Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan

Abstract

Purpose: To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. Methods: Subjects (≥60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. Results: More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75–376.42, p?<?0.001), age (1.38–4.81, p?<?0.05), and speech impairment (1.94–5.80, p?<?0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. Conclusions: Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability.

• Implications for Rehabilitation

• Older adults with physical disability often experience difficulties in household activities and mobility.

• Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease.

• Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

     

Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia

Background: To analyse the disability status of elderly Taiwanese dementia patients by using the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Methods: We enrolled 12 126 disabled elderly (>65 years) patients with dementia during July 2012–January 2014 from the Taiwan Data Bank of Persons with Disability. Trained interviewers evaluated the standardised scores in the six WHODAS 2.0 domains. Student’s t test was used for comparing WHODAS 2.0 scores of male and female dementia patients with different age groups. Results: The study population comprised 12 126 patients; 7612 were women and 4514 were men. The WHODAS 2.0 scores showed that the dementia patients had global activity limitation and participation restriction in all domains. Dementia-induced disability was prominent in male patients in all of the domains of the WHODAS 2.0. The domains of life activities, getting along with people and cognition were more strongly affected than the other domains. However, women experienced more rapid functional decline than men did as they aged. Conclusion: The data analysed in this large-scale, population-based study revealed crucial information on dementia-induced disability in elderly patients on the basis of the WHODAS 2.0 framework.

• Implications for rehabilitation

• Dementia patients have global functional disability in all domains of WHODAS 2.0 and multidisciplinary team is needed for rehabilitation programme intervention for these patients.

• When considering the rehabilitation resource and strategy, the domains of cognition, activities of daily living and life activities should be focussed.

• When dementia patients aged 65–75 years old, male patients got more restriction of function than female and more medical resource allocation for disabled male patients is recommended.

• With ageing, female dementia patients exhibited more rapid functional decline than male patients did and more budget about rehabilitation for maintain functional and dementia progression is crucial for female patients.

     

World Health Organization disability assessment schedule 2.0: An international systematic review

Purpose: This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

Method: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on “whodas” using the ProQuest, PubMed, and Google Scholar electronic databases.

Results: We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

Conclusions: The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them.

• Implications for Rehabilitation

• WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability.

• The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry.

• WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations.

• A critical issue for rehabilitation is that a single “minimal clinically important .difference” score for the WHODAS 2.0 has not yet been established.

     

Validity and reliability of an activity monitor to quantify arm movements and activity in adults following distal radius fracture

Purpose: To examine the validity and reliability of an activity monitor to estimate upper limb activity.

Methods: Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test–retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences.

Results: There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r?=?0.82, r?=?0.73, respectively] and floor sweeping activities [r?=?0.54, r?=?0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC_(2,1)?=?0.91, ICC_(2,1)?=?0.88, respectively], grocery shelving [ICC_(2,1)?=?0.83, ICC_(2,1)?=?0.89, respectively], and table dusting activities [ICC_(2,1)?=?0.77, ICC_(2,1)?=?0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed.

Conclusions: There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture.

• Implications for Rehabilitation

• Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions.

• After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels.

• Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence.

• Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture.

     

Validation of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in persons with disabilities and chronic illnesses for Chinese population

Abstract

Purpose: The aim of this study is to test the psychometric properties and validity of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in Traditional Chinese-speaking persons with disabilities and chronic illnesses. Method: The WHODAS II CT has been administrated to a sample of 1020 persons with disabilities and chronic illnesses. The construct validity, internal consistency, concurrent validity and convergent validity were evaluated. Results: WHODAS II CT showed a satisfactory model fit for the second-order confirmatory factor analysis model (χ²/df?=?3.05, root means square error of approximation?=?0.053, comparative fit index?=?0.912, standardized root mean square residual?=?0.076), high internal consistency (Cronbach’s α?=?0.98), high correlation with all domains of Dartmouth Primary Care Cooperative Research Network/World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physicians (COOP/WONCA) charts (partial correlation coefficient ranged from 0.26 to 0.74) and significance between persons with and without co-morbidity (all regression coefficients >0). Conclusions: WHODAS II CT is a reliable and valid instrument to measure the disability in persons with disabilities and chronic illnesses among Traditional Chinese-speaking population. A further study is required to validate the short version of WHODAS II in order to enhance its applicability in usual and clinical practices.

