The clinimetric properties of the World Health Organization Disability Assessment Schedule II in early inflammatory arthritis

Psychometric properties of Polish version of the 36-item WHODAS 2.0 in individuals with fibromyalgia

Fibromyalgia (FM) is chronic, widespread musculoskeletal pain and accompanying fatigue, sleep disturbances, cognitive, psychological, and somatic symptoms. The aim of the study is to assess the psychometric properties of the Polish version of the 36-item WHODAS 2.0 in FM patients. This is a cross-sectional study involving 456 FM polish patients. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-item version, the Fibromyalgia Impact Questionnaire (FIQ) and Beck's Depression Inventory (BDI) were used as an assessment tool in the study. The internal consistency of the 36-item WHODAS 2.0 was assessed using Cronbach's alpha. Values ranging from 0.824 to 0.951 were obtained. The interclass correlation coefficients (ICC) were very high. Internal structure of the 36-item WHODAS 2.0 was checked with Confirmatory Factor Analysis (CFA). RMSEA = 0.069, CFI = 0.963, TLI = 0.96, SRMR = 0.081 proved exactness of original six-dimensional structure of WHODAS 2.0. External validity was assessed by correlating the 36-item WHODAS 2.0 scores with the scores of two previously validated tools: FIQ and BDI. Positive correlations were obtained between the 36-item WHODAS 2.0 and these tools. Based on the conducted research, it has been shown that the 36-item WHODAS 2.0 is a reliable and valid tool for assessing disability in individuals with FM in Poland.

Quality of Life Among Breast Cancer Patients in Mures County, Romania: A Cross-Sectional Study

Background and aim Psychiatric pathology does not always start on its own but may be conditioned or triggered by a comorbidity with a high impact on the human psyche. When there are comorbidities, psychiatric pathology can occur due to the high diagnostic burden. Our study aims to find out if there is a correlation between the diagnosis of breast cancer and its severity, and psychiatric symptoms such as depressive mood, atypical anxiety, or even autolytic ideation that directly influence the quality of life of patients. Materials and methods The study is a prospective, cross-sectional, single-center study carried out between December 2023 and June 2024 at the Mureș County Clinical Hospital in Romania. The sample population had to be at least 18 years old and had to be diagnosed with breast cancer recently. We applied two tests, WHODAS 2 (World Health Organization's Disability Assessment Schedule 2.0) and level 1 (level 1 of cross-sectional measurements of symptoms), to be able to measure and aid assessment of mental health domains that are important across psychiatric diagnoses and also the degree of disability triggered by breast cancer. The statistical analysis included descriptive statistics and interferential statistics. Statistical tests, such as Shapiro-Wilk, Kruskal-Wallis, and Mann-Whitney U tests with Bonferroni correction tests, were used. The p-value was set to 0.05 with a confidence interval (CI) of 95%. Results The study included 120 women diagnosed with breast cancer, with a mean age of 56.64 ± 9.46 years. Regarding the severity of the diagnosis, 44 women (36.66%) had non-invasive cancer, 58 (48.33%) had invasive cancer, and 18 (15%) had metastases. There was a statistically significant difference between three of the five selected level 1 domains across cancer types. The WHODAS 2.0 disability scores showed a significant difference between groups (p < 0.001). Subjects with non-invasive cancer had the lowest WHODAS 2.0 score, followed by the invasive group, while metastases had the highest score. Conclusions Following the application of the two tests, level 1 and WHODAS 2.0, to our group of subjects, statistically significant differences were observed between the three categories of subjects. The degree of disability and the occurrence of psychological symptoms differed according to the severity of breast cancer. Adapting to the status of an oncological patient entails multiple changes from a psycho-emotional, social, occupational, and professional point of view. Although the most recent medications prolong survival, a holistic approach that considers psychological aspects can improve patients' long-term results.

The Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) is reliable and valid for chronic stroke survivors

BACKGROUND

Stroke is the leading cause of disability worldwide. Assessing stroke's impact on patients' daily activities and social participation can provide important complementary information to their rehabilitation process. However, no previous study had been conducted on the psychometric properties of the Brazilian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the stroke population.

OBJECTIVES

This study aimed to examine the internal consistency, test-retest and inter-rater reliability, convergent validity and floor/ceiling effect of the Brazilian version of the WHODAS 2.0 in individuals after chronic stroke.

METHODS

Two examiners interviewed 53 chronic stroke individuals who responded to the Brazilian 36-item version of the WHODAS 2.0 three times to analyze test-retest and inter-rater reliabilities. Floor/ceiling effects were calculated as relative frequencies of the lowest or the highest possible WHODAS 2.0 scores. Participants also responded to the Stroke Impact Scale 3.0 (SIS 3.0) and the Functional Independence Measure (FIM) to analyze convergent validity.

RESULTS

The internal consistency analyses for domains of WHODAS showed a strong correlation among the items of each domain (0.76-0.91) except for the "getting along" domain, which presented a moderate correlation (ρ = 0,62). Total scores of WHODAS 2.0 showed satisfactory internal consistency (α = 0.93), good inter-rater reliability (ICC = 0.85), excellent test-retest reliability (ICC = 0.92) and no significant floor/ceiling effect. Convergent validity indicated moderate to strong correlations (ρ=-0.51 to ρ=-0.88; p < 0.001), with the highest values associated with the correlation with the SIS scale.

CONCLUSIONS

The Brazilian version of the WHODAS 2.0 instrument presented evidence of reliability and validity for chronic post-stroke individuals.

Mapping the World Health Organization Disability Assessment Schedule (WHODAS 2.0) onto SF-6D Using Swedish General Population Data

BACKGROUND AND OBJECTIVE

Mapping algorithms can be used for estimating quality-adjusted life years (QALYs) when studies apply non-preference-based instruments. In this study, we estimate a regression-based algorithm for mapping between the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the preference-based instrument SF-6D to obtain preference estimates usable in health economic evaluations. This was done separately for the working and non-working populations, as WHODAS 2.0 discriminates between these groups when estimating scores.

METHODS

Using a dataset including 2258 participants from the general Swedish population, we estimated the statistical relationship between SF-6D and WHODAS 2.0. We applied three regression methods, i.e., ordinary least squares (OLS), generalized linear models (GLM), and Tobit, in mapping onto SF-6D from WHODAS 2.0 at the overall-score and domain levels. Root mean squared error (RMSE) and mean absolute error (MAE) were used for validation of the models; R2 was used to assess model fit.

RESULTS

The best-performing models for both the working and non-working populations were GLM models with RMSE ranging from 0.084 to 0.088, MAE ranging from 0.068 to 0.071, and R2 ranging from 0.503 to 0.608. When mapping from the WHODAS 2.0 overall score, the preferred model also included sex for both the working and non-working populations. When mapping from the WHODAS 2.0 domain level, the preferred model for the working population included the domains mobility, household activities, work/study activities, and sex. For the non-working population, the domain-level model included the domains mobility, household activities, participation, and education.

CONCLUSIONS

It is possible to apply the derived mapping algorithms for health economic evaluations in studies using WHODAS 2.0. As conceptual overlap is incomplete, we recommend using the domain-based algorithms over the overall score. Different algorithms must be applied depending on whether the population is working or non-working, due to the characteristics of WHODAS 2.0.

