Differences between rehabilitation team, rehabilitants, and significant others in opinions on functioning of subacute stroke survivors

LAY ABSTRACTThis study compared short generic International Classification of Functioning, Disability and Health (ICF)based measures of functioning, the patient-and proxyreported 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the 7-item WHO Minimal Generic Set of domains of functioning and health assessed by a neurologist, with traditionally used measures of stroke in the subacute phase. Although proxies rated 6 out of 12 separate WHODAS functions more impaired than did the patients, the scores of patient-and proxy-reported WHODAS 2.0 and the WHO Minimal Generic Set correlated well with each other and with older measures of stroke severity (National Institutes of Health Stroke Scale) and dependence (modified Rankin Scale and Functional Independence Measure). Both ICF-based tools, despite their brevity, were useful in finding disabilities for patient-and family-centred goal-setting and service-planning after subacute stroke rehabilitation. Objective: To compare short generic International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with traditional measures of stroke severity and dependence in subacute stroke. Methods: In this cross-sectional study patients with stroke (n = 195) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) at discharge from rehabilitation. A neurologist assessed functioning with the 7-item World Health Organization (WHO) Minimal Generic Set of domains of functioning and health. These scores were compared with assessments of severity of stroke (National Institutes of Health Stroke Scale; NIHSS) and dependence (modified Rankin Scale; mRS; and Functional Independence Measure; FIM).Results: From mild to severe stroke, increasing disability was found in single items and sum scores of WHODAS and the WHO Minimal Generic Set. Although proxies rated 6 out of the 12 separate WHO-DAS functions more impaired than did the patients, correlations between the different measures (proxyand patient-WHODAS, the WHO Minimal Generic Set, mRS, NIHSS and FIM total and sub-scores) were strong to very strong, except for moderate correlations between patient-WHODAS, and NIHSS or FIM cognitive sub-score. Conclusion: Despite their brevity, both generic ICFbased tools were useful in finding disabilities for patient-and family-centred goal-setting and serviceplanning after subacute rehabilitation.

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of Domains of Functioning and Health versus Conventional Instruments in subacute stroke

Tarvonen-Schröder

Hurme²,

Laimi³

2019

“…Both measures are, however, ICF-based and have many identical items. Even if WHODAS and the WHO minimal generic set seemed to be adequate in the chronic phase as in our study, these results are not directly generalizable to the acute or subacute phase (39). Patients and their significant others were not blinded to each others' evaluations; however, in the vast majority their responses differed from each other.…”

Section: Limitationcontrasting

confidence: 71%

Utility of the World Health Organization Disability Assessment Schedule and the World Health Organization minimal generic set of domains of functioning and health in spinal cord injury

Tarvonen-Schröder¹,

Kaljonen²,

Laimi³

2019

Two easy-to-use validated International Classification of Functioning, Disability and Health (ICF)-based tools, the 12-item patient and proxy World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the 7-item World Health Organization minimal generic set used by a physician, were found to be reliable and useful in assessing functioning in patients with spinal cord injury. These tools can, with little effort, be used to detect activity limitations and participation restrictions, and differentiate various severities and levels of spinal cord injury. As the minimal generic set is brief and limited, we recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury. Objective: To compare easy-to-use International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with the level and severity of spinal cord injury. Methods: Cross-sectional study. Patients (n = 142) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. A physician at the university hospital outpatient clinic assessed functioning with the 7-item World Health Organization (WHO) minimal generic set. Results: The patient and proxy WHODAS sum score was rated severe with decreasing severity in groups with complete and partial tetraplegia and paraplegia, respectively. Working ability was rated most severely impaired in the tetraplegic groups. Between-group differences were also found in mobility, household tasks, and self-care. Mobility was found to be associated with lesion severity; life activities, participation and friendships with lesion level; and self-care and WHODAS sum score with both lesion severity and level. Depending on the level and severity of spinal cord injury, a moderate to strong correlation was found between the sum scores of the 2 tools, and mostly very strong correlations between patient and proxy assessments of functioning. Conclusion: Both generic ICF-based tools, despite their briefness, seemed to be useful as they were able to differentiate various levels and severities of spinal cord injury. We recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury.

“…This study is a part of the ongoing Turku ICF study (13). The study was conducted in the in-patient rehabilitation clinic of a university hospital.…”

Section: Methodsmentioning

confidence: 99%

“…Does a health professional trained in using the FIM scale employ both of these concepts when assessing the level of functioning of a stroke survivor? It has been suggested that a rehabilitation nurse's opinion on a patient's functioning may well reflect the opinion formed by an entire interdisciplinary rehabilitation team (13).…”

Section: Introductionmentioning

confidence: 99%

Concepts of capacity and performance in assessment of functioning amongst stroke survivors: A comparison of the Functional Independence Measure and the International Classification of Functioning, Disability and Health

Tarvonen-Schröder¹,

Laimi²,

Kauko³

et al. 2015