Self-reported activity in tortured refugees with long-term sequelae including pain and the impact of foot pain from falanga – a cross-sectional study

Abstract

Purpose. To describe activity limitations in tortured refugees referred for rehabilitation, particularly the impact of neuropathic pain resulting from falanga (beatings under the feet).

Methods. Physiotherapists assessed 103 consecutively referred torture victims with a long history of sequelae, among them pain and mobility problems. All had been subjected to various forms of physical and psychological torture and 71 victims had also suffered falanga. Main outcome measures used were: the Disability Rating Index (DRI; 12 items) to assess self-reported capacity to carry out daily activities; for falanga victims, a specific foot assessment of sensory function in the feet.

Results. All patients perceived clear activity limitations according to the DRI. The falanga victims' feet were categorised according to the type of foot pain: stimulus-independent pain; stimulus-evoked pain; no pain. The two groups with foot pain displayed sensory dysfunction and suffered more extensive activity limitations. After correction for confounding factors, these two groups reported significantly more activity limitations in 7 out of 12 DRI items than those who were not exposed to falanga.

Conclusion. In this group of victims who had chronic pain for at least 5 years after torture, all perceived activity limitations, but pain from falanga had a greater overall impact on disability assessed in terms of daily activities.

Keywords:

• Disability evaluation
• foot injuries
• pain measurement
• somatosensory disorders
• trauma
• nervous system

Acknowledgements

We would like to thank the physiotherapists at our clinic for their engagement and thorough assessments. We would also like to thank Per-Erik Isberg, Department of Statistics, Lund University, for statistical guidance. The study was supported by grants from Foundation Juchum, Kong Christian den Tiendes Fond, Lippmann Fonden, Torkil Steenbeck's Legat, Danish Physiotherapist Association and Grosserer Andreas Collstrup and son Rudolf Collstrup's mindelegat.