Grading impairment in leprosy

The aim of the paper is to discuss the concept of 'severity grading' in rel ation to impairment in leprosy, and to describe the use of an impairment su m score, the Eyes, Hands, Feet (EHF) score, as an indicator of the severity and the evolution of impairment over time. The use of an impairment sum sc ore, the EHF score, is illustrated using data on impairment at diagnosis an d after a 2-year interval from MB patients released from MDT in the Western Region of Nepal. The WHO 1988 'disability' grading scale (0-2, for both ey es, hands and feet - six sites) was used as a measure of impairment. For th e analysis, the WHO grades for the six sires were summed to form an EHF sco re (minimum 0, maximum 12). The sensitivity to change over time of the EHF score was compared with that of the 'method of maximum grades'. Using the ' method of maximum grades', 509/706 patients (72%) appeared not to have chan ged in impairment status, compared with only 399 (56.5%) with the EHF score . Improvement or deterioration of impairment status was missed in 113 patie nts (16%). In 216/706 patients (30.6%), the changes detected with the EHF s core were bigger than those revealed by the method of maximum grades. The s ix components of the WHO impairment grading may be added up to form a EHF s um score of impairment. This score can be used to monitor changes in impair ment status in individuals or in groups. It should be recorded and reported at least at diagnosis and release from treatment. Reporting could be done as the 'proportion of patients with improved EHF score', 'stable EHF score' and 'EHF score worse', and 'proportion of patients without impairment', 'p roportion with WHO grade 1' and 'proportion with WHO grade 2'. It is recomm ended that the concepts and terminology of the WHO International Classifica tion of Impairments, Activities and Participation (ICIDH-2) be adopted in t he field of leprosy, particularly for the areas of prevention of impairment and disability and rehabilitation. The 'WHO disability grade' should be re named 'WHO impairment grade'.