|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 16
| Issue : 2 | Page : 81-83 |
|
Profile of functional limitation using Screening of Activity Limitation and Safety Awareness Scale in leprosy population of Mysore district
Preethi Hassan Shivanna1, RT Shruthi2
1 Lecturer, Department of Pediatrics, JSS College of Physiotherapy (Affiliated to Rajeev Ghandi Institute of Health Sciences, Bengaluru), Mysore, Karnataka, India
2 Department of Physiotherapy, District Leprosy Office at District Health Office, Mysore, Karnataka, India
| Date of Submission | 09-Jun-2022 |
| Date of Decision | 06-Sep-2022 |
| Date of Acceptance | 09-Sep-2022 |
| Date of Web Publication | 31-Jan-2023 |
Correspondence Address:
Preethi Hassan Shivanna
Department of Pediatrics, JSS College of Physiotherapy, MG Road, Mysore - 570 004, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/pjiap.pjiap_17_22
INTRODUCTION: Leprosy is known as Hansen's disease, a chronic disease caused by Mycobacterium leprae. It can be seen in all ages, from early infancy to old age. It is a significant cause of preventable disability. The impairments give rise to disabilities, such as limitations in performing activities involving using hands, feet, and eyes and restrictions in social participation. Functional movements are most important to fulfill one's activities of daily living.
OBJECTIVES: The objectives of this study were to identify the functional limitations using the Screening of Activity Limitation and Safety Awareness (SALSA) Scale in the leprosy population of Mysore district.
METHODS: This cross-sectional study included 92 participants diagnosed with leprosy and collected socioeconomic and clinical data. Each participant was evaluated for functional limitations using the SALSA Scale.
RESULTS: The participants were mainly male (58) and fewer female (34) with a minimum of one impairment. The result is written based on the five primary domains of the SALSA Scale. The study showed that 39.65% of participants did not present significant functional limitations and 24.36% of participants reported mild functional limitations. In comparison, 12.35% were moderately functionally limited, 14.32% had severe functional limitations, and 9.32% showed extremely severe limitations which described the most difficult activity were fine motor activity.
CONCLUSION: The study concludes that difficult functional activity reported by participants with leprosy was fine motor activity and hand sensation to carry the hot objects according to the profiling by SALSA Scale which intern leads to difficulty in quality of life.
Keywords: Activities of daily living, functional limitation, leprosy, leprosy and functional limitation, leprosy and screening of activity limitation and safety awareness, screening of activity limitation and safety awareness
How to cite this article:
Shivanna PH, Shruthi R T. Profile of functional limitation using Screening of Activity Limitation and Safety Awareness Scale in leprosy population of Mysore district. Physiother - J Indian Assoc Physiother 2022;16:81-3 |
How to cite this URL:
Shivanna PH, Shruthi R T. Profile of functional limitation using Screening of Activity Limitation and Safety Awareness Scale in leprosy population of Mysore district. Physiother - J Indian Assoc Physiother [serial online] 2022 [cited 2023 Jun 5];16:81-3. Available from: https://www.pjiap.org/text.asp?2022/16/2/81/368873 |
| Introduction | |  |
Leprosy, known as Hansen's disease, is a chronic infectious disease caused by Mycobacterium.[1],[2] A total of 174,608 new leprosy cases were reported in 136 countries worldwide in 2015, corresponding to a prevalence rate (PR)/10,000 individuals,[3] which is lower than the PR of 0.32/10,000 in 2014.[4] Leprosy is a significant cause of preventable disability.[5] Physical impairment associated with leprosy is usually secondary to nerve damage.[6] Impairments may give rise to disabilities, such as limitations in activities involving using hands, feet, and eyes and restrictions in social participation.
Multidrug treatment can cure leprosy and, if instituted early, can prevent disability. However, leprosy is often diagnosed too late when permanent impairment has already occurred. Even after completion of treatment, a significant proportion of patients sustain disability from nerve damage, requiring continued care to limit further secondary damage.[6] The Screening of Activity Limitation and Safety Awareness (SALSA) Scale is an instrument used to measure activity limitations based on the International Classification of Functioning, Disability, and Health, enabling more accurate clinical observation of leprosy patients. The SALSA evaluates the degree of sensory impairment resulting from peripheral neuropathies and risk awareness of patients on conditions that may affect their physical and mental integrity.[5],[6],[7] The SALSA Scale comprises 20 questions evaluating mechanical skills used to perform routine activities requiring preserved neural functions.[8]
Functional activity limitations (FALs) associated with leprosy are well described. However, little is known about the interaction between these FALs and the quality of life (QoL). Therefore, it is essential to assess how functional limitations affect the QoL of these individuals.[9],[10] The studies regarding the profile of functional disability in the Indian population are lacking concerning the SALSA Scale. Hence, the study aims to determine the profile of functional limitation in patients with leprosy using SALSA in the Mysore district.
