Locomotor disability in bancroftian filarial lymphoedema patients

Disability prevention in cases with lymphatic filarial disease has been a research priority in view of the current programme on global elimination of lymphatic filariasis. This is also important for estimation of disease burden, impact evaluation, developing strategy for morbidity management and rehabilitation for lymphoedema patients in the endemic countries. In this communication, we are presenting the results of quantification of functional limitations of lower extremities with lymphoedema caused due to bancroftian filariasis by objective assessment of movement of joints and power of muscles in the affected legs. A total of 81 consecutive lymphoedema patients attending a filariasis clinic in Pondicherry urban locality were recruited for the study. Assessment for restriction of movement of joints and loss of power of muscles was carried out as in Manual for doctors to evaluate permanent physical impairment, prescribed by an expert group of WHO and Ministry of Health, Govt. of India on evaluation for permanent disability. Of the cases assessed, 40% in grade-I, 55% in grade-II, 77.3% in grade-III and 94.7% in grade-IV lymphoedema cases had functional limitations either in joint movements or power of muscles or both. The effective loss of locomotor/function (combined loss of joint movement and power of muscles in %) increased with stage of lymphoedema (grade-I-4.3+7.4, grade-II-7.0+8.4, grade-III-15.4+14.8 and grade IV- 33.2+22.8). The degree of loss varied significantly between the grades (P< 0.0001). The methodology used in this study can be adapted to evaluate the impact of the morbidity management component of strategy for Elimination of Lymphatic Flariasis (ELF) programme. This study will also enable researchers for fine-tuning the method for estimating disease burden and, to develop and evaluate strategies for morbidity management/rehabilitation of filarial lymphoedema patients.