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Rationale and principles of early rehabilitation care after an acute injury or illness.

Patients hospitalized for an acute illness or injury are at risk of experiencing a significant loss of functioning as defined by the International Classification of Functioning, Disability and Health (ICF). The risk of a significant loss of functioning is increased in critically ill patients, in patients with complications or long-term intensive care stays, in persons with disabilities or with pre-existing chronic conditions and in the elderly. Early identification of rehabilitation needs and early start of rehabilitation can reduce healthcare costs by reducing dependence and nursing care, length of stay and prevention of disability. Two principles of rehabilitation for acute and early post-acute care can be distinguished. First, the provision of rehabilitation by health professionals who are generally not specialized in rehabilitation in the acute hospital. And second, specialized rehabilitation care provided by an interdisciplinary team. There is large variation how this specialized, typically post-acute rehabilitation care is organized, provided, and reimbursed in different countries, regions, and settings. For instance, it may be provided either in the acute hospital or in a rehabilitation or nursing setting. Most in-patients do not receive specialized rehabilitation at all during their whole stay in the acute hospital. But, it is important to point out that health professionals working in acute hospitals and who are not specialized in rehabilitation need to be able to recognize patients' needs for rehabilitation care and to perform rehabilitation interventions themselves or to assign patients to appropriate rehabilitation care settings. The principles outlined in this paper can serve as a basis for the development of clinical assessment instruments to describe and classify functioning, health and disability of patients receiving acute or early post-acute rehabilitation care.

Acute Disease↗

PubMed2004

Inter-rater reliability in assigning ICF codes to children with disabilities.

PURPOSE: The purpose of this study was to determine if independent raters would arrive at similar decisions about which codes from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to assign to children with disabilities based on the results of standard paediatric functional assessment measures. METHOD: Children (N = 60), 9 months to 17.75 years old, with a range of disabilities were assessed using either the Vineland Adaptive Behavior Scales (n = 20), the Pediatric Evaluation of Disability Inventory (PEDI) (n = 20), or the School Function Assessment (SFA) (n = 20). Two raters independently determined which of 40 codes from the Activities and Participation component of the ICF applied to each child based on items and standard scores from the assessment measure. The Cohen's kappa statistic was used as the measure of inter-rater reliability. RESULTS: The kappa statistic was >/= 0.70, the criterion for good agreement in this study, for 23/40 codes using the Vineland, 17/40 codes using the PEDI, and 17/40 codes using the SFA. The mean kappa statistic reached >/= 0.70 for the Self care domain, using all three tools. The mean kappa statistic also reached >/= 0.70 for Learning and Applying Knowledge and Mobility using the Vineland. CONCLUSIONS: Independent raters reached high rates of agreement when assessment test items were structured developmentally and corresponded to a single ICF code. For domains other than Self care, alternative assessment strategies may be necessary to improve assigning ICF codes to children with disabilities.

Activities of Daily Living↗

PubMed2005

Alzheimer's disease-associated disability: an ICF approach.

PURPOSE: The aim of the study is to provide a description of dementia-associated disability in Alzheimer's disease (AD) patients through the International Classification of Functioning, Disability and Health (ICF). METHOD: Twenty-six AD patients at different stages of disease participated in the study. Mini Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used to stage the degree of cognitive impairment and the stage of disease, respectively. All subjects were classified using the ICF categories in the more detailed four-level version. Correlation between compromised ICF items and both MMSE and GDS scores were calculated through Spearman Rho test. RESULTS: Mental functions were impaired in all the subjects examined. Data on activity and participation showed that not only domestic life, self care, and mobility but also communication and interaction and social relationships are compromised in AD patients. Three main areas appeared as the most relevant facilitators: products and technology, support and relationship and services, systems and policies. ICF codes were generally correlated with both MMSE and GDS: subjects who appeared more compromised on MMSE and GDS showed higher impairment of functions, activity limitation, and participation restriction.Conclusion. ICF is a useful tool to describe health status in AD patients in that it underlines important aspects of daily living generally not considered by activity of daily living scales such as communication, social relationships, and recreation and leisure.