Assessing Functioning across Common Mental Disorders in Psychiatric Emergency Patients: Results from the WHODAS-2

OBJECTIVE

Assessing global functioning in psychiatric emergency settings is important for clinicians to estimate severity of mental disorders, devise a treatment plan, and assess the evolution of their patients' progression over time. The World Health Organization Disability Assessment Schedule-2.0 (WHODAS-2) measures psychological, social, and professional functioning and is recommended as a standardized instrument of choice for use in psychiatric settings. Yet, studies investigating disability profiles of mental disorders using the WHODAS-2 are scarce, and psychometric properties have not been evaluated in a psychiatric emergency context. We describe and compare WHODAS-2 (12-item version) scores across mental disorders (anxiety, mood, psychotic, personality, and substance abuse) in adults admitted to psychiatric emergency.

METHODS

Data from the Signature Bank were used. Participants admitted to psychiatric emergency completed the WHODAS-2 at admission (n = 1,125). Mental disorders were evaluated by psychiatrists, and WHODAS-2 scores were compared across groups. Psychometric properties were evaluated using confirmatory factor analysis (CFA).

RESULTS

Higher mean WHODAS-2 scores were reported by those with anxiety, mood, and personality disorders (P < 0.001) compared to other psychopathologies. The measure showed good internal consistency (global score α = 0.88; domain subscores α = 0.59 to 0.85) and acceptable goodness of fit indices in CFA confirming the original structure of WHODAS-2.

CONCLUSIONS

Findings from this large-scale study could assist clinicians in interpreting WHODAS-2 scores in psychiatric populations and provide a more detailed portrait of disability profiles associated with different clinical diagnoses.

Functioning in the fibromyalgia syndrome: validity and reliability of the WHODAS 2.0

BACKGROUND

Fibromyalgia syndrome (FMS) is both a challenging and disabling condition. The International Association for the Study of Pain (IASP) classifies FMS as chronic primary pain, and it can negatively impact individuals' functioning including social, psychological, physical and work-related factors. Notably, while guidelines recommend a biopsychosocial approach for managing chronic pain conditions, FMS assessment remains clinical. The WHODAS 2.0 is a unified scale to measure disability in the light of the International Classification of Functioning, Disability and Health. Thus, this study aimed to evaluate the reliability and validity of the Brazilian version of WHODAS 2.0 for use in individuals with FMS.

METHODS

Methodological study of the validity and reliability of the Brazilian version of the 36-item WHODAS 2.0 with 110 individuals with FMS. The instrument gives a score from 0 to 100, the higher the value, the worse the level of functioning. We assessed participants with Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (0-100), Fibromyalgia Impact Questionnaire (FIQ) (0-10) and Beck Depression Inventory instrument (BDI) (0-63). The construct validity, internal consistency, and test-retest stability. We used SF-36, FIQ and BDI to study construct validity analysis. For statistical analysis, we performed the intraclass correlation (ICC), Spearman correlation, and Cronbach's alpha, with a statistical level of 5%.

RESULTS

Most participants were female (92.27%), aged 45 (± 15) years. The test-retest reliability analysis (n = 50) showed stability of the instrument (ICC = 0.54; ρ = 0.84, p < 0.05). The test-retest correlation between the domains was moderate to strong (ρ > 0.58 and < 0.90). Internal consistency was satisfactory for total WHODAS 2.0 (0.91) and also for domains, ranging from 0.44 to 0.81. The construct validity showed satisfactory values with all moderately correlated with WHODAS 2.0 instruments (> 0.46 and < 0.64; p < 0.05). WHODAS 2.0 evaluates the functioning encompassing components of health-related quality of life, functional impact, and depressive symptoms in those with FMS.

CONCLUSIONS

WHODAS 2.0 is a reliable and valid instrument to evaluate functioning of Brazilians with FMS. It provides reliable information on individuals' health through of a multidimensional perspective, that allows for individual-centered care.

Correlation between Oswestry disability index and 12-item self-administered version of World Health Organization Disability Assessment Schedule (WHODAS 2.0) in patients with chronic low back pain

The objective of the study was to investigate the correlation between the 12-item WHO Disability Assessment Schedule (WHODAS 2.0) and the Oswestry disability index (ODI). Prospective cross-sectional study of 1379 patients (age 48 years) with chronic low back pain. The Spearman's rank correlation test was employed. Of all the possible 143 correlations, 46 (32%) were strong and nine (6%) were very strong. The strongest correlations ≥0.6 were seen for 'personal care' (ODI) vs. 'washing whole body' (WHODAS 2.0), 'personal care' (ODI) vs. 'getting dressed' (WHODAS 2.0), 'walking' (ODI) vs. 'walking long distances' (WHODAS 2.0) and 'social life' (ODI) vs. the WHODAS 2.0 total score. In conclusion, while items defining physical functioning were mostly strongly correlated, items defining social or psychological functioning were less associated. Both scales could be used together providing valuable information regarding the functioning of people with chronic low back pain.

Increased GABA+ in People With Migraine, Headache, and Pain Conditions- A Potential Marker of Pain

Treatment outcomes for migraine and other chronic headache and pain conditions typically demonstrate modest results. A greater understanding of underlying pain mechanisms may better inform treatments and improve outcomes. Increased GABA+ has been identified in recent studies of migraine, however, it is unclear if this is present in other headache, and pain conditions. We primarily investigated GABA+ levels in the posterior cingulate gyrus (PCG) of people with migraine, whiplash-headache and low back pain compared to age- and sex-matched controls, GABA+ levels in the anterior cingulate cortex (ACC) and thalamus formed secondary aims. Using a cross-sectional design, we studied people with migraine, whiplash-headache or low back pain (n = 56) and compared them with a pool of age- and sex-matched controls (n = 22). We used spectral-edited magnetic resonance spectroscopy at 3T (MEGA-PRESS) to determine levels of GABA+ in the PCG, ACC and thalamus. PCG GABA+ levels were significantly higher in people with migraine and low back pain compared with controls (eg, migraine 4.89 IU ± 0.62 vs controls 4.62 IU ± 0.38; P = .02). Higher GABA+ levels in the PCG were not unique to migraine and could reflect a mechanism of chronic pain in general. A better understanding of pain at a neurochemical level informs the development of treatments that target aberrant brain neurochemistry to improve patient outcomes. PERSPECTIVE: This study provides insights into the underlying mechanisms of chronic pain. Higher levels of GABA+ in the PCG may reflect an underlying mechanism of chronic headache and pain conditions. This knowledge may help improve patient outcomes through developing treatments that specifically address this aberrant brain neurochemistry.

Psychometric properties of the Polish version of the 36-item WHODAS 2.0 in patients with hip and knee osteoarthritis

Purpose

To examine psychometric properties of the Polish version of the 36-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the population with hip and knee osteoarthritis (OA).

Methods

This was a longitudinal study with repeated measures during retest examinations. Subjects from a Polish Specialist Hospital (age = 68.3 ± 9.2years, 71% female, 44.2% knee OA, 55.8% hip OA) were tested three times. They completed the Polish version of the 36-item WHODAS 2.0, the SF-36 Health Survey 2.0, the Western Ontario and Macmaster Universities Osteoarthritis Index 3.1, the Hospital Anxiety and Depression Scale, and the Numerical Rating Scale.

Results

The 36-item WHODAS 2.0—Polish version demonstrated high internal consistency (Cronbach’s alpha for total = 0.94), and test–retest reliability (Total ICC_2,1 = 0.98). High construct validity was found as 12 out of 15 a priori hypotheses (80%) were confirmed. Most domains and Total Scores in the 36-item WHODAS 2.0 (Total ES = − 0.62, SMR = − 1.09) showed a moderate degree of responsiveness. Minimal clinically important difference (MCID) for the Total WHODAS 2.0 was 3.29 in patients undergoing rehabilitation for knee or hip OA.

