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Results for “International Classification of Functioning, Disability and Health”

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PubMed2002

The global burden of epilepsy.

We briefly describe the Global Burden of Diseases (GBD) study, its goals, and some of its outcomes as related to neurologic and psychiatric disorders. The summary measure of population health DALYs (Disability Adjusted Life Years) are described, as well as the implications for neuropsychiatric disorders of changing health indicators and the move from mortality toward disability indicators. The pressing need for new measures for health is answered by the new WHO Classification of Functioning Disability and Health, ICF, and a brief summary of its basic principles is provided. Although a better understanding of the physical, social, and economic burden of epilepsy has moved this disorder higher on the world's agenda, epilepsy still has problems to be recognized as a public health priority. The implications of a shift toward considering the disability of epilepsy, as outlined in the the WHO World Health Report 2001, are important. The burden of epilepsy is high and, for the year 2000, accounts for approximately 0.5% of the whole burden of diseases in the world.

Cost of Illness↗

PubMed2002

Characteristics of patients with persistent severe disability and medically unexplained neurological symptoms: a pilot study.

This study audited 25 patients (21 female) from Oxfordshire who had been referred to either the liaison psychiatry or the neurological disability service between 1992 and 1998, reported a Barthel activities of daily living index score < 20 or a global assessment of functioning score of < or = 30, and had no pathology to explain their neurological disability. Levels of motor impairment, disability, mood, and cognitive status were assessed using standardised scales, and all patients were assigned a psychiatric diagnosis according to the International classification of diseases, 10th revision. Of the 25 patients, 13 had a motor conversion disorder, 8 had diverse somatoform disorders, and 3 had chronic fatigue syndrome. Nine had extensive previous contact with psychiatric services and 11 had experienced physical or sexual abuse. In 6 patients cessation of repeated self harm was closely associated with the onset of wheelchair use. Seven were receiving treatment for depression. The commonest putative diagnoses were multiple sclerosis (6) and epilepsy (5). Twelve were unable to walk and 20 owned a wheelchair but only 3 had formal care packages. The mean (SD) Barthel score was 14.1 (3.3) and the mean (SD) Frenchay activity index score was 12.9 (7.5). All were unemployed and receiving a disability living allowance, and some had benefits of up to pound 1815 a month. This small but significant group of disabled patients had a variety of psychiatric and neurological diagnoses and used considerable health care resources.

Activities of Daily Living↗

PubMed2006

Adding injury to insult: fracture risk after stroke in veterans.

OBJECTIVES: To determine fracture risk in U.S. stroke patients and identify patient characteristics that predict highest fracture risk in two complementary cohorts. DESIGN: Secondary analyses of two prospective cohorts. SETTING: Veterans Affairs (VA) Medical Centers. PARTICIPANTS: The VA Acute Stroke (VASt) cohort includes 1,073 veterans admitted to nine VA hospitals for stroke between April 1995 and March 1997. The Integrated Stroke Outcomes Database (ISOD) includes 6,578 veterans who received inpatient rehabilitation for stroke at 121 VA facilities during fiscal years 2001 and 2002. MEASUREMENTS: Fractures detected using International Classification of Diseases, 9th Revision, codes in the VA computerized patient record system; baseline patient characteristics and stroke features; Functional Independence Measures scores in ISOD. RESULTS: Estimated 2-year fracture rates after stroke in the VASt and ISOD cohorts were 6.1% and 4.7%, respectively. Longer hospitalizations for stroke (P=.06) and new motor or sensory impairment (P=.09) showed trends toward greater risk in the VASt cohort. Female sex (P <.001), cognitive impairment (P=.01), and nonblack race (P=.04) were associated with higher fracture risk in the ISOD. Intermediate functional impairment conferred higher fracture risk than mild or severe functional impairment. CONCLUSION: Veterans who suffer a stroke are at high risk of subsequent fracture, which can lead to further disability. Women, nonblacks, and those with intermediate functional impairment were at particularly high risk of fracture. Future study should investigate therapies to decrease fracture risk in stroke patients.

Aged↗

PubMed2001

Demonstration of the healthy worker survivor effect in a cohort of workers in the construction industry.

