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Associations between chronic conditions, body functions, activity limitations and participation restrictions: a cross-sectional approach in Spanish non-clinical populations
  1. Carmen Rodríguez-Blázquez1,
  2. Javier Damián1,
  3. María José Andrés-Prado2,
  4. Javier Almazán-Isla1,
  5. Enrique Alcalde-Cabero1,
  6. Maria João Forjaz3,
  7. Juan Manuel Castellote4,
  8. Jesús González-Enríquez5,
  9. Pablo Martínez-Martín1,
  10. Magdalena Comín6,
  11. Jesús de Pedro-Cuesta1
  12. on behalf of the DISCAP-ARAGON Research Group
    1. 1National Centre for Epidemiology and Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas/CIBERNED), Carlos III Institute of Health, Madrid, Spain
    2. 2Admissions Department, Gómez Ulla Hospital, Madrid, Spain
    3. 3National School of Public Health and Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Carlos III Institute of Health, Madrid, Spain
    4. 4National School of Occupational Medicine, Carlos III Institute of Health, Madrid, Spain
    5. 5Health Technology Assessment Agency, Carlos III Institute of Health, Madrid, Spain
    6. 6School of Health Sciences, Zaragoza University, Zaragoza, Spain
    1. Correspondence to Dr Jesús de Pedro-Cuesta; jpedro{at}


    Objectives To analyse the relationships between chronic conditions, body functions, activity limitations and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) framework.

    Design A cross-sectional study.

    Setting 2 geographical areas in the Autonomous Region of Aragon, Spain, namely, a rural area, Cinco Villas, and an urban area in the city of Zaragoza.

    Participants 864 individuals selected by simple random sampling from the register of Social Security card holders, aged 50 years and over, positive to disability screening.

    Main outcome measures ICF Checklist—body function domains, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0, 36-item (WHODAS-36)) global scores and medical diagnoses (chronic conditions) from primary care records.

    Results Mild disability (WHODAS-36 level 5–24%) was present in 51.5% of the sample. In the adjusted ordinal regression model with WHODAS-36 as the dependent variable, disability was substantially associated with moderate-to-complete impairment in the following functions: mental, OR 212.8 (95% CI 72 to 628.9); neuromusculoskeletal, OR 44.8 (24.2 to 82.8); and sensory and pain, OR 6.3 (3.5 to 11.2). In the relationship between health conditions and body function impairments, the strongest links were seen for: dementia with mental functions, OR 50.6 (25.1 to 102.1); cerebrovascular disease with neuromusculoskeletal function, OR 5.8 (3.5 to 9.7); and chronic renal failure with sensory function and pain, OR 3.0 (1.49 to 6.4). Dementia, OR 8.1 (4.4 to 14.7) and cerebrovascular disease, OR 4.1 (2.7 to 6.4) were associated with WHODAS-36 scores.

    Conclusions Body functions are heterogeneously linked to limitations in activities and restrictions on participation, with the highest impact being due to mental and musculoskeletal functions. This may be relevant for disability assessment and intervention design, particularly if defined on a body function basis. Control of specific health conditions, such as dementia and cerebrovascular disease, appears to be paramount in reducing disability among persons aged 50 years and over.

    • Disability
    • Autonomy
    • Functioning

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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