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The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes

The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes
The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes
Purpose. The purpose of this study was to develop and validate a method of measuring activity limitation in leprosy and diabetes. The resulting questionnaire should be quick and simple to use in basic clinical settings, not require any testing skills or equipment, be validated across a number of cultures in order to be widely applicable, be relevant for anyone with long-standing peripheral neuropathy and be sensitive to changes in clients' capabilities. Because of impaired sensibility in hands or feet, persons affected by leprosy or diabetes are expected to be aware that many activities carry a risk of injury, particularly repetitive stress, excess pressure, friction or burns. They are expected to avoid these risky activities, or modify how they are carried out, in order to prevent injury. An additional aim of the study was therefore to find ways of assessing how far clients were aware of safety issues and how much they limited their activities voluntarily because of safety concerns.

Method. Lists of activities of daily living relevant for the target populations were generated through individual interviews and focus group discussions. A questionnaire of 374 items was compiled and administered to 436 persons affected by leprosy and 132 affected by diabetes in five countries in four continents. A total of 76% of respondents had impairments. Occupational therapists not otherwise involved in this study gave an independent assessment of the degree of activity limitation of 207 respondents. The process of item selection from this database is presented step by step. Items for the SALSA scale were practised by at least 70% of respondents in all participating populations, were easy to perform for some but difficult for others, correlated well with the assessment of independent practitioners and had good item-total correlation. The present set of 20 items is well represented by a single principal component and had a high scale reliability coefficient.

Results. On a 20-item scale, one would expect a score of 20 if the respondents practiced all the activities listed without difficulty. Higher scores reflect increasing activity limitation. The SALSA score varied from 10 to 75 with a mean of 32. The distribution of the scores was not different between men and women or between disease groups. There was a consistent increase of the SALSA score with age and with the level of impairment. Compared to India and Nigeria, the average SALSA scores, adjusted for age and impairment level, were higher in Israel and Brazil, but lower in China. The spearman correlation coefficient between the SALSA scores and the scores assigned by the independent experts was 0.67. Among 23 respondents without overt disease, the SALSA score had a median of 19 and half the respondents scored between 18 and 20.

Conclusions. The present research has resulted in the SALSA scale, a short questionnaire which can be administered within 10 min and which provides a standardized measure of activity limitation in clients with a peripheral neuropathy. It can be used to make comparisons between (groups of) individuals in different countries and in the same person (or group) over time. General health workers can use SALSA to screen clients and refer those with high scores to specialised services. In addition, the scale will assist service providers in designing appropriate interventions.
leprosy, diabetes mellitus, rehabilitation, occupational therapy, skin ulcer
0963-8288
689-700
Ebenso, J.
9d6c85b6-7777-4e59-8a46-b4ca86045446
Fuzikawa, P.
4a10d52b-bb96-4d94-bad6-5f9b86f4b69f
Melchior, H.
f3da69bd-76ee-48be-8cf4-12f8f57157ef
Wexler, R.
afd6418a-57d4-4105-a31a-72832d3453e3
Piefer, A.
8b5554db-6c53-4ecd-ba43-13dee57747d3
Min, C.S.
cefcc0e6-9e43-48af-9950-6f5b7120e855
Rajkumar, P.
e635fb1e-d928-49c4-ac0d-80eae28de12b
Anderson, A.
c3371376-d35e-4984-9658-b2ac80b5f5b3
Benbow, C.
6ebea8ef-0d21-4e4e-a426-f833f1864c65
Lehman, L.
ebbe1e69-1f67-4da5-a608-6a281ecbc7bc
Nicholls, P.
b806adfb-76d9-4b75-83b1-a1d63e779009
Saunderson, P.
f59650f4-f719-458b-8ea7-654e6abc45b1
Velema, J.P.
af0d9178-d357-49b3-881d-d9e8a8e43875
SALSA Collaborative Study Group
Ebenso, J.
9d6c85b6-7777-4e59-8a46-b4ca86045446
Fuzikawa, P.
4a10d52b-bb96-4d94-bad6-5f9b86f4b69f
Melchior, H.
f3da69bd-76ee-48be-8cf4-12f8f57157ef
Wexler, R.
afd6418a-57d4-4105-a31a-72832d3453e3
Piefer, A.
8b5554db-6c53-4ecd-ba43-13dee57747d3
Min, C.S.
cefcc0e6-9e43-48af-9950-6f5b7120e855
Rajkumar, P.
e635fb1e-d928-49c4-ac0d-80eae28de12b
Anderson, A.
c3371376-d35e-4984-9658-b2ac80b5f5b3
Benbow, C.
6ebea8ef-0d21-4e4e-a426-f833f1864c65
Lehman, L.
ebbe1e69-1f67-4da5-a608-6a281ecbc7bc
Nicholls, P.
b806adfb-76d9-4b75-83b1-a1d63e779009
Saunderson, P.
f59650f4-f719-458b-8ea7-654e6abc45b1
Velema, J.P.
af0d9178-d357-49b3-881d-d9e8a8e43875

