Development and validation of the World Health Organization disability Assessment Schedule 2.0 (WHODAS 2.0) Indonesian version in stroke survivors

Abstract

Purpose

Stroke is the third most common cause of disability worldwide. In order to effectively study the disability status experienced by stroke survivors, it is important to identify reliable and valid tools to measure disability that can be administered to this population. No previous study had been conducted on the Indonesian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). The aim of this study was to develop and validate the Indonesian version of the WHODAS 2.0 for stroke survivors in Indonesia.

Methods

Following translation and back-translation, the Indonesian version of the WHODAS 2.0 was administered to 183 stroke survivors. We used all six domains of the WHODAS 2.0, with the exception of four items of "work or school activities" in domain 5. Internal consistency was measured by Cronbach's alpha, the inter-rater reliability was measured by interclass correlations (ICCs), and the construct validity was tested with an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Results

The range of Cronbach's alpha was 0.86–0.92, which indicated excellent reliability, and ICC was very good at 0.87–0.99. The EFA and CFA for the main 32-item questionnaire exhibited a total variance of 95% (KMO) and a p value of <0.05. The factor loadings per items were >0.4, and all the model fit indices were acceptable.

Conclusions

The WHODAS 2.0 was adapted for use in Indonesia and showed good results for all six domains. Therefore, the Indonesian version of the WHODAS 2.0 can be applied to assess disability in Indonesian stroke survivors.

Implications for rehabilitation

• The WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed as a single, generic instrument for assessing the health status and disability in different cultures and settings.

• In this study, we adapted and validated an Indonesian version of the WHODAS 2.0 for stroke survivors in Indonesia.

• The WHODAS 2.0 was adapted for use in Indonesia and showed good results for all six domains.

• The Indonesian version of the WHODAS 2.0 can be applied to assess disability in Indonesian stroke survivors.

Keywords:

• Disability evaluation
• reliability
• stroke rehabilitation
• validity
• WHODAS 2.0
• World Health Organization Disability Assessment Schedule II

Acknowledgements

The authors thank West Nusa Tenggara Province Indonesia for supporting this project and giving permission to collect data in referral hospitals in different places in West Nusa Tenggara Province.

Ethical approval

Ethical approval was obtained from the IRB of Taipei Medical University and Muhammadiyah University of Malang. This study followed all relevant ethical standards.

Informed consent: All participants received an explanation about the study and provided informed consent including signing a consent form. If a participant did not completely fill out the questionnaire, authors deleted and excluded those data from the analysis.

Consent for publication: All authors agreed to publish the final version of this study.

Disclosure statement

The authors declare that they have no conflict of interest.

Data availability statement

The data that support the findings of this study are available and transparent if required.

Code availability statement

Data in this study were coded in SPSS vers. 21 and AMOS 23. Code can be made available on request.