associations in patients with a psychotic disorder with the following: other neurocognitive measures; psychotic symptoms; anxiety and depression symptoms, and daily-life outcome measures. MethodThis cross-sectional study consisted of baseline measures collected as part of a cohort study of people with a psychotic disorder (the UP'S study; n = 301). The Behavioral Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used to assess self-rated executive functioning, and the Tower of London (TOL) to assess performance-based executive functioning. Generalized linear models (GLM) were used with the appropriate distribution and link function to study the associations between TOL and BRIEF-A, and the other variables, including the Brief Assessment of Cognition in Schizophrenia (BACS), the Positive and Negative Symptoms Scale-Remission (PANSS-R), the General Anxiety Disorder – 7 (GAD-7), the Patient Health Questionnaire – 9 (PHQ-9) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Model selection was based on the Wald test. ResultsThe TOL was associated with other neurocognitive measures, such as verbal list learning (β = 0.24), digit sequencing (β = 0.35); token motor task (β = 0.20); verbal fluency (β = 0.24); symbol coding (β = 0.43); and a screener for intelligence (β = 2.02). It was not associated with PANNS-R or WHO-DAS scores. In contrast, the BRIEF-A was associated not with other neurocognitive measures, but with the PANSS-R (β = 0.32); PHQ-9 (β = 0.52); and GAD-7 (β = 0.55); and with all the WHODAS domains: cognition domain (β = 0.54), mobility domain (β = 0.30) and selfcare domain (β = 0.22). ConclusionPerformance-based and self-report measures of executive functioning measure different aspects of executive functioning. Both have different associations with neurocognition, symptomatology and daily functioning measures. The difference between the two instruments is probably due to differences in the underlying construct assessed.

B - 44 Social Capital and Aging across Cultures: Examining the Mediating Effects on the Cognitive Functioning-Functional Ability Relationship in Baltimore and Mumbai.

Examine social capital (social support, social network) as a mediator of the cognitive functioning and functional ability relationship in older adult populations. Examine this relationship cross-culturally, with culture as a moderator of the mediation model. 75 community dwelling participants recruited across India and the United States. Cognitive function was measured using the Montreal Cognitive Assessment. Functional ability was evaluated using the Duke OARS Multidimensional Functional Abilities Questionnaire and the World Health Organization Disability Assessment Schedule (WHODAS). Social network and social support were evaluated using the Lubben Social Network Scale and Multidimensional Scale of Perceived Social Support. Process Macro (Hayes & Rockwood, 2017) was used to examine the mediation and moderated mediation models. The internal consistency of the MoCA and OARS were below acceptable ranges in the Indian sample. Indian participants reported more social support than U.S participants, however, there were no differences in social network. Social support predicted functional ability as measured by the WHODAS, F(1, 63) = 4.34, p = 0.04, but not the OARS. Social network predicted functional ability as measured by both the WHODAS, F(1, 57) = 8.33, p = 0.006, and the OARS, F(1, 62) = 4.98, p = 0.03. Results suggested that social capital was not a significant mediator of the relationship, and that culture was not a significant moderator. Limitations due to small sample size indicate need for further exploration of the potential benefits of social capital on cognitive and functional ability across cultures. Important to consider appropriateness of measures when working with non-normative groups.

Peri-Operative Wearables in Elder Recover after Surgery (POWERS) study: a protocol for a multicentre, prospective cohort study to evaluate perioperative activity with postoperative disability in older adults after non-cardiac surgery

IntroductionThe ageing population has led to an increasing proportion of surgical patients with greater frailty and comorbidity. Complications and mortality within 30 days of a surgical procedure are often used...

Effect of a Novel Digital Leakage Notification System (Heylo) for Ostomy Care on Quality of Life and Burden of Living With an Intestinal Ostomy: The ASSISTER Trial, A Randomized Controlled Cross-Over Trial

