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Indian Journal of Community Medicine

Impairment of Activities of Daily Living Among Leprosy Patients

Author(s): Ms. W. Chitra

Vol. 31, No. 2 (2006-04 - 2006-06)

India has 61% of the world's recorded leprosy cases1. Disability rate influences the patient's capability of work and activities of daily living (ADL)2. The study was conducted in Government Leprosy Community Rehabilitation Home, Puthupatti Village of Madurai at Tamilnadu. List of 212 leprosy patients (151 males and 61 females) having Grade II deformity (Visible Deformity or Damage present) in the rehabilitation home (20-80 years) was procured. 100 patients were interviewed using modified Green Pastures Activity Scale (GPAS) consisting of three aspects namely activities, interpersonal relationship with family and use of assistive devices. The activity scale score was scaled as 4 - not difficult, 3 - a bit difficult, 2 - very difficult and 1 - impossible. Relationship scale score was scaled as 4 - no problem, 3 - some problem, 2 - more problem, and 1 - no such relation. Use of assistive devices the scale score was scaled as 4 -not necessary, 3-not difficult, 2- difficult, and 1- very difficult3,4.

Table 1 : Assessment of leprosy patients using green pastures activity scale

S.No. ADL Not Difficult % A bit Difficult % Very Difficult % Impossible %
A Activity
1. Comfort 46.5 31 169.75 5.75
2. Mobility 26.6 25.4 33.6 14.4
3. Seeing 23.5 13.5 30 33
4. Brushing 31.5 35 33 0.5
5. Bathing 38.2 29 28 4.8
6. Dressing 32.25 24 25.5 18.25
7. Combing 43 26.5 20 10.5
8. Nail cutting 17 11 14 58
9. Eating/drinking 36.75 26 24.5 12.75
10. Defecating 46.5 23.75 23 6.75
11. Preparing meals 10 10 12 68
12. Activite in the house 28 22.75 30.5 18.75
B. Relationship with family members No problem
Some problem
Many problem
No such relation
C. Assistive devices Not necessary
Not difficult
Very Difficult

The study population consisted of 65% of the male and 35% of the female subjects. 68% of the patients were staying separately and 32% were staying with their family. 40% of the subjects were married and 21 %, were unmarried. 13% of the total patients found it very difficult in carrying out activities of daily living, 33.6% found difficulty in mobility. 30.5% were not able to carry out activities in their house. 30% of patients had visual problems. 33% had difficulty in brushing, where as, 25.5% of patients has difficulty in dressing themselves.12% of the patients had difficulty in preparing meals.

The study findings showed that 36% of the patients expressed that they found no difficulty in carrying out activities of daily living. Each patient was using either one of the assistive devices. The assistive devices used by the study subjects are microcellular shoe (100%), spectacle (20%), crutches (10%), arm stick (11 %), wheel chair (2%) and artificial limb (5%). Significant relationships were found between the activities of daily living carried out by the patients and their age (χ2 = 18.5, p <0.001), sex (χ2 = 7.8, p < 0.05), family support (χ2 = 12.4, p < 0.01) and martial status (χ2 = 19.4, p<0.01).

Some activities were considered impossible to carry out like seeing, Nail cutting, and preparing meals respectively. (Table: 1). These findings are cnsistent with the Van Brakel study done on impairment and disability in leprosy patients3. The study showed that the most commonly affected indoor activities were cuttring nails (22%) washing clothes (16%) using scissors (17%) and tying a knot (18%). Among the out door activities cutting grass, digging, harvesting and milking a cow or buffalo were the most commonly affected ones (22%-26%). Information about the impairment and activity status of leprosy patients may be used for decision making and management concerning (Physical) rehabilitation of individual patients, assessing the effectiveness of a leprosy programme in preventing the development of impairments and activity limitations and treatment of pre-existing ones and planning of resources needed for treatment and care of patients with impairments and activity limitations before and after release from drug therapy. The community health nurse should take initiative in preventing the further impairment by early diagnosis and treatment. Mass health education programme in leprosy will be useful in creating awareness about the condition of the disease in general population and to remove the social stigma, so that the people will accept the patient with Hansen's disease just as healthy individual.


  1. Desikan, K. V. The current leprosy situation. Health for the Millions, 2001, 27:31.
  2. Shamez, L. "Leprosy Disabilities", International Journal of Dermatology, 1997, 36: 561-572.
  3. Van Brakel, W.H, Reed N.K. & Red D.S., "Grading Impairment in Leprosy", International Journal of Leprosy, 1999, 68: 106.
  4. World health organization "Grading of Disabilities", Indian Journal of Leprosy, 1988, 71: 126.

Ms. W. CHITRA (Msc Nursing), Assistant Professor
College of Nursing,
Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore
Received: 15.02.2005

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