international literature review on whodas ii - life span pdf.6.pdf · the whodas ii has been used...

Abstract

This review is a critical analysis regarding the study and utilization of theWorld Health Organization Disability Assessment Schedule II (WHO-DAS II) as a basis for establishing specific criteria for evaluating relevantinternational scientific literature. The WHODAS II is an instrument devel-oped by the World Health Organisation in order to assess behaviourallimitations and restrictions related to an individual’s participation, inde-pendent from a medical diagnosis. This instrument was developed by theWHO’s Assessment, Classification and Epidemiology Group within theframework of the WHO/NIH Joint Project on Assessment and Classifica-tion of Disablements.To ascertain the international dissemination level of for WHODAS II’sutilization and, at the same time, analyse the studies regarding the psycho-metric validation of the WHODAS II translation and adaptation in otherlanguages and geographical contests. Particularly, our goal is to highlightwhich psychometric features have been investigated, focusing on the fac-torial structure, the reliability, and the validity of this instrument.International literature was researched through the main data bases of in-dexed scientific production: the Cambridge Scientific Abstracts – CSA,PubMed, and Google Scholar, from 1990 through to December 2008. Thefollowing search terms were used: “whodas”, in the field query, plus “title”and “abstract”.

* Received: 19 March 2009, Revised: 8 May 2009, Accepted: 8 May 2009.

© 2009 Associazione Oasi Maria SS. - IRCCS / Città Aperta Edizioni

1 Department of Human and Educational Sciences, University of Perugia, InterdisciplinaryResearch Centre on Disability and Technologies for Autonomy (CIRID) “Sapienza” Univer-sity of Rome, e-mail: [email protected]

2 Ph.D. in Cognitive, Psycho-physiological, and Personality Psychology, InteruniversityCenter for Research on Cognitive Processing in Natural and Artificial System (ECONA) -“Sapienza” University of Rome.

3 Interdisciplinary Research Centre on Disability and Technologies for Autonomy(CIRID) “Sapienza” University of Rome.

83

Life Span and Disability / XII, 1 (2009), 83-110

International Literature Review on WHODAS II (World Health Organization Disability Assessment Schedule II)

Stefano Federici,1 Fabio Meloni,2 & Alessandra Lo Presti1

The WHODAS II has been used in 54 studies, of which 51 articles are pub-lished in international journals, 2 conference abstracts, and one disserta-tion abstract. Nevertheless, only 7 articles are published in journals andconference proceedings regarding disability and rehabilitation. Othershave been published in medical and psychiatric journals, with the aim ofindentifying comorbidity correlations in clinical diagnosis concerning pa-tients with mental illness. Just 8 out of 51 articles have studied the psycho-metric properties of the WHODAS II. The instruments have been trans-lated into 11 languages and administered to a total of 88,844 subjects. Fi-nally, the WHODAS II is prevalently used in the medical field, with majoremphasis in the specialities of psychiatry, general medicine, and rehabili-tation.All studies point out that WHODAS II as an effective and reliable instru-ment in order to assess the disability, individual functioning and partici-pation levels. Furthermore, they often suggest administering the WHO-DAS II along with quality of life measures. Finally, the studies about thepsychometric properties of the instrument agree in considering the WHO-DAS II a reliable and valid tool for disability assessment.

Keywords: WHODAS II, WHO classifications, Biopsychosocial model,Disability classifications

1. Introduction

1.1. The classifications of disability: ICIDH and ICF1.1.1. The ICIDHSince 1948 the World Health Organization (WHO) has been the spe-

cialized agency of the United Nations to review the international nomen-clature of diseases and standardize the methods of diagnosis (WHO, 1948).The success obtained from the edition of International Classification of Dis-ease (ICD) led, in the early 1970s, to the preparation of a classification ofthe consequences of disease. Since 1975 there has been in circulation, as aninternal document of the WHO, a version of the International Classificationof Impairments, Disabilities, and Handicaps (ICIDH). Subsequently, theWHO requested Philip Wood to collect the material produced until thenand transform it into a classification. In 1980 the WHO published the re-sults, the ICIDH, in a book for study and research (World Health Organi-zation (WHO), 1980; cfr. also: Pfeiffer, 1998; Üstün, Bickenbach, Badley, &Chatterji, 1998). The aim of the ICIDH was to clarify some concepts andterminology that were used with reference to disability, to facilitate re-search and policy choices in an area of growing importance. The classifica-tion has been translated into many languages and used to conduct statisti-cal surveys on population, to encode information on the health of people

84

Life Span and Disability Federici S. / Meloni F. / Lo Presti A.

and as a starting point for the implementation of social and welfare policies.The ICIDH has an unquestionable merit: it introduced, from the healthpoint of view, a first-time distinction and definition of terms that, until then,had been used interchangeably, creating considerable confusion amonghealth professionals.

The ICIDH proposes a tripartite distinction between Impairment, Dis-ability and Handicap, defined as follows:

- Impairment: any loss, or abnormality, of psychological, physiological oranatomical structures or functions.

- Disability: any limitation or loss (due to an impairment) of ability toperform an activity or variations in the way considered normal for a humanbeing.

- Handicap: disadvantage experienced by a particular person, the resultof an impairment or a disability that limits or prevents the opportunity tofill the role usually just one person (in relation to age, sex and socio-cultur-al factors).

In the definition of handicap a clear causal relationship is established be-tween handicap and other conditions, i.e. the handicap is always the resultof an impairment or the consequence of a disability. Therefore, the impair-ment, or disability, or both, are necessary so that we can talk about handi-cap; and yet, they are not sufficient, since not all impairments producehandicap. It is essential, according to the ICIDH, that the handicap is livedor experienced as such, that the person is aware of the disproportion be-tween expected performance and that actually given because of the condi-tion of disability.

The ICIDH was designed with the intent to offer a non-medical modelof disability, and this is demonstrated by the substantial lack of aetiologicalfactors. And yet, as the ICIDH declares that among the three levels of im-pairment, disability and handicap there is a relationship that can not be sim-ply linear, literature evaluates the classification as the product of a culturalcontext in which the handicap was considered the product of an impair-ment and/or a disability. While it is acknowledged that the ICIDH is un-doubtedly a tool developed with the goal of utilizing a common and uni-versal language on disability at an international level (Üstün, Bickenbach,et al., 1998; Bickenbach, Chatterji, Badley, & Üstün, 1999; Buono & Zagaria,1999; Üstün, Chatterji, et al., 2001), it has been the focus of great controver-sy, especially animated by the supporters of the social model of disabilitywho considered the Classification too oriented towards the medical model(Chamie, 1995; Pfeiffer, 1998), despite what is claimed by its editors (Bury,2000). In any case, we can only note that each of the three key concepts ofclassification is defined in relation to a concept of normality that it is as-sumed to be related primarily to biomedical categories.

85

International Literature Rewiew on WHODAS II

1.1.2. The ICFIn 2001, the World Health Organization adopted the new International

Classification of Functioning, Disability and Health.The final document col-lects work published over the last decade and which has had as its goal revi-sion of the ICIDH. The nine years dedicated to completing the reviewprocess will certainly give an idea of the complexity of the problems dealtwith and the extent of the criticisms raised by the proposal for a new Classi-fication (Üstün, Bickenbach, et al., 1998; Pfeiffer, 1998; Hurst, 2000; Pfeiffer,2000).As has already been pointed-out, the criticisms about several concep-tual aspects of the ICIDH, which has determined the need for a revision, are:

- The reference to a medical model of disability, which is sequential andcausal, according to which disability (or/and handicap) is regarded as thedirect outcome of an impairment of the individual.

- The application of an approach based on a linear succession consider-ing the handicap as a direct consequence of impairment.

- The presence of a negative terminological bias, as most conditions aredescribed by using a negative terminology.

From an operative viewpoint, the main limitations characterising theICIDH were given by the use of terms which were inadequate with refer-ence to the contemporary scientific context, as well as by the impossibilityto compare data from different contexts (Chatterji et al., 2001; Rehm et al.,2001; Trotter et al., 2001; Üstün, Chatterji et al., 2001).

The linear progressive perspective applied in the old classification isabandoned in the ICF, to implement a circular interactive model in whichfunctioning and disability of a person are considered as the product of thedynamic interaction between health conditions and contextual factors, in-cluding personal and environmental ones.

