assessing disability – world health organization disability assessment
DESCRIPTION
disability assessment, WHO DAS 2.0, occupational therapy, occupational health, damages, personal injury, medical compensationTRANSCRIPT
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Assessing Disability – World Health Organization Disability Assessment Schedule II
(WHODAS II)
Mr Vaikunthan Rajaratnam MBBS(Mal),AM(Mal),FRCS(Ed),FRCS(Glasg),FICS(USA),MBA(USA),
Dip Hand Surgery(Eur),PG CertMedEd(Dundee),FHEA(UK),AFFST(Ed),FAcadMEd(UK).
Senior Consultant Hand SurgeonAlexandra Health, SINGAPORE
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Disability and Damage
Injury/Illness Treatment Intervention Outcome
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43 year-old female, right-handed, cook
Traumatic amputation of right thumb and index finger
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Unreplantable thumb
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Underwent right thumb reconstruction with right big toe osteoplastic wrap-around flap 1 week post-injury, after counseling and consenting
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Toe wrap based on dorsalis pedis
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Defining•
Impairment: any loss or abnormality of psychological, physiological or anatomical structure or function.
•Disability: any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
•Handicap: a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal
•As traditionally used, impairment refers to a problem with a structure or organ of the body; disability is a functional limitation with regard to a particular activity; and handicap refers to a disadvantage in filling a role in life relative to a peer group.
World Health Organization (1980) in The International Classification of Impairments, Disabilities, and Handicaps:
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International Classification of Functioning, Disability and Health (ICF)
• classified from body, individual and societal perspectives
• measuring health and disability at both individual and population levels
• shifting the focus from cause to impact• the social aspects of disability
– http://apps.who.int/classifications/icfbrowser/
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Psychometrics
construction and validation of measurement instruments such as questionnaires, tests, and
personality assessments
Katies , tahils and pikul
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Classical test theory• reliability and validity.
– Pearson correlation coefficient, and is often called test-retest reliability.
– index of reliability is Cronbach's α
• concurrent validity; predictive validity, construct validity, Content validity
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WHODAS II
• ISBN 978 92 4 154759 8 • (NLM classification: W 15)• © World Health Organization 2010• http://p.ideaday.de/104.2/icf/en/index.html
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WHODAS II
• generic assessment instrument• standardized method for measuring health
and disability• developed from a comprehensive set of
International Classification of Functioning, Disability and Health (ICF)
• Cross cultural applicability, utility, reliability and validity
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Why is disability assessment important?
• “there are no diseases, but patients”
• There are no disabilities but people with problems that affect their lives
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Why develop a method to assess disability?
• “a decrement in each functioning domain”– Body, person and society
• International Classification of Functioning, Disability and Health (ICF) – impractical for daily use
• WHODAS 2.0 – practical, reliable and valid
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Why learn and use a disability measure?
• patient’s needs• level of care• outcome of the condition• length of hospitalization• receipt of disability benefits• work performance• social integration
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Disability assessment
• identifying needs• matching
treatments and interventions
• measuring outcomes and effectiveness
• setting priorities• allocating resources.
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Why use WHODAS 2.0?
• sound theoretical underpinnings• good psychometric properties• numerous applications• direct link to the ICF• Cross-cultural comparability• Ease of use and availability
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WHODAS 2.0practical, generic assessment instrument measuring health and disability
• 1: Cognition – understanding and communicating• 2: Mobility – moving and getting around• 3: Self-care – attending to one’s hygiene, dressing, eating and staying alone• 4: Getting along – interacting with other people• 5: Life activities – domestic responsibilities, leisure, work and school• 6: Participation – joining in community activities, participating in society.
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WHODA II contd
• common metric• generic measure• possible to design and monitor interventions• etiologically neutral• focus directly on functioning and disability• full version has 36 and the short version 12
questions
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Bio psychosocial model of ICF
• disability is multidimensional• interaction between attributes of an individual
and features of the person’s physical, social and attitudinal environment
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WHODAS and WHOQOL
• WHODAS 2.0 measures functioning (i.e. an objective performance in a given life domain), while WHOQOL measures subjective well-being (i.e. a feeling of satisfaction about one’s performance in a given life domain).
• Does vs Feel
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36-item version
• interviewer-administered, self-administered and proxy-administered
• most detailed• 20 minutes.
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12-item version
• brief assessments of overall functioning• interviewer-administered, self administered
and proxy-administered.• explains 81% of the variance of the 36-item
version• five minutes.
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12+24-item version
• hybrid of the 12-item and 36-item versions• Based on positive responses to the initial 12
items, respondents may be given up to 24 additional questions
• administered by interview or computer-adaptive testing (CAT).
• 20 minutes.
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Psychometric properties
• Test–retest reliability and internal consistency - Cronbach’s alpha levels 0.98
• Most questions fitted in their assigned domains, confirming the unidimensionality of domains
• summary change scores were unaffected by sociodemographic factors
• Face , construct and concurrent validity
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Practical aspects of administering and scoring
• Privacy• • frame 1 – degree of difficulty• • frame 2 – due to health conditions• • frame 3 – in the past 30 days• • frame 4 – averaging good and bad days• • frame 5 – as the respondent usually does the
activity• • frame 6 – items not experienced in the past 30
days are not rated.
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Frame of reference 1 – degree of difficulty
• • increased effort• • discomfort or pain• • slowness• • changes in the way the person does the
activity.
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Frame of reference 2 – due to health conditions
• diseases, illnesses or other health problems• • injuries• • mental or emotional problems• • problems with alcohol• • problems with drugs.
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Scoring
• “none” (1), • “mild” (2) • “moderate” (3), • “severe”(4) and • “extreme” (5)
Simple vs complex scoring
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• Questions A1–A5: Demographic and background information1: Cognition – understanding and communicating• 2: Mobility – moving and getting around• 3: Self-care – attending to one’s hygiene, dressing, eating and staying alone• 4: Getting along – interacting with other people• 5: Life activities – domestic responsibilities, leisure, work and school• 6: Participation – joining in community activities, participating in society.• Questions F1–F5: Face sheet
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THANK YOU