Fabio Meloni

World Health Organisation Disability Assessment Schedule II: Contribution to the Italian validation

Introduction. The World Health Organisation Disability Assessment Schedule II (WHODAS II) is an instrument developed by the World Health Organisation in order to assess behavioural limitations and restrictions to participation experienced by an individual, independently from a medical diagnosis. The conceptual frame of reference of this instrument is the International Classification of Functioning, Disability and Health: ICF. Specifically, the instrument is designed to evaluate the functioning of the individual in six activity domains: Understanding and communicating, Getting around, Self-care, Getting along with people, Life activities, Participation in society. Purposes. Considering the widespread consent about the usefulness of the WHODAS II, the general aim of the present study is to provide a contribution to the validation of the Italian version. Method. The WHODAS II Italian version has been administered to a sample of 500 participants subdivided in two groups: 271 normal adults and 229 disabled adults. The disabled participants group has been subdivided in three sub-groups, according to their disability: 111 motor disabled, 45 mental disabled, 73 sensory disabled. Results. The mean Total score of the WHODAS II is 12.95 for the normal adults and 22.93 for the disabled group. Either group obtains the least impairment in the Self-care domain. This could be probably due to the presence of social-health workers in everyday life for all Italian disabled people. For the three disabled participant groups separately computed the mean Total score is: 28.66 for the motor disabled, 24.60 for the mental disabled, and 14.97 for the sensory disabled, confirming that sensory disabled do not perceive their disability as a personal functioning problem but a socially constructed one. Some subscales of WHODAS II show relatively strong floor effects. The Cronbachs Alpha calculated for each of the subscales is found to be high. The correlations of the subscales show strong correlations in all subscales. Conclusions. The WHODAS II is a useful instrument for measuring disability and functioning in normal and disabled people. It shows high reliability and a stable factor structure; although an additional psychometric evaluation of a representative sample of Italian disabled should be carried out in order to reach standard scores for each macro-category of disability.

The effectiveness of powered, active lower limb exoskeletons in neurorehabilitation: A systematic review

OBJECTIVE This review examines the utility of current active, powered, wearable lower limb exoskeletons as aids to rehabilitation in paraplegic patients with gait disorders resulting from central nervous system lesions. METHODS The PRISMA guidelines were used to review literature on the use of powered and active lower limb exoskeletons for neurorehabilitative training in paraplegic subjects retrieved in a search of the electronic databases PubMed, EBSCO, Web of Science, Scopus, ProQuest, and Google Scholar. RESULTS We reviewed 27 studies published between 2001 and 2014, involving a total of 144 participants from the USA, Japan, Germany, Sweden, Israel, Italy, and Spain. Seventy percent of the studies were experimental tests of safety or efficacy and 29% evaluated rehabilitative effectiveness through uncontrolled (22%) or controlled (7%) clinical trials. CONCLUSIONS Exoskeletons provide a safe and practical method of neurorehabilitation which is not physically exhausting and makes minimal demands on working memory. It is easy to learn to use an exoskeleton and they increase mobility, improve functioning and reduce the risk of secondary injury by reinstating a more normal gait pattern. A limitation of the field is the lack of experimental methods for demonstrating the relative effectiveness of the exoskeleton in comparison with other rehabilitative techniques and technologies.

World Health Organization disability assessment schedule 2.0: An international systematic review

Abstract Purpose: This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. Method: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on “whodas” using the ProQuest, PubMed, and Google Scholar electronic databases. Results: We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). Conclusions: The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single “minimal clinically important .difference” score for the WHODAS 2.0 has not yet been established.

A note on the theoretical framework of World Health Organization Disability Assessment Schedule II

With our 2007 study on knowledge and spread of biopsychosocial model of disability (launched by the ICF – International Classification of Functioning, Disability and Health [1]) among teachers, educators, and disabled students’ parents [2,3], we soon realized that an adequate understanding of the model itself and its applications was a long way off. Nevertheless, we were certain that the concepts of functioning, disability, and health, according to the theoretical perspective of the biopsychosocial model, were widely understood, at least within international scientific community. We, therefore, are quite surprised with A. Schlote, M. Richter, M.T. Wunderlich, U. Poppendick, C. Moller, K. Schwelm, and C.W. Wallesch research entitled ‘WHODAS II with people after stroke and their relatives’ [4] recently published in this journal because it seems as if these concepts are not shared by these researchers. A. Schlote et al. intend to measure the internal consistency and the validity of the World Health Organization Disability Assessment Schedule II (WHODAS II), besides the inter-rater-correlation among the scores gathered by the administration of the tool to patients with stroke and their closest significant others. In a articulated and not always clear experimental procedure, during which data have been collected to analyze the psychometric validation, the 36 items version of WHODAS II, the modified Rankin Scale (which assesses the functioning limitations of people after stroke), and the National Institute of Health-Stroke Scale (a diagnostic scale that assesses typical stroke-related neurological deficits) have been administered. The results indicate, according to the international scientific literature [5], that the WHODAS II is a valid, generally reliable and useful instrument for the assessment of patients with stroke over the 1st year after stroke. Herein, we will demonstrate A. Schlote et al.’s serious errors in defining the theoretical model of the WHODAS II and in doing so critically comment on some aspects of their experimental design.