The structure of this new classification can thus be divided into two“parts”, each one including two “components”: Part 1, “Functioning andDisability”; including the following components: a) body functions andstructures and b) activities and participation; Part 2, “Contextual factors”,including the following components: a) environmental factors and b) per-sonal factors. Each component is formed by several domains, and each do-main is organised in categories at different levels, which represents theunits of classification.

Moreover, in contrast with the ICIDH, the ICF sets a common, “stan-dard” language, which not only allows a common understanding and use byoperators belonging to different professional areas, but is also easily applic-able to remarkably different environmental contexts.

There are two consequences stemming from this approach:- First, the context and the life environment of each individual dramati-

cally influences the level of her/his functioning in presence of a given dis-ability and, given the same impairment, different contexts have very diverseeffects on individual functioning and adaptation.

86


- Secondly, any person during her/his life can experience a changing stateof health which, in a given environment, becomes disabling, i.e. influencingnegatively on the person’s functioning abilities.

The ICF, wanting to describe functional states of each individual andhis/her limitations, proposes a dynamic model of mutual interaction be-tween health conditions and contextual factors.

The presence of an impairment necessarily implies a “cause”, which maynot be sufficient to explain the result of impairment.

Therefore, the disability is the complex and multiderminated outcome ofthree main factors: the health of an individual, the personal and environ-mental factors.The triadic reciprocal causation of factors exceeds the linearetiological prospect which from altered states of health leads to disability.In the new biopsychosocial model, the disability, understood both as a lim-itation of individual abilities as well as restrictions in social participation, iscertainly related to a state of health, conventionally regarded as pathologi-cal, but not necessarily caused by the same condition as in the linear modelof the ICIDH.

The biopsychosocial model provides a perspective on the health conceptthat is not always in line with the medical one. Since different environmentsmay have a very different impact on the same individual with a certainhealth condition, like the ICF notes «two persons with the same diseasemay have different levels of functioning and two persons with the same lev-el of functioning not necessarily have the same condition of health» (ICF, p.12). The interconnections between biological, structural, functional factors,of abilities, social participation, various contexts and personal and psycho-logical dimensions do not allow simple aetiologies, focusing only on thephysiopathological, anatomical and neurological levels.

1.2. Traditional tools for measuring and assessing the disabilit.Specific rating scales for measuring disability can be regarded as the

Barthel Index and FIM (Functional Independence Measure). The first onehas the advantage that it can be administered quickly and without specialtraining; the second one involves slightly longer times of administration andrequires specific training.

The Barthel Index (Mahoney & Barthel, 1965) is an ordinal scale withtotal score from 0 (totally dependent) to 100 (totally independent) andcomprising 10 items. The index shows the level of autonomy in various ac-tivities: feeding, taking a bath, personal hygiene, dressing, rectum and blad-der control, transfers to bathroom or chair/bed, walking and climbing stairs.The performance should be established using the best available data, theusual sources are direct questions to the patient, friends/relatives and nurs-es, but also direct observation and common sense are important. Excellentvalidity and reliability are the strong points of the index that, however, ap-pears to be subject to a “plateau” effect in highlighting the changes in more

87


complex functions. Reflecting a background determined by the culturalprevalence of the medical model, the Barthel index assigns an absolutelyrelevant weight to functions such as continence or mobility and not theleast, also explores self-sufficiency in cognitive areas. Moreover, it is not areal standard, since there are at least 8 different versions published that dif-fer in the number of items and methodology in assignment of scores.

Also the FIM (Keith, Granger, Hamilton, & Sherwin, 1987) measuresself-sufficiency in 18 activities of daily living (like dressing, feeding, loco-motion, etc.) that cumulatively provide a quantitative index of disability.Beyond the advantages of scale, such as the statistical validity, the simplici-ty of implementation and the ability to compare data at the internationallevel, thanks to its wide distribution, the FIM is an instrument that assessesthe level of self-sufficiency of a person from the perspective of an outsideobserver, leaving no space for self-evaluation.

1.3. The assessment of disability according to the biopsychosocial modelThe direct application of the ICF and its codes appeared since the be-

ginning as a rather demanding and complex task: for this reason, the WHOintroduced the ICF Checklist (WHO, 2003), which allows the description ofthe functioning profile of a subject based on 128 codes selected among thethousands forming the whole ICF (in the second level there are already 362codes, that become 1.424 in the third and fourth level) (ivi, p. 3). The ICFchecklist is not really an instrument for measure or assessment: its utilitycomes from the possibility to “open” the codes on the basis of the identifi-cation of a person’s functioning problem, and at the same time to establishwhether, and in which measure, the environment acts either as barrier orconversely facilitates the individual.

The ICF Checklist is administered to the patient or his/her caregiver. Itis structurally divided into four parts: the introductory part, which includesbiographical data, the ICD-10 code, and the specification of informationsource; the first part, containing the list of codes of Body Functions (b) andBody Structures (s); the second part, comprising the list of codes for Activ-ities and Participation (d); and finally, the third part, containing the list ofcodes relating to Environmental Factors (e). In Italy, the translation, vali-dation, and a first application in the research and clinical field were coordi-nated by the Disability Italian Network (DIN) in 2004.

The WHODAS II, however, proposes to evaluate the disability from adifferent viewpoint from that of the normal tools of measurement. In fact,while the ICF Checklist was developed as a practical tool to elicit clinicians’overall impressions of a patient’s condition and to record information onfunctioning and disability, the WHODAS II rates the nature of disability di-rectly from the patient’s responses. Therefore, the ICF Checklist offers anexternal (objective) view on disability while the WHODAS II does an in-ternal (subjective) one.

88


The WHODAS II assesses the limitations in activities and restrictions inparticipation experienced by an individual, independently from a medicaldiagnosis. Specifically, the instrument is designed to evaluate the function-ing of the individual in six activity domains:

1. Understanding and communicating 2. Getting around 3. Self-care 4. Getting along with people 5. Life activities 6. Participation in society There are different forms of the WHODAS II, each of them has been

structured in relation to the number of item (6, 12, 24, 12 + 24 and 36), themode of administration (self-administered or administered by an inter-viewer) and the user to whom the interview is proposed (subject, clinician,caregiver). In any case, the WHO recommends the use of the 36 item formadministered by an interviewer for completeness.

The participants interviewed are asked to indicate the experienced levelof “difficulty” (none, mild, moderate, severe, extreme), by taking into accountthe way in which they normally perform a given activity, and including theuse of whatever support or/and help by a person (aids). For every item re-ceiving a positive answer, the subsequent question asks the number of days(“in the last 30 days”) in which the interviewed has met such a difficulty, interms of a 5-point ordinal scale: 1) Only one day; 2) Up to a week = from 2to 7 days; 3) Up to two weeks = from 8 to 14 days; 4) More than two weeks= from 15 to 29 days; 5) Every day = 30 days.

Then, the person is asked how much the difficulties have interfered withhis/her life.

Respondents should answer the questions according to the followingreferences:

1. Degree of difficulty (the increase in the effort, discomfort or pain, orslowness, or differences in general);

2. Health conditions (disease or illness, or injury, or mental or emotionalproblems, or related to alcohol, or problems associated with drug abuse);

3. The last 30 days;4. The average between “good” and “bad” days;5. The way in which they normally perform the activity.The items that refer to activities not experienced in the last 30 days are

not classified.

2. Purpose and methodology

The general aim of the study presented here is to check the spread of theWHODAS II at international level and in different fields of application

89


Specifically, given the widespread consent universally reached about theusefulness of the WHODAS II, we need to verify its reliability in assessingthe functioning and the self-perception of disability in persons with normalabilities and disabled participants, both through the analysis of some psy-chometric characteristics such as reliability, validity and factorial structure,either through correlational analysis. The bibliographic review, in the nextparagraph, is intended to provide an overview, as complete as possible, ofscientific studies that have been made using the WHODAS II, since its pub-lication until now. In most of these studies, moreover, the WHODAS II wasused in combination with other assessment tools: this has allowed us to ver-ify its convergent validity, and its compatibility and complementarities withthese instruments.

A survey on the main databases of international indexed scientific pro-duction, Cambridge Scientific Abstracts – CSA and PubMed, using as keysearch the term “whodas” in the “title” and “abstract” field query, it wasfound that the WHODAS II was used in 54 works. Table 1 shows the listof the 54 studies, specifying for each the type of study, the number of par-ticipants, the nationality, the field of research and the main purposes andresults.

