WHO DAS II rules OK

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WHO DAS II rules OK?

• Gavin Andrews
• WHO Collaborating Centre
• St Vincents Hospital, Sydney
• gavina_at_unsw.edu.au

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Panic Confronting fears
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Heart Failure Daily Routine
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Chronic Asthma Becoming Adherent
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Osteoarthritis Goals Achieved
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Type 2 Diabetes Denial of illness
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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

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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)

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WHO DAS II rules