Validation of a Simple Instrument of Fast Application to Track Disability in Leprosy Patients

Pinho, Adriano Bastos; Freitas, Murilo Moraes de; Fontes, Cor Jesus Fernandes

doi:10.1055/s-0042-1742342

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Original Article • Rev. bras. ortop. 58 (1) • Jan-Feb 2023 • https://doi.org/10.1055/s-0042-1742342 copy

Validation of a Simple Instrument of Fast Application to Track Disability in Leprosy Patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate a simple and fast diagnostic instrument to be used by any health professional to track the disability presented by leprosy patients.

Method

Validation study of a diagnostic test performed in a sample of 156 leprosy patients to track functional disability through the shortened disabilities of arm, shoulder, and hand (QuickDASH) questionnaire. The simplified neurological assessment proposed by the World Health Organization was used as a reference. A receiver operating characteristic (ROC) curve was constructed to determine the cutoff point of QuickDASH that best discriminated patients with functional disability caused by leprosy.

Results

We identified 86 (55.5%) patients with functional disability by simplified neurological evaluation. The performance of the QuickDASH instrument showed that, at a cut-off point of 30 points, the sensitivity and specificity were 72.1% and 68.1% (accuracy of 70.3%), respectively, to identify functional disability, with a positive predictive value of 73.8%.

Conclusion

The QuickDASH instrument showed good accuracy to track functional disability in leprosy patients, and it may be useful in clinical practice of primary and general outpatient care, with the goal of identifying patients who need specialized reference for the prevention and treatment of this condition.

Keywords
leprosy; biomedical technology; disability evaluation

Feature		n	%
Age group (years)	18-30	11	7.0
	31-40	30	19.2
	41-50	33	21.2
	51-60	50	32.1
	> 60	32	20.5
Sex	Male	82	52.6
	Female	74	47.4
Occupation	Administrative	22	14.2
	Heavy work	62	40.0
	Housework	31	20.0
	Trade	26	16.8
	Health	14	9.0
Residence area	Rural	27	17.4
	Urban	129	82.6
Family income (minimum wage)	< 1	22	14.1
	1-2	84	53.8
	2-3	19	12.2
	≥ 3	31	19.9
Schooling (years)	0-8	79	50.6
	8-9	22	14.1
	9-12	33	21.2
	≥ 12	22	14.1
Operational classification (n = 155)*	Multibacilar	127	81.9
Operational classification (n = 155)*	Paucibacilar	28	18.1
Polychemotherapy	Current	92	59.0
	Previous	64	41.0
Retratamento	Yes	30	19.2
	No	126	80.8

Inability		n	%
Type*	Any deficit	86	55.5
	Visual	31	19.9
	Upper limbs	49	31.4
	Lower limbs	60	38.5
Degree of disability	0	70	44.9
	1	46	29.5
	2	40	25.6

Cutoff point	Sensitivity (%)	Specificity (%)	Positive predictive value (%)	Negative predictive value (%)	Accuracy (%)
15.0	87.2	42.0	65.2	72.5	67.1
20.0	84.9	46.4	66.4	71.1	67.7
25.0	77.9	58.0	69.8	67.8	69.0
30.0	72.1	68.1	73.8	66.2	70.3
35.0	66.3	75.4	77.0	64.2	70.3
40.0	59.3	79.7	78.5	61.1	68.4
45.0	57.0	82.6	80.6	60.6	68.4

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Adriano Bastos Pinho, MD, Rua Alfenas, 400 Edifício Reserva Bonifácia, Apt 191 (Bloco A), Bairro Jardim Mariana, Cuiabá, MT, 78040-600, Brazil (e-mail: adrianobpinho@gmail.com).

Degree of dificulty in the performance	None	Little	Some	A lot	Incapable
1. To open a new or tightly closed bottle	1	2	3	4	5
2. To do heavy household chores (wash the floor)	1	2	3	4	5
3. to carry a shopping bag or a briefcase	1	2	3	4	5
4. To wash one's own back	1	2	3	4	5
5. To use a knife to cut food	1	2	3	4	5
6. To perform an activity that requires force (hammer, sickle, hoe)	1	2	3	4	5
Interference in everyday life	None	Little	Some	A lot	Total
7. To what extent have the above problems interfered with your social relationship with family, neighbors, friends, and others	1	2	3	4	5
8. To what extent have the above problems interfered with your ability to work or other tasks	1	2	3	4	5
Severity of symptoms in the last week	None	Little	Some	A lot	Extreme
9. Pain in the arm, shoulder, or hand	1	2	3	4	5
10. Numbness (tingling) in the arm, shoulder, or hand	1	2	3	4	5
11. Difficulty sleeping because of this pain	1	2	3	4	5