Journal of Rehabilitation Medicine 51-9 | Page 51

J Rehabil Med 2019; 51: 675–682 ORIGINAL REPORT THE WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE (WHODAS 2.0) AND THE WHO MINIMAL GENERIC SET OF DOMAINS OF FUNCTIONING AND HEALTH VERSUS CONVENTIONAL INSTRUMENTS IN SUBACUTE STROKE Sinikka TARVONEN-SCHRÖDER, MD, PhD 1 , Saija HURME, MSc 2 and Katri LAIMI, MD, PhD 3 From the 1 Department of Rehabilitation and Brain Trauma, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, 2 Department of Biostatistics, University of Turku and 3 Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland Objective: To compare short generic International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with traditio- nal measures of stroke severity and dependence in subacute stroke. Methods: In this cross-sectional study patients with stroke (n  = 195) and their significant others comple- ted the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) at discharge from rehabilitation. A neurologist assessed functio- ning with the 7-item World Health Organization (WHO) Minimal Generic Set of domains of functio- ning and health. These scores were compared with assessments of severity of stroke (National Institu- tes of Health Stroke Scale; NIHSS) and dependence (modified Rankin Scale; mRS; and Functional Inde- pendence Measure; FIM). Results: From mild to severe stroke, increasing disability was found in single items and sum scores of WHODAS and the WHO Minimal Generic Set. Al­ though proxies rated 6 out of the 12 separate WHO- DAS functions more impaired than did the patients, correlations between the different measures (proxy- and patient-WHODAS, the WHO Minimal Generic Set, mRS, NIHSS and FIM total and sub-scores) were strong to very strong, except for moderate correla- tions between patient-WHODAS, and NIHSS or FIM cognitive sub-score. Conclusion: Despite their brevity, both generic ICF- based tools were useful in finding disabilities for pa- tient- and family-centred goal-setting and service- planning after subacute rehabilitation. Key words: disability; Functional Independence Measure; modified Rankin Scale; National Institutes of Health Stroke Scale; stroke; subacute; WHODAS; WHO Minimal Generic Set of domains of functioning and health. Accepted Jul 4, 2019; Epub ahead of print Aug 12, 2019 J Rehabil Med 2019; 51: 675–682 This study compared short generic International Clas- sification of Functioning, Disability and Health (ICF)- based measures of functioning, the patient- and proxy- reported 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the 7-item WHO Minimal Generic Set of domains of functioning and health assessed by a neurologist, with traditionally used measures of stroke in the subacute phase. Although proxies rated 6 out of 12 separate WHODAS functions more impaired than did the patients, the scores of pa- tient- and proxy-reported WHODAS 2.0 and the WHO Minimal Generic Set correlated well with each other and with older measures of stroke severity (National Insti- tutes of Health Stroke Scale) and dependence (modified Rankin Scale and Functional Independence Measure). Both ICF-based tools, despite their brevity, were use- ful in finding disabilities for patient- and family-centred goal-setting and service-planning after subacute stroke rehabilitation. S troke is a leading cause of severe long-term disabi- lity. The incidence of stroke is increasing globally, especially in low- and middle-income countries. At the same time, advances in healthcare, including the use of technology, have led to higher survival rates (1–3). Consequently, there is a greater demand for interdisci- plinary rehabilitation and for individual goal-making and service-planning, in which patient- and family- centred functional assessments are needed. There is a vast number of generic and specific scales and measures for post-stroke patients (4–7), but no gold standard or single instrument to address the concepts of medical and social disability as a composite of ICF domains body structure, functions, activity, and parti- cipation. However, all these aspects should be included in the assessment of recovery after stroke. The National Institutes of Health Stroke Scale (NIHSS) is the most widely used severity scale for acute and subacute stroke, also predicting survival, functional recovery Correspondence address: Sinikka Tarvonen-Schröder, Division of Clini- cal Neurosciences, Turku University Hospital, PO Box 52, FI-20521 Turku, Finland. E-mail: [email protected] LAY ABSTRACT This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2583