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PubMed2004

ICF Core Sets for osteoporosis.

OBJECTIVE: To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set and a Brief ICF Core Set for osteoporosis. METHODS: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies, relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS: The preliminary studies identified a set of 239 ICF categories at the second, third and fourth ICF levels with 72 categories on body functions, 41 on body structures, 81 on activities and participation, and 45 on environmental factors. Fifteen experts from 7 different countries attended the consensus conference on osteoporosis. Altogether 67 second-level and 2 third-level categories were included in the Comprehensive ICF Core Set with 15 categories from the component body functions, 7 from body structures, 21 from activities and participation, and 26 from environmental factors. The Brief ICF Core Set included a total of 22 second-level categories with 5 on body functions, 4 on body structures, 6 on activities and participation, and 7 on environmental factors. CONCLUSION: A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for osteoporosis. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Activities of Daily Living↗

PubMed2006

The Participation Scale: measuring a key concept in public health.

PURPOSE: To develop a scale to measure (social) participation for use in rehabilitation, stigma reduction and social integration programmes. METHOD: A scale development study was carried out in Nepal, India and Brazil using standard methods. The instrument was to be based on the Participation domains of the International Classification of Functioning, Disability and Health (ICF), be cross-cultural in nature and assess client-perceived participation. Respondents rated their participation in comparison with a "peer", defined as "someone similar to the respondent in all respects except for the disease or disability". RESULTS: An 18-item instrument was developed in seven languages. Crohnbach's alpha was 0.92, intra-tester stability 0.83 and inter-tester reliability 0.80. Discrimination between controls and clients was good at a Participation Score threshold of 12. Responsiveness after a "life change" was according to expectation. CONCLUSIONS: The Participation Scale is reliable and valid to measure client-perceived participation in people affected by leprosy or disability. It is expected to be valid in other (stigmatised) conditions also, but this needs confirmation. The scale allows collection of participation data and impact assessment of interventions to improve social participation. Such data may be compared between clients, interventions and programmes. The scale is suitable for use in institutions, but also at the peripheral level.

Algorithms↗

PubMed2002

Clinimetric instruments to assess functional health status in patients with haemophilia: a literature review.

The World Federation of Hemophilia scoring system (WFH-1) evaluates primarily body functions and structures, whereas assessment of the whole area of functional health status is considered nowadays to be a better measure. In addition, the WFH-1 lacks psychometric properties (reliability, validity and sensitivity to change). This study aimed to gain insight into the clinimetric assessment of functional health status in patients with haemophilia by way of a systematic literature search. A standardized literature search and selection was performed on the databases of CINAHL (1982-2001), Medline (1966-2001), and PubMed (January-July 2001). Clinimetric instruments applied in the selected articles were classified based on the international classification of functioning, disability, and health (ICF) and analysed for their psychometric properties. In 19 articles published between 1979 and 2001, 34 clinimetric instruments were used to assess functional health status. Instruments were classified as measuring the ICF components body structure and function (n = 17), activities (12) and participation (4). Reliability was measured in four articles on three different instruments, the validity (construct) of the instruments for patients with haemophilia was reported in six articles on five instruments, and sensitivity to change in three articles on three instruments. The populations under study varied in number (7-9 35), mean age (21.6-50.8 years), and in the distribution of haemophilia severity. Reports on the evaluation of functional health status in patients with haemophilia are increasing. Further research on the psychometric properties of the instruments is warranted in more groups of patients with haemophilia. Development of the new core set of clinimetric instruments, the WFH-2, might benefit from this strategy.

Health Status Indicators↗

PubMed2005

Assessing functional health status in adults with haemophilia: towards a preliminary core set of clinimetric instruments based on a literature search in Rheumatoid Arthritis and Osteoarthritis.

