In order to analyze the data more accurately, the WHODAS score differences were subsequently compared, according to both the patient's self-evaluation and the professional's evaluation. The analyses and results are presented below in the order listed above.
Initially, the study collected sociodemographic data from the patients. Of the 103 subjects, 49.8% were women, aged between 19 and 59 years (M = 41.38; SD = 10.22). Regarding the level of education, 5.8% had not received any education, 46.6% had completed primary school, 35.9% at secondary school, and 11.7% at the university. In terms of their familial situation, 25.2% lived alone while 74.8% lived with someone. Of the total sample, 89 participants completed reassessment; the remaining 14 could only make the initial assessment. In total, the patients stayed in the facilities for an average of 119 days ± 56.07.
Secondly, the frequency of patients participating in occupational interventions was assessed. As shown in Table 2, cognitive stimulation, cooking workshops, therapeutic walks, relaxation, and creative activities were the activities in which most patients were involved.
Table 2. Participation of subjects in occupational interventions during the stay in the center - Murcia, Spain, 2016-2017.
|
Ma
|
SDb
|
Swimming
|
1.27
|
2.24
|
Cognitive stimulation
|
9.42
|
7.82
|
Social skills
|
5.20
|
4.05
|
Kitchen skills
|
10.29
|
9.48
|
News
|
7.49
|
8.16
|
Therapeutic outings
|
10.63
|
8.59
|
Gym
|
8.58
|
9.08
|
Relaxation
|
9.87
|
9.88
|
Music therapy
|
5.71
|
4.66
|
Allotment work
|
2.70
|
3.87
|
Aesthetic workshop
|
3.95
|
4.57
|
Creative Workshop
|
8.69
|
14.25
|
Film Forum
|
1.33
|
1.81
|
aM: Mean; bSD: Standard Deviation
Thirdly, an analysis was carried out to check the difference in factors relating to WHODAS before and after the intervention according to the patient's self-assessment. As shown in Table 3, significant differences were found in all factors. Specifically, the self-evaluation in each of the factors was more positive (lower) when they were discharged than when they were admitted, showing an improvement in the patients' self-perception regarding their limitations. The two factors in which the change was greater were Understanding and Communicating and Participation in Society, the factor that the patients found the most difficult as a whole was Activities of Daily Living.
Table 3. Simple effects of time on the different factors of the WHODAS according to the patient's self-evaluation.
|
Income Ma (SDb)
|
High Ma (SDb)
|
t
|
p
|
Cohen’s d
|
UCc
|
2.25 (.80)
|
1.60 (.61)
|
6.943
|
0.000
|
1.07
|
CMd
|
1.56 (.78)
|
1.32 (.62)
|
3.427
|
0.001
|
0.34
|
PCe
|
1.39 (.68)
|
1.23 (.47)
|
2.355
|
0.021
|
0.27
|
IRf
|
2.16 (.80)
|
1.79 (.70)
|
4.023
|
0.000
|
0.49
|
ADLsg
|
2.24 (1.06)
|
1.63 (.82)
|
5.077
|
0.000
|
0.64
|
PSh
|
2.42 (.72)
|
1.83 (.52)
|
2.742
|
0.023
|
0.94
|
aM: Mean; bSD: Standard Deviation; t: Student's t; p: Statistical Significance; cUC; Understanding and Communicatig; dCM; Community Mobility; ePC; Personal Care fIR: Interpersonal Relationships;
gADLs: Activities of Daily Living; hPS; Participation in Society
Fourthly, the same analyses were carried out, but, in this case, using the professional's patient evaluation. As shown in Table 4, there were significant differences in all the WHODAS factors. Self-evaluations by the patients and the professionals' assessments both found a more positive outcome when discharged than initial admission. The analysis showed improvements from both patients and professionals. Regarding the patients' self-evaluation, the two factors in which there was a more significant change were Understanding and Communicating and Participation in Society. These two factors were also those that received the most negative evaluation from the professionals, together with Activities of Daily Living and Interpersonal Relationships. In contrast to the patients' view, Interpersonal Relationships were unrecognizable as a more significant barrier.
