A scale to assess activities of daily living in persons affected by leprosy

The aim of this study was to develop a scale for identifying disability amo ng people in the rural areas of developing countries. The studies were carr ied out in the Green Pastures Hospital and the leprosy field programme of t he Western Region of Nepal. With the help of staff experienced in working w ith people with disability, a 68-question questionnaire was made, based on the International Classification of Impairments, Activities and Participati on (ICIDH-2). A survey was carried out of 269 people affected by leprosy wh o had impairments, as well as a sample of those who were unimpaired. The su rvey results were used to develop the questionnaire into a scale, using sta ndard scale development methods. This included checking of criterion validi ty, discrimination and reliability and stability using weighted kappa stati stics. Of the 68 questions, 38 were included in the second draft of the ins trument. Eight questions were added to identify difficulty in relationships , about the use of aids and about occupation and employment. The sum score of the scale against the expert score gave a Spearman correlation coefficie nt of 0.72. Intra- and inter-interviewer reliability coefficients were 0.77 (95% CI 0.73-0.81) and 0.61 (95% CI 0.56-0.67), respectively. The stabilit y test gave an overall kappa of 0.76 (95% CI 0.70-0.82). Four questions wit h particularly poor results were omitted from the final draft of the instru ment. An interview-based instrument was developed for identifying limitatio ns in activities of daily living (disability) in people Living in a rural s etting in a developing country-the Green Pastures Activity Scale (GPAS). Th e scale performed well during validity and reliability testing. It consists of 34 activity questions, five relationship questions, and three questions on the use of aids, occupation and employment.