Conclusions

The Polish version of the 36-item WHODAS 2.0 assesses disability according to ICF in a reliable, valid and responsive way. Therefore, it provides considerable support in clinical practice and national and international scientific research of patients with hip or knee OA.

Psychometric Properties of the Polish Version of the 36-Item WHODAS 2.0 in Patients with Low Back Pain

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is considered by the World Health Organization (WHO) to be a useful tool for assessing the functioning and disability of the general population as well as the effectiveness of the applied interventions. Until this study, no data regarding the validity of the 36-item WHODAS 2.0 in chronic low back pain (LBP) in Poland have been explored. This study was conducted on 92 patients suffering from chronic LBP admitted to the rehabilitation ward. The Polish version of the 36-item WHODAS 2.0, the Sf-36 Health Survey (SF-36), the Oswestry Disability Index (ODI), the Hospital Anxiety and Depression Scale (HADS) and the Visual Analogue Scale (VAS) questionnaires were applied to assess patients. The scale score reliability of the entire tool for the study population was very high. The Cronbach's alpha test result for the entire scale was 0.92. For the overall result of the WHODAS 2.0, the Intraclass Correlation Coefficient (ICC1,2) was 0.928, which confirmed that the scale was consistent over time. The total result and the vast majority of domains of the 36-item WHODAS 2.0 correlated negatively with domains of the SF-36 questionnaire; thus, a higher WHODAS 2.0 score was associated with a lower score on the SF-36 questionnaire. We found that the minimal clinically important difference (MCID) for the total WHODAS 2.0 score in patients after rehabilitation for LBP was 4.87. Overall, the results indicated that the Polish version of the 36-item WHODAS is suitable for assessing health and disability status in patients with LBP.

Psychometric properties and validation of the polish version of the 12-item WHODAS 2.0

Background

The assessment of disability in a population is an important part of public health management. In this article, we examine the psychometric properties and validation of the Polish version of the 12-item World Health Organization Disability Assessment Schedule 2.0. (12-item WHODAS 2.0).

Methods

A systematic random sample comprised 584 adult urban residents. The Polish version of the 12-item WHODAS 2.0 and the World Health Organization Quality of Life-BREF, Short Form (WHOQOL-BREF) questionnaire were used to assess disability and quality of life, respectively. Basic sociodemographic data and selected health-related data (e.g., pain and depressive moods) were also collected.

Results

Good scale score reliability for the entire tool was confirmed in the study population (Cronbach’s α = 0.90; Composite reliability = 0.95). In confirmatory factor analysis (CFA), satisfactory values of the fit indices were obtained (comparative fit index, CFI = 0.999; Tucker-Lewis Index, TLI = 0.999; root mean square error of approximation, RMSEA = 0.004; standardized root mean square residual, SRMR = 0.043, p = 0.454). Good consistency was noted over time (correlation coefficient = 0.88). The tool was found to have an appropriate level of validity.

Conclusions

We found that the 12-item WHODAS is short and easy to use, and it is suitable for use in the form of an interview during screening tests. This tool is appropriate for measuring the health status, functioning, and disability of an average population. It may be more relevant for studying populations with health problems. The 12-item WHODAS can be used to successfully obtain information about the general level of disability in a population.

Measuring functional disability in children with developmental disorders in low-resource settings: validation of Developmental Disorders-Children Disability Assessment Schedule (DD-CDAS) in rural Pakistan

BACKGROUND

Developmental disorders (DDs) in children are a priority condition and guidelines have been developed for their management within low-resource community settings. However, a key obstacle is lack of open access, reliable and valid tools that lay health workers can use to evaluate the impact of such programmes on child outcomes. We adapted and validated the World Health Organization's Disability Assessment Schedule for children (WHODAS-Child), a lay health worker-administered functioning-related tool, for children with DDs in Pakistan.

METHODS

Lay health workers administered a version of the WHODAS-Child to parents of children with DDs (N = 400) and without DDs (N = 400), aged 2-12 years, after it was adapted using qualitative study. Factor analysis, validity, reliability and sensitivity to change analyses were conducted to evaluate the psychometric properties of the adapted outcome measure.

RESULTS

Among 800 children, 58% of children were male [mean (s.d.) age 6.68 (s.d. = 2.89)]. Confirmatory Factor Analysis showed a robust factor structure [χ2/df 2.86, RMSEA 0.068 (90% CI 0.064-0.073); Tucker-Lewis Index (TLI) 0.92; Comparative Fit Index (CFI) 0.93; Incremental Fit Index (IFI) 0.93]. The tool demonstrated high internal consistency (α 0.82-0.94), test-retest [Intra-class Correlation Coefficient (ICC) 0.71-0.98] and inter-data collector (ICC 0.97-0.99) reliabilities; good criterion (r -0.71), convergent (r -0.35 to 0.71) and discriminative [M (s.d.) 52.00 (s.d. = 21.97) v. 2.14 (s.d. = 4.00); 95% CI -52.05 to -47.67] validities; and adequate sensitivity to change over time (ES 0.19-0.23).

CONCLUSIONS

The lay health worker administrated version of adapted WHODAS-Child is a reliable, valid and sensitive-to-change measure of functional disability in children aged 2-12 years with DDs in rural community settings of Pakistan.

Propriedades psicométricas do WHODAS para uso em pessoas com chikungunya no Brasil

RESUMO O objetivo deste estudo é validar um instrumento de aferição da funcionalidade segundo a proposta conceitual da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para uso em pessoas pós-chikungunya. Este é um estudo de validação com indivíduos >17 anos, de ambos os sexos, em atendimento para manejo clínico da chikungunya. A coleta de dados foi realizada por meio de entrevistas coletando informações sobre funcionalidade (WHODAS), qualidade de vida (WHOQOL-bref) e sociodemográficas. A análise estatística usou o coeficiente alfa de Cronbach (consistência interna) e coeficiente de correlação de Spearman (validade convergente), médias e desvios-padrão para a determinação do perfil de qualidade de vida, com nível de significância de 5%. A amostra foi composta por 68 indivíduos. Os valores médios das pontuações dos instrumentos foram: 45,4 (±16,38) para o WHODAS e 12,1 (±2,10) para o WHOQOL-bref. O alfa de Cronbach do valor total foi de α=0,93; todos os domínios do WHODAS apresentaram valores acima de 0,75. O valor total do WHODAS 2.0 apresentou forte correlação com o domínio físico (r=−0,74) e moderada correlação com os domínios psicológico (r=−0,68) e social (r=−0,42) do WHOQOL-bref. Os resultados indicam que o WHODAS 2.0 é um instrumento válido para a mensuração da autopercepção de alteração da funcionalidade em pacientes acometidos pela chikungunya, capaz de fornecer dados que podem ajudar a construir um perfil de impacto da doença no perfil de funcionalidade dessa população.

Self-reported disability in women with fibromyalgia from a tertiary care center

Background

The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient’s perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia.

Methods

One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability.

Results

Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire.

Conclusions

Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).

Validation of the World Health Organization Disability Assessment Schedule 2.0 among older adults in an Asian country

INTRODUCTION

As populations age globally and the burden of chronic illnesses increases, valid measures of disability are needed for assessment in the older adult population. The aim of the current analysis was to explore the psychometric properties and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an epidemiological survey of older adults in Singapore.

