Wen Chou Chi

Implementing disability evaluation and welfare services based on the framework of the international classification of functioning, disability and health: experiences in Taiwan

BackgroundBefore 2007, the disability evaluation was based on the medical model in Taiwan. According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person’s eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. The purposes of this study were to: 1) design the evaluation tools for disability eligibility system based on the ICF/ICF-Children and Youth; 2) compare the differences of grades of disability between the old and new evaluation systems; 3) analyse the outcome of the new disability evaluation system.MethodsTo develop evaluation tools and procedure for disability determination, we formed an implementation taskforce, including 199 professional experts, and conducted a small-scale field trial to examine the feasibility of evaluation tools in Phase I. To refine the evaluation tools and process and to compare the difference of the grades of disability between new and old systems, 7,329 persons with disabilities were randomly recruited in a national population-based study in Phase II. To implement the new system smoothly and understand the impact of the new system, the collaboration mechanism was established and data of 168,052 persons who applied for the disability benefits was extracted from the information system and analysed in Phase III.ResultsThe measures of the 43 categories for body function/structure components, the Functioning Scale of Disability Evaluation System for activities/participation components, and the needs assessment have been developed and used in the field after several revisions. In Phase II, there was 49.7% agreement of disability grades between the old and new systems. In Phase III, 110,667 persons with a disability received their welfare services through the new system. Among them, 77% received basic social welfare support, 89% financial support, 24% allowance for assistive technology, 7% caregiver support, 8% nursing care and rehabilitation services at home, and 47% were issued parking permits for persons with disability.ConclusionThis study demonstrated that disability evaluation system based on the ICF could provide a common language between disability assessment, needs assessment and welfare services. However, the proposed assessment protocol and tools require additional testing and validation.

Validity and reliability of the Functioning Disability Evaluation Scale-Adult Version based on the WHODAS 2.0--36 items.

BACKGROUND/PURPOSE The disability eligibility determination system is based on the International Classification of Functioning, Disability and Health (ICF) framework in Taiwan. The Functioning Disability Evaluation Scale (FUNDES) has been developed since 2007 for assessing the status of an individuals activities and participation in the disability eligibility system. The purpose of this study was to examine the reliability and validity of the FUNDES-Adult Version (FUNDES-Adult). METHODS During 2011-2012, a total of 5736 adults with disabilities (aged 58.4 ± 18.2 years) were randomly recruited for a national population-based study. These adults were assessed in person by certified professionals in the authorized hospitals. Domains 1-6 of the FUNDES-Adult addressing the performance and capability dimensions are modified from the World Health Organization Disability Assessment Schedule 2.0-36-item version, and Domain 7 (Environmental attribute) and capability and capacity dimensions of Domain 8 (Motor action) are designed based on the ICF coding system. RESULTS The internal consistency was excellent (Cronbachs α ≥ 0.9). An exploratory factor analysis yielded a five-factor FUNDES structure with a variance of 76.1% and 76.9% and factor loadings of 0.56-0.94 and 0.55-0.94 for the performance and capability dimensions, respectively. The factor loadings for the second-order confirmatory factor analysis for the performance and capability dimensions were from 0.81 to 0.89. In Domains 1-6 and 8, the ceiling effects were from 9% to 36%, and the floor effects were from 5% to 45%. CONCLUSION FUNDES-Adult has acceptable reliability and validity and can be used to measure activities and participation for people with disabilities.

Functioning and Disability Analysis of Patients with Traumatic Brain Injury and Spinal Cord Injury by Using the World Health Organization Disability Assessment Schedule 2.0

The purpose of this study is to compare traumatic brain injuries (TBI) and spinal cord injuries (SCI) patients’ function and disability by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); and to clarify the factors that contribute to disability. We analyzed data available between September 2012 and August 2013 from Taiwan’s national disability registry which is based on the International Classification of Functioning, Disability, and Health (ICF) framework. Of the 2664 cases selected for the study, 1316 pertained to TBI and 1348 to SCI. A larger percentage of patients with TBI compared with those with SCI exhibited poor cognition, self-care, relationships, life activities, and participation in society (all p < 0.001). Age, sex, injury type, socioeconomic status, place of residence, and severity of impairment were determined as factors that independently contribute to disability (all p < 0.05). The WHODAS 2.0 is a generic assessment instrument which is appropriate for assessing the complex and multifaceted disability associated with TBI and SCI. Further studies are needed to validate the WHODAS 2.0 for TBI and SCI from a multidisciplinary perspective.

Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan.

Abstract Purpose: To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. Methods: Subjects (≥60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. Results: More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75–376.42, p < 0.001), age (1.38–4.81, p < 0.05), and speech impairment (1.94–5.80, p < 0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. Conclusions: Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability. Implications for Rehabilitation Older adults with physical disability often experience difficulties in household activities and mobility. Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease. Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

Measuring Disability and Its Predicting Factors in a Large Database in Taiwan Using the World Health Organization Disability Assessment Schedule 2.0

The definition of disability had been unclear until the International Classification of Functioning, Disability, and Health was promulgated in 2001 by the World Health Organization (WHO). Disability is a critical but relatively neglected public-health concern. We conducted this study to measure disabilities by using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and identify the factors that contribute to disabilities. We obtained and analyzed the data on people who applied to Taiwan’s disability registration system between September 2012 and August 2013. A total of 158,174 cases were selected for this study. Among the people included in this study, 53% were male, and the females were on average 3 years older than the males. More males than females were of a low socioeconomic status, but the rate of employment was higher among the males than among the females. Age, sex, place of residence, and types and severity of impairment were all determined to be factors that independently contributed to disability. This study has demonstrated that disability can be measured and compared using WHODAS 2.0. Increasing the public-health attention devoted to disability and identifying the factors associated with disability can promote independence and social participation in people with disabilities.

Participation of children with disabilities in Taiwan: The gap between independence and frequency

Background Independence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored. Methods A total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children’s daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment. Findings A negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment. Conclusions Children’s participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed.

Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia

Abstract Background: To analyse the disability status of elderly Taiwanese dementia patients by using the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Methods: We enrolled 12 126 disabled elderly (>65 years) patients with dementia during July 2012–January 2014 from the Taiwan Data Bank of Persons with Disability. Trained interviewers evaluated the standardised scores in the six WHODAS 2.0 domains. Student’s t test was used for comparing WHODAS 2.0 scores of male and female dementia patients with different age groups. Results: The study population comprised 12 126 patients; 7612 were women and 4514 were men. The WHODAS 2.0 scores showed that the dementia patients had global activity limitation and participation restriction in all domains. Dementia-induced disability was prominent in male patients in all of the domains of the WHODAS 2.0. The domains of life activities, getting along with people and cognition were more strongly affected than the other domains. However, women experienced more rapid functional decline than men did as they aged. Conclusion: The data analysed in this large-scale, population-based study revealed crucial information on dementia-induced disability in elderly patients on the basis of the WHODAS 2.0 framework. Implications for rehabilitation Dementia patients have global functional disability in all domains of WHODAS 2.0 and multidisciplinary team is needed for rehabilitation programme intervention for these patients. When considering the rehabilitation resource and strategy, the domains of cognition, activities of daily living and life activities should be focussed. When dementia patients aged 65–75 years old, male patients got more restriction of function than female and more medical resource allocation for disabled male patients is recommended. With ageing, female dementia patients exhibited more rapid functional decline than male patients did and more budget about rehabilitation for maintain functional and dementia progression is crucial for female patients.

The Chinese version of the Child and Adolescent Scale of Environment (CASE-C): validity and reliability for children with disabilities in Taiwan.

Measurement of childrens participation and environmental factors is a key component of the assessment in the new Disability Evaluation System (DES) in Taiwan. The Child and Adolescent Scale of Environment (CASE) was translated into Traditional Chinese (CASE-C) and used for assessing environmental factors affecting the participation of children and youth with disabilities in the DES. The aim of this study was to validate the CASE-C. Participants were 614 children and youth aged 6.0-17.9 years with disabilities, with the largest condition group comprised of children with intellectual disability (61%). Internal structure, internal consistency, test-retest reliability, convergent validity, and discriminant (known group) validity were examined using exploratory factor analyses, Cronbachs α coefficient, intra-class correlation coefficients (ICC), correlation analyses, and univariate ANOVAs. A three-factor structure (Family/Community Resources, Assistance/Attitude Supports, and Physical Design Access) of the CASE-C was produced with 38% variance explained. The CASE-C had adequate internal consistency (Cronbachs α=.74-.86) and test-retest reliability (ICCs=.73-.90). Children and youth with disabilities who had higher levels of severity of impairment encountered more environmental barriers and those experiencing more environmental problems also had greater restrictions in participation. The CASE-C scores were found to distinguish children on the basis of disability condition and impairment severity, but not on the basis of age or sex. The CASE-C is valid for assessing environmental problems experienced by children and youth with disabilities in Taiwan.

