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RehabMeasures Instrument

World Health Organization Disability Assessment Schedule 2.0

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Purpose

A generic instrument that measures health and disability in six life domains across cultures using a standardized method.

Link to Instrument

Acronym WHODAS 2.0

Area of Assessment

Cognition
Functional Mobility
Life Participation
Activities of Daily Living
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • The WHODAS 2.0 has 3 versions: 36-item, 12-item and 12+24 item.
  • All items relate to individual’s difficulties in functioning within past 30 days.
  • Assesses day to day functioning in the following six domains:
    1) Cognition
    2) Mobility
    3) Self-care
    4) Getting along with others
    5) Life Activities
    6) Participation
  • Sum scores for overall functioning are converted to into a metric ranging from 0-100:
    A) Maximum Score: 100 = full disability
    B) Minimum Score: 0 = no disability
  • Results provide domain specific scores as well as an overall disability score.
  • Items can be scored two different ways, simple scoring and complex scoring:
    A) In simple scoring, the scores assigned to each of the items are summed. The following scores are assigned to each item: “none” (0), “mild” (1) “moderate” (2), “severe” (3) and “extreme” (4)*. Simple scoring is practical to use as a hand-scoring approach (busy clinical settings or in paper–pencil interview).
    B) In complex scoring, there is weighting of individual items dependent on severity. Complex scoring can be done using a computer program available on the WHO website.
  • Due to feedback from practitioners, scoring system updated to scale of 0-4, original scale of 1-5 is outdated but listed in current manual (WHO, 2017).

Number of Items

36

Equipment Required

  • Copy of questionnaire
  • Pen/Pencil

Time to Administer

20 minutes

5 to 20 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed in 2018 by University of Illinois at Chicago Master of Science in Occupational Therapy students Michelle Dominguez, OTS; Claudia Sanchez-Ayala, OTS; Vivian Villegas, OTS.

ICF Domain

Participation
Activity

Measurement Domain

Activities of Daily Living
Cognition
Emotion
General Health
Motor

Considerations

  • Interviewer, proxy, and self-administered versions available.

  • WHODAS 2.0 does not assess environmental factors enabling/inhibiting activity and participation.

Arthritis

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Normative Data

Rheumatoid Arthritis: (Meesters et al., 2009; n = 85; mean age = 61.0 years; mean duration of RA = 6.0 years; female = 77%; scores after inpatient and day-patient therapy by trained multidisciplinary team; Netherlands sample)

  • Median score at baseline: 40.5

  • Median score at 6 weeks after discharge: 4.6

Internal Consistency

Rheumatoid Arthritis: (Meesters et al., 2009)

  • Excellent internal consistency (Cronbach’s alpha = 0.91)

Construct Validity

Convergent validity:

Rheumatoid Arthritis: (Meesters et al., 2009)

  • Adequate: HAQ, stair test, grip strength, D-AIMS2, DAS-28, VAS-Pain, and RAQoL (Pearson rank correlation coefficients = 0.50, 0.39, 0.29, 0.53, 0.28, 0.42, 0.52)

  • Poor: 50-feet walk test, timed-stands test, and Escola Paulista de Medicina Range of Motion scale (Pearson rank correlation coefficients = 0.22, 0.20, 0.19)

Floor/Ceiling Effects

Rheumatoid Arthritis: (Meesters et al., 2009)

  • Adequate floor effect of 17% for subscale “understanding and communicating”

  • Adequate floor effect of 18% for subscale “getting along with people”

  • Adequate floor effect of 14% for subscale “self-care”

 

Responsiveness

Rheumatoid Arthritis: (Meesters et al., 2009)

  • High: “getting around” and “participation in society” (RR = 0.84, 0.80)

  • Moderate: WHODAS 2.0 total score, “understanding and communicating”, “self-care”, “life activities” (RR = 0.58, 0.56, 0.58, 0.48)

  • Low: “getting along with people” (RR = 0.04)

Non-Specific Patient Population

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Test/Retest Reliability

Schizophrenia: (Guilera et al., 2012; n = 352; mean age = 36.7; mean average duration of illness = 140.65 months; diagnoses include schizophrenia, schizoaffective disorder and schizophreniform disorder; Spanish sample)

  • Excellent test-retest reliability: (ICC = 0.92). Subscale range = 0.63-0.88

Interrater/Intrarater Reliability

Trauma: (Abedzadeh-kalahroudi, 2015; n = 220; mean age = 34.7; mean time post trauma = at least 24 hours; mean GCS score = 12.7; Persian)

  • Excellent interrater reliability: (ICC = 0.99)

 

Internal Consistency

Trauma: (Abedzadeh-kalahroudi, 2015)

  • Acceptable to Excellent: Cronbach’s alpha = 0.51-0.87 (only 3/12 items had an alpha value < 0.68)

Schizophrenia (Guilera et al., 2012)

  • Excellent: Cronbach’s alpha = 0.94)

Normative Sample: (Haley et al., 1992; n = 412)

  • Excellent: Cronbach's alpha range from 0.95-0.99

 

Criterion Validity (Predictive/Concurrent)

Schizophrenia (Guilera et al., 2012)

  • Low/Moderate to High correlation with the Positive and Negative Syndrome Scale (PANSS-G) and the Hamilton Depression Rating Scale (HAM-D)

Construct Validity

Trauma: (Abedzadeh-kalahroudi et al., 2015)

  • Items representing the activity domain have a very strong mean Spearman’s rank coefficient (rho = .81). The range for these items is 0.67 - 0.93)

  • Items representing the participation domain have a strong mean Spearman’s rank coefficient (rho = .76). The range for these items is 0.50 - 0.92)

Content Validity

Schizophrenia (Guilera et al., 2012)

  • All indicators are relevant for defining the corresponding domains (cognition, mobility, self-care, getting along, life activities and participation).