| Methods | | |
A cross-sectional study was done with both male and female patients with leprosy in the Mysore district. Patients with all types of leprosy, age 12 and above, were recruited for the study and source of data by personal interview method. The no objection certificate was obtained from the district leprosy office of Mysore. Ethical approval for the study was obtained from the institutional ethical committee. Informed consent was taken from patients with leprosy; the individual who did not know how to read and write was given oral consent (with reference to Helsinki declaration 2013 ICMR guidelines). The SALSA Scale (reliability 0.9 and established face validity) was in English, translated to the Kannada language, validated by the local experts, and then used for the study. Each participant was interviewed with the SALSA Scale, and the response was noted.
| Results | | |
A total of 122 participants, 92 participants with leprosy, were responded to and recruited through the personal interview method for the study, 32 participants dropped out of the study as they were not able to understand the description, out of which 58 were male, and 34 were female participants. The demographic characteristics of the participants are given in [Table 1]. | Table 1: Demographic characteristics of the participants (n=92) with disease duration
Click here to view |
Nineteen activities were reported by the participants which are given in the SALSA Scale. Most commonly reported difficult activities were noted and summarized as given in SALSA Scale. The report on functional vision says that out of 92, 86 individuals had difficulty seeing and 6 did not have any issue seeing. In the information on mobility-related activities, 92% of individuals with leprosy had trouble sitting or squatting on the ground. In the section on self-care activities, the individuals reported that washing the whole body was the most difficult to perform. In the next area, activities related to work (hand), the individuals said working with tools was the more challenging to serve in the section. In the last component activities related to hand dexterity, the individuals reported picking up things from the floor was the most difficult to perform. The result showed that 39.65% of participants did not present significant functional limitation and 24.36% of participants reported a mild functional limitation. In comparison, 12.35% were moderately functionally limited, 14.32% had severe functional limitations, and 9.32% showed extremely severe limitations which described the most difficult activity were fine motor activity.
| Discussion | | |
Leprosy is one of the reasons for the restriction of functional activities in an individual. The core objective of this study was to analyze the functional limitation in patients with leprosy using the most commonly used scale for leprosy (SALSA). From the current study, it showed that the disability due to leprosy will worsen as the disease progress and there will be a drastic decrement in the activities of daily living (ADL) which in turn leads to the dependency in all the activities of daily living of the leprosy survival. An author stated in his study that low SALSA scores which represent a higher rate of functional limitation and dependency for ADL activities.[11]
An author in their study stated that 70% of patients had activity limitations and which indicates the severity of nerve damage and related disability. This could be because of variable differences in leprosy patient's diagnosis and management in tertiary care centers.[11] A huge number of patients with activity limitations indicate late diagnosis and management and inability to reach rehabilitation services. Interdisciplinary team involvement in diagnosis, monitoring and management of leprosy-related impairment could enhance patients QoL.[12],[13]
The SALSA Scale allows to measure activity limitation in people with peripheral neuropathy and in leprosy.[14] The activities were rated on a scale using the descriptive manner which is mentioned in the scale. The profile was made more specific for both male and female participants by making each domain as a separate entity.[15],[16],[17],[18],[19] The most frequently reported activity in overall data was difficulty in using the hand for the fine motor activity and hand sensation to carry the hot objects which were reported by an average of 54 participants. Along with that, the other activities such as opening/closing screw-capped bottles and opening jars with screw-on lids were also reported by participants.
Strength
The strength of this study is that leprosy individuals were made free to express his/her desired activity limitation in the scale. Other important methods used in the study were that the scale was translated from English to Kannada with the support of strong ethical values which made it easy for the participants to understand the scale.
