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

Olatz Garin, Jose Luis Ayuso-Mateos, Josué Almansa, Marta Nieto, Somnath Chatterji, Gemma Vilagut, Jordi Alonso, Alarcos Cieza, Olga Svetskova, Helena Burger, Vittorio Racca, Carlo Francescutti, Eduard Vieta, Nenad Kostanjsek, Alberto Raggi, Matilde Leonardi, Montse Ferrer, MHADIE consortium, Matilde Leonardi, Alberto Raggi, Jerome Bickenbach, Somnath Chatterji, Nenad Kostanjsek, Bedirhan T Ustun, Mary Baker, Alistair Newton, Olga Svestkova, Carlo Francescutti, Vladimir Kosic, Mariagrazia Franco, Marina Matucci, Vittorio Racca, Daniele Pellegatta, Giorgio Gandolini, Giovanni Rainero, Carla Finocchiaro, Anne Good, Jose Luis Ayuso-Mateos, Marta Nieto, Maria Cabello, Patricia Gimeno Blanco, Olatz Garin, Josué Almansa, Gemma Vilagut, Jordi Alonso, Montse Ferrer, Ester Villalonga Olives, Jose Maria Valderas, Alarcos Cieza, Gerold Stucki, Monika Bullinger, Michael Erhart, Silviu Didilescu, Adrian Mindroiu, Helena Burger, Crt Marincek, Eva Bjorck-Akesson, Mats Grandlund, Rune Simeonsson, Judith Hollenweger, Kai Felkendorff, Walter Kern, Peter Diezi-Duplain, Ulrike Ravens-Sieberer, Thorsten Afflerbach, Lucian Agafitei, Peter Evans, Giampiero Griffo, André Gubbels, Alessandro Solipaca, Ferdinando Cornelio, Adriano Pessina, Johnathan Witztum, Olatz Garin, Jose Luis Ayuso-Mateos, Josué Almansa, Marta Nieto, Somnath Chatterji, Gemma Vilagut, Jordi Alonso, Alarcos Cieza, Olga Svetskova, Helena Burger, Vittorio Racca, Carlo Francescutti, Eduard Vieta, Nenad Kostanjsek, Alberto Raggi, Matilde Leonardi, Montse Ferrer, MHADIE consortium, Matilde Leonardi, Alberto Raggi, Jerome Bickenbach, Somnath Chatterji, Nenad Kostanjsek, Bedirhan T Ustun, Mary Baker, Alistair Newton, Olga Svestkova, Carlo Francescutti, Vladimir Kosic, Mariagrazia Franco, Marina Matucci, Vittorio Racca, Daniele Pellegatta, Giorgio Gandolini, Giovanni Rainero, Carla Finocchiaro, Anne Good, Jose Luis Ayuso-Mateos, Marta Nieto, Maria Cabello, Patricia Gimeno Blanco, Olatz Garin, Josué Almansa, Gemma Vilagut, Jordi Alonso, Montse Ferrer, Ester Villalonga Olives, Jose Maria Valderas, Alarcos Cieza, Gerold Stucki, Monika Bullinger, Michael Erhart, Silviu Didilescu, Adrian Mindroiu, Helena Burger, Crt Marincek, Eva Bjorck-Akesson, Mats Grandlund, Rune Simeonsson, Judith Hollenweger, Kai Felkendorff, Walter Kern, Peter Diezi-Duplain, Ulrike Ravens-Sieberer, Thorsten Afflerbach, Lucian Agafitei, Peter Evans, Giampiero Griffo, André Gubbels, Alessandro Solipaca, Ferdinando Cornelio, Adriano Pessina, Johnathan Witztum

Abstract

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.

Figures

Figure 1
Figure 1
WHODAS-2 global score for each severity group by pathology. *no statistical significant difference. Mean and 95% confidence interval is shown. Effect Size (ES) coefficient among extreme groups.
Figure 2
Figure 2
WHODAS-2 scores for patients working (dots) and not working-sick leave (striped). Mean and 95% confidence interval is shown. Effect Size (ES) coefficient between working and not working-sick leave patients.
Figure 3
Figure 3
Mean chage of the WHODAS-2 scores and the SF-36 component summaries, after 3 months. Mean change and 95% confidence interval is shown. Effect Size (ES) responsiveness coefficient.