90


91


Art

icle

spu

blis

hed

in in

tern

atio

nal

jour

nals

Typ

e of

stud

yN

atio

nalit

yS

ubj

ects

Are

a of

rese

arch

Pur

pos

esR

esul

ts

1. A

lexo

po

ulos

et a

l.(2

003)

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robl

em-s

olvi

ng th

erap

y ve

rsus

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por

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ther

apy

in g

eria

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maj

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pres

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n w

ith

exec

utiv

e dy

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n.

Qua

ntit

ativ

eem

piri

cal s

tudy

of c

linic

altr

eatm

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Uni

ted

Stat

es25

P

sych

iatr

yC

ompa

riso

nof

the

effe

ctiv

enes

s of

pro

blem

-sol

ving

ther

apy

and

sup

por

tive

care

in a

grou

pof

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erly

subj

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wit

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dysf

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ss o

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lem

-so

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g re

cogn

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.

2. A

nnic

chia

rico

et a

l. (2

004)

.Q

ualit

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e pr

ofile

s of

dis

abil

ity.

Qua

litat

ive

empi

rica

l stu

dyIt

aly

96

Dis

abil

ity

and

reha

bil

itat

ion

Iden

tifi

cati

on

of p

rofi

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offu

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disa

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sed

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Iden

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ndi

vid

uals

wit

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sab

ilit

ies.

3. B

adr

et a

l. (2

007)

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Gen

der

in C

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ies

amon

gY

ou

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isua

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Stud

ents

.

Cor

rela

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nal

qua

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Egy

pt20

0 D

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vis

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n oc

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aner

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008)

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of d

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d it

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fect

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disa

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pati

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wit

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late

d m

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egen

erat

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Cor

rela

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eem

piri

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tudy

Indi

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53

Psy

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Ass

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erat

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Cor

rela

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n oc

curr

ed.

5. B

aron

et a

l.(2

008)

. The

clin

imet

ric

pro

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ies

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ly in

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mat

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arth

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cq

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Can

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172

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s.

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lity

and

vali

dity

.

6. B

onne

wyn

et a

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005)

.The

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l dis

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mun

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2419

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Tab.

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WH

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92


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rre

lati

on

co

nfi

rme

d.

11

. Ch

wa

stia

k e

t al.

(20

03

).D

isa

bil

ity

in

de

pre

ssio

na

nd

ba

ckp

ain

:e

va

lua

tio

no

fth

e W

orl

d H

ea

lth

Org

an

izati

on

Dis

ab

ilit

yA

sse

ssm

en

tS

che

du

le (

WH

O D

AS

II)

in

ap

rim

ary

ca

rese

ttin

g.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s1

49

M

ed

icin

eE

va

lua

tio

no

f m

ea

sure

me

nt

pro

pe

rtie

so

fth

eW

HO

DA

S I

I in

tw

o d

iso

rde

rs

com

mo

nly

en

cou

nte

red

in

pri

ma

ry c

are

sett

ing

.

Go

od

va

lid

ity a

nd

resp

on

siv

en

ess

to

cha

ng

e.

12

. Do

nm

ez

et a

l. (2

00

5).

Dis

ab

ilit

ya

nd

its

eff

ect

s o

n q

ua

lity

of

life

am

on

g o

lde

rp

eo

ple

liv

ing

in

An

taly

a c

ity c

en

ter,

Tu

rke

y.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Tu

rke

y

84

0

Me

dic

ine

Dete

ctio

no

ffr

eq

ue

ncy

an

d s

eve

rity

leve

lo

f d

isa

bil

ity

for

old

er

pe

op

leli

vin

g i

nA

nta

lya

cit

y c

en

ter;

eva

lua

tio

no

f th

e e

ffect

s o

f d

isa

bil

ity a

nd

va

ria

ble

s a

sso

cia

ted

wit

h i

t o

n l

ivin

g c

on

dit

ion

s.

Fre

qu

en

cy a

nd

se

ve

rity

de

tect

ed

; co

rre

lati

on

de

tect

ed

.

13

. Ert

ug

rul

et a

l. (2

004

). P

erc

ep

tio

no

f st

igm

a a

mo

ng

pa

tie

nts

wit

h

sch

izo

ph

ren

ia.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Tu

rke

y

60

P

sych

iatr

yM

ea

sure

me

nt

of

the

re

lati

on

ship

be

twe

en

th

e s

ym

pto

ms

an

d o

the

rch

ara

cte

rist

ics

of

sch

izo

ph

ren

ic p

ati

en

tsw

ith

se

lf-p

erc

eiv

ed

sti

gm

a.

Co

rre

lati

on

occ

urr

ed

.

14

. ES

EM

eD

/MH

ED

EA

200

0in

ve

stig

ato

rs. (

20

04

). D

isa

bil

ity

an

dq

ua

lity

of

life

im

pa

ct o

fm

en

tal

dis

ord

ers

in

Eu

rop

e.

Ep

ide

mio

log

ica

lco

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Be

lgiu

m,

Ge

rma

ny,

Ita

ly, S

pa

in,

Fra

nce

an

dN

eth

erl

an

ds

21

42

5

Psy

chia

try

Su

rve

y o

n t

he

im

pa

ct o

fth

e s

tate

of

me

nta

l h

ea

lth

an

d s

pe

cifi

cm

en

tal

an

dp

hy

sica

l d

iso

rde

rso

n w

ork

pe

rfo

rma

nce

an

d q

ua

lity

of

life

in

six

Eu

rop

ea

n c

ou

ntr

ies.

Co

rre

lati

on

s o

ccu

rre

d.

15

. Fe

de

rici

et a

l. (2

00

8).

Wo

rld

He

alt

h O

rga

niz

ati

on

Dis

ab

ilit

y

Ass

ess

me

nt

Sch

ed

ule

II

(WH

OD

AS

II):

A c

on

trib

uti

on

to

th

eIt

ali

an

va

lid

ati

on

.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ita

ly

50

0

Dis

ab

ilit

ya

nd

reh

ab

ilit

ati

on

Va

lid

ati

on

of

the

Ita

lia

n v

ers

ion

of

the

W

HO

DA

S I

I.G

oo

d v

ali

dit

y a

nd

reli

ab

ilit

y a

nd

fact

ori

al

stru

ctu

re c

on

firm

ed

.

16

. Ga

lla

gh

er

et a

l. (2

004

). L

eve

ls o

fa

bil

ity

an

d f

un

ctio

nin

g: u

sin

g t

he

W

HO

DA

SII

ina

nIr

ish

con

tex

t

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

lst

ud

y

Ire

lan

d

13

04

D

isa

bil

ity

an

dre

ha

bil

ita

tio

Co

rre

lati

on

al

an

aly

sis

be

twe

en

so

cio

-d

em

og

rap

hic

va

ria

ble

s,ca

use

s o

fd

isa

bil

ity

an

dd

om

ain

so

fin

div

idu

al

Co

rre

lati

on

s co

nfi

rme

d.

93


the

WH

OD

AS

II.

17

. Go

ya

let

al.

(20

02

).E

ffic

acy

of

Me

no

san

, a p

oly

he

rba

l fo

rmu

lati

on

in t

he

ma

na

ge

me

nt

of

me

no

pa

usa

lsy

nd

rom

e w

ith

re

spe

ctto

qu

ali

ty o

fli

fe.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ind

ia4

0M

ed

icin

eA

sse

ssm

en

t o

fth

e e

ffect

s o

fM

en

osa

n, a

po

lyh

erb

alfo

rmu

lati

on

, on

qu

ali

tyo

fli

fe i

n m

en

op

au

sal

wo

me

n.

Co

rre

lati

on

co

nfi

rme

d;

eff

icacy

of

Me

no

san

de

mo

nst

rate

d.

18

. Hu

dso

net

al.

(20

08

). C

lin

ica

lco

rre

late

s o

f q

ua

lity

of

life

in

syst

em

ic s

cle

rosi

s m

ea

sure

d w

ith

the

W

orl

d H

ea

lth

Org

an

iza

tio

nD

isa

bil

ity

Ass

ess

me

nt

Sch

ed

ule

II.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ca

na

da

33

7M

ed

icin

eId

en

tifi

cati

on

of

clin

ica

l fe

atu

res

of

syst

em

ic s

cle

rosi

s th

at

be

stco

rre

late

wit

h t

he

qu

ali

ty o

f li

fe r

ela

ted

to

th

e

he

alt

h o

f p

ati

en

ts.

