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Introduction: Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed‐methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures—the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System—best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice. Methods: Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi‐structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis. Findings: Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'. Conclusion: Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large‐scale evaluation of the value of occupational therapy. Key Points for Occupational Therapy: Routine use of standardised measures may improve patient outcomes and demonstrate the benefits of occupational therapy.The Functional Autonomy Measurement System (SMAF), Personal Care Participation Assessment and Resource Tool (PC‐PART), and Home Support Needs Assessment (HSNA) are promising tools for inpatient settings, subject to occupational therapists' acceptability.Outcome measures can be integrated within the practice context using knowledge translation principles. [ABSTRACT FROM AUTHOR]

Anecdotal evidence suggests that non-communicable diseases (NCDs) contribute substantially to mortality, morbidity and disability in Ghana. Nonetheless, no data are presently available on Ghanaians with disability from major NCDs, such as hypertension, diabetes and stroke. Using data from the 2007/2008 Ghana World Health Organization Study on Global Ageing and Adult Health (SAGE) and applying ordinary least squares techniques, the prevalence of and associations between activity limitations and participation restrictions in Ghanaians with NCDs are examined in the present study. The results show stroke is the major contributor to activity limitations and participation restrictions among the Ghanaian population with NCDs. The study results further revealed that respondents with higher education reported high levels of disability compared to those with no education. The results suggest that functioning can be restored by providing assistive technologies, such as wheelchairs, prosthetic limbs, walking aids, etc., that can enhance participation of persons with disability in society. [ABSTRACT FROM AUTHOR]

Abstract Background A fifth of adults in low- and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization, and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among older adults. Moreover, data regarding disease patterns and their impact on person-centered outcomes are limited. There is a need for research into understanding common patterns of multimorbidity, and their association with functional impairments, particularly in LMICs. Such information may contribute towards evidence-based and context-relevant strategic policy, planning, and delivery models for health and rehabilitation services, which is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs. Methods A scoping review will be conducted using a five-step framework and reported according to the PRISMA-ScR guidelines. A comprehensive electronic search of PubMed/MEDLINE, Scopus, EBSCOhost, Scielo, Cochrane and Google Scholar will be conducted and updated from the last pilot search ran in September 2020. Studies of any design will be included if they are reported in English, published (between January 1976 and the last search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover study characteristics, participants’ characteristics, multimorbidity measures, patterns analysis, and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize findings. Discussion Patients with multimorbidity have unique and cross-cutting needs, hence the need for integrated and person-centered approaches to policy, planning, and delivery of medical and rehabilitation services. Considering the shift towards UHC and primary healthcare-led management of chronic diseases, the proposed scoping review is timely. Findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field. Trial registration Open Science Framework (OSF), https://osf.io/gcy7z/

Abstract Background Osteoarthritis (OA) and Rheumatoid arthritis (RA) are the most common joint diseases leading to chronic pain and disability. Given the chronicity and disabling nature of OA and RA, they are likely to influence full participation of individuals in the society. An activity limitation occurs when a person has difficulty executing an activity; a participation restriction is experienced when a person has difficulty participating in a real-life situation. The aim of this study was to examine the associations between OA and RA and the domains of activity limitation and participation restriction. Methods A cross-sectional study design comprised 3604 adults from the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES). All participants aged ≥ 20 years with complete data were included. Activity limitation and participation restriction were assessed by reported difficulty in performing 14 tasks selected from Physical Functioning Questionnaire. Data on OA and RA were obtained from Medical Conditions Questionnaire. Weighted logistic regression model was used to examine the associations between OA and RA and the selected tasks. Results Over 36% of participants had limitations. Both OA (OR = 2.11) and RA (OR = 2.36) were positively associated with activity limitation and participation restriction (p

IntroductionThe concept of participation restriction was first described by the World Health Organization in 2001 as a component of The International Classification of Functioning, Disability and Health Framework. Both falls and fear of falling (FOF) are associated with social isolation, depression, anxiety, poor quality of life and cognitive impairment resulting in participation restriction. Life-space mobility (LSM) is an important indicator for participation restriction which depends on multiple inter-related factors. We aimed to determine participation patterns using latent cluster analysis (LCA) in older adults at risk of falls, its relationship with intrinsic capacity (IC) and its risk prediction.MethodsCross-sectional study of 154 community dwelling older adults ≥ 60 years with falls or risk of falls was conducted. Questionnaires were administered on demographics, hearing, LSM, frailty (FRAIL scale), anorexia of aging (SNAQ), cognition (Montreal Cognitive Assessment, MoCA), FOF (Falls Efficacy Scale-International), physical function, and assessment for handgrip strength (HGS), gait speed, 5-times sit to stand (STS), vision and times-up-and-go (TUG) were performed. Six IC domains (vision and hearing, cognition, nutrition, mobility and depression) were measured.ResultsThree pattern of participation cluster were identified, high (n = 63, 40.9%), moderate (n = 83, 53.9%) and low (n = 8, 33 5.2%). Individuals in the high participation cluster were significantly younger, had higher LSM scores and lower FES-I scores, more robust, fewer ADL and IADL limitations, lower prevalence of low HGS, higher gait speed and shorter TUG. In the fully adjusted model compared to the high participation cluster, moderate participation was significantly associated with low MoCA scores (OR 4.2, 95% CI 1.7–10.4, p = 0.02), poor STS (OR 7.1, 95% CI 3.0–17.0, p < 0.001) whereas low participation was associated with anorexia of aging (OR 9.9, 95% CI 1.6–60.9, p = 0.014), poor STS (OR 19.1, 95% CI 2.0–187.5, p = 0.011) and hearing impairment (OR 9.8, 95% CI 1.4–70.8, p = 0.024). Participants with 3 out of 6 IC decline had a probability of greater than 80% to belong to the low/moderate participation class.DiscussionPhysical function, cognition, hearing and nutrition were significantly associated with low and/or moderate participation class. Future studies are needed to evaluate improvement in participation of those with falls or at risk for falls through restoration of IC.

