Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 46
Disability in spinal cord injury
43
Table IV. Spearman Correlations of patient-rated World Health Organization Disability Assessment Schedule (WHODAS) domains with
spinal cord injury severity (AIS grade), level, walking ability, working status, and physician-rated functioning
Variable Lesion level tetraplegia Any walking ability
AIS grade D (n = 89)
(n = 71) vs paraplegia (n = 100) vs seated
vs grades A–C (n = 53) (n = 71)
(n = 42) Current
employment (n = 19) Generic set sum
(n = 142)
Cognition
Mobility
Self-care
Getting along
Life activities
Participation
WHODAS sum score
Generic set sum score 0.15
–0.52****
–0.24**
–0.04
–0.04
0.07
–0.16*
–0.33**** 0.09
0.34****
0.26**
0.11
0.24**
0.13
0.27***
0.33**** 0.08
0.56****
0.39****
0.26**
0.40****
0.27***
0.49****
1.00
–0.04
0.09
–0.30***
–0.19*
–0.27**
–0.18*
–0.24**
0.02
0.21*
–0.52****
–0.25**
–0.01
–0.06
0.19*
–0.15
–0.41****
*p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001.
AIS: ASIA (American Spinal Cord Injury Association) Impairment Scale.
found in household activities and self-care. When the
ratings of those with a complete lesion (AIS A–B) were
compared with those with a partial lesion (AIS C–D), a
complete lesion was associated with more difficulties
in getting around and self-care, and a partial lesion
with participation difficulties.
The Spearman correlations of the 6 patient-rated
WHODAS domains with SCI severity (AIS grade),
lesion level, walking ability, current working status,
and physician-rated functioning (generic set sum score)
are shown in Table IV. The correlation between the
patient-rated WHODAS sum score and the physician-
rated generic set sum score was moderate in all other
patient groups, except for a strong correlation in the
group with AIS D tetraplegia. The generic set sum
score was correlated with all other WHODAS domains
(0.26–0.56) except cognition.
The correlation coefficient between patient and
proxy WHODAS sum scores was very strong (0.89)
with strong to very strong correlations in single items
except for the item “dealing with strangers” with only a
moderate correlation. The significant others rated both
the total disability (sum score) and the items learning,
emotions and dressing as slightly more impaired than
did the patients themselves. Cronbach’s alpha value
for reliability of the WHODAS patient sum was 0.86,
the WHODAS significant other 0.86 and the minimal
generic set sum 0.75.
DISCUSSION
These results support the utility of both generic measu-
res WHODAS 2.0 and the WHO minimal generic set in
assessing functioning of patients with SCI. The degree
of perceived impairment (WHODAS sum score) was
found to increase from incomplete paraplegia through
complete paraplegia and partial tetraplegia to complete
tetraplegia, respectively.
In our study population, participants typically had
hardly any problems in cognition, emotions or rela-
tionships. The most severe impairments were found
in getting around and life activities, followed by self-
care, these results being largely in line with previous
studies in SCI (15–17, 31, 32). Participation, on the
other hand, was rated less severely impaired among
our participants, the restriction being only mild in all
other groups except those with a partial tetraplegia.
Obviously, the ratings do not strictly measure the level
of functional capacity, but evaluate the level of actual
performance in real-life situations and also reflect
environmental factors, e.g. the amount of assistance
and aids, support and services the patients receive in
the community, as in previous studies (13). Unexpec-
tedly, those with an incomplete SCI lesion were found
to experience more difficulties in community life than
those with a complete lesion. Our hypothesis is that, if
people with a complete lesion and more severe symp-
toms get daily help from trained caregivers, those with
a milder injury with no such aid may experience more
restricted participation than those with a more severe
or complete injury. The groups with a partial lesion
were also 7–9 years older than the other 2 groups with
a complete lesion, which could have some influence
on the results even if the age difference was not sta-
tistically significant.
These results show that participants with a cervical
lesion (partial or complete tetraplegia) experience
more impairments in self-care and life activities,
including the ability to work, than those with a lower
lesion, which is in agreement with previous studies
(18, 33–35). It is natural that, when those with a com-
plete motor lesion were compared with those with an
incomplete lesion, a complete lesion was associated
with more difficulties in getting around and self-care.
In our study, inability to walk was correlated with other
impairments (getting around, self-care, participation
and cognition) as in previous studies, which found
wheelchair-dependency (36, 37) and mobility restric-
tions (17) to increase difficulties in other domains of
participation (17, 37) and to decrease quality of life
(36). Also, current employment was found to be asso-
ciated with other domains (mobility, self-care, and life
J Rehabil Med 51, 2019