Relationship between Demographic and Clinical Factors with Physical Functioning of Stroke Patients / Jurnal Sains Kesihatan Malaysia

Stroke is a causal factor that commonly caused physical impairments and activity limitations among patients to perform daily activities until at certain level stroke patients will experience disability. The aim of this study is to examine the relationship of each demographic and clinical factors that is believed to associate with physical functioning of patients those who experienced stroke. This present study also try to compare physical functioning of patients with associated factors and then examine the correlation between those factors with physical functioning. A total of 147 respondents that pass for cognitive screening test involved in this study. Barthel Index (ADL) was administered to the respondents after 6 weeks of stroke attack in order to measure their physical functioning status. Results found that there was a significant difference [F(3, 143) = 4.06; p < 0.01] between level of educations with physical functioning of patients. With respect to clinical factors also showed a significant difference (p < 0.01) was higher in physical functioning when stroke attack occurred at right hemisphere of brain. There was a significant difference (p < 0.01) in physical functioning with respect to belief of recovery. Furthermore, number of stroke attack also showed a significant difference [F(1, 145) = 11.19; [p < 0.01] in physical functioning of patients. Correlation test that was carried out found a positive significant correlation (r = 0.24; p < 0.01) between physical functioning with respect to the affected lesion side. In conclusion, demographic and clinical factors also played the roles to determine level of physical functioning among stroke patients and thus these factors should be considered in any studies that intended to enhance physical functioning of patients in future.

Clinical variables associated with leprosy reactions and persistence of physical impairment

Introduction Leprosy is a chronic disease that affects skin and peripheral nerves. Disease complications include reactional episodes and physical impairment. One World Health Organization (WHO) goal of leprosy programs is to decrease the number of grade 2 impairment diagnoses by 2015. This study aims to evaluate clinical factors associated with the occurrence of leprosy reactions and physical impairment in leprosy patients. Methods We conducted a retrospective study of data from medical records of patients followed in two important centers for the treatment of leprosy in Aracaju, Sergipe, Brazil, from 2005 to 2011. We used the chi-square test to analyze associations between the following categorical variables: gender, age, operational classification, clinical forms, leprosy reactions, corticosteroid treatment, and physical impairment at the diagnosis and after cure. Clinical variables associated with multibacillary leprosy and/or reactional episodes and the presence of any grade of physical impairment after cure were evaluated using the logistic regression model. Results We found that men were more affected by multibacillary forms, reactional episodes, and grade 2 physical impairment at diagnosis. Leprosy reactions were detected in a total of 40% of patients and all were treated with corticosteroids. However, physical impairment was observed in 29.8% of the patients analyzed at the end of the treatment and our multivariate analysis associated a low dose and short period of corticosteroid treatment with persistence of physical impairments. Conclusions Physical impairment should receive an increased attention before and after treatment, and adequate treatment should be emphasized. .

Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment; Kidney, Bladder, Urethra, Male and Female Reproductive Systems (Preliminary Report)

For the evaluation of the kidney impairment, serum creatinine concentrations or glomerular filtration rates are mainly used, and the conditions of solitary or transplanted kidney and chronic dialysis are also taken into the considerations. Some symptoms and signs of the chronic renal disability in spite of adequate treatment add one additional grade. For evaluating bladder and urethral impairment, the criteria include voiding symptoms and signs. The patients with urinary diversions have impairment grades depending on the alteration of upper urinary tract function. For penile impairment, the degrees are evaluated using the international index of erectile function, nocturnal penile tumescence and color doppler ultrasonography. For evaluating impairment of other male reproductive organs, functional and anatomical changes of these organs, analysis of the semen or hormones and the state of solitary testis are used as the criteria. For evaluating impairment of female reproductive organs, pregnancy potential, requirement of continuous treatment and the ability of sexual intercourse are used. Also, degree of impairment is modified according to the ages in evaluating female reproductive systems. We have tried to make this evaluation system objective, scientific, and convenient, but still find it leaving much to be desired.