Background: A fifth of adults in low- and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization, and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among older adults. Moreover, data regarding disease patterns and their impact on person-centered outcomes are limited. There is a need for research into understanding common patterns of multimorbidity, and their association with functional impairments, particularly in LMICs. Such information may contribute towards evidence-based and context-relevant strategic policy, planning, and delivery models for health and rehabilitation services, which is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs. Methods: A scoping review will be conducted using a five-step framework and reported according to the PRISMA-ScR guidelines. A comprehensive electronic search of PubMed/MEDLINE, Scopus, EBSCOhost, Scielo, Cochrane and Google Scholar will be conducted and updated from the last pilot search ran in September 2020. Studies of any design will be included if they are reported in English, published (between January 1976 and the last search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover study characteristics, participants' characteristics, multimorbidity measures, patterns analysis, and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize findings. Discussion: Patients with multimorbidity have unique and cross-cutting needs, hence the need for integrated and person-centered approaches to policy, planning, and delivery of medical and rehabilitation services. Considering the shift towards UHC and primary healthcare-led management of chronic diseases, the proposed scoping review is timely. Findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field. Trial registration: Open Science Framework (OSF), https://osf.io/gcy7z/ [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) and Rheumatoid arthritis (RA) are the most common joint diseases leading to chronic pain and disability. Given the chronicity and disabling nature of OA and RA, they are likely to influence full participation of individuals in the society. An activity limitation occurs when a person has difficulty executing an activity; a participation restriction is experienced when a person has difficulty participating in a real-life situation. The aim of this study was to examine the associations between OA and RA and the domains of activity limitation and participation restriction.Methods: A cross-sectional study design comprised 3604 adults from the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES). All participants aged ≥ 20 years with complete data were included. Activity limitation and participation restriction were assessed by reported difficulty in performing 14 tasks selected from Physical Functioning Questionnaire. Data on OA and RA were obtained from Medical Conditions Questionnaire. Weighted logistic regression model was used to examine the associations between OA and RA and the selected tasks.Results: Over 36% of participants had limitations. Both OA (OR = 2.11) and RA (OR = 2.36) were positively associated with activity limitation and participation restriction (p < 0.001). Poor or fair health was associated with difficulty in physical functioning, with highest odds observed in leisure activities (OR = 2.05), followed by difficulty in attending social events (OR = 1.99), walking for a quarter mile (OR = 1.97), preparing meals (OR = 1.93) and walking up ten steps (OR = 1.92).Conclusion: Adults with OA and RA had nearly similar odds of having activity limitations and participation restrictions. Difficulty in executing most activities of daily living (ADLs) has significant association with poor or fair health. Holistic interdisciplinary care to individuals with OA or RA focusing on ADLs and environmental factors may improve health status. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim of this study was to determine the contributions of background disorders responsible for participation restriction as indexed by a structured interview for the modified Rankin Scale (mRS‐SI). Methods: A subset of 256 patients was assessed at 6 months after stroke using the National Institutes of Health Stroke Scale (NIHSS), gait score, comprehensive cognitive battery (yielding a global cognitive Z‐score), behavioral dysexecutive disorders (DDs), anxiety and depressive symptoms, epilepsy, and headache. Following bivariate analyses, determinants of participation restriction were selected using ordinal regression analysis with partial odds. Results: Poststroke participation restriction (mRS‐SI score > 1) was observed in 59% of the patients. In bivariate analyses, mRS‐SI score was associated with prestroke mRS‐SI score, 6‐month NIHSS score, gait score, global cognitive Z‐score, behavioral DDs, and presence of anxiety and depression (all: p = 0.0001; epilepsy: p =0.3; headache: p = 0.7). After logistic regression analysis, NIHSS score was associated with increasing mRS‐SI score (p = 0.00001). Prestroke mRS‐SI score (p = 0.00001), behavioral DDs (p = 0.0008) and global cognitive Z‐score (p = 0.01) were associated with both mRS‐SI score > 1 and mRS‐SI score > 2. In addition, gait score was associated with mRS‐SI score > 2 (p = 0.00001). This model classified 85% of mRS‐SI scores correctly (p = 0.001). Structural equation modeling showed the contributions of gait limitation (standardized coefficient [SC]: 0.68; p = 0.01), prestroke mRS‐SI (SC: 0.41; p = 0.01), severity of neurological impairment (SC: 0.16; p = 0.01), global cognitive Z‐score (SC: −0.14; p = 0.05), and behavioral DDs (SC: 0.13; p = 0.01). Conclusion: These results provide a statistical model of weights of determinants responsible for poststroke participation restriction and highlight a new independent determinant: behavioral DDs. [ABSTRACT FROM AUTHOR]

Purpose: The global activity limitation indicator (GALI) is the only internationally agreed and harmonised participation restriction measure. We examine if GALI, as intended, is a reflective measure of the domains of participation; furthermore, we determine the relative importance of these domains. Also, we investigated the consistency of response to GALI by age and gender and compared the performance of GALI with that of self-rated health (SRH). Methods: We used Spanish data from the European Health and Social Integration Survey and selected adults aged 18 and over (N = 13,568). Data analysis, based on logistic regression models and Shapley value decomposition, were also stratified by age. The predictors of the models were demographic variables and restrictions in participation domains: studies, work, mobility, leisure and social activities, domestic life, and self-care. The GALI and SRH were the response variables. Results: GALI was strongly associated with all participation domains (e.g. for domestic life, adjusted OR 24.34 (95% CI 18.53–31.97) in adult under 65) and performed differentially with age (e.g. for domestic life, adjusted OR 13.33 (95% CI 10.42–17.03) in adults over 64), but not with gender. The relative importance of domains varied with age (e.g. work was the most important domain for younger and domestic life for older adults). The results with SRH were parallel to those of GALI, but the association of SRH with participation domains was lowest. Conclusions: GALI reflects well restrictions in multiple participation domains and performs differently with age, probably because older people lower their standard of good functioning. [ABSTRACT FROM AUTHOR]