Cli

nic

al co

rre

late

sid

en

tifi

ed

.

19

. Hu

dso

net

al.

(20

08

). Q

ua

lity

of

life

in

sy

stem

icsc

lero

sis:

psy

cho

me

tric

pro

pe

rtie

s o

fth

eW

orl

d H

ea

lth

Org

an

iza

tio

nD

isa

bil

ity

Ass

ess

me

nt

Sch

ed

ule

II.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ca

na

da

40

2M

ed

icin

eS

tud

yo

f va

lid

ity o

fth

eW

HO

DA

S I

I in

pa

tie

nts

wit

h s

yst

em

ic s

cle

rosi

s.G

oo

d v

ali

dit

y.

20

. Ja

nca

et a

l.(1

99

6).

Th

eW

orl

dH

ea

lth

Org

an

izati

on

Sh

ort

D

isa

bil

ity

Ass

ess

me

nt

Sch

ed

ule

(WH

O D

AS

-S):

ato

ol

for

the

ass

ess

me

nt

of

dif

ficu

ltie

s in

se

lect

ed

are

as

of

fun

ctio

nin

g o

f p

ati

en

tsw

ith

m

en

tal

dis

ord

ers

.

An

aly

tica

l st

ud

yS

wit

zerl

an

d0

P

sych

iatr

ya

nd

me

dic

ine

Stu

dy

of

cha

ract

eri

stic

s o

f th

eW

HO

DA

S-S

as

a c

lin

ica

l to

ol

for

eva

lua

tio

no

f in

div

idu

alfu

nct

ion

ing

in

psy

chia

tric

su

bje

cts.

Dete

ctio

n o

fa

go

od

uti

lity

an

d e

ase

of

use

a

nd

acc

ep

tab

lere

lia

bil

ity

for

use

by

clin

icia

ns

be

lon

gin

g t

od

iffe

ren

t sc

ho

ols

an

dp

sych

iatr

ic t

rad

itio

ns.

21

. Ke

mm

ler

et a

l. (2

00

3).

Qu

ali

ty o

fli

fe o

fH

IV-i

nfe

cte

d p

ati

en

ts:

Psy

cho

me

tric

pro

pe

rtie

s a

nd

va

lid

ati

on

of

the G

erm

an

ve

rsio

no

fth

e M

QO

L-H

IV.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ge

rma

ny

2

07

M

ed

icin

eC

on

ve

rge

nt

va

lid

ity

stu

dy

of

the

G

erm

an

ve

rsio

n o

fth

eM

ult

idim

en

sio

na

l Q

ua

lity

of

Lif

eQ

ue

stio

nn

air

efo

r H

IV/A

IDS

on

asa

mp

le o

f H

IV-i

nfe

cte

d p

ati

en

ts.

Go

od

va

lid

ity a

nd

reli

ab

ilit

y o

fth

e

Mu

ltid

ime

nsi

on

al

Qu

ali

ty o

f L

ife

Qu

est

ion

na

ire

fo

rH

IV/A

IDS

; co

nv

erg

en

tva

lid

ity

de

mo

nst

rate

d.

22

. Ke

ssle

ret

al.

(20

03

).T

he

E

pid

em

iolo

gy

of

Ma

jor

De

pre

ssiv

e

Dis

ord

er:

Re

sult

s fr

om

th

e;N

ati

on

al

Co

mo

rbid

ity

Su

rve

y R

ep

lica

tio

n(N

CS

-R).

Ep

ide

mio

log

ica

lco

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s9

09

0

Me

dic

ine

Su

rve

y o

np

reva

len

ce,c

orr

ela

tio

n a

nd

clin

ica

l re

leva

nce

of

the D

SM

dis

ord

ers

an

d a

sse

ssm

en

t o

ftr

eatm

en

ts a

de

qu

acy

.

Pre

va

len

ce, c

orr

ela

tes

an

d c

lin

ica

l re

leva

nce

ide

nti

fie

d; i

na

de

qu

acy

of

tre

atm

en

td

ete

cte

d.

23

. Kim

et a

l. (2

00

5).

Ph

ysi

cal

he

alt

h,

de

pre

ssio

n a

nd

co

gn

itiv

efu

nct

ion

as

corr

ela

tes

of

dis

ab

ilit

y i

n a

n o

lde

rK

ore

an

po

pu

lati

on

.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

So

uth

Ko

rea

12

04

P

sych

iatr

yS

urv

ey

on

ind

ep

en

de

nt

ass

oci

ati

on

sb

etw

ee

n p

hy

sica

lh

ea

lth

, de

pre

ssio

n,

cog

nit

ive

fu

nct

ion

an

d d

isa

bil

ity

in

the

o

lde

r K

ore

an

po

pu

lati

on

.

Co

rre

lati

on

s co

nfi

rme

d.

24

. Kim

et a

l. (2

00

8).

BD

NF

tt

till

dif

ith

Co

rre

lati

on

al

qu

an

tita

tive

So

uth

Ko

rea

50

0

Psy

chia

try

Su

rve

y o

n t

he

ro

leo

fa g

en

oty

pe

(va

l66

met)

of

the

ne

uro

tro

ph

icfa

cto

rC

orr

ela

tio

n c

on

firm

ed

.

94


ass

oci

ati

on

be

twe

en

in

cid

en

t st

rok

ea

nd

de

pre

ssio

n.

em

pir

ica

l st

ud

yd

eri

ve

dfr

om

the b

rain

(B

DN

F)

in t

he

ass

oci

ati

on

be

twe

en

str

ok

e a

nd

d

ep

ress

ion

.2

5. L

ast

raet

al.

(20

00

).T

he

cl

ass

ific

ati

on

of

firs

t e

pis

od

e

sch

izo

ph

ren

ia: a

clu

ste

r-a

na

lyti

cal

ap

pro

ach

.

Qu

ali

tati

ve

em

pir

ica

l st

ud

yS

pa

in8

6

Psy

chia

try

Ch

eck

th

e c

lass

ific

ati

on

of

asc

hiz

op

hre

nic

po

pu

lati

on

into

sub

gro

up

s fo

r si

mil

ar

sym

pto

ms

pro

file

s.

Div

isio

n i

nto

sub

gro

up

s co

nfi

rme

d,

bu

t n

ot

pre

dic

tiv

e.

26

. MaG

PIe

Re

sea

rch

Gro

up

.(2

00

4).

Ge

ne

ral

pra

ctit

ion

er

reco

gn

itio

no

fm

en

tal

illn

ess

in

the

a

bse

nce

of

a ‘

go

ld s

tan

da

rd’.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

New

Ze

ala

nd

84

5

Psy

chia

try

Co

mp

ari

son

be

twe

en

th

e g

en

era

lp

ract

ice o

f re

cog

nit

ion

of

me

nta

l il

lne

ssa

nd

th

eca

ses

ide

nti

fie

db

y d

iag

no

stic

inst

rum

en

ts a

nd

scr

ee

nin

g.

Co

rre

lati

on

is

no

tve

rifi

ed

; va

ria

bil

ity

be

twe

en

in

stru

me

nts

a

nd

be

twe

en

clin

ica

lo

pin

ion

an

d s

cre

en

ing

an

d d

iag

no

stic

test

s.2

7. M

aG

PIe

Re

sea

rch

Gro

up

.(2

00

3).

Th

e n

atu

rea

nd

pre

va

len

ceo

f p

sych

olo

gic

al

pro

ble

ms

inN

ew

Ze

ala

nd

pri

ma

ry h

ea

lth

care

:are

po

rt o

n M

en

talH

ea

lth

an

dG

en

era

l P

ract

ice I

nve

stig

ati

on

(MaG

PIe

).

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

New

Ze

ala

nd

70

M

ed

icin

eS

tud

yo

fth

e d

eg

ree

of

dis

ab

ilit

y a

nd

oth

er

fact

ors

th

at

infl

ue

nce

th

ere

cog

nit

ion

, ma

na

ge

me

nt,

cou

rse

an

do

utc

om

e o

fm

en

tal

dis

ord

ers

in

pa

tie

nts

o

f N

ew

Ze

ala

nd

.

Co

rre

lati

on

s co

nfi

rme

d.

28

. Matí

as-

Ca

rre

loet

al.