A Korean Academy of Medical Sciences Guides for the Evaluation of Permanent Impairment

Several different tools for the evaluation of the physical impairments or disabilities have been employed in Korea. In some cases, the same impairment has received different evaluations in accordance with different evaluation criteria. Sometimes evaluation tools from abroad have been used without efforts of adapting those tools to Korean situations. The general framework for developing impairment evaluation should be objective, useful, and actual. The Korean Academy of Medical Sciences (KAMS) guides has been developed as a tool for the evaluation of impairment by the experts' discussion and public consensus. The KAMS guides measure the impairment, not the disability, by the rate and encompass all kinds of physical impairments and diseases as many as possible. The guides need the next steps for being legislative and valid from the authorities.

A Comparative Study on Evaluation of Physical Impairment Among Revised Evaluation by Medical Association, McBride Disablitlity Evaluation and Evaluation of Permanent Impairment by American Medical Association

In 1992 the Korean Medical Association intended to make revised evaluation and rate of physical impairment based upon rate and evaluation of physical impairment according to National Compensation Law which was composed of 14 subdivisions with various rates of physical impairment. Committee of Evaluation of Physical Impairment in Korean Neurosurgical Society provided revised evaluation of nervous or mental impairment, peripheral never impairment and spinal column impairment. Because McBride Disability Evaluation and Guide to the Evaluation of Permanent Impairment by American Medical Association have been used widely in this field the author describe evaluation and rate of physical impairment in each method briefly and compare to revised evaluation by Korean Medical Association in subject of neurologic and spinal impairment.

Assesment of Physical Impairment and Disability Evaluation: Problem of Present System and Design for Better System

The assesment of physical impairment and disability evaluation must be precise and equitable to minimize a disadvantage on both claimer and obligator that may result from the unreasonable medical judgement. However, present systems are considered to be out of date, vague and inequitable to assess physical impairment and disability. A new guide for assessment of physical impairment and disability evaluation is required. As a guide for assessment of physical impairment, the American Medical Association's Guide can be used as a model, and a method of the disability evaluation, the Occupational Grading of Disability to Impairment Variants which is suggested by Korean Labor Ministry can be used. As a supplementary guide for disability evaluation, an adaptability index is proposed. The disability may be affected with the personal adaptability and care for the daily life, which may be improved by several personal factors, as age, occupation, life style, level of education, IQ, and a will for social adaptation. The adaptability index is suggested as a guide for a reasonable evaluation of the disability to be correlated to several factors during the life, which may be necessary for calcluation of the disable duration and correction of the cared duration. The final degree of a disability must be assessed as summation to be correlated to several factors which may be affected to physical disability.

A Comparative Study on Evaluation Methods of Permanent Impairment in Korea / 예방의학회지

In this study, literature review was done to examine and compare the current status and problems of different evaluation approaches toward permanent impairment in Korea. Alternatives and improvements in the current approaches in Korea were suggested. Series of cases were also examined to compare different approaches applied to the real cases, using 105 cases from a hospital data and another 207 cases from insurance company data. The main findings of the literature review are as follows; 1. The current evaluation methods of permanent impairment in Korea are grouped into two categories, grading and rating. Grading of impairments are expressly specified in 17 various statutes. 2. In Grading methods, the rigid system of 14 different grades has been adopted uniformally for the convenience of administration, which may not be, appropriate or valid from medical and scientifical aspect. 3. The advantage of McBride method is assessment of occupational disability rate. However the classified compensable occupations are only 280 and limited to manufacturing industries in 1960s' of U.S.A., which is not appropriate to current Korean circumstances. Especially, the job list does not include managerial officers or mental workers. 4. AMA Guides is the scientific and reasonable method for the assessment of physical impairment rate. However compensation and reparation of impairment case is difficult because this method cannot assess the disability rate according to occupation, age, etc. The results of cases comparative study are as follows: 5. The physical impairment could be compared in 167 out of total 312 cases and for the cases of complex impairment, McBride method underestimate physical impairment rate compared with AMA method. 6. When disability rate was assessed, occupation was considered the compensation of only 85 cases, and age was used in only 21 cases. This was because occupation and age compensation in McBride method are unreasonable. 7. The most ideal alternative is to assess physical impairment according to AMA method and then to develop a compensation method appropriate for the circumstances of Korea society.

Evaluation of Physical Impairment

In terms of the evaluating and the rating of permanent disability, medical opnion has the responsibility of informing the court on the scientific medical findings and evaluating the extent of permanent physical impairment. On this paper, the evaluation of physical impairment resulting from disease or injury involving the nervous system mainly based on domestic law will be reviewed.