Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys

Abstract

This study analyses the use of the self-reported Washington Group (WG) question sets as a first stage screening to identify people with clinical impairments, service and assistive product (AP) referral needs using different cut-off levels in four functional domains (vision, hearing, mobility and cognition). Secondary data analysis was undertaken using population-based survey data from five countries, including one national survey (The Gambia) and four regional/district surveys (Cameroon, Chile, India and Turkey). In total 19,951 participants were sampled (range 538–9188 in individual studies). The WG question sets on functioning were completed for all participants alongside clinical impairment assessments/questionnaires. Using the WG “some/worse difficulty” cut-off identified people with mild/worse impairments with variable sensitivity (44–79%) and specificity (73–92%) in three of the domains. At least 64% and 60% of people with mild/worse impairments who required referral for surgical/medical and rehabilitation/AP services, respectively, self-reported “some/worse difficulty”, and much fewer reported “a lot/worse difficulty.” For moderate/worse impairment, both screening cut-offs improved identification of service/AP need, but a smaller proportion of people with need were identified. In conclusion, WG questions could be used as a first-stage screening option to identify people with impairment and referral needs, but only with moderate sensitivity and specificity.

Global and regional prevalence of disabilities among children and adolescents: Analysis of findings from global health databases

“…However, the estimates are not intended to provide information on the diagnostic entities underlying the survey responses based on the available ICD codes. Attempts to use survey responses, for example, as a first stage screening to identify people with clinical impairments, service and assistive product referral needs in four functional domains (vision, hearing, mobility, and cognition) have been shown to be associated with less-than-optimal sensitivity and specificity ( 37 ). In fact, UNICEF specifically stated that the results should not be used to assess the epidemiological characteristics of any disease or impairment but an indication of the prevalence of moderate to severe functional difficulties that, in interaction with various barriers, can place children at increased risk for non-participation and exclusion ( 17 ).…”

“…However, the ICF was never intended to replace the medical model but to enhance it ( 45 ). While it may be easier to elicit functional difficulties through household surveys, such responses do not provide a pathway for the effective care of children with disabilities within the health systems ( 37 ). In fact, it is difficult to identify children with self-limiting constitutional developmental delays based on survey responses.…”

Measuring Disability among Migrants with Washington Group Tools: Reflections for Field Use

“…Self-reporting measures are questionnaire-based, low-cost, rapid to administer, and provide information on activity limitations and participation restriction, while clinician-based measurement is typically impairment-focused and often involves impairment assessment. They are time consuming, require trained clinicians and are expensive [ 41 ]. This paper explores the use of WG tools as a first-stage screening for disability in migrant populations.…”

Psychiatric Symptoms, Treatment Uptake, and Barriers to Mental Health Care Among US Adults With Post–COVID-19 Condition

“…The NHIS contains a question from the Washington Group (WG) that asks participants if they have difficulty remembering or concentrating; we classified participants as having cognitive difficulties if they responded that they had at least some difficulty . This question was shown to have a sensitivity of 83% for identifying at least mild cognitive impairment in a population-based sample . Fatigue was assessed using 3 WG questions that asked about the frequency, duration, and severity of tiredness.…”

“…37,38 This question was shown to have a sensitivity of 83% for identifying at least mild cognitive impairment in a population-based sample. 39 Fatigue was assessed using 3 WG questions that asked about the frequency, duration, and severity of tiredness.…”