Fig 1.
Map of Lewoleba (Lembata, East Nusa Tenggara) and Likupang (North Minahasa, North Sulawesi), Indonesia.
(A) Map of Indonesia, scaled 1: 8000000 (2599x1527) (available from: https://www.openstreetmap.org/#map = 5/0.637/117.466&layers = G, Geo URI: geo:1.779,114.917?z = 5), yellow circle indicates Likupang, North Minahasa and orange rectangle indicates Lewoleba, Lembata. (B) Map of Lembata Island (East Nusa Tenggara), scaled 1: 273895 (1186 x 697) (available from: https://www.openstreetmap.org/#map = 10/-8.4078/123.6017&layers = G, Geo URI: geo:-8.3732,123.4369?z = 10), black arrow indicates Lewoleba. (C) Map of North Minahasa (North Sulawesi), scaled 1: 276738 (1174 x 690) (available from: https://www.openstreetmap.org/?mlat = 1.6961&mlon = 125.0011#map = 11/1.6961/125.0011&layers = G, Geo URI: geo:1.6960,125.0011?z = 13), black arrow indicates Likupang. The map contains information from OpenStreetMap (OSM) and OpenStreetMap Foundation (accessed online on 16th of October 2023), Manual markings were done to locate Lewoleba and Likupang (Fig 1).
Fig 2.
Application of the International Classification of Functioning, Disability and Health (ICF) domains in the study.[29]
The domains of ICF have been adjusted to the availability of data within both populations in Likupang and Lembata. SALSA, screening of activity limitation and safety awareness; JTT, Jebsen-Taylor hand function test; TUG, timed up and go test.
Table 1.
Assessment Tools according to the domains of International Classification of Functioning, Disability, and Health (ICF).
Table 2.
Demographics of Leprosy Patients in Lewoleba (Lembata) and Likupang (North Minahasa), Indonesia (n = 150).
Fig 3.
Comparison of SALSA and P-scales according to different educational levels (n = 150).
(A) Total SALSA scores. Mann-Whitney U tests showed statistically different scores between those who attended primary education vs middle school (median + range = 23 + 26 vs 21 + 21, 95% CI of median difference: -4.00 to 0.00, respectively, p = 0.0127), as well as those who attended primary education and secondary school (median + range = 23 + 26 vs 21 + 16, respectively, 95% CI of median difference: -4.0 to -1.0, p = 0.0025). (B) SALSA-Work scores. Mann-Whitney U tests yielded significant different scores between primary education vs middle school (median + range = 7 + 14 vs 7 + 4, respectively, 95% CI of median difference: -1.0 to 0.0, p = 0.0092), as well as those who attended primary education and secondary school (median + range = 7 + 14 vs 7 + 4, respectively, 95% CI of median difference: -1.0 to 0.0, p = 0.0003). (C) Jebsen-Taylor Hand Function Test in dominant hand. Significant differences were observed between uneducated (25.28 + 104.6 s) vs middle school (19.06 + 20.48 s, 95% CI of median difference: -11.33 to -1.29, p = 0.0091), secondary school (19.19 + 39.19 s, 95% CI of median difference: -11.20 to -1.78, p = 0.0068), and higher education (14.97 + 12.02 s, 95% CI of median difference: -16.72 to -2.67, p = 0.0033), as well as between primary education (23.71 + 51.76 s) vs middle school (95% CI of median difference: -7.30 to -2.19, p = 0.0002), secondary school (95% CI of median difference: -7.00 to -2.56, p<0.0001), and higher education (95% CI of median difference: -11.91 to -3.19, p = 0.0004). (D) Jebsen-Taylor Hand Function Test in non-dominant hand. Mann Whitney U tests showed statistically significant differences between the group who only graduated from primary education (28.17 + 61.40 s) and those who finished middle school (22.06 + 26.31 s, 95% CI of median difference: -8.98 to -3.00, p<0.0001), secondary school (23.51 + 29.88 s, 95% CI of median difference: -8.43 to -2.66, p<0.0001), and higher education (21.26 + 19.82 s, 95% CI of median difference: -12.06 to -1.76, p = 0.0099). (E) Timed up and go test. Mann Whitney U tests showed significant differences between those who only attended primary education (8.015 + 12.37 s) with those who attended middle school (7.110 + 6.450 s, 95% CI of median difference: -1.69 to -0.04, p = 0.0348) and secondary school (6.650 + 8.620 s, 95% CI of median difference: -2.34 to -0.80, p<0.0001). Unpaired t test showed significant differences between those who attended middle school and secondary school (mean + SD = 7.453 + 1.516 s vs 6.585 + 1.519 s, 95% CI: -2.606 to 3.847, p = 0.0454).
