Disability and its clinical correlates in pulmonary hypertension measured through the World Health Organization Disability Assessment Schedule 2.0: a prospective, observational study

Abstract

Objective: To characterise the degree of disability in pulmonary hypertension (PH) patients based on the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Method: A prospective and observational study of patients with documented PH (N = 46). Patients completed the WHODAS 2.0 questionnaire during a scheduled routine clinical visit, and their demographic and clinical characteristics were retrieved from electronic medical records (EMR). In subsequent visits, selected clinical variables were registered to assess disease progression. Results: WHODAS 2.0 scores were indicative of mild to moderate disability for the domains of mobility (22.0 ± 23.2), life activities (23.7 ± 25.5), and participation in society (17.2 ± 15.9), as well as total WHODAS 2.0 score (15.3 ± 15.2). For the domains of cognition (9.1 ± 14.1), self-care (8.3 ± 14.4), and interpersonal relationships (11.7 ± 15.7), scores were lower. Disability scores were, generally, proportional to the PH severity. The main baseline correlates of disability were World Health Organisation (WHO) functional class, fatigue, dyspnoea, 6-minute walking distance (6MWD), and N-terminal pro b-type natriuretic peptide (NTproBNP). Baseline WHODAS 2.0 scores showed significant associations with disease progression. However, this effect was not transversal to all domains, with only a few domains significantly associated with disease progression variables. Conclusions: This PH population shows mild disability, with higher degree of disability in the domains of mobility and life activities. This study is the first one to assess disability in PH using WHODAS 2.0. Further studies should apply this scale to larger PH populations with suitable representations of more severe PH forms.

Adapting World Health Organization Disability Assessment Schedule 2.0 for Nepal

“…In keeping with most validity studies of people with either mental disorders [9,16] or chronic physical conditions [18,[21][22][23] or both [14], the Nepali WHODAS 2.0 version preserved the validity of the general disability criterion. The Nepali scores were higher among persons with any disability, physical, psychiatric, or both, in comparison to those without any disability.…”

“…The potential total score ranges from 3-29. Based on the total score, the SES of a family was categorized into: Upper (above 25), Middle (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and Lower (10 and below) [31].…”

“…Most of the validation studies were done in relation to psychiatric populations. Some were conducted among persons with physical health conditions like chronic illnesses such as visceral disability [11], pulmonary hypertension [21], hand injuries [4], fall-related injuries [22], low back pain [5,23], Huntington's disease (HD) [24]; and among patients with comorbid psychiatric disorders with a variety of medical conditions [14].…”

Outcome Measures Used in Studies of Rehabilitation in Pulmonary Hypertension

“…Its inclusion of items relating to relationships, intimacy, dignity, practical and financial burden, which reflect concerns frequently raised by people with pulmonary hypertension (26), suggest it may warrant further exploration and adoption in studies exploring rehabilitation. Although its use is growing there is only a single instance of its use to date in pulmonary hypertension, in a study that uses the measure to characterise patients with the disease (27). While used in only one study of rehabilitation, the Nottingham Health Profile covers 7 of the 9 domains (Table 4) and therefore may also warrant further investigation.…”