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Huang YC, Hong CT, Chi WC, Yen CF, Fang Liao H, Liou TH, Chan L. Deterioration of fine motor skills and functional disability in patients with moderate-to-advanced Parkinson disease: A longitudinal follow-up study. Arch Gerontol Geriatr 2024; 121:105366. [PMID: 38341958 DOI: 10.1016/j.archger.2024.105366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Parkinson disease (PD) caused substantially disability. The impairment of fine motor skills (FMSs) is correlated with the severity of functional disability (FD) cross-sectionally in people with PD (PwP). The present study investigated the decline in FMSs and the predictive value of baseline FMSs for the progression of FD. METHODS People with moderate-to-advanced PD who received two evaluations within 1-5 years were identified from the Taiwan Data Bank of Persons with Disability database. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate FD, and FMSs including pen-holding, buttoning, and knotting were assessed. RESULTS Our study included 2,271 people with moderate-to-advanced PD. We observed annual progression of FD in each domain of the WHODAS 2.0, with no difference between the sexes. The most significant correlation between FD and FMSs was that of decline in buttoning ability and deterioration of summary WHODAS 2.0 scores. Deterioration in FD across all domains of WHODAS 2.0 was associated with at least one FMS. The extent of disability in all three types of FMS at baseline was also correlated with deterioration of motility. Additionally, baseline disability in buttoning was significantly correlated with cognitive decline, and disability in knotting was significantly associated with the progression of FD. CONCLUSION FMSs may be reliable markers for further FD, particularly in the areas of cognition, motility, and life activity. Because of the significant FD observed in people with moderate-to-advanced PD, the availability of predictors is essential for applying precautionary measures and providing appropriate treatment.
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Affiliation(s)
- Yin-Chia Huang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, 11031, Taiwan
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, 23561, Taiwan; Department of Occupational Therapy, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, 23561, Taiwan; Department of Public Health, Tzu Chi University, Hualien City, 97004, Taiwan
| | - Hua- Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, 23561, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - Tsan-Hon Liou
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, 11031, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, 11031, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
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Lin LC, Liou TH, Chi WC, Yen CF, Liao HF, Wu CW. Mobility, educational, and social performance of children with learning problems in Taiwan: A 3-year follow-up study. Dev Med Child Neurol 2022; 64:1156-1167. [PMID: 35318642 DOI: 10.1111/dmcn.15203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/19/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
AIM This study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability. METHOD We included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System-Child version to investigate performance at follow-up for at least 3 years. RESULTS These participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement. INTERPRETATION This cross-diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects. WHAT THIS PAPER ADDS Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.
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Affiliation(s)
- Lien-Chieh Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chou Chi
- School of Occupational Therapy, Chungshan Medical University, Taichung, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Hua-Fang Liao
- Taiwan Association of Child Development and Early Intervention, Hualien City, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Liao HF, Yen CF, Chiu TY, Chi WC, Liou TH, Chang BS, Wu TF, Lu SJ. Factor Structure of an ICF-Based Measure of Activity and Participations for Adults in Taiwan's Disability Eligibility Determination System. Front Rehabilit Sci 2022; 3:879898. [PMID: 36188921 PMCID: PMC9397969 DOI: 10.3389/fresc.2022.879898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
To assess activity and participation for adults in Taiwan's Disability Eligibility Determination System (DEDS), we developed a measure, the Functioning Disability Evaluation Scale—Adult version (FUNDES-Adult), based on the 36-item interviewer-administered version of the WHO Disability Assessment Schedule 2.0. The purpose of this study was to examine the factor structures of performance and capability dimensions of the FUNDES-Adult. This study followed a methodology research design to investigate the construct validity of the two dimensions of the FUNDES-Adult. Two samples were randomly stratified from the databank of adults with disabilities to examine structural validity by the exploratory factor analysis (EFA) (n = 8,730, mean age of 52.9 ± 16.81) and the confirmatory factor analysis (CFA) (n = 500, mean age of 54.3 ± 16.81). The results demonstrated that the EFA yielded 5-factor structures for both performance dimension (73.5% variance explained) and capability dimension (75.9% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (GFI, NFI, CFI, and TLI ≥ 0.95, RMSEA < 0.09). The results of this study provide evidence that the FUNDES-Adult has acceptable structural validity for use in Taiwan's DEDS. Utility of the FUNDES-Adult in rehabilitation, employment, welfare, and long-term care services needs further study.
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Affiliation(s)
- Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
- Taiwan Society of ICF, Taipei, Taiwan
- *Correspondence: Hua-Fang Liao
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
- Chia-Feng Yen
| | - Tzu-Ying Chiu
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
| | - Wen-Chou Chi
- Department of Occupational Therapy, Chungshan Medical University, Taichung, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ben-Sheng Chang
- Department of Psychology, Soochow University, Taipei, Taiwan
| | - Ting-Fang Wu
- Graduate Institute of Rehabilitation Counseling, National Taiwan Normal University, Taipei, Taiwan
| | - Shu-Jen Lu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Jen HJ, Kao CM, Chang KH, Yen CF, Liao HF, Chi WC, Chung WK, Liou TH. Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: A 4-year follow-up study. Ann Phys Rehabil Med 2021; 64:101442. [PMID: 33069868 DOI: 10.1016/j.rehab.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Stroke is a leading cause of long-term disability and is considered a major global health burden. OBJECTIVES We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan. METHODS We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects. RESULTS A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains. CONCLUSION Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.
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Affiliation(s)
- Hsiu-Ju Jen
- Department of nursing, Taipei medical university, Shuang Ho hospital, New Taipei, Taiwan; School of nursing, college of nursing, Taipei medical university, Taipei, Taiwan.
| | - Chia-Man Kao
- Department of nursing, Taipei medical university, Shuang Ho hospital, New Taipei, Taiwan.
| | - Kwang-Hwa Chang
- Department of physical medicine and rehabilitation, school of medicine, college of medicine, Taipei medical university, Taipei, Taiwan; Graduate institute of injury prevention and control, college of public health, Taipei medical university, Taipei, Taiwan; Department of physical medicine and rehabilitation, Taipei medical university, Wan Fang hospital, Taipei, Taiwan.
| | - Chia-Feng Yen
- Department of public health, Tzu Chi university, Hualien, Taiwan.
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, Taipei, Taiwan; School and graduate institute of physical therapy, college of medicine, National Taiwan university, Taipei, Taiwan.
| | - Wen-Chou Chi
- Department of occupational therapy, Chung Shan medical university, Taichung, Taiwan.
| | - Wen-Kuei Chung
- Department of physical medicine and rehabilitation, Taipei medical university, Wan Fang hospital, Taipei, Taiwan.
| | - Tsan-Hon Liou
- Department of physical medicine and rehabilitation, school of medicine, college of medicine, Taipei medical university, Taipei, Taiwan; Taiwan Society of International Classification of Functioning, Disability and Health, Taipei, Taiwan.
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Chao PZ, Huang SW, Escorpizo R, Chi WC, Yen CF, Liao HF, Chen YW, Liou TH. Effects of Hearing Disability on the Employment Status Using WHODAS 2.0 in Taiwan. Int J Environ Res Public Health 2020; 17:ijerph17249374. [PMID: 33333752 PMCID: PMC7765231 DOI: 10.3390/ijerph17249374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 11/16/2022]
Abstract
The aim of this study was to explore the association between employment status and World Health Organization Disability Assessment Schedule, Second Edition (WHODAS 2.0) scores of working-age subjects with hearing impairment. The data of 18,573 working-age subjects (age ≥ 18 and <65 years) with disabling hearing impairment were obtained from the Taiwan Data Bank of Persons with Disability (TDPD) for the period from 11 July 2012 to 31 October 2018. Demographic data and WHODAS 2.0 scores for each domain were analyzed to identify their relationship with employment status. Unemployed subjects with disabling hearing impairment had higher WHODAS 2.0 scores in all domains compared with the employed subjects. Binary logistic regression revealed that older age, female sex, lower educational level, institutional residence, rural residence, lower family income, and moderate to severe impairment were more strongly associated with unemployment status. The data in this large population-based study offer comprehensive information on important factors associated with the employment status of people with disabling hearing impairment. Early identification of risks of unemployment of patients with hearing impairment can raise awareness for aggressive community and government campaigns regarding public health to improve the self-confidence, social participation, and related psycho-social wellbeing of people.
