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Rassegna della letteratura internazionale sulla WHODAS II (Scheda per la Valutazione della Disabilità dell’Organizzazione Mondiale della Sanità)
Abstract
Introduzione. Questo studio presenta una rassegna critica sullo studio e l’utilizzo del WHODAS II, (World Health Organization Disability Assessment Schedule II) in base a quanto ad oggi compare nella letteratura scientifica internazionale. L’WHODAS II è uno strumento per l’autovalutazione delle limitazioni nell’attività e delle restrizioni nella partecipazione vissute da un individuo, indipendentemente da una diagnosi medica. L’WHODAS II è stato elaborato dal WHO’s Assessment, Classification and Epidemiology Group all’interno del WHO/NIH Joint Project sulla valutazione e sulla classificazione delle disabilità.
Obiettivi. Scopo del presente studio è di accertare il grado di diffusione, a livello mondiale, dell’utilizzo del WHODAS II e, al tempo stesso, di analizzare gli eventuali studi di validazione che siano stati compiuti sulle differenti traduzioni ed adattamenti dello strumento stesso. In particolare, ci si propone di evidenziare quali caratteristiche psicometriche dell’WHODAS II siano state indagate, con particolare riferimento alla struttura fattoriale, all’attendibilità e alla validità.
Metodo. La metodologia di indagine prescelta ha preso in considerazione le principali banche dati della produzione scientifica internazionale indicizzata, Cambridge Scientific Abstracts CSA, PubMed e Google Scholar, dal 1990 a dicembre del 2008, utilizzando come chiave di ricerca il termine “whodas” nei campi “title” e “abstract”.
Risultati. Dalla ricerca è emerso che l’WHODAS II è stato utilizzato, ad oggi, in 54 lavori, dei quali 51 sono articoli pubblicati su riviste internazionali, 2 sono stati inclusi in conferenze e 1 è una dissertazione. Tuttavia, soltanto sette articoli sono stati pubblicati su riviste o atti di conferenze che hanno come principale oggetto di interesse la disabilità e la riabilitazione. I restanti lavori sono stati pubblicati su riviste di interesse medico e psichiatrico, con l’obiettivo di individuare eventuali correlazioni sulle valutazioni di comorbidità in merito ad alcuni disturbi mentali. Inoltre, dei 51 articoli, soltanto 8 hanno indagato le proprietà psicometriche dell’WHODAS II. Dalla letteratura esaminata risulta che lo strumento sia stato tradotto in 11 differenti lingue e che sia stato somministrato finora, complessivamente, a 88.844 soggetti. Infine, l’ambito di ricerca nel quale l’WHODAS II risulta prevalentemente utilizzato è quello medico, con particolare rilievo per le specialità psichiatriche, di medicina generale e riabilitative.
Conclusioni. Tutti gli studi esaminati ritengono l’WHODAS II uno strumento efficace ed attendibile per l’accertamento del livello di disabilità, del funzionamento e della partecipazione sociale, suggerendo, non di rado, di accompagnare la somministrazione soprattutto con scale adibite alla misurazione della qualità della vita. Inoltre, gli articoli che hanno indagato le proprietà psicometriche dello strumento concordano nel considerarlo uno strumento valido ed affidabile per la valutazione della disabilità.
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IMPACT-S is the screener part of the ICF Measure of Participation and ACTivities questionnaire. IMPACT-S consists of 33 items in 9 scales, reflecting the 9 activity and participation chapters of the International Classification of Functioning, Disability and Health (ICF). The reliability and validity of IMPACT-S as an independent brief measure of activities and participation was examined.
Repeated administration of a postal questionnaire.
Road accident victims were recruited through several Dutch hospitals and rehabilitation centres. A total of 276 patients participated and 197 took part in both measurements.
Examination of test-retest reliability, reproducibility and construct validity. The World Health Organization Disability Assessment Schedule II (WHODAS-II) was included as criterion measure for concurrent validity.
Types of main injury were fractures (38%), trauma?tic brain injury (37%), spinal cord injury (13%), whiplash (9%) and other (3%). Mean time after injury was 2.2 years. Internal consistency of IMPACT-S was satisfying for all 9 domains (0.75-0.89) and excellent for the total score (0.96). Test-retest reliability was good at item level (0.44-0.72), domain level (0.72-0.92) and total score (0.94). Strong correlations (0.61-0.88) between IMPACT-S and corresponding WHODAS-II scores were found.
IMPACT-S is a reliable and valid generic measure of activity limitations and participation restrictions that fits the ICF.
The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) published and used by the World Health Organization is currently undergoing a revision. Its conceptual basis is the medical model which leads to the medicalization of disability. From this point it is a short step to eugenics and a class-based evaluation of people with disabilities using the concept of 'normal'. People with disabilities are found to be lacking and a burden. The language and the logic of the ICIDH are faulty. It is replete with biased, handicapist language. In its present form and even in its proposed revised form (ICIDH-2) it is a threat to the disability community world wide.
To estimate depression in patients with age-related macular degeneration (AMD) and study the relationships among depression, visual acuity, and disability.
It was a cross-sectional study with consecutive sampling (n = 53) of patients with AMD aged 50 years and above attending the retina clinic of a tertiary care hospital in North India. Depression, general disability and vision-specific disability were assessed in subjects meeting selection criteria. Assessments were done using the fourth edition of Diagnostic and Statistical Manual of mental disorders (DSM- IV) Geriatric Depression Scale (GDS), Structured Clinical Interview for DSM-IV Axis -I Disorders, Clinical Version (SCID-CV), World Health Organization Disability Assessment Schedule-II (WHODAS-II) and Daily Living Tasks dependent on Vision scale (DLTV). Non-parametric correlation analyses and regression analyses were performed.
Out of 53 participants, 26.4% (n = 14) met DSM-IV criteria for the diagnosis of depressive disorder. Depressed patients had significantly greater levels of general and vision-specific disability than non-depressed patients. General disability was predicted better by depression and vision-specific disability than by visual acuity.
Depression is a major concern in patients with AMD and contributes more to disability than visual impairment.
This study assessed the factor structure, internal consistency, and discriminatory validity of the World Health Organization Disability Assessment Schedule (WHODAS) version used in the European Study of the Epidemiology of Mental Disorders (ESEMeD). In total 8796 adults were assessed using the ESEMeD WHODAS (22 severity and 8 frequency items). An Exploratory Factor Analysis (EFA) with promax rotation was done with a random 50%. The other half was used for confirmatory factor analysis (CFA) comparing models (a) suggested by EFA; (b) hypothesized a priori; and (c) reduced with four items. A CFA model with covariates was conducted in the whole sample to assess invariance across Mediterranean (Spain, France and Italy) and non-Mediterranean (Belgium, Germany and the Netherlands) countries. Cronbach's alphas and discriminatory validity were also examined. EFA identified seven factors (explained variance: 80%). The reduced model (six factors, four frequency items excluded) presented the best fit [Confirmatory Fit Index (CFI) = 0.992, Tucker-Lewis Index (TLI) = 0.996, Root Mean Square Error of Approximation (RMSEA) = 0.024]. The second-order factor structure also fitted well (CFI = 0.987, TLI = 0.991, RMSEA = 0.036). Measurement non-invariance was found for Embarrassment. Cronbach's alphas ranged from 0.84 for Participation to 0.93 for Mobility. Preliminary data suggest acceptable discriminatory validity. Thus, the ESEMeD WHODAS may well be a valuable shortened version of the WHODAS-II, but future users should reconsider the filter questions.