METHODS

The study comprised secondary data analysis of the Well-being of the Singapore Elderly study. Inclusion criteria for the study were Singapore residents (Singapore citizens and permanent residents) aged 60 years and above. The 12-item interviewer-administered version of the WHODAS 2.0 was used to assess disability in the study. Data on cognition, health status and sociodemographic information were collected. Depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy.

RESULTS

The study found a one-factor model solution for WHODAS 2.0 with a high internal consistency of all items. The internal consistency for the overall scale was 0.92. The WHODAS 2.0 score positively correlated with multimorbidity, perceived overall health status, depression and subsyndromal depression. There was a significant inverse association between the WHODAS 2.0 score and the cognitive status. After adjustment for all sociodemographic variables in the multiple linear regression analysis, these measures remained significantly associated with the WHODAS 2.0 score.

CONCLUSION

WHODAS 2.0 was found to be a valid measure of disability among older adults. However, further research is required to determine its usefulness as a responsive instrument that can detect change following interventions.

Validade e confiabilidade da versão brasileira do World Health Organization Disability Assessment Schedule em pessoas com cegueira

RESUMO O World Health Organization Disability Assessment Schedule (WHODAS 2.0) é uma ferramenta desenvolvida pela Organização Mundial de Saúde (OMS) para medir deficiência e incapacidade, apoiando o modelo da Classificação Internacional de Saúde, Incapacidade e Funcionalidade. A versão brasileira do WHODAS 2.0 foi traduzida e disponibilizada para uso pela OMS em 2015. Assim, este estudo pretende validar a versão brasileira do WHODAS 2.0 para uso em pessoas com cegueira. Participaram 56 pessoas com cegueira (idade média: 48,4±13,6 anos). Foram utilizadas duas ferramentas de avaliação: a versão de 36 itens do WHODAS 2.0 e o World Health Organization Quality of Life-bref (WHOQOL-abreviado). As propriedades psicométricas testadas foram consistência interna, teste-reteste e validade de critério. Houve boa confiabilidade teste-reteste (ICC≥0,63). Os valores de a de Cronbach mostraram boa consistência interna na maioria das áreas, exceto no subdomínio de atividades escolares ou de trabalho (a=0,55). A validade do critério foi adequada, com correlações moderadas entre os domínios do WHODAS 2.0 e áreas do WHOQOL-abreviado. Os resultados indicaram a validade do WHODAS 2.0 para avaliar a funcionalidade de pessoas com cegueira.

Validation of the Brazilian version of WHODAS 2.0 in patients on hemodialysis therapy

Abstract Introduction: Chronic kidney disease and hemodialysis normally have an impact on the functioning. Objective: To validate the Brazilian version of the World Health Organization Disability Assessment Schedule 2.0 in individuals with chronic kidney disease on hemodialysis treatment. Methods: The 36-item version was applied to interview 51 individuals with chronic kidney disease undergoing dialysis treatment. To ascertain the instrument’s applicability, its internal consistency and test-retest stability were studied. To check the validity, a convergent/divergent analysis was performed. Results: The participants answered the questions on the main instrument at two timepoints and on the World Health Organization Quality of Life Abbreviated instrument and the Kidney Disease Quality of Life - Short FormTM 1.3 once each. Cronbach’s α coefficient was appropriate in all domains except the “Getting along” domain. The test-retest coefficients were above the recommended value (> 0.70). Convergent and divergent validity analysis also showed consistent results by correlation coefficient assessment. Conclusion: The instrument is valid and reliable. This study supports the use of the questionnaire by presenting its appropriate psychometric properties. We suggest that some care should be taken specifically in the sexual questions of the “Getting along” domain.

A comparison between WHODAS 2.0 and Modified Barthel Index: which tool is more suitable for assessing the disability and the recovery rate in orthopedic rehabilitation?

Purpose

The aim of the present study was to compare 2 clinical assessment tools, the Modified Barthel Index (currently administered to patients admitted into inpatient rehabilitation units after elective hip or knee arthroplasty) with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 scale, in order to identify which tool is more suitable for assessing the disability and the "recovery rate".

Patients and methods

A perspective multicenter observational study was developed, involving 2 hospital authorities in Italy. Eighty consecutive cases of inpatients were enrolled. Patient's disability was evaluated using both of the aforementioned tools, before and after the rehabilitation program.

Results

The WHODAS 2.0 score was, on average, 12.21% higher than the Modified Barthel Index, before the surgical intervention. Modified Barthel Index measures could be considered as a determinant and a predictor of length of stay.

Conclusion

The Modified Barthel Index is limited, since it does not consider a patient's perspective. The WHODAS 2.0 scale fully considers a patient's perception of disability. Therefore, both assessment scales should be administered in clinical practice, in order to provide integration of clinical information with a patient's reported outcome measures.

Validation of the Polish version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in an elderly population (60-70 years old)

PURPOSE

To assess the reliability and validity of the Polish version of the 36-point World Health Organization Disability Assessment Schedule (WHODAS 2.0) in an elderly population.

METHOD

One thousand randomly selected individuals, aged 60-70 years, living in south-eastern Poland were assessed using the Polish version of the WHODAS 2.0.

RESULTS

The analysis confirmed the high reliability and validity of the tool. Cronbach's α index was 0.89. The tool had high stability, and the correlation between test and retest results was high. The relevance of the domain selection was high or very high. A factor analysis confirmed the relevance of assigning questions to domains. High theoretical relevance was also demonstrated. Statistically significant differences between those who were and were not suffering from health problems were observed. An analysis of the internal structure of the WHODAS 2.0 revealed strong correlations between the components of each domain and the final result.

CONCLUSION

The Polish version of the WHODAS 2.0 showed high reliability and validity; thus, it can be used to assess health, functioning and disability in the elderly population of Poland.

Reliability and validity of the 12-item WHODAS 2.0 in patients with Kashin-Beck disease

The purpose of this study was to check the reliability and validity of the 12-item Chinese version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for the assessment of disability in patients with Kashin-Beck disease (KBD). We recruited 219 patients with KBD from the high-risk KBD area in the Shaanxi province, using stratified multistage random sampling. We assessed each patient using the Chinese version of the 12-item WHODAS 2.0 and the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC). Statistical evaluations of the instruments consisted of Cronbach's alpha, intraclass correlation coefficient (ICC), confirmatory factor analysis (CFA), and Pearson's correlation coefficient. Cronbach's alpha and ICC for the six domains ranged from 0.704 to 0.906 and 0.690 to 0.852, respectively. A six-factor structure fits the data well (CFI = 0.967, TLI = 0.944, RMSEA = 0.08). Regarding convergent validity, the four domains of the 12-item WHODAS 2.0 (getting around, self-care, life activity, and participation) showed moderate-to-strong correlation for all three domains of the WOMAC (0.428 < |r| < 0.804). Regarding divergent validity, the two domains of the 12-item WHODAS 2.0 (understanding and communication, and getting along with people) showed weak correlation for the three domains of WOMAC (0.182 < |r| < 0.295). The Chinese version of 12-item WHODAS 2.0 questionnaire is a reliable and valid instrument when administered to KBD patients.

Validation of World Health Organization Assessment Schedule 2.0 in specialized somatic rehabilitation services in Norway

PURPOSE

The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability covering six domains. The purpose of this study was to investigate the potential of the instrument for monitoring disability in specialized somatic rehabilitation by testing reliability, construct validity and responsiveness of WHODAS 2.0, Norwegian version, among patients with various health conditions.

