Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan

Abstract

Purpose: To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. Methods: Subjects (≥60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. Results: More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75–376.42, p?<?0.001), age (1.38–4.81, p?<?0.05), and speech impairment (1.94–5.80, p?<?0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. Conclusions: Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability.

• Implications for Rehabilitation

• Older adults with physical disability often experience difficulties in household activities and mobility.

• Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease.

• Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

     

Inter-rater reliability,standard error of measurement and minimal detectable change of the 12-item WHODAS 2.0 and four performance tests in institutionalized ambulatory older adults

Purpose: Self-reported and performance-based instruments are both necessary for a comprehensive view of the functioning of institutionalized older adults. Our aim was to assess the reliability and measurement error of the 12-item World Health Organization Disability assessment Schedule and compare these indexes against performance-based tests.

Materials and methods: One hundred participants from Nursing Homes and Day Care Centers were assessed twice (two days to one week apart) by two independent assessors. Reliability and measurement error indexes were calculated.

Results: Reliability of the World Health Organization Disability assessment Schedule total score, and of three performance tests was appropriate for individual comparisons (ICC?≥?0.92). Reliability for the five times seat to stand test was appropriate for group comparisons only (ICC?=?0.84). The high measurement error of the timed up and go test (SEM?=?4.25; MDC?=?11.78) and of the five times seat to stand test (SEM?=?3.47; MDC?=?9.62) and the number of participants unable to perform them (TUG: n?=?11; FTSST: n?=?41) suggest that these tests are less suitable to monitor individual changes.

Conclusions: The 12-item World Health Organization Disability Assessment Schedule total score, the gait speed and hand grip tests could be used to monitor changes at both the individual and group level in a population with decreased functioning.

• Implications for Rehabilitation

• The 12-item World Health Organization Disability assessment Schedule, could be used to monitor changes in perceived functioning both at the individual and group level in institutionalized ambulatory older adults.

• The gait speed and hand grip tests could be used to monitor changes in performance both at the individual and group level in institutionalized ambulatory older adults’ functioning.

• The utility of the time up and go and of the five times seat to stand test might be of limited value when aiming to monitor changes in institutionalized older adults’ functioning.

     

World Health Organization disability assessment schedule 2.0: An international systematic review

Purpose: This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

Method: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on “whodas” using the ProQuest, PubMed, and Google Scholar electronic databases.

Results: We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

Conclusions: The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them.

• Implications for Rehabilitation

• WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability.

• The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry.

• WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations.

• A critical issue for rehabilitation is that a single “minimal clinically important .difference” score for the WHODAS 2.0 has not yet been established.

     

Prevalence of cardiovascular disorders among the elderly in primary care in Estonia

Scand J Prim Health Care 2003;21:000-000. ISSN 0281-3432 Objectiv e &#114 - &#114 To assess the prevalence of diagnoses of cardiovascular disorders among the elderly in family practice. Design &#114 - &#114 Cross-sectional study. Setting &#114 - &#114 Estonia, population aged 65 years or older (206 &#116 915 persons). Subjects &#114 - &#114 811 elderly persons selected randomly from the lists of family practitioners. Main outcome measures &#114 - &#114 Prevalence of hypertension, hypotension, coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) and cardiac arrhythmias; differences between the genders and age groups. Results &#114 - &#114 The prevalence of cardiovascular disorders was as follows: hypertension 63.2%, hypotension 11.1%, CHD 56.5%, MI 9.8%, HF 41.4% and arrhythmias 37.5%. Women had a significantly higher prevalence of hypertension and men of MI. The prevalence of CHD and hypotension was significantly higher in the oldest elderly persons. Conclusion &#114 - &#114 Among the older population in Estonia, cardiovascular disorders that have broader diagnostic criteria and need expensive methods for verifying (CHD, HF) have a high prevalence and are most likely over-diagnosed. The need for strict and simple diagnostic methods for these disorders in primary care practice continues to be serious.     

Capacity Measures Explain Only a Small Part of Self-Reported Disability in Institutionalized Ambulatory Older Adults: An Observational Study

Aims: To investigate the association between self-reported disability and capacity-based measures for older adults attending day care centers and nursing homes. Methods: 312 institutionalized ambulatory older adults were assessed for self-reported disability (WHODAS 2.0), capacity-based measures (gait velocity test, timed up and go test (TUG) and grip strength), demographics, pain and depression. Results: Regression models using self-reported disability as the dependent variable and capacity–based measures as the independent variables explained only 5% and 11% of self-reported disability in older adults from nursing homes and day care centers, respectively. When adding to the regression analysis, pain, depression and demographic variables as independent variables, the final model explained 52% of the variance of self-reported disability both in older adults from day care centers and nursing homes. Conclusion: These results show that self-reported disability and capacity-based measures assess very different constructs and highlight the need for interventions targeting pain and depression as a potential mean to improve self-reported disability.     

