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PubMed2006

Validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis from the patient perspective using focus groups.

Functioning is recognized as an important study outcome in rheumatoid arthritis (RA). The Comprehensive ICF Core Set for RA is an application of the International Classification of Functioning, Disability and Health (ICF) of the World Health Organisation with the purpose of representing the typical spectrum of functioning of patients with RA. To strengthen the patient perspective, persons with RA were explicitly involved in the validation of the Comprehensive ICF Core Set for RA using qualitative methodology. The objective of the study was twofold: to come forward with a proposal for the most appropriate methodology to validate Comprehensive ICF Core Sets from the patient perspective; and to add evidence to the validation of the Comprehensive ICF Core Set for RA from the perspective of patients. The specific aims were to explore the aspects of functioning and health important to patients with RA using two different focus group approaches (open approach and ICF-based approach) and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for RA. The sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. After qualitative data analysis, the resulting concepts were linked to ICF categories according to established linking rules. Forty-nine patients participated in ten focus groups (five in each approach). Of the 76 ICF categories contained in the Comprehensive ICF Core Set for RA, 65 were reported by the patients based on the open approach and 71 based on the ICF-based approach. Sixty-six additional categories (open approach, 41; ICF-based approach, 57) that are not covered in the Comprehensive ICF Core Set for RA were raised. The existing version of the Comprehensive ICF Core Set for RA could be confirmed almost entirely by the two different focus group approaches applied. Focus groups are a highly useful qualitative method to validate the Comprehensive ICF Core Set for RA from the patient perspective. The ICF-based approach seems to be the most appropriate technique.

Adult↗
PubMed2006

Analyzing the content of outcome measures in clinical trials on irritable bowel syndrome using the international classification of functioning, disability and health as a reference.

BACKGROUND: Patients with irritable bowel syndrome (IBS) report a significant impact of their symptoms on functional health. In outcome assessment of clinical studies on IBS, however, functional aspects other than gastrointestinal symptoms seem to be disregarded to a great extent. AIM: To analyze the content of outcome measures used in clinical IBS trials. METHODS: A systematic review was performed in terms of a quantitative content analysis using the International Classification of Functioning, Disability and Health (ICF) as a coding scheme. Outcome measures were selected from all randomized controlled trials on IBS published in PubMed from the beginning to April 2002. From the outcome measures pre-specified text passages, so-called coding units, were extracted and linked to the ICF. A coding unit had to describe a single health aspect or an internal or external factor with an impact on health. If the outcome measure was a test the goal of the test was semantically implicated. Only second-level ICF categories contained in the outcome assessment of at least 10 % of the studies were considered. All steps of the review were performed by three independent raters. RESULTS: 99 studies were included. Single items were used as outcome measures in 88, clinical and paraclinical tests in 42 and questionnaires in 24 studies. Ninety percent of the coding units (n = 2271) could be linked to the ICF. ICF categories describing gastrointestinal symptoms were considered in the outcome assessment of 37 to 85 studies depending on the type of content compared to extra-gastrointestinal symptoms in 10 to 22 studies. Health information of ICF components other than "body functions" was scarcely included. Clear secular trends for individual ICF categories could not be found. Only a single IBS-specific questionnaire considered health information other than gastrointestinal symptoms. DISCUSSION AND CONCLUSION: Outcome assessment of clinical IBS studies is mainly based on gastrointestinal symptoms. The assessment of other health aspects like comorbid psychological symptoms or social consequences of the disease seems to be similarly important and should be considered in future trials. This would also facilitate the understanding of IBS as a biopsychosocial health condition, both in matters of aetiology and consequences.

Activities of Daily Living↗
PubMed2006

Identification of intervention categories for physical therapy, based on the international classification of functioning, disability and health: a Delphi exercise.

