Assessing disability – world health organization disability assessment

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disability assessment, WHO DAS 2.0, occupational therapy, occupational health, damages, personal injury, medical compensation

disability assessment, WHO DAS 2.0, occupational therapy, occupational health, damages, personal injury, medical compensation

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  • bone graft from ipsilateral olecranon was harvested

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  • 1. 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 Surgeon Alexandra Health, SINGAPORE
  • 2. Disability and Damage Injury/Illness Treatment Intervention Outcome
  • 3.  43 year-old female, right-handed, cook Traumatic amputation of right thumb and index finger 
  • 4. Unreplantable thumb
  • 5. Underwent right thumb reconstruction with right big toe osteoplastic wrap- around flap 1 week post-injury, after counseling and consenting
  • 6. Toe wrap based on dorsalis pedis
  • 7. 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:
  • 8. 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/
  • 9. Psychometrics construction and validation of measurement instruments such as questionnaires, tests, and personality assessments
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. Why is disability assessment important? • “there are no diseases, but patients” • There are no disabilities but people with problems that affect their lives
  • 14. 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
  • 15. 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
  • 16. Disability assessment • identifying needs • matching treatments and interventions • measuring outcomes and effectiveness • setting priorities • allocating resources.
  • 17. 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
  • 18. WHODAS 2.0 practical, 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.
  • 19. 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
  • 20. 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
  • 21. 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
  • 22. 36-item version • interviewer-administered, self-administered and proxy-administered • most detailed • 20 minutes.
  • 23. 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.
  • 24. 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.
  • 25. 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
  • 26. 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.
  • 27. Frame of reference 1 – degree of difficulty • • increased effort • • discomfort or pain • • slowness • • changes in the way the person does the activity.
  • 28. 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.
  • 29. Scoring • “none” (1), • “mild” (2) • “moderate” (3), • “severe”(4) and • “extreme” (5) Simple vs complex scoring
  • 30. • Questions A1–A5: Demographic and background information 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. • Questions F1–F5: Face sheet
  • 31. THANK YOU