Parents’ Education Shapes, but Does Not Originate, the Disability Representations of Their Children

The present research tested whether children’s disability representations are influenced by cultural variables (e.g., social activities, parent education, custom complex variables) or by cognitive constraints. Four questionnaires were administered to a sample of 76 primary school aged children and one of their parents (n = 152). Questionnaires included both open-ended and closed-ended questions. The open-ended questions were created to collect uncensored personal explanations of disability, whereas the closed-ended questions were designed to elicit a response of agreement for statements built on the basis of the three most widespread disability models: individual, social, and biopsychosocial. For youngest children (6–8 years old), people with disabilities are thought of as being sick. This early disability representation of children is consistent with the individual model of disability and independent from parents’ disability explanations and representations. As children grow older (9–11 years old), knowledge regarding disability increases and stereotypical beliefs about disability decrease, by tending to espouse their parents representations. The individual model remains in the background for the adults too, emerging when the respondents rely on their most immediately available mental representation of disability such as when they respond to an open-ended question. These findings support that the youngest children are not completely permeable to social representations of disability likely due to cognitive constraints. Nevertheless, as the age grows, children appear educable on perspectives of disability adhering to a model of disability representation integral with social context and parent perspective.

Models of Disability in Children’s Pretend Play: Measurement of Cognitive Representations and Affective Expression Using the Affect in Play Scale

Play is a natural mode of children’s expression and constitutes a fundamental aspect of their life. Cognitive, affective, and social aspects can be assessed through play, considered as a “window” to observe a child’s functioning. According to Russ’s model, cognitive and affective components and their reciprocal connections can be assessed through the Affect in Play Scale (APS). The aim of the present study was to investigate children’s representations of the three main models of disability (medical, social, and biopsychosocial) and how these models affected cognitive and affective components of children’s play. Sixty-three children, aged 6–10 years, were assessed by means of the APS. Participants were randomly assigned to one of two APS task orders: the standard APS task followed by the modified APS task (including a wheelchair toy), or vice versa. The standard and modified APS sessions were coded according to the APS system. The modified APS sessions were also coded for the model of disability expressed by children. A one-way ANOVA conducted on the APS affective and cognitive indexes revealed an effect of condition on the affective components of play and no effect on cognitive components and variety of affect as assessed by the APS. In addition, when children are involved in pretend play from which concepts of disability emerge, these concepts are almost exclusively related to the medical model of disability. Results suggested implications for intervention with children in educational contexts that aim to teach children about disability.

UX Evaluation Design of UTAssistant: A New Usability Testing Support Tool for Italian Public Administrations

Since 2012, usability testing in Italian public administration (PA) has been guided by the eGLU 2.1 technical protocols, which provide a set of principles and procedures to support specialized usability assessments in a controlled and predictable way. This paper describes a new support tool for usability testing that aims to facilitate the application of eGLU 2.1 and the design of its User eXperience (UX) evaluation methodology. The usability evaluation tool described in this paper is called UTAssistant (Usability Tool Assistant). UTAssistant has been entirely developed as a Web platform, supporting evaluators in designing usability tests, analyzing the data gathered during the test and aiding Web users step-by-step to complete the tasks required by an evaluator. It also provides a library of questionnaires to be administered to Web users at the end of the usability test. The UX evaluation methodology adopted to assess the UTAssistant platform uses both standard and new bio-behavioral evaluation methods. From a technological point of view, UTAssistant is an important step forward in the assessment of Web services in PA, fostering a standardized procedure for usability testing without requiring dedicated devices, unlike existing software and platforms for usability testing.

Assessing Individual Functioning and Disability

This chapter explains enabling activities and participation using assistive technology (AT) from an occupational therapy perspective. This perspective is based on facilitating people to do the things they want and need to do. Occupational therapy is complex owing to the need to consider a wide range of roles, activities, environments, and contexts for each person and their AT. Occupational therapy aims to achieve a person–environment–occupation fit, which may be achieved through skill acquisition, education, environment adaptation, and/or activity redesign in conjunction with AT. The AT process involves four steps (stages/phases) imagining possibilities, seeking information, choosing the best option, and living successfully with AT. The occupational therapists role is to actively involve the person in all stages of this process. This process has been illustrated using two case studies. The occupational therapist using a person–environment–occupation lens and breadth of knowledge across AT devices is well placed to partner with people to attain optimal AT solutions.

The Relationship between Functioning, Disability and Binge Eating Disorder in a Sample of Patients Candidates for Bariatric Surgery

Italian Society of Obesity VIII National Congress Rome, 29 September – 1 October 2016 Springer International Publishing Switzerland 2016

A model of web-based follow-up to reduce assistive technology abandonment

The abandonment of assistive technology (AT) is strictly related to the subjective quality of the service delivery regarding the whole AT assignation process. Starting from this consideration, the aim of this work is to show the design of a Web-based follow-up model (WFM) aimed at overcoming the hearing aid abandonment in the Italian Umbria Region AT service delivery system. The WFM model described here is developed in two phases: an implementation phase, and an experimental evaluation which is still under development. The model meets the current objective of the Umbria Region’s Units of Local Health Service to digitize their services in order to easily monitor the quality of the delivery service and evaluate the post-provision outcome.