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Affiliation(s)
- Pin-Zhir Chao
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan;
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan; (S.-W.H.); (Y.-W.C.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT 05405, USA;
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.)
- Department of Occupational Therapy, College of Medical Sciences and Technology, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.)
- Department of Public Health, Tzu Chi University, Hualien 97004, Taiwan
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.)
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan; (S.-W.H.); (Y.-W.C.)
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan; (S.-W.H.); (Y.-W.C.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.)
- Correspondence: ; Tel.: +886-222-490-088 (ext. 1600)
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Liou WC, Chan L, Hong CT, Chi WC, Yen CF, Liao HF, Chen JH, Liou TH. Hand fine motor skill disability correlates with dementia severity. Arch Gerontol Geriatr 2020; 90:104168. [PMID: 32650157 DOI: 10.1016/j.archger.2020.104168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The progression of dementia, which impairs motor skills and cognitive function, is a warning of greater disability. The present study investigated the association between hand fine motor skills, assessed according to the Functioning Disability Evaluation Scale - Adult Version (FUNDES-Adult), and dementia severity. METHODS People with mild and moderate to severe dementia were identified from the Taiwan Data Bank of Persons with Disability. The FUNDES-Adult was assessed for all enrollees, and the following hand fine motor skills were evaluated: pen-holding, buttoning, and knotting. Statistical analysis was performed using SAS, and P values < 0.05 were considered significant. RESULTS Disability in all the 3 fin. motor skills was significantly greater in patients with moderate to severe dementia than in those with mild dementia. Disability in any of the skills was sensitive to distinguish mild from moderate to severe dementia (sensitivity: 78.1 %, specificity: 55.2 %, area under the curve: 0.739, 95 % confidence interval [CI]: 0.734-0.745). Those with fine motor skill disability were at a significantly higher risk of moderate to severe dementia (odds ratio: 3.71, 95 % CI: 3.53-3.90, P < .001). CONCLUSION Hand fine motor skill disability was more prevalent in patients with moderate to severe dementia than in patients with mild dementia. A straightforward motor skill assessment can serve as a screening tool in the community to detect the progression of dementia.
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Affiliation(s)
- Wei-Chin Liou
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Jia-Hung Chen
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
| | - Tsan-Hon Liou
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan.
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Tan S, Hong CT, Chen JH, Chan L, Chi WC, Yen CF, Liao HF, Liou TH, Wu D. Hand Fine Motor Skill Disability Correlates with Cognition in Patients with Moderate-to-Advanced Parkinson's Disease. Brain Sci 2020; 10:brainsci10060337. [PMID: 32498218 PMCID: PMC7349665 DOI: 10.3390/brainsci10060337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
In older individuals, hand fine motor skill disability is associated with cognitive levels. Similarly, patients with moderate-to-advanced Parkinson's disease (PD) often have cognitive dysfunction. Here, we investigated the association between hand fine motor skill and cognitive dysfunction in patients with moderate-to-advanced PD. Moderate and advanced PD patients with and without dementia were identified from the Taiwan Data Bank of Persons with Disability. Hand fine motor capacities, namely pen holding, buttoning, and knotting, were assessed with the World Health Organization Disability Assessment Schedule 2.0. Statistical analyses were performed on Statistical Analysis System (SAS) and a p value of <0.05 was considered significant. In total, 3440 patients with PD were enrolled, of which 612 had dementia, exhibiting significant disability in all three tasks. After adjustments for age, sex, and PD severity, pen holding and knotting were significantly associated with PD dementia. The presence of any disability in either task was not only sensitive to the presence of dementia but also associated with cognitive disability in moderate and advanced PD patients without dementia. In conclusion, hand fine motor skill disability was associated with cognitive disability in patients with moderate-to-advanced PD. These simple hand fine motor skills may thus be applicable in screening tests for the early identification of cognitive dysfunction in patients with moderate-to-advanced PD.
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Affiliation(s)
- Shennie Tan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (S.T.); (C.T.H.); (J.-H.C.); (L.C.)
| | - Chien Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (S.T.); (C.T.H.); (J.-H.C.); (L.C.)
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 23561, Taiwan
| | - Jia-Hung Chen
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (S.T.); (C.T.H.); (J.-H.C.); (L.C.)
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (S.T.); (C.T.H.); (J.-H.C.); (L.C.)
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 23561, Taiwan
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.); (T.-H.L.)
- Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.); (T.-H.L.)
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.); (T.-H.L.)
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Tsan-Hon Liou
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan; (W.-C.C.); (C.-F.Y.); (H.-F.L.); (T.-H.L.)
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Dean Wu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (S.T.); (C.T.H.); (J.-H.C.); (L.C.)
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 23561, Taiwan
- Correspondence: or
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Chi WC, Lin PJ, Chang IC, Chen SL. The inhibiting effects of resistance to change of disability determination system: a status quo bias perspective. BMC Med Inform Decis Mak 2020; 20:82. [PMID: 32349754 PMCID: PMC7191711 DOI: 10.1186/s12911-020-1090-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Information systems implementation projects have been historically plagued by failures for which user resistance has consistently been identified as a salient reason. Most prior studies investigated either the causes or the consequences of Resistance to Change (RTC) of medical related Information Systems. In this study, we simultaneously explore the causes and impacts of RTC of Disability Determination System (DDS). Methods This study adopts the Status Quo Bias perspective and combines the information systems usage model and Technology Acceptance Model (TAM) as theoretical foundation to investigates the causes and impacts of users’ RTC on their intention to use the DDS. Data were obtained through internet questionnaire survey. Totally, 326 respondents from 22 local governments and 142 hospitals were collected, of which 252 were valid samples and were analyzed using structure model analysis. Results The research model is proved with eight out of 11 hypotheses being supported. The antecedents of RTC can explain 21.4% of the RTC variation, and the RTC impacts can explain 57.5% of the variation of intention to use DDS. Conclusions Combining the Status Quo Bias perspective and key component of TAM provides an adequate explanation of adopting intention of changing systems and extend the existing knowledge of information systems adoption. The results provide as a reference for managing users’ RTC and enhance the effects and efficiency of new systems adoption.
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Affiliation(s)
- Wen-Chou Chi
- Department of Occupation Therapy, Chung Shan Medical University, Occupational Therapy Room, Chung Shan Medical University Hospital, No.110, Sec.1, Jianguo N.Rd, Taichung City, 40201, Taiwan, Republic of China
| | - Po-Jin Lin
- Department of Information Management, National Chung Cheng University, No.168, Sec. 1, University Rd., Minhsiung, Chiayi, 62102, Taiwan, Republic of China
| | - I-Chiu Chang
- Department of Information Management, National Chung Cheng University, No.168, Sec. 1, University Rd., Minhsiung, Chiayi, 62102, Taiwan, Republic of China
| | - Sing-Liang Chen
- Department of Information Management, Nanhua University, No.55, Sec. 1, Nanhua Rd., Dalin Township, Chiayi County, 62249, Taiwan, Republic of China.
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Chen R, Liou TH, Miao NF, Chang KH, Yen CF, Liao HF, Chi WC, Chou KR. Using World Health Organization Disability Assessment Schedule 2.0 in people with schizophrenia: a 4-year follow-up. Eur Arch Psychiatry Clin Neurosci 2020; 270:301-310. [PMID: 31011812 DOI: 10.1007/s00406-019-01000-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/21/2019] [Indexed: 11/30/2022]
Abstract
Little is known about the changes of people with schizophrenia disability in Taiwan who receive routine treatments under the current mental healthcare system. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to assess and track changes in the degree of disability in people with schizophrenia before and after 4 years of follow-up. Data on 4497 people with schizophrenia were acquired from the Taiwan Data Bank of Persons with Disability. The WHODAS 2.0 was used for disability assessment, and the chi-square test, logistic regression and generalised estimating equations were adopted for statistical analysis. People with schizophrenia exhibited improvement in cognition, mobility and participation among the six domains as well as in the overall score. The degree of disability in all domains remained mild to moderate among people aged 18-64 years; the degree of disability in cognition declined from moderate to severe among patients aged ≥65 years. The degree of disability in all domains remained mild to moderate among people with mild to moderate impairment; among those with severe impairment, the degree of disability in the domains of cognition and life activities declined from moderate to severe and the degree of disability in the domain of mobility declined from mild to moderate. Community-dwelling patients exhibited less degree of disability in all domains than their institutionalised peers. Early detection and treatment and an emphasis on communication and social problem-solving skills in rehabilitation programmes are recommended for people with schizophrenia.