METHODS

For taxonomy, terminology and definitions, the Consensus-based Standards for the Selection of Health Measurement Instruments were followed. Reproducibility was investigated by the intra-class correlation coefficient (ICC) in a randomly selected sample. Internal consistency was assessed by Cronbach's alpha. Construct validity was evaluated by correlations between WHODAS 2.0 and the Medical Outcomes Study 36-item Short Form, and fit of the hypothesized structure using confirmatory factor analysis (CFA). Responsiveness was evaluated in another randomly selected sample by testing a priori formulated hypotheses.

RESULTS

Nine hundred seventy patients were included in the study. Reproducibility and responsiveness were evaluated in 53 and 104 patients, respectively. The ICC for the WHODAS 2.0 domains ranged from 0.63 to 0.84 and was 0.87 for total score. Cronbach's alpha for domains ranged from 0.75 to 0.94 and was 0.93 for total score. For construct validity, 6 of 12 expected correlations were confirmed and CFA did not achieve satisfactory fit indices. For responsiveness, 3 of 8 hypotheses were confirmed.

CONCLUSION

The Norwegian version of WHODAS 2.0 showed moderate to satisfactory reliability and moderate validity in rehabilitation patients. However, the present study indicated possible limitations in terms of responsiveness.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Psychometric properties of the world health organization disability assessment schedule II -12 Item (WHODAS II) in trauma patients

BACKGROUND

The 12-item WHODAS II is widely used for assessing disability among different populations. This study aimed at assessing the psychometric properties of the Persian version of the 12-item WHODAS II among trauma patients.

PATIENTS AND METHODS

In this methodological study, 220 patients aging 15-65-year-old hospitalized in Shahid Beheshti Hospital, Kashan, Iran, were studied. The WHODAS II was used for data collection. The reliability of this schedule was assessed by evaluating its internal consistency. Its validity was evaluated by using the known-groups approach and the convergent validity method. The exploratory and the confirmatory factor analysis techniques were also used for assessing the factor structure of the schedule.

RESULTS

The mean of participants' ages was 34.7±14.5 years. Most of the participants were male patients (84.1%), had multiple injury (77.7%), and had been injured in road traffic accidents (76.8%). The Cronbach's alpha of the WHODAS II was 0.91, confirming its acceptable internal consistency. Known-groups comparisons revealed that this schedule can satisfactorily differentiate among patients with different severity of trauma (P value<0.0001). The results of exploratory factor analysis showed that the WHODAS II had a two-factor structure while the confirmatory factor analysis revealed that one-factor model fitted the data.

CONCLUSION

Study findings suggest that the Persian version of the 12-item WHODAS II is a valid and reliable scale for assessing trauma patients' disability. More Large-scale studies are needed for assessing the validity and the reliability of this schedule among other patients.

Asking patients about their general level of functioning: Is IT worth IT for common mental disorders?

Functional disability (FD) is a diagnostic criterion for the psychiatric diagnosis of many mental disorders (e.g. generalized anxiety disorder (GAD); major depressive episode (MDE)). We aimed to assess the contribution of measuring FD to diagnosing GAD and MDE using clinical (Global Assessment of Functioning, GAF) and self-reported methods (Analog scale of functioning, ASF and World Health Organization Disability Assessment Schedule WHODAS 2.0). Patients seeking professional help for mood/anxiety symptoms (N=244) were evaluated. The MINI interview was used to determine the presence of common mental disorders. Symptoms were assessed with two short checklists. Logistic and hierarchical logistic models were used to determine the diagnostic accuracy and the added diagnostic value of FD assessment in detecting GAD and MDE. For GAD, FD alone had a diagnostic accuracy of 0.79 (GAF), 0.79 (ASF) and 0.78 (WHODAS) and for MDE of 0.83, 0.84 and 0.81, respectively. Self-reported measures of FD improved the diagnostic performance of the number of symptoms (4% AUC increase) for GAD, but not for MDE. If assessed before symptom evaluation, FD can discriminate well between patients with and without GAD/MDE. When assessed together with symptoms, self-reported methods improve GAD detection rates.

Disability in bipolar I disorder: the 36-item World Health Organization Disability Assessment Schedule 2.0

BACKGROUND

The WHODAS 2.0 is an ICF-based multidimensional instrument developed for measuring disability. The present study analyzes the utility of the 36-item interviewer-administered version in a sample of patients with bipolar disorder. There is no study to date that analyses how the scale works in a sample that only comprises such patients.

METHODS

A total of 291 patients with bipolar disorder (42.6% males) according to DSM-IV-TR criteria from a cross-sectional study conducted in outpatient psychiatric clinics were enrolled. In addition to the WHODAS 2.0, patients completed a comprehensive assessment battery including measures on psychopathology, functionality and quality of life. Analyses were centered on providing evidence on the validity and utility of the Spanish version of the WHODAS 2.0 in bipolar patients.

RESULTS

Participation domain had the highest percentage of missing data (2.7%). Confirmatory factorial analysis was used to test three models formulated in the literature: six primary correlated factors, six primary factors with a single second-order factor, and six primary factors with two second-order factors. The three models were plausible, although the one formed by six correlated factors produced the best fit. Cronbach's alpha values ranged between .73 for the Self-care domain and .92 for Life activities, and the internal consistency of the total score was .96. Relationships between the WHODAS 2.0 and measures of psychopathology, functionality and quality of life were in the expected direction, and the scale was found to be able to differentiate among patients with different intensity of clinical symptoms and work situation.

LIMITATIONS

The percentage of euthymic patients was considerable. However, the assessment of euthymic patients is less influenced by mood. Some psychometric properties have not been studied, such as score stability and sensitivity to change.

CONCLUSIONS

The Spanish version of the 36-item WHODAS 2.0 has suitable psychometric properties in terms of reliability and validity when applied to patients with bipolar disorder. Disability in bipolar patients is especially prominent in Cognition, Getting along, Life activities, and Participation domains, so functional remediation interventions should emphasize these areas in order to improve the daily living activities of these patients.

Validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with Huntington disease (HD)

PURPOSE

The reliability and construct validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) were examined in individuals with Huntington disease (HD).

METHODS

We examined factor structure (confirmatory factor analysis), internal consistency reliability (Cronbach's alpha), floor and ceiling effects, convergent validity (Pearson correlations), and known-groups validity (multivariate analysis).

RESULTS

Results of a confirmatory factor analysis replicated the six-factor latent model that reflects the six separate scales within the WHODAS 2.0 (understanding and communicating; getting around; self-care; getting along with others; life activities; participation). Cronbach's alpha for the scale was 0.94, suggesting good internal consistency reliability. The WHODAS demonstrated a ceiling effect for 19.5 % of participants; there were no floor effects. There was evidence for convergent validity; the WHODAS demonstrated moderate significant correlations with other general measures of health-related quality of life (HRQOL; i.e., RAND-12, EQ5D). Multivariate analyses indicated that late-stage HD participants indicated poorer HRQOL than both early-stage HD and prodromal HD participants for all HRQOL measures.

CONCLUSIONS

Findings provide support for both the reliability and validity of the WHODAS 2.0 in individuals with HD.

Development of traditional Chinese version of World Health Organization disability assessment schedule 2.0 36--item (WHODAS 2.0) in Taiwan: validity and reliability analyses

BACKGROUND

World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provided a standardized method for measuring the health and disability and the traditional Chinese version has not been developed.