Activities of Daily Living↗

PubMed2006

Exploring the role of contextual factors in disability models.

PURPOSE: The objective of this paper is to define and categorize the types of relationships that contextual factors have within models of disability according to the WHO International Classification of Disability, Functioning, and Health (ICF) conceptual scheme. METHOD: A conceptual analysis building on the disability literature specifies the causal relationships for contextual factors in relation to the association between activity limitation and participation using a person with arthritis as an example. RESULTS: From a statistical point of view, in relation to disability process, contextual factors can act as an independent factor, confounding factor, moderating factor, and mediating factor. How the role of a particular contextual factor is specified depends on the researcher's hypothesized disability framework and research goals. Moderating and mediating contextual factors are of particular importance in disability model specification. Various sub-types of moderating contextual factors are also identified. CONCLUSION: This paper provides a framework for the conceptualization of contextual factors in the examination of disability models. This framework has implications in constructing conceptual models as well as for setting up analytical plans. In light of the increasing awareness and application of the ICF model, we intend this work to stimulate additional discussion on this topic.

Activities of Daily Living↗

PubMed2006

Assessment of everyday functioning in young children with disabilities: an ICF-based analysis of concepts and content of the Pediatric Evaluation of Disability Inventory (PEDI).

BACKGROUND: Assessment of everyday functioning in children may depend to a considerable extent on the framework used to conceptualise functioning and disability. The Pediatric Evaluation of Disability Inventory (PEDI) has incorporated the mediating role of the environment on disability, using different measurement scales. The construction of the Functional Skills scales, which measure capability, and the Caregiver Assistance scales, which measure performance, was based on the Nagi disablement scheme. The International Classification of Functioning, Disability and Health (ICF) represents a new framework of functioning and disability that could be used to compare the measurement constructs and the content of different outcome measurements. PURPOSE: To examine the conceptual basis and the content of the PEDI using the ICF. METHOD: Phrases that describe the conceptual basis of the PEDI scales and of the ICF classifications were systematically collected and compared. Two researchers classified the item content of the Functional Skills scales independently before consensus was reached. RESULTS: The analyses indicate that the conceptual basis of the PEDI scales to a large extent match the ICF concepts of activity, participation and environmental factors. Both the PEDI and the ICF use the constructs of capacity and performance, but differ in how to operationalise these constructs. The classification of the Functional Skills scales shows that the PEDI primarily is a measure of activities and participation. The frequently use of environmental codes to classify the context of the requested functions demonstrates that the PEDI has incorporated the environment into the assessment. CONCLUSIONS: Our analyses indicate that the ICF could serve as a conceptual framework to clarify the measurement construct of the PEDI scales, and as taxonomy to describe and clarify the item content of the Functional Skills scales. Both as framework and taxonomy the ICF showed limitations in covering functioning in early childhood.

Activities of Daily Living↗

PubMed2006

Using the ICF to clarify team roles and demonstrate clinical reasoning in stroke rehabilitation.

PURPOSE: The International Classification of Functioning, Disability and Health (ICF) is advocated as a tool to structure rehabilitation and a universal language to aid communication, within the multi-disciplinary team (MDT). The ICF may also facilitate clarification of team roles and clinical reasoning for intervention. This article aims to explore both factors in stroke rehabilitation. METHOD: Following a review of the literature, a summary was presented and discussed with clinicians working within stroke rehabilitation, to gather expert opinions. The discussions were informal, being part of service development and on-going education. The clinicians summarised key themes for the potential use of the ICF within clinical practice. RESULTS: Two key themes emerged from the literature and expert opinion for the potential use of the ICF in stroke rehabilitation: (i) to aid communication and structure service provision, (ii) to clarify team roles and aid clinical reasoning. Expert opinion was that clarification of team roles needs to occur at a local level due to the skill mix, particular interests, setting and staffing levels within individual teams. The ICF has the potential to demonstrate/facilitate clinical reasoning, especially when different MDT members are working on the same intervention. CONCLUSION: There is potential for the ICF to be used to clarify team roles and demonstrate clinical reasoning within stroke rehabilitation. Further experiential research is required to substantiate this view.