• Implications for Rehabilitation

• This is the first study to evaluate the reliability and validity of WHODAS II in persons with disability and chronic illnesses among Traditional Chinese-speaking population.

• The WHODAS II CT is a valid instrument in Chinese adults with disabilities and chronic illnesses.

• The WHODAS II CT is recommended to be used in population-based survey to investigate the health needs of persons with disabilities and chronic illnesses as well as in the rehabilitation programs as an outcome measure.

     

Reproducibility of the items on the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning,Disability and Health

Purpose: To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score.

Methods: Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC_2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland–Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman’s correlation coefficients (rho) and simple linear regression. An alpha risk?≤?0.05 was considered for all analyses.

Results: The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC_2,1?=?0.96; inter-rater ICC_2,1?=?0.95). The SEM and MDC were adequate. The Bland–Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho?=?0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life.

Conclusion: The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items.

• Implications for Rehabilitation

• The 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke.

• The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals.

• The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke.

     

Factors predicting community participation in patients living with stroke,in the Western Cape,South Africa

Abstract

Purpose: An important focus of poststroke rehabilitation is the attainment of community participation. However, several factors may influence participation some of which vary from setting to setting. The aim of this study is to investigate the factors influencing community participation among community-dwelling stroke survivors in the Western Cape, South Africa.

Materials and methods: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Social Support Questionnaire 6 (SSQ6) were the instruments used to collect data. Participant demographics, clinical features and domain-specific scores of the WHODAS 2.0 were used as potential predictors. Correlation analysis and multiple regression models were used to examine determinants of community participation. All assessments were conducted using face-to-face interviews.

Results: One hundred and six stroke survivors enrolled in this cross-sectional study. Risk factors, cognition, mobility, self-care, getting along with people, household activities and total WHODAS 2.0 score were associated with participation. Four predictors of community participation were identified from multiple regression, namely mobility (38%), cognition (11%), life activities (4%) and stroke risk factors (1%). Determinants varied by gender and age group. Mobility predominated in males and younger adults, while cognition was more pronounced in females and the elderly. Lastly, the influence of social support on community participation was largely defined by the gender and age of stroke survivors.

Conclusion: The findings suggest focusing stroke rehabilitation on important factors such as mobility, cognition, life activities and risk factors to advance patients’ participation. It also emphasizes giving specific consideration to key factors specific for gender and age of stroke survivors.

• Implications for Rehabilitation

• Community participation in the general population of stroke survivors’ is largely determined by their mobility function.

• Determinants of community participation among stroke survivors essentially vary according to age and gender.

• Clinically, this study suggests that focusing on specific determinants of improved community participation according to stroke patients’ demographic categories (gender and age) may be an important impetus to enhance rehabilitation outcome.

     

Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke

Purpose: To translate and cross-culturally adapt the Functional Independence Measure (FIM) into the Persian language and to test the reliability and validity of the Persian FIM (PFIM) in patients with stroke. Method: In this cross-sectional study carried out in an outpatient stroke rehabilitation center, 40 patients with stroke (mean age 60 years) were participated. A standard forward–backward translation method and expert panel validation was followed to develop the PFIM. Two experienced occupational therapists (OTs) assessed the patients independently in all items of the PFIM in a single session for inter-rater reliability. One of the OTs reassessed the patients after 1 week for intra-rater reliability. Results: There were no floor or ceiling effects for the PFIM. Excellent inter-rater and intra-rater reliability was noted for the PFIM total score, motor and cognitive subscales (ICC_agreement 0.88–0.98). According to the Bland–Altman agreement analysis, there was no systematic bias between raters and within raters. The internal consistency of the PFIM was with Cronbach's alpha from 0.70 to 0.96. The principal component analysis with varimax rotation indicated a three-factor structure: (1) self-care and mobility; (2) sphincter control and (3) cognitive that jointly accounted for 74.8% of the total variance. Construct validity was supported by a significant Pearson correlation between the PFIM and the Persian Barthel Index (r?=?0.95; p?Conclusions: The PFIM is a highly reliable and valid instrument for measuring functional status of Persian patients with stroke.

