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Measurement properties and minimal important change of the World Health Organization Disability Assessment Schedule 2.0 in persons with low back pain: A systematic review

  • Jessica J. Wong
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 Canada

    Division of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
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  • Astrid DeSouza
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
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  • Sheilah Hogg-Johnson
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 Canada

    Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
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  • Wouter De Groote
    Affiliations
    Rehabilitation Programme, Department of Noncommunicable Diseases, Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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  • Danielle Southerst
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
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  • Melissa Belchos
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Division of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada

    Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
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  • Nadège Lemeunier
    Affiliations
    Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Equipe constitutive du CERPOP, UMR 1295, unité mixte INSERM - Université Toulouse III Paul Sabatier, Toulouse France
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  • Stephanie Alexopulos
    Affiliations
    Division of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
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  • Hamid Varmazyar
    Affiliations
    Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
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  • Silvano A. Mior
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
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  • Paula J. Stern
    Affiliations
    Division of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
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  • Margareta C. Nordin
    Affiliations
    Departments of Orthopedic Surgery and Environmental Medicine, New York University, 550 First Avenue, New York, NY 10016 United States
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  • Anne Taylor-Vaisey
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
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  • Alarcos Cieza
    Affiliations
    Rehabilitation Programme, Department of Noncommunicable Diseases, Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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  • Pierre Côté
    Correspondence
    Corresponding author. Pierre Côté, Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, Canada L1G 0C5. Telephone: 905-721-8668 ext. 2629
    Affiliations
    Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 Canada

    Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
    Search for articles by this author

      Abstract

      Objective

      We conducted a systematic review to determine measurement properties and minimal important change (MIC) of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) short (12 questions) and full (36 questions) versions in persons with non-specific LBP.

      Data Sources

      MEDLINE, Embase, CINAHL, APA-PsycInfo, CENTRAL (inception-May 2021).

      Study Selection, Data Extraction

      Eligible studies assessed measurement properties or MIC of WHODAS 2.0 in persons with LBP. Paired reviewers screened articles, extracted data, and assessed risk-of-bias using COnsensus-based Standards for selection of health-Measurement INstruments (COSMIN) and COSMIN-Outcome Measures in Rheumatology checklists.

      Data Synthesis

      We descriptively synthesized results stratified by measurement property and LBP duration (subacute: 6 weeks-3 months; chronic: ≥3 months).

      Results

      We screened 297 citations and included 14 studies (reported in 15 articles). Methodological quality of studies was very good for internal consistency, varied between very good and doubtful for construct validity, doubtful for responsiveness, and adequate for all other properties assessed. Evidence suggests that WHODAS 2.0 full version has adequate content validity (2 studies); WHODAS 2.0 short and full versions have adequate structural validity (3 studies), but construct validity is indeterminate (9 studies). WHODAS 2.0 short and full versions have adequate internal consistency (10 studies), and the full version has adequate test-retest and inter-rater reliability (3 studies) in persons with LBP. Minimal detectable change (MDC) was 10.45-13.99/100 for the full version and 8.6/48 for the short version in persons with LBP (4 studies). WHODAS 2.0 full version has no floor or ceiling effects, but the short version has potential floor effects in persons with chronic LBP (3 studies). One study estimated MIC for the full version as 4.87/100 or 9.74/100 (corresponding to 1- and 2-point change on 0-10cm visual-analogue-scale for pain, respectively), and one study estimated 3.09-4.68/48 for the short version.

      Conclusions

      In persons with LBP, WHODAS 2.0 full version has adequate content validity, structural validity, internal consistency, and reliability. WHODAS 2.0 short version has adequate structural validity and internal consistency. Construct validity of the short and full versions is indeterminate. Since MDC is estimated to be larger than MIC, knowledge users may consider both MIC and MDC thresholds to measure change in functioning for LBP.

      Key words

      List of abbreviations:

      COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments), ICC (intraclass correlation coefficient), ICF (International Classification of Functioning, Disability and Health), LBP (low back pain), MIC (minimal important change), MDC (minimal detectable change), OMERACT (Outcome Measures in Rheumatology), WHO (World Health Organization), WHODAS 2.0 (World Health Organization Disability Assessment Schedule 2.0)
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