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RehabMeasures Instrument

World Health Organization Disability Assessment Schedule II

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Purpose

A generic instrument that measures health and disability in six life domains across cultures using a standardized method.

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instrument details

Acronym WHODAS II

Area of Assessment

Cognition
Functional Mobility
Life Participation
Activities of Daily Living
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • The WHODAS 2.0 has 3 versions: 36-item, 12-item and 12+24 item.
  • All items relate to individual’s difficulties in functioning within past 30 days.
  • Assesses day to day functioning in the following six domains:
    1) Cognition
    2) Mobility
    3) Self-care
    4) Getting along with others
    5) Life Activities
    6) Participation
  • Sum scores for overall functioning are converted to into a metric ranging from 0-100:
    A) Maximum Score: 100 = full disability
    B) Minimum Score: 0 = no disability
  • Results provide domain specific scores as well as an overall disability score.
  • Items can be scored two different ways, simple scoring and complex scoring:
    A) In simple scoring, the scores assigned to each of the items are summed. The following scores are assigned to each item: “none” (0), “mild” (1) “moderate” (2), “severe” (3) and “extreme” (4)*. Simple scoring is practical to use as a hand-scoring approach (busy clinical settings or in paper–pencil interview).
    B) In complex scoring, there is weighting of individual items dependent on severity. Complex scoring can be done using a computer program available on the WHO website.
  • Due to feedback from practitioners, scoring system updated to scale of 0-4, original scale of 1-5 is outdated but listed in current manual (WHO, 2017).

Number of Items

36

Equipment Required

  • Copy of questionnaire
  • Pen/Pencil

Time to Administer

20 minutes

5 to 20 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed in 2018 by University of Illinois at Chicago Master of Science in Occupational Therapy students Michelle Dominguez, OTS; Claudia Sanchez-Ayala, OTS; Vivian Villegas, OTS.

ICF Domain

Participation
Activity

Measurement Domain

Activities of Daily Living
Cognition
Emotion
General Health
Motor

Considerations

  • Interviewer, proxy, and self-administered versions available.

  • WHODAS 2.0 does not assess environmental factors enabling/inhibiting activity and participation.

Arthritis

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Normative Data

Rheumatoid Arthritis: (Meesters et al., 2009; n = 85; mean age = 61.0 years; mean duration of RA = 6.0 years; female = 77%; scores after inpatient and day-patient therapy by trained multidisciplinary team; Netherlands sample)

  • Median score at baseline: 40.5

  • Median score at 6 weeks after discharge: 4.6

Internal Consistency

Rheumatoid Arthritis: (Meesters et al., 2009)

  • Excellent internal consistency (Cronbach’s alpha = 0.91)

Construct Validity

Convergent validity:

Rheumatoid Arthritis: (Meesters et al., 2009)

  • Adequate: HAQ, stair test, grip strength, D-AIMS2, DAS-28, VAS-Pain, and RAQoL (Pearson rank correlation coefficients = 0.50, 0.39, 0.29, 0.53, 0.28, 0.42, 0.52)

  • Poor: 50-feet walk test, timed-stands test, and Escola Paulista de Medicina Range of Motion scale (Pearson rank correlation coefficients = 0.22, 0.20, 0.19)

Floor/Ceiling Effects

Rheumatoid Arthritis: (Meesters et al., 2009)

  • Adequate floor effect of 17% for subscale “understanding and communicating”

  • Adequate floor effect of 18% for subscale “getting along with people”

  • Adequate floor effect of 14% for subscale “self-care”

 

Responsiveness

Rheumatoid Arthritis: (Meesters et al., 2009)

  • High: “getting around” and “participation in society” (RR = 0.84, 0.80)

  • Moderate: WHODAS 2.0 total score, “understanding and communicating”, “self-care”, “life activities” (RR = 0.58, 0.56, 0.58, 0.48)

  • Low: “getting along with people” (RR = 0.04)

Non-Specific Patient Population

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Test/Retest Reliability

Schizophrenia: (Guilera et al., 2012; n = 352; mean age = 36.7; mean average duration of illness = 140.65 months; diagnoses include schizophrenia, schizoaffective disorder and schizophreniform disorder; Spanish sample)

  • Excellent test-retest reliability: (ICC = 0.92). Subscale range = 0.63-0.88

Interrater/Intrarater Reliability

Trauma: (Abedzadeh-kalahroudi, 2015; n = 220; mean age = 34.7; mean time post trauma = at least 24 hours; mean GCS score = 12.7; Persian)

  • Excellent interrater reliability: (ICC = 0.99)

 

Internal Consistency

Trauma: (Abedzadeh-kalahroudi, 2015)

  • Acceptable to Excellent: Cronbach’s alpha = 0.51-0.87 (only 3/12 items had an alpha value < 0.68)

Schizophrenia (Guilera et al., 2012)

  • Excellent: Cronbach’s alpha = 0.94)

Normative Sample: (Haley et al., 1992; n = 412)

  • Excellent: Cronbach's alpha range from 0.95-0.99

 

Criterion Validity (Predictive/Concurrent)

Schizophrenia (Guilera et al., 2012)

  • Low/Moderate to High correlation with the Positive and Negative Syndrome Scale (PANSS-G) and the Hamilton Depression Rating Scale (HAM-D)

Construct Validity

Trauma: (Abedzadeh-kalahroudi et al., 2015)

  • Items representing the activity domain have a very strong mean Spearman’s rank coefficient (rho = .81). The range for these items is 0.67 - 0.93)

  • Items representing the participation domain have a strong mean Spearman’s rank coefficient (rho = .76). The range for these items is 0.50 - 0.92)

Content Validity

Schizophrenia (Guilera et al., 2012)

  • All indicators are relevant for defining the corresponding domains (cognition, mobility, self-care, getting along, life activities and participation).