Hospice - the ideology and perspectives in Estonia

BACKGROUND: Death and dying tend to be taboo for much of humankind. Themes about death and life ending have not been popular in Estonia because of its cultural traditions and history. AIMS: To describe the attitudes of Estonian professionals towards death and dying and to describe some future visions of hospice service in Estonia. METHODS: The theoretical view in this work comes from hospice conception and empirical data gained from structured interviews with professionals who are connected with dying people in their everyday work. FINDINGS: Some ideas of the hospice conception (e.g. pain control and psychosocial support) are used in hospitals and general care centres in Estonia, but there is little respect towards dying people and their needs. The idea of interdisciplinary teamwork is not in use.     

Development of a needs assessment system in rehabilitation

The aim of this project was to develop a standardized, valid and reliable instrument for determining needs of patients and quality of care as perceived by patients. A questionnaire was constructed based upon the Service Quality Model. This model, patient expectations and experiences all play an important role in the questionnaire. The questionnaire contains a general part which includes ten determinants of care, the information the patient got and the perceived quality of care in general. The questionnaire also contains a specific part which includes questions about the actual care for diagnosis related problems. Twenty-four spinal cord injured patients, staying at a Dutch rehabilitation centre, participated in this study. It is concluded that with the developed questionnaire the perceived quality of care according to the Service Quality Model can be assessed. Major contributions of the questionnaire to rehabilitation care will be its ability to highlight patient needs related to identified symptoms, and to provide a tool to signal aspects in the organization that can be improved. Thus it becomes a tool for quality management. Recommendations have been made for further research to make future use of the questionnaire in other settings and populations possible.     

Community health service needs assessment in Korea using OMAHA Classification System

This study examined the appropriateness of OMAHA Classification System in identifying health service needs and relevant strategies for intervention by public health nurses working in community health centers in Seoul. The face-to-face interview using a questionnaire was used to assess individual and family health needs in the targeted district. Respondents were 4024 persons from 1449 households in one municipal district in Seoul, Korea. Based on OCS, 16 problems were identified including insufficient income and inadequate living space, ineffective communication with community resources, pain, and substance use. Health teaching, guidance and counseling, case management, treatment, and surveillance were identified as interventions for these problems. These results suggest that OCS is appropriate to implement in Korea to plan and organize better nursing interventions for community residents by public health nurses working in health centers.     

Validation of the Greek version of the device subscale of the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0)

The purpose of the study was to evaluate the device subscale of the QUEST 2.0 instrument and provide evidence for the validity and reliability of the Greek version. To this end, a cross-cultural adaptation was performed. Field test studies were conducted to validate the appropriateness of the final outcome. Data were drawn from a study of 115 subjects who had been administered the GR-QUEST questionnaire. Ratings related to the different items were statistically analyzed. The exploratory factor analysis with varimax rotation conducted revealed a three factors structure of the device subscale in contrast with previous studies. Our “Safe Use” subscale contains the items adjustments, safety and effectiveness of the original instrument, the “Fit to Use” subscale contains the dimensions, weight and ease of use items, and the “Endurance” subscale contains the items durability and comfort of the original questionnaire. Reliability measures (ICC=0.949, Pearson´s correlation=0.903, Cronbach´s α=0.754) yielded high values. Test-retest outcome showed great stability. Based on the results, the GR-QUEST can be considered as a valid and reliable instrument and thus it can be used to measure the satisfaction of patients with assistive devices, while it is applicable to the Greek population. Further assessment of the services subscale is needed.     

Development of paediatric critical care in northwestern Nigeria: Initial implementation with a needs assessment model

IntroductionThere is high paediatric morbidity and mortality in northwestern Nigeria, attributable in part to vaccine-preventable illnesses and lack of comprehensive training of medical and nursing staff in the healthcare delivery of paediatric critical care. Pediatric Universal Life-Saving Effort Inc. (PULSE), a New York–based nonprofit organisation with a mission to develop paediatric critical care in resource-limited settings, collaborated with Aminu Kano University Teaching Hospital to decrease the gaps in knowledge and skills of medical and nursing personnel. The joint effort also aims to address and remove barriers to the delivery of paediatric critical care in northwestern Nigeria. The primary objective was to perform a needs assessment for paediatric intensive care resources in northwestern Nigeria, identify barriers to delivering these services, and designate a hub for the development of paediatric critical care educational programs for healthcare professionals.MethodsAn anonymous survey was designed and distributed using SurveyMonkey® online software to medical and nursing staff from nine healthcare institutions in northwestern Nigeria.ResultsAnalysis from 67 responses revealed that care delivered to critically ill paediatric patients was by anaesthesiologists (77%), pediatricians (26%), and adult intensive care specialists (10%). The acquisition of clinical skills was perceived to be an essential need (65%), followed by adequate staffing of critical care units (19%), continuing medical and nursing education (13%), and availability of medical equipment (3%).DiscussionThere is an identified need for paediatric critical care training and resources in northwestern Nigeria.ConclusionThe needs assessment conducted has provided important results that will form the basis for building staff capacity and training programs for paediatric critical care in northwestern Nigeria.     

