World Health Organization Disability Assessment Schedule versus Functional Independence Measure in Traumatic Brain Injury.
Sinikka Tarvonen-Schröder, Mari Koivisto
PMID 38032144WHAT IT FOUND
Proxy WHODAS-12 scores differentiated mild from moderate traumatic brain injury more accurately than the Functional Independence Measure.
Participation restrictions were more severe than activity limitations, especially in milder injuries, suggesting a need to assess social and community involvement specifically.
Key findings
01Proxy WHODAS sum and component scores showed the most significant differences between mild and moderate TBI groups, outperforming FIM total and sub-scores.
02Participation was scored as more impaired than activities in both patient and proxy WHODAS ratings, particularly in mild and moderate TBI.
03WHODAS and FIM scores correlated strongly at discharge, with proxy WHODAS correlating more strongly with FIM than patient self-ratings did.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted in a single academic hospital in Finland, which may limit generalizability to other healthcare systems or cultural contexts. The cross-sectional design prevents establishing causal relationships between disability levels and outcomes. Patients with severe TBI who could not respond due to cognitive impairment or aphasia were excluded from patient WHODAS analysis, potentially biasing self-report data. WHODAS was administered based on current status at discharge rather than the standard preceding 30 days, to align with FIM timing.
Declared interests
The authors declared no conflicts of interest. The study was funded by the Finnish Cultural Foundation and the University of Helsinki.
The easy way to misread this
Do not assume that WHODAS and FIM are interchangeable. FIM measures assistance needed for independence, while WHODAS measures perceived difficulty in participation and activities. Proxy WHODAS may be more sensitive to mild-to-moderate deficits than FIM, but it reflects the observer's perspective, not the patient's experience.