OBJECTIVES: To assess the potential of a healthy worker survivor effect due to differential occupational mobility in a cohort of construction workers. METHODS: A cohort of 10 809 male employees in the German construction industry aged 15-64 years was followed up for occupational mobility, early retirement due to permanent disability, and total mortality from 1986 to 1994. Using the Cox's proportional hazards model of relative rates (RRs) with 95% confidence intervals (95% CIs) of occupational mobility, early retirement and total mortality were estimated according to medical diagnoses at baseline after adjustment for various covariates. RESULTS: During follow up, 2472 subjects changed employment, 359 employees were granted a disability pension for health reasons and 188 subjects died. A wide range of chronic diseases was associated with increased rates of early retirement and total mortality but not occupational mobility. However, a healthy worker survivor effect was identified related to disorders of the back and spine (ninth revision of the international classification of diseases, ICD-9, code 720-4), a common predictor of both occupational mobility (RR 1.17, 95% CI 1.04 to 1.32) and early retirement (RR 1.50, 95% CI 1.20 to 1.88). In total, there were about as many events of occupational changes (n = 41) as events of early retirement due to permanent disability (n = 39) significantly attributable to disorders of the back and spine. Differential occupational mobility preceded differential early retirement due to permanent disability by more than one decade. CONCLUSIONS: These findings show the need to consider a healthy worker survivor effect due to occupational mobility in occupational epidemiological research. Furthermore these results underline the necessity of further health promotion targeting work related conditions in the construction industry.

Adolescent↗

PubMed2004

Assessing disability in older patients with schizophrenia: results from the WHODAS-II.

The World Health Organization has recently published an instrument to evaluate disability, entitled the World Health Organization Disability Assessment Schedule-Second Version (WHODAS-II). We sought to evaluate its reliability and validity in older patients with schizophrenia. We studied 54 outpatients with schizophrenia and 22 normal comparison subjects. Besides WHODAS-II, we used standardized rating scales to assess positive and negative symptoms, depressive symptoms, cognitive functioning, everyday functioning, and quality of well-being. There was high internal consistency in WHODAS-II item scores and significant test-retest reliability. Patients reported greater disability than normal comparison subjects. Among the patients, disability scores were significantly associated with severity of depressive symptoms and quality of well-being, but not with cognitive performance and everyday functioning. The findings offer strong evidence for reliability and some evidence for validity of the WHODAS-II in older patients with schizophrenia.

Activities of Daily Living↗

PubMed2000

Making sense of rehabilitation projects: classification by objectives.

Rehabilitation of disabled persons can take many different forms according to the socio-cultural and political context in which it is undertaken. Some approaches have emphasized the restoration of the physical function of the client, while others have looked beyond to psychological and social well-being. Some have built on the expertise of professionals while others have emphasized the caring capacity available in the family and the community and sought to reinforce it. Besides providing a wide range of possible services to disabled persons, rehabilitation seeks to change the attitudes that prevail in society as a whole and promote the integration of disabled people into society with equal rights and opportunities. This paper reviews a range of models and approaches which have been put forward in the international debate on rehabilitation. Furthermore, four dimensions are described which can be used to characterize and define classes of rehabilitation projects based on the objectives that are defined for them. Thus types of rehabilitation projects can be distinguished. Management, evaluation and technical support for rehabilitation projects need to take these essential characteristics into account.

Community Networks↗

PubMed2005

Headache symptoms in pediatric sickle cell patients.

The purposes of this study were to determine the characteristics of headaches in children with sickle cell disease (SCD) and to assess the relationship between headache symptoms and children's physical and emotional status. A detailed headache questionnaire using International Classification of Headache Disorders (ICHD-2) criteria was mailed to a cohort (n = 50) of children with SCD, ages 9 to 17 years. Respondents also completed measures of functional disability and psychological distress. Headaches had occurred over the previous 3-month period in 76.2% of the patients. Frequent headaches were common, occurring greater than once a week in 31.2% of children. Average pain severity was reported as moderate on a 0-to-10 scale (mean = 5.8). Duration of headaches ranged from 30 minutes to several days, with a mean of 5 hours. Based on ICHD-2 criteria, 43.8% of children had headache symptoms consistent with migraines, 6.2% with migraine with aura, and 50.0% with tension-type headaches. Children with symptoms of migraine had significantly greater functional disability compared with children with symptoms of tension-type headaches (P < 0.01). Further studies to determine the characteristics and determinants of headaches experienced in SCD patients will help maximize treatment of headaches and enhance daily functioning in these patients.

Adolescent↗

PubMed2003

New wine in old bottles: the WHO ICF as an explanatory model of human behaviour.

