1. Assessing Disability World Health Organization Disability Assessment Schedule II (WHODAS II) Mr Vaikunthan Rajaratnam MBBS(Mal),AM(Mal),FRCS(Ed),FRCS(Glasg),FICS(USA),MBA(USA), Dip Hand Surgery(Eur),Dip MedEd(Dundee),FHEA(UK),FFST(Ed),FAcadMEd(UK).Senior Consultant Hand Surgeon Alexandra Health, SINGAPORE

2. Disability and DamageInjury/IllnessTreatmentInterventionOutcome 3. 43 year-old female, right-handed, cookTraumatic amputation of right thumb and index finger 4. Unreplantable thumb 5. Underwent right thumb reconstruction with right big toe osteoplastic wraparound flap 1 week post-injury, after counseling and consenting 6. Toe wrap based on dorsalis pedis 7. Defining Impairment: any loss or abnormality of psychological, physiological or anatomical structure or function. Disability: any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap: a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal As traditionally used, impairment refers to a problem with a structure or organ of the body; disability is a functional limitation with regard to a particular activity; and handicap refers to a disadvantage in filling a role in life relative to a peer group. World Health Organization (1980) in The International Classification of Impairments, Disabilities, and Handicaps: 8. International Classification of Functioning, Disability and Health (ICF) classified from body, individual and societal perspectives measuring health and disability at both individual and population levels shifting the focus from cause to impact the social aspects of disability http://apps.who.int/classifications/icfbrowser/ 9. Psychometrics construction and validation of measurement instruments such as questionnaires, tests, and personality assessments 10. Classical test theory reliability and validity. Pearson correlation coefficient, and is often called test-retest reliability. index of reliability is Cronbach's concurrent validity; predictive validity, construct validity, Content validity 11. WHODAS II ISBN 978 92 4 154759 8 (NLM classification: W 15) World Health Organization 2010 http://p.ideaday.de/104.2/icf/en/index.html 12. WHODAS II generic assessment instrument standardized method for measuring health and disability developed from a comprehensive set of International Classification of Functioning, Disability and Health (ICF) Cross cultural applicability, utility, reliability and validity 13. Why is disability assessment important? there are no diseases, but patients There are no disabilities but people with problems that affect their lives 14. Why develop a method to assess disability? a decrement in each functioning domain Body, person and society International Classification of Functioning, Disability and Health (ICF) impractical for daily use WHODAS 2.0 practical, reliable and valid 15. Why learn and use a disability measure? patients needs level of care outcome of the condition length of hospitalization receipt of disability benefits work performance social integration 16. Disability assessment identifying needs matching treatments and interventions measuring outcomes and effectiveness setting priorities allocating resources. 17. Why use WHODAS 2.0? sound theoretical underpinnings good psychometric properties numerous applications direct link to the ICF Cross-cultural comparability Ease of use and availability 18. WHODAS 2.0 practical, generic assessment instrument measuring health and disability 1: Cognition understanding and communicating 2: Mobility moving and getting around 3: Self-care attending to ones hygiene, dressing, eating and staying alone 4: Getting along interacting with other people 5: Life activities domestic responsibilities, leisure, work and school 6: Participation joining in community activities, participating in society. 19. WHODA II contd common metric generic measure possible to design and monitor interventions etiologically neutral focus directly on functioning and disability full version has 36 and the short version 12 questions 20. Bio psychosocial model of ICF disability is multidimensional interaction between attributes of an individual and features of the persons physical, social and attitudinal environment 21. WHODAS and WHOQOL WHODAS 2.0 measures functioning (i.e. an objective performance in a given life domain), while WHOQOL measures subjective well-being (i.e. a feeling of satisfaction about ones performance in a given life domain). Does vs Feel 22. 36-item version interviewer-administered, self-administered and proxy-administered most detailed 20 minutes. 23. 12-item version brief assessments of overall functioning interviewer-administered, self administered and proxy-administered. explains 81% of the variance of the 36-item version five minutes. 24. 12+24-item version hybrid of the 12-item and 36-item versions Based on positive responses to the initial 12 items, respondents may be given up to 24 additional questions administered by interview or computeradaptive testing (CAT). 20 minutes. 25. Psychometric properties Testretest reliability and internal consistency - Cronbachs alpha levels 0.98 Most questions fitted in their assigned domains, confirming the unidimensionality of domains summary change scores were unaffected by sociodemographic factors Face , construct and concurrent validity 26. Practical aspects of administering and scoring Privacy frame 1 degree of difficulty frame 2 due to health conditions frame 3 in the past 30 days frame 4 averaging good and bad days frame 5 as the respondent usually does the activity frame 6 items not experienced in the past 30 days are not rated. 27. Frame of reference 1 degree of difficulty increased effort discomfort or pain slowness changes in the way the person does the activity. 28. Frame of reference 2 due to health conditions diseases, illnesses or other health problems injuries mental or emotional problems problems with alcohol problems with drugs. 29. Scoring none (1), mild (2) moderate (3), severe(4) and extreme (5)Simple vs complex scoring 30. Questions A1A5: Demographic and background information 1: Cognition understanding and communicating 2: Mobility moving and getting around 3: Self-care attending to ones hygiene, dressing, eating and staying alone 4: Getting along interacting with other people 5: Life activities domestic responsibilities, leisure, work and school 6: Participation joining in community activities, participating in society. Questions F1F5: Face sheet 31. THANK YOU