This study aimed to identify children with restricted community participation and examine the extent to which the child, family, and environmental factors were associated with restricted participation. A school-based sample of 92 children with disabilities and 391 children without disabilities aged 5–12 years was recruited in Hong Kong. Parents completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire. Moreover, children completed the Children's Depression Inventory. Rasch analysis was used to determine the criteria that differentiated between children with and without participation restriction, based on frequency of activities. Logistic regression was used to identify the factors associated with participation restriction. One hundred seventy-three children (35.8% of the sample), including 42 with disabilities, were identified as having restricted participation. Participation restriction was associated with higher depressive symptoms in children (odds ratio (OR) = 1.05, 95% confidence interval (CI) [1.01, 1.08]), lower environmental resources (OR = 0.97, 95% CI [0.96, 0.99]), and coming from families with three or more children (OR = 2.80, 95% CI [1.44, 5.46]). The results suggest that a sizable number of children are at risk for restricted participation in the community. Healthcare services and strategies that address the associated factors are needed to promote children's community participation. [ABSTRACT FROM AUTHOR]

Abstract Background Although identifying vulnerable groups is an important step in shaping appropriate and efficient policies for targeting populations of disabled people, it remains a challenge. This study aims to evaluate for the first time the comparability of the different disability measurements used in Cameroon. This is done by comparing them with the international standards proposed by the Washington Group (WG). It also evaluates the consistency of the association between the disability as measured by these surveys and the sociodemographic characteristics. Method We used data from the third Cameroonian Population and Housing Census (3RGPH) of 2005, the third Cameroonian Household survey (ECAM3) of 2007, the Demographic Health and Multiple Indicator Cluster Survey (DHS-MICS) of 2011 and a survey conducted on adults in Yaoundé (HandiVIH) in 2015 with the WG tool. The proportion and their confidence intervals, chi-square tests and multivariate logistic regressions are used for analyses. Results In the city of Yaoundé and for the 15–49 age group, disability prevalence was estimated at 3.6% (CI = [2.5, 5.1]), 2.7% CI = [2.1, 3.5]), 2.6% (CI = [2.4, 2.7]) and 1.0% (CI = [1.0, 1.10]), according to DHS-MICS, ECAM3, HandiVIH and 3RGPH, respectively. The prevalence of severe motor and mental disabilities in DHS-MICS (0.4% CI = [0.2, 0.8], 1.1% CI = [0.7, 1.8] and 0.5% CI = [0.2, 1.1], respectively) are not significantly different from the findings of HandiVIH (0.3% CI = [0.2, 0.3], 0.8% CI = [0.7, 0.9] and 0.5% CI = [0.5, 0.6], respectively). Only motor disability prevalence in ECAM3 (0.8%, CI = [0.5, 1.2]) is not different from that of HandiVIH. When the WG screening tool is used in HandiVIH, disability is positively associated with age, negatively associated with educational level, being in a union and socioeconomic status (SES) and it is not associated with sex. Severe disability, for its part, is not associated with SES and is positively associated with being a male. A different association trend is observed with 3RGPH, ECAM3 and DHS-MICS. Conclusion None of the instruments used in the nationally representative Cameroonian surveys produced both disability prevalence and association trends that are exactly similar to those obtained when using the WG disability screening tool, thus highlighting the necessity to include the WG questions in nationally representative surveys.

From a patient's perspective, participation is a major determinant of quality of life. We aimed to review contextual factors, both personal and environmental, potentially associated with post-stroke participation. PubMed, PsycINFO, and Web of Science were searched for original quantitative and qualitative studies that investigated contextual factors of post-stroke participation, measured participation as the primary outcome, and met inclusion criteria. Socio-demographic determinants were mostly unrelated with participation or showed discordant and inconclusive results. Although less investigated, psychosocial/psychological factors, particularly self-esteem and acceptance, were associated with participation in most studies. Motivation was found in qualitative studies, but discordant in quantitative ones. Environmental factors were even less investigated and mainly in qualitative studies among patients with communication disabilities. Among these, social support and attitude of others appeared to be major determinants of participation as well as physical environment and societal environment (services and polices). Personal factors, particularly psychological and psychosocial factors, were identified as positively associated with post-stroke participation. Environmental factors such as support, relationships, and positive attitudes towards patients were major facilitators of participation as well as physical environment and accessibility to appropriate services. Most of these factors are modifiable and should be addressed to improve patient participation. Psychosocial factors (motivational aspects, acceptance of a new condition, self-esteem) and environmental factors (social support, attitudes towards the patient, physical environment, access to health, social services and policies) were identified as determinants of post-stroke participation. A structured evaluation of determinants of participation may be used in clinical practice to propose appropriate support and then improve patients' recovery Programs to improve patients' psychosocial skills such as self-esteem, acceptance, motivation should be tested and implemented, and policies to develop appropriate services accessibility should be encouraged. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background and Purpose: The Survey of Activities and Fear of Falling in the Elderly (SAFE) was originally developed in English to determine the level of fear of falling and its interactions with activities of daily living. The purpose of this study was to translate and cross-culturally adapt the SAFE instrument into Turkish and investigate its psychometric properties. Participants: One hundred eleven older adults (72 females) with a mean age of 69 years (SD = 7.22; range, 60-87) were included. Methods: For cross-cultural adaptation, 2 bilingual translators used the back-translation procedure. Within a 5- to 7-day period after the first assessment, the participants completed the Turkish version of the SAFE (SAFE-T) to evaluate test-retest reliability. Cronbach's α was used to assess internal consistency. The correlation with the Turkish version of the Falls Efficacy Scale-International (FES-T) was determined to check the validity. Results: The SAFE-T had excellent internal consistency (α = 0.96) and test-retest reliability (intraclass correlation coefficient [ICC2,1] = 0.96 for activity level, ICC2,1 = 0.95 for fear of falling, and ICC2,1 = 0.86 for activity restriction subscales). The SAFE-T activity level and SAFE-T activity restriction subscales were moderately correlated with the FES-I (ρ = −0.51, P <.001; ρ = 0.55, P <.001, respectively). A strong positive correlation was found between the SAFE-T fear of falling subscale and the FES-I (ρ = 0.75, P <.001), indicating good concurrent validity. Conclusions: The results show that the SAFE-T is semantically and linguistically adequate to assess the fear of falling in adults older than 60 years. Excellent internal validity and test-retest reliability of the SAFE-T were defined to evaluate the fear of falling among Turkish speaking older adults. [ABSTRACT FROM AUTHOR]

