Activity limitation and participation restrictions of breast cancer patients receiving chemotherapy: psychometric properties and validation of the Chinese version of the WHODAS 2.0.
ABSTRACT PURPOSE: This study sought to determine the psychometric properties of the Chinese version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in a sample of 402 primary breast cancer patients receiving chemotherapy after surgery. METHODS: Four-hundred and two subjects were interviewed with the Chinese version of the WHODAS 2.0. Patients also completed the Functional Assessment of Cancer Therapy-Breast (FACT-B). Internal consistency reliability was measured by Cronbach's α. Spearman correlation coefficients between total scores and subscales of FACT-B and WHODAS 2.0 were examined to get the convergent validity. Independent sample t test was applied to test discriminant validity by comparing the difference of disability scores for different degree of relevant symptoms. The factor structure of the WHODAS 2.0 was examined by Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis. RESULTS: The Chinese version of the WHODAS 2.0 showed satisfactory internal consistency (r, 0.72-0.92), convergent validity and discriminant validity. After 4 items(item D2.2: standing up; D3.3: eating; D4.5: sexual activities; and D6.3: living with dignity) were excluded, EFA identified seven separate factors for 'Self-care and Household activities,' 'Getting along with people,' 'Getting around,' 'Understanding,' 'Communicating,' 'Participation in society' and 'Family burden'(explained variance 72.13 %). The reduced model also presented the best fit [Confirmatory Fit Index = 0.914, Tucker-Lewis Index = 0.900, Root Mean Square Error of Approximation = 0.069] compared with the model suggested by EFA and hypothesized a prior. CONCLUSIONS: Overall, the Chinese version of the WHODAS 2.0 is a reliable and valid instrument for measuring activity limitation and participation restrictions in Chinese breast cancer patients receiving chemotherapy.
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ABSTRACT: To describe the development of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for measuring functioning and disability in accordance with the International Classification of Functioning, Disability and Health. WHODAS 2.0 is a standard metric for ensuring scientific comparability across different populations. A series of studies was carried out globally. Over 65,000 respondents drawn from the general population and from specific patient populations were interviewed by trained interviewers who applied the WHODAS 2.0 (with 36 items in its full version and 12 items in a shortened version). The WHODAS 2.0 was found to have high internal consistency (Cronbach's alpha, α: 0.86), a stable factor structure; high test-retest reliability (intraclass correlation coefficient: 0.98); good concurrent validity in patient classification when compared with other recognized disability measurement instruments; conformity to Rasch scaling properties across populations, and good responsiveness (i.e. sensitivity to change). Effect sizes ranged from 0.44 to 1.38 for different health interventions targeting various health conditions. The WHODAS 2.0 meets the need for a robust instrument that can be easily administered to measure the impact of health conditions, monitor the effectiveness of interventions and estimate the burden of both mental and physical disorders across different populations.Bulletin of the World Health Organisation 11/2010; 88(11):815-23. · 5.25 Impact Factor
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ABSTRACT: The World Health Organization Disability Assessment Schedule (WHO DAS II) is a new measure of disability based on the ICIDH-2 model of functioning and disability. This study evaluates the measurement properties of the WHO DAS II in two disorders commonly encountered in the primary care setting. Seventy-three patients with depression and 76 patients with back pain were interviewed at baseline and after 3 months of usual primary care. Internal validity, convergent validity, and responsiveness to change of the WHO DAS II were evaluated. The WHO DAS II had excellent internal validity and convergent validity in the primary care setting. The responsiveness to change of the WHO DAS II was comparable to that of the SF-36. The WHO DAS II appears to be a useful health status instrument for measuring the disability associated with both physical and mental disorders in the primary care setting. This instrument facilitates the use of the ICIDH-2 as a framework for evaluating activity limitations and participation.Journal of Clinical Epidemiology 07/2003; 56(6):507-14. · 5.33 Impact Factor
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ABSTRACT: The WHODAS-2 is a disability assessment instrument based on the conceptual framework of the International Classification of Functioning, Disability, and Health (ICF). It provides a global measure of disability and 7 domain-specific scores. The aim of this study was to assess WHODAS-2 conceptual model and metric properties in a set of chronic and prevalent clinical conditions accounting for a wide scope of disability in Europe. 1,119 patients with one of 13 chronic conditions were recruited in 7 European centres. Participants were clinically evaluated and administered the WHODAS-2 and the SF-36 at baseline, 6 weeks and 3 months of follow-up. The latent structure was explored and confirmed by factor analysis (FA). Reliability was assessed in terms of internal consistency (Cronbach's alpha) and reproducibility (intra-class correlation coefficients, ICC). Construct validity was evaluated by correlating the WHODAS-2 and SF-36 domains, and comparing known groups based on the clinical-severity and work status. Effect size (ES) coefficient was used to assess responsiveness. To assess reproducibility and responsiveness, subsamples of stable (at 6 weeks) and improved (after 3 moths) patients were defined, respectively, according to changes in their clinical-severity. The satisfactory FA goodness of fit indexes confirmed a second order factor structure with 7 dimensions, and a global score for the WHODAS-2. Cronbach's alpha ranged from 0.77 (self care) to 0.98 (life activities: work or school), and the ICC was lower, but achieved the recommended standard of 0.7 for four domains. Correlations between global WHODAS-2 score and the different domains of the SF-36 ranged from -0.29 to -0.65. Most of the WHODAS-2 scores showed statistically significant differences among clinical-severity groups for all pathologies, and between working patients and those not working due to ill health (p < 0.001). Among the subsample of patients who had improved, responsiveness coefficients were small to moderate (ES = 0.3-0.7), but higher than those of the SF-36. The latent structure originally designed by WHODAS-2 developers has been confirmed for the first time, and it has shown good metric properties in clinic and rehabilitation samples. Therefore, considerable support is provided to the WHODAS-2 utilization as an international instrument to measure disability based on the ICF model.Health and Quality of Life Outcomes 01/2010; 8:51. · 2.27 Impact Factor