Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery
Authors: Daza Julian F , Cuthbertson Brian H , Myles Paul S , Shulman Mark A , Wijeysundera Duminda N ,   6MWT-METS Substudy Investigators, Cuthbertson B H , Wijeysundera D N , Pearse R M , Myles P S , Abbott T E F , Shulman M A , Torres E , Ambosta A , Melo M , Mamdani M , Thorpe K E , Wallace S , Farrington C , Croal B L , Granton J T , Oh P , Thompson B , Hillis G , Beattie W S , Wijeysundera H C , Ellis M , Borg B , Kerridge R K , Douglas J , Brannan J , Pretto J , Godsall M G , Beauchamp N , Allen S , Kennedy A , Wright E , Malherbe J , Ismail H , Riedel B , Melville A , Sivakumar H , Murmane A , Kenchington K , Kirabiyik Y , Gurunathan U , Stonell C , Brunello K , Steele K , Tronstad O , Masel P , Dent A , Smith E , Bodger A , Abolfathi M , Sivalingam P , Hall A , Painter T W , Macklin S , Elliott A , Carrera A M , Terblanche N C S , Pitt S , Samuels J , Wilde C , Leslie K , MacCormick A , Bramley D , Southcott A M , Grant J , Taylor H , Bates S , Towns M , Tippett A , Marshall F , McCartney C J L , Choi S , Somascanthan P , Flores K , Karkouti K , Clarke H A , Jerath A , McCluskey S A , Wasowicz M , Day L , Pazmino-Canizares J , Belliard R , Lee L , Dobson K , Stanbrook M , Hagen K , Campbell D , Short T , Van Der Westhuizen J , Higgie K , Lindsay H , Jang R , Wong C , McAllister D , Ali M , Kumar J , Waymouth E , Kim C , Dimech J , Lorimer M , Tai J , Miller R , Sara R , Collingwood A , Olliff S , Gabriel S , Houston H , Dalley P , Hurford S , Hunt A , Andrews L , Navarra L , Jason-Smith A , Thompson H , McMillan N , Back G 
Published: October 2022

Abstract

Background
Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort.

Methods
Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups.

Results
The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L—for example, mobility (Spearman’s rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from ‘small’ to ‘large’ in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status.

Conclusion
The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.