WHODAS 2.0 in community rehabilitation: a qualitative investigation into the validity of a generic patient-reported measure of disability

Abstract

Purpose: The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was considered as a potentially appropriate patient-reported outcome measure (PROM) for community rehabilitation services in the UK. The study explored qualitative aspects of the measure’s content and content and construct validity. Method: A convenience sample of 10 community rehabilitation service users participated in semi-structured interviews and completed the WHODAS 2.0. Content analysis and a constant comparative method of analysis were applied. Participants’ accounts were compared with the measure’s content and its underlying construct of disability. Results: Participants’ reports of current difficulties were rich with accounts of bodily impairments and activity and participation limitations. WHODAS 2.0 content largely covered those activities that interviewees found difficult. Participants tended to conceptualize disability according to the medical model. The wording of the questionnaire allowed for ambiguity with respect to social perspectives on disability, which resulted in variability of scores. Conclusions: While WHODAS 2.0 content coverage appears comprehensive, the questionnaire in its current form tends to favor a medical construct of disability. We recommend caution when applying WHODAS 2.0 in contexts such as community rehabilitation, where social aspects of disability may be considered important. Further investigation of the measure’s construct validity might be warranted.

Implications for Rehabilitation

• WHODAS 2.0 implicitly favors a medical interpretation of disability.

• WHODAS 2.0 may not be appropriate in contexts where social perspectives on disability are considered important, such as in community rehabilitation.

• Community rehabilitation
• patient-reported outcome measures
• validity
• WHODAS 2.0

Acknowledgements

The authors would like to thank the study participants for contributing their time and sharing their viewpoints and experiences; Roanna Braganza, Mary Hickson, Leigh Forsyth and Central London Community Healthcare NHS Trust for supporting this research; and Mary Hickson and Sarah Holmes for helpful comments on this article.

Notes

*This research was presented as a poster at the 18th European Congress of Physical and Rehabilitation Medicine, 28 May to 1 June 2012, in Thessaloniki, Greece.