Using World Health Organization Disability Assessment Schedule 2.0 in people with schizophrenia: a 4-year follow-up.

Little is known about the changes of people with schizophrenia disability in Taiwan who receive routine treatments under the current mental healthcare system. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to assess and track changes in the degree of disability in people with schizophrenia before and after 4 years of follow-up. Data on 4497 people with schizophrenia were acquired from the Taiwan Data Bank of Persons with Disability. The WHODAS 2.0 was used for disability assessment, and the chi-square test, logistic regression and generalised estimating equations were adopted for statistical analysis. People with schizophrenia exhibited improvement in cognition, mobility and participation among the six domains as well as in the overall score. The degree of disability in all domains remained mild to moderate among people aged 18-64 years; the degree of disability in cognition declined from moderate to severe among patients aged ≥65 years. The degree of disability in all domains remained mild to moderate among people with mild to moderate impairment; among those with severe impairment, the degree of disability in the domains of cognition and life activities declined from moderate to severe and the degree of disability in the domain of mobility declined from mild to moderate. Community-dwelling patients exhibited less degree of disability in all domains than their institutionalised peers. Early detection and treatment and an emphasis on communication and social problem-solving skills in rehabilitation programmes are recommended for people with schizophrenia.

Accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score as an objective assessment tool for predicting return-to-work status after head and neck cancer in male survivors.

PURPOSE: The objective of this nationwide study in Taiwan was to predict work participation by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score as an objective assessment tool. METHOD: Data from between July 2012 and July 2017 regarding 1206 male head and neck cancer (HNC) survivors with disability aged < 50 years were obtained from the Taiwan Data Bank of Persons with Disability (TDPD). Demographic data and the WHODAS 2.0 scores were analyzed to compare employment statuses among HNC survivors. RESULTS: The WHODAS 2.0 scores in all the domains were lower in unemployed than in employed HNC survivors (p < 0.001). The receiver operating characteristic (ROC) curve revealed that the summary WHODAS 2.0 score (area under curve > 0.8) was an extremely accurate predictive tool. Binary logistic regression revealed that the severity levels of impairment and standardized WHODAS 2.0 summary scores less than the cutoff value (27.81) were predictors for the return-to-work (RTW) status of HNC survivors with disability in the working age group. CONCLUSIONS: The WHODAS 2.0 score is an objective quantitative assessment tool for evaluating the RTW possibility among these patient groups.

Assessment of functioning and disability in patients with schizophrenia using the WHO Disability Assessment Schedule 2.0 in a large-scale database.

Schizophrenia is a common mental disorder characterized by deficits in multiple domains of functioning. This study is arguably the first of its kind in Taiwan to examine, in a multifaceted and objective manner, the disability of patients with schizophrenia and the factors affecting it. A cross-sectional design was adopted to gather data from 24,299 patients with schizophrenia who were listed in the Taiwan Databank of Persons with Disabilities. The level of disability in these patients was measured using the World Health Organization Disability Assessment Schedule 2.0. Statistical analyses were conducted through the χ 2 statistic and Poisson regression. The highest level of disability was in participation and the lowest was in self-care. An analysis of disability in all six domains of functioning on the basis of sex, age, type of residence, and socioeconomic status (SES) showed significant differences (P < 0.05). Significant factors (P < 0.05) affecting disability in these domains were female gender, age, educational attainment, SES, type of residence, and employment status. The overall degree of disability in schizophrenia patients was moderate. Six domains were measured in this study. The degrees of disability in mobility and self-care were mild while cognition, getting along, life activities, and participation were moderate. Moreover, female gender, an age of 45 or older, low educational attainment, middle to low SES, staying at healthcare institutions, and unemployment were crucial factors affecting disability of the participants. Preventive and rehabilitation programs should be developed to delay disability and functional degeneration in schizophrenic patients with these characteristics.

Non-elastic taping, but not elastic taping, provides benefits for patients with knee osteoarthritis: systemic review and meta-analysis.

