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.

Effectiveness of hyaluronic acid for treating diabetic foot: a systematic review and meta-analysis.

Diabetic foot ulceration is a major complication of diabetes mellitus. Hyaluronic acid (HA) is used in the treatment of diabetic foot. This meta-analysis was designed to evaluate if HA increased the complete healing rate of diabetic foot compared with controls. We searched Medline, Cochrane, EMBASE, Google Scholar (until January 31, 2014) databases for prospective randomized controlled trials that assessed the effectiveness of HA in treating foot ulcers resulting from diabetes. The primary outcome for the study was complete healing rate of the ulcer at 12 weeks. Three hundred twenty-eight patients were identified from four studies that evaluated the rate of healing of diabetic foot that were treated with HA or controls. Among the four studies, odd ratios (OR) ranged from 1.19 to 8.86, with the overall OR being 1.71 (p = 0.047; 95% confidence interval = 1.01 to 2.90). In summary, our meta-analysis strengthens the findings that HA is beneficial in treating diabetic foot by increasing the rate of wound healing. These findings support the use of HA in treating diabetic foot.

Possible association between phantom vibration syndrome and occupational burnout.

BACKGROUND: Phantom vibration syndrome (PVS) and phantom ringing syndrome (PRS) occur in many cell phone users. Previous studies have indicated an association between PVS/PRS and job stress. The aim of this study was to determine if PVS/PRS were also associated with occupational burnout. METHODS: This was a cross-sectional study of 384 employees of a high-tech company in northern Taiwan. They all completed a phantom vibration and ringing questionnaire, the Hospital Anxiety and Depression Scale, and the Chinese version of the Occupational Burnout Inventory. RESULTS: Significantly more women and people with at least a college education were in the population with PRS and PVS, respectively. Anxiety and depression had no associations with PVS/PRS. Higher scores for personal fatigue, job fatigue, and service target fatigue had an independent impact on the presence of PVS, but only a higher score for service target fatigue had an independent impact on the presence of PRS. CONCLUSION: The independent association between work-related burnout and PVS/PRS suggests that PVS/PRS may be a harbinger of mental stress or a component of the clinical burnout syndrome, and may even be a more convenient and accurate predictor of occupational burnout.