AIMS

To describe the process of developing the traditional Chinese version of the WHODAS 2.0 36-item version and to evaluate the concurrent validity and test-retest reliability of this instrument.

METHODS

The study was conducted in two phases. Phase I was the process of translation of WHODAS 2.0 36-item version. Phase II was a cross-sectional study. The participants were 307 adults who were tested the validity and reliability of draft traditional Chinese version.

RESULTS

The reliability of Cronbach's α and ICC in the WHODAS 2.0 traditional Chinese version were 0.73-0.99 and 0.8-089, respectively. The content validity was good (r=0.7-0.76), and the concurrent validity was excellent in comparison with the WHOQOL-BREF (p<0.5). The construct validity, the model was explained total variance was 67.26% by the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) illustrated the traditional Chinese version was good to assess disability. There was a valid and reliable measurement scales for evaluating functioning and disability status.

CONCLUSION

For disability eligibility system of Taiwan government to measure the disability, the traditional Chinese version of the WHODAS 2.0 provided valuable evidence to design the assessment instrument.

Validity and reliability of the Functioning Disability Evaluation Scale-Adult Version based on the WHODAS 2.0--36 items

BACKGROUND/PURPOSE

The disability eligibility determination system is based on the International Classification of Functioning, Disability and Health (ICF) framework in Taiwan. The Functioning Disability Evaluation Scale (FUNDES) has been developed since 2007 for assessing the status of an individual's activities and participation in the disability eligibility system. The purpose of this study was to examine the reliability and validity of the FUNDES-Adult Version (FUNDES-Adult).

METHODS

During 2011-2012, a total of 5736 adults with disabilities (aged 58.4 ± 18.2 years) were randomly recruited for a national population-based study. These adults were assessed in person by certified professionals in the authorized hospitals. Domains 1-6 of the FUNDES-Adult addressing the performance and capability dimensions are modified from the World Health Organization Disability Assessment Schedule 2.0-36-item version, and Domain 7 (Environmental attribute) and capability and capacity dimensions of Domain 8 (Motor action) are designed based on the ICF coding system.

RESULTS

The internal consistency was excellent (Cronbach's α ≥ 0.9). An exploratory factor analysis yielded a five-factor FUNDES structure with a variance of 76.1% and 76.9% and factor loadings of 0.56-0.94 and 0.55-0.94 for the performance and capability dimensions, respectively. The factor loadings for the second-order confirmatory factor analysis for the performance and capability dimensions were from 0.81 to 0.89. In Domains 1-6 and 8, the ceiling effects were from 9% to 36%, and the floor effects were from 5% to 45%.

CONCLUSION

FUNDES-Adult has acceptable reliability and validity and can be used to measure activities and participation for people with disabilities.

Validation of the World Health Organization Disability Assessment Schedule II (WHODAS-II) in patients with multiple sclerosis

Background:

The World Health Organization Disability Assessment Schedule (WHODAS-II) is a widely used generic assessment instrument for health and disability. However, a specific psychometric evaluation for this scale in multiple sclerosis (MS) is lacking. This study is aimed at the assessment of the psychometric properties of the WHODAS-II in MS with Cronbach’s α and modern Rasch-model analyses.

Methods:

The WHODAS-II was administered to 136 consecutively recruited MS patients. Several indexes of fit to the Rasch model were evaluated in order to assess internal construct validity. Internal consistency was assessed with Cronbach’s α and the Person Separation Index (PSI). External validity was evaluated by analyzing correlations between the WHODAS-II and the Multiple Sclerosis Quality of Life-54 (MSQoL-54).

Results:

Classical reliability indexes (Cronbach’s α and intraclass correlation) showed good to excellent reliability for most of the subscales and for the total scale (α = 0.93). The total scale both with (36 items) or without (32 items) work items reached good fit to the Rasch model (PSI = 0.83). However, analysis of the subscales could resolve only four subscales out of seven.

Conclusions:

The WHODAS-II is a reliable and valid instrument for the assessment of patient-reported disability in MS, with some limitations including some item redundancy and questionable reliability of some subscales.

Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan

PURPOSE

To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability.

METHODS

Subjects (≥ 60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain.

RESULTS

More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75-376.42, p < 0.001), age (1.38-4.81, p < 0.05), and speech impairment (1.94-5.80, p < 0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study.

CONCLUSIONS

Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability.

IMPLICATIONS FOR REHABILITATION

Older adults with physical disability often experience difficulties in household activities and mobility. Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease. Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

A naturalistic study of the acceptability and effectiveness of internet-delivered cognitive behavioural therapy for psychiatric disorders in older australians

Objectives

The current study investigates the acceptability, effectiveness and uptake of internet-delivered cognitive behavioural therapy (iCBT) amongst older individuals (>60 years) seeking psychiatric treatment in general practice.

Methods

The sample consisted of 2413 (mean age 39.5; range 18–83 years) patients prescribed iCBT through This Way Up clinic by their primary care clinician. The intervention consisted of six fully automated, unassisted online lessons specific to four disorders major depression, generalised anxiety disorder, panic disorder or social phobia. Patients were categorised into five age groups (18–29 years, 30–39 years, 40–49 years, 50–59 years, 60 years and above). 225 (9.3%) patients were aged over 60 years. Analyses were conducted across the four disorders to ensure sufficient sample sizes in the 60 years and older age group. Age differences in adherence to the six lesson courses were assessed to demonstrate acceptability. Age-based reductions in psychological distress (Kessler Psychological Distress Scale; K10) and disability (the World Health Organisation Disability Assessment Schedule; WHODAS-II) were compared to demonstrate effectiveness. To evaluate the uptake of iCBT, the age distribution of those commencing iCBT was compared with the prevalence of these disorders in the 2007 Australian National Survey of Mental Health and Well-Being.

Results

Older adults were more likely to complete all six lessons when compared with their younger counterparts. Marginal model analyses indicated that there were significant reductions in the K10 and WHODAS-II from baseline to post-intervention, regardless of age (p<0.001). The measurement occasion by age interactions were not significant, indicating that individuals showed similar reductions in the K10 and WHODAS-II regardless of age. In general, the age distribution of individuals commencing the iCBT courses matched the age distribution of the four diagnoses in the Australian general population, indicating that iCBT successfully captures older individuals who need treatment.

Conclusion

iCBT is effective and acceptable for use in older populations.

A comparative review of measurement instruments to inform and evaluate effectiveness of disability inclusive development

PURPOSE

A review of existing measurement instruments was conducted to examine their suitability to measure disability prevalence and assess quality of life, protection of disability rights and community participation by people with disabilities, specifically within the context of development programs in low and middle-income countries.

METHODS

From a search of PubMed and the grey literature, potentially relevant measurement instruments were identified and examined for their content and psychometric properties, where possible. Criteria for inclusion were: based on the WHO's International Classification of Functioning Disability and Health (ICF), used quantitative methods, suitable for population-based studies of disability inclusive development in English and published after 1990. Characteristics of existing instruments were analysed according to components of the ICF and quality of life domains.

RESULTS

Ten instruments were identified and reviewed according to the criteria listed above. Each version of instruments was analysed separately. Only three instruments included a component on quality of life. Domains from the ICF that were addressed by some but not all instruments included the environment, technology and communication.