OBJECTIVE: To determine whether therapeutic taping, which includes elastic (Kinesio tape) and non-elastic (Leukotape) taping, is superior to control taping in improving pain and functions for patients with knee arthritis. To understand whether both elastic and non-elastic taping are beneficial. METHODS: We searched the PubMed and Scopus databases from their earliest record to 31 May 2017 for randomized controlled and cross-over studies that used taping to treat knee osteoarthritis. We extracted the mean differences and SD between baseline and posttreatment for selected outcomes measured in the experimental and control groups for subsequent meta-analyses. RESULTS: In total, 11 studies were included in the review. Of which, five Leukotaping and five Kinesio taping studies involving 379 participants were used in the meta-analysis. PEDro scores of the Leukotaping and Kinesio taping studies were 4.2 and 7.8, respectively. Overall, therapeutic taping exhibited significantly greater pain reduction than control taping with a significant weighted mean difference of 12.8 mm on a 0- to 100-mm visual analogue scale. Compared to control taping, Leukotaping produced a significant weighted mean difference of 11.6 mm regarding pain with a large effect size of 0.89 and I2 = 0%, while Kinesio taping produced a non-significant weighted mean difference of 12.1 mm and I2 = 93%. Leukotaping also exhibited a large and significant standard mean difference of 0.82, while Kinesio taping exhibited a non-significant standard mean difference of 1.34 regarding climbing stairs and stepping. CONCLUSION: Therapeutic taping seemed to be superior to control taping in pain control for knee osteoarthritis. Non-elastic taping, but not elastic taping, provides benefits in pain reduction and functional performance.

Validation of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D).

OBJECTIVE: To examine the construct validity of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), a multidimensional participation measure developed for use in rehabilitation practice. DESIGN: Cross-sectional study. SETTING: Outpatient rehabilitation programs. PARTICIPANTS: Rehabilitation patients (N=556; mean age, 61.4±23.6y; 47.1% women). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The PM-3D4D is a 19-item measure designed to evaluate participation in 3 domains-Productivity, Social, and Community-across 4 dimensions-Diversity, Frequency, Desire for change, and Difficulty. Intercorrelations among the 4 dimensions of the PM-3D4D and correlations between the PM-3D4D and 3 legacy instruments-Participation Assessment with Recombined Tools-Objective, Participation Measure for Post-Acute Care, and Satisfaction With Life Scale-were examined to establish the convergent and divergent validity of the PM-3D4D. Known-group validity was evaluated by comparing PM-3D4D scores across age groups and groups of people classified by functional level. RESULTS: The Diversity scale of the PM-3D4D was strongly correlated with the Frequency scale (Spearman correlation coefficient, rs=.83-.96 across the 3 domains), and these 2 scales showed moderate to strong correlations with the Difficulty scale (rs=.42-.70) but weak (rs=-.4 to 0) and insignificant correlations with the Desire for change scale. The Frequency and Difficulty scales of the PM-3D4D showed moderate to strong correlations with the Participation Assessment with Recombined Tools-Objective and Participation Measure for Post-Acute Care (rs=.41-.82), respectively, and the Desire for change scale had weak correlations with the Satisfaction With Life Scale (rs=-.32 to -.18). Significant differences in PM-3D4D scores were found by age and functional level. CONCLUSIONS: Findings of this study support the construct validity of the PM-3D4D, providing evidence for using the PM-3D4D to assess rehabilitation patients' participation performance and helping practitioners identify intervention priorities to improve patients' participation outcomes.

Development of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D): A New Outcome Measure for Rehabilitation.