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Affiliation(s)
- Ruey Chen
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, ROC.,School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Hsing Street, 110, Taipei, Taiwan, ROC
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Nae-Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
| | - Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, ROC.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan, ROC
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, Taipei, Taiwan, ROC.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Wen-Chou Chi
- Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan, ROC. .,Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
| | - Kuei-Ru Chou
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, ROC. .,School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Hsing Street, 110, Taipei, Taiwan, ROC. .,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
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10
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Wang CY, Chan L, Wu D, Chi WC, Yen CF, Liao HF, Hong CT, Liou TH. Effect of Cognitive Disability and Ambulation Status on Functioning in Moderate-to-Advanced Parkinson Disease. Front Neurol 2020; 10:1360. [PMID: 31998219 PMCID: PMC6962294 DOI: 10.3389/fneur.2019.01360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/09/2019] [Indexed: 12/23/2022] Open
Abstract
Background: As the disease progresses to moderate to advanced stages, people with Parkinson's disease (PwP) are likely to have various degrees of disability due to the motor and non-motor symptoms, such as ambulatory difficulty and cognitive impairment. The objective of this study was to investigate the impact of cognition and ambulation status on the functioning and disability of PwP using the World Health Orgnaization Disability Assessment Schedule 2.0 (WHODAS 2.0). Materials and Methods: A group of 10,581 PwP with Hoehn and Yahr Staging 3 and above were collected from a database of disability evaluation and functional assessment using the Taiwan Data Bank of Persons with Disability between July 2012 and October 2018. WHODAS 2.0 was administered and all PwP were grouped based on their ambulatory status, which was assessed by 3-m back and forth walk and cognitive ability, assessed by WHODAS 2.0 first domain with cut-off level at 58. Results: Non-ambulation and cognitive disability contributed independently to disability in all aspects of WHODAS 2.0 survey, including self-care, getting along with others, performing life activities and participation in society. Compared to ambulation status, cognitive disability had a greater negative impact on functioning in all aspects. Conclusion: Cognitive disability was associated with greater disability in moderate to advanced PwP than non-ambulatory status. The results of this study may indicate that cognition preservation is essential to ameliorate functional impairment and disability in moderate to advanced PwP.
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Affiliation(s)
- Chen Yu Wang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Dean Wu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Public Health, Tzu Chi University, Hualien City, Taiwan
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
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11
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Lee YH, Goo-Yoshino S, Lew HL, Chi WC, Yen CF, Liao HF, Chen SC, Liou TH. Social participation in head and neck cancer survivors with swallowing disorder: World Health Organization Disability Assessment Schedule 2.0 study. Head Neck 2019; 42:905-912. [PMID: 31886608 DOI: 10.1002/hed.26062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/17/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Social function and quality of life were negatively impacted by the sequelae of treatment for the disease in the head and neck cancer survivor with swallowing disorder. METHOD Data from a total of 1023 survivors between July 2012 and November 2017 were collected from the Taiwan Data Bank of Persons with Disability. Nonparametric rank F test was used to analyze the influence of different variables on social participation. RESULTS (a) All WHODAS (World Health Organization Disability Assessment Schedule) 2.0 scores revealed significantly increased difficulty when swallowing impairment increased (P < .001). (b) Unemployment, institutionalization, severity of swallowing impairment, cancer sites, and WHODAS 2.0 score of domains 1 to 4 were negatively related to social participation, while living in rural area is related to increased social participation. CONCLUSIONS Social participation was negatively affected by many variables in this population. Among these variables, cancer sites and WHODAS 2.0 score of domains 1 to 4 were the strongest factors.
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Affiliation(s)
- Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shari Goo-Yoshino
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Henry L Lew
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii.,Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Wen-Chou Chi
- School of Occupational Therapy, Chungshan Medical University, Taichung, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Hua-Fang Liao
- Taiwan Association of Child Development and Early Intervention, Hualien City, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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12
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Lee HH, Hong CT, Wu D, Chi WC, Yen CF, Liao HF, Chan L, Liou TH. Association between Ambulatory Status and Functional Disability in Elderly People with Dementia. Int J Environ Res Public Health 2019; 16:E2168. [PMID: 31248158 PMCID: PMC6616473 DOI: 10.3390/ijerph16122168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 11/16/2022]
Abstract
Dementia is highly comorbid with gait disturbance, and both conditions negatively impact the ability of elderly people to conduct daily living activities. The ambulatory status of older adults with dementia may cause variable functional disability, which is crucial for the progression of dementia. The present study investigated the association between ambulatory status with functional disability in elderly people and dementia by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). In total, 34,040 older adults with mild-to-advanced dementia were analyzed and categorized according to their ambulatory status into three groups: Nonambulatory, assisted ambulatory, and ambulatory. In general, poor ambulatory status was associated with both greater severity of dementia and functional disability. The study participants were further segregated according to their ages and dementia severity levels, which demonstrated that the WHODAS 2.0 domains of functioning for getting along, life activities, and participation (domains 4, 5-1, and 6) were all associated with ambulatory status. In addition, nonambulatory status was significantly associated with institution residency among older adults with dementia. In conclusion, the present study clearly demonstrated the role of ambulatory status in functional disability in older adults with dementia, and the association persisted among older adults of different ages and severities of dementia. This finding indicates the importance of maintaining walking ability in the management of dementia in older adults.
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Affiliation(s)
- Hsun-Hua Lee
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Dizziness and Balance Disorder Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Dean Wu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan.
- Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan.
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan.
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan.
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan.
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Tsan-Hon Liou
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City 23561, Taiwan.
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan.
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan.
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13
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Chiu TY, Finger ME, Fellinghauer CS, Escorpizo R, Chi WC, Liou TH, Yen CF. Validation of the World Health Organization Disability Assessment Schedule 2.0 in adults with spinal cord injury in Taiwan: a psychometric study. Spinal Cord 2019; 57:516-524. [DOI: 10.1038/s41393-018-0231-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 11/09/2022]
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14
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Chang KH, Chi WC, Liao HF, Chen SC, Chiou HY, Escorpizo R, Liou TH. Development of indicators to assure quality of disability evaluation based on the International Classification of Functioning, Disability, and Health in Taiwan: a Delphi consensus. Disabil Rehabil 2019; 42:975-982. [PMID: 30596295 DOI: 10.1080/09638288.2018.1514536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To develop a set of quality indicators (QIs) for managing the International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan.Method: Using a three-round Delphi exercise, 20 representatives from the social welfare associations for people with disability completed the consensus process. Questionnaire 1 comprised 52 potentially important factors relevant to good services for persons with disabilities in the system. An additional nine items were added to questionnaires 2 and 3. The responders rated the importance of each item using a 5-point Likert scale. The set of QIs for managing the system comprised items that obtained high consensus and a mean score ≥4.5 found in round 3.Results: Those QIs included a composite of measures about a comfortable and barrier-free assessment room, on-site assistance (being important for client access and safety), client's privacy, rights protection, and satisfaction, convenient service, attitude of staff (towards client centeredness), accuracy of report (system effectiveness), and competent staff (system efficiency). Spearman's rho (mean ± standard deviation) of round 3 was 0.79 ± 0.09, and Cronbach's α = 0.90.Conclusions: This set of QIs is suitable for managing the system serving people with disabilities. It is feasible in practice and scientifically acceptable, but further validation is needed.Implications for rehabilitationWith this study, we were able to develop a set of quality indicators for managing the International Classification of Functioning, Disability and Health-based disability evaluation system.The set of quality indicators included a composite of measures about a comfortable and barrier-free assessment room and on-site assistance; client's privacy, rights protection, and satisfaction, convenient service, attitude of staff; accuracy of report, and competent staff.These quality indicators foster client-centeredness, access, safety, system effectiveness and efficiency, feasibility, and science; and are relevant to managing a system that is intended to serve people with disabilities.
