|Year : 2019 | Volume
| Issue : 7 | Page : 2283-2288
Need for mobile application for disability assessment in India
Ankur Agarwal1, Shantanu Shah2, Sheetal Agarwal3
1 Department of Orthopaedics, Superspecialty Pediatric Hospital and Postgraduate Teaching Institute, Noida, Uttar Pradesh, India
2 Department of Computer Engineering, Cornell University, Ithca, New York, USA
3 PGIMER and RML Hospital, Delhi, India
|Date of Submission||12-Apr-2019|
|Date of Decision||13-Apr-2019|
|Date of Acceptance||27-Apr-2019|
|Date of Web Publication||31-Jul-2019|
Dr. Ankur Agarwal
Department of Orthopaedics, Superspecialty Pediatric Hospital and Postgraduate Teaching Institute, Ortho.OPD Room No. 15, Sector 30, Noida - 201 303, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Disability can be by birth or by any tragic event in life or medical illness. Such differently abled persons can become a valuable asset to the nation rather than a liability if we properly quantify their disabilities and help them rehabilitate into jobs best suited for them. The aim of this study was to develop a mobile application for easy quantification of disability of a differently abled person according to the latest Government of India guidelines. Material and Methods: The Government of India Gazette notification of January 2018 spells out revised guidelines approved by the Ministry of Social Justice and Empowerment for calculation of disabilities of differently abled persons. These were first converted into a spreadsheet, workflow, and interface modules. Subsequently, they were coded into a mobile application using a simple web language. Results: The result is an android App that can be downloaded from Google Play Store for free use. The rigorous testing of the App with all possible combination of input values was done to weed out errors. The results through the App were compared against manual calculation used as a control for validation purposes. Conclusion: To bring about uniformity, objectivity, ease in disability calculation for a large population of differently abled persons, a mobile App is truly justified.
Keywords: Android, app, application, assessment, disability, excel sheet, mobile
|How to cite this article:|
Agarwal A, Shah S, Agarwal S. Need for mobile application for disability assessment in India. J Family Med Prim Care 2019;8:2283-8
|How to cite this URL:|
Agarwal A, Shah S, Agarwal S. Need for mobile application for disability assessment in India. J Family Med Prim Care [serial online] 2019 [cited 2019 Dec 14];8:2283-8. Available from: http://www.jfmpc.com/text.asp?2019/8/7/2283/263760
| Introduction|| |
As per WHO data, 15% of the world's population is suffering from one or the other disability. The global disability prevalence is higher than the previous WHO estimates, which suggested a figure of around 10%. This global estimate for disability is on the rise because of aging population and rapid spread of chronic diseases, as well as improvements in the methodologies used to measure disability. Disability can be by birth or by any tragic events in life or medical illnesses. Persons with disabilities are now more appropriately called differently abled persons (divyang). Facilitating lives of persons with disabilities, so that they can live with respect without being a burden on society, is the collective responsibility of medical institutions, society, and all welfare governments. By facilitating the lives of such persons, they can be made into a valuable human resource for the country.
The most important job of a clinician is the restoration of anatomy and function as early as possible, and hence, minimize the disability both temporary and permanent caused to a person arising out of any cause. At times, the disability might be pre-existing that can be corrected to a certain degree by interventions done by a clinician. However, in most cases, the treatment of the condition leaves some or the other residual disability. Such residual disability might range from being insignificant to enormous proportions so as to interfere in the discharge of activities of daily living. Even in such cases, the role of a clinician is of paramount importance. He as a part of the disability certification board needs to assess this disability. Assessment needs to be quantitative to assess the degree of disability. It also needs to be qualitative, so as to assess its permanency and type. This is important because the quantum of disability will decide the amount of compensation the victim or sufferer needs to be granted as per the case. However, type of disability will decide the jobs suited for the social rehabilitation of the sufferer.