People with haemophilia experience a progressive deterioration of their functional health status. Regular clinical assessment of functional health status provides insight into their process of disablement. As such, the development of a core-set of measurement tools is warranted. The aim of this study was to gather data to prepare a (preliminary) core set of clinically relevant and feasible instruments to assess the functional health status of adults with haemophilia, and to indicate their psychometric qualities. Therefore, clinimetric instruments frequently used in two haemophilia-resembling diseases (Rheumatoid Arthritis and Osteoarthritis) were reviewed from the literature. An extensive search in Medline yielded 13 relevant review articles, incorporating a total of 182 instruments, of which 40 were appropriate for haemophilia. Of these 40 instruments 3 measure body structures, 13 body functions, 19 activities (of which 5 are performance based and 14 self-report based), and 3 measure participation. This classification is based on the International Classification of Functioning, Disability and Health. Detailed information regarding the psychometrics (reliability, validity and responsiveness) of four instruments is described fully in the literature, whereas the psychometrics of the majority of the other instruments are only partly described. The results of this literature study may contribute to the formation of a (preliminary) core set of clinimetric instruments to assess the functional health status of adults with haemophilia. Decisions on the final core set should be held within the Musculoskeletal Committee of the World Federation of Haemophilia.

Adult↗

PubMed2005

[The "Mini-ICF-Rating for Mental Disorders (Mini-ICF-P)". A short instrument for the assessment of disabilities in mental disorders].

Supplementary to the description of diseases at symptom level, the International Classification of Functioning, Disability and Health (ICF), edited by the WHO, for the first time enables a systematic description also at the level of disabilities and impairments. The Mini-ICF-Rating for Mental Disorders (Mini-ICF-P) is a short observer rating instrument for the assessment of disabilities, especially with regard to occupational functioning. The Mini-ICF-P was first evaluated empirically in 125 patients of a Department of Behavioural Medicine and Psychosomatics. Parallel-test reliability was r = 0.59. Correlates were found with cognitive and motivational variables and duration of sick leave from work. In summary, the Mini-ICF-P is a quick and practicable instrument.

Disability Evaluation↗

PubMed2002

Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine.

The authors developed an instrument called the "Rehabilitation Problem-Solving Form" (RPS-Form), which allows health care professionals analyze patient problems, to focus on specific targets, and to relate the salient disabilities to relevant and modifiable variables. In particular, the RPS-Form was designed to address the patients' perspectives and enhance their participation in the decision-making process. Because the RPS-Form is based on the International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability, it could provide a common language for the description of human functioning and therefore facilitates multidisciplinary responsibility and coordination of interventions. The use of the RPS-Form in clinical practice is demonstrated by presenting an application case of a patient with a chronic pain syndrome.

Arthritis↗

PubMed2004

[Health, social, societal and organizational political effects of the implementation of the ICF on integrated rehabilitation--a vision of the conversion and its consequences].

Fundamental joint principles on expert opinions according to the social law code no. IX (SGB IX) and their application to a virtual individual case history were published recently in this journal. They are based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). A visionary review of the chances and prospects for the further development of the rehabilitative system is outlined and the necessary steps for their implementation are demonstrated.

Diagnosis-Related Groups↗

PubMedDate not supplied

Identification of relevant ICF categories by health professionals in the acute hospital.

PURPOSE: To identify the most relevant problems of patients in the acute hospital in the view of health professionals using focus groups followed by a Delphi process. METHODS: Focus group and Delphi methodology were applied. The focus groups were conducted at three university hospitals. Three groups focusing on the problems in patients with neurological/neurosurgical, cardiopulmonary and musculoskeletal conditions were conducted at each hospital. The participants had to decide about which categories of the International Classification of Functioning, Disability and Health are relevant to patients in the acute hospital. The results from the focus groups were then followed by a Delphi process. RESULTS: Forty health professionals participated in the nine focus groups, 14 in the three neurological/neurosurgical groups, 13 in the three musculoskeletal groups, 13 in the three cardiopulmonary groups. One hundred and sixty-four of the second-level ICF categories (61.7% of all second-level categories) were considered as relevant by the health professionals of the neurological group, 100 categories (37.6%) by the musculoskeletal group and 91 (34.2%) by the cardiopulmonary group. CONCLUSIONS: The involvement of experts from different health professions is a valuable tool to identify typical patient characteristics, expressed as distinct ICF categories, which can be used across different acute conditions.

Activities of Daily Living↗

PubMed2006

Functioning description according to the icf model in chronic back pain: disablement appears even more complex with decreasing symptom-specificity.