Patients’ needs assessment in cancer care: a review of assessment tools

Background The assessment of patients’ needs for care is a critical step in achieving patient-centred cancer care. Tools can be used to assess needs and inform care planning. This review discusses the importance of systematic assessment of needs in routine care and the contribution tools can make to this process. Method A rapid appraisal was undertaken to identify currently available tools for patient assessment in cancer care through searches conducted with Medline and CINHAL databases. It focused on tools for the systematic assessment of individual patients’ needs for help, care or support, to be used for clinical purposes—not for research or other purposes. Tools that focused on a single domain of care such as psychosocial needs were excluded, as were studies of patient satisfaction. A wide list of search terms was used, with references stored and managed using bibliographic software. Results In all, 1,803 papers were identified from the initial search, with 91 papers found to be relevant; although 36 tools were identified, only 15 tools were found to fit our criteria. These were appraised for their validity, reliability, responsiveness to change and feasibility, including acceptability to patients. The process of their development and psychometric properties were reasonably well documented, but data on how feasible they were to use in practice was scarce. Each tool met some but not all the widely accepted criteria for validity, reliability, responsiveness and burden. None were found to be complete for all dimensions of needs assessment. Most have not been sufficiently well tested for use in routine care. Conclusion There is a need to continue to develop and test tools that have the attributes necessary for effective practice and to research their effects on the quality of supportive cancer care.     

Mental health needs assessment of prisoners

A mental health needs assessment scale (MHNAS) was designed for use in prisons.The new tool was based on the Camberwell Assessment of Need (CAN) with many items considered irrelevant removed, the coding simplified, and open responses added.The new tool was more acceptable to prisoners and mental health staff. The tool had high internal reliability and showed face, content and convergent validity. A factor analysis suggested two dimensions, substance abuse and other mental health symptoms.     

Validation of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in persons with disabilities and chronic illnesses for Chinese population

Abstract

Purpose: The aim of this study is to test the psychometric properties and validity of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in Traditional Chinese-speaking persons with disabilities and chronic illnesses. Method: The WHODAS II CT has been administrated to a sample of 1020 persons with disabilities and chronic illnesses. The construct validity, internal consistency, concurrent validity and convergent validity were evaluated. Results: WHODAS II CT showed a satisfactory model fit for the second-order confirmatory factor analysis model (χ²/df?=?3.05, root means square error of approximation?=?0.053, comparative fit index?=?0.912, standardized root mean square residual?=?0.076), high internal consistency (Cronbach’s α?=?0.98), high correlation with all domains of Dartmouth Primary Care Cooperative Research Network/World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physicians (COOP/WONCA) charts (partial correlation coefficient ranged from 0.26 to 0.74) and significance between persons with and without co-morbidity (all regression coefficients >0). Conclusions: WHODAS II CT is a reliable and valid instrument to measure the disability in persons with disabilities and chronic illnesses among Traditional Chinese-speaking population. A further study is required to validate the short version of WHODAS II in order to enhance its applicability in usual and clinical practices.

• Implications for Rehabilitation

• This is the first study to evaluate the reliability and validity of WHODAS II in persons with disability and chronic illnesses among Traditional Chinese-speaking population.

• The WHODAS II CT is a valid instrument in Chinese adults with disabilities and chronic illnesses.

• The WHODAS II CT is recommended to be used in population-based survey to investigate the health needs of persons with disabilities and chronic illnesses as well as in the rehabilitation programs as an outcome measure.

     

An empowerment approach to needs assessment in health visiting practice

This paper examines the usefulness of an integrated approach to needs assessment using an empowerment framework, within a health visitor/client interaction, in the home setting. It is intended to demonstrate the existence of a flexible approach to assessing need that is based on research about necessary processes for carrying out health visiting. The design of the tool described in this paper allows the use of professional judgement as well as fulfilling commissioning requirements to address health outcomes. Health promotion and empowerment are central to health visiting practice and should be reflected in the way needs are assessed. Many NHS trusts have introduced a system of targeting and prioritizing health visiting through a system of questioning to assess needs. This may reveal the work that health visitors do, but may also inhibit the open, listening approach required for client empowerment. Different methods of assessing need can be used that do not compromise the commissioning requirements, the health visitor's duty of care or professional accountability. The empowerment approach is key to the philosophy of health visiting. There are ways of approaching needs assessment that do not compromise the ethos of partnership-working in a health promoting way.     