OBJECTIVES: To describe the development of a participation measure that assesses 3 domains (productivity, social, and community) and 4 dimensions (frequency, diversity, desire for change, and perceived difficulty) of participation and to evaluate the initial psychometric properties in rehabilitation outpatients. DESIGN: A mixed-method approach included a literature review, item selection, expert reviews, cognitive interviews, and field testing with rehabilitation outpatients. Confirmatory factor analysis (CFA) and Rasch analysis were used to validate the construct validity of the difficulty dimension of the instrument. SETTING: Outpatient rehabilitation programs. PARTICIPANTS: An expert panel consisting of 12 rehabilitation and measurement experts contributed to measurement development; 20 rehabilitation outpatients participated in cognitive interviews; and a sample of rehabilitation outpatients (N=556) (average age, 61.36±23.62y; 53% men) participated in field testing. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). RESULTS: A scoring method for each dimension of the PM-3D4D was established. The instrument displayed good overall model fit in the CFA and unidimensionality across 3 domains after removing and collapsing locally dependent items identified from a principal component analysis. However, considering the poor personal reliability of the social subscale and its high correlation with the community subscale, we decided to merge the 2 subscales into 1. The combined subscale showed improved reliability and good construct validity by demonstrating a good model fit (comparative fit index, .985; Tucker-Lewis Index, .982, root mean square error of approximation, .061) and item fit. CONCLUSIONS: The PM-3D4D is a newly developed participation measure designed to assess multiple domains and dimensions of participation by rehabilitation patients. The psychometric analysis results supported the construct of the instrument and helped item revision. Further examination of the validity and reliability of the PM-3D4D will be conducted.

Association Between Manual Loading and Newly Developed Carpal Tunnel Syndrome in Subjects With Physical Disabilities: A Follow-Up Study.

OBJECTIVE: To identify the association between body composition and newly developed carpal tunnel syndrome (CTS) and to search for the best probabilistic cutoff value of associated factors to predict subjects with physical disabilities developing new CTS. DESIGN: Longitudinal. SETTING: University-affiliated medical center. PARTICIPANTS: Subjects with physical disabilities (N=47; mean age ± SD, 42.1±7.7y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Median and ulnar sensory nerve conduction velocity (SNCV) were measured at the initial and follow-up tests (interval >2y). Total and regional body composition were measured with dual-energy x-ray absorptiometry at the initial test. Leg lean tissue percentage was calculated to delineate each participant's manual loading degree during locomotion. Leg lean tissue percentage is the lean tissue mass of both legs divided by body weight. RESULTS: Based on median SNCV changes, we divided all participants into 3 groups: subjects with bilateral CTS (median SNCV value <45m/s plus a normative ulnar SNCV value >37.8m/s) in the initial test (n=10), subjects with newly developed CTS in the follow-up test (n=8), and subjects without additional CTS in the follow-up test (n=27). Eight of 35 subjects not having bilateral CTS initially developed new CTS (8.8% per year; mean follow-up period, 2.6y). Leg lean tissue percentage was associated with the probability of newly developed CTS (adjusted odds ratio, .64; P<.05). Subjects with a leg lean tissue percentage >12% were less likely to have developed new CTS at the follow-up test (sensitivity, .75; specificity, .85; area under the curve, .88; P<.005). CONCLUSIONS: Leg lean tissue percentage may be useful for early identification of developing new CTS in subjects with physical disabilities. Therefore, a preventive program for those subjects at risk can start early.

The effects of surface neuromuscular electrical stimulation on post-stroke dysphagia: a systemic review and meta-analysis.

OBJECTIVE: In this study, we intended to evaluate whether swallow treatment with neuromuscular electrical stimulation is superior to that without neuromuscular electrical stimulation, and whether neuromuscular electrical stimulation alone is superior to swallow therapy. METHODS: We searched the PubMed and Scopus databases from their earliest record to 31 December 2014 for randomized and quasi-randomized controlled trials that used neuromuscular electrical stimulation to treat post-stroke dysphagia. The Jadad scale was used to assess the quality of the included studies. We extracted the mean differences and standard deviation (SD) between baseline and posttreatment or posttreatment mean and SD for selected outcomes measured in the experimental and control groups for subsequent meta-analyses. RESULTS: Eight studies were identified. For the comparison "swallow treatment with neuromuscular electrical stimulation vs. swallow treatment without neuromuscular electrical stimulation," we found a significant standardized mean difference (SMD) of 1.27 (95% confidence interval (CI) = 0.51-2.02, P = 0.001) with significant heterogeneity (I(2) = 85%). The meta-analysis for the comparison of neuromuscular electrical stimulation alone and swallow therapy demonstrated a non-significant SMD of 0.25 (95% CI = -0.16-0.65, P = 0.23) without significant heterogeneity (I(2) = 16%). CONCLUSION: Swallow treatment with neuromuscular electrical stimulation seems to be more effective than that without neuromuscular electrical stimulation for post-stroke dysphagia in the short term considering the limited number of studies available. Evidence was insufficient to indicate that neuromuscular electrical stimulation alone was superior to swallow therapy.