• Implications for Rehabilitation

• The Functional Independence Measure (FIM) is an outcome measure for disability based on the International Classification of Functioning, Disability and Health (ICF).

• The FIM was cross-culturally adapted and validated into Persian language.

• The Persian version of the FIM (PFIM) is reliable and valid for assessing functional status of patients with stroke.

• The PFIM can be used in Persian speaking countries to assess the limitations in activities of daily living of patients with stroke.

     

Cross-cultural adaptation,reliability and validity of the Turkish version of the Lower Limb Functional Index

Abstract

Purpose: This study aims to adapt culturally a Turkish version of the Lower Limb Functional Index (LLFI) and to determine its validity, reliability, internal consistency, measurement sensitivity and factor structure in lower limb problems. Method: The LLFI was translated into Turkish and cross-culturally adapted with a double forward–backward protocol that determined face and content validity. Individuals (n?=?120) with lower limb musculoskeletal disorders completed the LLFI and Short Form-36 questionnaires and the Timed Up and Go physical test. The psychometric properties were evaluated for the all participants from patient-reported outcome measures made at baseline and repeated at day 3 to determine criterion between scores (Pearson’s r), internal consistency (Cronbachs α) and test–retest reliability (intraclass correlation coefficient – ICC_2.1). Error was determined using standard error of the measurement (SEM) and minimal detectable change at the 90% level (MDC₉₀), while factor structure was determined using exploratory factor analysis with maximum likelihood extraction and Varimax rotation. Results: The psychometric characteristics showed strong criterion validity (r?=?0.74–0.76), high internal consistency (α?=?0.82) and high test–retest reability (ICC_2.1?=?0.97). The SEM of 3.2% gave an MDC₉₀?=?5.8%. The factor structure was uni-dimensional. Conclusions: Turkish version of LLFI was found to be valid and reliable for the measurement of lower limb function in a Turkish population.

• Implications for Rehabilitation

• Lower extremity musculoskeletal disorders are common and greatly impact activities among the affected individuals pertaining to daily living, work, leisure and quality of life.

• Patient-reported outcome (PRO) measures have advantages as they are practical, cost-effective and clinically convenient for use in patient-centered care.

• The Lower Limb Functional Index is a recently validated PRO measure shown to have strong clinimetric properties.

     

Translation,cross-cultural adaptation and validity of the Brazilian version of the Foot and Ankle Ability Measure questionnaire

Purpose: To translate and cross-culturally adapt the Foot and Ankle Ability Measure (FAAM) questionnaire and verify the psychometric properties of the Brazilian–Portuguese version of this instrument.

Methods: Analysis of validity was carried out by applying the Rasch model and evaluating correlations with the Short Form-36 (SF-36) Physical Function (PF) subscale. Test–retest reliability and internal consistency were analyzed with the intraclass correlation coefficient (ICC_2,1) and Cronbach’s alpha tests, respectively.

Results: Ninety subjects with various foot and ankle musculoskeletal disorders (age 37.05 SD 10.49 years) were included. The ICC_2,1 was 0.88 and 0.82 with Cronbach’s alphas of 0.93 and 0.90 for the “Activities of Daily Living” (ADL) and “Sports” subscales, respectively. Correlations with the SF-36 PF were 0.78 (p?95: 0.62–0.87) and 0.65 (p?95: 0.45–0.79) for the ADL and Sports subscales, respectively. Item reliability indices in Rasch analysis were 0.91 (ADL) and 0.84 (Sports). Three items from the ADL subscale (14.2%) did not match the expectations of the model. All items from the Sports subscale fit the model.

Conclusions: There is evidence of validity and reliability of the FAAM-Brazil. Rasch analysis indicated that three items of the ADL subscale did not fit the model in the sample studied.

• Implications for Rehabilitation

• Self-report questionnaires are commonly used in both clinical practice and research because of their ability to efficiently collect information. If the instrument is created properly, the information collected can be used to interpret the effect of clinical conditions on physical function.