For quantitative and qualitative assessment of disability, the Governments of respective countries outline or adopt certain regulations. The Department of Empowerment of Persons with Disabilities, Ministry of Social Justice and Empowerment, Government of India has come up with such guidelines from time to time. In 2018, a new revised guidelines were published in the Indian Gazette Notification. However, as previously, the assessment guidelines are descriptive. The aim of this study was to convert the descriptive guidelines laid down by Government of India into objective universal tool available as a free mobile application for easy assessment and calculation of disability at the hands of a clinician.
| Materials and Methods|| |
The latest guidelines by the Ministry of Social Justice and empowerment, for calculation of locomotor disability were first tabulated as a spreadsheet [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Microsoft Excel software version 2010 was used for this along with Visual Basic Macros. Headings and subheadings were framed with varying font size. Light gray cells were used for various parameters and depiction of normal values. Dark gray cells were used to indicate the value, which needed to be entered by the user. Multiple colors backgrounds were used to delineate cells for different calculations. Subsequently, a flowchart was prepared to outline the workflow for the mobile application. This helped in understanding the various functions that will be required in the App, the unit modules that need to be separately developed, and the interlinking of these modules. Various interfaces were also designed, so as to have an idea of how the App should look like. It was also decided that the application should be workable on android platform because it is currently the most popular mobile operating system worldwide.
The software team, which consisted of a developer, was elaborated in multiple sittings about the spreadsheet, the flowchart, and the interfaces. The developer decided to do coding in JAVA scripting language commonly used for web development. Java is also used as a general-purpose programming language. It is concurrent, highly compatible, task-oriented, and specifically designed to have as few implementation dependencies as possible. After coding, the initial basic application along with the backend calculating spreadsheet was put through rigorous testing and trials to remove the bugs. The rigorous testing was done using all possible hypothetical combination of input values to weed out errors and test all components of affection. After several rounds of testing, the free downloadable version of the App was uploaded on Google Play Store  as depicted in [Figure 2]. Google Play Store is also a mobile application, which serves as e-library cum e-marketplace for other android applications, both free and paid, for users to download and use on their mobiles.
The mobile application authenticity was validated in two ways. First by using a variation of hypothetical data and using the same input data for manual calculation as per guidelines and then comparing the results. The results obtained by both methods were compared. Any difference in output from the App (test) and manual calculation (control) meant an error (deviation from the control) in the application. The error was searched for in retrograde fashion within the backend spreadsheet and bugs within the application rectified.
Second testing was performed using actual data from randomly selected thirty patients. The patient's data were input in the installed application by the developer, and the same data were used by the researcher for manual calculation of disability as done by the conventional method.
| Results|| |
The final manually calculated result in each case was compared with the result from the application. There was no discrepancy in the final result between manual calculation and that generated by the mobile application. The output from a case example given in Disability Evaluation guidelines manual  worked through our mobile App has been presented in [Figure 3].
|Figure 3: Simple example calculation given in guidelines manual done through Mobile App|
Click here to view
The mobile application is available for free download and use. Approval has been sought from the Ministry of Social Justice and Empowerment, Government of India for permitting its official use by doctors in medical boards for disability assessment.
| Discussion|| |
Prior to 1981, doctors were using a variety of guidelines, namely ESI Act 1948 with its various amendments, Workman's Compensation (Amendment) Act 1959, and Indian Fatal Accidents Act 1855 for disability evaluation. Artificial Limbs Manufacturing Corporation of India published a manual according to 1962 guidelines of the American Academy of Orthopedic Surgeons for disability assessment. An expert group from All India Institute of Medical Sciences, World Health Organization, and Director General Health Services, Government of India developed a manual to evaluate permanent physical impairment of upper limbs, lower limbs, spine, amputations, neurological conditions, facial injuries, burns, and cardiopulmonary diseases in 1981. The aim was to have simple norms for evaluation of permanent physical impairment in Indian patients. In 1986, the Ministry of Welfare, Government of India, issued an O.M. No. 4-2/83-HW.-III, dated 6 August 1986 dealing with uniform definitions and general guidance for evaluation and assessment of various disabilities. These were largely according to 1981 guidelines with some variations. In 2001, the new amended guidelines for disability evaluation and certification were issued by the Government of India through Gazette notification according to Persons with Disabilities Act 1995. It contained methods of estimation of different types of impairments and disabilities, a copy of the proposed format for a disability certificate, and a ready reckoner for computations by using combining formula. Subsequently, National Institute of Orthopedically Handicapped, Kolkata compiled these guidelines into a manual form for easy reference. Dr Arun Goyal, Senior Burns and Plastic Surgeon, Lok Nayak Hospital, Delhi compiled these guidelines into a booklet form for ready reckoning. In 2013, Dr Sunderraj Ellur, a plastic surgeon from Bengaluru came up with two spreadsheets for calculation of locomotor disability. However, these spreadsheets are not freely available for download. In addition, locomotor disability is just 20% of all disabilities; hence, a tool to cover other forms of disabilities needed to be evolved.