Ebenso, J., Fuzikawa, P., Melchior, H., Wexler, R., Piefer, A., Min, C.S., Rajkumar, P., Anderson, A., Benbow, C., Lehman, L., Nicholls, P., Saunderson, P. and Velema, J.P. , SALSA Collaborative Study Group (2007) The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes. Disability and Rehabilitation, 29 (9), 689-700. (doi:10.1080/09638280600926587). (PMID:17453991)

Record type: Article

Abstract

Purpose. The purpose of this study was to develop and validate a method of measuring activity limitation in leprosy and diabetes. The resulting questionnaire should be quick and simple to use in basic clinical settings, not require any testing skills or equipment, be validated across a number of cultures in order to be widely applicable, be relevant for anyone with long-standing peripheral neuropathy and be sensitive to changes in clients' capabilities. Because of impaired sensibility in hands or feet, persons affected by leprosy or diabetes are expected to be aware that many activities carry a risk of injury, particularly repetitive stress, excess pressure, friction or burns. They are expected to avoid these risky activities, or modify how they are carried out, in order to prevent injury. An additional aim of the study was therefore to find ways of assessing how far clients were aware of safety issues and how much they limited their activities voluntarily because of safety concerns.

Method. Lists of activities of daily living relevant for the target populations were generated through individual interviews and focus group discussions. A questionnaire of 374 items was compiled and administered to 436 persons affected by leprosy and 132 affected by diabetes in five countries in four continents. A total of 76% of respondents had impairments. Occupational therapists not otherwise involved in this study gave an independent assessment of the degree of activity limitation of 207 respondents. The process of item selection from this database is presented step by step. Items for the SALSA scale were practised by at least 70% of respondents in all participating populations, were easy to perform for some but difficult for others, correlated well with the assessment of independent practitioners and had good item-total correlation. The present set of 20 items is well represented by a single principal component and had a high scale reliability coefficient.

Results. On a 20-item scale, one would expect a score of 20 if the respondents practiced all the activities listed without difficulty. Higher scores reflect increasing activity limitation. The SALSA score varied from 10 to 75 with a mean of 32. The distribution of the scores was not different between men and women or between disease groups. There was a consistent increase of the SALSA score with age and with the level of impairment. Compared to India and Nigeria, the average SALSA scores, adjusted for age and impairment level, were higher in Israel and Brazil, but lower in China. The spearman correlation coefficient between the SALSA scores and the scores assigned by the independent experts was 0.67. Among 23 respondents without overt disease, the SALSA score had a median of 19 and half the respondents scored between 18 and 20.

Conclusions. The present research has resulted in the SALSA scale, a short questionnaire which can be administered within 10 min and which provides a standardized measure of activity limitation in clients with a peripheral neuropathy. It can be used to make comparisons between (groups of) individuals in different countries and in the same person (or group) over time. General health workers can use SALSA to screen clients and refer those with high scores to specialised services. In addition, the scale will assist service providers in designing appropriate interventions.

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More information

Published date: May 2007
Keywords: leprosy, diabetes mellitus, rehabilitation, occupational therapy, skin ulcer

Identifiers

Local EPrints ID: 59001
URI: http://eprints.soton.ac.uk/id/eprint/59001
ISSN: 0963-8288
PURE UUID: e5ff8766-71a5-419b-818d-a64991dfd688

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Date deposited: 20 Aug 2008
Last modified: 15 Mar 2024 11:13

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Contributors

Author: J. Ebenso
Author: P. Fuzikawa
Author: H. Melchior
Author: R. Wexler
Author: A. Piefer
Author: C.S. Min
Author: P. Rajkumar
Author: A. Anderson
Author: C. Benbow
Author: L. Lehman
Author: P. Nicholls
Author: P. Saunderson
Author: J.P. Velema
Corporate Author: SALSA Collaborative Study Group

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