• The Foot and Ankle Ability Measure (FAAM) is an evaluative instrument that assesses functional limitations for those with foot- and ankle-related disorders. It was translated into four languages and has evidence of validity, reliability, and responsiveness.

• Evidence of validity and reliability is provided for the FAAM-Brazil when applied to subjects with a wide range of foot and ankle musculoskeletal disorders.

     

Psychometric properties of the Spanish version of the Cumberland Ankle Instability Tool

Abstract

Purpose: To estimate the psychometric properties of the Spanish version of the Cumberland Ankle Instability Tool (CAIT-Sv). Method: One hundred and seventy-one subjects participated. The psychometric properties tested for CAIT-Sv were internal consistency with Cronbach’s α (n?=?171) in the first measurement; test–retest reliability using the intraclass correlation coefficient (ICC_2,1) (n?=?171) in two measurements separated by one week; criterion validity by ICC_2,1 between the original CAIT and CAIT-Sv in two measurements separated by two weeks for a subgroup of 54 bilingual subjects; ceiling and floor effects (n?=?78 subjects with a history of at least one ankle sprain), and responsiveness using Cohen’s d in a subgroup of 25 subjects with a history of at least one ankle sprain and a score ≤24 points on the CAIT-Sv and treated with a rehabilitation program during four weeks. Results: Internal consistency was excellent (Cronbach’s α: 0.8–0.84). Test–retest reliability was high (ICC_2,1: 0.95). Criterion validity was high (ICC_2,1: 0.91; 95% CI: 0.84–0.94; p?<?0.001 for dominant ankle). There were no ceiling (9%) and floor (0%) effects. Responsiveness was moderate (Cohen’s d: 0.6995; CI: 0.11–1.27). Conclusions: CAIT-Sv is a reliable instrument with high criterion validity to measure the presence and severity of chronic ankle instability (CAI) in the Spanish population.

• Implications for Rehabilitation

• Chronic ankle instability is the most prevalent complication after ankle injuries.

• CAIT is a widely used tool for clinical detection of subjects with chronic ankle instability (CAI).

• In this study, CAIT-Sv has shown good phsychometric properties for using with Spanish speaking individuals.

     

Education and social inclusion of people with disabilities in five countries in West Africa: a literature review

Abstract

Purpose: An estimated 1 billion people worldwide live with some form of disability. With the adoption of the Sustainable Development Goals and the “Leave no one behind” agenda, there is a global momentum to ensure that disadvantaged groups, not least people with disabilities, are included and accounted for, in mainstream development efforts. However, in many low-income settings little is known about disability and the policies and programs in place to improve the lives of those affected.

Method: This literature review describes the extent and quality of published and unpublished literature on education and social inclusion of people with disabilities in five West African countries: Cameroon, Liberia, Mali, Sierra Leone and Senegal.

Results: Fifty-four unique documents met inclusion criteria of the review and described related policy and legislation; national and international stakeholders; intervention programs and primary research related to disability and inclusion. The majority of documents were from Sierra Leone (19); and four described more than one country. Primary research included mainly qualitative studies and cross-sectional surveys; 33 sources were critically appraised with the majority being attributed unclear risk of bias (20).

Conclusions: The findings call for (i) standardized tools for monitoring the implementation of programs and policies at national level; (ii) improved stakeholder coordination mechanisms; (iii) development and adoption of coordinated approaches to measuring disability and social exclusion; (iv) rigorous evaluations of the effectiveness of disability programs and (v) disaggregation of routine data by disability.

• Implication for Rehabilitation

• There is a need for standardized tools for monitoring the implementation of programs and policies at national level.

• Countries that have not yet ratified the UNCRPD or the protocol should be supported to do so.

• Stakeholder coordination mechanisms need to be improved.

• Improved coordination between stakeholders involved in disability at the country level could help improve the quality of services delivered.

• Development and adoption of coordinated approaches is key to measuring disability and social exclusion.

• There are few, if any, rigorous evaluation of the effectiveness of disability-specific evaluations in the five countries.

• There is a need for disaggregation of routine data from development programs by disability to inform implementation.

     

The progression of disability among older adults in Mexico

Purpose: This paper seeks to document the progression of disability in a developing country and to examine gender differences in this process.