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Affiliation(s)
- Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chou Chi
- Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Tsan-Hon Liou
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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15
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Hsu TH, Liou TH, Chou KR, Chi WC, Yen CF, Liao HF, Tseng IJ. Large-Scale Assessment of Function and Disability in Patients with Parkinson's Disease Using the Functioning Disability Evaluation Scale-Adult Version. Int J Environ Res Public Health 2018; 15:ijerph15122788. [PMID: 30544859 PMCID: PMC6313551 DOI: 10.3390/ijerph15122788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022]
Abstract
This study assesses the functioning and disability related to Parkinson's disease using the Functioning Disability Evaluation Scale-Adult Version (FUNDES-Adult), based on the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in a large-scale database; this study describes, discusses and clarifies the predictive factor of not being in an ambulatory status. Of 7455 patients included in this study, 3561 were not ambulatory and 3894 were ambulatory or assisted ambulatory. Patients with poor walking status revealed higher FUNDES-Adult scores in all domains. Age, modified Hoehn⁻Yahr stage, living in an institution and the standardized score of FUNDES-Adult domains 1 and 2 were positive independent predictors of the not ambulatory status. The FUNDES-Adult could evaluate multifaceted disability and predict the walking status in patients with Parkinson's disease.
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Affiliation(s)
- Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan.
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan.
| | - Wen-Chou Chi
- Department of Occupational Therapy, Chung Shan Medical University, Taichung City 40201, Taiwan.
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan.
| | - Hua-Fang Liao
- Taiwan Association of Child Development and Early Intervention, Hualien City 97064, Taiwan.
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 10055, Taiwan.
| | - Ing-Jy Tseng
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan.
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16
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Liao HF, Hwang AW, Schiariti V, Yen CF, Chi WC, Liou TH, Hung HC, Hsieh YH. Validating the ICF core set for cerebral palsy using a national disability sample in Taiwan. Disabil Rehabil 2018; 42:642-650. [PMID: 30451019 DOI: 10.1080/09638288.2018.1504328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To validate the activities and participation (d) codes of two age-specific brief International Classification of Functioning, Disability, and Health (ICF) core sets for school-aged children with cerebral palsy (CP), using national dataset of the child version of the Functioning Scale of the Disability Evaluation System (FUNDES) in Taiwan.Methods: Students with CP aged 6-17.9 years (n = 546) in the national dataset were analyzed. Items of the child version of the FUNDES were linked to the ICF d-codes and matched to two brief ICF core sets for CP. The restriction rate of the linked d-codes were calculated. Random Forest regression was applied to select the important linked d-codes for predicting school participation frequency.Results: The vast majority of the content of the Taiwanese dataset was covered by two core sets. The matched d-codes represent high restriction rates (80%) and most were important for predicting school participation. One important code, d740 (formal relationships, such as relationship with teachers), identified in this study were not included in two ICF core sets.Conclusions: Two brief ICF core sets for CP capture the majority of relevant functional information collected by the child version of the FUNDES. Some additional codes not covered in the international ICF core sets should be considered for inclusion in the revised Taiwanese version.Implications for rehabilitationCerebral palsy (CP) is the most common cause of severe physical disability in childhood. ICF core sets for CP promote a comprehensive assessment and service provision.To ensure applicability, ICF core sets for CP were validated in Taiwan using the child and youth national dataset of the child version of the Functioning Scale of the Disability Evaluation System. This study shows content validity and proposes new ICF codes additions for the Taiwanese version.Among top five ICF-based predictors for school participation frequency, four of them were consistent in both children and youth groups as d310-d350 (basic communication), d750 (informal social relationships), d820 (school education), and d710-d720, d880 and d920 (social play), which could be taken into consideration in clinical application.
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Affiliation(s)
- Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan
| | - Ai-Wen Hwang
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Veronica Schiariti
- Division of Medical Sciences, University of Victoria, British Columbia, Canada
| | - Chia-Feng Yen
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Public Health, Tzu Chi University, Hualien City, Taiwan
| | - Wen-Chou Chi
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Tsan-Hon Liou
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital Taipei Medical University, New, Taipei City, Taiwan
| | - Hsiu-Chuan Hung
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan
| | - Yu-Hsin Hsieh
- Taiwan Society of International Classification of Functioning, Disability and Health, TSICF, New Taipei City, Taiwan
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17
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Lee YH, Chang KH, Escorpizo R, Chi WC, Yen CF, Liao HF, Huang SW, Liou TH. Accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score as an objective assessment tool for predicting return-to-work status after head and neck cancer in male survivors. Support Care Cancer 2018; 27:433-441. [DOI: 10.1007/s00520-018-4322-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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18
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Chang KF, Chang KH, Chi WC, Huang SW, Yen CF, Liao HF, Liou TH, Chao PZ, Lin IC. Influence of visual impairment and hearing impairment on functional dependence status among people in Taiwan-An evaluation using the WHODAS 2.0 score. J Chin Med Assoc 2018; 81:376-382. [PMID: 29033374 DOI: 10.1016/j.jcma.2017.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/21/2017] [Accepted: 08/01/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Visual impairment (VI) and hearing impairment (HI) are the two most common types of sensory disability encountered clinically. However, VI and HI result in different limitations in daily life. We assessed the level of functioning in patients with VI or HI based on the International Classification of Functioning, Disability, and Health. METHODS This nationwide, cross-sectional study included 312 people with VI and 540 people with HI. Each participant's degree of functioning and disability was evaluated using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The standardized WHODAS 2.0 scores ranged from 0 (least difficulty) to 100 (most difficulty). RESULTS Patients with VI and those with HI had a mean (±standard error) 32-item WHODAS 2.0 score of 42.4 ± 2.9 and 27.1 ± 1.6, respectively. The degree of restriction was positively related to the level of VI. Specifically, the patients with VI and a WHODAS 2.0 score of 33.7-35.3 or higher were likely to experience barriers to accessing mobility products, communication products, and education products. Furthermore, patients with a score of 42.9 or higher might experience barriers to accessing ingestion products and living products. CONCLUSION WHODAS 2.0 scores are strongly correlated with the severity of VI. Mild VI should be targeted for treatment and referral as early as possible. Compared with the patients with HI, the patients with VI more frequently experience barriers to accessing environmental factors.
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Affiliation(s)
- Ko-Fang Chang
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wen-Chou Chi
- Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Chia-Feng Yen
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan, ROC
| | - Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Tsan-Hon Liou
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Pin-Zhir Chao
- Department of Otorhinolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - I-Chan Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC.
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Chang KH, Chi WC, Huang SW, Chang FH, Liao HF, Escorpizo R, Liou TH. Perceptions and attitudes towards the implementation of a disability evaluation system based on the international classification of functioning, disability, and health among people with disabilities in Taiwan. Disabil Rehabil 2018; 41:1552-1560. [PMID: 29478346 DOI: 10.1080/09638288.2018.1442506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan. METHOD Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age, ≥18 years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire. RESULTS Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3 ∼ 0.4) and its item of long interval (0.2 ∼ 0.6). Contrariwise, the probability was high for the other subscales (3.9 ∼ 13.7) and the item of identifying needs (21.9 ∼ 23.4). CONCLUSIONS Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system's quality of process and facilitate its usability. IMPLICATIONS FOR REHABILITATION Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation. The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.
