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Related Experiment Videos

Grading impairment in leprosy.

W H van Brakel1, N K Reed, D S Reed

  • 1INF Leprosy Project, Pokhara, Nepal. wvbrakel@iname.com

Leprosy Review
|August 28, 1999
PubMed
Summary
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The Eyes, Hands, Feet (EHF) score effectively tracks leprosy impairment changes over time, revealing more patient status shifts than the standard WHO grading method. This sum score offers a sensitive measure for monitoring leprosy progression and treatment impact.

Area of Science:

  • Medical research
  • Public health
  • Epidemiology

Background:

  • Leprosy impairment assessment traditionally uses the WHO 'disability' grading scale.
  • This scale may not be sensitive enough to detect subtle changes in impairment over time.
  • A more sensitive tool is needed to monitor leprosy progression and treatment effectiveness.

Purpose of the Study:

  • To introduce and evaluate the Eyes, Hands, Feet (EHF) score as a sum score for leprosy impairment.
  • To compare the sensitivity of the EHF score with the traditional WHO grading method in detecting changes in impairment.
  • To advocate for the adoption of standardized terminology for impairments in leprosy research.

Main Methods:

  • Utilized data from MB patients released from MDT in Nepal.

Related Experiment Videos

  • Calculated the EHF score by summing WHO impairment grades (0-2) across six sites (eyes, hands, feet).
  • Compared changes in impairment status detected by the EHF score versus the 'method of maximum grades' over a 2-year interval.

    • Main Results:

    • The EHF score identified changes in impairment status in 43.5% of patients, compared to 28% using the 'method of maximum grades'.
    • Improvement or deterioration was missed in 16% of patients with the 'method of maximum grades'.
    • Changes detected by the EHF score were larger than those from the 'method of maximum grades' in 30.6% of patients.

    Conclusions:

    • The EHF sum score is a sensitive indicator for monitoring leprosy impairment severity and evolution.
    • The EHF score should be routinely recorded at diagnosis and treatment release.
    • Adopting WHO International Classification of Impairments, Activities and Participation (ICIDH-2) terminology, including renaming 'WHO disability grade' to 'WHO impairment grade', is recommended.