Limitation
The limitations of this study were the population, uneven distribution of urban and rural areas, and most of the participants are from the rural area very less participants from the urban area.
| Conclusion | | |
The profile of functional limitation showed that the most difficult activity reported by participants with leprosy was fine motor activity and hand sensation to carry the hot objects. The functional disability profile of the patients with leprosy derived from the results of this study as fine motor activity (list of activities related to the dexterity of hand), hand sensation to carry hot objects, opening/closing screw-capped bottle, walking on an uneven surface, and cooking.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Abdela SG, van Henten S, Abegaz SH, Bayuh FB, Zewdu FT, Berhe FT, et al. Activity limitation and social participation restriction among leprosy patients in Boru Meda Hospital, Amhara Region, Ethiopia. PLoS Negl Trop Dis 2020;14:e0008702.  |
| 2. | Barbosa JC, Ramos Junior AN, Alencar MJ, Castro CG. Post-treatment of Leprosy in Ceará: activity and functional limitation, safety awareness and social participation. Rev Bras Enferm 2008;61:727-33. |
| 3. | Van Brakel WH, Officer A. Approaches and tools for measuring disability in low and middle-income countries. Lepr Rev 2008;79:50-64. |
| 4. | Britton WJ, Lockwood DN. Leprosy. Lancet 2004;363:1209-19. |
| 5. | Aben-Athar CY, Lima SS, Ishak R, Vallinoto AC. Assessment of the sensory and physical limitations imposed by leprosy in a Brazilian Amazon population. Rev Soc Bras Med Trop 2017;50:223-8. |
| 6. | de Paula HL, de Souza CD, Silva SR, Martins-Filho PR, Barreto JG, Gurgel RQ, et al. Risk factors for physical disability in patients with leprosy: A systematic review and meta-analysis. JAMA Dermatol 2019;155:1120-8. |
| 7. | Fonseca AB, Simon MD, Cazzaniga RA, de Moura TR, de Almeida RP, Duthie MS, et al. The influence of innate and adaptative immune responses on the differential clinical outcomes of leprosy. Infect Dis Poverty 2017;6:5. |
| 8. | Irawati Y, Lestari Y, Bani A, Menaldi S, Wahyuni L, Kur niawardhani D. Health care service for leprosy patients in Sitanala Tangerang (A proposed approach of comprehensive health care for Leprosy patient). AJCE 2018;2:281–97. |
| 9. | Ebenso J, Velema JP. Test-retest reliability of the screening activity limitation and safety awareness (SALSA) scale in North-West Nigeria. Lepr Rev 2009;80:197-204. |
| 10. | Long S, Yu M, Yan L, Zhang G, Sun P. Epidemiological features of leprosy in China from 2011 to 2015. Chin J Dermatol 2017;50:400-3. |
| 11. | Monteiro LD, Alencar CH, Barbosa JC, Novaes CC, da Silva Rde C, Heukelbach J. Limited activity and social participation after hospital discharge from leprosy treatment in a hyperendemic area in North Brazil. Rev Bras Epidemiol 2014;17:91-104. |
| 12. | Nardi SM, Paschoal VD, Zanetta DM. Limitations in activities of people affected by leprosy after completing multidrug therapy: Application of the SALSA scale. Lepr Rev 2012;83:172-83. |
| 13. | Richardus JH, Habbema JD. The impact of leprosy control on the transmission of M. leprae: Is elimination being attained? Lepr Rev 2007;78:330-7. |
| 14. | Pinho AB, Borghesan FH, Lotufo MN, Allet MA. Avaliac¸ão dos tratamentoscirúrgicos das Sequelas de hanseníasepelasescalas SALSA and Dash. Rev Bras Ortop 2013;49:292-6. |
| 15. | Santos VS, Oliveira LS, Castro FD, Gois-Santos VT, Lemos LM, Ribeiro Mdo C, et al. Functional activity limitation and quality of life of leprosy cases in an endemic area in Northeastern Brazil. PLoS Negl Trop Dis 2015;9:e0003900. |
| 16. | Toh HS, Maharjan J, Thapa R, Neupane KD, Shah M, Baral S, et al. Diagnosis and impact of neuropathic pain in leprosy patients in Nepal after completion of multidrug therapy. PLoS Negl Trop Dis 2018;12:e0006610. |
| 17. | Wagenaar I, Post E, Brandsma W, Bowers B, Alam K, Shetty V, et al. Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial. PLoS Negl Trop Dis 2017;11:e0005952. |
| 18. | Wilder-Smith EP, Van Brakel WH. Nerve damage in leprosy and its management. Nat Clin Pract Neurol 2008;4:656-63. |
| 19. | van Brakel WH, Sihombing B, Djarir H, Beise K, Kusumawardhani L, Yulihane R, et al. Disability in people affected by leprosy: The role of impairment, activity, social participation, stigma and discrimination. Glob Health Action 2012;5:10. |
[Table 1]
|
Search Pubmed for