CONCLUSION

The measurement instruments reviewed covered the range of elements required to measure disability-inclusion within development contexts. However no single measurement instrument has the capacity to measure both disability prevalence and changes in quality of life according to contemporary disability paradigms. The review of measurement instruments supports the need for developing an instrument specifically intended to measure disability inclusive practice within development programs. Implications for Rehabilitation Surveys and tools are needed to plan disability inclusive development. Existing measurement tools to determine prevalence of disability, wellbeing, rights and access to the community were reviewed. No single validated tool exists for population-based studies, uses quantitative methods and the components of the ICF to measure prevalence of disability, well-being of people with disability and their access to their communities. A measurement tool that reflects the UNCRPD and addresses all components of the ICF is needed to assist in disability inclusive development, especially in low and mid resource countries.

Adaptacao e validacao do WHODAS 2.0 em utentes com dor musculoesqueletica

OBJETIVO Validar a versão em português do World Health Organization Disability Assessment Schedule (WHODAS 2.0). MÉTODOS A versão original de 36 itens do WHODAS 2.0, administrada por entrevista, foi traduzida para o português de acordo com orientações internacionais e testada em nove participantes da população em geral. A versão em português foi administrada em 204 pacientes com patologia musculoesquelética. Foram coletados os dados sociodemográficos e de saúde dos pacientes, assim como o número de locais onde apresentavam dor e sua intensidade. O WHODAS 2.0 foi novamente administrado por um segundo entrevistador, um a três dias após a primeira entrevista, para avaliar a confiabilidade interavaliadores. A validade de constructo foi avaliada quanto a: capacidade do WHODAS 2.0 para diferenciar participantes com diferentes locais com dor e associação entre o WHODAS 2.0 e a intensidade da dor. A consistência interna também foi avaliada. RESULTADOS A versão portuguesa do WHODAS 2.0 teve fácil compreensão, apresentou boa consistência interna (α = 0,84) e confiabilidade interavaliadores (CCI = 0,95). Mostrou ser capaz de detectar diferenças estatisticamente significativas entre indivíduos com diferente número de locais com dor (p < 0,01) e indicar que maior incapacidade está associada à maior intensidade da dor (r = 0,44, p < 0,01), indicando validade de constructo. CONCLUSÕES A versão portuguesa do WHODAS 2.0 mostrou-se confiável e válida quando utilizada em pacientes com dor associada à patologia musculoesquelética.

The effectiveness of internet cognitive behavioural therapy for generalized anxiety disorder in clinical practice

BACKGROUND

Clinical trials have demonstrated the efficacy of internet cognitive behavioral therapy (iCBT) in the treatment of generalized anxiety disorder (GAD). The current study aims to determine whether these efficacy findings, established under controlled research conditions, translate into effectiveness in practice.

METHODS

The sample comprised 588 patients who completed at least one iCBT lesson for GAD through CRUfAD clinic (www.crufadclinic.org). This six-lesson course became available to primary care physicians to prescribe in 2009. Routine data collection included demographics, GAD symptomatology (GAD-7), psychological distress (K-10), and disability (WHODAS).

RESULTS

All six lessons were completed by 324/588 (55.1%) patients. When compared with completers, noncompleters tended to be younger and based in rural locations. Prior to discontinuing the course, noncompleters demonstrated statistically significant reductions in psychological distress. For those who completed the course, effect sizes on all outcome measures were medium to large and over 60% of moderate-to-severe GAD cases met criteria for remission upon treatment completion.

CONCLUSIONS

The current study indicates that computerized CBT for GAD is effective in generating positive, clinically significant outcomes among typical patients treated under the usual conditions in primary care. Future research should focus on reducing treatment discontinuation among younger people and those based in rural locations.

Development of the Global Disability Scale (Glo.Di.S): preliminary results

BACKGROUND

The assessment of functioning and disability is an important part of the clinical evaluation, since it measures disease burden and reflects the effectiveness of therapeutic planning and interventions. The aim of the current study was to develop such a self-report instrument on the basis of a review of the literature, and compatible with the WHO approach.

MATERIAL AND METHODS

The review of the literature led to the development of the Global Disability Scale (Glo.Di.S) with 25 items assessing different aspects of disability. The study sample included 728 persons from vulnerable populations (homeless, jobless, very low income, single parent families etc.; (29.12% males and 70.88% females; aged 55.96 ± 15.22 years). The protocol included also the STAI and the CES-D. The statistical analysis included factor analysis item analysis and ANCOVA.

RESULTS

The factor analysis revealed the presence of 4 factors explaining 71% of total variance (Everyday functioning, Social and interpersonal functioning, Severity and Mental disability). Chronbach's alpha for the whole scale was 0.95 and for subscales were 0.74-0.94.

DISCUSSION

The results of the current study suggest that the Glo.Di.S. has the potential to serve as a reliable and valid tool for assessing functioning and disability. Further research is needed to prove that it could be useful across countries, populations and diseases, and whether it provides data that are culturally meaningful and comparable. It can be used in surveys and in clinical research settings and it can generate information of use in evaluating health needs and the effectiveness of interventions to reduce disability and improve health.

Measurement properties of physical function scales validated for use in patients with rheumatoid arthritis: a systematic review of the literature

Background

The aim of this study was to systematically review the content validity and measurement properties of all physical function (PF) scales which are currently validated for use with patients with rheumatoid arthritis (RA).

Methods

Systematic literature searches were performed in the Scopus and PubMed databases to identify articles on the development or psychometric evaluation of PF scales for patients with RA. The content validity of included scales was evaluated by linking their items to the International Classification of Functioning Disability and Health (ICF). Furthermore, available evidence of the reliability, validity, responsiveness, and interpretability of the included scales was rated according to published quality criteria.

Results

The search identified 26 questionnaires with PF scales. Ten questionnaires were rated to have adequate content validity. Construct validity, internal consistency, test-retest reliability and responsiveness was rated favourably for respectively 15, 11, 5, and 6 of the investigated scales. Information about the absolute measurement error and minimal important change scores were rarely reported.

Conclusion

Based on this literature review, the disease-specificHAQ and the generic SF-36 can currently be most confidently recommended to measure PF in RA for most research purposes. The HAQ, however, was frequently associated with considerable ceiling effects while the SF-36 has limited content coverage. Alternative scales that might be better suited for specific research purposes are identified along with future directions for research.

Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

Objective

To develop evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis (UPIA).

Methods

697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008–9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007–2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed.

Results

A total of 39 756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA.

Conclusions

Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use.

Spinal Cord Injuries and Disabilities: A Review

La lesión medular es una entidad neurológica causante de importantes procesos de discapacidad. Su incidencia en el país puede estar cercana a los mayores estimativos mundiales debido a las condiciones actuales de violencia. El aumento de la expectativa de vida de esta población —gracias a los avances tecnológicos y científicos en prevención, atención y manejo de complicaciones— lleva a la necesidad de proveer servicios de rehabilitación integrales que trasciendan los aspectos funcionales y permitan la inclusión social. Para este propósito es necesario un abordaje integral de la situación, que en el ámbito de la evaluación debe incluir no sólo la estimación de la condición de salud, sino todo lo relacionado con el funcionamiento de las personas en su vida diaria. La clasificación internacional del funcionamiento, la discapacidad y la salud, brinda un marco conceptual para abordar la discapacidad y el funcionamiento humano relacionado con la salud desde un enfoque biopsicosocial que articula las dimensiones corporal, individual y social de las personas y su relación con los factores del ambiente. Este enfoque de abordaje, plasmado en el instrumento de evaluación denominado WHO-DAS II, se considera un referente importante para evaluar la discapacidad asociada a la lesión medular.