Introduction: The armed forces provide lifelong medical benefits to all their veterans. As most of them are older, their health needs are quite different from those of serving personnel. Having led a relatively active and disciplined life in the services, their general health might also be better than that of their civilian counterparts. Unfortunately, there are no data available on the health of Indian military veterans. This study was planned to ascertain the level of activity limitation (AL) and participation restriction (PR) and determine factors affecting AL and PR. Material and Methods: This community-based, cross-sectional study was conducted among 406 veterans and their spouses aged 60 years and above residing in an urban housing society. House-to-house surveys were conducted. The study was done over 6 months (July–December 2016). Ethical clearance and informed consent were taken. The questionnaire used in the study was designed by incorporating elements from the International Classification of Functioning, Disability, and Health questionnaire and the WHO Disability Assessment Schedule. Results: Of the 406 veterans and their spouses surveyed, 188 (46.3%) were male and 218 (53.7%) were female. The majority of them were in the age groups of 61–70 years (175, 43.1%) and 71–80 years (173, 42.6%). Most of them were living with other family members with only 59 (14.5%) living alone. AL score was good or average in most of them (263 and 124, respectively), and it was bad or very bad in only a small number (11 and 8, respectively) Similarly, the PR score was good or average in 316 and 78 participants, respectively. Only 12 (2.8%) had a bad PR score. PR score increased significantly beyond the age of 80 years (P = 0.00). AL was more in males as compared to females. PR was more in those who were not married/divorced/single (P < 0.05). AL and PR were independent of the type of caregivers (P > 0.05). The most common ailments reported by males were body aches and pains, hearing defects, and problems related to micturition. Complaints of feeling low or depressed were significantly higher in females (P < 0.05). The top five causes of morbidity in the study population were hypertension (209, 51.5%), diabetes (125, 30.8%), defective vision (116, 28.6%), cataract (105, 25.9%), and dental problems (102, 25.1%). Conclusion: This study provides an insight into the magnitude of disease, impairment, and disability among veterans. Hypertension was the most common morbidity. Assessment of the AL and PR is useful planning geriatric care and educating caregivers and families to improve the quality of life of the elders.

Abstract Background GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI. Methods Following the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations. Results Four cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI. Conclusion GALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.

Introduction: The primary purpose of this study was to examine the feasibility and informativeness of the Patient-Specific Functional Scale (PSFS) for identifying activities that persons with Parkinson disease (PD) self-identified as difficult.Method: Informativeness was investigated by cross-referencing the identified activities with the International Classification of Functioning, Disability, and Health (ICF), the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Parkinson's Disease Questionnaire (PDQ-39). Twenty-eight individuals with PD (Hoehn & Yahr stage 1–4) completed the PSFS. Activities identified by the participants were classified according to the ICF and then cross-referenced across the MDS-UPDRS and PDQ-39.Results: Participants identified 98 specific (60 different) activities that they were unable to do or were having difficulty with as a result of PD. Activities most frequently listed as difficult included some aspect of fine hand use, dressing, eating, or changing position (e.g. transferring). All activities could be classified using the ICF, but many were not addressed specifically by the MDS-UPDRS or PDQ-39.Conclusion: We conclude that the PSFS can be used for identifying activities that persons with PD personally find difficult and may be useful as a compliment to the MDS-UPDRS and PDQ-39. [ABSTRACT FROM AUTHOR]

Background: Compromised vocal health in teachers affects their quality of life. Magnitude of voice problem varies depending individuals’ perception and their adaption to existing condition. This study focused on analyzing the contributing factors of voice problems from a bio-psychosocial perspective (using WHO, ICF framework) and its impact on teachers. Method: A vocal health questionnaire that included sections on personal factors, voice use, vocal symptoms, activity limitations and environmental factors was developed and administered on 105 teachers. Frequency analysis and odds-ratio was used to report the presence of voice problems, contributing factors and its impact on daily situation. Findings: Teachers faced considerable impairment in body function (such as tiredness after speaking, throat pain, & feeling upset). As a result, it posed significant limitation in communication with family/friends and engaging in social/religious ceremonies. Though teachers had positive support from their colleagues and society,noisy classrooms and tropical weather had an adverse consequence on the quality of life of teachers. These details are vital to design and implement vocal hygiene programs. They could also serve as prognostic indicators in vocal habilitation. [ABSTRACT FROM AUTHOR]

In this article, the authors propose to conduct a pertinent analysis of the use of mathematical models in relation to optimal effort taxation. The effort taxation must be a balance between allocative efficiency and distribution. It is a question of determining the optimal tax level for three conditions. The theory is that the shift to a fixed amount, a single share, is not feasible for wage compensation, being important to note that this condition is one that must be considered. The mathematical model proposed by the authors regarding optimal taxation of multi-condition effort is relevant and suggestive for the analysis. It is well known that, in order to increase tax revenue, they must inevitably be based on the unobservable variant, which is the potential gain or, most importantly, on the individual productivity of labor. Solving a problem of this sensibility, such as the optimal taxation of multi-state effort, needs to be analyzed and conditioned by the establishment of a mathematical-econometric model that highlights both the aspects of a minimum expectation threshold or a situation that depends on the economic outcome. The authors consider the existing variants and establish variants based on a mathematical model that is analyzed to best answer the problem of the adverse selection ie the balance between allocation efficiency and distribution. We analyze the optimization problem from Lagrange’s function and associated multiplier, highlighting the mathematical functions that can be used. Further, the authors consider the case of adverse selection based on asymmetric information. For the objective function and budget constraint, the authors consider that they need to add incentive restrictions, especially when they are taxed on income. By analyzing this hypothesis in depth, the authors propose and demonstrate a mathematical function that best suits these adjustment needs and solve the adverse selection. The way in which the authors suggest and demonstrate the implementation condition that is equivalent to the assertion that the plurality of admissible solutions is unclear gives a solution perspective applicable in most cases. The authors propose, by synthesizing, conditions (sentences) that demonstrate that the model used is one that must be considered and can be successfully used in optimal taxation of the multi-state effort. In the explanatory approach, it is also appreciated that the combination of the Kuhn-Tucker multipliers of the two constructions can determine the Lagrange function. This feature built by all Kuhn-Tucker multipliers is strictly positive and the level of effort is optimal given by a series of equalities that imply a final aspect of its use.