(20

03

). T

he

S

pa

nis

h t

ran

sla

tio

n a

nd

cu

ltu

ral

ad

ap

tati

on

of

five

me

nta

lh

ea

lth

ou

tco

me

me

asu

res.

Qu

ali

tati

ve

em

pir

ica

l st

ud

y

of

tra

nsl

ati

on

an

d a

da

pta

tio

n

Sp

ain

13

0M

ed

icin

eS

pa

nis

h t

ran

sla

tio

n a

nd

ad

ap

tati

on

of

five

me

asu

res

of

me

nta

lh

ea

lth

.S

em

an

tic,

tech

nic

al

an

dco

nte

nt

eq

uiv

ale

nce

d

em

on

stra

ted

.

29

. McA

rdle

et a

l.(2

00

5).

Th

e W

HO

-D

AS

II:

me

asu

rin

g o

utc

om

es

of

he

ari

ng

aid

in

terv

en

tio

n f

or

ad

ult

s.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s3

80

D

isa

bil

ity

an

dre

ha

bil

ita

tio

n

Ass

ess

me

nt

of

react

ivit

y o

fth

eW

HO

DA

SII

to

th

esh

ort

an

d l

on

g t

erm

eff

ect

s in

ap

pli

cati

on

so

f aco

ust

icd

ev

ice

s.

Go

od

re

act

ivit

y o

fth

e

WH

OD

AS

II,

corr

ela

tio

n d

ete

cte

d.

30

. McK

ibb

inet

al.

(20

04

). A

sse

ssin

gD

isa

bil

ity i

n O

lde

r P

ati

en

ts W

ith

Sch

izo

ph

ren

ia R

esu

lts

Fro

mth

eW

HO

DA

S-I

I.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s7

6M

ed

icin

eE

va

lua

tio

no

f re

lia

bil

ity

an

d v

ali

dit

yo

fth

e W

HO

DA

S I

I in

old

er

pa

tie

nts

wit

h

sch

izo

ph

ren

ia.

Str

on

g e

vid

en

ce o

fg

oo

d r

eli

ab

ilit

ya

nd

som

e e

vid

en

ce o

f g

oo

dva

lid

ity.

3

1.M

ub

ara

kA

R. (

20

05

). S

oci

al

fun

ctio

nin

g a

nd

qu

ali

ty o

f li

fe o

fp

eo

ple

wit

h s

chiz

op

hre

nia

in

th

en

ort

he

rn r

eg

ion

of

Ma

lay

sia

.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ma

lay

sia

25

8

Me

dic

ine

Inve

stig

ati

on

on

th

e r

ela

tio

nsh

ipb

etw

ee

n s

oci

alfu

nct

ion

ing

an

d q

ua

lity

of

life

of

pe

op

le w

ith

sch

izo

ph

ren

ia i

nM

ala

ysi

a.

Co

rre

lati

on

co

nfi

rme

d.

32

. No

rto

net

al.

(20

04

). P

sych

iatr

icm

orb

idit

y,d

isa

bil

ity

an

d s

erv

ice

use

am

on

gst

pri

ma

ry c

are

att

en

de

rs i

nF

ran

ce.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Fra

nce

12

4

Psy

chia

try

Inve

stig

ati

on

on

th

e r

ela

tio

nsh

ipb

etw

ee

n p

sych

iatr

icm

orb

idit

y,d

isa

bil

ity

an

du

se o

f se

rvic

es

inF

ren

chp

ati

en

ts.

Co

rre

lati

on

s co

nfi

rme

d.

33

. Pe

rin

iet

al.

(20

06

).G

en

eri

ceff

ect

ive

ne

ssm

ea

sure

s:S

en

siti

vit

yto

Co

rre

lati

on

al

qu

an

tita

tive

Au

stra

lia

16

9M

ed

icin

eS

tud

yw

ith

co

nve

rge

nt

me

asu

res

on

sen

siti

vit

yto

cha

ng

ein

pe

op

lew

ith

Co

nv

erg

en

t va

lid

ity

d

em

on

stra

ted

95


dis

ord

ers

.3

4. P

ett

ers

son

et a

l. (2

00

6).

Th

e e

ffect

of

an

ou

tdo

or

po

we

red

wh

ee

lch

air

on

act

ivit

ya

nd

pa

rtic

ipa

tio

n i

n u

sers

wit

h s

tro

ke

.

Qu

an

tita

tive

an

d

lon

git

ud

ina

le

mp

iric

al

stu

dy

Sw

ed

en

3

2D

isa

bil

ity

an

dre

ha

bil

ita

tio

n

Se

lf-e

va

lua

tio

n o

fth

e l

imit

ati

on

s in

act

ivit

ies

an

d r

est

rict

ion

sin

th

e

pa

rtic

ipa

tio

n o

f p

eo

ple

wit

h s

tro

ke

,b

efo

re a

nd

aft

er

the

use

of

an

ou

tdo

or

po

we

red

wh

ee

lch

air

.

Po

siti

ve

eff

ect

s o

fw

he

elc

ha

ir f

ou

nd

.

35

. Pö

slet

al.

(200

7).

Psy

cho

me

tric

pro

pe

rtie

s o

fth

eW

HO

DA

S I

I in

reh

ab

ilit

ati

on

pa

tie

nts

.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ge

rma

ny

9

04

D

isa

bil

ity

an

dre

ha

bil

ita

tio

n

Va

lid

ati

on

of

the

Ge

rma

nve

rsio

n o

fth

e W

HO

DA

SII

.G

oo

d v

ali

dit

y a

nd

reli

ab

ilit

y a

nd

fact

ori

al

stru

ctu

re c

on

firm

ed

.

36

. Po

stet

al.

(20

08

). D

eve

lop

me

nt

an

d v

ali

da

tio

no

f IM

PA

CT

-S, a

nIC

F-b

ase

d q

ue

stio

nn

air

eto

me

asu

re a

ctiv

itie

s a

nd

pa

rtic

ipa

tio

n.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ne

the

rla

nd

s2

76

D

isa

bil

ity

an

dre

ha

bil

ita

tio

n

Va

lid

ati

on

of

the

IM

PA

CT

-S, a

n I

CF

-b

ase

d q

ue

stio

nn

air

e t

o m

ea

sure

act

ivit

ya

nd

pa

rtic

ipa

tio

n.

Go

od

co

ncu

rre

nt

va

lid

ity,

te

st-r

ete

st

reli

ab

ilit

y a

nd

inte

rna

lco

nsi

ste

ncy

.3

7. P

yn

e e

t al.

(20

03

). C

om

pa

rin

g t

he

S

en

siti

vit

y o

f G

en

eri

c E

ffect

ive

ne

ssM

ea

sure

s W

ith

Sy

mp

tom

Imp

rove

me

nt

inP

ers

on

s W

ith

Sch

izo

ph

ren

ia.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s1

34

M

ed

icin

eS

tud

yw

ith

co

nve

rge

nt

me

asu

res

on

the

se

nsi

tiv

ity o

fg

en

eri

c eff

ect

ive

ne

ss i

nim

pro

vin

gth

e s

ym

pto

ms

of

pe

op

le w

ith

sc

hiz

op

hre

nia

.

Co

nv

erg

en

t va

lid

ity

d

em

on

stra

ted

.

38

. Py

sze

let

al.

(20

06

). D

isa

bil

ity,

psy

cho

log

ica

l d

istr

ess

an

dq

ua

lity

of

life

in

bre

ast

can

cer

surv

ivo

rs w

ith

arm

ly

mp

he

de

ma

.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Po

lan

d1

00

0

Me

dic

ine

Ass

ess

me

nt

of

dis

ab

ilit

y,p

sych

olo

gic

al

dis

tre

ss a

nd

qu

ali

ty o

f li

fe i

nb

rea

stca

nce

r P

oli

sh s

urv

ivo

rs w

ith

arm

lym

ph

ed

em

a.

Co

rre

lati

on

s co

nfi

rme

d.

39

. Ro

thet

al.

(20

06

). S

lee

pP

rob

lem

s, C

om

orb

id M

en

tal

Dis

ord

ers

, an

d R

ole

Fu

nct

ion

ing

in

the

Nati

on

al

Co

mo

rbid

ity S

urv

ey

R

ep

lica

tio

n.

