Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: a 4-year follow-up study.

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 3,506 participants (2,080 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 54.4, 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.