Background: Vocational rehabilitation (VR) aims to rehabilitate a person with an amputation back into actively participating in society. Even though lower limb amputation (LLA) surgery is commonly performed in South Africa (SA), little research has been published on the participation restrictions experienced by and vocational needs of persons with LLA in the Western Cape (WC). Objectives: The aim of this study was to determine and explore the participation restrictions and VR needs of persons with a unilateral LLA in the WC. Method: A mixed-methods approach and a sequential exploratory design were utilised to collect data from 50 persons with an LLA. Participants were conveniently sampled within the Cape Metropole region of the WC, SA. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) tool was used to collect the quantitative data, and telephonic interviews were conducted for qualitative data collection. Results: A third (28%) of participants in this study were unemployed, and only 14% (n = 7) of the participants owned or used a prosthesis. In addition, 50% of the participants either had a disability grant or were on pension. The participation restrictions identified were mainly related to mobility where 74% (n = 37) of participants had extreme difficulty with mobility in general, 92% (n = 46) struggled with walking distances longer than 1 km and 80% (n = 40) had extreme difficulty in completing household tasks quickly. The main VR needs identified in this study were the inadequate rehabilitation services that target ambulation (standing and walking) to facilitate employment. Conclusion: Persons with a unilateral LLA still experience significant difficulties in mobility 3 months post-amputation, which negatively affects their participation in society and vocational activities.

The diagnosis of inflammatory bowel disease (IBD) is a life-changing moment for most adults. Biomedical advances over the past 2 decades have resulted in unprecedented growth of therapeutic options for IBD. However, due to the incurable nature of IBD, medical and surgical intervention alone may not be adequate to completely normalize health status and prevent long-term disability. In the biopsychosocial model of health and disease, a person's health and function result from complex physical, psychosocial, and environmental interactions. Adapting the World Health Organization definition, IBD-related disability encompasses limitations in educational and employment opportunities, exclusions in economic and social activities, and impairments in physical and psychosocial function. Although the concept of IBD-related disability is a long-term treatment end point in the updated Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) treatment guideline, it has received limited attention in the literature. This review article explores an etiological framework of the physical and psychosocial aspects that contribute to IBD-related disability. We also explore the impact of IBD-related disability on the direct and indirect costs of IBD. Lastly, we present the available evidence for interventions with the potential to improve function and reduce IBD-related disability., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: In general, multidrug therapy (MDT) completion rate and the change in disability levels before and after medical treatment are reported as outcomes in leprosy programmes. Changes in activity and social participation levels are rarely reported, possibly because the parameters are more difficult to measure. The study aimed to assess and evaluate the changes in social participation among leprosy-affected persons after completion of MDT. Method: An observational study was conducted among 108 newly-diagnosed leprosy- affected clients, who were registered at the Leprosy Referral Hospital in Champa, Chhattisgarh. Their disability levels pre- and post- MDT were assessed using the WHO Disability Grading, and their social participation level was assessed using the Participation Scale. Results: Of the 108 clients registered during the study period, 90 completed the full course of MDT and were included in the analysis. The majority of these 90 clients or 83% were multibacillary and 23% had Grade 2 disability at the time of diagnosis. At the end of MDT with steroids therapy for reaction and neuritis, the proportion of clients with no participation restriction increased from 76% to 93%. Clients with visible impairments had more restriction as compared to those with no deformity or no visible deformity, before and after MDT. Among those with visible impairments, 78% had mild to severe restriction before MDT and it declined to 26% on completion of treatment. Conclusion: Presence of Grade 2 disability at the time of diagnosis was significantly associated with participation restriction. MDT and steroid therapy for management of reaction and/or neuritis improves the participation level of leprosy-aff ected clients, suggesting that early detection and appropriate management would reduce their risk of participation restriction. [ABSTRACT FROM AUTHOR]

Background: Vocational rehabilitation (VR) aims to rehabilitate a person with an amputation back into actively participating in society. Even though lower limb amputation (LLA) surgery is commonly performed in South Africa (SA), little research has been published on the participation restrictions experienced by and vocational needs of persons with LLA in the Western Cape (WC). Objectives: The aim of this study was to determine and explore the participation restrictions and VR needs of persons with a unilateral LLA in the WC. Method: A mixed-methods approach and a sequential exploratory design were utilised to collect data from 50 persons with an LLA. Participants were conveniently sampled within the Cape Metropole region of the WC, SA. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) tool was used to collect the quantitative data, and telephonic interviews were conducted for qualitative data collection. Results: A third (28%) of participants in this study were unemployed, and only 14% (n = 7) of the participants owned or used a prosthesis. In addition, 50% of the participants either had a disability grant or were on pension. The participation restrictions identified were mainly related to mobility where 74% (n = 37) of participants had extreme difficulty with mobility in general, 92% (n = 46) struggled with walking distances longer than 1 km and 80% (n = 40) had extreme difficulty in completing household tasks quickly. The main VR needs identified in this study were the inadequate rehabilitation services that target ambulation (standing and walking) to facilitate employment. Conclusion: Persons with a unilateral LLA still experience significant difficulties in mobility 3 months post-amputation, which negatively affects their participation in society and vocational activities. [ABSTRACT FROM AUTHOR]