Effect of psoriatic arthritis according to the affected categories of the international classification of functioning, disability and health

OBJECTIVE

To determine the categories of the International Classification of Functioning, Disability and Health (ICF) checklist and core sets of rheumatoid arthritis and ankylosing spondylitis frequently occurring in people with psoriatic arthritis (PsA) and to compare the number of such categories with scores on self-report measures of participation restrictions and activity limitations.

METHODS

Data were collected from 94 patients with PsA attending rheumatology clinics in 6 centers. For each ICF category affected by PsA in at least 30% of patients, the percentage of such patients was determined for Body Structures, Body Functions, Activities and Participation, and Environmental Factors. A count of all affected categories by ICF chapter was compared to patient self-report scores on a number of functional and health status instruments using Spearman's correlation.

RESULTS

There were 25 categories in the Body Functions section, 6 categories in the Body Structures section, and 51 categories in the Activities and Participation section that were relevant in at least 30% of participants. Thirteen Environmental Factors were facilitating and 1 Environmental Factor (climate) was a barrier in at least 30% of participants. The number of involved Activities and Participation categories by chapter did not correlate in predictable ways with self-report measures of participation restrictions and activity limitations.

CONCLUSION

PsA is associated with a wide range of impairments, limitations, and restrictions across the ICF categories. People with PsA find environmental factors to be helpful more often than to be barriers. The unexpected pattern of correlation between ICF chapters and self-report measures suggests the need for a better way of quantitatively representing the ICF concepts.

The 12-item World Health Organization Disability Assessment Schedule II (WHO-DAS II): a nonparametric item response analysis

BACKGROUND

Previous studies have analyzed the psychometric properties of the World Health Organization Disability Assessment Schedule II (WHO-DAS II) using classical omnibus measures of scale quality. These analyses are sample dependent and do not model item responses as a function of the underlying trait level. The main objective of this study was to examine the effectiveness of the WHO-DAS II items and their options in discriminating between changes in the underlying disability level by means of item response analyses. We also explored differential item functioning (DIF) in men and women.

METHODS

The participants were 3615 adult general practice patients from 17 regions of Spain, with a first diagnosed major depressive episode. The 12-item WHO-DAS II was administered by the general practitioners during the consultation. We used a non-parametric item response method (Kernel-Smoothing) implemented with the TestGraf software to examine the effectiveness of each item (item characteristic curves) and their options (option characteristic curves) in discriminating between changes in the underliying disability level. We examined composite DIF to know whether women had a higher probability than men of endorsing each item.

RESULTS

Item response analyses indicated that the twelve items forming the WHO-DAS II perform very well. All items were determined to provide good discrimination across varying standardized levels of the trait. The items also had option characteristic curves that showed good discrimination, given that each increasing option became more likely than the previous as a function of increasing trait level. No gender-related DIF was found on any of the items.

CONCLUSIONS

All WHO-DAS II items were very good at assessing overall disability. Our results supported the appropriateness of the weights assigned to response option categories and showed an absence of gender differences in item functioning.

Developing the World Health Organization Disability Assessment Schedule 2.0

OBJECTIVE

To describe the development of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for measuring functioning and disability in accordance with the International Classification of Functioning, Disability and Health. WHODAS 2.0 is a standard metric for ensuring scientific comparability across different populations.

METHODS

A series of studies was carried out globally. Over 65,000 respondents drawn from the general population and from specific patient populations were interviewed by trained interviewers who applied the WHODAS 2.0 (with 36 items in its full version and 12 items in a shortened version).

FINDINGS

The WHODAS 2.0 was found to have high internal consistency (Cronbach's alpha, α: 0.86), a stable factor structure; high test-retest reliability (intraclass correlation coefficient: 0.98); good concurrent validity in patient classification when compared with other recognized disability measurement instruments; conformity to Rasch scaling properties across populations, and good responsiveness (i.e. sensitivity to change). Effect sizes ranged from 0.44 to 1.38 for different health interventions targeting various health conditions.

CONCLUSION

The WHODAS 2.0 meets the need for a robust instrument that can be easily administered to measure the impact of health conditions, monitor the effectiveness of interventions and estimate the burden of both mental and physical disorders across different populations.

Validation of the "World Health Organization Disability Assessment Schedule, WHODAS-2" in patients with chronic diseases

BACKGROUND

The WHODAS-2 is a disability assessment instrument based on the conceptual framework of the International Classification of Functioning, Disability, and Health (ICF). It provides a global measure of disability and 7 domain-specific scores. The aim of this study was to assess WHODAS-2 conceptual model and metric properties in a set of chronic and prevalent clinical conditions accounting for a wide scope of disability in Europe.

METHODS

1,119 patients with one of 13 chronic conditions were recruited in 7 European centres. Participants were clinically evaluated and administered the WHODAS-2 and the SF-36 at baseline, 6 weeks and 3 months of follow-up. The latent structure was explored and confirmed by factor analysis (FA). Reliability was assessed in terms of internal consistency (Cronbach's alpha) and reproducibility (intra-class correlation coefficients, ICC). Construct validity was evaluated by correlating the WHODAS-2 and SF-36 domains, and comparing known groups based on the clinical-severity and work status. Effect size (ES) coefficient was used to assess responsiveness. To assess reproducibility and responsiveness, subsamples of stable (at 6 weeks) and improved (after 3 moths) patients were defined, respectively, according to changes in their clinical-severity.

RESULTS

The satisfactory FA goodness of fit indexes confirmed a second order factor structure with 7 dimensions, and a global score for the WHODAS-2. Cronbach's alpha ranged from 0.77 (self care) to 0.98 (life activities: work or school), and the ICC was lower, but achieved the recommended standard of 0.7 for four domains. Correlations between global WHODAS-2 score and the different domains of the SF-36 ranged from -0.29 to -0.65. Most of the WHODAS-2 scores showed statistically significant differences among clinical-severity groups for all pathologies, and between working patients and those not working due to ill health (p < 0.001). Among the subsample of patients who had improved, responsiveness coefficients were small to moderate (ES = 0.3-0.7), but higher than those of the SF-36.

CONCLUSIONS

The latent structure originally designed by WHODAS-2 developers has been confirmed for the first time, and it has shown good metric properties in clinic and rehabilitation samples. Therefore, considerable support is provided to the WHODAS-2 utilization as an international instrument to measure disability based on the ICF model.

Measuring disability across cultures--the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries. The 10/66 Dementia Research Group population-based survey

We evaluated the psychometric properties of the 12-item interviewer-administered screener version of the World Health Organization Disability Assessment Schedule-version II (WHODAS II) among older people living in seven low- and middle-income countries. Principal component analysis (PCA), confirmatory factor analysis (CFA) and Mokken analyses were carried out to test for unidimensionality, hierarchical structure, and measurement invariance across 10/66 Dementia Research Group sites. PCA generated a one-factor solution in most sites. In CFA, the two-factor solution generated in Dominican Republic fitted better for all sites other than rural China. The two factors were not easily interpretable, and may have been an artefact of differing item difficulties. Strong internal consistency and high factor loadings for the one-factor solution supported unidimensionality. Furthermore, the WHODAS II was found to be a 'strong' Mokken scale. Measurement invariance was supported by the similarity of factor loadings across sites, and by the high between-site correlations in item difficulties. The Mokken results strongly support that the WHODAS II 12-item screener is a unidimensional and hierarchical scale confirming to item response theory (IRT) principles, at least at the monotone homogeneity model level. More work is needed to assess the generalizability of our findings to different populations.