Diferença mínima clinicamente importante e mínima mudança detectável do World Health Disability Assessment Schedule (WHODAS-2.0) para avaliação da incapacidade após acidente vascular cerebral crônico

Abstract

INTRODUCTION: Despite reported evidence of validity, reliability, and accuracy of the World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) for use in the population with chronic Stroke, the Minimal Detectable Change (MDC) and the Minimal Clinically Important Difference (MCID) of the WHODAS 2.0 score have not been studied in this population. OBJECTIVE: To estimate the MDC and MCID of WHODAS 2.0 in individuals after a stroke. METHODS: Disability assessment was performed using the WHODAS 2.0 instrument in three assessments. The MDC was calculated using the formula MDC = 1.96 x √2 x SEM. To determine the acceptability of MDC, minimum percentage changes below 30% were considered acceptable, and changes below 10% indicated excellence. The MCID was determined based on the standard deviation observed in the initial assessment and by anchoring method, based on the global rating scale regarding changes in the functional status in the last 6 months. The analysis of MCID was estimated by the ROC curve. In addition, the Youden index was applied to identify the most appropriate MCID. RESULTS: Test-retest reliability was adequate, with an SEM of 1.55 points and MDC of 3.45 points (corresponding to a 12.13% change). Regarding different calculation approaches, estimates for MCID in the WHODAS 2.0 score were 1.55 points (calculated by the standard error of measurement), 5.13 points (calculated as one-third of the standard deviation), and 7.78 points (calculated as half of the standard deviation). The ROC curve analysis revealed an AUC of 0.64 (95% CI = 0.50-0.77; p = 0.09), with a Youden index estimated at 0.30, sensitivity of 53.3%, specificity of 77.1%, and MCID of 3.45 points for the WHODAS 2.0 score. CONCLUSION: The total score of the WHODAS 2.0 showed a range of MCID from 1.55 to 7.78 points, with an MDC of 3.45 points and an SEM of 1.55 points. A change of nearly 13% in the total score is necessary for the detection of clinically relevant changes