# Assessment of functioning using the WHODAS 2.0 among people with myasthenia gravis-associated disability: a nationwide follow-up study

## TL;DR

This study assesses functional disability in Myasthenia Gravis patients using WHODAS 2.0, finding that younger patients initially perform better but long-term outcomes are similar to older patients.

## Contribution

The study provides a nationwide longitudinal analysis of functional changes in MG patients using WHODAS 2.0, identifying key factors like respiratory disability and social participation.

## Key findings

- Younger MG patients showed less severe disability except in social participation.
- Technical aids improved functional outcomes across all domains.
- Respiratory disability was linked to cognitive decline in MG patients.

## Abstract

Advancements in treatment have increased the life expectancy of patients with Myasthenia Gravis (MG), yet the understanding of functional changes in these individuals remains limited. In our study, we explored the functional abilities of individuals with MG using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).

This observational study analyzed data from 286 patients with MG, acquired from the Data Bank of Persons with Disabilities (TDPD) in Taiwan between July 11, 2012, and December 31, 2021. Participants were diagnosed with MG after the acute phase. The functional disability outcome was assessed using the WHODAS 2.0. Due to non-normal distribution of variables, we used the Wilcoxon rank sum and chi-square tests for group comparisons by age. Longitudinal associations between functional changes and demographic characteristics were assessed using generalized estimating equations (GEE), adjusting for age, sex, educational level, and respiratory dysfunction.

The average follow-up period was three years. At the initial evaluation, younger individuals (< 65 years) generally demonstrated less severe disability across most functional domains, with the exception of social participation. Patients with a single disability in a specific function performed better than those with multiple disabilities. The provision of technical aids or other environmental interventions resulted in significant functional improvements across all domains. During follow-up, significant functional improvements were observed, especially among patients residing in institutions, those without respiratory disabilities, and those with reduced mobility at the time of initial assessment. The GEE analysis indicated that younger patients with MG experienced functional changes comparable to older patients. Notably, respiratory disability was identified as a key factor contributing to cognitive decline. Additionally, only 10.5% of patients aged 18–64 were employed at the time of the study.

Our findings highlight the complexity of disabilities associated with MG, with social participation emerging as a particularly vulnerable domain. Although younger patients initially exhibited better functional performance, their long-term functional changes were comparable to those observed in older patients. Given the impact of functional limitations on employment, future research may focus on return-to-work interventions, as labor market participation plays a crucial role in fostering social engagement for individuals with MG.