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Activity limitation and participation restrictions of breast cancer patients receiving chemotherapy: psychometric properties and validation of the Chinese version of the WHODAS 2.0

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Abstract

Purpose

This study sought to determine the psychometric properties of the Chinese version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in a sample of 402 primary breast cancer patients receiving chemotherapy after surgery.

Methods

Four-hundred and two subjects were interviewed with the Chinese version of the WHODAS 2.0. Patients also completed the Functional Assessment of Cancer Therapy-Breast (FACT-B). Internal consistency reliability was measured by Cronbach’s α. Spearman correlation coefficients between total scores and subscales of FACT-B and WHODAS 2.0 were examined to get the convergent validity. Independent sample t test was applied to test discriminant validity by comparing the difference of disability scores for different degree of relevant symptoms. The factor structure of the WHODAS 2.0 was examined by Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis.

Results

The Chinese version of the WHODAS 2.0 showed satisfactory internal consistency (r, 0.72–0.92), convergent validity and discriminant validity. After 4 items(item D2.2: standing up; D3.3: eating; D4.5: sexual activities; and D6.3: living with dignity) were excluded, EFA identified seven separate factors for ‘Self-care and Household activities,’ ‘Getting along with people,’ ‘Getting around,’ ‘Understanding,’ ‘Communicating,’ ‘Participation in society’ and ‘Family burden’(explained variance 72.13 %). The reduced model also presented the best fit [Confirmatory Fit Index = 0.914, Tucker-Lewis Index = 0.900, Root Mean Square Error of Approximation = 0.069] compared with the model suggested by EFA and hypothesized a prior.

Conclusions

Overall, the Chinese version of the WHODAS 2.0 is a reliable and valid instrument for measuring activity limitation and participation restrictions in Chinese breast cancer patients receiving chemotherapy.

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References

  1. Mathers, C. D., & Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 3(11), 2011–2030.

    Article  Google Scholar 

  2. ICIDH-2: international classification of functioning and disability (1999) World Health Organization, Geneva.

  3. Bickenbach, J. E., Chatterji, S., Badley, E. M., & Ustun, T. B. (1999). Models of disablement, universalism, and the international classification of impairments, disabilities and handicaps. Social Science and Medicine, 48(9), 1173–1187.

    Article  PubMed  CAS  Google Scholar 

  4. 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 World Health Organization, 88(11), 815–823.

    Article  Google Scholar 

  5. World Health Organization Disability Assessment Schedule II (WHODASII) (2001) http://www.who.int/icidh/whodas/index.html. Accessed on 6 July 2009.

  6. Garin, O., Ayuso-Mateos, J., 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 and Quality of Life Outcomes, 8(1), 51–66.

    Article  PubMed  Google Scholar 

  7. Murphy, B., Herrman, H., Hawthorne, G., Pinzone, T., & Evert, H. (2000). Australian WHOQOL instruments: User’s manual and interpretation guide. Melbourne: The University of Melbourne Department of Psychiatry.

    Google Scholar 

  8. Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al. (1993). The functional assessment of cancer therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570–579.

    PubMed  CAS  Google Scholar 

  9. Chwastiak, L. A., & Von Korff, M. (2003). Disability in depression and back pain: Evaluation of the World Health Organization Disability Assessment Schedule (WHODAS II) in a primary care setting. Journal of Clinical Epidemiology, 56(6), 507–514.

    Article  PubMed  Google Scholar 

  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  11. 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 

  12. Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2006). Multivariate data analysis (6th ed.). New Jersey: Prentice Hall.

    Google Scholar 

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

    Article  Google Scholar 

  14. Kemmler, G., Schemied, B., Shetty-Lee, A., Zangerle, R., Hinterhuber, H., Schussler, G., et al. (2003). Quality of life of HIV-infected patients: Psychometric properties and validation of the German version of the MQOL-HIV. Quality of Life Research, 12(8), 1037–1050.

    Article  PubMed  CAS  Google Scholar 

  15. Ahles, T. A., & Saykin, A. (2001). Cognitive effects of standard-dose chemotherapy in patients with cancer. Cancer Investigation, 19(8), 812–820.

    Article  PubMed  CAS  Google Scholar 

  16. Minisini, A., Atlay, G., Bottomley, A., Puglisi, F., Piccart, M., & Biganzoli, L. (2004). What is the effect of anticancer treatment on cognitive function? Lancet Oncology, 5(5), 273–282.

    Article  PubMed  Google Scholar 

  17. Reid-Arndt, S., Yee, A., Perry, M. C., & Hsieh, C. (2009). Cognitive and psychological factors associated with early post-treatment functional outcomes in breast cancer survivors. Journal of Psychosocial Oncology, 27(4), 415–434.

    Article  PubMed  Google Scholar 

  18. Tchen, N., Juffs, H. G., Downie, F. P., Yi, Q. L., Hu, H. X., Chemerynsky, I., et al. (2003). Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 21(22), 4175–4183.