Methods: The data come from the Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults. An ordinal logistic regression (n?=?3283) is used to measure the progression of disability that considers: (1) no disability, (2) mobility problems, (3) mobility problems with IADLs limitations, (4) mobility problems with ADLs limitations, (5) combinations of the latter three and (6) death.

Results: Approximately 43% of the sample remained in the same level of disability after 2 years. The patterns of progression with two disabilities differ for men and women.

Conclusions: Our model reflects the importance of separating ADLs and IADLs in the study of disability progression in Mexico. Varying risk profiles and cultural differences might influence the divergent disability paths followed by each gender.

• Implications for Rehabilitation

• The disablement process involving transitions from mobility impairments to IADL and ADL limitations seen in developed countries differs for older adults in Mexico.

• Cultural differences may influence the progression from non-disabled to becoming disabled in different ways for females in developing countries like Mexico.

• One-fifth of individuals showed greater function and independence over time, suggesting that the disablement process is reversible. This finding highlights the need to focus on improving mobility, ADL, and IADL skills to facilitate successful aging.

• Although disability is often conceptualised as a combination of ADL and IADL limitations, gender differences seen in Mexico indicate the need to separate ADL and IADL when developing approaches to prevent or ameliorate disability.

     

Cross-cultural adaptation,reliability, and validation of the Korean version of the identification functional ankle instability (IdFAI)

Abstract

Purpose: To cross-culturally adapt the Identification Functional Ankle Instability for use with Korean-speaking participants.

Methods: The English version of the IdFAI was cross-culturally adapted into Korean based on the guidelines. The psychometric properties in the Korean version of the IdFAI were measured for test-retest reliability, internal consistency, criterion-related validity, discriminative validity, and measurement error 181 native Korean-speakers.

Results: Intra-class correlation coefficients (ICC_2,1) between the English and Korean versions of the IdFAI for test–retest reliability was 0.98 (standard error of measurement?=?1.41). The Cronbach’s alpha coefficient was 0.89 for the Korean versions of IdFAI. The Korean versions of the IdFAI had a strong correlation with the SF-36 (r_s?=??0.69, p?<?.001) and the Korean version of the Cumberland Ankle Instability Tool (r_s?=??0.65, p?<?.001). The cutoff score of >10 was the optimal cutoff score to distinguish between the group memberships. The minimally detectable change of the Korean versions of the IdFAI score was 3.91.

Conclusion: The Korean versions of the IdFAI have shown to be an excellent, reliable, and valid instrument. The Korean versions of the IdFAI can be utilized to assess the presence of Chronic Ankle Instability by researchers and clinicians working among Korean-speaking populations.

• Implications for rehabilitation

• The high recurrence rate of sprains may result into Chronic Ankle Instability (CAI).

• The Identification of Functional Ankle Instability Tool (IdFAI) has been validated and recommended to identify patients with Chronic Ankle Instability (CAI).

• The Korean version of the Identification of Functional Ankle Instability Tool (IdFAI) may be also recommend to researchers and clinicians for assessing the presence of Chronic Ankle Instability (CAI) in Korean-speaking population.

     

Psychometric evidence of self-reported questionnaires for patellofemoral pain syndrome: a systematic review

Abstract

Purpose: To conduct a systematic review of psychometric properties of self-reported questionnaires used to assess the level of symptoms and disability in individuals with patellofemoral pain syndrome (PFPS). Methods: A structured search was conducted in four databases (Medline, Embase, CINAHL, SportDiscus). A total of 24 studies about five different self-reported questionnaires were analyzed. A pair of independent raters extracted data on validity, reliability and responsiveness to change, and performed critical appraisal (0–100%). Results: Activities of Daily Living Scale (ADLS), Anterior Knee Pain Scale (AKPS), International Knee Documentation Committee (IKDC) and Lysholm Scale (LS) present excellent test–retest reliability (weighted average intraclass correlation coefficients [ICC]?>?0.80), whereas Functional Index Questionnaire (FIQ) is moderately reliable (ICC?=?0.61). Minimal detectable change is 8.3% for ADLS, 9.0% for AKPS, 19% for FIQ, 8.5% for IKDC and 30% for LS. ADLS, AKPS, IKDC and LS are highly responsive (effect size/standardized response mean >0.95) in individuals with PFPS, while FIQ is lowly responsive (effect size?=?0.49). Conclusion: Based on available evidence, ADLS presents the best psychometric properties and should be preferred when evaluating patients with PFPS. AKPS and IKDC are also adequate, while FIQ and LS are not recommended for individuals with PFPS.