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Affiliation(s)
- Kwang-Hwa Chang
- a Graduate Institute of Injury Prevention and Control, College of Public Health , Taipei Medical University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan.,c Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan
| | - Wen-Chou Chi
- d Department of Occupational Therapy , Chung Shan Medical University , Taichung , Taiwan
| | - Shih-Wei Huang
- c Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan.,e Department of Physical Medicine and Rehabilitation , Shuang Ho Hospital, Taipei Medical University , Taipei , Taiwan
| | - Feng-Hang Chang
- a Graduate Institute of Injury Prevention and Control, College of Public Health , Taipei Medical University , Taipei , Taiwan.,c Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan
| | - Hua-Fang Liao
- f School and Graduate Institute of Physical Therapy, College of Medicine , National Taiwan University , Taipei , Taiwan
| | - Reuben Escorpizo
- g Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences , University of Vermont , Burlington , VT , USA.,h Swiss Paraplegic Research , Nottwil , Switzerland
| | - Tsan-Hon Liou
- a Graduate Institute of Injury Prevention and Control, College of Public Health , Taipei Medical University , Taipei , Taiwan.,c Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan.,e Department of Physical Medicine and Rehabilitation , Shuang Ho Hospital, Taipei Medical University , Taipei , Taiwan
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Hu HY, Chi WC, Chang KH, Yen CF, Escorpizo R, Liao HF, Huang SW, Liou TH. The World Health Organization Disability Assessment Schedule 2.0 can predict the institutionalization of patients with stroke. Eur J Phys Rehabil Med 2017. [DOI: 10.23736/s1973-9087.17.04615-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Huang SW, Chi WC, Chang KH, Yen CF, Liao HF, Escorpizo R, Liou TH. World health organization disability assessment schedule 2.0 as an objective assessment tool for predicting return to work after a stroke. Disabil Rehabil 2017; 40:2592-2597. [DOI: 10.1080/09638288.2017.1342280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Sports Science, National Taiwan Sports University, Taoyuan, Taiwan
| | - Wen-Chou Chi
- Department of Occupational Therapy, College of Medical Sciences and Technology, Chung Shan Medical University, Taichung, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Hua-Fang Liao
- Taiwan Society of ICF, New Taipei City, Taiwan
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, USA
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Yen CF, Chiu TY, Liou TH, Chi WC, Liao HF, Liang CC, Escorpizo R. Development of Activity and Participation Norms among General Adult Populations in Taiwan. Int J Environ Res Public Health 2017; 14:ijerph14060603. [PMID: 28587271 PMCID: PMC5486289 DOI: 10.3390/ijerph14060603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/16/2022]
Abstract
Based on the International Classification of Functioning, Disability, and Health (ICF) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), The Functioning Disability Evaluation Scale-Adult version (FUNDES-Adult) began development in 2011. The FUNDES-Adult was designed to assess the difficulty level of an individual’s activities and participation in daily life. There is a lack of research regarding the profile of activity and participation for the general adult population. The purposes of this study were to establish activity and participation norms for the general adult population in Taiwan and to describe, discuss, and compare the activity and participation profile with other population. Method: A population-based survey was administered in 2013 using a computer-assisted telephone interviewing system (CATI system). Using probability proportional to size (PPS) sampling and systematic sampling with random digit dialing (RDD), 1500 adults from Taiwan’s general population were selected to participate in the survey. The FUNDES-Adult with six domains and two dimensions (performance and capability) was used to obtain data on activities and participation levels. A higher domain score indicated higher participation restriction. Results: Approximately 50% of the respondents were male, and the average age of the respondents was 45.23 years. There were no significant differences in the demographic features between the sample and the population. Among the six domains, the self-care domain score was the lowest (least restriction) and the participation domain score was the highest (most restriction). Approximately 90% of the sample scored were less than 15, and only 0.1% scored more than 80. This is the first cross-national population-based survey to assess norms of activity and participation relevant to the general population of Taiwan. As such, the results of this survey can be used as a reference for comparing the activity and participation (AP) functioning of other countries and subgroups.
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Affiliation(s)
- Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Tzu-Ying Chiu
- Institute of Health Policy and Management, National Taiwan University, Taipei 10055, Taiwan.
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei 23561, Taiwan.
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan.
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Wen-Chou Chi
- Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan.
| | - Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 10051, Taiwan.
| | - Chung-Chao Liang
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien 97002, Taiwan.
- School of Medicine, Tzu Chi University, Hualian 97004, Taiwan.
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT 05401, USA.
- Swiss Paraplegic Research, Nottwil 6207, Switzerland.
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Huang SW, Chi WC, Yen CF, Chang KH, Liao HF, Escorpizo R, Chang FH, Liou TH. Does more education mean less disability in people with dementia? A large cross-sectional study in Taiwan. BMJ Open 2017; 7:e013841. [PMID: 28473510 PMCID: PMC5566594 DOI: 10.1136/bmjopen-2016-013841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) is a feasible tool for assessing functional disability and analysing the risk of institutionalisation among elderly patients with dementia. However, the data for the effect of education on disability status in patients with dementia is lacking. The aim of this large-scale, population-based study was to analyse the effect of education on the disability status of elderly Taiwanese patients with dementia by using WHODAS 2.0. METHODS From the Taiwan Data Bank of Persons with Disability, we enrolled 7698 disabled elderly (older than 65 years) patients diagnosed with dementia between July 2012 and January 2014. According to their education status, we categorised these patients with and without formal education (3849 patients each). We controlled for the demographic variables through propensity score matching. The standardised scores of these patients in the six domains of WHODAS 2.0 were evaluated by certified interviewers. Student's t-test was used for comparing the WHODAS 2.0 scores of patients with dementia in the two aforementioned groups. Poisson regression was applied for analysing the association among all the investigated variables. RESULTS Patients with formal education had low disability status in the domains of getting along and social participation than did patients without formal education. Poisson regression revealed that standardised scores in all domains of WHODAS 2.0-except self-care-were associated with education status. CONCLUSIONS This study revealed lower disability status in the WHODAS 2.0 domains of getting along and social participation for patients with dementia with formal education compared with those without formal education. For patients with disability and dementia without formal education, community intervention of social participation should be implemented to maintain better social interaction ability.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chou Chi
- School of Occupational Therapy, College of Medicine, Chungshan Medical University, Taichung, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hua-Fang Liao
- Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City, Taipei, Taiwan
- School and Graduate Institute of Physical Therapy, College of Medicine, Chungshan Medical University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Huang SW, Chang KH, Escorpizo R, Chi WC, Yen CF, Liao HF, Chang FH, Chiu WT, Lin JW, Liou TH. Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia. Disabil Rehabil 2015; 38:1652-63. [DOI: 10.3109/09638288.2015.1107636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hwang AW, Yen CF, Liou TH, Bedell G, Granlund M, Teng SW, Chang KH, Chi WC, Liao HF. Development and validation of the ICF-CY-Based Functioning Scale of the Disability Evaluation System—Child Version in Taiwan. J Formos Med Assoc 2015; 114:1170-80. [DOI: 10.1016/j.jfma.2015.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 11/29/2022] Open
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Huang SW, Chang KH, Escorpizo R, Hu CJ, Chi WC, Yen CF, Liao HF, Chiu WT, Liou TH. Using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for Predicting Institutionalization of Patients With Dementia in Taiwan. Medicine (Baltimore) 2015; 94:e2155. [PMID: 26632747 PMCID: PMC5059016 DOI: 10.1097/md.0000000000002155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is an assessment tool and it has been applied for disability status assessment of Taiwanese dementia patients since July 2012. The aim of this study was to investigate the predicting accuracy of WHODAS 2.0 for institutionalization of dementia patients.Of these patients, 13,774 resided in a community and 4406 in a long-term care facility. Demographic data and WHODAS 2.0 standardized scores were analyzed using the Chi-square test and independent t test to compare patients with dementia in an institution with those in a community. The receiver operating characteristic (ROC) curve was applied to investigate accuracy in predicting institutionalization, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was used to analyze variables to determine risk factors for the institutionalization of patients with dementia.WHODAS 2.0 scores in all domains were higher in patients with dementia in a long-term care facility than in those in a community (P < 0.01). The ROC curve showed moderate accuracy for all domains of WHODAS 2.0 (area under curve 0.6~0.8). Binary logistic regression revealed that the male gender, severity of disease, and standardized WHODAS 2.0 scores surpassing the cutoff values were risk factors for the institutionalization of patients with dementia.Although the accuracy of WHODAS 2.0 in predicting institutionalization is not considerably high for patients with dementia, our study found that the WHODAS 2.0 scores, the male gender, education status, urbanization level, and severity of disease were risk factors for institutionalization in long-term care facilities.