The World Health Organization Disability Assessment Schedule 2.0 can predict the institutionalization of the patients with stroke

BACKGROUND The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a well-known questionnaire used to evaluate disability. We can not only evaluate disability but also obtain additional information by using the standardized WHODAS 2.0 scores. AIM To predict the institutionalization of the patients with stroke by using the standardized WHODAS 2.0 scores. DESIGN Observational study. SETTING The data of 10,255 patients with stroke were acquired from the Data Bank of Persons with Disabilities (TDPD) in Taiwan. POPULATION Patients with either ischemic or hemorrhagic stroke during chronic stage. METHODS For the patients with stroke, we used a χ2 analysis for the categorical variables, and an independent Students t test to compare the standardized WHODAS 2.0 scores in the six domains between different groups. We also generated a receiver operating characteristic curve using the standardized WHODAS 2.0 scores, and applied Youden Index to calculating the optimal cut-off point on the ROC curve. Then, we used a binary logistic regression analysis to determine risk factors for the institutionalization. RESULTS All WHODAS 2.0 domains had higher scores in the institution group than in the community group. The ROC curve used to predict the institutionalization of patients with stroke revealed that all WHODAS 2.0 domains were statistically significant. The cognition, and mobility domains and the sum of WHODAS 2.0 scores were more accurate for predicting the risk of institutionalization in a long-term care facility. In a logistic regression analysis, standardized WHODAS 2.0 scores ≥69, residence in an urban area, and severity of impairment were factors for predicting the institutionalization of the patients with stroke. CONCLUSIONS WHODAS 2.0 scores, urbanization level, and severity of impairment were positive factors for the institutionalization of patients with stroke in long-term care facilities, whereas the female sex and an age of ≥85 years were negative factors. The cognition and mobility domains and standardized WHODAS 2.0 scores were more accurate for predicting the institutionalization of patients with stroke. CLINICAL REHABILITATION IMPACT Proper analysis of the functioning status and risk factors, as well as prediction of discharge destination for the patients with stroke can help the healthcare system reduce unnecessary expenditures and make the allocation of social resources more efficient.

World health organization disability assessment schedule 2.0 as an objective assessment tool for predicting return to work after a stroke

Abstract Purpose: To analyze whether World Health Organization Disability Assessment Schedule 2.0 can be used as an objective assessment tool for predicting the return-to-work status of working-age patients with stroke. Method: We obtained the data on 2963 patients disabled by stroke (age <60 years) from the Taiwan Data Bank of Persons with Disability for the July 2012–January 2014 period. Of these patients, 119 could return to work, whereas 2844 could not. Demographic data and World Health Organization Disability Assessment Schedule 2.0 standardized scores of patients with stroke who could return to work and those who could not (return to work and nonreturn-to-work groups, respectively) were analyzed and compared using the chi-squared and independent Student’s t-tests. Receiver operating characteristic curve analysis was performed to investigate the prediction accuracy for the return-to-work status, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was employed to determine the predictors of the return-to-work status of patients with stroke. Results: The World Health Organization Disability Assessment Schedule 2.0 scores in all domains were lower in the return-to-work group than in the nonreturn-to-work group. The receiver operating characteristic curve showed moderate accuracy for all domain-specific scores [area under the curve, 0.6–0.8] and good accuracy for the summary scores of World Health Organization Disability Assessment Schedule 2.0 (area under the curve, >0.8). Binary logistic regression revealed that younger age, less severe stroke and standardized World Health Organization Disability Assessment Schedule 2.0 summary scores below the cutoff points were predictors of the return to work status of working-age patients disabled by stroke. Conclusions: World Health Organization Disability Assessment Schedule 2.0 can be used as an objective assessment tool for predicting the return-to-work status of working-age patients disabled by stroke. This tool can aid in establishing rehabilitation strategies and goal-setting processes for the return-to-work of patients with stroke. Implications for rehabilitation World Health Organization Disability Assessment Schedule 2.0 summary scores can predict the return-to-work status of working-age patients with stroke. Younger age and less severe stroke are associated with the return-to-work status of patients with stroke. Lower disability scores of the World Health Organization Disability Assessment Schedule 2.0 items result in a favorable return-to-work status and help in establishing effective rehabilitation strategies for facilitating the return-to-work of young patients with stroke.