Evaluation of Physical Impairment and Psychosocial Disorders in New Leprosy Patients before and after Multidrug Therapy in a Referral Hospital in Belo Horizonte, Minas Gerais, Brazil: The Value of Rating Scales in the Assessment of Disabilities

摘要

This study aimed at assessing the ability of rating scales to reflect changes in leprosy-related disabilities in new patients at the time of diagnosis and completion of multidrug therapy (MDT), to evaluate the association between physical disabilities and psychosocial disorders in such patients and to identify the factors associated with high impairment scores. The study population comprised of 56 new leprosy patients. Physical disabilities were evaluated by means of Maximum WHO Impairment Grade (IG) and Eye-Hand-Foot (EHF) impairment scores, while psychomotor and social disorders were evaluated using Screening of Activity Limitation and Self Awareness (SALSA), Green Pastures Activity Scale (GPAS), Participation, Hamilton depression and Jacoby stigma scales. The SALSA and Hamilton scales were the most efficient in reflecting changes in the status of patients after completion of MDT. Depression and activity limitations increased the probabilities of high IG and EHF scores by 6.39- and 5.61-times, respectively. Age and education were significantly associated with poor disability scores. It is sufficient to apply the IG scale alone in the routine of basic health units. The SALSA and an adapted version of the Hamilton depression scale should be introduced to assess psychosocial disorders in leprosy cases. Educational approaches addressed to older and less educated patients should be implemented. The significant concordance between the scores obtained with the SALSA, GPAS, Participation, Hamilton depression and Jacoby stigma scales at the time of diagnosis and at completion of MDT suggests that all of these tools provide consistent evaluation of the physical impairments and psychosocial disorders associated with leprosy.