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