Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 43
J Rehabil Med 2019; 51: 40–46
ORIGINAL REPORT
UTILITY OF THE WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT
SCHEDULE AND THE WORLD HEALTH ORGANIZATION MINIMAL GENERIC SET
OF DOMAINS OF FUNCTIONING AND HEALTH IN SPINAL CORD INJURY
Sinikka TARVONEN-SCHRÖDER, MD, PhD 1 , Anne KALJONEN, BSc 1 and Katri LAIMI, MD, PhD 1
From the 1 Department of Rehabilitation and Brain Trauma, Division of Clinical Neurosciences and 3 Department of Physical and
Rehabilitation Medicine, Turku University Hospital and University of Turku, and 2 Department of Biostatistics, University of Turku,
Turku, Finland
Objective: To compare easy-to-use International
Classification of Functioning, Disability and Health
(ICF)-based measures of functioning with the level
and severity of spinal cord injury.
Methods: Cross-sectional study. Patients (n = 142)
and their significant others completed the 12-item
World Health Organization Disability Assessment
Schedule (WHODAS 2.0) questionnaire. A physician
at the university hospital outpatient clinic assessed
functioning with the 7-item World Health Organiza-
tion (WHO) minimal generic set.
Results: The patient and proxy WHODAS sum score
was rated severe with decreasing severity in groups
with complete and partial tetraplegia and paraple-
gia, respectively. Working ability was rated most
severely impaired in the tetraplegic groups. Bet-
ween-group differences were also found in mobility,
household tasks, and self-care. Mobility was found
to be associated with lesion severity; life activities,
participation and friendships with lesion level; and
self-care and WHODAS sum score with both lesion
severity and level. Depending on the level and seve-
rity of spinal cord injury, a moderate to strong cor-
relation was found between the sum scores of the 2
tools, and mostly very strong correlations between
patient and proxy assessments of functioning.
Conclusion: Both generic ICF-based tools, despite
their briefness, seemed to be useful as they were
able to differentiate various levels and severities of
spinal cord injury. We recommend using the 12-item
WHODAS 2.0 when planning individualized services
for patients with spinal cord injury.
Key words: disability; ICF; severity; spinal cord injury; WHO
minimal generic set of domains of functioning and health;
WHODAS.
Accepted Oct 3, 2018; Epub ahead of print Nov 8, 2018
J Rehabil Med 2019; 51: 40–46
Correspondence address: Sinikka Tarvonen-Schröder, Division of Clini-
cal Neurosciences, Turku University Hospital, PO Box 52, FIN-20521
Turku, Finland. E-mail: [email protected]
S
pinal cord injury (SCI) is a major cause of long-
term disability (1–9), with increasing prevalence
rates unless measures are taken to control incidence
(2). It has been estimated that the prevalence of non-
traumatic SCI may overtake traumatic SCI in the next
LAY ABSTRACT
Two easy-to-use validated International Classification
of Functioning, Disability and Health (ICF)-based tools,
the 12-item patient and proxy World Health Organiza-
tion Disability Assessment Schedule (WHODAS 2.0) and
the 7-item World Health Organization minimal generic
set used by a physician, were found to be reliable and
useful in assessing functioning in patients with spinal
cord injury. These tools can, with little effort, be used to
detect activity limitations and participation restrictions,
and differentiate various severities and levels of spinal
cord injury. As the minimal generic set is brief and li-
mited, we recommend using the 12-item WHODAS 2.0
when planning individualized services for patients with
spinal cord injury.
decades (6). In the light of previous studies, patients
with non-traumatic SCI seem to reach the same fun-
ctional outcomes as those with traumatic SCI (1, 4).
With improved acute care and greater life expectancies
after SCI, the focus of management has shifted to
interventions aiming to improve functioning, quality
of life and involvement in life situations. The ultimate
aim of rehabilitation is for patients to reach optimal
participation despite their disabilities.
Different instruments have been used to evaluate
the severity of SCI, patient’s needs and treatment ef-
fects (10–13). Some of these outcome measures do
not address functional relevance (11). Priorities in
developing appropriate functioning instruments for
patients with SCI include understanding the dimen-
sions of participation, and the importance of both
objective and subjective measures (10). Only a few
studies, however, have tested participation instruments,
such as WHODAS 2.0, in individuals with SCI, and
there is still a lack of studies comparing self-rated
functioning with more objectively defined parameters
(14–19). Other difficulties in measuring functioning
lie in a redundancy of instruments for different health
conditions and tools that are too time-consuming for
clinical settings. Among ICF-based tools developed
by the WHO (20), the 2 shortest validated generic
assessment scales are the 7-item minimal generic set
of domains of functioning and health (21) and the 12-
item World Health Organization Disability Assessment
Schedule (WHODAS 2.0) (22). These 7- and 12-item
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
doi: 10.2340/16501977-2501
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977