BACKGROUND AND PURPOSE: Disability or limitations in human functioning are universal experiences that concern all people. Physical therapists aim to improve functioning and prevent disability. With the approval of the new International Classification of Functioning, Disability and Health (ICF), we can now rely on a globally recognized framework and classification to be used in different health care situations by all health care professionals in multidisciplinary teams. The objective of this study was to identify ICF categories that describe the most relevant and common patient problems managed by physical therapists in acute, rehabilitation, and community health care situations taking into account 3 major groups of health conditions: musculoskeletal, neurological, and internal. SUBJECTS: The subjects were physical therapists who were identified as possible participants by the heads of physical therapy departments who were members of the Swiss Association of Physical Therapy Department Heads or who were recruited from the membership of the Swiss Association of Physiotherapy. METHODS: A consensus-building, 3-round, electronic-mail survey with 9 groups of physical therapists was conducted using the Delphi technique. RESULTS: Two hundred sixty-three physical therapists participated in at least one round of the Delphi exercise. They had consensus levels of 80% or higher for categories in all ICF components (Body Functions, Body Structures, Activities and Participation, and Environmental Factors 1 and 2). DISCUSSION AND CONCLUSION: This study is a first step toward identifying a list of intervention categories relevant for physical therapy according to the ICF. The ICF, designed as a common language for multidisciplinary use, is also a very helpful framework for defining the core competence for the physical therapy profession.

Delphi Technique↗
PubMed2005

Assessment of patients with intellectual disability using the International Classification of Functioning, Disability and Health to evaluate dental treatment tolerability.

BACKGROUND: Patients with serious intellectual disability (ID) are occasionally unable to tolerate dental treatment when intravenous sedation or general anaesthesia (IVS/GA) is involved. In order to make a decision regarding the application of IVS/GA, the International Classification of Functioning, Disability and Health (ICF) is useful. Therefore, in this study, a set of codes involved in dental problems were chosen from the ICF, and patients with ID who could tolerate dental treatments were compared with those who could not. METHODS: From preliminary interviews of six patients with ID, 16 codes were chosen, and an objective five-rank scale was then constructed for use with all chosen codes. Forty-nine ID patients who visited the Okayama University Hospital for dental treatment between January and April 2003 were evaluated. Facility workers were interviewed according to the code set chosen. The participants were then divided into two subgroups depending on their tolerability of dental treatment. The results of these groups for all 16 codes were then compared. RESULTS: Of the 49 patients interviewed, 23 were able to tolerate the dental treatment. In the 'Activities & Participation' section of the ICF, the tolerable group showed lower disability levels with regard to d110 Watching, d540 Dressing and d550 Eating. In other sections, there were no significant differences between the groups. The code set chosen in this study and the five-rank scales in each code were useful as they enabled easy interviewing. CONCLUSIONS: The ICF was raised as a possibility for considering the application of IVS/GA for dental treatment on patients with ID. For clinical use of the ICF, it is recommended that significant codes should be selected and that the five-rank scale is used so that more objective results are obtained from interviews.

Adult↗
PubMed2006

Content comparison of low back pain-specific measures based on the International Classification of Functioning, Disability and Health (ICF).

OBJECTIVES: The objective of this study was to compare the content covered by the North American Spine Society Lumbar Spine Outcome Assessment Instrument, the Oswestry Low Back Disability Questionnaire, and the Roland-Morris Disability Questionnaire based on the International Classification of Functioning, Disability and Health (ICF). METHODS: The linkage of items of the three measures to the ICF involved three steps, which were performed by two different health professionals and in which 10 different linking rules were applied. RESULTS: In the 48 items of the three instruments, a total of 123 concepts were identified and linked to the ICF. The concepts contained in the items were linked to 10 ICF categories of the component "body functions," 27 of the component "activities and participation," and 4 of the component "environmental factors." The estimated kappa coefficients ranged from 0.67 to 1.00. CONCLUSION: Comparison based on the ICF provides insight into both the breadth of health dimensions measured as well as the thoroughness and depth of measurement. Therefore, it can be a useful tool when selecting specific measures for a study. Compared with other types of qualitative review, the most important advantage of the content comparison of measures based on the ICF is the use of an external and independent reference to which all the instruments can be linked and by which all the instruments can be compared. The three back-specific measures are comparable, with their common focus on physical aspects of body functions and activities and participation.

Activities of Daily Living↗
PubMed2006

A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning, Disability and Health (ICF) as a reference tool.