The probability of spontaneous regression of lumbar herniated disc: a systematic review.

OBJECTIVE: To determine the probability of spontaneous disc regression among each type of lumbar herniated disc, using a systematic review. DATA SOURCES: Medline, Cochrane Library, CINAHL, and Web of Science were searched using key words for relevant original articles published before March 2014. Articles were limited to those published in English and human studies. REVIEW METHODS: Articles had to: (1) include patients with lumbar disc herniation treated conservatively; (2) have at least two imaging evaluations of the lumbar spine; and (3) exclude patients with prior lumbar surgery, spinal infections, tumors, spondylolisthesis, or spinal stenosis. Two reviewers independently extracted study details and findings. Thirty-one studies met the inclusion criteria. Furthermore, if the classification of herniation matched the recommended classification of the combined Task Forces, the data were used for combined analysis of the probability of disc regression of each type. Nine studies were applicable for probability calculation. RESULTS: The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs. CONCLUSIONS: Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc sequestration had a significantly higher rate of complete regression than did disc extrusion.

Using surface electromyography to guide the activation during motor-evoked potential measurement: An activation control method for follow-up studies.

OBJECTIVE: This study evaluated the reliability and validity of a convenient method that uses the real-time feedback surface electromyography (sEMG) to control muscle activation while measuring the MEP recorded from the quadriceps muscle in patients with stroke. METHODS: It measured the MEP parameters as well as the clinical assessment at initial test. Participants were directed to adjust their quadriceps contraction to extend the knee isometrically and maintain the EMG amplitude at 0.2 mV. MEPs were measured 2 weeks after the initial test again to assess the reliability of this measurement. RESULTS: A good test-re-test reliability was demonstrated with an intra-class correlation coefficient (ICC) > 0.8 for the motor threshold and a moderate reliability (ICC > 0.6) for the MEP latency and MEP amplitude, for both paretic and non-paretic legs. Patients with present MEPs had significantly higher scores in muscle power, the Fugl-Meyer assessment, the balance sub-scale of performance-oriented mobility assessment and the Barthel index; and lower NIHSS scores than those of patients with absent MEPs (all p < 0.05). CONCLUSION: The sEMG-guided low level muscle activation is suitable for MEP assessment in patients with leg weakness after a stroke and may be used for long-term follow-up studies.

Development and validation of the ICF-CY-Based Functioning Scale of the Disability Evaluation System--Child Version in Taiwan.

BACKGROUND/PURPOSE: The International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY) depicts human functioning [body functions (b), structures (s), and activities and participation (d) components] as the product of the interaction between health conditions and contextual factors [environmental factors (e) and personal factors]. In Taiwan, testers use the Functioning Scale of the Disability Evaluation System-Child version (FUNDES-Child) to collect information related to b, d, and e for children aged 6.0-17.9 years in the Disability Eligibility System (DES). The purpose of this study was to examine the content and construct validity of the FUNDES-Child. METHODS: We developed the FUNDES-Child through translating the existing questionnaires, cross-cultural adaptation, expert consensus, and field tests. Consensus meetings were conducted to link items from the FUNDES-Child to ICF-CY codes. To investigate construct validity, we examined associations among scores from the FUNDES-Child that reflected ICF-CY chapter-linked components. RESULTS: The FUNDES-Child items were successfully linked to all nine d-, five b-, and four e-chapters of the ICF-CY. Moderate correlations were found between scores that were expected to be related to specific chapters in the b, d, and e components. The scores of the b-chapters had stronger relationships with the d independence scores, while attitudes of others (e4) had stronger relationships with the d participation frequency scores. CONCLUSION: The FUNDES-Child had acceptable content validity and construct validity in the DES. The associations found among the ICF-CY chapter scores provided a model for investigating the impact of body functions and environmental factors on children's activities and participation.

Environmental effects on WHODAS 2.0 among patients with stroke with a focus on ICF category e120.

