Development and structural validation of a shortened version of the Participation Scale.

PURPOSE: To validate a shortened version of the Participation Scale (P-scale) that will be quicker to use and to describe the factor structure found in the P-scale data in various study samples. METHODS: A large multi-country and multi-cultural database was compiled consisting of 5125 respondents. Item analysis, explanatory factor analysis and confirmatory factor analysis were applied to identify items for deletion and investigate the factor structure of the P-scale. RESULTS: The multi-country database included 11 databases from six different countries. Respondents were affected by a range of health conditions, including leprosy, HIV/AIDS, dermatological conditions and various disabilities. Of the respondents included 57% were male. The P-scale Short (PSS) contains 13 items. A two-factor structure, with factors named "work-related participation" (three items) and "general participation" (10 items), showed the best model fit (Comparative Fit Index = 0.983, Tucker Lewis Index = 0.979, Rooted Mean Square Error of Approximation = 0.061). The Cronbach's alphas were very good for both the whole scale and the subscales, 0.91, 0.83 and 0.90, respectively. Correlation between the two factors was high (r = 0.75) indicating that interpreting the P-scale as measuring an overall factor "participation" is still valid. A very high correlation (r = 0.99) was found between the full P-scale and the PSS. CONCLUSIONS: The findings suggest good validity of the P-scale across a range of languages and cultures. However, field testing needs to confirm the validity of the PSS to measure the level of social participation restrictions across cultures and health conditions.

Opponens plasty rehabilitation protocol--a case report.

In this case report of opponens plasty, we will attempt to accomplish two objectives: 1) to characterize some innovative modifications to the standard rehabilitation protocol for an opponens plasty and 2) to explain the role and advantages of a new muscle re-education splint in this modified protocol.

The impact of hand dominance and ulnar and median nerve impairment on strength and basic daily activities.

The authors sought to determine the impact of hand dominance and its relation to function among ulnar alone and combined ulnar and median nerve lesions in leprosy patients. The study sample consisted of 62 persons affected with leprosy (mean age 36.1 years) who were either suffering from ulnar nerve lesions alone (34 patients) or combined ulnar and median lesions (28 patients). The data from the earlier work of this institution with normal hands in the adjacent rural uninvolved population were taken as controls. Grip, pulp-to-pulp, lateral, and three-jaw-chuck pinch strengths were measured using a hydraulic hand dynamometer and a pinch gauge. Basic daily activities were assessed using the battery developed at Karigiri. Means, standard errors, correlations, and t-tests were used in the analyses. The overall difference between grip and pinch strength measurements in both dominant and nondominant hands was 40% less than those in normal hands if the ulnar nerve alone was involved. If impairment of this nerve was combined with that of the median nerve, the overall difference in strength measurements increased to 51%. The hand strength of the dominant side was statistically significant between single and two nerves for pulp-to-pulp pinch (p = 0.019). No other strength tests produced statistically significantly results related to hand dominance (grip strength, lateral, chuck pinch) with either one or two nerve involvement. To observe differences in basic daily activities, scores were compared to Karigiri norms. The bilateral basic daily activities score was impaired by 45% compared with norms with only ulnar nerve involvement and by 59% with ulnar and median nerve involvement. The different pinch strengths related to basic daily activities was not significantly affected in nondominant hands, whether it was ulnar alone or combined ulnar and median nerve lesions. In this population diagnosed with leprosy, ulnar nerve impairment at the level of the elbow reduced the grip and pinch strengths and performance in basic daily activities by 40% and 45%, respectively. If combined with median nerve lesion at wrist level, the strengths and daily activity losses increased to 50% and 60%, respectively. There is no effect on grip strength either in ulnar or ulnar and median nerve injuries, irrespective of whether dominant or nondominant hands were involved. Different pinch strengths related to basic daily activities were significantly affected only in the dominant hand with involvement of these nerves.

Social stigma: a comparative qualitative study of integrated and vertical care approaches to leprosy.