Establishing a framework for research: the example of needs assessment

• ? This paper explains the early planning stage of a study commissioned by the English National Board which will investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act 1990.
• ? Two focus groups, comprising 22 participants altogether, generated data which were used to augment and clarify issues explored in an initial literature review. Some of the methodological issues are explained.
• ? Traditional community nursing approaches to needs assessment appeared to value process and integration, while the new legislation emphasizes the separate-ness of assessment; there is a danger that it may be seen as a single event. The consumer views were both supportive and critical about each of the approaches; some important insights were gained, and a confident basis from which to launch the study identified.
• ? The approach offers one possible way to clarify the starting point of a project when carrying out a standard literature review seems insufficient. This may occur with under-researched or rapidly changing phenomena, or if a field of interest is the subject of multiple interpretations or lack of consensus.

     

Cross-cultural adaptation of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for Hebrew-speaking subjects with and without hand injury

Purpose: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire is used internationally to assess function and disability. The instrument has been translated into several languages, but no Hebrew version exists. The objective of this study was to evaluate the use of the 12-item WHODAS 2.0 questionnaire among Hebrew speakers with and without hand injuries (HI).

Methods: The translated questionnaire was conducted among 155 uninjured subjects (UI) and 77 male workers with HI. Internal consistency was assessed using Cronbach’s alpha. Test–retest reliability was assessed in UI subjects and calculated using the intraclass correlation coefficient (ICC_agreement). Validity was evaluated by correlating the 12-item WHODAS 2.0 to the short-form of health survey (SF-12) in UI subjects and comparing the 12-item WHODAS 2.0 scores and the Quick Disability of Arm, Shoulder, and Hand (QDASH) Outcome Measure in the HI group.

Results: The Cronbach’s alpha of the WHODAS 2.0 for the entire sample was α?=?0.83. The ICC_agreement for test–retest reliability was 0.88. A positive significant correlation was found between the 12-item WHODAS 2.0 and the QDASH (r_s?=?0.53, p?Conclusions: The results support the reliability and validity of this Hebrew translation of the 12-item WHODAS 2.0.

• IMPLICATIONS FOR REHABILITATION

• Measurement tools that assess activities and participation after HI are an essential part of the rehabilitation process. The 12-item WHODAS 2.0 is a useful tool, since it addresses a broader range of activity and participation domains compared to the DASH and enables better implementation of the ICF model.

• Since the WHODAS 2.0 does not target a specific disease (as oppose to the DASH), it can be used to compare disabilities caused by different diseases or traumas.

• The WHODAS 2.0 measures both the function and disability in general populations as well as clinical situations; therefore, the instrument is useful for assessing both health and disability.

     

脑性瘫痪并发言语障碍的诊断、评估与康复：基于WHO-FICs研究

目的 依据世界卫生组织国际健康分类家族(WHO-FICs)对脑性瘫痪并发言语障碍进行诊断、功能分析和康复干预研究。方法 基于《国际疾病分类》第11次修订本(ICD-11)研究相关诊断,基于《国际功能、残疾和健康分类》(ICF)研究相关功能分类,基于《国际健康干预分类》(ICHIβ-3)对言语康复进行系统分析,并制定结构化康复策略。结果 脑性瘫痪ICD-11分类为08神经系统疾病,进一步分为8D20.0痉挛型单侧脑瘫、8D20.1痉挛型双侧脑瘫(8D20.10痉挛型四肢瘫脑瘫、8D20.11痉挛型双侧脑瘫)等临床亚型;常并发的言语障碍涉及6A00智力发育障碍、6A01发育性言语或语言障碍、MA80言语障碍、MA81言语不流畅、MA82语音障碍。脑性瘫痪并发的言语功能障碍主要涉及ICF s1神经系统结构、s3涉及发声和言语的结构、b3发声和言语功能、d1学习和应用知识,以及环境和个人等多个因素;在b3发声和言语功能中,主要涉及的功能包括b310发声功能、b320构音功能和b330言语的流畅和节奏功能。脑性瘫痪言语功能的康复策略,涉及ICHIβ-3身体结构和功能、活动与参与、环境因素等领域的康复治疗方法。结论 基于WHO-FICs的ICD-11、ICF和ICHIβ-3,系统构建了脑性瘫痪并发言语障碍的评估与康复方法体系,包括疾病分类、言语并发症分类,言语功能的分类、评估与康复,建立脑性瘫痪并发言语功能障碍的临床诊断、功能分析和康复干预的方法体系和编码方法。