Activities of Daily Living↗

PubMed2006

A multi-dimensional approach to the transition of children with developmental disabilities into young adulthood: the acquisition of adult social roles.

PURPOSE: To test the hypothesis that the difficulties young adults with developmental disabilities have in obtaining adult social roles are not inevitable consequences of their childhood impairment. We used the conceptual framework of the International Classification of Functioning, Disability, and Health to test this hypothesis. METHOD: We used a structured questionnaire to obtain information on the consequences of childhood impairment in young adulthood and to examine the relationship between impairment and acquisition of adult social roles. The sample (n = 635) came from the Metropolitan Atlanta Developmental Disabilities Follow-up Study of Young Adults, a population-based cohort of young adults aged 21 - 25 years identified at age 10 with childhood impairment. RESULTS: The results suggest that: (i) attaining adult social roles varies by impairment type and severity, (ii) experiencing activity limitations partially mediate the relationship between impairment and adult social roles, and (iii) attending postsecondary education increases the likelihood of attaining markers of adulthood. CONCLUSIONS: Intervention to reduce activity limitations and to develop strategies to increase attendance in postsecondary education may increase the likelihood for the acquisition of adult social roles among young adults with childhood impairment.

Adolescent↗

PubMed2006

Participation of disabled children: how should it be characterised and measured?

PURPOSE: The aim of the paper is to explore the issues involved in measuring children's participation. METHOD: The concept of participation as encapsulated in the International Classification of Functioning, Disability and Health (ICF) is discussed as it applies to children. The essential components of any measure of children's participation are outlined, including participation essential for normal development and survival, leisure activities, and educational participation. Some existing instruments are briefly reviewed in terms of their coverage of the essential components and the adequacy of their approach to measurement. RESULTS: Key issues regarding the content of an adequate measure of participation include the need to consider the child's dependency on the family, and their changing abilities and autonomy as they grow older. Instruments may be most appropriate where they ask the child directly, implying use of visual as well as verbal presentation. Their focus should be on 'performance' such as whether and how often an activity is taken part in, and not incorporate degree of assistance within the measurement scaling. CONCLUSIONS: Currently available measures of children's participation all have some limitations in terms of their applicability across impairment groupings, whether the child can directly respond, and in the ICF components covered. The feasibility of developing measurement instruments of children's participation at different ages is discussed.

Activities of Daily Living↗

PubMed2005

Contemporary measurement techniques for rehabilitation outcomes assessment.

In this article, we review the limitations of traditional rehabilitation functional outcome instruments currently in use within the rehabilitation field to assess Activity and Participation domains as defined by the International Classification of Function, Disability, and Health. These include a narrow scope of functional outcomes, data incompatibility across instruments, and the precision vs feasibility dilemma. Following this, we illustrate how contemporary measurement techniques, such as item response theory methods combined with computer adaptive testing methodology, can be applied in rehabilitation to design functional outcome instruments that are comprehensive in scope, accurate, allow for compatibility across instruments, and are sensitive to clinically important change without sacrificing their feasibility. Finally, we present some of the pressing challenges that need to be overcome to provide effective dissemination and training assistance to ensure that current and future generations of rehabilitation professionals are familiar with and skilled in the application of contemporary outcomes measurement.

Activities of Daily Living↗

PubMed2004

Functional consequences of hemispherectomy.

Using the International Classification of Functioning Disability and Health (ICF) (WHO, 2001), impairments, activities and social participation are reported in 12 children (mean age at surgery 5.9 years) who were investigated before and three times over a 2-year period after hemispherectomy. Impairments were assessed (i) in terms of seizure frequency (Engel classification) and seizure severity (HASS) and (ii) with respect to muscle strength (MRC), range of motion (JAM score) and muscle tone (modified Ashworth scale). Activities were assessed in terms of gross motor functioning (GMFM) and self-care, mobility and social function (PEDI). Participation was assessed in terms of epilepsy-related restrictions and quantified by means of the Hague Restrictions in Childhood Epilepsy Scale (HARCES). Nine out of 12 children could be classified as free of seizures (Engel class I), and in the remaining three seizure frequency was Engel class III. HASS scores showed maximum improvement in 10 out of 12 children and near-maximum improvement in the two remaining children. Muscle strength and muscle tone on the side of the body contralateral to the hemispherectomy, which were already decreased preoperatively, decreased even further in the first 6 months after surgery, but returned to the presurgical baseline thereafter, except for the distal part of the arm. Range of motion was abnormal prior to operation and remained so after operation. Mean GMFM increase was 20% after 2 years (95% confidence interval 10-33); all five dimensions improved statistically significantly (P < 0.05). Mean PEDI increase was more than 20 scale points (95% confidence interval 10-35); again, all domains improved significantly (P < 0.05). In nearly all children, HARCES scores had normalized 2 years after surgery. In conclusion, decrease of seizure frequency and severity widens the scope of motor and social functioning, which overrides the effects of remaining motor impairments.

Child↗

PubMed2005

Evolution of team care and evaluation of effectiveness.

PURPOSE OF REVIEW: This paper describes the evolution and modern development of rheumatologic team care, reviews and defines methods of evaluation and assessment of rheumatologic team care, summarizes recent research, and discusses possible future directions for the refinement of and research in rheumatologic team care. RECENT FINDINGS: The modern concept of multiprofessional team care for patients with rheumatic diseases has been evolving over more than 50 years. Research interest in rheumatologic team care is increasing, as is evidenced in international congresses and research networks addressing team care. Over the past decade, several studies of the effects and effectiveness of multiprofessional team care have been published. Few recent publication, however, have focused on team care because of a lack of optimal methods for studying team care and a lower priority for research in this area. SUMMARY: Team care in the care, treatment, and rehabilitation of patients with rheumatologic diseases has a long and strong tradition in many countries. The role of team care is clinically relevant, and interest in the evidence-based evaluation and development of team care is growing. The International Classification of Functioning, Disability, and Health is a useful framework for examining the effects and effectiveness of team care. There is also a need for research and development with other outcome measures to analyze the different factors acting within team care. Furthermore, more specific studies of the effectiveness of team care are needed.

Humans↗

PubMed2006

Attempting to improve function and quality of life using the FTM Protocol: case report.

BACKGROUND AND PURPOSE: The Functional Tone Management (FTM) arm training program uses repetitive task practice, stretching, and electrical stimulation as patients with moderate upper extremity hemiparesis wear a dynamic hand orthosis to retrain grasp and release of objects. The case study quantitatively evaluates the extent to which FTM training improved function and quality of life in a patient who met criteria for which the device was intended. CASE DESCRIPTION: The participant, a 44-year-old male in the chronic stage of stroke recovery with moderate right upper extremity motor impairment, was trained for 10 days over a 2-week period by a licensed clinician with extensive experience in FTM training methods. Measurements were taken over 3 baseline visits, then immediately preintervention, postintervention, and at a 3-month follow-up. The outcome measures, following the International Classification of Functioning, Disability, and Health (ICF) Model, included the: Fugl-Meyer assessment (FMA) (upper extremity portion), UE range of motion (ROM), Modified Ashworth scale, Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Health related quality of life was measured using the Stroke Impact Scale (SIS). OUTCOMES: The participant showed limited gains in upper extremity function immediately postintervention. Increases in AROM occurred in forearm supination and wrist flexion and extension, but no improvements were noted in finger ROM. A slight decrease in tone was found in forearm pronators (1 to 0) and wrist flexors (1+ to 1). WMFT values for the more affected upper extremity did not change immediately after training, but a 17% reduction in time occurred at follow-up, with improvements, most notably in the tasks of lifting a pencil and lifting a paper clip. No changes occurred in UE-FMA scores immediately following the intervention, however, a 17% improvement was measured at followup. A slight improvement in MAL scores was noted but not to a level of independent functional use of the impaired upper extremity. SIS scores improved in the domains of strength, communication, mobility, social participation, hand recovery, and overall physical component, while decreases were seen in the ADL/IADL, hand function, emotion, and cognitive domains. DISCUSSION: The case study indicates that for this patient with chronic, moderate upper extremity impairment following stroke, a 2-week FTM training regimen resulted in modest changes occurring as a decrease in impairment, with functional improvement and improved quality of life. Further investigation of the innovative training program should be undertaken before the efficacy of its use can be ascertained amongst patients with limitations comparable to the participant.

