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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
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European Journal of Physical and Rehabilitation Medicine 2017 Jun 19

DOI: 10.23736/S1973-9087.17.04615-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

The World Health Organization Disability Assessment Schedule 2.0 can predict the institutionalization of the patients with stroke

Hsiang-Yueh HU 1, Wen-Chou CHI 2, Kwang-Hwa CHANG 3, 4, Chia-Feng YEN 5, Reuben ESCORPIZO 6, 7, Hua-Fang LIAO 8, 9, Shih-Wei HUANG 1, 10, 11, Tsan-Hon LIOU 1, 3, 10

1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; 2 School of Occupational Therapy, Chung Shan Medical University, Taipei, Taiwan; 3 Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; 4 Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 5 Department of Public Health, Tzu Chi University, Hualien, Taiwan; 6 Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA; 7 Swiss Paraplegic Research, Nottwil, Switzerland; 8 Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City, Taiwan; 9 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; 10 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 11 Graduate Institute of Sports Science, National Taiwan Sports University, Taoyuan, Taiwan


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BACKGROUND: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a well-known questionnaire used to evaluate disability. We can not only evaluate disability but also obtain additional information by using the standardized WHODAS 2.0 scores.
AIM: To predict the institutionalization of the patients with stroke by using the standardized WHODAS 2.0 scores.
DESIGN: Observational study.
SETTING: The data of 10,255 patients with stroke were acquired from the Data Bank of Persons with Disabilities (TDPD) in Taiwan.
POPULATION: Patients with either ischemic or hemorrhagic stroke during chronic stage.
METHODS: For the patients with stroke, we used a chi-squared analysis for the categorical variables, and an independent Student’s t test to compare the standardized WHODAS 2.0 scores in the six domains between different groups. We also generated a receiver operating characteristic curve using the standardized WHODAS 2.0 scores, and applied Youden index to calculating the optimal cutoff point on the ROC curve. Then, we used a binary logistic regression analysis to determine risk factors for the institutionalization.
RESULTS: All WHODAS 2.0 domains had higher scores in the institution group than in the community group. The ROC curve used to predict the institutionalization of patients with stroke revealed that all WHODAS 2.0 domains were statistically significant. The cognition, and mobility domains and the sum of WHODAS 2.0 scores were more accurate for predicting the risk of institutionalization in a long-term care facility. In a logistic regression analysis, standardized WHODAS 2.0 scores ≥69, residence in an urban area, and severity of impairment were factors for predicting the institutionalization of the patients with stroke.
CONCLUSIONS: WHODAS 2.0 scores, urbanization level, and severity of impairment were positive factors for the institutionalization of patients with stroke in long-term care facilities, whereas the female sex and an age of ≥85 years were negative factors. The cognition and mobility domains and standardized WHODAS 2.0 scores were more accurate for predicting the institutionalization of patients with stroke.
CLINICAL REHABILITATION IMPACT: Proper analysis of the functioning status and risk factors, as well as prediction of discharge destination for the patients with stroke can help the healthcare system reduce unnecessary expenditures and make the allocation of social resources more efficient.


KEY WORDS: Stroke - Disability - Institutionalization - World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) - Long-term care - International classification of functioning - Disability - Health (ICF)

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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 the patients with stroke. Eur J Phys Rehabil Med 2017 Jun 19. DOI: 10.23736/S1973-9087.17.04615-9

Corresponding author e-mail

peter_liou@s.tmu.edu.tw