ObjectiveTo investigate the effect of a novel digital leakage notification system (Heylo) on quality of life (QoL) and burden of living with an intestinal ostomy. Patients and MethodsA randomized, controlled, open-label, cross-over trial was conducted in Germany with people having intestinal ostomies, who were cared for by 13 ostomy care specialists. Participants with fecal leakage problems were randomized by a centralized system to either Heylo + Standard of Care (SoC) or SoC alone for 8 weeks, whereafter participants crossed over to the opposite treatment for an additional 8 weeks. Primary and secondary end points were: Emotional impact domain score of the Ostomy Leak Impact tool and Participation domain score of the WHO Disability Assessment Schedule 2.0, respectively. Primary comparisons between Heylo and SoC were evaluated using linear mixed models, taking time and study period into account. The trial is registered with ClinicalTrials.gov, NCT05200416. ResultsA total of 144 participants were allocated to a treatment sequence after giving informed consent (safety population). Analyses included randomized participants who had been exposed to at least 1 product and with information on at least 1 end point (intention-to-treat population, n=139). Both the Emotional impact and Participation domain scores improved significantly after 8 weeks use of Heylo compared with SoC (LS mean difference of 11.4; 95% CI, 7.8-15.0; P<.001 and −4.2; 95% CI, −6.7 to −1.6; P=.001, respectively). Few adverse events related to Heylo were reported (n=5, 3.5%; all related to skin irritation). ConclusionUse of Heylo reported positive effects on quality of life and the overall burden of living with an intestinal ostomy.

Measuring disability in multiple sclerosis: the WHODAS 2.0

IntroductionReliable measurement of disability in multiple sclerosis (MS) using a comprehensive, patient self-reported scale, such as the World Health Organization Disability Assessment Schedule (WHODAS) 2.0, would be of clinical and research benefit.MethodsIn the Trajectories of Outcome in Neurological Conditions-MS study, WHODAS 2.0 (WHODAS-36 items for working, WHODAS-32 items if not working, WHODAS-12 items short-form) was examined using Rasch analysis in 5809 people with MS.ResultsThe 36- and 32-item parallel forms, and the cognitive and physical domains, showed reliability consistent with individual or group use. The 12-item short-form is valid for group use only. Interval level measurement for parametric statistics can be derived from all three scales which showed medium to strong effect sizes for discrimination across characteristics such as age, subtype, and disease duration. Smallest detectable difference for each scale was < 6 on the standardised metric of 0–100 so < 6% of the total range. There was no substantial differential item functioning (DIF) by age, gender, education, working full/part-time, or disease duration; the finding of no DIF for time or sample supports the use of WHODAS 2.0 for longitudinal studies, with the 36- and 32-item versions and the physical and cognitive domains valid for individual patient follow-up.ConclusionsDisability in MS can be comprehensively measured at interval level by the WHODAS 2.0, and validly monitored over time. Routine use of this self-reported measure in clinical and research practice would give valuable information on the trajectories of disability of individuals and groups.

Symptoms and Engagement in Anti-social Behavior 10 Years After Mild Traumatic Brain Injury Within a Community Civilian Sample: A Prospective Cohort Study With Age-Sex Matched Control Group

ObjectiveTo determine if there are longer-term effects on symptoms, health status, mood, and behavior 10 years after a mild traumatic brain injury (mTBI). DesignProspective cohort study. SettingCommunity-based, civilian sample. ParticipantsAdults aged ≥16 years at follow-up who experienced an mTBI 10 years ago, and an age and sex-matched non-injured control group. InterventionsNot applicable. Main Outcome MeasuresmTBI cases and controls were asked to complete self-report assessments of functioning (WHO Disability Assessment Schedule Version 2), symptoms (Rivermead Post-Concussion Symptom Questionnaire), health status (100-point scale), alcohol (Alcohol Use Disorders Identification Test) and substance use (Alcohol, Smoking and Substance Involvement Screening Test), and whether they had engaged in any anti-social behaviors over the past 12 months. ResultsData were analyzed for 368 participants (184 mTBI cases and 184 age-sex matched controls). Just over a third of mTBI cases (64, 34.8%) reported that they were still affected by their index mTBI 10 years later. After adjusting for education and ethnicity, the mTBI group had statistically higher overall symptom burden (F=22.32, P<.001, ηp2=0.07) compared with controls. This difference remained after excluding those who experienced a recurrent TBI. The mTBI group were more than 3 times as likely to have engaged in anti-social behavior during the previous 12 months (F=5.89, P=.02). There were no group differences in health status, functioning, or problematic alcohol or substance use 10 years post-injury. ConclusionsThis study provides evidence of potential longer-term associations between mTBI, post-concussion symptoms, and anti-social behavior which warrants further evaluation. Future research should also examine if longer-term effects may be preventable with access to early rehabilitation post-injury.