Floor/Ceiling Effects

Schizophrenia (Guilera et al., 2012).

  • Strong floor effects

  • Strong ceiling effects, with more than 60% of participants obtaining the best score on sub scales of “getting around” and “self-care”

Spinal Injuries

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Internal Consistency

Spinal Cord Injury: (De Wolf et al., 2012; n = 63; mean age = 34.7 years; studied at 2 years post discharge from inpatient unit; male = 81%; ASIA Impairment Scale: A = 59%, B = 6%, C = 6%, D = 29%; Australian sample)

  • Excellent internal consistency for WHODAS 2.0 Total Score (Cronbach’s alpha = 0.95)

  • Excellent internal consistency for following domains: “understanding and communicating”, “self-care”, “life activities”, and “participation” (Cronbach’s alpha = 0.93, 0.94, 0.96, 0.97)

  • Adequate internal consistency for “getting along with others” domain (Cronbach’s alpha = 0.73)

  • Poor internal consistency for “getting around” domain (Cronbach’s alpha = 0.61)

Construct Validity

Discriminant validity:

Spinal Cord Injury: (De Wolf et al., 2012)

  • Excellent discriminant validity for WHODAS 2.0 Total Score (Mann-Whitney U = 2.02)

  • Excellent discriminant validity for following domains: “getting around”, “self-care”, and “life activities” (Mann-Whitney U = 2.79, 4.90, 1.89)

Floor/Ceiling Effects

Spinal Cord Injury: (De Wolf et al., 2012)

  • Adequate ceiling effect of following domains: “getting along with others” and “life activities” (Ceiling Effects % = 19, 16)

  • Poor ceiling effect of following domains: “understanding and communicating” and “self-care” (Ceiling Effects % = 54, 29)

Stroke

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Interrater/Intrarater Reliability

Stroke: (Schlote et al., 2008, n = 84; mean age = 56; diagnoses include: ischemic and hemorrhagic strokes)

  • Satisfactory to Excellent Interrater Reliability (ICC= 0.64*-0.94)

*Understanding and Communication and Total Score

 

Internal Consistency

Stroke: (Kü?ükdeveci et al., 2013; n = 188; mean age = 61; time since stroke: min = 3 months, median = 27 months, and max = 240 months)

  • Excellent: Cronbach's Alpha = 0.90- 0.93

Stroke: (Schlote et al., 2008)

  • Good to Excellent: Cronbach's Αlpha = 0.81-0.99

Construct Validity

Stroke: (Schlote et al., 2008)

 

  • Items representing the different domains of the assessment have varying Spearman’s Rank coefficients ranging from low to strong: (0.31-0.83)

  • Low to moderate correlation with ratings for understanding and communicating (rho = 0.44-0.56).

  • Moderate to strong correlation with rating for getting around (rho = 0.60-0.75).

  • Moderate to strong correlations with rating for self-care (rho = 0.62-0.83)

  • Moderate correlation with ratings for getting along with people (rho = 0.43-0.58).

  • Moderate to strong correlation with ratings for life activities (rho = 0.64-0.78).

  • Low to moderate correlation with ratings for participation in society (rho = 0.31-0.59).

  • Moderate correlation with ratings for single items (rho = 0.49-0.58)

 

Bibliography

Abedzadeh–kalahroudi, M., Razi, E., Sehat, M., & Asadi-Lari, M. (2016). Psychometric properties of the World Health Organization Disability Assessment Schedule II-12 Item (WHODAS II) in trauma patients. Injury, 47(5), 1104-1108.

De Wolf, A. C., Tate, R. L., Lannin, N. A., Middleton, J., Lane-Brown, A., & Cameron, I. D. (2012). The World Health Organization Disability Assessment Scale, WHODAS II: Reliability and validity in the measurement of activity and participation in a spinal cord injury population. Journal of Rehabilitation Medicine, 44(9), 747-755.

Guilera, G., Gómez-Benito, J., Pino, O., Rojo, J. E., Cuesta, M. J., Martínez-Arán, A., ... & Crespo-Facorro, B. (2012). Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138(2), 240-247.

Kü?ükdeveci, A. A., Kutlay, ?., Y?ld?zlar, D., ?ztuna, D., Elhan, A. H., & Tennant, A. (2013). The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke. Disability and Rehabilitation, 35(3), 214-220.

Meesters, J. J., Verhoef, J., Liem, I. S., Putter, H., & Vliet Vlieland, T. P. (2009). Validity and responsiveness of the World Health Organization Disability Assessment Schedule II to assess disability in rheumatoid arthritis patients. Rheumatology, 49(2), 326-333.

Schlote, A., Richter, M., Wunderlich, M. T., Poppendick, U., M?ller, C., Schwelm, K., & Wallesch, C. W. (2009). WHODAS II with people after stroke and their relatives. Disability and Rehabilitation, 31(11), 855-864.

World Health Organization. (2017, September 4). WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Retrieved from

World Health Organization. (2010). Measuring health and disability. Manual for WHO disability assessment scale. Whodas 2.0. [assessment manual]. Retrieved from