Aims: The Participation Scale (P-Scale) is a widely used generic self-report measure designed to assess an individual’s participation restriction consequent to any disease condition. The present study aimed to evaluate the validity and reliability of a south Indian (Kannada language) version of the P-Scale for use with adults with hearing loss. This study is a part of an ongoing research program on the assessment of outcomes of hearing health rehabilitation with hearing aids involving Indian client groups. Methods: One hundred and three adults with hearing loss completed the original English and the newly translated-adapted Kannada P-Scale questionnaire. Nearly half of the participants completed repeat testing of the Kannada version 15 days after the initial assessment. Along with the P-Scale, Kannada versions of the Hearing Handicap Questionnaire (HHQ) and the Assessment of Quality of Life - 4 Dimensions Questionnaire (AQoL-4D) were also administered. Based on predefined quality criteria, five different psychometric properties of the P-Scale were evaluated, together with an analysis of the Kannada P-Scale’s factor structure. The psychometric properties assessed included internal consistency, test-retest reliability, convergent validity, discriminant validity, and floor-ceiling effects. Results: Principal component analysis indicated a four-factor complex structure, which explained 69.78% of the variance in the Kannada P-Scale. High internal consistency (Cronbach’s alpha = 0.90) and test-retest reliability (internal consistency coefficient  >0.90) were obtained. Comparisons with the HHQ (ρ = 0.52) and AQoL-4 D (ρ = 0.76) indicated good convergent validity. Discriminant validity among the P-Scale questions was acceptable (inter-item correlation  <0.60). Floor and ceiling effects were not evident in the Kannada P-Scale. Conclusions: The psychometric characteristics of the Kannada P-scale were found to be sufficient for use with the participant group (literate, Kannada-speaking adults with hearing loss) who were assessed in this study. Further research is required to determine generalizability of the Kannada P-Scale among other Kannada-speaking communities. Implications for Rehabilitation: The Kannada version of the Participation Scale (P-Scale) can be validly used with Kannada speaking adults with hearing loss. The Kannada P-Scale can be used for clinical/research purposes to assess outcome (specifically, change in participation restriction) before, during, and after the hearing rehabilitation process. However, education and socioeconomic status may have an effect of the Kannada P-Scale results and these factors need to be further investigated prior to wider clinical use. [ABSTRACT FROM AUTHOR]

Background: Involvement of amputees in societal activities such as sports, recreation, cultural activities and employment will not only reduce stigmatization but also enhance their wellbeing and longevity. However, it is not known whether the type of amputation may influence activity limitation, participation restriction and quality of life of amputees in Kano. Objective: This study aimed to assess the influence of amputation type on activity limitation, participation restriction and quality of life of amputees in Kano. Methods: A cross-sectional survey design with 100 participants recruited and assessed was used. Outcome measures used included the Groningen activity restriction scale (GARS) to assess activity limitation, the participation scale (P-scale) to assess participation restriction and the short form health status survey (SF-12) to assess quality of life of respondents. Frequency and percentage distribution were used to analyse the descriptive variables, while linear regression was applied to assess the influence of amputation type on activity limitation, participation restriction and quality of life of amputees at alpha = 0.05. Results: The majority of participants belonged to the age category of 26-39 years (34.4%) and 40-60 years (32.2%) with the mean age of 41.53±15.17 years. The study population included 62.2% of males and 37.8% of females. Above knee amputation (AKA) was most commonly performed (54.4%). The results showed that the amputation type had a significant effect on participation restriction (B= -0.185, p < 0.05) without any influence on activity limitation and quality of life (p >0.05). Conclusion: The type of amputation has significant influence on participation restriction yet does not limit the individual's performance in the society and does not affect their self-image and self-esteem. [ABSTRACT FROM AUTHOR]

Background: Auditory Neuropathy Spectrum Disorder (ANSD) is a hearing disorder which may be characterized by normal or near normal hearing, or hearing loss ranging between mild to severe; but always associated with pronounced difficulty in speech recognition. This difficulty in speech recognition can affect communication in all situations, subsequently causing activity limitation and participation restriction in the affected individual. The current study aims to study the extent of activity limitation and participation restriction in adults with ANSD using a clinician developed tool. Material and Methods: Data was obtained from a sample of 23 adults with bilateral ANSD ranging in age between 18 and 52 years. The hearing status of the participants ranged from normal hearing sensitivity to severe hearing loss. A tool was developed based on ICF framework, including body functions, activities and participation and environmental factors. It consists of 83 statements spanning ten domains. Each statement was rated using a 5-point scale i.e. always, often, sometimes, seldom and never to indicate the frequency with which the participant experienced that phenomenon. Results: Every adult who participated in the study faced activity limitation and participation restriction in all domains. However severe difficulty was faced in domains of sensory functions and pain, learning, communication and domestic life. Moderate problem was experienced in domains of mental functions, general tasks and demands, interpersonal relations and interactions, major life areas, community and social life and supports and relationships. Conclusions: Results imply considerable activity limitation and participation restriction in adults with ANSD. Such information can help the clinician to address specific problems during intervention; especially considering that patients with ANSD do not get adequate benefit from amplification devices. [ABSTRACT FROM AUTHOR]