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Affiliation(s)
- Shih-Wei Huang
- From the Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital (S-WH, W-CC, T-HL); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine (S-WH, T-HL); Graduate Institute of Injury Prevention and Control (K-HC, W-TC, T-HL); Department of Physical Medicine and Rehabilitation, Wan Fang Hospital (K-HC); Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA (RE); Swiss Paraplegic Research, Nottwil, Switzerland (RE); Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City (C-JH); Department of Public Health, Tzu Chi University, Hualien (C-FY); Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City (H-FL); School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan (H-FL)
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Lin SW, Yen CF, Chiu TY, Chi WC, Liou TH. New indices for home nursing care resource disparities in rural and urban areas, based on geocoding and geographic distance barriers: a cross-sectional study. Int J Health Geogr 2015; 14:28. [PMID: 26449322 PMCID: PMC4598966 DOI: 10.1186/s12942-015-0021-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aging in place is the crucial object of long-term care policy worldwide. Approximately 15.6-19.4% of people aged 15 or above live with a disability, and 15.3% of them have moderate or severe disabilities. The allocation of home nursing care services is therefore an important issue. Service providers in Taiwan vary substantially across regions, and between rural and urban areas. There are no appropriate indices for describing the capacity of providers that it is due to the distances from care recipients. This study therefore aimed to describe and compare distance barriers for home nursing care providers using indices of the "profit willing distance" and the "tolerance limited distance". METHODS This cross-sectional study was conducted during 2012 and 2013 using geocoding and a geographic information system to identify the distance from the providers' locations to participants' homes in urban (Taipei City) and rural (Hualien County) areas in Taiwan. Data were collected in-person by professionals in Taiwanese hospitals using the World Health Organization Disability Assessment Schedule 2.0. The indices were calculated using regression curves, and the first inflection points were determined as the points on the curves where the first and second derivatives equaled 0. RESULTS There were 5627 participants from urban areas and 956 from rural areas. In urban areas, the profit willing distance was 550-600 m, and we were unable to identify them in rural areas. This demonstrates that providers may need to supply services even when there is little profit. The tolerance limited distance were 1600-1650 m in urban areas and 1950-2000 m in rural areas. In rural areas, 33.3% of those living inside the tolerance limited distance and there was no provider within this distance, but this figure fell to just 13.9% in urban areas. There were strong disparities between urban and rural areas in home nursing care resource allocation. CONCLUSIONS Our new "profit willing distance" and the "tolerance limited distance" are considered to be clearer and more equitable than other evaluation indices. They have practical application in considering resource distribution issues around the world, and in particular the rural-urban disparities for public resource.
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Affiliation(s)
- Shyang-Woei Lin
- Department of Natural Resources and Environmental Studies, National Dong Hwa University, Hualien, Taiwan.
| | - Chia-Feng Yen
- Department of Public Health, Buddhist Tzu-Chi University, Hualien, Taiwan.
| | - Tzu-Ying Chiu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
| | - Wen-Chou Chi
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan.
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Hwang AW, Yen CF, Liou TH, Simeonsson RJ, Chi WC, Lollar DJ, Liao HF, Kang LJ, Wu TF, Teng SW, Chiu WT. Participation of Children with Disabilities in Taiwan: The Gap between Independence and Frequency. PLoS One 2015; 10:e0126693. [PMID: 25962175 PMCID: PMC4427311 DOI: 10.1371/journal.pone.0126693] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Independence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored. METHODS A total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children's daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment. FINDINGS A negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment. CONCLUSIONS Children's participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed.
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Affiliation(s)
- Ai-Wen Hwang
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Tsan-Hon Liou
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Rune J. Simeonsson
- School Psychology Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- School of Education and Communication, Jönköping University, Jönköping, Sweden
| | - Wen-Chou Chi
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Donald J. Lollar
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Hua-Fang Liao
- The School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Lin-Ju Kang
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ting-Fang Wu
- Graduate Institute of Rehabilitation Counseling, National Taiwan Normal University, Taipei, Taiwan
| | | | - Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
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Kuo CY, Liou TH, Chang KH, Chi WC, Escorpizo R, Yen CF, Liao HF, Chiou HY, Chiu WT, Tsai JT. Functioning and disability analysis of patients with traumatic brain injury and spinal cord injury by using the world health organization disability assessment schedule 2.0. Int J Environ Res Public Health 2015; 12:4116-27. [PMID: 25874682 PMCID: PMC4410236 DOI: 10.3390/ijerph120404116] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to compare traumatic brain injuries (TBI) and spinal cord injuries (SCI) patients’ function and disability by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); and to clarify the factors that contribute to disability. We analyzed data available between September 2012 and August 2013 from Taiwan’s national disability registry which is based on the International Classification of Functioning, Disability, and Health (ICF) framework. Of the 2664 cases selected for the study, 1316 pertained to TBI and 1348 to SCI. A larger percentage of patients with TBI compared with those with SCI exhibited poor cognition, self-care, relationships, life activities, and participation in society (all p < 0.001). Age, sex, injury type, socioeconomic status, place of residence, and severity of impairment were determined as factors that independently contribute to disability (all p < 0.05). The WHODAS 2.0 is a generic assessment instrument which is appropriate for assessing the complex and multifaceted disability associated with TBI and SCI. Further studies are needed to validate the WHODAS 2.0 for TBI and SCI from a multidisciplinary perspective.
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Affiliation(s)
- Chia-Ying Kuo
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
- Office of Medical Affairs, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
| | - Tsan-Hon Liou
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan.
| | - Wen-Chou Chi
- School of Occupational Therapy, Chung Shan Medical University, Taichung City 40201 Taiwan.
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT 05401, USA.
- Swiss Paraplegic Research, Nottwil 6207, Switzerland.
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien City 97004, Taiwan.
| | - Hua-Fang Liao
- Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City 97064, Taiwan.
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 10055, Taiwan.
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
| | - Wen-Ta Chiu
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
| | - Jo-Ting Tsai
- Radiation Oncology Department, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561,Taiwan.
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Kang LJ, Yen CF, Bedell G, Simeonsson RJ, Liou TH, Chi WC, Liu SW, Liao HF, Hwang AW. The Chinese version of the Child and Adolescent Scale of Environment (CASE-C): validity and reliability for children with disabilities in Taiwan. Res Dev Disabil 2015; 38:64-74. [PMID: 25546296 DOI: 10.1016/j.ridd.2014.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
Measurement of children's participation and environmental factors is a key component of the assessment in the new Disability Evaluation System (DES) in Taiwan. The Child and Adolescent Scale of Environment (CASE) was translated into Traditional Chinese (CASE-C) and used for assessing environmental factors affecting the participation of children and youth with disabilities in the DES. The aim of this study was to validate the CASE-C. Participants were 614 children and youth aged 6.0-17.9 years with disabilities, with the largest condition group comprised of children with intellectual disability (61%). Internal structure, internal consistency, test-retest reliability, convergent validity, and discriminant (known group) validity were examined using exploratory factor analyses, Cronbach's α coefficient, intra-class correlation coefficients (ICC), correlation analyses, and univariate ANOVAs. A three-factor structure (Family/Community Resources, Assistance/Attitude Supports, and Physical Design Access) of the CASE-C was produced with 38% variance explained. The CASE-C had adequate internal consistency (Cronbach's α=.74-.86) and test-retest reliability (ICCs=.73-.90). Children and youth with disabilities who had higher levels of severity of impairment encountered more environmental barriers and those experiencing more environmental problems also had greater restrictions in participation. The CASE-C scores were found to distinguish children on the basis of disability condition and impairment severity, but not on the basis of age or sex. The CASE-C is valid for assessing environmental problems experienced by children and youth with disabilities in Taiwan.
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Affiliation(s)
- Lin-Ju Kang
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Gary Bedell
- Department of Occupational Therapy, Tufts University, Medford, MA, United States
| | - Rune J Simeonsson
- School Psychology, University of North Carolina at Chapel Hill, NC, United States; School of Learning & Communication, Jönköping University, Jönköping, Sweden
| | - Tsan-Hon Liou
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chou Chi
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wen Liu
- Center for Teacher Education and Career Guidance, University of Taipei, Taipei, Taiwan
| | - Hua-Fang Liao
- The School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Ai-Wen Hwang
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Chi WC, Chang KH, Escorpizo R, Yen CF, Liao HF, Chang FH, Chiou HY, Teng SW, Chiu WT, Liou TH. Measuring disability and its predicting factors in a large database in Taiwan using the World Health Organization Disability Assessment Schedule 2.0. Int J Environ Res Public Health 2014; 11:12148-61. [PMID: 25429682 PMCID: PMC4276606 DOI: 10.3390/ijerph111212148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/17/2022]
Abstract
The definition of disability had been unclear until the International Classification of Functioning, Disability, and Health was promulgated in 2001 by the World Health Organization (WHO). Disability is a critical but relatively neglected public-health concern. We conducted this study to measure disabilities by using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and identify the factors that contribute to disabilities. We obtained and analyzed the data on people who applied to Taiwan's disability registration system between September 2012 and August 2013. A total of 158,174 cases were selected for this study. Among the people included in this study, 53% were male, and the females were on average 3 years older than the males. More males than females were of a low socioeconomic status, but the rate of employment was higher among the males than among the females. Age, sex, place of residence, and types and severity of impairment were all determined to be factors that independently contributed to disability. This study has demonstrated that disability can be measured and compared using WHODAS 2.0. Increasing the public-health attention devoted to disability and identifying the factors associated with disability can promote independence and social participation in people with disabilities.