OBJECTIVE: To determine the significance of degree of symptom-specificity in the disablement condition in chronic back pain. DESIGN: Cross-sectional design. SUBJECTS: All inhabitants of a restricted geographical area of Norway, who had had 8 weeks of sick-leave due to back pain during a 2-year period, were included in this study. Following examination they were diagnosed as having "specific back pain" (n=34), "non-specific back pain" (n=113) or "widespread pain" (n=49). METHODS: Functioning of the 3 diagnostic subgroups was described and compared. Functioning assessment was guided by the concepts of the International Classification of Functioning, Disability and Health (ICF): health condition, body function and structure, activity, participation and contextual factors. RESULTS: Pain components and final participation restriction did not differ among the diagnostic subgroups. However, with increasing symptom-specificity, loss of physical body functions and structures and subsequent activity limitation tended to increase. On the other hand, with decreasing symptom-specificity, mental distress, unfavourable contextual factors and dissatisfaction with various factors of life tend to increase, which may raise the impact of pain on restricting participation in activities. CONCLUSION: Functioning description according to the components of the ICF model indicated that the disablement condition in patients with back pain who had been on sick-leave for 8 weeks may appear more complex with decreasing symptom-specificity.

Adolescent↗

PubMed2004

Use of the ICF conceptual framework to interpret hand function outcomes following tendon transfer surgery for tetraplegia.

STUDY DESIGN: Clinical commentary OBJECTIVE AND SETTING: This paper is a clinical commentary based on the Round Table discussion on Assessment and Outcomes at the 7th International Conference on Tetraplegia: Surgery and Rehabilitation, Bologna, Italy 6-8 June, 2001. It refers specifically to the 10-year re-review undertaken in 2001 at the Spinal Unit, Burwood Hospital, Christchurch, New Zealand. SUBJECTS: In all, 24 tetraplegic persons at a minimum of 12 years and up to 18 years following bilateral forearm tendon transfer surgery. METHOD: The data were interpreted using the International Classification of Functioning, Disability, and Health (ICF) conceptual framework as the basis of interdisciplinary understanding of the participation dimension. RESULTS: The results of the study outlined confirm that outcome measurement at more than one level of functioning is desirable to determine the functional effects beyond grip strength levels and activities of daily living, to consider the dimension of participation. CONCLUSIONS: Use of the ICF as a theoretical framework for interpretation of the results enhanced the clinical applicability of the outcome measures used in the 10-year re-review undertaken in New Zealand in 2001.

Activities of Daily Living↗

PubMed2006

Study protocol: SPARCLE--a multi-centre European study of the relationship of environment to participation and quality of life in children with cerebral palsy.

BACKGROUND: SPARCLE is a nine-centre European epidemiological research study examining the relationship of participation and quality of life to impairment and environment (physical, social and attitudinal) in 8-12 year old children with cerebral palsy. Concepts are adopted from the International Classification of Functioning, Disability and Health which bridges the medical and social models of disability. METHODS/DESIGN: A cross sectional study of children with cerebral palsy sampled from total population databases in 9 European regions. Children were visited by research associates in each country who had been trained together. The main instruments used were KIDSCREEN, Life-H, Strength and Difficulties Questionnaire, Parenting Stress Index. A measure of environment was developed within the study. All instruments were translated according to international guidelines. The potential for bias due to non response and missing data will be examined. After initial analysis using multivariate regression of how the data captured by each instrument relate to impairment and socio-economic characteristics, relationships between the latent traits captured by the instruments will then be analysed using structural equation modelling. DISCUSSION: This study is original in its methods by directly engaging children themselves, ensuring those with learning or communication difficulty are not excluded, and by studying in quantitative terms the crucial outcomes of participation and quality of life. Specification and publication of this protocol prior to analysis, which is not common in epidemiology but well established for randomised controlled trials and systematic reviews, should avoid the pitfalls of data dredging and post hoc analyses.

Cerebral Palsy↗

PubMed2004

[Patient-centered assessment of functional health in systemic sclerosis -- where are we now?].