PURPOSE: To explore the environmental effects on the disabilities of people post stroke and to search for the best probabilistic cut-off value of the WHO Disability Assessment Schedule second edition (WHODAS 2.0) scores to predict people post stroke experiencing an access barrier to the International Classification of Functioning, Disability and Health category e120 products and technology for personal indoor and outdoor mobility and transportation (PMT). METHOD: We analyzed data of 162 younger (aged 18-64 years) and 202 older (aged ≥65 years) people post stroke from the databank of persons with disability between June 1, 2011 and February 29, 2012. All participants rated each WHODAS 2.0 item with environmental intervention (performance score) and without any intervention (capacity score). We used the paired capacity-performance score difference to assess the whole environmental effects on the participants' disability, evaluated each participant's access barrier to PMT (negative PMT), and used a receiver-operating characteristic curve to predict patients having a negative PMT. RESULTS: The whole environment acted as a barrier on mobility and self-care in >10 % of older people post stroke. Older patients having a summary index performance score of ≥78.8 points and younger patients having an index of ≥56.0 points were likely to experience a negative PMT. Older patients who have an access to PMT were possible to improve their daily activities performance, and younger patients could report less disability. CONCLUSIONS: An environmental support to improve the PMT accessibility is important for people post stroke to reduce their disability.

Delphi-based assessment of fall-related risk factors in acute rehabilitation settings according to the International Classification of Functioning, Disability and Health.

OBJECTIVE: To apply the International Classification of Functioning, Disability and Health (ICF) model to fall prevention by developing an ICF core set for fall risks in acute rehabilitation settings. DESIGN: Fall risk factors were identified based on a systematic review of the literature and linked to ICF categories. A consensus process was conducted using a Delphi-based evaluation technique. SETTING: University-based hospital. PARTICIPANTS: Multidisciplinary participants (N=20) from different institutions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A 5-point Likert-type scale was used to weigh the importance of each risk category. The level of agreement for each consensus was assessed based on Spearman rho and semi-interquartile range indices. Categories with a mean score ≥4 in the third round of evaluation were included in this ICF core set. RESULTS: The core set comprised 34 fall risk categories that were distributed as follows: 18 categories on body functions, 2 on body structures, 8 on activities and participation, 4 on environmental factors, and 2 categories on personal factors. CONCLUSIONS: An ICF core set for falls in acute rehabilitation settings was developed in this study. Further validation is required.

Implementing disability evaluation and welfare services based on the framework of the International Classification of Functioning, Disability and Health: experiences in Taiwan.

BACKGROUND: Before 2007, the disability evaluation was based on the medical model in Taiwan. According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person's eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. The purposes of this study were to: 1) design the evaluation tools for disability eligibility system based on the ICF/ICF-Children and Youth; 2) compare the differences of grades of disability between the old and new evaluation systems; 3) analyse the outcome of the new disability evaluation system. METHODS: To develop evaluation tools and procedure for disability determination, we formed an implementation taskforce, including 199 professional experts, and conducted a small-scale field trial to examine the feasibility of evaluation tools in Phase I. To refine the evaluation tools and process and to compare the difference of the grades of disability between new and old systems, 7,329 persons with disabilities were randomly recruited in a national population-based study in Phase II. To implement the new system smoothly and understand the impact of the new system, the collaboration mechanism was established and data of 168,052 persons who applied for the disability benefits was extracted from the information system and analysed in Phase III. RESULTS: The measures of the 43 categories for body function/structure components, the Functioning Scale of Disability Evaluation System for activities/participation components, and the needs assessment have been developed and used in the field after several revisions. In Phase II, there was 49.7% agreement of disability grades between the old and new systems. In Phase III, 110,667 persons with a disability received their welfare services through the new system. Among them, 77% received basic social welfare support, 89% financial support, 24% allowance for assistive technology, 7% caregiver support, 8% nursing care and rehabilitation services at home, and 47% were issued parking permits for persons with disability. CONCLUSION: This study demonstrated that disability evaluation system based on the ICF could provide a common language between disability assessment, needs assessment and welfare services. However, the proposed assessment protocol and tools require additional testing and validation.

