Dimensionality and hierarchical structure of disability measurement.

Since the D-code of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) in its full form has proven to be impractical, an instrument based on a selection of 28 items is used to measure disability in Dutch patients undergoing rehabilitation. The items are categorized into 5 domains of physical, activities of daily living (ADL), social, psychological, and communicative activity. Measurement is made on a 4-point scale ranging from 0 (not disabled) to 3 (severely disabled). As a result of the ordinal character of the rating, statistical and mathematical manipulations of the scores are complicated. The aim of this study was to obtain more insight in the dimensionality and hierarchical structure of the items, to overcome problems in comparing disability between items, between patients, and within patients between different moments in time. Mokken scale analysis of the disability scores from 1,967 rehabilitation inpatients showed that the 28 items constitute hierarchical scales. However, categorization of the items into the 5 original domains was not replicated. Five other scales or dimensions were investigated, measuring the level of extended ADL, extended psychological, fine motoric, work/leisure, and hearing/seeing activity, respectively. The number of items per dimension ranges from 14 in the extended ADL dimension to 2 each in the work/leisure and hearing/seeing dimensions. Although each disability item may be of importance in clinical case management, a reduced set of extended ADL items suffices to describe the disability level in this dimension for epidemiological research purposes. The other dimensions need further specification to provide reliable and sensitive measuring of disability.

Characteristics of patients from hospital-based in-patient rehabilitation in The Netherlands.

The University Hospital Dijkzigt in Rotterdam is one of the first hospitals in The Netherlands to have a rehabilitation department providing multidisciplinary, hospital-based-in-patient rehabilitation (HBIR). The main goals of HBIR are to estimate the final optimum level of patient's functioning, to investigate the most appropriate treatment setting to achieve this and to fulfil requirements for discharge from hospital as soon as possible. One of the central issues in rehabilitation in the Netherlands is to obtain more insight into the current daily practice of HBIR. The aim of this study was to describe the characteristics of the patients treated in HBIR in Dijkzigt Hospital. Registered data from 1967 HBIR patients treated between 1988 and 1990 were analysed retrospectively. The patients were on average 53.1 ( +/- 19.7) years old; the men (63%) were significantly younger than the women (mean age of 50.8 and 57.0 years, respectively). The main diagnostic groups were stroke (27%), progressive and regressive neurological conditions (17%), hand injuries (9%), spinal cord lesion (9%), orthopaedic injuries (8%) and amputation of lower extremity (8%). The median duration of HBIR and hospitalization were 13 days and 33 day, respectively. Most patients were discharged home (63%), or to a nursing home (14%) or a rehabilitation centre (8%). The results of this study can be used in policy discussions on HBIR and provides a description of the population which needs to be studied longitudinally in future research on the outcomes of HBIR.

[Usefulness of a physical examination upon return from the tropics]. / Nut van medisch onderzoek na terugkeer uit de tropen.

This study was undertaken to determine the usefulness of medical check-ups after return from the tropics by retrospective analysis of the data of the outpatient clinic for tropical medicine and imported diseases of the University Hospital of Nijmegen. During the years 1986-1990, 379 persons who had returned from the tropics and who were asymptomatic were subjected to a medical check-up (this group comprised 32% of the total of 1190 patients seen in the clinic during this period). In 230 persons (61%) no abnormality was detected. In 101 persons (27%) one or more diagnoses were made which were related to their stay in the tropics. For three-quarters of them treatment was indicated (77 patients). In the remaining 48 persons (13%) diagnoses were made which were neither related to the tropics nor required treatment (e.g. mild varices or minor kyphoscoliosis). Such diagnoses did not contribute to the usefulness of a medical check-up. In 200 persons a chest X-ray was made, either because they had stayed in the tropics for more than 3 years, or had had close contacts with the local population or because abnormalities were suspected on the basis of history or physical examination. While four X-rays revealed significant pathology, in only one of these did the patient benefit from its detection (early pulmonary tuberculosis). We conclude from our study that a medical check-up after return from the tropics is justifiable. The duration of the stay in the tropics by itself is no indication for a chest X-ray.(ABSTRACT TRUNCATED AT 250 WORDS)