Table 4. Simple effects of time on the different WHODAS factors according to the professional's evaluation - Murcia, Spain, 2016-2017.
|
Income Ma (SDb)
|
High Ma (SDb)
|
t
|
p
|
Cohen’s d
|
UCc
|
2.47 (0.64)
|
1.77 (0.56)
|
12.277
|
0.000
|
1.16
|
CMd
|
1.50 (0.67)
|
1.29 (0.56)
|
3.170
|
0.002
|
0.34
|
PCe
|
1.60 (0.63)
|
1.34 (0.49)
|
5.095
|
0.000
|
0.46
|
IRf
|
2.56 (0.69)
|
2.03 (0.60)
|
8.102
|
0.000
|
0.82
|
ADLsg
|
2.78 (0.87)
|
1.99 (0.80)
|
9.300
|
0.000
|
0.95
|
PSh
|
2.50 (0.62)
|
1.87 (0.47)
|
8.812
|
0.000
|
1.15
|
aM: Mean; bSD: Standard Deviation; t: Student's t; p: Statistical Significance; cUC; Understanding and Communicatig; dCM; Community Mobility; ePC; Personal Care fIR: Interpersonal Relationships;
gADLs: Activities of Daily Living; hPS; Participation in Society
Fifthly, a repeated measures analysis was performed with an intra-subject factor (Time: Admission vs. Discharge) and a factor between subjects (Evaluator: Patient vs. Expert) in order to check whether there were differences between the patient's self-assessment and the professionals' self-assessment, as well as the time when the measure was taken. The results only showed a significant interaction in Interpersonal Relationships (IR) (Table 5). Specifically, the evaluation of the patient in the IR was lower at discharge than at the beginning. However, when the patient was the evaluator, the patients' assessment showed an even lower than when it was the professional. No significant differences were found in the other factors, so we can affirm that both the patients' self-evaluation and the professionals' evaluation were similar when they were admitted and discharged.
Table 5. Interaction between time and the evaluator in the different factors of the WHODAS - Murcia, Spain, 2016-2017.
|
Patient
|
Professional
|
|
|
|
|
Entry
Ma (SDb)
|
high
Ma (SDb)
|
Entry
Ma (SDb)
|
high
Ma (SDb)
|
F
|
p
|
h2p
|
UCc
|
2.25 (0.80)
|
1.60 (0.61)
|
2.47 (0.64)
|
1.77 (0.56)
|
0.759
|
0.386
|
0.008
|
CMd
|
1.56 (0.78)
|
1.32 (0.62)
|
1.50 (0.67)
|
1.29 (0.56)
|
0.344
|
0.559
|
0.004
|
PCe
|
1.39 (0.68)
|
1.23 (0.47)
|
1.60 (0.63)
|
1.34 (0.49)
|
2.683
|
0.105
|
0.029
|
IRf
|
2.16 (0.80)
|
1.79 (0.70)
|
2.56 (0.69)
|
2.03 (0.60)
|
5.313
|
0.023
|
0.056
|
ADLsg
|
2.24 (1.06)
|
1.63 (0.82)
|
2.78 (0.87)
|
1.99 (0.80)
|
3.080
|
0.083
|
0.033
|
PSh
|
2.42 (0.72)
|
1.83 (0.52)
|
2.50 (0.62)
|
1.87 (0.47)
|
1.159
|
0.285
|
0.013
|
aM: Mean; bSD: Standard Deviation; t: Student's t; p: Statistical Significance; cUC; Understanding and Communicatig; dCM; Community Mobility; ePC; Personal Care fIR: Interpersonal Relationships;
gADLs: Activities of Daily Living; hPS; Participation in Society
Finally, different analyses were carried out to check whether there were differences in the different WHODAS factors, taking into account some sociodemographic variables and, in other cases, whether there was a correlation between the two. The results presented are mainly related to sex, age, educational level, familial situation, and the number of previous admissions. Only the data showing significant differences in the WHODAS evaluations are shown due to the large number of analyses for each factor.