Ep

ide

mio

log

ica

lco

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s9

28

2

Psy

chia

try

Na

tio

na

l su

rve

y o

n t

he

pre

va

len

ce o

fsl

ee

p d

iso

rde

rs, o

rth

e a

sso

cia

tio

ns

of

sle

ep

dis

ord

ers

wit

h r

ole

dis

ord

ers

rela

ted

to

co

mo

rbid

ity

of

me

nta

ld

iso

rde

rs.

Co

rre

lati

on

s co

nfi

rme

d.

40

. Sch

lote

et a

l.(2

00

8).

Use

of

the

W

HO

DA

S I

I w

ith

str

ok

e p

ati

en

tsa

nd

th

eir

re

lati

ve

s: r

eli

ab

ilit

y a

nd

in

ter-

rate

r-re

lia

bil

ity.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ge

rma

ny

1

68

D

isa

bil

ity

an

dre

ha

bil

ita

tio

n

Me

asu

rem

en

t o

fth

e r

eli

ab

ilit

y o

fW

HO

DA

S I

I w

ith

str

ok

e p

ati

en

ts a

nd

th

eir

re

lati

ve

s.

Go

od

re

lia

bil

ity.

41

. Sco

ttet

al.

(20

06

).D

isa

bil

ity

in

Te

Ra

u H

ine

ng

aro

:Th

e N

ew

Ze

ala

nd

Me

nta

l H

ea

lth

Su

rve

y.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

New

Ze

ala

nd

12

99

2

Psy

chia

try

Stu

dy

on

rela

tio

nsh

ip b

etw

ee

nth

e

dis

ab

ilit

y a

nd

th

e p

rese

nce

of

me

nta

ld

iso

rde

rs a

nd

ch

ron

ic p

hy

sica

lco

nd

itio

ns

inth

e p

op

ula

tio

n o

fN

ew

Ze

ala

nd

, co

ntr

oll

ing

co

mo

rbid

ity,

ag

ea

nd

se

x.

Co

rre

lati

on

s id

en

tifi

ed

.

42

. Sco

ttet

al.

(20

08

).M

en

tal-

ph

ysi

cal co

-mo

rbid

ity

an

dit

sl

tih

iit

hd

ib

ilit

lt

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

New

Ze

ala

nd

69

7

Me

dic

ine

Su

rve

y o

n m

en

tal-

ph

ysi

calco

mo

rbid

ity

a

nd

on

its

rela

tio

nsh

ip w

ith

dis

ab

ilit

y.

Sm

all

co

rre

lati

on

ide

nti

fie

d.

96


fro

mth

e W

orl

d M

en

talH

ea

lth

Su

rve

ys.

43

. So

be

rget

al.

(20

07

). L

on

g-t

erm

mu

ltid

ime

nsi

on

al

fun

ctio

na

lco

nse

qu

en

ces

of

seve

re m

ult

iple

inju

rie

s tw

o y

ea

rsaft

er

tra

um

a: a

pro

spe

ctiv

e l

on

git

ud

ina

l co

ho

rtst

ud

y.

Pro

spe

ctiv

eq

ua

nti

tati

ve

em

pir

ica

l st

ud

y

No

rwa

y1

05

Me

dic

ine

Eva

lua

tio

n, t

hro

ug

hp

rosp

ect

ive

co

ho

rtst

ud

y,o

f th

e f

un

ctio

nin

g a

nd

qu

ali

ty o

fli

fe i

n p

ati

en

ts w

ith

seve

rem

ult

iple

inju

rie

s.

Co

rre

lati

on

id

en

tifi

ed

.

44

. Stu

cki

et a

l. (2

00

3).

Ass

ess

me

nt

of

the

im

pa

ct o

f d

ise

ase

on

th

e

ind

ivid

ua

l.

Rev

iew

of

self

-a

dm

inis

tere

dm

ea

sure

s o

n t

he

h

ea

lth

Ge

rma

ny

0

M

ed

icin

eIm

ple

me

nta

tio

no

f a

n a

lgo

rith

mfo

rth

e

sele

ctio

no

f cu

rre

nt

me

asu

res

for

the

a

sse

ssm

en

t o

f h

ea

lth

con

dit

ion

s.

Ab

ou

t th

e W

HO

DA

Sst

ate

s th

at

the v

ali

dit

ya

nd

re

lia

bil

ity

of

the

inst

rum

en

t a

re s

till

un

de

r in

ve

stig

ati

on

.4

5. U

lug

et a

l. (2

00

1).

Re

lia

bil

ity a

nd

va

lid

ity

of

the

Tu

rkis

h v

ers

ion

of

the

Wo

rld

He

alt

hO

rga

niz

ati

on

Dis

ab

ilit

y A

sse

ssm

en

tS

che

du

le-I

I (W

HO

-DA

S-I

I) i

n s

chiz

op

hre

nia

.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Tu

rke

y

90

P

sych

iatr

yV

ali

da

tio

n o

fth

e T

urk

ish

ve

rsio

n o

fth

e W

HO

DA

S I

I in

pa

tie

nts

wit

h

sch

izo

ph

ren

ia.

Go

od

re

lia

bil

ity

an

dva

lid

ity.

46

. va

nT

ub

erg

en

et a

l. (2

003

).A

sse

ssm

en

t o

f d

isa

bil

ity

wit

h t

he

W

orl

d H

ea

lth

Org

an

isa

tio

nD

isa

bil

ity

Ass

ess

me

nt

Sch

ed

ule

II

in p

ati

en

tsw

ith

an

ky

losi

ng

spo

nd

yli

tis.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ne

the

rla

nd

s2

14

Me

dic

ine

Co

nv

erg

en

t va

lid

ity

stu

dy

in

pa

tie

nts

wit

h a

nk

ylo

sin

g s

po

nd

yli

tis.

Co

nv

erg

en

t va

lid

ity

d

em

on

stra

ted

.

47

. Vá

zqu

ez-

Ba

rqu

ero

et a

l. (2

00

0).

Sp

an

ish

ve

rsio

n o

fth

e n

ew

Wo

rld

H

ea

lth

Org

an

izati

on

Dis

ab

lem

en

t A

sse

ssm

en

t S

che

du

le I

I.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Sp

ain

16

3

Psy

chia

try

Va

lid

ati

on

of

the

Sp

an

ish

ve

rsio

no

fth

e W

HO

DA

SII

.G

oo

d v

ali

dit

y a

nd

reli

ab

ilit

y a

nd

fact

ori

al

stru

ctu

re c

on

firm

ed

.

48

. Vo

nK

orf

fet

al.

(20

05

).P

ote

nti

all

y M

od

ifia

ble

Fa

cto

rsA

sso

cia

ted

Wit

h D

isa

bil

ity

Am

on

gP

eo

ple

Wit

h D

iab

ete

s.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s4

35

7

Me

dic

ine

Ide

nti

fica

tio

no

f p

ote

nti

all

y m

od

ifia

ble

fact

ors

ass

oci

ate

dw

ith

dis

ab

ilit

y i

np

eo

ple

wit

h d

iab

ete

s.

Co

rre

lati

on

s id

en

tifi

ed

;id

en

tifi

cati

on

of

fact

ors

.

49

. Vo

nK

orf

fet

al.

(20

08

). M

od

ifie

dW

HO

DA

S-I

I p

rov

ide

s va

lid

me

asu

re o

f g

lob

al

dis

ab

ilit

y b

ut

filt

er

item

s in

cre

ase

d s

kew

ne

ss.

Psy

cho

me

tric

qu

an

tita

tive

em

pir

ica

l st

ud

y

Un

ite

dS

tate

s9

34

Me

dic

ine

Va

lid

ati

on

of

am

od

ifie

d v

ers

ion

of

the

WH

OD

AS

II w

ith

fil

ter

item

s.G

oo

d r

eli

ab

ilit

y a

nd

ge

ne

ral

va

lid

ity,

bu

tth

e

use

of

filt

er

qu

est

ion

sa

dve

rse

ly a

ffect

sth

e

pro

pe

rtie

s o

fth

ein

stru

me

nt.

50

. Wa

ng

et a

l. (2

006

).M

en

tal

he

alt

ha

nd

re

late

dd

isa

bil

ity

am

on

gw

ork

ers

:A p

op

ula

tio

n-b

ase

d s

tud

y.

