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Validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with Huntington disease (HD)

Quality of Life Research volume 24, pages 1963–1971 (2015)Cite this article

Abstract

Purpose

The reliability and construct validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) were examined in individuals with Huntington disease (HD).

Methods

We examined factor structure (confirmatory factor analysis), internal consistency reliability (Cronbach’s alpha), floor and ceiling effects, convergent validity (Pearson correlations), and known-groups validity (multivariate analysis).

Results

Results of a confirmatory factor analysis replicated the six-factor latent model that reflects the six separate scales within the WHODAS 2.0 (understanding and communicating; getting around; self-care; getting along with others; life activities; participation). Cronbach’s alpha for the scale was 0.94, suggesting good internal consistency reliability. The WHODAS demonstrated a ceiling effect for 19.5 % of participants; there were no floor effects. There was evidence for convergent validity; the WHODAS demonstrated moderate significant correlations with other general measures of health-related quality of life (HRQOL; i.e., RAND-12, EQ5D). Multivariate analyses indicated that late-stage HD participants indicated poorer HRQOL than both early-stage HD and prodromal HD participants for all HRQOL measures.

Conclusions

Findings provide support for both the reliability and validity of the WHODAS 2.0 in individuals with HD.

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References

  1. Ustun, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., et al. (2010). Developing the World Health Organization Disability Assessment Schedule 2.0. Bulletin of the World Health Organization, 88(11), 815–823.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Rehm, J., Ustun, B., Saxena, S., Nelson, C. B., Chatterji, S., Ivis, F., & Adlaf, E. (2006). On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population. International Journal of Methods in Psychiatric Research, 8(2), 110–122.

    Article  Google Scholar 

  3. Scorza, P., Stevenson, A., Canino, G., Mushashi, C., Kanyanganzi, F., Munyanah, M., & Betancourt, T. (2013). Validation of the “World Health Organization Disability Assessment Schedule for children, WHODAS-Child” in Rwanda. PLoS ONE, 8(3), e57725.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Posl, M., Cieza, A., & Stucki, G. (2007). Psychometric properties of the WHODASII in rehabilitation patients. Quality of Life Research, 16(9), 1521–1531.

    Article  PubMed  Google Scholar 

  5. Garin, O., Ayuso-Mateos, J. L., Almansa, J., Nieto, M., Chatterji, S., Vilagut, G., et al. (2010). Validation of the “World Health Organization Disability Assessment Schedule, WHODAS-2” in patients with chronic diseases. Health Qual Life Outcomes, 8, 51.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Federici, S., Meloni, F., Mancini, A., Lauriola, M., & Olivetti Belardinelli, M. (2009). World Health Organisation Disability Assessment Schedule II: Contribution to the Italian validation. Disability and Rehabilitation, 31(7), 553–564.

    Article  PubMed  Google Scholar 

  7. Kulnik, S. T., & Nikoletou, D. (2014). WHODAS 2.0 in community rehabilitation: A qualitative investigation into the validity of a generic patient-reported measure of disability. Disability and Rehabilitation, 36(2), 146–154.

    Article  PubMed  Google Scholar 

  8. McArdle, R., Chisolm, T. H., Abrams, H. B., Wilson, R. H., & Doyle, P. J. (2005). The WHO-DAS II: Measuring outcomes of hearing aid intervention for adults. Trends Amplif, 9(3), 127–143.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Chisolm, T. H., Abrams, H. B., McArdle, R., Wilson, R. H., & Doyle, P. J. (2005). The WHO-DAS II: Psychometric properties in the measurement of functional health status in adults with acquired hearing loss. Trends in Amplification, 9(3), 111–126.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Baron, M., Schieir, O., Hudson, M., Steele, R., Kolahi, S., Berkson, L., et al. (2008). The clinimetric properties of the World Health Organization Disability Assessment Schedule II in early inflammatory arthritis. Arthritis and Rheumatism, 59(3), 382–390.

    Article  PubMed  Google Scholar 

  11. Meesters, J. J., Verhoef, J., Liem, I. S., Putter, H., & Vliet Vlieland, T. P. (2010). Validity and responsiveness of the World Health Organization Disability Assessment Schedule II to assess disability in rheumatoid arthritis patients. Rheumatology (Oxford), 49(2), 326–333.

    Article  Google Scholar 

  12. Kutlay, S., Kucukdeveci, A. A., Elhan, A. H., Oztuna, D., Koc, N., & Tennant, A. (2011). Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis. Rheumatology International, 31(3), 339–346.

    Article  PubMed  Google Scholar 

  13. Hudson, M., Steele, R., Taillefer, S., & Baron, M. (2008). Quality of life in systemic sclerosis: Psychometric properties of the World Health Organization Disability Assessment Schedule II. Arthritis and Rheumatism, 59(2), 270–278.

    Article  PubMed  Google Scholar 

  14. Noonan, V. K., Kopec, J. A., Noreau, L., Singer, J., Masse, L. C., & Dvorak, M. F. (2010). Comparing the reliability of five participation instruments in persons with spinal conditions. Journal of Rehabilitation Medicine, 42(8), 735–743.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Noonan, V. K., Kopec, J. A., Noreau, L., Singer, J., Masse, L. C., Zhang, H., & Dvorak, M. F. (2010). Comparing the validity of five participation instruments in persons with spinal conditions. Journal of Rehabilitation Medicine, 42(8), 724–734.

    Article  PubMed  Google Scholar 

  17. Schlote, A., Richter, M., Wunderlich, M. T., Poppendick, U., Moller, C., Schwelm, K., & Wallesch, C. W. (2009). WHODAS II with people after stroke and their relatives. Disability and Rehabilitation, 31(11), 855–864.

    Article  CAS  PubMed  Google Scholar 

  18. Kucukdeveci, A. A., Kutlay, S., Yildizlar, D., Oztuna, 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.

    Article  PubMed  Google Scholar 

  19. Zhao, H. P., Liu, Y., Li, H. L., Ma, L., Zhang, Y. J., & Wang, J. (2013). Activity limitation and participation restrictions of breast cancer patients receiving chemotherapy: Psychometric properties and validation of the Chinese version of the WHODAS 2.0. Quality of Life Research, 22(4), 897–906.

    Article  PubMed  Google Scholar 

  20. Downing, N. R., Kim, J. I., Williams, J. K., Long, J. D., Mills, J. A., & Paulsen, J. S. (2014). WHODAS 2.0 in prodromal Huntington disease: Measures of functioning in neuropsychiatric disease. European Journal of Human Genetics, 22, 958–963.

  21. Guilera, G., Gomez-Benito, J., Pino, O., Rojo, J. E., Cuesta, M. J., Martinez-Aran, A., et al. (2012). Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138(2–3), 240–247.

    Article  PubMed  Google Scholar 

  22. Schippers, G. M., Broekman, T. G., Buchholz, A., Koeter, M. W., & van den Brink, W. (2010). Measurements in the Addictions for Triage and Evaluation (MATE): An instrument based on the World Health Organization family of international classifications. Addiction, 105(5), 862–871.

    Article  PubMed  Google Scholar 

  23. Kim, J. I., Long, J. D., Mills, J. A., Downing, N., Williams, J. K., Paulsen, J. S., the Predict-HD Investigators, & Group, t. C. o. t. H. S. (in press). Performance of the 12-item WHODAS 2.0 in prodromal Huntingon disease. European Journal of Human Genetics.

  24. Sousa, R. M., Dewey, M. E., Acosta, D., Jotheeswaran, A. T., Castro-Costa, E., Ferri, C. P., et al. (2010). Measuring disability across cultures–the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries. The 10/66 Dementia Research Group population-based survey. International Journal of Methods in Psychiatric Research, 19(1), 1–17.

    PubMed Central  PubMed  Google Scholar 

  25. Andrews, G., Kemp, A., Sunderland, M., Von Korff, M., & Ustun, T. B. (2009). Normative data for the 12 item WHO Disability Assessment Schedule 2.0. PLoS ONE, 4(12), e8343.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Pringsheim, T., Wiltshire, K., Day, L., Dykeman, J., Steeves, T., & Jette, N. (2012). The incidence and prevalence of Huntington’s disease: A systematic review and meta-analysis. Movement Disorders, 27(9), 1083–1091.

    Article  PubMed  Google Scholar 

  27. Ho, L. W., Carmichael, J., Swartz, J., Wyttenbach, A., Rankin, J., & Rubinsztein, D. C. (2001). The molecular biology of Huntington’s disease. Psychological Medicine, 31(1), 3–14.