Adult↗

PubMed2026

Exploring Immersive Virtual Reality as an Approach to Improve School Participation-Related Constructs in Children With ADHD.

BACKGROUND: School participation is frequency and involvement from person-environment transactions, not diagnosis, per the International Classification of Functioning, Disability and Health (ICF) and the family of participation-related constructs (fPRC). In this framework, the environmental and child determinants of school participation (e.g., school routines and peer/teacher context; self-regulation, activity competence and preferences) interact bidirectionally to shape everyday participation. However, many interventions still target isolated impairments, overlooking coordinated changes in capacities and context. Grounded in this contemporary view, this study aimed to investigate the impact of an immersive virtual reality (IVR) intervention on school participation-related constructs in children with ADHD. METHODS: The study included 92 children aged between 7 and 12 years diagnosed with ADHD. Participants were randomly assigned into intervention (n = 46) and control (n = 46) groups. Both groups completed the School Participation Questionnaire (SPQ) and Bruininks-Oseretsky Test of Motor Proficiency Test 2 Brief Form (BOT2-BF) assessment prior to the intervention. The intervention group received an IVR intervention program twice a week for 8 weeks. During this period, the control group did not receive additional therapy. At the end of the 8 weeks, the SPQ was readministered to both groups. RESULTS: Baseline characteristics showed no significant differences in SPQ and BOT2-BF results between groups, confirming homogeneity prior to intervention. Following the intervention, the study group demonstrated significant improvements across all domains of the SPQ (doing, being, symptoms and environment), with large effect sizes for SPQ total score (d = 0.978) and subdomains (d = 0.452-0.910). In contrast, the control group showed no improvements and even declines in subdomains. Post-intervention, between-group comparisons revealed significant differences favouring the study group across all domains (p < 0.001), with large effect sizes (d = 0.878-1.165). CONCLUSIONS: Findings suggest that the IVR program was associated with improvements in teacher-rated environmental and child determinants of school participation (SPQ domains) in children with ADHD.

Humans↗

PubMed2004

Functional recovery after bleeding episodes in haemophilia.

Haemophilia is characterized by intra-articular and intramuscular bleeding episodes. Although much work has been carried out into post-bleeding mechanisms in both synovial joints and muscles, the picture is not yet clear. A firm post-bleeding rehabilitation protocol is of utmost importance for people with haemophilia. The use of the International Classification of Functioning Disability and Health reveals that information worldwide is on body level, whereas the goals of patients with haemophilia implicitly aim at optimal functional recovery. This interferes much more with activities and participation in society. The Functional Independence Score for Haemophilia and the Post-bleeding Protocol Based on Functional Milestones are examples of post-bleeding approaches that deal more with function. Two cases will emphasize the value of this approach.

Child↗

PubMed2005

Risk behaviors for varying categories of disability in NELS:88.

A large body of research shows that youth with disabilities, who comprise about 13% of the country's school-aged population, report comparable to higher incidence rates of alcohol, tobacco, and other drug (ATOD) use than their peers. Furthermore, youth with disabilities who reported ATOD use or who engaged in binge drinking had significantly more negative educational outcomes and engaged in sexual activity at a younger age than nonusers. This study describes risk factors for substance use, personal characteristics, aspects of the attitudinal environment, and educational, employment, and social outcomes among youth across 6 categories of disability. Data came from the National Center for Education Statistics' National Education Longitudinal Study of 1988-2000 (NELS:88). The findings indicate that (a) youth with varying types of disabilities are relatively homogenous with respect to risk behaviors, personal characteristics, and outcomes; (b) youth with emotional, learning, or multiple disabilities may be at heightened risk for binge drinking and marijuana use; and (c) youth with emotional and multiple disabilities may be less likely to graduate from high school or its equivalent 8 years beyond the 12th grade. Based on these results and limitations of the NELS sampling strategy, appropriate interventions are discussed as well as the need for more definitive operational definitions for disabilities, specifically the biopsychosocial approach used by the International Classification of Functioning, Disability, and Health.