Co

rre

lati

on

al

qu

an

tita

tive

em

pir

ica

l st

ud

y

Ca

na

da

53

83

M

ed

icin

eS

urv

ey

on

th

e p

reva

len

ce o

f p

sych

iatr

icsy

nd

rom

es

an

d r

ela

ted

dis

ab

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3. Review of international literature on the WHODAS II

Among the 54 studies identified by following the method describedabove, 51 are articles published in international journals, 2 were includedin the conferences and one is a dissertation. However, only seven articleswere published in journals or acts of conferences whose main object of in-terest is disability and rehabilitation (Federici, Scherer, Micangeli, Lom-bardo, & Olivetti Belardinelli, 2003; Annicchiarico, Gibert, Cortes, Cam-pana, & Caltagirone, 2004; Gallagher & Mulvany, 2004; Chisolm, Abrams,McArdle, Wilson, & Doyle, 2005; McArdle, Chisolm, Abrams, Wilson, &Doyle, 2005; Pettersson, Törnquist, & Ahlström, 2006; Federici, Meloni,Mancini, Lauriola, & Olivetti Belardinelli, 2009). The remaining workswere published in journals of medicine and psychiatry; the main purposeof these studies is the identification of correlations on comorbidity evalua-tions performed by clinicians about certain mental disorders. All thesestudies have investigated the correlation between the 6 domains of theWHODAS and/or its total score with the scores obtained on scales mea-suring depression (Alexopoulos, Raue, & Areán, 2003; Chwastiak & VonKorff, 2003; Kemmler et al., 2003; Kessler et al., 2003; McKibbin, Patterson,& Jeste, 2004;Yoon et al., 2004; Kim et al., 2005;Von Korff et al., 2005; Scott,McGee, Wells, & Browne, 2006; Banerjee et al., 2008), pain (Chwastiak &Von Korff, 2003; Stucki & Sigl, 2003; Pyszel, Malyszczak, Pyszel, Andrze-jak, & Szuba, 2006; Soberg, Bautz-Holter, Roise, & Finset, 2007), schizo-phrenia and psychotic disorders (Janca et al., 1996; Lastra et al., 2000; Ulug,Ertugrul, Gögüs, & Kabakçi, 2001; Pyne, Sullivan, Kaplan, & Williams,2003; Baumgartner, 2004; McKibbin et al., 2004; Norton, de Roquefeuil,Benjamins, Boulenger, & Mann, 2004; Mubarak, 2005; Chopra et al., 2008),quality of life (Goyal & Kulkarni, 2002; Kemmler et al., 2003; Pyne, Sulli-van, Kaplan, & Williams, 2003; Chopra, Couper, & Herrman, 2004; ES-EMeD/MHEDEA 2000 investigators, 2004; Donmez, Gokkoca, &Dedeoglu, 2005; Mubarak, 2005; Pyszel, Malyszczak, Pyszel, Andrzejak, &Szuba, 2006; Pösl, Miriam, Alarcos Cieza, & Gerold Stucki, 2007; Soberg,Bautz-Holter, Roise, & Finset, 2007; Baron et al., 2008; Hudson, Steele,Taillefer, & Baron, 2008; Hudson, Thombs, Steele, Watterson, Taillefer &Baron, 2008), sleep disorders (Roth et al., 2006), diabetes (Von Korff et al.,2005), ageing (Alexopoulos et al., 2003;Yoon et al., 2004; Kim et al., 2005;Donmez, Gokkoca & Dedeoglu, 2005), rheumatic disorders (Stucki & Sigl,2003; van Tubergen et al., 2003; Baron, Hudson, & Taillefer, 2005), anxietydisorders (Bonnewyn, Bruffaerts, Van Oyen, Demarest, & Demyttenaere,2005; Perini, Slade, & Andrews, 2006), strokes (Schlote et al., 2008), copingskills (Badr et al., 2007), cognitive functions (Kim et al., 2008), limitationsof activity and restrictions in participation (Post et al., 2008) or in epidemi-ological and comorbidity national and international surveys (Kessler et al.,2003; MaGPIe Research Group, 2003; ESEMeD/MHEDEA 2000 investi-

98


gators, 2004; MaGPIe Research Group, 2004; Bonnewyn et al., 2005; Don-mez et al., 2005; Wang, Adair, & Patten, 2006; Buist-Bouwman et al., 2008;Scott et al., 2008).

The results obtained in these studies emphasize, first, that the WHODASII is a useful, reliable and valid tool for assessment of disability, functioningand social participation, and is sensitive to changes like the SF-36 (MedicalOutcomes Study Short Form 36); secondly, it facilitates the use of the ICF asa conceptual framework for the assessment of the limitations in activity andparticipation, and effectively discriminates between normal/healthy anddisabled/sick people (Ertugrul & Ulug, 2004). Some studies suggest to usingthe WHODAS II together with the SF-36 (Chwastiak & Von Korff, 2003;Pyne et al., 2003; Baron et al., 2005; Von Korff et al., 2005; Perini et al., 2006;Soberg et al., 2007) or with the WHO Quality of Life – short version(WHQOL-BREF) in order to improve the health profile (Goyal & Kulka-rni, 2002; Kemmler et al., 2003; Chopra et al., 2004) or together with CopingInventory for Stressful Situations (CISS) and Matching Person and Technol-ogy (MPT) to assess the individual coping strategies and the predisposi-tions to assistive technologies (Federici et al., 2003). Actually, the WHO-DAS II is a tool relatively complex and difficult to administer with full co-operation in psychiatric patients who reported that they were healthy anddenied “emotional or mental problems” as described in the WHODAS II(Chopra et al., 2004, p. 757).

Among the 51 articles, only eight have investigated the psychometricproperties of the WHODAS II (Vázquez-Barquero et al., 2000; Ulug et al.,2001; Yoon et al., 2004; Baron et al., 2005; Chisolm et al., 2005; Buist-Bouw-man et al., 2008; Von Korff et al., 2008; Federici et al., 2009) and one reportsthe translation into Spanish and its adaptation to the Latino culture(Matías-Carrelo et al., 2003).

Vázquez-Barquero and his/her collaborators (Vázquez-Barquero et al.,2000) have studied the development of the Spanish version of the WHO-DAS II through a pilot cross-cultural analysis with 54 Spanish, 50 Cubansand 59 Peruvians, male and female, adults. Factor analysis, analysis of re-dundancy and missing values were conducted. The scores of the modifiedversion of the instrument were compared with those of other countries.TheAuthors, however, failed to reach a clear and definitive assessment of thetool, merely to suggest further study on its psychometric properties.

Ulug et al. (2001) have assessed the reliability and validity of Turkishversion of the WHODAS II, in a study with 60 patients diagnosed withschizophrenia. The Cronbach’s Alpha, calculated for each of the six do-mains, reached values between .60 and .90, making possible to assess an ac-ceptable internal consistency of the instrument. Regarding construct valid-ity, domain scores displayed significant positive correlations with each oth-er as well as with the total DAS score. According to the Authors, therefore,the WHODAS II is able to distinguish patients from control subjects; in ad-

99


dition, the results show that the Turkish version of the instrument has satis-factory requirements of validity and reliability.

The study of Yoon et al. (2004) was conducted to assess the Korean ver-sion of the WHODAS II, the sample consisted of 1204 elderly (aged 65years or over) South Korean, community residents. In this study the WHO-DAS II-K showed high levels of internal consistency and reliability (split-half, inter-rater and test-retest reliability). In the correlation analyses, scoreson the WHODAS II-K were significantly correlated with the unfavorableconditions in all variables on health condition and contextual factors. Par-tial correlations of scores on the WHODAS II-K with the health conditionwere significant even after controlling for contextual factors. Therefore, theconclusion of the authors is that the WHODAS II-K is a reliable and validinstrument for assessing disability in elderly population. More recently, apreliminary study of validity was conducted on 67 Canadian subjects suf-fering from scleroderma. (The title of the poster appears as substantiallyconfusing. We have attributed this to a misprint). The short abstract alsodoes not provide sufficient information for an assessment of the study.

Chisolm et al. (2005) examined the psychometric properties of the Eng-lish version of the WHODAS II, in a sample of 380 adults with hearing loss.The results of the analysis of convergent validity showed that the WHO-DAS II-E is correlated with the scores of the Abbreviated Profile of Hear-ing Aid Benefit (APHAB), the Hearing Aid Handicap for the Elderly(HHIE), and the SF-36 (short form). The internal consistency of scores indifferent domains was satisfactory, except for the domain “Interactions andrelationships with others”.

