是时候重新思考腰痛的残疾评估了吗？巴西 WHODAS 2.0 评估慢性腰痛的可靠性、内部一致性和结构效度。
Is it time to rethink disability assessment in low back pain? Reliability, internal consistency, and construct validity of the Brazilian WHODAS 2.0 for chronic low back pain.
机构信息
Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil.
Federal Institute of Education, Science and Technology of Ceará, Fortaleza, Brazil.
出版信息
Physiother Res Int. 2023 Oct;28(4):e2025. doi: 10.1002/pri.2025. Epub 2023 May 25.
BACKGROUND AND PURPOSE
The World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed to assess health and disability based on the biopsychosocial model. The WHODAS 2.0 has not been validated for Brazilians with chronic non-specific low back pain (LBP). We aimed to evaluate the reliability, internal consistency, and construct validity of the Brazilian version of the WHODAS 2.0 in patients with chronic LBP.
METHODS
Methodological study. The Brazilian version of the WHODAS 2.0 was applied to 100 volunteers with chronic nonspecific LBP. Test-retest reliability, internal consistency, and construct validity were assessed using the Spearman correlation test, Cronbach's alpha (α) coefficient, and Spearman's correlation test between WHODAS 2.0, the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Fear Avoidance Beliefs Questionnaire (FABQ), respectively.
RESULTS
WHODAS 2.0 showed satisfactory test-retest reliability with a moderate correlation for total WHODAS 2.0 (r = 0.75, p < 0.05). Internal consistency was adequate for all domains and total score (α = 0.82-0.96). Regarding construct validity, WHODAS 2.0, ODI (r = 0.70, p < 0.05), and WHODAS 2.0 and RMDQ (r = 0.71, p < 0.05) had significant correlations. Total WHODAS 2.0 and FABQ-Phys subscale scores correlated moderately (r = 0.66, p < 0.05).
DISCUSSION
The Brazilian WHODAS 2.0 was proved to be a valid and reliable tool for patients with chronic LBP. The item referring to sexual intercourse had 27% and 30% of the missing values during the test and retest stage, respectively and had a high percentage of missing data for work-related questions (41% missing data) in the life activities domain; therefore, the data must be interpreted with caution.
IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE
WHODAS 2.0 can be used as a disability assessment strategy from a biopsychosocial perspective in this population.
背景与目的
世界卫生组织残疾评定量表 2.0（WHODAS 2.0）是基于生物心理社会模式开发的，用于评估健康和残疾状况。WHODAS 2.0 尚未在巴西患有慢性非特异性下腰痛（LBP）的人群中得到验证。我们旨在评估巴西版 WHODAS 2.0 在慢性 LBP 患者中的可靠性、内部一致性和结构效度。
方法
方法学研究。将巴西版 WHODAS 2.0 应用于 100 名慢性非特异性 LBP 志愿者。使用 Spearman 相关检验、Cronbach's alpha（α）系数和 Spearman 相关检验评估测试-重测信度、内部一致性和结构效度，分别为 WHODAS 2.0 与 Oswestry 残疾指数（ODI）、Roland-Morris 残疾问卷（RMDQ）和恐惧回避信念问卷（FABQ）之间的关系。
结果
WHODAS 2.0 总 WHODAS 2.0 的相关性为中度（r=0.75，p<0.05），表明具有良好的测试-重测信度。所有领域和总分的内部一致性均足够（α=0.82-0.96）。关于结构效度，WHODAS 2.0 与 ODI（r=0.70，p<0.05）和 WHODAS 2.0 与 RMDQ（r=0.71，p<0.05）之间具有显著相关性。WHODAS 2.0 总分和 FABQ-Phys 子量表评分中度相关（r=0.66，p<0.05）。
讨论
巴西 WHODAS 2.0 被证明是一种有效的、可靠的工具，适用于慢性 LBP 患者。在测试和重测阶段，涉及性生活的项目分别有 27%和 30%的缺失值，且在生活活动领域的与工作相关问题有 41%的缺失数据，因此必须谨慎解释这些数据。
物理治疗实践的意义
WHODAS 2.0 可作为一种从生物心理社会角度评估该人群残疾状况的策略。
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