WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)

[Andy]

WHODAS 2.0 is:

• A generic assessment instrument for health and disability A tool to produce standardized disability levels and profiles Applicable across cultures, in all adult populations Directly linked at the level of the concepts to the International Classification of Functioning, Disability and Health (ICF)
• Used across all diseases, including mental, neurological and addictive disorders
• Short, simple and easy to administer (5 to 20 minutes)
• Applicable in both clinical and general population settings
• A tool to produce standardized disability levels and profiles
• Applicable across cultures, in all adult populations
• Directly linked at the level of the concepts to the International Classification of Functioning, Disability and Health (ICF)

WHODAS 2.0 covers 6 Domains of Functioning, including:

• Cognition – understanding & communicating
• Mobility– moving & getting around
• Self-care– hygiene, dressing, eating & staying alone
• Getting along– interacting with other people
• Life activities– domestic responsibilities, leisure, work & school
• Participation– joining in community activities

Further reading, and access to scoring sheets, at https://www.who.int/classifications/icf/more_whodas/en/

 

[Andy]

12 item scoring sheet

Useful for brief assessments of overall functioning in surveys
Allows to compute overall functioning scores
Explains 81% of the variance of the 36-item version
Available as interviewer-, self-, and proxy-administered forms
Average interview time: 5 min.

0 = No Difficulty
1 = Mild Difficulty
2 = Moderate Difficulty
3 = Severe Difficulty
4 = Extreme Difficulty or Cannot Do

Q1. Standing for long periods such as 30 minutes?
Q2. Taking care of your household responsibilities?
Q3. Learning a new task, for example, learning how to get to a new place?
Q4. How much of a problem did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?
Q5. How much have you been emotionally affected by your health problems?
Q6. Concentrating on doing something for ten minutes?
Q7. Walking a long distance such as a kilometre [or equivalent]?
Q8. Washing your whole body?
Q9. Getting dressed?
Q10. Dealing with people you do not know?
Q11. Maintaining a friendship?
Q12. Your day-to-day work/school?

Available as a spreadsheet here, https://www.who.int/classifications/icf/docs/12item_Scoring_Template.xlsx?ua=1

 

[Andy]

36 item scoring sheet

36-item version
Provides most detail
Allows to compute overall and 6 domain specific functioning scores
Available as interviewer-, self-, and proxy-administered forms
Average interview time: 20 min.

0 = No Difficulty
1 = Mild Difficulty
2 = Moderate Difficulty
3 = Severe Difficulty
4 = Extreme Difficulty or Cannot Do

Q1. Concentrating on doing something for ten minutes?
Q2. Remembering to do important things?
Q3. Analysing and finding solutions to problems in day-to-day life?
Q4. Learning a new task, for example, learning how to get to a new place?
Q5. Generally understanding what people say?
Q6. Starting and maintaining a conversation?
Q7. Standing for long periods such as 30 minutes?
Q8. Standing up from sitting down?
Q9. Moving around inside your home?
Q10. Getting out of your home?
Q11. Walking a long distance such as a kilometre [or equivalent]?
Q12. Washing your whole body?
Q13. Getting dressed?
Q14. Eating?
Q15. Staying by yourself for a few days?
Q16. Dealing with people you do not know?
Q17. Maintaining a friendship?
Q18. Getting along with people who are close to you?
Q19. Making new friends?
Q20. Sexual activities?
Q21. Taking care of your household responsibilities?
Q22. Doing most important household tasks well?
Q23. Getting all the household work done that you needed to do?
Q24. Getting your household work done as quickly as needed?
Q25. Your day-to-day work/school?
Q26. Doing your most important work/school tasks well?
Q27. Getting all the work done that you need to do?
Q28. Getting your work done as quickly as needed?
Q29. How much of a problem did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?
Q30. How much of a problem did you have because of barriers or hindrances in the world around you?
Q31. How much of a problem did you have living with dignity because of the attitudes and actions of others?
Q32. How much time did you spend on your health condition, or its consequences?
Q33. How much have you been emotionally affected by your health condition?
Q34. How much has your health been a drain on the financial resources of you or your family?
Q35. How much of a problem did your family have because of your health problems?
Q36. How much of a problem did you have in doing things by yourself for relaxation or pleasure?

Available as a spreadsheet here, https://www.who.int/classifications/icf/docs/36item_Scoring_Template_Simple_Scoring.xlsx?ua=1
and 36-item Instrument Scoring Sheet, Domain-Weighted Scoring Calculation here, https://www.who.int/classifications/icf/36item_Scoring_Template_Complex_Scoring.xlsx?ua=1

Let the critique begin.