References

    1. MacDonalda Rhona, Mullana Zoë, Hortona Richard, Groceb Nora, Shakespearec Tom, Officerc Alana, Saxena Shekhar. Bringing disability off the sidelines: a call for papers. 2009. pp. 1065–1066.
    1. Mont D. Measuring health and disability. Lancet. 2007;369:1658–1663. doi: 10.1016/S0140-6736(07)60752-1.
    1. Bickenbach JE, Chatterji S, Badley EM, Ustun TB. Models of disablement, universalism and the international classification of impairments, disabilities and handicaps. Soc Sci Med. 1999;48:1173–1187. doi: 10.1016/S0277-9536(98)00441-9.
    1. Chatterji S, Ustun B, Bickenbach JE. What is disability after all? Disabil Rehabil. 1999;21:396–398. doi: 10.1080/096382899297549.
    1. Grimby G, Smedby B. ICF approved as the successor of ICIDH. J Rehabil Med. 2001;33:193–194. doi: 10.1080/165019701750419545.
    1. World Health Organization (WHO) International Classification of Functioning, Disability and Health: ICF. Geneva: WHO Library Cataloguing-in-Publication Data; 2001.
    1. Leonardi M, Bickenbach J, Ustun TB, Kostanjsek N, Chatterji S. The definition of disability: what is in a name? Lancet. 2006;368:1219–1221. doi: 10.1016/S0140-6736(06)69498-1.
    1. World Health Organization Disability Assessment Schedule II (WHODAS II) 2001. assessed on July 6, 2009.
    1. Cieza A, Stucki G. Understanding functioning, disability, and health in rheumatoid arthritis: the basis for rehabilitation care. Curr Opin Rheumatol. 2005;17:183–189. doi: 10.1097/01.bor.0000151405.56769.e4.
    1. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the afed. The Index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963;185:914–919.
    1. Pollard B, Johnston M. Problems with the sickness impact profile: a theoretically based analysis and a proposal for a new method of implementation and scoring. Soc Sci Med. 2001;52:921–934. doi: 10.1016/S0277-9536(00)00194-5.
    1. Jette AM, Davies AR, Cleary PD, Calkins DR, Rubenstein LV, Fink A, Kosecoff J, Young RT, Brook RH, Delbanco TL. The Functional Status Questionnaire: reliability and validity when used in primary care. J Gen Intern Med. 1986;1:143–149. doi: 10.1007/BF02602324.
    1. Jette AM, Haley SM, Coster WJ, Kooyoomjian JT, Levenson S, Heeren T, Ashba J. Late life function and disability instrument: I. Development and evaluation of the disability component. J Gerontol A Biol Sci Med Sci. 2002;57:M209–M216.
    1. Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol. 1991;16:39–58. doi: 10.1093/jpepsy/16.1.39.
    1. Baron M, Schieir O, Hudson M, Steele R, Kolahi S, Berkson L, Couture F, Fitzcharles MA, Gagne M, Garfield B, Gutkowski A, Kang H, Kapusta M, Ligier S, Mathieu JP, Menard H, Starr M, Stein M, Zummer M. The clinimetric properties of the World Health Organization Disability Assessment Schedule II in early inflammatory arthritis. Arthritis Rheum. 2008;59:382–390. doi: 10.1002/art.23314.
    1. Hudson M, Steele R, Taillefer S, Baron M. Quality of life in systemic sclerosis: psychometric properties of the World Health Organization Disability Assessment Schedule II. Arthritis Rheum. 2008;59:270–278. doi: 10.1002/art.23343.
    1. Chopra PK, Couper JW, Herrman H. The assessment of patients with long-term psychotic disorders: application of the WHO Disability Assessment Schedule II. Aust N Z J Psychiatry. 2004;38:753–759.
    1. Chisolm TH, Abrams HB, McArdle R, Wilson RH, Doyle PJ. The WHO-DAS II: psychometric properties in the measurement of functional health status in adults with acquired hearing loss. Trends Amplif. 2005;9:111–126. doi: 10.1177/108471380500900303.
    1. Schlote A, Richter M, Wunderlich MT, Poppendick U, Moller C, Wallesch CW. Use of the WHODAS II with stroke patients and their relatives: reliability and inter-rater-reliability. Rehabilitation (Stuttg) 2008;47:31–38.
    1. van Tubergen A, Landewe R, Heuft-Dorenbosch L, Spoorenberg A, van der HD, van der TH, van der LS. Assessment of disability with the World Health Organisation Disability Assessment Schedule II in patients with ankylosing spondylitis. Ann Rheum Dis. 2003;62:140–145. doi: 10.1136/ard.62.2.140.
    1. Chwastiak LA, Von Korff M. Disability in depression and back pain: evaluation of the World Health Organization Disability Assessment Schedule (WHO DAS II) in a primary care setting. J Clin Epidemiol. 2003;56:507–514. doi: 10.1016/S0895-4356(03)00051-9.
    1. McKibbin C, Patterson TL, Jeste DV. Assessing disability in older patients with schizophrenia: results from the WHODAS-II. J Nerv Ment Dis. 2004;192:405–413. doi: 10.1097/01.nmd.0000130133.32276.83.
    1. Posl M, Cieza A, Stucki G. Psychometric properties of the WHODASII in rehabilitation patients. Qual Life Res. 2007;16:1521–1531. doi: 10.1007/s11136-007-9259-4.