    Article  CAS  PubMed  Google Scholar 

  28. Paulsen, J. S., Hayden, M., Stout, J. C., Langbehn, D. R., Aylward, E., Ross, C. A., et al. (2006). Preparing for preventive clinical trials: The predict-HD study. Archives of Neurology, 63(6), 883–890.

    Article  PubMed  Google Scholar 

  29. Paulsen, J. S., Langbehn, D. R., Stout, J. C., Aylward, E., Ross, C. A., Nance, M., et al. (2008). Detection of Huntington’s disease decades before diagnosis: The Predict-HD study. Journal of Neurology, Neurosurgery and Psychiatry, 79(8), 874–880.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Shoulson, I., & Fahn, S. (1979). Huntington Disease—Clinical Care and Evaluation. Neurology, 29(1), 1–3.

    Article  CAS  PubMed  Google Scholar 

  31. Paulsen, J. S., Hayden, M., Stout, J. C., Langbehn, D. R., Aylward, E., Ross, C. A., et al. (2006). Preparing for preventive clinical trials—The Predict-HD study. Archives of Neurology, 63(6), 883–890.

    Article  PubMed  Google Scholar 

  32. Hays, R. D., Sherbourn, C. D., & Mazel, R. (1995). User’s manual for the Medical Outcomes Study (MOS) core measures of health-related quality of life. Santa Monica, CA: RAND corporation.

    Google Scholar 

  33. Feeny, D., Farris, K., Cote, I., Johnson, J. A., Tsuyuki, R. T., & Eng, K. (2005). A cohort study found the RAND-12 and Health Utilities Index Mark 3 demonstrated construct validity in high-risk primary care patients. Journal of Clinical Epidemiology, 58(2), 138–141.

    Article  PubMed  Google Scholar 

  34. Johnson, J. A., & Maddigan, S. L. (2004). Performance of the RAND-12 and SF-12 summary scores in type 2 diabetes. Quality of Life Research, 13(2), 449–456.

    Article  PubMed  Google Scholar 

  35. Maddigan, S. L., Feeny, D. H., Johnson, J. A., & Investigators, D. (2004). Construct validity of the RAND-12 and Health Utilities Index Mark 2 and 3 in type 2 diabetes. Quality of Life Research, 13(2), 435–448.

    Article  PubMed  Google Scholar 

  36. Selim, A. J., Rogers, W., Fleishman, J. A., Qian, S. X., Fincke, B. G., Rothendler, J. A., & Kazis, L. E. (2009). Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Quality of Life Research, 18(1), 43–52.

    Article  PubMed  Google Scholar 

  37. Rabin, R., & de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343.

    Article  CAS  PubMed  Google Scholar 

  38. Brazier, J. E., Walters, S. J., Nicholl, J. P., & Kohler, B. (1996). Using the SF-36 and Euroqol on an elderly population. Quality of Life Research, 5(2), 195–204.

    Article  CAS  PubMed  Google Scholar 

  39. Luo, N., Johnson, J. A., Shaw, J. W., Feeny, D., & Coons, S. J. (2005). Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index. Medical Care, 43(11), 1078–1086.

    Article  PubMed  Google Scholar 

  40. Fryback, D. G., Dunham, N. C., Palta, M., Hanmer, J., Buechner, J., Cherepanov, D., et al. (2007). US norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Medical Care, 45(12), 1162–1170.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Johnson, J. A., & Coons, S. J. (1998). Comparison of the EQ-5D and SF-12 in an adult US sample. Quality of Life Research, 7(2), 155–166.

    Article  CAS  PubMed  Google Scholar 

  42. Dyer, M. T., Goldsmith, K. A., Sharples, L. S., & Buxton, M. J. (2010). A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes, 8, 13.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Calvert, M. J., Freemantle, N., & Cleland, J. G. (2005). The impact of chronic heart failure on health-related quality of life data acquired in the baseline phase of the CARE-HF study. European Journal of Heart Failure, 7(2), 243–251.

    Article  PubMed  Google Scholar 

  44. Dorman, P., Slattery, J., Farrell, B., Dennis, M., & Sandercock, P. (1998). Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. Stroke, 29(1), 63–68.

    Article  CAS  PubMed  Google Scholar 

  45. Hurst, N. P., Kind, P., Ruta, D., Hunter, M., & Stubbings, A. (1997). Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D). British Journal of Rheumatology, 36(5), 551–559.

