Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan

Background: Stroke is a leading cause of long-term disability and is considered a major global health burden. Objectives: We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan. Methods: We used the “Taiwan Data Bank of Persons with Disability” (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults > 18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects. Results: A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P < 0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P < 0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains. Conclusion: Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.