Assessment of

Disabilities

DR. ABDUL RASHAD

SENIOR LECTURER
DPT,MPHILL(OPT)MPPTA
UNITED COLLEGE OF PHYSICAL THERAPY
DISABILITY AND DAMAGE

Injury/Illness Treatmen Intervention Outcom

t e
  43 year-old female, right-handed, cook

 Traumatic amputation of right thumb and

index n
ig
fer

UNREPLANTABLE THUMB
Underwent right thumb reconstruction
with right big toe osteoplastic wrap-
around flap 1 week post-injury, after
counseling and consenting
Toe wrap based
on dorsalis
pedis
DEFINITIONS
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

World Health Organization (1980) in The International Classification

of
Impairments, Disabilities, and
Handicaps:
 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/icfbro
wser/
PSYCHOMETRICS
the science of measuring mental
capacities and processes. construction and
validation of measurement instruments such as
questionnaires, tests, and personality assessments
 CLASSICAL TEST THEORY
• reliability and validity.
– Pearson correlation
coefficient, and is often
called test-retest reliability.
• concurrent validity;
predictive validity,
construct
validity, Content
validity
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
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
 WHY IS DISABILITY ASSESSMENT
IMPORTANT?
• “there are no
diseases, but
patients”
• There are no
disabilities but people
with problems that
affect their lives
 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
 WHY LEARN AND USE A
DISABILITY MEASURE?

• patient’s needs
• level of care
• outcome of the condition
• length of hospitalization
• receipt of disability
benefits
• work performance
• social integration
DISABILITY ASSESSMENT
• identifying needs
• matching
treatments
and
interventions
• measuring
outcomes
and
effectiveness
• setting
priorities
WHY USE WHODAS 2.0?
• sound theoretical
underpinnings
• numerous applications
• direct link to the ICF
• Cross-cultural comparability
• Ease of use and availability
 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 one’s
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.
BIO PSYCHOSOCIAL MODEL OF ICF
• Disability is multidimensional
• Interaction between attributes of an
individual and features of the person’s
physical, social and attitudinal environment
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 one’s performance in a
given life domain).
36-item version
• This questionnaire asks about difficulties due to
health/mental health conditions. Health conditions
include diseases or illnesses, other health problems
that may be short or long lasting, injuries, mental or
emotional problems, and problems with alcohol or
drugs. Think back over the past 30 days and answer
these questions thinking about how much difficulty
you had doing the following activities. For each
question, please circle only one response
• most detailed
• 20 minutes.
12-item version
• brief assessments of overall functioning
• interviewer-administered, self
administered
• five minutes.
 12+24-item version
• Based on positive responses to the initial
12 items, respondents may be given up to
24 additional questions
• administered by interview or
computer- adaptive testing (CAT).
• 20 minutes.
PSYCHOMETRIC PROPERTIES
• Test–retest reliability and internal
consistency
- Cronbach’s 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
 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.
 FRAME OF REFERENCE 1 – DEGREE OF
DIFFICULTY
• increased effort
• discomfort or pain
• slowness
• changes in the way the person does the
activity.
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.
SCORING
• “none” (1),
• “mild” (2)
• “moderate” (3),
• “severe”(4) and
• “extreme” (5)

Simple vs complex
scoring
Questions A1–A5: Demographic and background
information
1: Cognition – understanding and communicating
• 2: Mobility – moving and getting around
•3: Self-care – attending to one’s 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.