Background: The Reintegration to Normal Living Index (RNLI) was developed to measure reintegration to normal living after major traumas/illnesses. Its psychometric properties remain unknown when used to measure participation restriction under the World Health Organization's International Classification of Functioning, Disability, and Health (WHO-ICF) framework. This study examines the psychometric properties of the Chinese version-RNLI to measure WHO-ICF participation restriction among community-dwelling pre-frail and frail older people.Methods: A cross-sectional study was conducted in community and day-care centres in Hong Kong between May 2015 and January 2016. Through face-to-face interviews, information was collected on the participants' demographic background, medical history, frailty status, depressive mood, functional performance in daily activities, and participation restriction. The internal consistency, test-retest reliability, and construct and convergent validity of the C-RNLI were assessed.Results: Two hundred and ninety-nine pre-frail or frail community-dwelling older people with a mean age of 79.53 were recruited. A confirmatory factor analysis showed that the C-RNLI has a two-factor structure comprised of "participation in physical activities" and "participation in social events". The test-retest coefficient was 0.71. The Cronbach's alpha of the total C-RNLI score, and those of the factors "participation in physical activities" and "participation in social events" were 0.88, 0.82 and 0.84, respectively. Pre-frail older people had significantly higher scores for the factors "participation in physical activities" (z = -5.05, <0.01) and "participation in social events" (z = -6.04, p < 0.01) than frail older people. Older people from community centres had significantly higher scores for the factors "participation in physical activities" (z = -4.48, <0.01) and "participation in social events" (z = -4.03, p < 0.01) than older people from day-care centres. The factors "participation in physical activities" and "participation in social events" of the C-RNLI were significantly convergent with depressive mood (rs = -0.25 and rs = -0.39, respectively) and functional performance in daily activities (rs = 0.28 and rs = 0.45, respectively).Conclusions: The C-RNLI is a two-factor structured scale with acceptable level of reliability and validity to measure WHO-ICF participation restriction among community-dwelling pre-frail and frail older people. [ABSTRACT FROM AUTHOR]

Background: The International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability. Participation restriction refers to health problems that can hinder people's involvement in different life events. It is rational to believe that the prevalence of participation restriction increases among a frail population. However, information about the level of participation restriction among older people, particularly the pre-frail or frail, remains scant. The aim of this study was to identify the prevalence and underlying risk factors associated with participation restriction among community-dwelling frail and pre-frail older people.Methods: A cross-section of 299 community-dwelling frail older people with a mean age of 79.5 participated in this study. They had to have been identified as being either pre-frail or frail based on the five common characteristics of the frailty phenotype. Their level of participation restriction was assessed based on the Chinese Reintegration to Nursing Living Index (C-RNLI). All other independent variables were identified and systematically linked to different components in the WHO-ICF framework.Results: Among all participants, 207 (69.2%) were identified as encountering participation restrictions in at least one aspect of their life, with a mean C-RNLI score of 68.3 (SD 19.43). A multivariate regression analysis showed that the participants' status of frailty, self-perceived social status, level of exhibited depressive mood, sleep quality, mobility, level of fear of falling, and physical activity levels had a significant association with participation restriction. When all of the variables, regardless of significance, were included, the factors together explained 67.1% of the variance in the participants' participation restriction.Conclusion: Participation restriction was prevalent among community-dwelling frail older people and was associated with factors across different components in the WHO-ICF. This finding supports the view that participation restriction is multifactorial in nature. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated differences in impairment, activity limitation, participation restrictions and psychological distress between participants using ankle-foot orthoses (AFOs) as recommended, participants who did not use AFOs as recommended and participants who did not know recommendations for use.Method: Adults (n = 157) fitted with an AFO by an NHS Orthotic Service in Scotland completed a postal questionnaire that measured impairment, activity limitations participation restrictions and psychological distress using scales from the RAND 36-Item Health Survey 1.0 and the Hospital Anxiety and Depression Scale (HADS).Results: 41% of participants used their AFOs as recommended, 32% did not use their AFOs as recommended and 27% did not know the recommendations for use. Participants using AFOs as recommended reported lower levels of impairment and activity limitations, indicated by higher energy levels (p = 0.005), higher physical functioning (p = 0.005), lower role-limitations due to emotional problems (p = 0.001) and lower levels of anxiety (p = 0.003) compared to people not using AFOs as recommended.Conclusion: Health professionals need to ensure whether patients understand the recommendations for use of their AFO. Additionally, the results of the study support the value of evaluating patients’ psychological well-being to gain a better understanding of AFO use.Implications for RehabilitationParticipants who reported using AFOs as recommended had significantly lower levels of impairment, activity limitations and anxiety compared to those who did not use their AFO as recommended.In this study, 27% of participants did not know recommendations for use of AFOs. Health professionals should give consideration as to how information, regarding wearing instructions and use of AFOs, is provided to people who are prescribed AFOs.Psychological outcomes in orthotics are rarely assessed. However, this study demonstrates there is a value in measuring psychological outcomes in orthotic management. [ABSTRACT FROM PUBLISHER]

Background Severity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society. Method To study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life. Results Patients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62). Conclusion Mental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine. [ABSTRACT FROM AUTHOR]

Objective: The present cross-sectional study tested a hypothetical path model consisting of psychosocial factors in relation to activity participation restriction in chronic stroke. Motor and cognitive functions and age: psychological factors consisting of depressive symptoms, hopeful thinking, and self-esteem; and activities of daily living and social support served as psychosocial factors. Method: Data were collected from 171 community-dwelling individuals with chronic stroke in Korea. Path analysis was conducted to test the model fit between the obtained data and the hypothetical model to examine the direct and indirect effects of variables on participation restriction. Results: Among the psychosocial factors, psychological factors and activities of daily living played the most significant role in predicting the degree of participation restriction, as well as mediating the relationship. Motor and cognitive functions were mediated by activities of daily living, and social support was mediated by psychological factors to affect participation restriction. Among the psychological factors, hopeful thinking exhibited the strongest relationship. Conclusion: To increase stroke survivors' participation during the course of rehabilitation, psychosocial factors as well as biological factors should be included in a multidimensional treatment approach. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of physical disability at the community level is essential for rehabilitation and supply of services. This study aimed to assess the prevalence of physical disability among adults in an urban community in Sri Lanka. Methods: A descriptive cross-sectional study was conducted among 2460 adults (18 -59 years of age) who were selected using cluster sampling. Physical disability was measured using a Physical Impairment Examination Tool (PIET) and World Health Organisation Disability Assessment Schedule II (WHODAS II). Results: Prevalence of physical disability was 4.2% (95% CI= 3.5-5.1). Physical disability was higher among people in the age group of 40-59 years (6.5%, n=64) than among those in the age group of 18-39 years (2.6%, n=39) (P<0.05). Physical disability was more prevalent among females (4.4%, 95% CI= 4.2-4.6) than males (2.6%, 95% CI: 2.4-2.8), and among Tamils (7.8%, 95% CI=5.1%-10.5%) than Sinhalese (3.3%, 95% CI=2.4%- 4.1%). It was higher among those who were divorced/widowed (58.3%, 95% CI=30.4- 86.2) than among married people (3.6%, 95% CI=2.8- 4.4). The prevalence of physical disability was 7.1% (95% CI=4.6- 9.5) among people with primary education, 4.5% (95% CI=3.4- 5.6) among those with secondary education, and 1.8% (95% CI=0.8-2.8) among those with tertiary education. It was higher among the unemployed (7.2%, 95% CI=5.7-8.7) than the employed (1.8%, 95% CI=1.1-2.5). Age, gender, ethnicity, marital status, education levels and employment status were significantly associated with physical disability. Conclusions: Though the prevalence of physical disability appears to be higher among Sri Lankan adults than among people in developed countries, it is less than among people in other South-East Asian countries. Associations with socio-demographic variables were consistent with other studies. [ABSTRACT FROM AUTHOR]