Integration of leprosy into the general health system is very much emphasized by health care planners. One prime reason stated for this is to reduce stigma attached to this disease. This study was conducted in the state of Maharashtra, India, to compare the level of social stigma towards leprosy in communities with a vertical and an integrated programme. The data were collected in three areas of five villages each. The first two areas were in an integrated programme to test for internal consistency and the third in a vertical programme. All the leprosy patients with visible deformities in these villages were enrolled in the study, and an in-depth stigma measurement scale was administered. In addition, focus group discussions were conducted among the family members of leprosy patients and participative rural appraisal was done in the communities. The data were analysed using qualitative methods. A total of 24 leprosy patients with visible deformities participated in the in-depth stigma measurement exercise from 15 villages. Fifteen focus group discussions were conducted with families of leprosy patients and an equal number of participatory rural appraisals with communities were done. The results show that social stigma was virtually non-existent among the communities with the integrated approach and minimally experienced by leprosy patients in this model. However, a high level of self-stigmatization among leprosy patients was observed in the vertical approach and equally a high level of social stigma was found in their communities, which led to reduced interaction between the leprosy patients and their communities. The integrated approach to community-based primary health care is effective in reducing leprosy stigma in society.

Grip and pinch strength in relation to function in denervated hands.

A study was conducted in the Schieffelin Leprosy Research and Training Centre, Karigiri, Tamil Nadu, from March to September 2000 to find out the relationship between grip and pinch strengths and basic activities of daily living (BADL) in leprosy patients. Sixty-two patients (mean age: 36.1 years) suffering from impairment of motor nerve function in one or both hands were included in the study. Grip strength and pinch strength, namely pulp-to-pulp pinch strength, lateral pinch strength, tripod pinch strength, were measured using a hydraulic hand dynamometer and a pinch gauge. BADL was assessed using Karigiri activities of daily living rating scale. Frequency table, mean, median, range, standard deviation, correlation and multiple regressions were used in analysis. The results showed that there was a highly significant correlation (p < 0.001) between the grip and pinch strength and BADL. Multiple regression analysis showed only tripod pinch strength had a significant, independent influence on the BADL. Other two pinch strengths and grip strength were not significant. These results suggest that there is a significant relationship between the grip and pinch strengths and BADL. The tripod pinch strength is the most important hand strength contributing to the problems in BADL. In a measure of association between impairment and disability, the results revealed that out of 62 patients with physical impairment of the hand, 59 (95.2%) had experienced disabilities. This indicated that, despite impairment, 4.8% do not have any disabilities.

Hypopigmented face patches; their distribution and relevance to ocular complications in leprosy.

Eighty-two leprosy patients with hypopigmented patches over the face (cases) and an equal number of age-, sex-, and classification-matched leprosy patients without any hypopigmented patches over the face (controls) were examined for the distribution of hypopigmented facial patches, areas of anesthesia over the face, and eye complications. The hypopigmented patches did not follow any pattern and overlapped in the areas of sensation supplied by the three branches of the trigeminal nerve. Anesthesia over the face, evaluated by a Semmes-Weinstein monofilament which exerted a force of 0.05 grams, was present in 19.5% of the cases and 15.9% of the controls. Patients with hypopigmented facial patches were found to have more corneal hypoesthesia than patients who did not have hypopigmented facial patches. The risk of having impaired corneal sensation was three to four times higher in patients with hypopigmented facial patches. This feature can be used to identify decreased corneal sensation among leprosy patients under field conditions where direct estimation of corneal sensation is not advocated.

Quantitative assessment of facial sensation in leprosy.