• Implications for Rehabilitation

• While several questionnaires have been developed to assess symptoms and functional limitations caused by knee pain, their psychometric properties can vary depending on the condition presented by the patient.

• The Activities of Daily Living Scale of the Knee Outcome Survey should be preferred by clinicians when evaluating a patient with PFPS.

• The Anterior Knee Pain Scale and International Knee Documentation Committee Subjective knee evaluation are also adequate for use with this population.

• The Functional Index Questionnaire and Lysholm Scale are not recommended for PFPS.

     

Disability studies in Sri Lanka: priorities for action

Abstract

Purpose: To review the published literature relating to disability in Sri Lanka, identify research gaps and inform priorities for action. Methods: A narrative literature review was undertaken and relevant articles extracted using electronic databases such as Medline and PubMed. The available literature was examined in relation to the nine key recommendations of the World Report on Disability. Results: Over the past 30 years, published disability research in Sri Lanka has primarily focussed on mental health, visual impairment and healthcare delivery. Significant gaps were apparent in evidence relating to the status and services for people with intellectual disability, policies and their impact, provider attitudes, barriers to education and employment, health workforce training and access to healthcare. Conclusions: While published studies provide insights on several dimensions of disability, there are important research gaps pointing to unmet needs that require attention to support the health and wellbeing of people living with disability in Sri Lanka. To address these gaps, it is imperative that a critical mass of multi-disciplinary researchers including people living with disabilities collaborate on a strategic program of research using effective participatory approaches that engage all sectors and communities relevant to uphold the rights of people living with disability.

• Implications for Rehabilitation

• All nine key recommendations in the World Report on Disability are highly pertinent to the needs and status of people living with disabilities in Sri Lanka.

• Significant gaps in research on disability-related health issues exist and warrant more focussed attention by researchers, funders and policy makers.

• It is imperative that national stakeholders including the Ministries of Health and Social Welfare, organisations representing people living with disability and related advocacy groups, work collaboratively to identify and implement a research strategy that would better inform disability policies and programmes that have access and equity as core principles.

• Implementation of a national disability survey by the Department of Census and Statistics, will help prioritize disability research in the country.

     

Using intersectionality to explore experiences of disability and HIV among women and men in Zambia

Abstract

Purpose: Little is known about the experiences of people with disabilities (PWD) who live with HIV. Existing research largely assumes a “double burden” approach, which views HIV as doubling the load for people already burdened by disability. Intersectionality (a dynamic process of converging systems of relationships) offers an alternative approach for understanding differences in experience. This study uses an intersectional approach to explore the experiences of PWD in Zambia who have become HIV-positive. Methods: We conducted semi-structured, in depth interviews with 21 PWD who live with HIV in Zambia (12 women, 9 men). Participants had various impairments (visual, hearing, mobility, intellectual). Interviews were conducted to meet participants’ accessibility preferences. Results: Our intersectional analysis demonstrates the dynamic and situational emergent meanings and consequences for PWD who are living with HIV related to: (1) meanings of HIV and disability linked with time and trajectory; (2) oppression and negotiation related to accessing health services and (3) social roles and relationships. Three case studies illustrate these circumstances. Conclusions: Intersectionality offers a complementary approach for examining the complex interrelationship among HIV, disability, gender and time among PWD living with HIV. Findings illustrate directions for improved services and policies for this important group.

• Implications for Rehabilitation

• Rehabilitation services need to take a cross-disability (multiple disabilities) approach working with people living with HIV and disability.

• Rehabilitation, as illustrated by a CBR approach, needs to include services that will facilitate not only health, but education, jobs and housing for people living with HIV and disability.

• Rehabilitation needs to make more direct connections with Zambia social service sector to help address the fluctuating experience of living with HIV and disability.