Predicting institutionalization after Subacute Stroke Rehabilitation using the 12-Item World Health Organization Disability Assessment Schedule
DOI:
https://doi.org/10.2340/jrm.v55.6531Keywords:
institutionalization, rehabilitation, stroke, subacute, WHODASAbstract
Objective: To evaluate the utility of the 12-item World Health Organization Disability Assessment Schedule (WHODAS-12) in predicting institutionalization after subacute stroke rehabilitation.
Design: Prospective observational study.
Methods: On a specialized rehabilitation ward, discharge WHODAS-12 scores of 156 consecutive patients (24-h National Institutes of Health Stroke Scale (NIHSS) ≥ 15) and assessment from their proxies were compared, and receiver operating characteristic curves for predicting institutionalization were generated. Clinician-rated assessments of functioning were applied for comparison.
Results: Thirty-three percent of the patients were unfit to respond, due to the consequences of major stroke. However, both patient and proxy WHODAS-12 sum scores differentiated the community (n = 70) and institution (n = 86) groups (p = 0.02 and p < 0.0001, respectively), the discriminative accuracy (area under the curve; AUC) being 0.63 and 0.79, respectively. In proxy assessments, the institutionalized patients were significantly more impaired in all item comparisons except for emotions and concentrating. Ability to participate differentiated the groups as accurately as activities (AUC 0.75 vs 0.78, respectively). The corresponding discriminative accuracy of the clinician-rated World Health Organization (WHO) minimal generic dataset sum score and modified Rankin Scale were 0.74 and 0.79 (p < 0.0001), respectively.
Conclusion: Despite its brevity and subjectivity, the WHODAS-12 from proxies has shown high accuracy in predicting institutionalization after subacute rehabilitation of individuals with major stroke, the impact of participation being as relevant as that of activities.
LAY ABSTRACT
This study investigated the utility of the patient- and proxy-rated 12-item World Health Organization Disability Assessment Schedule (WHODAS-12) in predicting institutionalization after rehabilitation of patients with major stroke. At discharge from rehabilitation, a median of 3 months after stroke onset, 33% of the 156 patients were not fit to respond due to the consequences of major stroke. Both of these brief measures differentiated those discharged to community from those institutionalized. WHODAS from proxies was more accurate in predicting institutionalization, and as accurate as the clinician-rated gold-standard measure, the modified Rankin Scale. Both components of WHODAS, i.e. activities and participation, were equally relevant in differentiating the 2 discharge groups. WHODAS-12 is recommended as part of individualized patient- and family-centered discharge planning after rehabilitation of patients with major stroke.
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References
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795–820. DOI: https://doi.org/10.1016/S1474-4422(21)00252-0
Burton JK, Ferguson EEC, Barugh AJ, Walesby KE, MacLullich AMJ, Shenkin SD, et al. Predicting discharge to institutional long-term care after stroke: a systematic review and metaanalysis. J Am Geriatr Soc 2018;66:161–169. DOI: 10.1111/jgs.15101 DOI: https://doi.org/10.1111/jgs.15101
Saab A, Glass-Kaastra S, Young GB. Discharge destination from a rehabilitation unit after acute ischemic stroke. CJNS 2019; 46: 209–215. DOI: 10.1017/cjn.2018.386 DOI: https://doi.org/10.1017/cjn.2018.386
Tarvonen-Schroder S, Hurme S, Laimi K. 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. J Rehabil Med 2019; 51: 675–682. DOI: 10.2340/16501977-2583 DOI: https://doi.org/10.2340/16501977-2583
Vadassery SJ, Kong KH, Ho WML, Seneviratna A. Interview Functional Independence Measure score: self-reporting as a simpler alternative to multidisciplinary functional assessment. Singapore Med J 2019;60:199–201. DOI: 10.11622/smedj.2018048 DOI: https://doi.org/10.11622/smedj.2018048
Kasner SE. Clinical interpretation and use of stroke scales. Lancet Neurol 2006; 5: 603–612. DOI: 10.1016/s1474-4422(06)70495-1 DOI: https://doi.org/10.1016/S1474-4422(06)70495-1
Tanwir S, Montgomery K, Chari V, Nesathurai S. Stroke rehabilitation: availability of a family member as caregiver and discharge destination. Eur J Phys Rehabil Med 2014; 50: 355–362. https://pubmed.ncbi.nlm.nih.gov/24518145/