The trigeminal and great auricular nerves which supply sensation to the face are affected in leprosy. No objective sensory testing methods have been devised for testing sensation in the face. Testing for corneal sensation to ascertain trigeminal nerve or visualization and palpation of the great auricular nerve alone may not be enough to establish the involvement of these nerves. In a sample of leprosy patients, face sensation threshold measurements were done using a set of three Semmes-Weinstein (SW) monofilaments that gave a force of 0.05-0.07, 0.2 and 2 g. Sensation was tested by three examiners and intra- and inter-observer testing was used as a means to validate the findings. Within the limitations of this study, the results indicate that use of SW monofilaments is a fairly reliable and repeatable method for sensory testing in the face. During follow up, a single filament with a force of 0.5-0.7 g (2.83 marking number in SW filament or any other filament with a corresponding gram force) could be used to assess sensation. A simple procedure of quantifying sensation in these nerves is suggested. A method to incorporate trigeminal or great auricular nerve sensory testing into the existing sensory assessment charts is also discussed.

Professional freedom of government leprosy personnel.

BACKGROUND: Government employment in India is known for its lack of flexibility. We studied whether this also involved professional freedom among health personnel working for the National Leprosy Eradication Programme. METHODS: The sample population consisted of National Leprosy Eradication Programme employees from Tamil Nadu and Andhra Pradesh and 8 health professional groups. A questionnaire was developed for each of them to elicit information on 5 aspects of their autonomy. They were studied individually and as homogeneous groups so that comparisons were possible both within and between groups in different regions who were conducting similar health programmes. RESULTS: National Leprosy Eradication Programme personnel enjoy a high degree of autonomy within the organization. This autonomy was evident in both states investigated, despite different administrations and it was not connected with the professional positions they held. Professional freedom correlated with the training activities, promotional prospects and commitment to the organization. CONCLUSIONS: The National Leprosy Eradication Programme job is not rigid because the organization is small and the intellectual needs of the professionals are met within it.

Understanding the attitude of multidisciplinary teams working in leprosy.

This study investigated the attitude of health personnel who were working for the National Leprosy Eradication Programme (NLEP) in India to their leprosy patients. These personnel were studied individually and as homogeneous groups so that comparisons were possible within and among the groups, and between the groups in different regions who were conducting similar health programmes, with a difference in length of between 1 and 5 years. The sample population was the NLEP employees of 2 state governments, consisting of 8 health professional groups. A questionnaire was developed for each of these groups to elicit information on 5 aspects of the relationships with their patients. The main outcome of the study was that two-thirds of the personnel tested possessed the 'minimum desirable' interaction with their patients. The quality of their relationships differed only among work specialities, but was consistent within the same speciality in different regions; this pattern was unchanged after 5 years of a multidrug (MDT) programme. A further analysis showed that although they possessed a caring attitude towards patients from low socioeconomic classes, a domineering attitude towards these same patients was also prevalent. Analysis according to speciality revealed that laboratory technicians had the highest "desirable attitude" (74.67%) and health educators had the lowest (57.5%), while the rest of the team members fell in between. The stigma shown towards leprosy was higher among doctors when compared to the rest of the team members. Discussion is based on the performance, overall and in each of its 5 facets, of each the professional groups with reference to their job descriptions and with similar studies undertaken earlier.

Impact of multidrug therapy on health personnel in their level of job satisfaction.

This study examines the "service" factors of the health professionals working in the National Leprosy Eradication Programme (NLEP) resulting from the introduction of multidrug therapy (MDT) technology, and their impact on their job satisfaction. The findings show that both among physicians and paramedicals, the significant chemotherapeutic dissatisfaction observed before the introduction of multidrug therapy has been replaced by a moderately positive satisfaction. This was much higher than the other incentives like pay, promotional prospect and job significance within NLEP and the community. It was also consistent over five years which was not the case with hydnocarpus and monotherapy technologies. Intercorrelation matrix test revealed three positive intercorrelations. First, personnel associated technology with personal progress which provided a sense of accomplishment while also satisfying their economic needs; second, they saw it as a mode of developing relationships with their clients; and third, it improved their self-image in the community. However, this satisfaction may not be static when there is a reduction of work load, or, the leprosy programme is integrated into general health services. Therefore, while planning these changes, care must be taken that the present level of technological satisfaction is maintained or further improved.