BACKGROUND: A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS), however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomes assessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts contained in the International Classification of Functioning, Disability and Health (ICF). METHODS: The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical treatment for CTS. The outcomes assessed in these trials were identified, classified and linked to the different domains of the ICF. RESULTS: Twenty-eight studies were retrieved which met the inclusion criteria. The most frequently assessed outcomes were self-reported symptom resolution, grip or pinch strength and return to work. The majority of outcome measures employed assessed impairment of body function and body structure and a small number of studies used measures of activity and participation. CONCLUSION: The ICF provides a useful framework for identifying the concepts contained in outcome measures employed to date in trials of surgical intervention for CTS and may help in the selection of the most appropriate domains to be assessed, especially where studies are designed to capture the impact of the intervention at individual and societal level. Comparison of results from different studies and meta-analysis would be facilitated through the use of a core set of standardised outcome measures which cross all domains of the ICF. Further work on developing consensus on such a core set is needed.

Activities of Daily Living↗
PubMed2006

Measuring functioning in patients with hand osteoarthritis--content comparison of questionnaires based on the International Classification of Functioning, Disability and Health (ICF).

OBJECTIVE: When selecting a questionnaire, researchers and clinicians need to know whether or not a questionnaire covers the relevant outcomes. The aim of this study was to analyse and compare the content of questionnaires that have been used to assess functioning in patients with hand osteoarthritis (OA) based on the International Classification of Functioning, Disability and Health (ICF). METHOD: Questionnaires were identified in a structured literature search. All concepts included in the items of the questionnaires were linked to the ICF categories according to the 10 established linking rules by two health professionals. The degree of agreement between the two health professionals was determined by means of kappa statistic. On the basis of the linking, the content of the instruments was compared. For each concept, it was examined whether functioning is measured on the level of activity or participation or both activity and participation. Indicators for content density, content diversity and the percentage of linked ICF categories addressing participation were calculated. RESULTS: Health Assessment Questionnaire, AUSCAN, Cochin scale, FIHOA, SACRAH and AIMS2-SF were analysed. The result of the kappa statistic for agreement between the two investigators was 0.74. 163 concepts were identified in the 113 items of all instruments, which were then linked to seven ICF categories of the component body functions, 45 categories of the component activities and participation and six categories of the component environmental factors. AUSCAN and SACRAH had the lowest and AIMS2-SF showed the highest diversity ratio and the highest percentage of linked ICF categories that addressed participation. CONCLUSION: When selecting instruments for comprehensive measurements of functioning in hand OA, researchers and clinicians are advised to include both one instrument with a low diversity ratio (for disease-specific aspects) and another instrument with a high diversity ratio (for broader aspects of functioning including some aspects of participation).

Activities of Daily Living↗
PubMed2005

[The practical application of the International Classification of Functioning, Disability and Health (ICF) in medical rehabilitation of psychiatric patients].

The WHO Classification of Functioning, Disability and Health enables the description of functional health, disability and impairment on an international and interdisciplinary level in a common language. The fundamental underlying assumption of this Classification, which is orientated around a bio-psycho-social model of health and impairment, has been accepted by rehabilitation scientists in general. Unfortunately, the WHO does not make any recommendations as to how this classification could be applied in practice. In this article, various problems are outlined which could occur when the ICF is applied. Furthermore an example from a psychiatric rehabilitation institution illustrates the way the ICF could serve as an instrument for an extensive rehabilitation management programme. Here, Stucki's use will be made of Rehab-Cycle model. This describes a comprehensive sequence of steps which help analyse the patients problems from a patient-centred standpoint, to set up a schedule for treatment and to evaluate the results. Within Stucki's model the ICF is used as a system to analyse problems upon which intervention can be set. This method is illustrated with an example from a rehabilitation case. Summarizing, it is pointed out that through easier communication (as a result of the ICF) interdisciplinary productivity and efficiency will increase. On this basis it is possible to achieve a more comprehensive multimodal approach in the treatment of people suffering from psychic impairments or disability.

Decision Support Systems, Clinical↗
PubMed2003

Classification of communication disabilities in children: contribution of the International Classification on Functioning, Disability and Health.

Problems in communication serve as frequent markers of developmental delay and disability in childhood. Documentation of delayed or atypical receptive or expressive communication is one of the key diagnostic factors in the identification of children for intervention and support. This paper (1) reviews issues in classification and measurement of communication disabilities, (2) presents an overview of the development and publication of the WHO International Classification of Functioning, Disability and Health (ICF), and (3) identifies the implications of the ICF for children and youths with communication disabilities. As a conceptual framework, the ICF may be used productively to define the focus for different efforts to address children's language and communication difficulties. Impairments of a physical or mental nature can be covered in the Body Function and Body Structure components, complementing the information provided by the ICD-10 with descriptive documentation. The component of Activities, encompassing performance aspects of communication, lends itself to functional assessment and intervention in habilitation and education programs. The component of Participation provides an operational basis for policy initiatives focusing on social integration and community life Finally, the Environmental Factors component serves as a framework for identifying the nature and extent of access and opportunity for individuals and populations.

