M. Kader1, K.I. Hoque2, M.S. Hossain3, R. Islam4
1Karolinska Insitutet, Institute of Environmental Medicine, Stockholm, Sweden, 2International Committee of the Red Cross, Cox's Bazar, Bangladesh, 3University of Sydney, John Walsh Centre for Rehabilitation Research, Sydney, Australia, 4Handicap International - Humanity & Inclusion, Cox's Bazar, Bangladesh

Background: Physiotherapists play an important role in promoting activity and participation among people with disabilities. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a multidimensional generic assessment scale for disability in terms of activities and participation in adults. However, there is scarce data on psychometric properties (e.g., reliability and validity) of the WHODAS 2.0 in people with spinal cord injury (SCI). To the best of our knowledge, there is no previous study on reliability and validity of the WHODAS 2.0 in people with SCI in less-resourced regions/countries like Bangladesh.

Purpose: To assess reliability and validity of the Bengali version of the WHODAS 2.0 (36- item version) in people with SCI in Bangladesh, using classical test theory methods.

Methods: The study included 144 participants (81% men) with SCI while undergoing physiotherapy treatment at the Centre for the Rehabilitation of the Paralysed (CRP), in Dhaka, Bangladesh. Their mean (Standard deviation, SD) age is 32 (12.5) years, and mean (SD) injury duration is 6 (5.3) years. The participants were interviewed using the WHODAS 2.0 (scored 0-100, higher= worse) and the Spinal Cord Independence Measure (SCIM, scored 0-100, lower= worse). Data were also collected for socio-demographic factors (e.g., age, sex, education) and injury related factors (e.g., injury type and severity). A repeat assessment was conducted in a sub-sample (n = 62) of the participants, after 8-12 days of first assessment. Reliability was assessed in terms of internal consistency (Cronbach's alpha) and test-retest (Intra-class correlation coefficients, ICC). Validity was assessed in terms of convergent validity and discriminative validity. The convergent validity was assessed by correlating (Spearman correlations, rs) the WHODAS-2 domains and the SCIM domains, and discriminative validity was assessed by comparing the difference between group (Mann-Whitney U test) based on the injury severity (paraplegia and tetraplegia).

Results: The internal consistency ranged from questionable, alpha = 0.69 (getting around) to excellent, alpha = 0.93 (life activities) for the domains. The test-retest showed moderate, ICC=0.58 (cognition) to excellent, ICC=0.92 (self-care) reliability for the domains. Moderate correlations were found between the WHODAS-2 mobility domain and the SCIM mobility domain, and between the WHODAS-2 self-care domain and the SCIM self-care domain, rs= -0.67, and -0.50, respectively. WHODAS-2 total score showed significant difference between persons with paraplegia and tetraplegia (P= 0.011).

Conclusion(s): This study provides preliminary support for reliability and validity of the Bengali version of WHODAS 2.0 (36 items) in people with SCI in a less-resourced country. Majority of the WHODAS 2.0 domains have acceptable reliability and validity. However, limitations were noted for questionable unidimensionality in one domain (getting around). Findings need to be confirmed in larger sample to determine whether this generic version of measurement scale of activities and participation is applicable to people with SCI in Bangladesh.

Implications: This evaluation of reliability and validity of WHODAS 2.0 in people with SCI will broaden our understanding on the assessment of activity and participation. The results thereby provide a preliminary foundation for the development of physiotherapy assessment and rehabilitation model specific to this population in a less-resourced country.

Funding, acknowledgements: None

Keywords: assessment, activity-participation, psychometric properties

Topic: Neurology: spinal cord injury

Did this work require ethics approval? Yes
Institution: The Centre for the Rehabilitation of the Paralysed (CRP)
Committee: The CRP Ethics Committee
Ethics number: CRP/RE/0401/235)

All authors, affiliations and abstracts have been published as submitted.

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