As of date, there are 5 laws that aim to provide certain benefits and rights to the differently-abled people in India. These include The National Trust Act 1999, The Rehabilitation Council of India Amendment Act 2000, The National Policy for Persons with Disabilities 2006, The Rights of Persons with Disabilities Act 2016, and The Mental Healthcare Act 2017. On the basis of these legislations, the Ministry of Social Justice and Empowerment, Government of India formed an Expert Committee with eight sub-committees to revise the Disability Evaluation Guidelines 2001. The latest guidelines for disability evaluation were published in Gazette Notification in January 2018. It also identified 12 new disabilities along with bringing amendments in the earlier guidelines.
Hence, a new ready reckoner cum calculating tool needed to be developed for the assessment of disabilities of the differently-abled according to these new guidelines. Because smart phone is the latest most widely used handy tool available to mankind, we decided to develop an android mobile application instead of making a new computer-based spreadsheet or a website.
Various problems are encountered normally in Disability Certification. Often tedious and lengthy calculations have to be done, which can result in errors. To weed out errors in calculations, repeated checking has to be carried out. When there are many candidates in waiting for medical boards for certifications, faster processing is required as much time also goes in the medical assessment of the candidate. Many senior members of the medical board are from different specialties would like to save time from certification work and spend more time in clinical, teaching, and research work. Many times a certificate is issued in the peripheral hospital, where there is no medical board but a single Medical Officer; in such a situation errors might creep in. All these problems can be solved to a large extent by the use of this Mobile App. There are various other advantages of this mobile App vis a vis previously available tools. It is easier to scan through a readily available mobile App than refer to print format manual of guidelines. Calculation excel sheet, records, and reports can be easily stored/archived. They can also be easily, yet safely retrieved, by registered users only. Printing and emailing of reports and calculation excel sheets can be very easily done.
There are various mobile applications available on Google Play Store pertaining to disability. A mobile application titled “Rights of Persons with Disabilities Act, 2016” by Neha Goenka describes in details the provisions of the Act. However, it has no computation options. There are quite a few mobile applications for disability calculation from developers outside India, according to the guidelines of their respective countries. For example, there is an android application on Google Play Store by Dalia Estas named as Disability Calculator for disability assessment of people with Multiple sclerosis.
There are certain limitations with our App. It focuses on locomotor, spinal, congenital, and neurological disabilities at present. The modules for disabilities arising out of blindness, hearing impairment, mental illness, autism disorder, chronic neurological conditions, speech and language problems, blood dyscrasias, etc., will be added in version 2 that will be available as an upgrade. In addition, the App needs to be made available for iPhone users, which uses a different software platform i.e. iPhone operating system (iOS).
| Conclusion|| |
There are 26.8 million differently-abled persons in India alone as per the latest data. The disability certificates are issued all around the country by various government medical functionaries. To bring about uniformity, objectivity, ease in disability calculation for this large population of persons with disabilities, a mobile App is truly justified. This will also help in generating an online accessible digital database for weeding out problems in job recruitment by government departments and awarding of compensation by courts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ministry of Social Justice and Empowerment, Government of India. Guidelines for the purpose of assessing the extent of specified disability in a person included under the Rights of Persons with Disabilities Act, 2016. Gazette of India Notification Extraordinary No. 61 Part II Section 3 sub-section ii, 2018.
Binstock, A. Java's 20 years of innovation. Forbes 2015;5.
Ministry of Social Justice and Empowerment, Government of India. Guidelines for evaluation of various disabilities and procedure for certification. Gazette of India Notification Extraordinary Part II, Section 1, 2001.
Kumar R. Disability (Permanent Physical Impairment) assessment and certification. National Institute for Orthopedically Handicapped, Kolkata; 2002.
Ellur S. Spreadsheet software to assess locomotor disability to quantify permanent physical impairment. Indian J Plast Surg 2013;46:595-7.
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[Figure 1], [Figure 2], [Figure 3]