    1. Federici S, Meloni F, Mancini A, Lauriola M, Olivetti BM. World Health Organisation Disability Assessment Schedule II: contribution to the Italian validation. Disabil Rehabil. 2009;31:553–564. doi: 10.1080/09638280802240498.
    1. Buist-Bouwman MA, Ormel J, De Graaf R, Vilagut G, Alonso J, Van Sonderen E, Vollebergh WA. Psychometric properties of the World Health Organization Disability Assessment Schedule used in the European Study of the Epidemiology of Mental Disorders. Int J Methods Psychiatr Res. 2008;17:185–197. doi: 10.1002/mpr.261.
    1. Von Korff M, Crane PK, Alonso J, Vilagut G, Angermeyer MC, Bruffaerts R, de Girolamo G, Gureje O, De Graaf R, Huang Y, Iwata N, Karam EG, Kovess V, Lara C, Levinson D, Posada-Villa J, Scott KM, Ormel J. Modified WHODAS-II provides valid measure of global disability but filter items increased skewness. J Clin Epidemiol. 2008;61:1132–1143. doi: 10.1016/j.jclinepi.2007.12.009.
    1. Leonardi M. Definition of disability: the UN Convention and ICF. 2006.
    1. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483. doi: 10.1097/00005650-199206000-00002.
    1. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263. doi: 10.1097/00005650-199303000-00006.
    1. Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33:AS264–AS279. doi: 10.1097/00005650-199501001-00005.
    1. Ware JE, Kosinski M, Dewey JE. How to Score. Version 2 of the SF-36 Health Survey (Standard & Acute Forms) Lincoln RI: Quality Metric Incorporated; 2000.
    1. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429–435. doi: 10.1192/bjp.133.5.429.
    1. HAMILTON M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Andrews G, Slade T. The classification of anxiety disorders in ICD-10 and DSM-IV: a concordance analysis. Psychopathology. 2002;35:100–106. doi: 10.1159/000065127.
    1. Hochberg MC, Chang RW, Dwosh I, Lindsey S, Pincus T, Wolfe F. The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum. 1992;35:498–502. doi: 10.1002/art.1780350502.
    1. Rossi G. Nomenclature and diagnostic criteria in cardiology set by the New York Heart Association. Considerations on the 6th edition. Cuore Circ. 1967;51:287–293.
    1. Stewart WF, Lipton RB, Kolodner K, Liberman J, Sawyer J. Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia. 1999;19:107–114. doi: 10.1046/j.1468-2982.1999.019002107.x.
    1. Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. 1967. Neurology. 1998;50:318.
    1. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurology. 1983;33:1444–1452.
    1. Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987;1:6–18.
    1. Stevens JP. Applied Multivariate Statistics for the Social Sciences. Third. Mahwah, New Jersey: Lawrence Erlbaum Associates (Applied Multivariate STATS); 2001.
    1. Flora DB, Curran PJ. An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychol Methods. 2004;9:466–491. doi: 10.1037/1082-989X.9.4.466.
    1. Browne MW. An Overview of Analytic Rotation in Exploratory Factor Analysis. Multivariate Behav Res. 2001;36:111–150. doi: 10.1207/S15327906MBR3601_05.
    1. Chen FF, West SG, Sousa KH. A Comparison of Bifactor and Second-Order Models of Quality of Life. Multivariate Behav Res. 2006;41:189–225. doi: 10.1207/s15327906mbr4102_5.
    1. Muthen BO. (1998-2004). Mplus Technical Appendices. Los Angeles, CA: Muthén & Muthén; 2004.
    1. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334. doi: 10.1007/BF02310555.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.
    1. CAMPBELL DT, FISKE DW. Convergent and discriminant validation by the multitrait-multimethod matrix. Psychol Bull. 1959;56:81–105. doi: 10.1037/h0046016.
    1. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27:S178–S189. doi: 10.1097/00005650-198903001-00015.
    1. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: Lawrence Elrbaum Associates; 1988.
    1. Scientific Advisory Committee of the Medical Outcomes Trust. Assessing health status and quality-of- life instruments: attributes and review criteria. Qual Life Res. 2002;11:193–205. doi: 10.1023/A:1015291021312.
    1. Beaton DE, Hogg-Johnson S, Bombardier C. Evaluating changes in health status: reliability and responsiveness of five generic health status measures in workers with musculoskeletal disorders. J Clin Epidemiol. 1997;50:79–93. doi: 10.1016/S0895-4356(96)00296-X.
    1. Petersen MA, Groenvold M, Bjorner JB, Aaronson N, Conroy T, Cull A, Fayers P, Hjermstad M, Sprangers M, Sullivan M. Use of differential item functioning analysis to assess the equivalence of translations of a questionnaire. Qual Life Res. 2003;12:373–385. doi: 10.1023/A:1023488915557.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться