Functional impairment in alcoholic liver disease and non-alcoholic fatty liver disease is significant and persists over 3 years of follow-up

BACKGROUND AND AIMS

Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are common and increasing in prevalence. We examined prevalence and predictors of functional impairment in biopsy-proven ALD and NAFLD. Change in function over 3 years was explored.

METHODS

Validated functional, cognitive, autonomic, and fatigue symptom assessment tools were completed by patients who had attended our liver clinic.

RESULTS

Totals of 224 NAFLD and 107 ALD patients returned the assessment tools. NAFLD and ALD demonstrated comparable functional difficulties, which were significantly worse than controls (p < 0.001) with the proportion of participants experiencing difficulty significantly higher [x (2) 8.93(3), (p = 0.01)]. No significant functional difficulty was demonstrated between those participants who were pre-cirrhotic or cirrhotic. Independent associations were present between difficulty with function in ALD and higher burden of autonomic and cognitive symptoms (p = 0.02) and in NAFLD-increased cognitive difficulty (p < 0.0001), age (p = 0.001), fatigue (p = 0.01), lower albumin (p = 0.02), and bilirubin (p = 0.04). PHAQ scores increased 21 % 2008-2011 {(3.2/15.6) [15.6 (0-93.8)] to 18.75 (0-90.6)}. Functional difficulty of participants alive [15.6 (0-96.9)] was significantly less compared to those who died [40.6 (0-100)] (p = 0.02).

CONCLUSIONS

NAFLD and ALD patients experience significant functional impairment affecting activities of daily living that persists over time. This has implications for the management of liver disease and service provision.

Occupational Therapy in Chronic Liver Disease: A Preliminary Study to Explore the Views of Occupational Therapists and Physicians Working in Acute Medical Settings

Chronic liver disease (CLD) is on the increase worldwide. Occupational therapists are well placed to address many of the symptoms associated with CLD; however, there is a dearth of literature to support this or to define the current working practice of occupational therapists in this clinical area.

This study used questionnaires and mixed methodological analysis to describe both the current working practice of occupational therapists in CLD and the perceptions of the occupational therapist's role by physicians referring patients with CLD to occupational therapy.

Thematic analysis of the structured data demonstrated an appropriate understanding of, and referral to, occupational therapy in the context of safe discharge from hospital and the provision of equipment. Cross-sectional analysis revealed a homogeneous approach to current occupational therapy working practice in CLD which, although expedient, lacks emphasis on the treatment of the symptoms experienced by this client group.