    Article  PubMed  Google Scholar 

  19. Avis, N. E., Crawford, S., & Manuel, J. (2004). Psychosocial problems among younger women with breast cancer. Psycho-Oncology, 13(5), 295–308.

    Article  PubMed  Google Scholar 

  20. Lohr, K. N. (2002). Assessing health status and quality of life instruments: Attributes and review criteria. Quality of Life Research, 11(3), 193–205.

    Article  Google Scholar 

  21. Brady, M. J., Cella, D. F., Mo, F., Bonomi, A. E., Tulsky, D. S., Lloyd, S. R., et al. (1997). Reliability and validity of the functional assessment of cancer therapy-breast quality of life instrument. Journal of Clinical Oncology, 15(3), 974–986.

    PubMed  CAS  Google Scholar 

  22. Yellen, B. Y., Cella, D. F., Webster, K., Blendowski, C., Kaplan, E., & Sarokhan, B. (1997). Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy measurement system. Journal of Pain and System Management, 13(2), 63–74.

    Article  CAS  Google Scholar 

  23. McKibbin, C., Patterson, T. L., & Jeste, D. V. (2004). Assessing disability in older patients with schizophrenia: Results from the WHODAS-II. The Journal of Nervous and Mental Disease, 192(6), 405–413.

    Article  PubMed  Google Scholar 

  24. Chen, F. F., West, S. G., & Sousa, K. H. (2006). A comparison of bifactor and second order models of quality of life. Multivariate Behavioral Research, 41(2), 189–225.

    Article  Google Scholar 

  25. Tang, S. T. (2009). Supporting cancer patients dying at home or at a hospital for Taiwanese family caregivers. Cancer Nursing, 32(2), 151–157.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was made possible in part by a Grant of Higher Education Research Program from Education Affairs Bureau of Liaoning Province (L2010677). Professor Zhuoying Qiu as the WHO coordinator of ICF program in China gave permission to the application of Chinese version of WHODAS 2.0. We are grateful to Mr. Peter Messenger for his assistance on language correction.

Author information

Authors and Affiliations

  1. The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China

    Ying Liu & Yan Jun Zhang

  2. School of Nursing, China Medical University, Shenyang, Liaoning, China

    Hai Ping Zhao, Hong Li Li & Li Ma

  3. Affiliated Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

    Jing Wang

Authors
  1. Hai Ping Zhao
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  2. Ying Liu
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  3. Hong Li Li
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  4. Li Ma
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  5. Yan Jun Zhang
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  6. Jing Wang
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Corresponding author

Correspondence to Ying Liu.

Appendix

Appendix

32-item interviewer-administered the World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0)

Domain question

None

Mild

Moderate

Severe

Extreme/Can not do

1

2

3

4

5

Domain 1: Understanding & Communicating in the last 30 days, how much difficulty did you have in:

     

D1.1 concentrating

     

D1.2 remembering

     

D1.3 finding solutions

     

D1.4 learning new task

     

D1.5 understanding

     

D1.6 conversation

     

Domain 2:Getting around in the last 30 days, how much difficulty did you have in:

     

D2.1 standing

     

D2.2 standing up

     

D2.3 moving around

     

D2.4 getting out of home

     

D2.5 walking

     

Domain 3: Self-care in the last 30 days, how much difficulty did you have in:

     

D3.1 washing

     

D3.2 dressing

     

D3.3 eating

     

D3.4 staying by yourself

     

Domain 4: Getting along with people in the last 30 days, how much difficulty did you have in:

     

D4.1 dealing with people unknown

     

D4.2 maintaining friendship

     

D4.3 getting along with people close

     

D4.4 make new friends

     

D4.5 sexual activities

     

Domain 5: Household activities in the last 30 days, how much difficulty did you have in:

     

D5.1 household responsibilities

     

D5.2 doing household tasks well

     

D5.3 doing housework needed

     

D5.4 household work done quickly

     

Domain 6: Participation in society in the last 30 days,

     

D6.1 how much of a problem did you have in joining in communities activities

     

D6.2 how much of a problem did you have because of barriers

     

D6.3 how much of a problem did you have living with dignity

     

D6.4 how much time did you spend on health condition

     

D6.5 how much have you been emotionally affected

     

D6.6 how much has your health been a drain on financial resources

     

D6.7how much of a problems did your family have

     

D6.8 how much of a problem did you have in doing things for relaxation

     

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Zhao, H.P., Liu, Y., Li, H.L. et al. Activity limitation and participation restrictions of breast cancer patients receiving chemotherapy: psychometric properties and validation of the Chinese version of the WHODAS 2.0. Qual Life Res 22, 897–906 (2013). https://doi.org/10.1007/s11136-012-0212-9

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  • DOI: https://doi.org/10.1007/s11136-012-0212-9

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