Table 3.
Significant bivariate analyses of ICF variables with quantitative values with age and their adjusted coefficients as predictors of age after multivariable linear regression analyses.
Fig 4.
Comparison of hand structure impairment according to hand function impairment, activity limitation, and participation restriction (n = 150).
(A) Total SALSA scores. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (median + range 21.50 + 19 vs 27.50 + 48, 95% CI of difference: 2.00 to 9.00, p = 0.0004). (B) SALSA-Work. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (7 + 9 vs 8.5 + 19, 95% CI of difference: 0.00 to 2.00, p = 0.0058). (C) SALSA-Dexterity. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (5 + 7 vs 8 + 15, 95% CI of difference: 0.00 to 3.00, p = 0.0018). (D) P-Scale. Mann-Whitney U test showed significant differences between grade 0 and grade 1 (1 + 32 vs 3 + 29, 95% CI of median difference: 0.00 to 3.00, p = 0.0070). (E) JTT dominant hand. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (20.5 + 39.06 s vs 24.51 + 105.8 s, 95% CI of median difference: 1.09 to 8.54, p = 0.0077). (F) JTT non-dominant hand. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (24.37 + 50.03 s vs 35.62 + 138.2 s, 95% CI of median difference: 4.40 to 14.04, p = 0.0009).
Fig 5.
Comparisons of foot structure impairment according activity limitation and participation restriction (n = 150).
(A) Total SALSA scores. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (median + range 21.25 + 20 vs 31.50 + 48, 95% CI of median difference: 3.00 to 12.00, p<0.0001) and between grade 1 and grade 2 (23.5 + 26 vs 31.50 + 48, 95% CI of median difference: 1.00 to 2.00, p = 0.0146). (B) SALSA-Mobility. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (4 + 8 vs 6 + 14, 95% CI of median difference: 0.00 to 3.00, p = 0.0339). (C) P-scale. Mann-Whitney U test showed significant differences between grade 0 and grade 2 (1 + 32 vs 3 + 29, 95% CI of median difference: 0.00 to 3.00, p = 0.0413).
Fig 6.
Bivariate analyses of the variables in the body function, activity limitation, and participation restriction domains according to the International Classification of Functioning, Disability and Health (ICF) (n = 150).
Strongest correlations were observed between body function impairment (JTT) in dominant hand and total SALSA scores (Spearman’s rho = 0.4659, 95% CI: 0.3261–0.5858, p<0.0001) and in non-dominant hand (Spearman’s rho = 0.4296, 95% CI: 0.2849–0.5552, p<0.0001), followed by correlations between JTT and SALSA-work in dominant (Spearman’s rho = 0.4236, 95% CI: 0.2781–0.5501, p<0.0001) and non-dominant (Spearman’s rho = 0.3967, 95% CI: 0.2480–0.5271, p<0.0001) hands. There were also significant correlations between JTT in dominant and non-dominant hands with SALSA-dexterity (Spearman’s rho = 0.3737, 95% CI: 0.2225–0.5074, p<0.0001 and Spearman’s rho = 0.4212, 95% CI: 0.2755–0.5481, p<0.0001, respectively), between body function impairment (TUG) and activity limitation in relation to lower extremities (total SALSA (Spearman’s rho = 0.4232, 95% CI: 0.2776–0.5497, p<0.0001) and SALSA-mobility (Spearman’s rho = 0.3296, 95% CI: 0.1741–0.4690, p<0.0001)), and between participation restriction (P-scale) and SALSA-mobility (Spearman’s rho = 0.3347, 95% CI: 0.1797–0.4735, p<0.0001)). SALSA, screening of activity limitation and safety awareness; JTT, Jebsen-Taylor hand function test; TUG, timed up and go test.