Objective: Aural fullness in Ménière's disease and the predisposing and consequential factors were investigated and possible consequences of aural fullness on participation activity were explored. Methods: 726 subjects of the Finnish Ménière Association replied to a questionnaire focusing on symptoms of Ménière's disease, sense of coherence, attitude, participation restriction, and general health-related quality of life (EQ-5D). In the analysis, the severity of the disease was controlled. Results: 68% of the subjects had aural fullness and in 37% it was moderate or strong. Aural fullness was rated as the worst problem by 4.4% of the subjects. Females reported more aural fullness than males. Tinnitus, hyperacusis and balance problems were significant predictors of aural fullness. Aural fullness was associated with reduced quality of life and complaints such as vertigo attacks, balance problems and hearing loss. Analysis based on participation restriction indicated that severe aural fullness leads to social isolation. Conclusions: Largely, psychological factors and personal traits modify problems experienced by aural fullness. Relaxation was the only statistically significant method that alleviated aural fullness. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A voice activity and participation profile (VAPP) is a self-assessment tool used to measure activity and participation limitations resulting from voice disorders. This study aims to demonstrate the adaptation, validity, and reliability of the Turkish version of the VAPP scale. A total of 231 individuals, 155 with voice disorders (patient group) and 76 without voice disorders (normal group), were included in this study. With reliability, internal consistency, and test-retest methods; validity was evaluated with criterion and convergent validity methods. The Cronbach α coefficient calculated for internal consistency was found to be 0.985 for the VAPP total and between 0.914 and 0.978 for the subsections. Intraclass Correlation Coefficient was found to be 0.974 for the VAPP total and between 0.800 and 0.981 for the subsections. Total and subsection scores of the VAPP scale had correlation coefficients ranged between 0.725 and 0.903 with VHI T and V-RQOL T in the whole sample (all P<0.001). The cut-off point was determined as ≥ 8 by ROC curve analysis for criterion validity. VAPP-TR is a valid and reliable tool that can be used to evaluate the quality of life of Turkish patients with voice disorders, particularly those with activity limitations and participation restrictions., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

BACKGROUND: Stroke is not gender-discriminatory. Yet, the subject of stroke among females has apparently not received significant attention from clinical researchers. The consequences of stroke include functional and psychosocial sequelae which may cause disability, hinder community reintegration and restrict participation. The inter-relationships among functional ability, community reintegration and participation restriction of community-dwelling, female stroke survivors in Ibadan were assessed in this descriptive study. METHODS: Fifty-two community-dwelling female stroke survivors (mean age = 56.55±9.91 years) were surveyed using consecutive sampling technique. Their functional ability level was measured using the Functional Independence Measure (FIM) while London Handicap Scale (LHS) was used to assess their participation restriction. Data were analyzed using Spearman Rank Correlation Coefficient (rho) and Mann-Whitney U test at p = 0.05. RESULTS: Significantly positive correlations (p< 0.05) were found between functional ability and community reintegration (r = 0.54, p = 0.01) as well as between participation restriction and community reintegration (r = 0.34, p = 0.05). Individuals with left hemiplegia had significantly higher mean rank scores in functional ability (30.41) than those who had right hemiplegia (mean rank scores = 21.94). CONCLUSION: Functional ability which appears to be related to stroke laterality showed positive association with both community reintegration and participation restriction. This suggests that improving the functional ability of the stroke survivors may reduce participation restriction and enhance their reintegration into the community. A similar study which compares male and female stroke survivors in the same community is thus necessary. [ABSTRACT FROM AUTHOR]

Objective: To explore the role of fatigue and its predisposing and consequential factors and consequences, on quality of life and social participation. Subjects and methods: A questionnaire survey of 728 members of the Finnish Ménière Association was performed. Questions focused on the symptoms of Ménière's disease, sense of coherence (SOC), positive attitude, participation and restriction problems classified by the International Classification of Function (ICF), and general health related quality of life (EQ-5D). Results: Seventy percent of the subjects reported fatigue and in 30% fatigue was moderate or strong. Fatigue was associated with reduced quality of life and complaints of vertigo attacks, balance problems and hearing loss. Mobility related symptoms and mood disorders in a broad sense were the most significant determinants of fatigue. SOC and attitude were predictors of reduced vitality. Analysis based on participation restrictions indicated isolation being a consequence of fatigue. In the analysis the severity of the disease was controlled. Conclusion: Fatigue is a common complaint in Ménière's disease, reducing quality of life and leading to social and personal isolation. Fatigue is associated with personality trait and anxiety disorders. Therapeutically, a positive attitude and physical activity might help to reduce anxiety and escape the social and personal isolation. [ABSTRACT FROM AUTHOR]