Adolescent↗

PubMed2005

ICF based comparison of disease specific instruments measuring physical functional ability in ankylosing spondylitis.

OBJECTIVES: To link validated and widely used instruments measuring physical functional ability in ankylosing spondylitis to the International Classification of Functioning, Disability, and Health (ICF) and to compare their contents, based on the results of the linking process. METHODS: The Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), the Health Assessment Questionnaire modified for the spondylarthropathies (HAQ-S), and the Revised Leeds Disability Questionnaire (RLDQ) were linked to the ICF separately by two trained health professionals according to 10 linkage rules. RESULTS: All concepts contained in the items of the selected instruments could be successfully linked to the ICF except for "illness" included in the HAQ-S. Altogether 55 different ICF categories were linked. Seven belonged to "body functions", 43 to "activities and participation", and five to "environmental factors". The component "body structure" was not contained in any of the four instruments. Only two ICF categories were common to all selected questionnaires, but there was a high level of concordance on the concepts represented in them. However, especially in terms of "activities and participation", the emphasised aspects differed. CONCLUSIONS: The ICF provides an excellent common framework for the comparison of disease specific instruments for ankylosing spondylitis. For a future revision of the ICF, a specification of major limitations in patients with ankylosing spondylitis is suggested.

Activities of Daily Living↗

PubMed2007

Reliability of the ICF Core Set for rheumatoid arthritis.

BACKGROUND: The comprehensive ICF Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the International Classification of Functioning, Disability and Health (ICF), representing relevant aspects in the functioning of RA patients. OBJECTIVES: To study the reliability of the ICF Core Set for RA in rheumatological practice, and to explore the metric of the qualifiers' scale. METHODS: 25 RA patients from an outpatient department of rheumatology were interviewed using the ICF Core Set for RA (76% females, mean (SD) age 57.5 (12.5) years, disease duration 15.9 (14.6) years). Interviews were performed independently by both a physiotherapist and an occupational therapist on the same day and again after one week by one of them. The severity of the patients' problems was quantified on a qualifier scale ranging from 0 (no problem) to 4 (complete problem). Analyses of intra-rater and inter-rater agreement, kappa statistics, and Rasch analyses were applied. RESULTS: Mean intra-rater (inter-rater) complete agreement for all categories was seen in 59% (47%) of observations, ranging from 29% (0%) to 96% (80%) for individual categories. Weighted kappa statistics with value > or =0.4 showed reliability in 86% of categories within raters, and in 43% of categories between raters. Improved inter-rater and intra-rater reliability was observed with a reduced number of qualifiers for the categories. CONCLUSIONS: Inter-rater and intra-rater reliability of the ICF Core Set of RA was low to moderate. The metric of the qualifiers' scale may be improved by reducing the number of qualifiers to three for all components.

Activities of Daily Living↗

PubMed2006

Outcomes of physical therapy, speech pathology, and occupational therapy for people with motor neuron disease: a systematic review.

This article describes a systematic review and critical evaluation of the international literature on the effects of physical therapy, speech pathology, and occupational therapy for people with motor neuron disease (PwMND). The results were interpreted using the framework of the International Classification of Functioning, Disability and Health. This enabled us to summarize therapy outcomes at the level of body structure and function, activity limitations, participation restrictions, and quality of life. Databases searched included MEDLINE, PUBMED, CINAHL, PSYCInfo, Data base of Abstracts of Reviews of Effectiveness (DARE), The Physiotherapy Evidence data base (PEDro), Evidence Based Medicine Reviews (EMBASE), the Cochrane database of systematic reviews, and the Cochrane Controlled Trials Register. Evidence was graded according to the Harbour and Miller classification. Most of the evidence was found to be at the level of "clinical opinion" rather than of controlled clinical trials. Several nonrandomized small group and "observational studies" provided low-level evidence to support physical therapy for improving muscle strength and pulmonary function. There was also some evidence to support the effectiveness of speech pathology interventions for dysarthria. The search identified a small number of studies on occupational therapy for PwMND, which were small, noncontrolled pre-post-designs or clinical reports.

Humans↗