Floor/Ceiling Effects

Schizophrenia (Guilera et al., 2012).

  • Strong floor effects

  • Strong ceiling effects, with more than 60% of participants obtaining the best score on sub scales of “getting around” and “self-care”

Spinal Injuries

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Internal Consistency

Spinal Cord Injury: (De Wolf et al., 2012; n = 63; mean age = 34.7 years; studied at 2 years post discharge from inpatient unit; male = 81%; ASIA Impairment Scale: A = 59%, B = 6%, C = 6%, D = 29%; Australian sample)

  • Excellent internal consistency for WHODAS 2.0 Total Score (Cronbach’s alpha = 0.95)

  • Excellent internal consistency for following domains: “understanding and communicating”, “self-care”, “life activities”, and “participation” (Cronbach’s alpha = 0.93, 0.94, 0.96, 0.97)

  • Adequate internal consistency for “getting along with others” domain (Cronbach’s alpha = 0.73)

  • Poor internal consistency for “getting around” domain (Cronbach’s alpha = 0.61)

Construct Validity

Discriminant validity:

Spinal Cord Injury: (De Wolf et al., 2012)

  • Excellent discriminant validity for WHODAS 2.0 Total Score (Mann-Whitney U = 2.02)

  • Excellent discriminant validity for following domains: “getting around”, “self-care”, and “life activities” (Mann-Whitney U = 2.79, 4.90, 1.89)

Floor/Ceiling Effects

Spinal Cord Injury: (De Wolf et al., 2012)

  • Adequate ceiling effect of following domains: “getting along with others” and “life activities” (Ceiling Effects % = 19, 16)

  • Poor ceiling effect of following domains: “understanding and communicating” and “self-care” (Ceiling Effects % = 54, 29)

Stroke

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Interrater/Intrarater Reliability

Stroke: (Schlote et al., 2008, n = 84; mean age = 56; diagnoses include: ischemic and hemorrhagic strokes)

  • Satisfactory to Excellent Interrater Reliability (ICC= 0.64*-0.94)

*Understanding and Communication and Total Score

 

Internal Consistency

Stroke: (Küçükdeveci et al., 2013; n = 188; mean age = 61; time since stroke: min = 3 months, median = 27 months, and max = 240 months)

  • Excellent: Cronbach's Alpha = 0.90- 0.93

Stroke: (Schlote et al., 2008)

  • Good to Excellent: Cronbach's Αlpha = 0.81-0.99

Construct Validity

Stroke: (Schlote et al., 2008)

 

  • Items representing the different domains of the assessment have varying Spearman’s Rank coefficients ranging from low to strong: (0.31-0.83)

  • Low to moderate correlation with ratings for understanding and communicating (rho = 0.44-0.56).

  • Moderate to strong correlation with rating for getting around (rho = 0.60-0.75).

  • Moderate to strong correlations with rating for self-care (rho = 0.62-0.83)

  • Moderate correlation with ratings for getting along with people (rho = 0.43-0.58).

  • Moderate to strong correlation with ratings for life activities (rho = 0.64-0.78).

  • Low to moderate correlation with ratings for participation in society (rho = 0.31-0.59).

  • Moderate correlation with ratings for single items (rho = 0.49-0.58)

 

Bibliography

Abedzadeh–kalahroudi, M., Razi, E., Sehat, M., & Asadi-Lari, M. (2016). Psychometric properties of the World Health Organization Disability Assessment Schedule II-12 Item (WHODAS II) in trauma patients. Injury, 47(5), 1104-1108. Find it on PubMed

De Wolf, A. C., Tate, R. L., Lannin, N. A., Middleton, J., Lane-Brown, A., & Cameron, I. D. (2012). The World Health Organization Disability Assessment Scale, WHODAS II: Reliability and validity in the measurement of activity and participation in a spinal cord injury population. Journal of Rehabilitation Medicine, 44(9), 747-755. Find it on PubMed

Guilera, G., Gómez-Benito, J., Pino, O., Rojo, J. E., Cuesta, M. J., Martínez-Arán, A., ... & Crespo-Facorro, B. (2012). Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138(2), 240-247. Find it on PubMed

Küçükdeveci, A. A., Kutlay, Ş., Yıldızlar, D., Öztuna, D., Elhan, A. H., & Tennant, A. (2013). The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke. Disability and Rehabilitation, 35(3), 214-220. Find it on PubMed

Meesters, J. J., Verhoef, J., Liem, I. S., Putter, H., & Vliet Vlieland, T. P. (2009). Validity and responsiveness of the World Health Organization Disability Assessment Schedule II to assess disability in rheumatoid arthritis patients. Rheumatology, 49(2), 326-333. Find it on PubMed

Schlote, A., Richter, M., Wunderlich, M. T., Poppendick, U., Möller, C., Schwelm, K., & Wallesch, C. W. (2009). WHODAS II with people after stroke and their relatives. Disability and Rehabilitation, 31(11), 855-864. Find it on PubMed

World Health Organization. (2017, September 4). WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Retrieved from http://www.who.int/classifications/icf/more_whodas/en/

World Health Organization. (2010). Measuring health and disability. Manual for WHO disability assessment scale. Whodas 2.0. [assessment manual]. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/43974/9789241547598_eng.pdf;jsessionid=73DE626D8D6E4E4B7577B086E3B29AC6?sequence=1

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