The test-retest stability was adequate for the scores of all domains.Buist-Bouwman et al., (2008) have assessed the factorial structure, the in-ternal consistency and the discriminant validity of the ESEMeD version ofthe WHODAS II, that is used in a European Study of Epidemiology ofMental Disorders.The sample was 8796 adults.The study confirms the struc-ture of six factors of the WHODAS II, finds a good internal consistency ofthe instrument and also the results of discriminant validity appear, on a pre-liminary analysis, as acceptable. Finally, Von Korff et al. (2008) consider thepsychometric properties of a WHODAS II modified for use in the WorldMental Health Surveys with the addition of filter items in different sub-scales. Internal consistency and validity of the modified WHODAS II aregenerally supported, but the use of filter questions impairs measurementproperties of the instrument.

The most comprehensive psychometric analysis conducted, to date, onthe WHODAS II is the work of Pösl et al. (2007), from a doctoral thesis, un-published, of M. Pösl (2004), under the direction of G. Stucki, University ofMonaco. The Authors evaluated the usefulness of the WHODAS II formeasuring functioning and disability in patients with musculoskeletal dis-eases, internal diseases, stroke, breast cancer, and depressive disorder. The

100


validation of the German version of the WHODAS II was conducted in a sampleof 904 patients from 19 rehabilitation centers and clinics in Bavaria.There was,amongother things, a convergent validity with the SF-36.The conclusions of the study con-firm the structure of six domains of the WHODAS II; furthermore, the instrumentappears reliable and valid,and shows a sensitivity to change similar to that of the SF-36 in the corresponding subscales.

Given all the studies mentioned above, the WHODAS II was translatedinto the following languages: Italian (Federici et al., 2003;Annicchiarico et al.,2004; ESEMeD/MHEDEA 2000 investigators, 2004; Federici et al., 2009),English (Janca et al., 1996; Goyal & Kulkarni, 2002; Alexopoulos et al., 2003;Chwastiak & Von Korff, 2003; Kessler et al., 2003; MaGPIe Research Group,2003; Pyne J.M., Sullivan et al., 2003; Baumgartner, 2004; Chopra et al., 2004;ESEMeD/MHEDEA 2000 investigators, 2004; Gallagher & Mulvany, 2004;McKibbin et al., 2004; MaGPIe Research Group, 2004; Baron et al., 2005;Chisolm et al., 2005; McArdle et al., 2005; Mubarak, 2005; Von Korff et al.,2005; Perini et al., 2006; Roth et al., 2006; Scott et al. 2006; Wang et al., 2006;Baron et al., 2008; Hudson et al., 2008), Swedish (Pettersson et al., 2006),Dutch (van Tubergen et al., 2003; ESEMeD/MHEDEA 2000 investigators,2004;), German (Kemmler et al., 2003; Stucki & Sigl, 2003;ESEMeD/MHEDEA 2000 investigators, 2004; Pösl, 2007; Schlote et al.,2008), Korean (Yoon et al., 2004; Kim et al., 2005), Polish (Pyszel et al., 2006),Norwegian (Soberg et al., 2007), Turkish (Ulug et al., 2001; Ertugrul & Ulug,2004; Donmez et al., 2005), Spanish (Lastra et al., 2000; Vázquez-Barquero etal., 2000; Matías-Carrelo et al., 2003; ESEMeD/MHEDEA 2000 investigators,2004), French (Norton et al., 2004; ESEMeD/MHEDEA 2000 investigators,2004; Bonnewyn et al., 2005), Arabic (Badr et al., 2007). Korean, Polish andSwedish translations are not provided by WHO (WHO, 2004).

In conclusion, the review of international literature on the WHODASshows a broad consensus on the reliability and validity of the instrument, al-though the lack of standardized scores for the different translations of theWHODAS and the scarcity of particularly thorough studies does not guar-antee that the cultural and psychometric requirements have been met bythe instrument.

4. Characteristics of the Italian version of the WHODAS II

The study of Federici et al. had as general aim to provide a contributionto the validation of the Italian version of the WHODAS II, considering thewidespread consent about the usefulness of the tool. Specifically, the Au-thors wanted to test if the WHODAS II can be regarded as a reliable in-strument to assess the functioning and the self-perception of disability inpersons with normal abilities and disabled participants, by the means of theanalysis of some psychometric characteristics such as the reliability (inter-

101


nal homogeneity, Cronbach’s Alpha) and the validity (principal compo-nents analysis).

The Italian version of the WHODAS II has been adapted by the Authorsin the same format as the English one (36-Item Interviewer Administered,Day Codes Version – February 2000), because this was the most recent ver-sion of the instrument. The Authors have deleted the Italian items of thesections 3 and 5, since they were not further included in the last format ofthe English version.

The WHODAS II was administered to a sample of 500 participants (185males and 315 females,) divided into two sub-samples: 271 normal adultsand 229 disabled adults. Moreover, the disabled participant group com-prised 111 motor disabled, 45 mental disabled and 73 sensory disabled. Thefindings obtained show a good correspondence with the original structureof the WHODAS II. Furthermore, the internal consistency of most sub-scales, estimated by means of the Cronbach’s Alpha, was found to be highin the examined sample. Regarding the factorial structure of the instru-ment, the results confirm the presence of six main factors, according to thesix activity domains expected to be assessed by the WHODAS II.

The study of Federici et al. presents, however, some limitations: first, thethree subgroups of disabled do not match each other for participant num-ber, age and sex; moreover, the enrolment of mental disabled respondentsran into difficulties because it was not easy to access the centres for mentaldisabled in Italy. Finally, neither the convergent validity nor the reliabilitytest – re-test of the instrument- has been studied. A research prosecution istherefore desirable which proposes, among other things, achieving standardscores for each macro-category of disability. Normative scores of disabilitywould be useful to integrate the self-evaluation of a single individual re-garding his/her functioning in a specific context. Indeed, by comparing thedisability self-evaluation of a single individual to standard scores it will bepossible to assess how much each factor of the biopsychosocial determi-nants of the individual’s functioning influences the disability self-evaluationof that person.

5. Conclusions

The WHODAS II is a tool for the self-evaluation of limitations in activ-ities and restrictions in participation experienced by an individual, inde-pendently from a medical diagnosis. The self- evaluation of the instrumentappears a fundamental element compared to tests or questionnaires tradi-tionally used for the assessment of disability, which usually reveal the pointof view of the caregiver or clinician who compiles them. The revolution inthe conception of disability, functioning and health represented by the bio-psycho-social model and the new International Classification (ICF), con-

102


ceptually compatible with it, reveals the absolute priority of an individualsubjective perspective, compared to any other etiopathological assessment,both the objective and reducing-individual-to-object point of view of theclinician.

The increasingly widespread utilization of the bio-psycho-social modelat international level and the simultaneous promotion of the use of the newclassification, have brought, in recent years, even increasing use of the newassessment tools, above all WHODAS II. This has involved, first, the needto accurately analyze the psychometric properties of the instrument, and inparticular its reliability, stability, internal consistency, convergent validityand factorial structure.

This study has reviewed all studies published (until 2008) in the majorscientific search engines, where has described the use and/or validation ofWHODAS II. Research conducted identified 54 studies: 51 articles in inter-national journals, 2 included in conferences and a doctoral dissertation. Ofthese, only six articles were published in journals or acts of conferenceswhose main object of interest is disability and rehabilitation. All studiesconsidered have assessed the degree of correlation between the scores ofthe WHODAS II and the scores obtained by subjects on rating scales relat-ed to: depression, pain, schizophrenia and other psychotic disorders, quali-ty of life, sleep disorders, diabetes, ageing , rheumatic disorders, anxiety dis-orders.All studies reviewed agree that the WHODAS II is an useful instru-ment for the assessment of disability, functioning and social participation,suggesting quite often to join the administration with scales used for mea-suring quality of life (eg.: SF-36 or WHQOL-BREF).Among the 51 articlesonly eight, however, have investigated the psychometric properties of theinstrument, concluding, almost unanimously, that the psychometric proper-ties of the WHODAS II allow it to be to considered a valid and reliable in-strument for the assessment of disability.

Among the main limitations that this review has helped to highlight, it isimportant to note that, to date, there are no standardized scores for the var-ious translations of the WHODAS and that the number of studies thatsought to investigate in detail the psychometric properties of the tool is par-ticularly limited. Therefore, it would be desirable not only to universalizethe tool, but also to deepen the studies conducted so far, in order to deter-mine more precisely the advantages and limitations of WHODAS II.

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