    Article  CAS  PubMed  Google Scholar 

  46. Carlozzi, N. E., Miciura, A., Migliore, N., & Dayalu, P. (2014). Understanding the outcomes measures used in Huntington disease pharmacological trials: A systematic review. Journal of Huntington’s Disease, 3(3), 233–252.

    PubMed Central  PubMed  Google Scholar 

  47. Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York: Guilford Press.

    Google Scholar 

  48. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246.

    Article  CAS  PubMed  Google Scholar 

  49. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling-A Multidisciplinary Journal, 6(1), 1–55.

    Article  Google Scholar 

  50. Hatcher, L. (1994). A step-by-step approach to using SAS for factor analysis and structural equation modeling. Cary, NC: SAS Institute Inc.

    Google Scholar 

  51. Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81–105.

    Article  CAS  PubMed  Google Scholar 

  52. Buist-Bouwman, M. A., Ormel, J., De Graaf, R., Vilagut, G., Alonso, J., Van Sonderen, E., & Vollebergh, W. A. (2008). Psychometric properties of the World Health Organization Disability Assessment Schedule used in the European Study of the Epidemiology of Mental Disorders. International Journal of Methods in Psychiatric Research, 17(4), 185–197.

    Article  CAS  PubMed  Google Scholar 

  53. Carlozzi, N. E., & Tulsky, D. S. (2013). Identification of health-related quality of life (HRQOL) issues relevant to individuals with Huntington disease. Journal of Health Psychology, 18(2), 212–225.

  54. Downing, N. R., Williams, J. K., & Paulsen, J. S. (2010). Couples’ attributions for work function changes in prodromal Huntington disease. Journal of Genetic Counseling, 19(4), 343–352.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

Work on this manuscript was supported by the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (1R01NS077946, 5R01NS040068, 1R01NS077946), the National Center for Advancing Translational Sciences (UL1TR000114), the CHDI Foundation awards to the University of Iowa, and the NIH support of the phenotyping performed by CIDR. We thank the University of Iowa, the Investigators and Coordinators of the Huntington Study Group, the study participants, the National Research Roster for Huntington Disease Patients and Families, and the Huntington’s Disease Society of America. We acknowledge the assistance of Jeffrey D. Long, Hans J. Johnson, and Jeremy H. Bockholt. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. HDQLIFE Site Investigators and Coordinators: Praveen Dayalu, Amy Austin (University of Michigan, Ann Arbor, MI); Courtney Shadrick, Amanda Miller (University of Iowa, Iowa City, IA); Kimberly Quaid, Melissa Wesson (Indiana University, Indianapolis, IN); Christopher Ross, Gregory Churchill, Mary Jane Ong (Johns Hopkins University, Baltimore, MD); Susan Perlman, Brian Clemente (University of California-Los Angeles, Los Angeles, CA); Michael McCormack, Humberto Marin, Allison Dicke (Rutgers University, Piscataway, NJ); Joel Perlmutter, Stacey Barton, Shineeka Smith (Washington University, St. Louis, MO); Martha Nance, Pat Ede (Struthers Parkinson’s Center); Anwar Ahmed, Christine Reece, Lyla Mourany (Cleveland Clinic Foundation, Cleveland, OH); Michael Geschwind, Joseph Winer (University of California-San Francisco, San Francisco, CA).

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, USA

    Noelle E. Carlozzi, Anna L. Kratz, Siera Goodnight, Jennifer A. Miner & Nicholas Migliore

  2. College of Nursing, The University of Iowa, Iowa City, IA, USA

    Nancy R. Downing

  3. Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA

    Jane S. Paulsen

  4. Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA

    Jane S. Paulsen

  5. Department of Psychology, The University of Iowa, Iowa City, IA, USA

    Jane S. Paulsen

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  1. Noelle E. Carlozzi
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  2. Anna L. Kratz
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  3. Nancy R. Downing
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  4. Siera Goodnight
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  5. Jennifer A. Miner
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  6. Nicholas Migliore
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  7. Jane S. Paulsen
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Correspondence to Noelle E. Carlozzi.

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Carlozzi, N.E., Kratz, A.L., Downing, N.R. et al. Validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with Huntington disease (HD). Qual Life Res 24, 1963–1971 (2015). https://doi.org/10.1007/s11136-015-0930-x

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