In the case of gender, differences in the PS factor were found in the self-assessment of the patients upon admission (t = 3.060, p = 0.003). Specifically, women (2.70 ± 0.81) presented a higher self-assessment than men (2.26 ± 0.66). On the other hand, in the self-evaluation they carried out when they were discharged, differences were found in the factors CM (t = 2.408, p = 0.020), PC (t = 2.026, p = 0.049) and PS (t = 2.176, p = 0.032). In the three cases, women (CM: 1.53 ± 0.80; PC: 1.37 ± 0.67; PS: 1.97 ± 0.54) presented higher self-evaluations than men (CM: 1.18 ± 0.42; PC: 1.13 ± 0.24; PS: 1.73 ± 0.49).
Regarding the professionals' evaluations, in reference to the admission of the patients, differences were found in factors CM (t = 2.520, p = 0.014), ADLs (t = 4.187, p <0.001) and PS (t = 2.872, p = 0.005). Again, women (CM: 1.71 ± 0.81; PS: M = 2.73, DT = 0.72) obtained higher evaluations than men (CM: 1.36 ± 0.47; PS: 2.36 ± 0.50) in CM and PS; however, men (3.07 ± 0.58) ) scored lower than women (2.36 ± 0.99) in ADLs. Regarding discharge, differences were found in CM (t = 2.402, p = 0.020) and ADLs (t = 2.052, p = 0.044). Specifically, in CM, women (1.48 ± 0.71) scored lower than men (1.17 ± 0.40) and in ADLs, men (2.13 ± 0.72) scored lower than women (1.77 ± 0.88).
In the case of age, in the self-assessment of patients upon admission, only a negative correlation was found between age and UC (r = -0.246, p = 0.012), while in the self-assessment carried out when they were discharged, no correlation was found. When the evaluation was carried out by professionals, age was positively correlated with CM (r = 0.307, p = 0.002) and PC (r = 0.240, p = 0.014) during admission, while at discharge only a positive relationship was found with PC (r = 0.304, p = 0.003).
In the case of the number of previous admissions to the hospital, correlations were also made. Upon admission, patients were given a self-assessment showing a significant positive relationship with UC (r = 0.202, p = 0.04), whereas no significant correlation was found at discharge. During the professional's evaluation, the same positive relationship between the number of previous admissions and UC was significant (r = 0.203, p = 0.039), and again at discharge, no significant relationship was found.
In the case of education, the patients' self-evaluations found no significant difference (p = 0.094) neither at discharge nor at admission. However, in the professional's evaluation, significant differences were found. At admission, significant differences appeared in UC (F = 3.120, p = 0.029). A posthoc analysis by the Tukey method revealed that the differences were found between those with primary education (2.62 ± 0.59) and university education (2.06 ± 0.67), the former being the ones with the most difficulties. At discharge, significant differences were found in UC (F = 3.404, p = 0.021) and ADLs (F = 2.758, p = 0.047). In the case of UC, those with primary education had a worse prognosis (M = 1.93, SD = 0.56) than those with secondary education (1.60 ± 0.48) or university education (1.46 ± 0.40); while in the case of ADLs, who had primary education (2.21 ± 0.75) had a worse prognosis than those with secondary education (M = 1.71 ± 0.75).
Lastly, regarding the familial situation, significant differences appeared in CM during the self-evaluation at admission (t = 2.708, p = 0.008). Those who lived with a family (1.64 ± 0.85) had a worse prognosis than those who lived alone (1.32 ± 0.34). No significant differences appeared at discharge. On the other hand, regarding the evaluation of the professionals, no significant differences were found either at admission or discharge.