Perceived cognitive impairment is related to internalizing psychopathology but unrelated to objective cognitive performance among nongeriatric adults presenting for outpatient neuropsychological evaluation

Objective: This study investigated the relationship between perceived cognitive impairment, objective cognitive performance, and intrapersonal variables thought to influence ratings of perceived cognitive impairment. Method : Study sample comprised 194 nongeriatric adults who were seen in a general outpatient neuropsychology clinic for a variety of referral questions. The cognition subscale score from the WHO Disability Assessment Schedule served as the measure of perceived cognitive impairment. Objective cognitive performance was indexed via a composite score derived from a comprehensive neuropsychological battery. Internalizing psychopathology was indexed via a composite score derived from anxiety and depression measures. Medical and neuropsychiatric comorbidities were indexed by the number of different ICD diagnostic categories documented in medical records. Demographics included age, sex, race, and years of education. Results: Objective cognitive performance was unrelated to subjective concerns, explaining <1% of the variance in perceived cognitive impairment ratings. Conversely, internalizing psychopathology was significantly predictive, explaining nearly one-third of the variance in perceived cognitive impairment ratings, even after accounting for test performance, demographics, and number of comorbidities. Internalizing psychopathology was also highly associated with a greater discrepancy between scores on perceived and objective cognitive measures among participants with greater cognitive concerns. Clinically significant somatic symptoms uniquely contributed to the explained variance in perceived cognitive impairment (by ∼13%) when analyzed in a model with internalizing symptoms. Conclusions: These findings suggest that perceived cognitive impairment may be more indicative of the extent of internalizing psychopathology and somatic concerns than cognitive ability.

Predicting Death or Disability after Surgery in the Older Adult.

Older patients are vulnerable to developing new or worsening disability after surgery. Despite this, patient or surgical characteristics predisposing to postoperative disability are poorly defined. Our aim was to develop and validate a model, subsequently transformed to point-score form, to predict 6-month death or disability in older patients after surgery. The authors built a prospective, single-center registry to develop and validate the prediction model. The registry included patients 70 years of age or older undergoing elective and non-elective, cardiac and non-cardiac surgery between 25 May 2017 to 11 February 2021, and combined clinical data from the electronic medical record, hospital administrative data (ICD-10 AM codes) and World Health Organization Disability Assessment Schedule (WHODAS) data collected directly from the patients. Death or disability was defined as being dead or having a WHODAS score ≥16%. Included patients were randomly divided into model development (70%) and internal validation (30%) cohorts. Once constructed, the logistic regression and point-score models were assessed using the internal validation cohort and an external validation cohort comprising data from a separate randomized trial. Of 2176 patients who completed the WHODAS immediately prior to surgery, 927 (43%) patients were disabled and 413 (19%) had significant disability. By 6 months after surgery, 1640 patients (75%) had data available for the primary outcome analysis. Of these patients 195 (12%) patients had died and 691 (42%) were dead or disabled.The developed point-score model included the preoperative WHODAS score, patient age, dementia, and chronic kidney disease. The point score model retained good discrimination in the internal (area under the curve 0.74, 95% CI 0.69 to 0.79) and external (area under the curve 0.77, 95% CI 0.74, 0.80) validation data sets. We developed and validated a point score model to predict death or disability in older patients after surgery.

The perception of disability in cerebral palsy: a cross-sectional study using the WHODAS 2.0

ABSTRACT This observational study aims to describe the level of perceived disability in Cerebral Palsy (CP). We described the perception of adults by using the interviewer-administered version of the WHO disability assessment schedule (WHODAS 2.0). In case of intellectual disability (ID), the proxy-administered version was used, and a caregiver was asked to report the difficulties experienced by the patient; 199 patients were enrolled. The level of perceived disability was higher when referred to patients with ID (proxy report) than when referred to patients without ID (p < .001). For all patients, the level of perceived disability varied depending on the severity and the localization of motor impairment (both p < .001). No differences were observed based on the type of motor impairment. The perceived disability was correlated with age only for patients with no ID (p < .05). The WHODAS 2.0 may be a useful tool to explore the perception of disability in CP.

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.

Effects of real-time remote cardiac rehabilitation on exercise capacity and quality of life: a quasi-randomised controlled trial

BackgroundThe impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline.MethodsPatients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed.ResultsSixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min−1·kg−1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, –8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β = − 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01).ConclusionsRemote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals.Trial registrationThis interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564; registration date: 2020/09/09).

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.