Kucukdeveci AA, Kutlay S, Yildizlar D, Oztuna D, Elhan AH, Tennant A. The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke. Disabil Rehabil 2013; 35: 214–220. DOI: 10.3109/09638288.2012.690817 DOI: https://doi.org/10.3109/09638288.2012.690817
Reznik ME, Yaghi S, Jayaraman MV, McTaggart RA, Hemendinger M, Mac Grory BC, et al. Baseline NIH Stroke Scale is an inferior predictor of functional outcome in the era of acute stroke intervention. Int J Stroke 2018: 13: 806–810. DOI: 10.1177/1747493018783759 DOI: https://doi.org/10.1177/1747493018783759
Lord FM, Novick M R, BirnBaum A. Statistical theories of mental test scores. Reading, MA: Addison-Wesley; 1968. https://psycnet.apa.org/record/1968-35040-000
Rasch G. Probabilistic models for some intelligence and attainment tests. 2nd edition. Chicago: University of Chicago Press; 1980. https://www.abebooks.com/9780226705545/Probabilistic-Models-Intelligence-Attainment-Tests-0226705544/plp
Andrews G, Kemp A, Sunderland M, Von Korff M, Ustun T. Normative Data for the 12 Item WHO Disability Assessment Schedule 2.0. PloS One 2009; 4: e8343. DOI: 10.1371/journal.pone.0008343 DOI: https://doi.org/10.1371/journal.pone.0008343
Üstün TB KN, Chatterji S, Rehm J. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva: WHO; 2010. https://www.who.int/publications/i/item/measuring-health-and-disability-manual-for-who-disability-assessment-schedule-(-whodas-2.0)
Cieza A, Oberhauser C, Bickenbach J, Chatterji S, Stucki G. Towards a minimal generic set of domains of functioning and health. BMC Public Health 2014; 14: 218. DOI: 10.1186/1471-2458-14-218 DOI: https://doi.org/10.1186/1471-2458-14-218
Taylor-Rowan M, Wilson A, Dawson J, Quinn TJ. Functional assessment for acute stroke trials: properties, analysis, and application. Front Neurol 2018; 9: 191. DOI: 10.3389/fneur.2018.00191 DOI: https://doi.org/10.3389/fneur.2018.00191
Mees M, Klein J, Yperzeele L, Vanacker P, Cras P. Predicting discharge destination after stroke: a systematic review. Clin Neurol Neurosurg 2016; 142: 15–21. DOI: 10.1016/j.clineuro.2016.01.004 DOI: https://doi.org/10.1016/j.clineuro.2016.01.004
Thorpe ER, Garrett KB, Smith AM, Reneker JC, Phillips RS. Outcome measure scores predict discharge destination in patients with acute and subacute stroke: a systematic review and series of meta-analyses. J Neurol Phys Ther 2018; 42: 2–11. DOI: 10.1097/npt.0000000000000211 DOI: https://doi.org/10.1097/NPT.0000000000000211
Brauer SG, Bew PG, Kuys SS, Lynch MR, Morrison G. Prediction of discharge destination after stroke using the motor assessment scale on admission: a prospective, multisite study. Arch Phys Med Rehabil 2008; 89: 1061–1065. DOI: 10.1016/j.apmr.2007.10.042 DOI: https://doi.org/10.1016/j.apmr.2007.10.042
Meijer R, van Limbeek J, de Haan R. Development of the Stroke-unit discharge guideline: choice of assessment instruments for prediction in the subacute phase post-stroke. Int J Rehabil Res 2006; 29: 1–8. DOI: 10.1097/01.mrr.0000175269.59788.41 DOI: https://doi.org/10.1097/01.mrr.0000175269.59788.41
Tarvonen-Schröder S, Koivisto M. Utility of the World Health Organization Disability Assessment Scale Short Version and the WHO Minimal Generic Data Set covering functioning and health in assessing discharge disposition after sub-acute stroke rehabilitation. Res Rep Med 2020; 3: 1–9. [cited 2020 Dec 14]. Available from: https://escires.com/articles/RRM-3-108.pdf
Tseng H-P, Lin F-J, Chen P-T, Mou C-H, Lee S-P, Chang C-Y, et al. Derivation and validation of a discharge disposition predicting model after acute stroke. J Stroke Cerebrovasc Dis 2015; 24: 1179–1186. [cited 2015 Apr 03]. Available from: https://www-sciencedirect-com.ezproxy.utu.fi/science/article/pii/S1052305715000142
Qureshi AI, Chaudhry SA, Sapkota BL, Rodriguez GJ, Suri MF. Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months post-stroke among stroke survivors. Arch Phys Med Rehabil 2012; 93: 1408–1413.e1. DOI: 10.1016/j.apmr.2012.02.032 DOI: https://doi.org/10.1016/j.apmr.2012.02.032
Küçükdeveci AA, Tennant A, Grimby G, Franchignoni F. Strategies for assessment and outcome measurement in physical and rehabilitation medicine: an educational review. J Rehabil Med 2011; 43: 661–672. DOI: 10.2340/16501977-0844 DOI: https://doi.org/10.2340/16501977-0844
Hu HY, Chi WC, Chang KH, Yen CF, Escorpizo R, Liao HF, et al. The World Health Organization Disability Assessment Schedule 2.0 can predict the institutionalization of patients with stroke. Eur J Phys Rehabil Med 2017; 53: 856–862. DOI: 10.23736/s1973-9087.17.04615-9 DOI: https://doi.org/10.23736/S1973-9087.17.04615-9
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