Activities of Daily Living↗
PubMed2002

[International classification of daily living function, disability and health status].

The World Health Organisation issued the international classification of impairments, disabilities and handicap in 1980. As no Hungarian translation appeared, it was mainly utilised in Hungary in education, with good results. Based on practical application in foreign countries and on positive and negative experiences, as a result of an almost ten years development process a new version was published, entitled the International classification of functioning, disability and health. The new classification, employing qualifiers, enables the description of both the nature and the magnitude of the problems, thus it may be applied in rehabilitation medicine practice. It may also support the establishment of still missing disability data bases. Applying together with quality of life assessments, it may serve obtaining better knowledge of the persons in need of rehabilitation.

Activities of Daily Living↗
PubMed2003

Idiopathic intracranial hypertension within the ICF model: a review of the literature.

Idiopathic intracranial hypertension (IIH) is an unusual disease, seen most often in women of childbearing age who are obese. If left untreated, IIH can cause chronic pain and blindness. Although IIH has been recognized by healthcare providers since the late 1880s, the cause is still not known and risk factors remain unclear. Treatment has not changed over the years. While professionals struggle to define, describe, and successfully treat IIH, persons with the disease are struggling to cope. Internet support group communications relate numerous personal stories of frustration, depression, pain, anxiety, and disability. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) model provides an appropriate framework through which to view what is known and what is yet to be discovered about IIH. The ICF model was designed to complement the International Statistical Classification of Diseases and Related Health Problems, looking beyond mortality and disease by describing how people live with their health conditions. Applying this framework to IIH reveals many opportunities for nursing research within the ICF domains of health condition, body function and structure, ability and participation, and environmental and personal factors.

Activities of Daily Living↗
PubMedDate not supplied

Public health and disability: emerging opportunities.

The public health community has traditionally paid little attention to the health needs of people with disabilities. Recent activities, however, on the part of federal and international organizations mark a shift toward engaging the health concerns of this large and growing population. First, the World Health Organization published the International Classification of Functioning, Disability, and Health (ICF), a companion to the International Classification of Diseases. The ICF describes both a conceptual framework and a classification system, providing the foundation for public health science and policy. Second, a vision for the future of public health and disability is outlined in Healthy People 2010 that, for the first time, includes people with disabilities as a targeted population. The article briefly describes activities and emerging opportunities for a public health focus on people with disabilities with the ICF as a foundation and Healthy People 2010 as a vision. Public health has traditionally responded to emerging needs; people with disabilities are a group whose health needs should be targeted.

Chronic Disease↗
PubMed2003

The implementation of the 'International Classification of Functioning, Disability and Health' (ICF) in daily practice of neurorehabilitation: an interdisciplinary project at the Kantonsspital of Lucerne, Switzerland.

PURPOSE: The current paper describes the implementation of ICF as a standard language and framework for description of human functioning and disability for common use in every day work by the multiprofessional team. METHOD: An interdisciplinary project team involving all rehabilitation specialities was constituted. The extensive original document of ICF was broken down to a simplified raster for body functions and structures, activities and participation, as well as for contextual factors. These rasters had to cover the most important aspects concerning the patients treated on our unit. Checklists on the basis of these rasters were worked out for use by the different specialized teams. Using these checklists, rehabilitation conferences, form and language of interdisciplinary communication, goal setting and documentation were introduced newly in every day work for the interdisciplinary rehabilitation team, structured strictly based on the ICF-criteria. RESULTS: Since April 2002 the ICF-based processes are implemented in routine work for all members of the rehabilitation staff. First experiences show good acceptance by the team members, improvements in communication and documentation as well as substantial gains in content and handling of rehabilitation conferences. As a result of the implementation we observed, that participation, context and domiciliary interventions gained quite more influence in every day work at the unit. CONCLUSION: Implementation improved considerably the quality of interdisciplinary work processes and contributed to a more systematic approach to rehabilitation tasks by the team members.

Activities of Daily Living↗