 

[Andy]

For reference, from Validation of the "World Health Organization Disability Assessment Schedule, WHODAS-2" in patients with chronic diseases, open access https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-8-51

Scoring over 60% puts me on par with the most impaired in this study - a claim to fame that I'd prefer not to have.

 

[Wonko]

It is, at first glance, an improvement over other such things - although I really, really, doubt that it will lead to a 'standard' in terms of recognising the level of disability of people.

Many things are still quite 'vague'.

One that jumps out at me is Q16. 'Dealing with people you do not know?'

WTF does that actually mean.

I 'deal with' many people I do not know all the time, simply by not interacting with them. I successfully deal with over 7 billion people this way.

Does it mean a 'simple' thing, like the momentary transaction of putting a pint of milk on a counter, paying for it, and then picking it up and leaving, or does it mean trying to sort out a missing order, or a totally out of the blue housing inspection.

Or any of a thousand other different things where interacting with an unknown person is necessary.

What does 'dealing with' actually mean?

(I know you probably don't have an answer - but all of these sorts of things leave the 'standard' scale open to manipulation and misinterpretation by those who choose to. Let alone one organisation deciding that a score of x means you are disabled enough to require help, but another deciding that a score of 5x is needed, and anyone with a score of x is not disabled, in any way)

ETA - There was originally another paragraph on how 'successfully' should be defined, as the implication is that 'dealing with other people' would mean dealing with them successfully - and what that might mean - but on re-reading I discovered that the question doesn't use the word, only implies it - so I removed that paragraph.

That's just one question, out of the 36 - 7 words.

 

[Trish]

I tried it and scored just under 70% but some of the questions make no sense on their scoring system, and some are impossible to score. And of course almost all of them I could have shifted up or down by a point according to how I interpret them.

Take the last question:
How much of a problem did you have in doing things by yourself for relaxation or pleasure?
I could score that as moderate difficulty (2 points), because I have managed to find things to do that I enjoy within my limitations, but can only do them for short periods on good days.
Or I could score it as cannot do (4 points), because I have had to drop altogether most of the things I enjoyed doing before I got sick.

 

[Wonko]

68.75% - but, as mentioned, a lot (if not all) of the questions are 'vague', and for some the contents of the answer key are meaningless as an answer.

For myself, mostly relaxation is lying down, doing as little as possible - this isn't always easy, but it also isn't an 'activity' in the strictest sense, it's whole purpose being to curtail activity, as I need to rest in a, mainly, horizontal fashion. Unless of course resting is an activity. Which it is, if looked at a certain way.

Sometimes, but only sometimes, my body reports that it is happy not to be upright and/or doing things (as opposed to merely dropping the number of complaints) - this is evidenced by the sort of 'comfort' sensations and movements I often saw my cat perform when she was 'content' and 'comfortable' - this could, by the determined, be construed as 'pleasurable'. I am not sure if this state can be achieved without pharmaceutical help these days - as without them my sofa feels like spiky rocks.

 

[rvallee]

36 item scoring sheet


0 = No Difficulty
1 = Mild Difficulty
2 = Moderate Difficulty
3 = Severe Difficulty
4 = Extreme Difficulty or Cannot Do

Q1. Concentrating on doing something for ten minutes?
Q2. Remembering to do important things?
Q3. Analysing and finding solutions to problems in day-to-day life?
Q4. Learning a new task, for example, learning how to get to a new place?
Q5. Generally understanding what people say?
Q6. Starting and maintaining a conversation?
Q7. Standing for long periods such as 30 minutes?
Q8. Standing up from sitting down?
Q9. Moving around inside your home?
Q10. Getting out of your home?
Q11. Walking a long distance such as a kilometre [or equivalent]?
Q12. Washing your whole body?
Q13. Getting dressed?
Q14. Eating?
Q15. Staying by yourself for a few days?
Q16. Dealing with people you do not know?
Q17. Maintaining a friendship?
Q18. Getting along with people who are close to you?
Q19. Making new friends?
Q20. Sexual activities?
Q21. Taking care of your household responsibilities?
Q22. Doing most important household tasks well?
Q23. Getting all the household work done that you needed to do?
Q24. Getting your household work done as quickly as needed?
Q25. Your day-to-day work/school?
Q26. Doing your most important work/school tasks well?
Q27. Getting all the work done that you need to do?
Q28. Getting your work done as quickly as needed?
Q29. How much of a problem did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?
Q30. How much of a problem did you have because of barriers or hindrances in the world around you?
Q31. How much of a problem did you have living with dignity because of the attitudes and actions of others?
Q32. How much time did you spend on your health condition, or its consequences?
Q33. How much have you been emotionally affected by your health condition?
Q34. How much has your health been a drain on the financial resources of you or your family?
Q35. How much of a problem did your family have because of your health problems?
Q36. How much of a problem did you have in doing things by yourself for relaxation or pleasure?