The World Health Organization's International Classification of Functioning (WHO ICF) is a good but incomplete framework for describing the situation of someone with long-term ill health. Several deficiencies exist for which improvements are suggested. The WHO needs to integrate the ICF with the ICD-10 to form a comprehensive system of classification of illness. Words are needed for normality at the level of organ and person, and the words 'histology' and 'physiology', and 'anatomy' and 'capacity' are suggested for the two levels respectively. A fourth context, that of time, is needed to understand fully a person's situation. The classification framework needs to take more account of the patient. It needs to recognize two separate perspectives, that of the subject and that of external observers and it needs to recognize two other specific person-centred phenomena: free will and quality of life. With changes and additions to take account of these deficiencies, the WHO ICF can be used as a powerful analytic and explanatory model of human experience and behaviour in any situation, not only in illness and disease.

Activities of Daily Living↗

PubMed2003

Community rehabilitation, or rehabilitation in the community?

PURPOSE: Political and other considerations are increasing the profile of 'community rehabilitation' but there is little agreement on the nature of community rehabilitation or its benefits and disadvantages. This paper clarifies some of the underlying conceptual and evidential matters in the context of the WHO International Classification of Functioning model of disablement. CLASSIFICATIONS: Rehabilitation services can be classified by their specialist skills (e.g. spinal injury services, wheelchair services), by the geographic location of the service (e.g. inpatient stroke service), by the organization managing the service (e.g. social services rehabilitation service), or by location of service delivery. There is no useful consistent comprehensive classificatory system, and all classificatory labels may carry hidden implications. EVIDENCE: The evidence suggests that rehabilitation is more effective when given in the patient's own environment. It also suggests that most so-called community rehabilitation teams are relatively short-lived and are not multi-disciplinary and not expert. SOLUTION: We should work towards a network of rehabilitation teams, some specialized in specific diseases or interventions, and some in longer-term involvement with patients in the community with special emphasis on increasing social participation and ensuring good support. At all times we should balance the advantages of delivering the service in the patient's home against the obvious problems concerning practicality and the equitable use of scarce specialist staff time.

Community Health Services↗

PubMed2005

Identifying migraine in primary care settings.

Migraine disorders are largely unrecognized and untreated, despite the heavy burden they impose on individuals and society. Studies have shown that the symptom severity and disability associated with undiagnosed migraine are as burdensome as those associated with diagnosed migraine. Of those persons with migraine identified in population-based surveys, many were previously unaware that they had migraine. Furthermore, coexisting headache types and comorbid conditions contribute to misdiagnosis among those who consult a physician for headache. Patients who do seek medical attention for headaches usually visit their primary care providers. The purpose of this review is to highlight the distinguishing characteristics of migraine compared with other headache disorders, based on the new International Classification of Headache Disorders. To aid in diagnosis, simple screening tools, such as ID Migraine (Pfizer Inc., New York, NY), are recommended. The clinical interview and headache diary aid in refining the diagnosis or suggesting the need for further evaluation. Improved recognition of migraine in primary care will increase the rate of successful treatment with effective migraine-specific therapies. This will result in improved functionality and decreased pain, and may help prevent disease progression.

Comorbidity↗

PubMedDate not supplied

Adult health status of women HMO members with posttraumatic stress disorder symptoms.

Posttraumatic stress disorder (PTSD) is associated with high numbers of self-reported physical symptoms and functional disability in clinical samples, but little is known about the magnitude of these associations in population samples and using actual physician-coded diagnoses. We administered a 22-page survey to 1225 female HMO enrollees randomly selected from the current membership of a large, staff model HMO in Seattle, Washington. Using the PTSD Checklist (internally validated against a subset of clinical interviews) we compared women with low, moderate, and high scores with respect to differences in self-reported physical health status, functional disability (36-item short form health survey), numbers and types of self-reported health risk behaviors, common physical symptoms, and physician-coded ICD-9 diagnoses. Compared to women with low PTSD symptom severity, those with moderate or high severity reported significantly higher functional disability (P<.001), rates of abuse and neglect (P<.01 to P<.001), health risk behavior scores (P<0.05), as well as higher mean numbers of common physical symptoms (P<.05). Compared to women with low PTSD symptom severity those with moderate or high severity had significantly higher adjusted odds ratios for aversive physical symptoms (range, 1.7-10.1). The mean number of physician-coded ICD-9 diagnoses was also significantly higher in the both the moderate and high severity groups. Among female HMO members, PTSD symptoms are associated with a wide range of both self-reported and physician-coded adverse physical health outcomes.