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Affiliation(s)
- Wen-Chou Chi
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.
| | - Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT 05401, USA.
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien 970, Taiwan.
| | - Hua-Fang Liao
- Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City 970, Taiwan.
| | - Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan.
| | - Hung-Yi Chiou
- School of Public Health, Taipei Medical University, Taipei 116, Taiwan.
| | - Sue-Wen Teng
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.
| | - Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan.
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.
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Chiu TY, Yen CF, Chou CH, Lin JD, Hwang AW, Liao HF, Chi WC. Development of traditional Chinese version of World Health Organization disability assessment schedule 2.0 36--item (WHODAS 2.0) in Taiwan: validity and reliability analyses. Res Dev Disabil 2014; 35:2812-2820. [PMID: 25094056 DOI: 10.1016/j.ridd.2014.07.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/29/2014] [Accepted: 07/02/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provided a standardized method for measuring the health and disability and the traditional Chinese version has not been developed. AIMS To describe the process of developing the traditional Chinese version of the WHODAS 2.0 36-item version and to evaluate the concurrent validity and test-retest reliability of this instrument. METHODS The study was conducted in two phases. Phase I was the process of translation of WHODAS 2.0 36-item version. Phase II was a cross-sectional study. The participants were 307 adults who were tested the validity and reliability of draft traditional Chinese version. RESULTS The reliability of Cronbach's α and ICC in the WHODAS 2.0 traditional Chinese version were 0.73-0.99 and 0.8-089, respectively. The content validity was good (r=0.7-0.76), and the concurrent validity was excellent in comparison with the WHOQOL-BREF (p<0.5). The construct validity, the model was explained total variance was 67.26% by the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) illustrated the traditional Chinese version was good to assess disability. There was a valid and reliable measurement scales for evaluating functioning and disability status. CONCLUSION For disability eligibility system of Taiwan government to measure the disability, the traditional Chinese version of the WHODAS 2.0 provided valuable evidence to design the assessment instrument.
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Affiliation(s)
- Tzu-Ying Chiu
- Institute of Medical Science, Tzu Chi University, Hualien, Taiwan
| | - Chia-Feng Yen
- Institute of Medical Science, Tzu Chi University, Hualien, Taiwan; Department of Public Health, Tzu Chi University, Hualien, Taiwan.
| | - Cheng-Hsiu Chou
- Departments of Family Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ai-Wen Hwang
- College of Medicine, Chang Gung University, Graduate Institute of Early Intervention, Taoyuan, Taiwan
| | - Hua-Fang Liao
- Chinese Association of Early Intervention Profession for Children with Developmental Delays, Taipei, Taiwan
| | - Wen-Chou Chi
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei, Taiwan
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Yen CF, Hwang AW, Liou TH, Chiu TY, Hsu HY, Chi WC, Wu TF, Chang BS, Lu SJ, Liao HF, Teng SW, Chiu WT. Validity and reliability of the Functioning Disability Evaluation Scale-Adult Version based on the WHODAS 2.0--36 items. J Formos Med Assoc 2014; 113:839-49. [PMID: 25294100 DOI: 10.1016/j.jfma.2014.08.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE The disability eligibility determination system is based on the International Classification of Functioning, Disability and Health (ICF) framework in Taiwan. The Functioning Disability Evaluation Scale (FUNDES) has been developed since 2007 for assessing the status of an individual's activities and participation in the disability eligibility system. The purpose of this study was to examine the reliability and validity of the FUNDES-Adult Version (FUNDES-Adult). METHODS During 2011-2012, a total of 5736 adults with disabilities (aged 58.4 ± 18.2 years) were randomly recruited for a national population-based study. These adults were assessed in person by certified professionals in the authorized hospitals. Domains 1-6 of the FUNDES-Adult addressing the performance and capability dimensions are modified from the World Health Organization Disability Assessment Schedule 2.0-36-item version, and Domain 7 (Environmental attribute) and capability and capacity dimensions of Domain 8 (Motor action) are designed based on the ICF coding system. RESULTS The internal consistency was excellent (Cronbach's α ≥ 0.9). An exploratory factor analysis yielded a five-factor FUNDES structure with a variance of 76.1% and 76.9% and factor loadings of 0.56-0.94 and 0.55-0.94 for the performance and capability dimensions, respectively. The factor loadings for the second-order confirmatory factor analysis for the performance and capability dimensions were from 0.81 to 0.89. In Domains 1-6 and 8, the ceiling effects were from 9% to 36%, and the floor effects were from 5% to 45%. CONCLUSION FUNDES-Adult has acceptable reliability and validity and can be used to measure activities and participation for people with disabilities.
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Affiliation(s)
- Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Ai-Wen Hwang
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Ying Chiu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Hsin-Yuan Hsu
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Wen-Chou Chi
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ting-Fang Wu
- Graduate Institute of Rehabilitation Counseling, National Taiwan Normal University, Taipei, Taiwan
| | - Ben-Shang Chang
- Department of Psychology, Soochow University, Taipei, Taiwan
| | - Shu-Jen Lu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Su-Wen Teng
- Department of Nursing and Health Care, Ministry of Health and Welfare, Taipei, Taiwan.
| | - Wen-Ta Chiu
- Ministry of Health and Welfare, Taipei, Taiwan
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Liao HF, Hwang AW, Chi WC, Liou TH, Yen CF, Kang LJ, Chang BS, Wu TF, Lu SJ. Validating Generic Core Set and Developmental Code Set by Using National Disability Sample in Taiwan. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liou TH, Yen CF, Liao HF, Chang KH, Chi WC. Measuring Disability Using WHO Disability Assessment Schedule 2.0 and its Associated Factors in Taiwan. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hwang AW, Liao HF, Liou TH, Yen CF, Chi WC, Kang LJ, Chang BS, Wu TF, Lu SJ, Chang KH. The Gaps Between the Capability and the Performance Among Children with Disabilities in Taiwan. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chang KH, Liou TH, Chi WC, Hwang AW, Liao HF, Yen CF. Factors Associated With Difficulties in WHODAS 2.0 Domains Among Patients With Stroke. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kang LJ, Hwang AW, Bedell GM, Liao HF, Liou TH, Yen CF, Chi WC, Chang BS, Wu TF, Lu SJ. Environmental Barriers Differed Based on Impairment Severity but not Diagnosis in Children With Disabilities. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chang KH, Liao HF, Yen CF, Hwang AW, Chi WC, Escorpizo R, Liou TH. Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan. Disabil Rehabil 2014; 37:712-20. [PMID: 25026509 DOI: 10.3109/09638288.2014.940428] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. METHODS Subjects (≥ 60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. RESULTS More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75-376.42, p < 0.001), age (1.38-4.81, p < 0.05), and speech impairment (1.94-5.80, p < 0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. CONCLUSIONS Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability. IMPLICATIONS FOR REHABILITATION Older adults with physical disability often experience difficulties in household activities and mobility. Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease. Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.
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Affiliation(s)
- Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan
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Chiu WT, Yen CF, Teng SW, Liao HF, Chang KH, Chi WC, Wang YH, Liou TH. Implementing disability evaluation and welfare services based on the framework of the International Classification of Functioning, Disability and Health: experiences in Taiwan. BMC Health Serv Res 2013; 13:416. [PMID: 24125482 PMCID: PMC3853212 DOI: 10.1186/1472-6963-13-416] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 10/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before 2007, the disability evaluation was based on the medical model in Taiwan. According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person's eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. The purposes of this study were to: 1) design the evaluation tools for disability eligibility system based on the ICF/ICF-Children and Youth; 2) compare the differences of grades of disability between the old and new evaluation systems; 3) analyse the outcome of the new disability evaluation system. METHODS To develop evaluation tools and procedure for disability determination, we formed an implementation taskforce, including 199 professional experts, and conducted a small-scale field trial to examine the feasibility of evaluation tools in Phase I. To refine the evaluation tools and process and to compare the difference of the grades of disability between new and old systems, 7,329 persons with disabilities were randomly recruited in a national population-based study in Phase II. To implement the new system smoothly and understand the impact of the new system, the collaboration mechanism was established and data of 168,052 persons who applied for the disability benefits was extracted from the information system and analysed in Phase III. RESULTS The measures of the 43 categories for body function/structure components, the Functioning Scale of Disability Evaluation System for activities/participation components, and the needs assessment have been developed and used in the field after several revisions. In Phase II, there was 49.7% agreement of disability grades between the old and new systems. In Phase III, 110,667 persons with a disability received their welfare services through the new system. Among them, 77% received basic social welfare support, 89% financial support, 24% allowance for assistive technology, 7% caregiver support, 8% nursing care and rehabilitation services at home, and 47% were issued parking permits for persons with disability. CONCLUSION This study demonstrated that disability evaluation system based on the ICF could provide a common language between disability assessment, needs assessment and welfare services. However, the proposed assessment protocol and tools require additional testing and validation.
