Morbidity in haemophilia has been described predominantly in terms of musculoskeletal dysfunction and assessed by the clinical and radiological joint scores. These scores document changes in a particular joint, but do not reflect the impact of these changes on the individual in terms of his overall musculoskeletal function. Several self-assessment instruments have been used to measure musculoskeletal function but none have been specifically validated for use in haemophilia. In order to objectively assess musculoskeletal function of patients with haemophilia, we developed Functional Independence Score in Hemophilia (FISH), a performance-based instrument. FISH measures the patient's independence in performing seven activities under three categories: self-care (grooming and eating, bathing and dressing), transfers (chair and floor) and mobility (walking and step climbing). Each function is graded from 1 to 4 depending on the amount of assistance needed in performing the function. We evaluated 35 patients who were over 10 years old and had had at least three major bleeds per year. All subjects were scored for clinical (World Federation of Hemophilia, WFH score) and radiological changes (Pettersson's score). Functional independence of the patient was assessed using the Stanford Health Assessment Questionnaire (HAQ) and the FISH. Correlation of the FISH score was modest with both the WFH clinical score (r = -0.68) and the radiological score (r = -0.44). While there was good correlation between FISH and HAQ (r = -0.90), FISH had better internal consistency than HAQ (Cronbach's alpha 0.83 vs. 0.66). FISH appears to be a promising disease-specific instrument for assessing overall musculoskeletal function in haemophilia. It requires evaluation in different patient populations.

Study design: Cross sectional survey. Objective: To examine the nature and prevalence of common mental disorders among informal carers of people with Spinal Cord Injury (SCI) and the association with their leisure satisfaction. Setting: Christian Medical College, Vellore, Tamilnadu, India. Methods: A cross-sectional survey of informal carers of people SCI at the Department of Physical Medicine and Rehabilitation. Fifty-three informal carers of people with SCI were interviewed using the Revised Clinical Interview Schedule to assess psychiatric morbidity, and using the Leisure Satisfaction Scale to measure leisure and contentment. Data on carers with psychiatric morbidity were compared to those without common mental disorders using univariate and multivariate statistics. Results: Study reported a high morbidity (53%), with most consistent diagnoses of depression and anxiety. Carers who were spouses, women, currently married and those with lower education had greater psychiatric morbidity and lesser leisure satisfaction, even after adjusting for age and education using logistic/linear regression. Age, occupation, residence, socioeconomic status, type and duration of SCI were not associated with either morbidity or leisure satisfaction. Conclusion: Many carers of people with SCI suffer from psychiatric morbidity and also have low scores on leisure satisfaction.

Study design: A cross-sectional study that assessed people with spinal cord injury (SCI) and their carers who attended the 3-day health care program. Objectives: The study examined the nature and prevalence of the factors associated with psychological morbidity among carers of people with SCI. Setting: A community reintegrated population of persons with SCI and their carers attended the 3-day program in the Department of Physical Medicine and Rehabilitation, Christian Medical College Hospitals, Vellore, South India. Methods: Thirty-eight people with SCI and their carers participated in this cross-sectional study. Results: Thirty (78.9%) carers of people with SCI were psychologically distressed. While carers were distressed, they were not signi®cantly depressed. Educational level of carers and suicidal behavior of people with SCI were signi®cantly associated with psychological distress. Conclusion: The ®ndings of this study suggest that health care workers should have a high index of suspicion of psychological morbidity, in carers of people with SCI. Identi®cation of risk factors may lead to useful target interventions. Sponsorship: Nil. Spinal Cord (2000) 38, 559 ± 562

Leisure is an important component in the lives of persons with disabilities and it is often associated with life satisfaction, self-esteem and depression. However, leisure specialists have all but ignored the leisure patterns and needs of people with disabilities. Thus this study attempts leisure intervention through groups by altering the attitude of patients towards leisure and subsequently finding out the effect on leisure satisfaction and quality of life. This study was a clinical trial conducted for patients with spinal cord injury who were evaluated using both the World Health Organization quality of life scale and the leisure satisfaction scale prior to intervention and afterwards. The experimental group had five 1 h-long group sessions as intervention while the control group had none. Twenty-five clients with paraplegia were included in both the experimental and the control groups. The mean ages of clients in both the groups were 33.40 and 37.24 years respectively. Significant improvements were observed in all domains of quality of life and leisure satisfaction in the experimental group as compared with the control group. The data show the definite impact of leisure satisfaction on quality of life. It is evident from the study that leisure intervention groups facilitate both leisure satisfaction and improved quality of life. Such an assertion definitely requires further research, corroboration and substantiation.

The need for a sound social support system, and its positive impact on physical, mental and behavioural health in the ever-increasing spinal cord injury (SCI) clientele, is undeniable. It is evident from recent research that spousal support should be weighed as an important contributing factor to the ongoing health and well-being of their SCI partners. Stress (severe depressive symptoms) to the care-giving spouses, and implications on their health and thereby the SCI partner, is often underestimated. Thus the present study is an attempt to treat this highly susceptible population through the provision of support groups. This study was a two-group experimental design. The study results bring to light the definite impact of SCI on the spouse's well-being. Thus it is essential to direct research towards life domains designed to improve the quality of life of these individuals. This research demonstrates the unquestionable positive effect of group therapy on the impact of well-being of spouses of SCI survivors. This finding may only be the tip of the iceberg and further research with a larger sample size must be conducted for the adequate generalization of this study.