Adolescent↗

PubMed2001

Defining the population, treatments, and outcomes of interest: reconciling the rules of biology with meaningfulness.

Population characteristics, treatment needs, therapeutic interventions, and outcomes are inextricably linked. To appreciate the treatment needs and outcomes of populations served by rehabilitation medicine, it is essential to understand how specific conditions impair mental and physical functioning, given the environments within which people choose to live. States of the mind and body combine with the characteristics of the man-made and natural world and the social infrastructure to yield disabilities and, thus, shape the demand for rehabilitation services. The 1997 draft of ICIDH-2: International Classification of Impairments, Activities, and Participation (ICIDH-2) is described as an approach to population definition and outcome assessment. A new and evolving model referred to as the spheres of human-environmental integration (HEI) is applied to expressing the nonlinear and overlapping relationships among the ICIDH-2 dimensions. HEI is defined as the individual's potential for meaningful physical and mental activity as determined by physical and mental capabilities in relationship to the man-made and natural worlds, social expectations, and available resources. HEI can be expanded by reducing disabilities through medical and rehabilitation interventions and by eliminating environmental barriers. This dual approach implies a need to integrate rehabilitation sciences with the principles of independent living, which view disablement as a function of the environment. The ICIDH-2 dimensions combined with HEI are used to define populations and to study the mechanisms and effects of alternative treatments through various techniques of case-mix measurement, disability staging, and utility assessment.

Activities of Daily Living↗

PubMed2001

[Is the ICIDH (International Classification of Impairments, Disabilities and Handicaps) suitible for geriatric rehabilitation?].

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH), a manual of disease consequences issued by WHO, at present exists in two versions. ICIDH-1, issued in 1980, has been under revision since 1993. This revision process will result in a more sophisticated and more comprehensive ICIDH-2 in 2001. The ICIDH, based on the biopsychosocial disease model, describes disease consequences in three dimensions: Structural and functional body impairments. Disabilities (ICIDH-1) or restrictions of activities (ICIDH-2) in activities of daily living. Handicaps (ICIDH-1) or participation limitations (ICIDH-2) in social integration. In the field of geriatrics ICIDH is also helpful as a coherent conceptual framework and reference manual to determine and code the disabilities and handicaps with regard to daily living competence. Geriatric assessment instruments are no alternative, but complementary to the ICIDH. In view of the high frequency of geriatric patients with multimorbidity, i.e. multiple impairments, disabilities, and handicaps, the utility of the ICIDH in geriatric care is highly dependent on the flexible application of this classification system.

Activities of Daily Living↗

PubMed1991

[Health and handicap profile of patients with cerebrovascular diseases in an inpatient rehabilitation center].

In order to get more precise information on the staffing and structural capacities needed in the care and rehabilitative treatment of patients with cerebrovascular diseases (CVD), the profiles of illness and disability were studied retrospectively on the basis of the medical histories of CVD patients who had been treated at a neurological rehabilitation centre in 1987 and had mostly come from the facility's assigned catchment area. Due to insufficient documentation of certain profile data in the patients histories, the same data were recorded in a complementary study for all patients in this target population admitted in the first half of 1988. The classification of patients into nursing care categories, already practiced in everyday clinical routines, turned out a valid global estimate for the total nursing, medical and therapeutic efforts required in the individual patient. A high correlation exists between the nursing care category assigned and the numbers of necessary care interventions as well as functional disorders requiring rehabilitative attention. The nursing care interventions needed concentrate on certain situations during the day, which has to be taken into account in staff planning. Given the multitude of impairments and disabilities seen, comprehensive management in a neurological rehabilitation unit presupposes a team of diverse diagnostic and therapeutic specialists, which, apart from medical specialists and nursing staff, should at least comprise physio- and Occupational Therapists, neuro-linguistic or logopedic specialists, as well as psychologists. In view of the high incidence of accompanying internal diseases, a stroke rehabilitation unit must have access to an internal medical service at least on a consultancy basis, and available on an extended time scale.

Activities of Daily Living↗

PubMed1999

[Everything was done--patient still not satisfied: introduction to evidence-based surgery].

