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WHO DAS II rules OK

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Title: WHO DAS II rules OK


1
WHO DAS II rules OK?
  • Gavin Andrews
  • WHO Collaborating Centre
  • St Vincents Hospital, Sydney
  • gavina_at_unsw.edu.au

2
Why Measure?
  • Good Reason
  • To quantify disease status and functioning
  • To guide clinical practice
  • baseline,
  • effectiveness of intervention,
  • alarm signal
  • To guide service delivery HbA1c PHQ9
  • To inform disease burden relativities
  • DALY YLL YLD

3
Bad reasons for measuring
  • For political advantage
  • The case of stuttering
  • Measurement of pre post treatment SS, SPM
  • Stability, attitudes, self-efficacy, neurotic
    basis
  • To look responsible
  • What the Commonwealth and States do now
  • Use clinical time to record data that is never
    used
  • The measures are old, do not inform
  • This is unethical and immoral

4
Outcome measures there are none
  • There are only measures that are repeated before
    and after an intervention
  • Change may be due to the intervention, or to the
    placebo response, or to remission
  • Only RCTs can tell if the change is due to the
    intervention whether that be a treatment, a
    risk factor change, or a change in environment

5
Disease specific vs general
  • Specific disease status measures
  • lab or questionnaire HbA1c, PHQ9
  • Specific disease functioning measures
  • performance or questionnaire
  • General measures of disease status
  • D-T scale, distress (K6 10)
  • General measures of functioning
  • RFS, SF36/12, WHO DAS II 36/12

6
Development of the WHO DAS IIUstun et al 2006,
Epping Jordan et al 2006
  • From ICF six domains
  • Understanding and communicating
  • Getting around
  • Self care
  • Getting along with others
  • Household and work activities
  • Participation in society

7
Development of the WHO DAS II
  • 92 items tested, field trials in 19 countries
  • 36 item version loads on the six domains
  • The 6 domains load on a general disability factor
    0.71-0.92
  • The 12 item version accounts for 85 of the
    variance in the 36 item version
  • Score is independent of specific disorder
  • The WHO DAS II is sensitive to change

8
Versions in 16 languages
  • 36 item
  • Self administered, interviewer administered, and
    proxy
  • Best for determination in an individual
  • 12 item
  • Self administered, interviewer administered
  • Best for epidemiology, outcome measurement

9
Detail of the 12 item version
  • In the last 30 days, how much difficulty did you
    have in
  • Standing for long periods such as 30 minutes
  • Taking care of your household responsibilities
  • Learning a new task, such as
  • joining in community activities
  • How much have you been emotionally affected
    by..health..
  • Concentrating on doing something for ten minutes
  • Walking a long distance such as a kilometre
  • Washing your whole body
  • Getting dressed
  • Dealing with people you do not know
  • Maintaining a friendship
  • Your day to day work

10
Uses - Epidemiology
  • World Mental Health Surveys 2001/2007 covering 29
    countries and 170,000 respondents. Purpose -
    estimate disease specific and total disablement
  • 2007 Australian NSMHWb (n10,000) for estimates
    of functioning disease burden. ?National
    Health Survey

11
(No Transcript)
12
www.climate.tv
  • Is a one stop shop for prevention, physician
    education and patient education
  • Accurate
  • Cheap
  • Always available, infinitely scaleable
  • Needs clinician mentoring for prevention and
    patient education to stick

13
16 modules for 8 disordersprepared in
consultation with the appropriate peak body
  • asthma (2 modules) diabetes (2 modules)
  • anxiety (3 modules) depression (5 modules)
  • breast cancer heart failure
  • osteoarthritis incontinence

14
Panic Confronting fears
15
(No Transcript)
16
Heart Failure Daily Routine
17
Chronic Asthma Becoming Adherent
18
Osteoarthritis Goals Achieved
19
Type 2 Diabetes Denial of illness
20
Results 19th October 2005
  • N50 completers
  • WHO-DAS-II mean scores
  • first session 34.6, last session 43.8, 20 up
  • Effect size 0.6, plt0.01
  • Need 500 completers to know if it is sensitive to
    change in all disorders

21
Challenge does the WHO DAS II work in social
phobia?
  • Social phobia
  • Fear and avoidance of negative evaluation
  • The disorder is fearful thoughts, the disability
    is the avoidance
  • Cumulative disability equals schizophrenia
  • Sensitivity to change with treatment (n91)
  • WHO DAS II gt K10SF12 gt NCS disability days
  • Disability and distress are correlated, in a
    study of n100, measuring both adds little to
    either one alone, on the prediction of change on
    disorder specific measures
    (Perini et al, JAffDis
    2006)

22
WHO DAS II rules
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