Self-administered patient-centered questionnaires have been shown to be practical, reliable and valid in terms of evaluating functional limitations in rheumatic diseases. In systemic sclerosis a modified version of the HAQ and condition-specific questionnaires have been used. The Health Assessment Questionnaire (HAQ) does not comprehensively cover functional limitations in patients with systemic sclerosis. Visual Analogue Scales added to the modified HAQ reflect general and organ-specific symptoms only to some extent. The Self-administered Systemic Sclerosis Questionnaire (SySQ) includes general, organ-specific and musculoskeletal symptoms with a focus on functional limitations of the upper and lower extremities. The SySQ has not been examined longitudinally nor has it been validated cross-culturally. WHO's International Classification of Functioning, Disability and Health (ICF) could serve as a future reference framework and common language in terms of the design of new disease-specific, patient-centered, comprehensive questionnaires for systemic sclerosis as well as in the further improvement of established questionnaires.

Activities of Daily Living↗

PubMed2005

[Guidelines for rehabilitation of dermatological diseases].

Guidelines for dermatological rehabilitation are based on the International Classification of Functioning, Disabilities and Health (ICF), which includes context factors such as physical environment, socioeconomic conditions, and the personal situation of the patient. Guidelines give specific recommendations for personal conditions of rehabilitation, staff, equipment, process of treatment, and evaluation. They assist doctors, patients, and public institutions in orientation and decision making. The latest publications are a joint summary obtained from experts, with substantial participation of the social insurance agencies, and demonstrate the growing importance of guidelines which are the result of a compromise between the conflicting interests of medical progress on the one hand and economic restrictions on the other. Consequences for allocation of financial resources in the health system are discussed.

Dermatology↗

PubMed2004

Activity outcome measurement for postacute care.

BACKGROUND: Efforts to evaluate the effectiveness of a broad range of postacute care services have been hindered by the lack of conceptually sound and comprehensive measures of outcomes. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. OBJECTIVE: To investigate the factor structure, reliability, and scale properties of items underlying the Activity domains of the International Classification of Functioning, Disability and Health (ICF) for use in postacute care outcome measurement. METHODS: We developed a 41-item Activity Measure for Postacute Care (AM-PAC) that assessed an individual's execution of discrete daily tasks in his or her own environment across major content domains as defined by the ICF. We evaluated the reliability and discriminant validity of the prototype AM-PAC in 477 individuals in active rehabilitation programs across 4 rehabilitation settings using factor analyses, tests of item scaling, internal consistency reliability analyses, Rasch item response theory modeling, residual component analysis, and modified parallel analysis. RESULTS: Results from an initial exploratory factor analysis produced 3 distinct, interpretable factors that accounted for 72% of the variance: Applied Cognition (44%), Personal Care & Instrumental Activities (19%), and Physical & Movement Activities (9%); these 3 activity factors were verified by a confirmatory factor analysis. Scaling assumptions were met for each factor in the total sample and across diagnostic groups. Internal consistency reliability was high for the total sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95). Rasch scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain. CONCLUSIONS: This 3-factor model of the AM-PAC can form the conceptual basis for common-item equating and computer-adaptive applications, leading to a comprehensive system of outcome instruments for postacute care settings.

Activities of Daily Living↗

PubMed2005

Successfully living with chronic arthritis. The role of the allied health professionals.

The treatment and care of patients with rheumatoid arthritis (RA) is complex and various health professionals with different areas of expertise may be involved. The objective of this article is to review the treatments and their efficacy as provided by health care professionals in RA care. The requirements for further research in this area are formulated. To achieve better effects of treatment it is necessary to improve the coordination of services as provided by the different specialists. The important roles of the patients themselves in the care and management of the disease are emphasized, as well as the roles of the informal caregivers such as a spouse or other family members and friends and the role of patient societies. The possible role of the International Classification of Functioning, Disability and Health (ICF) to improve the communication and facilitate the coordination among health professionals and between patients and health professionals is mentioned. The topics presented in this article may encourage further discussion and research, particularly concerning the effects of the treatments as provided by allied health professionals. Health professionals play an important role in the life of patients with rheumatic disorders, in all the domains of the ICF: body functions and structure, activities (action by an individual) and participation (involvement in a life situation). Health professionals in rheumatology can make the difference in the lives of RA patients and their families.