Stroke risk in poliomyelitis survivors: a nationwide population-based study.

OBJECTIVES: To assess the prevalence and risk of stroke among adults with polio and controls. DESIGN: A prospective, probability-sampling, 6-year population-based cohort study. SETTING: A National Health Insurance Research Database consisting of 316,355 randomly selected enrollees. The database is related to a National Health Insurance program with more than 22 million participants. PARTICIPANTS: After excluding patients under 40 years of age, polio patients (N=212) (mean age ± SD, 54.0±10.2 y; 57.1% men) were identified from the database from January 1, 2003 to December 31, 2008. For each polio patient, 2 age- and sex-matched patients were recruited as controls. Control patients did not have any neuromuscular diseases commonly found in childhood. The frequencies of patients with potential risk factors for stroke were assessed. INTERVENTION: None. MAIN OUTCOME MEASURE: The prevalence and the adjusted odds ratio of ischemic stroke among polio patients and the controls were estimated. RESULTS: Polio patients had a higher prevalence of stroke (10.8% vs 2.4%, P<.001) than the controls. Polio patients with hypertension had a much higher prevalence of stroke (23.0%). The risk of stroke was higher for polio patients compared with the controls, yielding an adjusted odds ratio of 4.17 (95% confidence interval, 1.84-9.45, P<.001). Polio was a significant risk factor for stroke independent from hypertension, diabetes mellitus, hyperlipidemia, and cardiac diseases. CONCLUSIONS: Adults with polio had a high prevalence of ischemic stroke. Polio was an additional risk factor for stroke. Polio patients with hypertension might potentiate the risk of stroke. Developing a health promotion program, suitable for polio patients, to increase participation in activities and exercises may be essential, especially for polio patients with hypertension.

Clustering of functioning and disability profile based on the WHO disability assessment schedule 2.0 - a nationwide databank study.

OBJECTIVE: To compare and cluster the health status and disability restrictions associated with eight major physiological functions of body systems, using functioning domains of WHO Disability Assessment Schedule 2.0. DESIGN: Retrospective analyses of a nation-wide disability database. SETTING: Population-based study. PARTICIPANTS: Records from patients >18 years of age with disability were obtained from the Taiwan Data Bank of Persons with Disability (July 2012-November 2017). Disability functioning profile of the following diagnosis were analyzed: stroke, schizophrenia, hearing loss, liver cirrhosis, chronic kidney disease, congestive heart failure, burn, head and neck cancer. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic data, severity of impairment, and Disability Assessment Scale scores were obtained and analyzed. Radar charts were constructed using the WHO Disability Assessment Schedule 2.0. functioning domain score. Degree of similarity between any two given diagnosis was assessed by cluster analysis, comparing the Euclidean distances between radar chart data points among the six domains. RESULTS: Based on cluster analysis of similarities between functioning domain profiles, the eight diagnoses were grouped into different disability clusters. Four clusters of disability were named according to the type restriction patterns: global-impact cluster (stroke); interaction-restriction cluster (schizophrenia, hearing loss); physical-limitation cluster, (liver cirrhosis, CKD, and congestive heart failure); and specific-impact cluster (burn, head and neck cancer). The rates of institutionalization and unemployment differed between the four clusters. CONCLUSION: We converted WHO Disability Assessment Schedule 2.0. functioning domain scores into six-dimensioned radar chart, and demonstrate disability restrictions can be further categorized into clusters according to similarity of functioning impairment. Understanding of disease-related disabilities provides an important basis for designing rehabilitation programs and policies on social welfare and health that reflect the daily-living needs of people according to diagnosis.Implication for RehabilitationThe use of radar charts provided a direct visualization of the scope and severity of disabilities associated with specific diagnoses.Diagnosis-related disabilities can be organized into clusters based on similarities in WHODAS 2.0 disability domain profiles.Knowledge of the characteristics of disability clusters is important to understand disease-related disabilities and provide a basis for designing rehabilitation.

Contribution of ischemic stroke to hip fracture risk and the influence of gender difference.

