Diagnostic accuracy of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to estimate disability after stroke

Abstract

Purpose

To analyze WHODAS 2.0’s diagnostic capacity and accuracy in stroke survivors.

Methods

Cross-sectional methodological study, in which individuals with chronic stroke were evaluated. Disability was considered the outcome variable, being evaluated by WHODAS 2.0; the modified Rankin scale (mRS) was used as the parameter variable. Disability was categorized in two levels being: “No or mild disability” (mRS 0–2) and “Moderate to severe disability” (mRS 3–5). To identify the cutoff point, a Receiver-Operating Characteristic (ROC) curve was constructed with a confidence interval (CI) of 95% and considering sensitivity and specificity.

Results

The cutoff point >39.62 proved acceptable for distinguishing individuals with moderate/severe disability from individuals with no or mild disability (≤39.62 points), with 66.22% sensitivity, 72.41% specificity, positive predictive value (PPV) of 45.45%, and negative predictive value (NPV) of 84.74%. The area under the curve (AUC) was 0.747 (CI 95%: 0.65–0.83; p < 0.001).

Conclusion

WHODAS 2.0 demonstrated acceptable diagnostic capacity and the cutoff point of 39.62 proved suitable for distinguishing individuals with moderate/severe disability from those with no or mild disability after stroke.

Implications for rehabilitation

• WHODAS 2.0 demonstrated acceptable diagnostic capacity.

• The WHODAS 2.0 cut-off point of >39.62 allows stratification of post-stroke disability into two different levels (no/mild disability versus moderate/severe disability).

• These results facilitate clinical decision-making by rehabilitation professionals.

Keywords:

• Stroke
• disability
• accuracy
• World Health Assessment Disability Schedule 2.0
• International Classification of Functioning
• disability and health

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was partially supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Brazilian Federal Agency for Support and Evaluation of Graduate Education of the Ministry of Education, finance code 001.