Allied Health Occupations↗

PubMed2006

[The Impact of Diseases (ICD-10) and Impairments of Activity and Participation (ICF) on the Long-Term Care Insurance in Germany (SGB XI)].

On the basis of a representative sample of expert records from the Medical Review Board of the statutory care insurance funds (MDK) it could be shown that in the year 2003 more diseases of dementia had been examined for the long-term care insurance. The diagnois of dementia is statistically significant as a determinat of exposition related to get benefit from the care insuance. Help assistance which is needed after suffering form fraturs of bones are significant too, but related to get no benefits. In Germany the expert records of the long-term care insurance investigate the help assistance defined by the Social Code (SGB XI) which is needed in the daily live of the disabled and handicaped people. The classification of the SGB XI for daily performances offers the required transparency by using the mulitvariate logistic regression analysis with the predictor to get benefits from the care insurance. The help assistance estimated in the sample was recoded with the International Classification of Functioning, Disability and Health (ICF). Within this classification activity and participation in daily life of disabled and handicapped people are investigated. It was found that there could be more subdivions for these performances. A new analysis of the body function recorded in the ICF could be of interest to explain significant variables relating to the amount of help assistance.

Disability Evaluation↗

PubMed2005

[Development and psychometric testing of a patient questionnaire for medical rehabilitation (IRES-3)].

BACKGROUND: Re-analyses of extensive datasets as well as theoretical considerations have led to the conclusion that the patient questionnaire "Indicators of Rehabilitation Status" (IRES) should be revised in several respects. The new version IRES-3 was developed on the basis of a theoretical model of rehabilitation following the ICF (International Classification of Functioning, Disability and Health) as well as of elements of the earlier version IRES-2. In addition, we included the results of expert panels on the definition of treatment goals in medical rehabilitation. METHODS: The IRES-3 was tested in 453 patients in rehabilitation clinics of seven diagnostic areas. To compare the IRES-3 with other generic instruments, the SF-36 and the HADS were employed at the same time. For purposes of cross-validation, an external sample could be used. The dimensional structure was tested in confirmatory factor analyses. RESULTS: With rare exceptions, the tests showed good values for item difficulties, ceiling and floor effects, internal consistencies and test-retest-reliability. Convergent validity could be established for the IRES-3 when compared to relevant scales of the SF-36 and the HADS. Indices of sensitivity to change were comparable, if not somewhat superior to the effects on comparable scales of the SF-36. The assessment of the construct validity and the dimensional structure of the questionnaire led to the definition of eight dimensions which can be interpreted as somatic, emotional, functional, occupational, social, pain, coping, as well as health information and behaviour. The dimensional structure of the IRES-3 can be regarded as theoretically meaningful as well as empirically proven. STANDARDIZATION: For purposes of standardization, data were collected on a sample representative of the population aged 30-75 years in Germany. These data allow a norm-oriented interpretation of scales and dimensions of the IRES-3 for patients in rehabilitation. APPLICATION: The questionnaire is ready for application, including a computer programme for data entry and analysis.

Activities of Daily Living↗

PubMed2006

Are models of disability useful in real cases? Pediatric case examples realized in research, clinical practice, and education.

Conceptual models are useful devices for organizing complex material and examining interrelationships among variables. For example, speakers at the 1990 II STEP Conference presented a systems model of motor control, the dynamical systems model as used in studying infant motor development, and the World Health Organization model as a systematic approach to the description of impairments, functional limitations, and disability. The purpose of this perspective is to provide examples of the usefulness of models of disability in organizing research, educational materials, and measurement in clinical practice. The disability model of the National Center for Medical Rehabilitation Research was used: (1) to design a measurement strategy for assessing effects of spasticity reduction in a child with cerebral palsy, (2) to develop a new assessment of functional motor performance in infants, and (3) as the conceptual framework for a comprehensive reference book for the practice of pediatric physical therapy (the current edition has been reformatted to conform to the International Classification of Function, Disability and Health). Similar models of the dimensions of disability have guided extensive development of tests designed by physical therapists for assessing function and quality of life in children with neurologic conditions.

Cerebral Palsy↗