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Affiliation(s)
- Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, No, 250 Wu-Hsing Street, Taipei 11031, Taiwan.
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Teng SW, Yen CF, Liao HF, Chang KH, Chi WC, Wang YH, Liou TH. Evolution of system for disability assessment based on the International Classification of Functioning, Disability, and Health: A Taiwanese study. J Formos Med Assoc 2013; 112:691-8. [PMID: 24099681 DOI: 10.1016/j.jfma.2013.09.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE The criteria for disability were mainly based on the medical model, and the candidates for disability benefits were identified by physicians mainly depending on their degree of bodily impairment, but without sufficient evaluation of their activity, participation, and environment in Taiwan. According to the People with Disabilities Rights Protection Act, the assessment of a person's eligibility for disability benefits was required to be based on the International Classification of Functioning, Disability, and Health (ICF) framework since July 11, 2012. This study investigated a proposed system to assess patients' eligibility for disability in Taiwan, based on the ICF. METHODS We have initiated a national decision-making process involving members of Taiwan's ICF Team. We facilitated 16 group discussions on the ICF coding system, in which 199 professionals participated. In each group, one member led the group discussion until a consensus was reached. RESULTS We have developed a process to determine the eligibility of people with disabilities. This study set up the standards, tools, and practice manuals for each category. We have also developed a core set for disability assessment. CONCLUSION We implemented a new system to assess patients' eligibility for disability. The proposed assessment protocol and tools require further validation.
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Affiliation(s)
- Sue-Wen Teng
- Bureau of Nursing and Health Services Development, Department of Health, Taipei, Taiwan
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Chi WC, Liou TH, Wennie Huang WN, Yen CF, Teng SW, Chang IC. Developing a disability determination model using a decision support system in Taiwan: A pilot study. J Formos Med Assoc 2013; 112:473-81. [DOI: 10.1016/j.jfma.2013.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 11/29/2022] Open
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Affiliation(s)
- Wen-Ni Wennie Huang
- Assistant Professor, Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, Republic of China
| | - Wen-Chou Chi
- Occupational Therapist, Department of Information Management, National Chung Cheng University, Chia-yi County, Taiwan, Republic of China
| | - Li-Jing Hu
- Chief of Health Section, Ren-ai Senior Citizen's Home, Bureau of Social Affairs of Kaohsiung City Government, Kaohsiung, Taiwan, Republic of China
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Chi WC, Wen CH, Lin CY, Poon SK, Huang SC. Use of RSS Feeds for the Implementation of Clinical Reminder. J Med Syst 2012; 36:2029-36. [DOI: 10.1007/s10916-011-9665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 02/11/2011] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Gallstone disease has been regarded as an obesity-related disease. Therefore, we hypothesized that leptin and adiponectin, mainly produced by adipose tissue, may play roles in gallstone disease. PATIENTS AND METHODS The RIA method was used to analyze serum leptin and adiponectin levels of 90 gallstone patients and 91 healthy subjects. RESULTS Our results showed that BMI, fasting glucose, serum AST and ALT, and leptin were significantly increased in the gallstone patients as compared with the healthy subjects (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.013, respectively). Intriguingly, serum adiponectin was the only variable to be significantly decreased in the gallstone patients (P = 0.002). Furthermore, serum AST, leptin, and adiponectin were significantly associated with gallstone disease (P < 0.001, P = 0.021, and P = 0.006, respectively). Overweight (BMI >or= 25 kg m(-2)), but not normal-weight, gallstone patients had an increased serum leptin and a decreased serum adiponectin level as compared with matched healthy subjects (P < 0.001 and P = 0.024, respectively). In addition, serum leptin was positively correlated with BMI and serum cholesterol, while serum adiponectin was inversely correlated with serum triglyceride in the gallstone patients. CONCLUSIONS Our study indicated that hyperleptinaemia and hypoadiponectinaemia might be involved in the occurrence of gallstone disease. However, the causal relationship of hyperleptinaemia and hypoadiponectinaemia with gallstone disease might require further investigation.
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Affiliation(s)
- S N Wang
- Division of Hepato-biliary-pancreatic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Abstract
OBJECTIVE To evaluate the therapeutic effect of intramuscular injection of botulinum toxin on spasticity of the upper limb, with emphasis on its influence over limb function. DESIGN An open-label, noncontrolled trial with a duration of 12 wk was designed to determine the safety and efficacy of intramuscular botulinum toxin A injection in the treatment of 16 patients with stroke with spastic hemiparesis. Electromyographically guided intramuscular botulinum toxin A injections were applied to the spastic limbs. A detailed scale system was used for the evaluation of muscle tone and functional changes induced by botulinum toxin A treatment. RESULTS No major side effect secondary to botulinum toxin A injection was reported. Statistically significant (P < 0.05) improvements of muscle tone, joint range of motion, hand muscle strength, and muscular pain were seen after the injection. The improvements lasted up to 8-12 wk after the treatment. However, there was no significant functional improvement except in two of the patients. CONCLUSIONS Botulinum toxin A injection may help relieve upper limb spasticity and pain in patients with stroke. Its effect on function is probably determined by case selection.
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Affiliation(s)
- Han-Cheng Wang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China
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Kuo CE, Chi WC, Liu SM. Biotransformation of p-toluic acid in anoxic estuarine sediments under a CO2 or N2/H2 atmosphere. Chemosphere 2001; 45:835-842. [PMID: 11695603 DOI: 10.1016/s0045-6535(01)00098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The composition of the headspace gas affected the growth dynamics of microbial populations and the biotransformation pattern of p-toluic acid in anoxic estuarine sediments. Under CO2 atmosphere, p-toluic acid was transformed by the sediment microorganisms without a lag period, while under N2/H2 atmosphere, p-toluic acid was transformed after a lag period of 55 days. Under the N2/H2 atmosphere, the methanogen population, following a rapid increase of almost two orders of magnitude, remained at a high level until just before the onset of biotransformation. We hypothesize that during the lag period, the hydrogenotrophic methanogens were removing the H2, a step which is essential before the reaction can be exergonic. Acetogenic bacteria did not initiate decarboxylation as the first step of biotransformation under either atmosphere. Neither the methanogens nor the acetogenic bacteria appeared to be directly involved in the biotransformation of p-toluic acid under either atmosphere. Under the CO2 atmosphere, biotransformation of p-toluic acid involved sulfate-reducing bacteria, while under N2/H2, both sulfate-reducing bacteria and other eubacteria were involved.
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Affiliation(s)
- C E Kuo
- Institute of Marine Biology, National Taiwan Ocean University, Keelung, ROC
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Huang JJ, Wu JS, Chi WC, Lan RR, Yang LF, Chiu NT. Hydrothorax in continuous ambulatory peritoneal dialysis: therapeutic implications of Tc-99m MAA peritoneal scintigraphy. Nephrol Dial Transplant 1999; 14:992-7. [PMID: 10328489 DOI: 10.1093/ndt/14.4.992] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J J Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China
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Abstract
The spectrum of clinical severity for scrub typhus ranges from inapparent, mild, to severe or fatal. The pathologic changes are focal or disseminated multiorgan vasculitis of the small blood vessels, a fact that helps explain the great diversity of clinical manifestations that can be encountered. We reported a case of scrub typhus with unusual and serious multiorgan involvement, including tubulointerstitial nephritis (TIN) with acute renal failure (ARF), interstitial pneumonitis with adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), liver function impairment, upper gastrointestinal bleeding, prolonged hyperamylasaemia and hyperlipasaemia. Chloramphenicol administration rapidly altered the clinical course, but with sequelae of renal impairment and prolonged hyperamylasaemia and hyperlipasaemia for 10 months.
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Affiliation(s)
- W C Chi
- Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
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