Available as a spreadsheet here, https://www.who.int/classifications/icf/docs/36item_Scoring_Template_Simple_Scoring.xlsx?ua=1
and 36-item Instrument Scoring Sheet, Domain-Weighted Scoring Calculation here, https://www.who.int/classifications/icf/36item_Scoring_Template_Complex_Scoring.xlsx?ua=1

Let the critique begin.

Well ain't that nice. Basically the same general idea we were discussing a few weeks ago here: https://www.s4me.info/threads/does-...tch-your-mecfs-level.16467/page-2#post-283092.

Contains additional items but it's based on practical limitations of everyday activities. Promising, although some items appear to be too vague or open to too much interpretation.

 

[Denise]

Several questions in the WHODAS 2.0 would not be possible for young people to answer. Supposedly a child and your version is underway but that's been the case for a while now (a couple of years at least).

"Is there a children and youth version of the WHODAS 2.0 ?
Not yet available, but has been initiated in light of the growing importance of child and youth populations worldwide, and the need to assess functioning and disability in children and youth is becoming more prominent." https://www.who.int/classifications/icf/whodasii/en/index6.html

 

[Hutan]

Scoring over 60% puts me on par with the most impaired in this study - a claim to fame that I'd prefer not to have.

Same.

It's quite good I think. Of course it is vague, but I like that it covered not only being able to do housework or work, but how well you can do it and how fast you can do it. There's the problem of the variability of ME/CFS, that I could be functioning well one hour and curled up on my bed feeling as though I've been run over the next, but any simple questionnaire is going to struggle with that. And that variability has a big impact on my ability to work, so I guess the work questions cover it a bit.

Given that it's from WHO, it seems a tool worth looking at some more. It would be nice to see some ME/CFS research use it.

Those figures for Parkinsons and MS look amazingly low.

 

[alktipping]

over 100% i think this form needs some modifications since many disabling diseases or illnesses are fluctuating in nature . its also very depressing to score yourself on any scale because i am sure like most people i ignore how bad things are for most of the time until i actually have to do something having recently improved a little as in no longer getting rapid muscle fatigue pain just brushing my teeth .the small things really do count as far as emotional wellbeing goes .

 

[alex3619]

i am sure like most people i ignore how bad things are for most of the time until i actually have to do something

Its worse than that for some of us. I literally forget what problems I have until I am having to do something again and have issues. How do subjective evaluations do in people with serious memory issues? Heck, memory is not entirely reliable even in healthy people!

 

[adambeyoncelowe]

Same.

It's quite good I think. Of course it is vague, but I like that it covered not only being able to do housework or work, but how well you can do it and how fast you can do it. There's the problem of the variability of ME/CFS, that I could be functioning well one hour and curled up on my bed feeling as though I've been run over the next, but any simple questionnaire is going to struggle with that. And that variability has a big impact on my ability to work, so I guess the work questions cover it a bit.

Given that it's from WHO, it seems a tool worth looking at some more. It would be nice to see some ME/CFS research use it.

Those figures for Parkinsons and MS look amazingly low.

I think this is maybe a reflection of the treatments available and the general awareness of those conditions? Also, depression probably scores highly because of stigma, but also because of the impact of motivation/anhedonia on the social and domestic elements.

I notice that positivity would affect my results quite a bit. For some, the answers could be 2-4, depending on interpretation. But even if I went with 2s, it would still put my overall QOL on a par with severe stroke.

If I went bang in the middle, it's worse than RA.

Going with the higher result scores very highly compared to the other conditions.

The number of days affected doesn't seem to impact the scoring, though, unless I'm doing it wrong? You'd think it would bear that in mind, too. A mild patient might have fewer really bad days than a moderately affected one.

I suspect enjoyment and positivity are big factors in the scoring here.

For us there's the added complication that we probably could do some things once or twice that we don't do, because the cost of doing it is unpredictable and/or not worth it.

There are so many minute and invisible factors that affect our energy envelopes (e.g., how well we slept last night, whether our other conditions are playing up too, whether we've caught a bug, whether we ate something we struggle to digest, whether there's a tad too much light or noise, etc). I think planning only gets us so far.

I don't think questionnaires like this capture that risk or variation as well as they could.

 

[Kitty]

I don't think questionnaires like this capture that risk or variation as well as they could.

Absolutely. You'd have to repeat it every day for months in order to get a broad historic average, but as that wouldn't describe your status accurately for most of the time – and would be subject to change anyway – it's probably a waste of energy.