Disability transitions after 30 months in three community-dwelling diagnostic groups in Spain.

BACKGROUND: Little is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions. PATIENTS AND METHODS: 300 chronic obstructive pulmonary disease (COPD), chronic heart failure and stroke patients living at home in Madrid were selected from general practitioner lists. In 2009, disability was assessed after a mean of 30 months using the World Health Organisation (WHO) Disability Assessment Schedule 2.0 (WHODAS 2.0). Follow-up was completed using death registries. Losses to follow-up were due to: death, 56; institutionalisation, 9; non-location, 18; and non-participation, 17. Changes in WHODAS 2.0 scores and life status were described and analysed using Cox and multinomial regression. Disability at end of follow-up was imputed for 56 deceased and 44 surviving patients. RESULTS: Mean disability scores for 200 surviving patients at end of follow-up were similar to baseline scores for the whole group, higher than their own baseline scores, and rose by 16.3% when imputed values were added. The strongest Cox predictors of death were: age over 84 years, adjusted hazard ratios with 95%CI 8.18 (3.06-21.85); severe/complete vs. no/mild disability, 5.18 (0.68-39.48); and stroke compared to COPD, 1.40 (0.67-2.91). Non-participants and institutionalised patients had higher proportions with severe/complete baseline disability. A one-point change in baseline WHODAS 2.0 score predicted independent increases in risk of 12% (8%-15%) for severe/complete disability or death. CONCLUSIONS: A considerably high proportion of community-dwelling patients diagnosed with COPD, CHF and stroke undergo medium-term changes in disability or vital status. The main features of the emerging pattern for this group appear to be as follows: approximately two-thirds of patients continue living at home with moderately reduced functional status; 1/3 die or worsen to severe/complete disability; and 1/10 improve. Baseline disability scores, age and diagnosis are associated with disability and death in the medium term.

ICF disability measured by WHO-DAS II in three community diagnostic groups in Madrid, Spain.

OBJECTIVE: The planning, provision and monitoring of medical and support services for patient groups with chronic ailments may require disability assessment and registration. The purpose of this study was to assess disability in three groups of patients with chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) or stroke. METHODS: Convenience samples of consecutive patients diagnosed with COPD (102), CHF (99), and stroke (99) were taken from 1,053 primary care users in the southern area of the autonomous region of Madrid. The patients were informed of the study and were assessed in their homes by trained field workers using the World Health Organization Disability Assessment Schedule II (WHO-DAS II). RESULTS: None of the groups had patients with extreme disability on their global WHO-DAS II scores. The prevalence of severe disability differed among the groups and was highest for stroke and CHF (33.33% and 29.29%, respectively) and lowest for COPD (14.71%). The three groups shared two similar traits, namely, a higher prevalence of disability among women than men, and a specific pattern by domain, with the highest prevalence of severe/extreme limitations being found in household life activities and mobility. Severe restrictions in Social Participation were more frequent in patients with stroke and CHF. The group with moderate disability according to the global WHODAS II score (n=94) showed a high prevalence of severe limitations in mobility, life activities and self-care. CONCLUSIONS: Disability among non-institutionalized persons with COPD, CHF and stroke is frequent and shows gender- and domain-related patterns similar to those described in a population-based study performed using the WHO-DAS II in elderly persons in Spain. ICF-validated disability categories could be useful in epidemiological surveys, individual assessments and primary care data monitoring systems.

ICF disability measured by WHO-DAS II in three community diagnostic groups in Madrid, Spain / Discapacidad CIF, según WHODAS-2, en tres grupos diagnósticos de atención primaria en un Área de Salud del sur de Madrid, España

Objective: The planning, provision and monitoring of medical and support services for patient groups with chronic ailments may require disability assessment and registration. The purpose of this study was to assess disability in three groups of patients with chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) or stroke. Methods: Convenience samples of consecutive patients diagnosed with COPD (102), CHF (99), and stroke (99) were taken from 1,053 primary care users in the southern area of the autonomous region of Madrid. The patients were informed of the study and were assessed in their homes by trained field workers using the World Health Organization Disability Assessment Schedule II (WHO-DAS II). Results: None of the groups had patients with extreme disability on their global WHO-DAS II scores. The prevalence of severe disability differed among the groups and was highest for stroke and CHF (33.33% and 29.29%, respectively) and lowest for COPD (14.71%). The three groups shared two similar traits, namely, a higher prevalence of disability among women than men, and a specific pattern by domain, with the highest prevalence of severe/extreme limitations being found in household life activities and mobility. Severe restrictions in Social Participation were more frequent in patients with stroke and CHF. The group with moderate disability according to the global WHODAS II score (n=94) showed a high prevalence of severe limitations in mobility, life activities and self-care. Conclusions: Disability among non-institutionalized persons with COPD, CHF and stroke is frequent and shows gender- and domain-related patterns similar to those described in a population-based study performed using the WHO-DAS II in elderly persons in Spain. ICF-validated disability categories could be useful in epidemiological surveys, individual assessments and primary care data monitoring systems (AU)

Objetivo: La planificación, prestación y monitorización de servicios sociales y sanitarios a pacientes con trastornos crónicos puede requerir evaluación y registro de su discapacidad. El objetivo de este estudio fue evaluar la discapacidad de tres grupos de pacientes con enfermedad pulmonar obstructiva crónica (EPOC), insuficiencia cardiaca congestiva (ICC) o ictus. Métodos: Pacientes con EPOC (102), ICC (99) e ictus (99), vistos consecutivamente, identificados de una lista de 1053 usuarios de atención primaria en el sur de la Comunidad Autónoma de Madrid, España. Tras ser informados, fueron evaluados en sus casas por entrevistadores entrenados utilizando WHODAS-2. Resultados: No hubo casos de discapacidad extrema, pero las tres poblaciones mostraron prevalencias de discapacidad grave según WHODAS-2 total, más altas en ictus e ICC (33,33% y 29,29%, respectivamente) y menores en EPOC (14,71%). Los grupos compartían un patrón de discapacidad más alta en mujeres y otro específico por dominios, con prevalencias más altas de discapacidad grave/extrema en actividades domésticas y movilidad. La participación social estaba más restringida en ictus e ICC. El grupo con discapacidad moderada en WHODAS-2 global (94 enfermos) mostraba prevalencias altas de discapacidad grave en movilidad, actividades diarias domésticas y autocuidado. Conclusiones: La discapacidad en personas no institucionalizadas con EPOC, ICC e ictus es frecuente, con patrones por sexo y dominio similares a los descritos en España con WHODAS-2 en un estudio poblacional de personas de edad avanzada. Las categorías CIF de discapacidad podrían utilizarse en encuestas epidemiológicas y evaluaciones individuales, así como en sistemas de información orientados a la monitorización de la discapacidad en atención primaria (AU)