OBJECTIVES: To clarify the contribution of stroke to the risk of hip fracture (HF) and the influence of gender difference on HF, and to estimate the incidence rate of poststroke HF. DESIGN: A prospective, probability-sampling, 10-year, population-based cohort study. SETTING: A National Health Insurance Research Database consisting of 200,432 randomly selected enrollees. PARTICIPANTS: Subjects with acute ischemic stroke (N=1951; mean age ± SD, 65.6 ± 9.8y; 56.5% men) were identified. For each stroke subject, 2 age- and gender-matched controls were recruited. Control subjects did not have any brain disease. Those subjects younger than 45 years were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The incidence rate and the adjusted hazard ratio of sustaining an HF were estimated. The cumulative HF-free probability was plotted. RESULTS: Stroke subjects had a higher incidence rate of HF than their controls (women: 11.3 vs 4.4/1000 person-years, P<.001; men: 5.6 vs 2.9/1000 person-years, P<.001). The risk of HF was higher among stroke subjects, yielding an adjusted hazard ratio (95% confidence interval) of 2.33 (1.62-3.34) for women and 1.73 (1.12-2.68) for men. Compared with men with stroke, women with stroke had an adjusted hazard ratio of 1.83 (1.18-2.85). Stroke subjects had a lower cumulative HF-free probability throughout the 10-year duration than did the control subjects (women, P<.001; men, P=.005). Half of the poststroke HFs occurred within 2.5 years of the onset of stroke. CONCLUSIONS: Ischemic stroke is a risk factor for HF, which is at work over and beyond age and gender. Being a woman with stroke increases this fracture risk. An active program for fracture prevention might prove effective for stroke subjects, and this may be especially true for women.

Body composition assessment in Taiwanese individuals with poliomyelitis.

OBJECTIVES: To measure the changes in the total and regional body fat mass, and assess the clinical usefulness of the body mass index (BMI) in detecting overweight subjects with sequelae of poliomyelitis. DESIGN: Prospective, cross-sectional study. SETTING: General community. PARTICIPANTS: Subjects with poliomyelitis (n=17; age range, 42-57y; mean, 47y; 12 men, 5 women) and able-bodied people (n=17) matched by sex, age, body weight, and body height participated in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Total and regional body composition was measured with dual-energy x-ray absorptiometry. Clinical characteristics such as blood pressure, serum biochemical studies, and habitual behaviors (daily cigarette smoking, alcohol consumption, and exercise regimen) of all participants were evaluated. RESULTS: Compared with able-bodied controls, subjects with poliomyelitis had a 50% greater total body fat mass, significant increases in the regional fat mass in every part of the body, and had the greatest increase of fat mass in the thorax. Nearly all the subjects (94%) with poliomyelitis were obese according to standards of body composition. However, one third of them had a BMI value of less than 25.0kg/m(2). CONCLUSIONS: People with poliomyelitis have a higher prevalence of obesity and a significant increase in total and regional fat mass. Current BMI underestimates the total body fat mass percentage compared with the control; therefore, a population-specific BMI should be used to address the prevalence of obesity in postpolio survivors.

Subdural hygroma-related heterotopic ossification in a patient with a stroke: a case report.

BACKGROUND: This study presents a patient with a stroke who had total paralysis of his left-side limbs after intracranial haemorrhaging, who later experienced partial weakness of the right-side limbs after a subdural hygroma. Both conditions occurred without major trauma. He received two separate operations, a craniotomy and placement of a ventriculoperitoneal shunt, before the appearance of the subdural hygroma. CASE STUDY: According to the literature, heterotopic ossification is often reported with major trauma-associated diseases, but is less frequently found in patients with non-traumatic conditions, from which this patient suffered. Although the patient had experienced no major trauma, he had multiple heterotopic ossifications on the side of the subdural hygroma-affected limbs, which exhibited better motor control and were less spastic than those of the opposite side. These heterotopic ossifications were around joints of the hip, knee and shoulder on his right side, as proven by plain radiography and a triple-phase bone scan and resulted in marked limitations of joint motions. This patient thus had major disabilities of his limbs bilaterally. CONCLUSIONS: The occurrence of heterotopic ossifications in the less-paretic limbs might have worsened this patient's functional outcome.