Measuring disability in patients with neurodegenerative disease using the ‘Yesterday Interview’

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Abstract
Objectives To illustrate the use of time‐budget methodology as a means of measuring disability within the framework of the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF) in a mixed group of patients with neurodegenerative disease. Methods A semi‐structured interview method (the ‘Yesterday Interview’) was used to reconstruct the preceding 24‐hour period in terms of activity, social and environmental context, and subjective enjoyment. Data were collected on 40 elderly control subjects and a sample of 99 community based patients diagnosed with either Parkinson's disease without or with dementia, Alzheimer's disease, Dementia with Lewy bodies, Progressive Supranuclear Palsy or Multiple System Atrophy. All participants were seen in their own home. The results were translated hierarchically into the ICF framework of disability domains, and further into a higher level formulation based on the constructs of discretionary/obligatory activity. Results Disability profiles were obtained for the patient group as a whole and for the individual disorders. Restricted patterns of time‐use were noted across a range of domains encompassing both obligatory and discretionary activity, and accompanied by a significant increase in passive activity such as day‐time sleeping or sitting in front of the television. The data also illustrated the restrictions in both the social and environmental contexts of the patient's lives, and the diminished levels of subjective enjoyment associated with their pattern of daily time‐use. With the exception of time spent on discretionary activities, these various indices were significantly associated with standard clinical measures disability. Conclusions With further studies to assess reliability and validity, time‐use and contextual data obtained from structured interviews may provide a useful means of measuring disability within the ICF framework in patients with degenerative neurological disease. Copyright © 2004 John Wiley & Sons, Ltd.