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dc.contributor.authorPedro-Cuesta, Jesus de 
dc.contributor.authorGarcia-Sagredo, Pilar 
dc.contributor.authorAlcalde-Cabero, Enrique 
dc.contributor.authorAlberquilla, Angel
dc.contributor.authorDamian, Javier 
dc.contributor.authorBosca, Graciela 
dc.contributor.authorLópez-Rodríguez, Fernando
dc.contributor.authorCarmona, Montserrat 
dc.contributor.authorTena-Davila, Maria Jose 
dc.contributor.authorGarcía-Olmos, Luis
dc.contributor.authorHernandez-Salvador, Carlos
dc.identifier.citationPLoS One. 2013; 8(10): e77482.es_ES
dc.description.abstractBACKGROUND: Little is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions. PATIENTS AND METHODS: 300 chronic obstructive pulmonary disease (COPD), chronic heart failure and stroke patients living at home in Madrid were selected from general practitioner lists. In 2009, disability was assessed after a mean of 30 months using the World Health Organisation (WHO) Disability Assessment Schedule 2.0 (WHODAS 2.0). Follow-up was completed using death registries. Losses to follow-up were due to: death, 56; institutionalisation, 9; non-location, 18; and non-participation, 17. Changes in WHODAS 2.0 scores and life status were described and analysed using Cox and multinomial regression. Disability at end of follow-up was imputed for 56 deceased and 44 surviving patients. RESULTS: Mean disability scores for 200 surviving patients at end of follow-up were similar to baseline scores for the whole group, higher than their own baseline scores, and rose by 16.3% when imputed values were added. The strongest Cox predictors of death were: age over 84 years, adjusted hazard ratios with 95%CI 8.18 (3.06-21.85); severe/complete vs. no/mild disability, 5.18 (0.68-39.48); and stroke compared to COPD, 1.40 (0.67-2.91). Non-participants and institutionalised patients had higher proportions with severe/complete baseline disability. A one-point change in baseline WHODAS 2.0 score predicted independent increases in risk of 12% (8%-15%) for severe/complete disability or death. CONCLUSIONS: A considerably high proportion of community-dwelling patients diagnosed with COPD, CHF and stroke undergo medium-term changes in disability or vital status. The main features of the emerging pattern for this group appear to be as follows: approximately two-thirds of patients continue living at home with moderately reduced functional status; 1/3 die or worsen to severe/complete disability; and 1/10 improve. Baseline disability scores, age and diagnosis are associated with disability and death in the medium term.es_ES
dc.description.sponsorshipThis study was partially supported by the CENIT Program (MICINN-CDTI) [CEN-2007-1010 "Digital personal environment for health and wellbeing –AmiVital" project], a grant from the Ministry of Health & Consumer Affairs [FIS PI08-0435 Definition, design, development and evaluation of services of monitoring, follow-up and control of aging people in independent life] and by projects PI06/1098 and PI07/90206 from Fondo de Investigaciones Sanitarias. Enrique Alcalde was in part supported by Fundacion Cien/CIBERNED. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
dc.publisherPublic Library of Science (PLOS) 
dc.subject.meshActivities of Daily Living es_ES
dc.subject.meshAge Factors es_ES
dc.subject.meshAged es_ES
dc.subject.meshChronic Disease es_ES
dc.subject.meshDisability Evaluation es_ES
dc.subject.meshFemale es_ES
dc.subject.meshFollow-Up Studies es_ES
dc.subject.meshHeart Failure es_ES
dc.subject.meshHumans es_ES
dc.subject.meshLung Diseases es_ES
dc.subject.meshMale es_ES
dc.subject.meshMiddle Aged es_ES
dc.subject.meshPulmonary Disease, Chronic Obstructive es_ES
dc.subject.meshResidence Characteristics es_ES
dc.subject.meshSpain es_ES
dc.subject.meshStroke es_ES
dc.subject.meshWorld Health Organization es_ES
dc.titleDisability transitions after 30 months in three community-dwelling diagnostic groups in Spaines_ES
dc.typejournal articlees_ES
dc.rights.licenseAtribución-4.0 Internacional*
dc.contributor.funderMinisterio de Ciencia e Innovación (España) 
dc.contributor.funderInstituto de Salud Carlos III 
dc.identifier.journalPLoS ONEes_ES
dc.repisalud.centroISCIII::Centro Nacional de Epidemologíaes_ES
dc.repisalud.centroISCIII::Unidad de Investigación en Telemedicina y eSaludes_ES
dc.rights.accessRightsopen accesses_ES

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