A 14-month study of change in disability and mood state in patients with chronic migraine associated to medication overuse

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.

Burden of migraine: what should we say more?

Several international campaigns to increase awareness on the high burden of migraine stimulated population-based studies in the last few years that provided broader data on prevalence, correlates, and impact of migraine. The last version of the Global Burden of Disease 2010 posed migraine with a twofold increase with respect to the previous version as one of the first disabling diseases. Migraine, and in general headache disorders are among the top ten causes of disability because they are common and disabling: that is now clear. It is also clear that the descriptive epidemiology of migraine has reached its maturity. The prevalence rates and sociodemographic correlates have been stable across 50 years. Last but not least, despite international efforts an illness that can be relieved does not, and the heavy burden that it poses at individual and societal levels, persists when it could be mitigated. Describing and accounting the burden of migraine worldwide is not enough anymore, we need to change our paradigm again and move towards new pathways. The opportunity is provided by the biopsychosocial approach that enables to act on the environment once the most adequate medical therapy has been provided. To reduce the burden, international efforts should focus certainly on development of new drugs but mainly on improving health care systems' response to millions of migraine and headache sufferers.