Although the best knowledge in academic medicine has been used, some patients are still unsatisfied. By reason of these experiences there is a certain need to reflect our patterns of thinking. The surgical act is based on the laws of causality from Newton and Galilei and it is determined by the principle of cause and effect. Therefore the healing process must be interpreted as a turning back of pathogenesis or the linear chain of causalities. Scientific knowledge of this century demonstrate, that biologic healing processes are connected with the laws of cybernetics and the principles of semiotics. There are functional relations between the level of the organ (impairments) of the individual (disabilities) and of the society (handicaps). This International Classification of Impairments, Disabilities and Handicaps (ICIDH) serves as the key for the management of chronic diseases. An independent and a separate classification of the severity in each level is necessary to identify the consequences of the disease to the patient. Surgical interventions occur on the organ level, benefit and evidence are reflected especially on the individual level (gain of abilities). The assessment and the integration of the so called "sensory impairment", influenced by the biographical events of the patient, an the evaluation of the psychosocial resistance are important factors to recognize a unfavourable conformity between the degree of impairment and the degree of disability. With this classification a more patient-oriented discussion of the indications regarding operative procedures can be realised. The MARA model (mean age related ability) serves as a pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve as ethical guideline. This model, which is derived on ICIDH, the hierarchy of needs and the salutogenesis (semiotics, cybernetics), facilitate the introduction of evidence based surgery. It helps to estimate the several predictive values and correlation factors influencing the manifestation of the disease. On this way astonishing results in evidence can be expected. Finally many misunderstandings in health care discussions are explained by the fact that the differences between pathology and illness are not clearly interpreted.

Adult↗

PubMed2004

ICF Core Sets for breast cancer.

OBJECTIVE: To report on the results of the consensus process to develop the first version of both a Comprehensive ICF Core Set and a Brief ICF Core Set for breast cancer. METHODS: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was realized. 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 317 ICF categories at the second, third, and fourth ICF levels with 150 categories on body functions, 44 on body structures, 77 on activities and participation, and 46 on environmental factors. Nineteen experts attended the consensus conference on breast cancer (7 physicians with at least a specialization in physical and rehabilitation medicine, 2 with a specialization in internal medicine and one radiologist, 4 physical therapists, 2 occupational therapists, one psychologist, one epidemiologist and one nurse). Altogether 80 categories (73 second-level and 7 third-level categories) were included in the Comprehensive ICF Core Set with 26 categories from the component body functions, 9 from body structures, 22 from activities and participation, and 23 from environmental factors. The Brief ICF Core Set included a total of 40 second-level categories with 11 on body functions, 5 on body structures, 11 on activities and participation, and 13 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 breast cancer. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were selected.

Activities of Daily Living↗

PubMedDate not supplied

[The patient as expert--introduction to evidence-based orthopedics].

The surgical act is based on the laws of causality from Newton and Galilei and it is determined by the principle of cause and effect. Therefore, the healing process must be interpreted as a turning back of pathogenesis or the linear chain of casualities. Scientific knowledge of this century demonstrates that biological healing processes are connected with the laws of cybernetics and the principles of semiotics. There are functional relations between the level of the organ (impairments) of the individual (disabilities) and of the society (handicaps). This International Classification of Impairments, Disabilities and Handicaps (ICIDH) serves as the key for the management of chronic diseases. An independent and a separate classification of the severity in each level is necessary to identify the consequences of the disease to the patient. Surgical interventions occur on the organ level, benefit and evidence are reflected especially on the individual level (gain of abilities). The assessment and the integration of the so-called "sensory impairment", influenced by the biographical events of the patient and the evaluation of the psychosocial resistance are important factors to recognize unfavourable conformity between the degree of impairment and the degree of disability. With this classification, a more patient-oriented discussion of the indications regarding operative procedures can be realised. The MARA model (mean age-related ability) serves as a pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve as an ethical guideline. This model, which is on ICIDH, the hierarchy of needs and the salutogenesis (semiotics, cybernetics), facilitate the introduction of evidence-based surgery. It helps to estimate the several predictive values and correlation factors influencing the manifestation of the disease. In this way astonishing results in evidence can be expected. Finally, many misunderstandings in health care discussions are explained by the fact that the differences between pathology and illness are not clearly interpreted.

Cybernetics↗

PubMed2005

The International Classification of Functioning as an explanatory model of health after distal radius fracture: a cohort study.

BACKGROUND: Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. METHODS: This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. RESULTS: Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE. CONCLUSION: The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.

Activities of Daily Living↗