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PubMed2005

Assessing the benefits of using assistive technologies and other supports for thinking, remembering and learning.

PURPOSE: Planning assistive technologies and other supports for individuals with cognitive disabilities requires a comprehensive and individualized assessment of current goals, past experiences with the use of technologies and other supports, and the person's predisposition to the use of alternative or additional supports. This paper discusses a foundation for the refinement of an existing assessment process to match technologies to individuals with cognitive disabilities. METHOD: Prior research and a literature review identified the critical needs for an assessment process that would serve to identify key elements known to influence the success use of assistive technology and other supports by persons with cognitive disabilities. RESULTS: The components of successful, effective and satisfied support use result from a good match of device and support features, user goals and preferences, and environmental resources. The relationship to the World Health Organization's International Classification of Functioning, Disability and Health and the International Standardization Organization's international standard ISO DIS 9999 is discussed. CONCLUSIONS: As the number of assistive technology options increase, individualized interventions for individuals with cognitive disabilities will be easier to accomplish. The key to successful and optimal use of these products will be an appropriate and comprehensive assessment of consumer needs and preferences and the identification of additional accommodations and supports.

Cognition↗

PubMed2005

Benchmarking patient improvement in physical therapy with data envelopment analysis.

PURPOSE: The purpose of this article is to present a case study that documents how management science techniques (in particular data envelopment analysis) can be applied to performance improvement initiatives in an inpatient physical therapy setting. DESIGN/METHODOLOGY/APPROACH: The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery (at a medium-sized medical facility in the Midwestern USA) during the fiscal year 2002. Data envelopment analysis (DEA) was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using non-parametric and parametric methods. FINDINGS: Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension. RESEARCH LIMITATIONS/IMPLICATIONS: The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling: adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities (or the same disability with other outcome variables, such as Functional Independence Measure scores) may give dissimilar results. PRACTICAL IMPLICATIONS: This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics. ORIGINALITY/VALUE: DEA has not been applied to rehabilitation, especially in the case where managers have limited data available.

Arthroplasty, Replacement, Knee↗

PubMed2005

Dispelling the disability stereotype: embracing a universalistic perspective of disablement.

BACKGROUND: The notion of universalism was introduced to me during my first year of PhD studies in Rehabilitation Science. During a class discussion, we debated the merits of two theoretical perspectives that offered contradicting views as to the most effective means to facilitating a shift in societal perceptions of disability. As exemplified by the World Health Organization's current model of health, the International Classification of Functioning, Disability and Health (ICF), there has been a shift from a minority group analysis towards a universalistic perspective of disablement. PURPOSE: This paper introduces readers to the underlying concepts of both minority group analysis and universalism and, in doing so, proposes that universalism is closely aligned with the underlying constructs of occupational therapy. Universalism provides a comprehensive framework that can be utilized by occupational therapists to encourage the development of health and social-related policies that promote inclusiveness, yet still the respect the differences that exist among individuals. PRACTICE IMPLICATIONS By improving their familiarity with such theories, occupational therapists may be better positioned to contribute to policy development within their respective treatment and/or community settings.

Persons with Disabilities↗

PubMed2006

Meeting the criteria of a nursing diagnosis classification: Evaluation of ICNP, ICF, NANDA and ZEFP.

BACKGROUND: Few studies described nursing diagnosis classification criteria and how classifications meet these criteria. OBJECTIVES: The purpose was to identify criteria for nursing diagnosis classifications and to assess how these criteria are met by different classifications. DESIGN/METHODS: First, a literature review was conducted (N=50) to identify criteria for nursing diagnoses classifications and to evaluate how these criteria are met by the International Classification of Nursing Practice (ICNP), the International Classification of Functioning, Disability and Health (ICF), the International Nursing Diagnoses Classification (NANDA), and the Nursing Diagnostic System of the Centre for Nursing Development and Research (ZEFP). Using literature review based general and specific criteria, the principal investigator evaluated each classification, applying a matrix. Second, a convenience sample of 20 nursing experts from different Swiss care institutions answered standardized interview forms, querying current national and international classification state and use. RESULTS: The first general criterion is that a diagnosis classification should describe the knowledge base and subject matter for which the nursing profession is responsible. ICNP) and NANDA meet this goal. The second general criterion is that each class fits within a central concept. The ICF and NANDA are the only two classifications built on conceptually driven classes. The third general classification criterion is that each diagnosis possesses a description, diagnostic criteria, and related etiologies. Although ICF and ICNP describe diagnostic terms, only NANDA fulfils this criterion. The analysis indicated that NANDA fulfilled most of the specific classification criteria in the matrix. The nursing experts considered NANDA to be the best-researched and most widely implemented classification in Switzerland and internationally. CONCLUSIONS: The international literature and the opinion of Swiss expert nurses indicate that-from the perspective of classifying comprehensive nursing diagnoses-NANDA should be recommended for nursing practice and electronic nursing documentation. Study limitations and future research needs are discussed.

Attitude of Health Personnel↗

PubMed2006

Toward a common language for function, disability, and health.

Within physical therapy, the disablement model has proven useful as a language to delineate the consequences of disease and injury. This perspective provides an update on the changing language of disablement, reviews selected contemporary disablement models, and discusses some challenges that need to be addressed to achieve a universal disablement language that can be used to discuss physical therapy research and clinical interventions. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework has the potential of becoming a standard for disablement language that looks beyond mortality and disease to focus on how people live with their conditions. If widely adopted, the ICF framework could provide the rehabilitation field with a common, international language with the potential to facilitate communication and scholarly discourse across disciplines and national boundaries, to stimulate interdisciplinary research, to improve clinical care, and ultimately to better inform health policy and management.

Activities of Daily Living↗

PubMed2004

Measuring disability in patients with neurodegenerative disease using the 'Yesterday Interview'.

OBJECTIVES: To illustrate the use of time-budget methodology as a means of measuring disability within the framework of the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF) in a mixed group of patients with neurodegenerative disease. METHODS: A semi-structured interview method (the 'Yesterday Interview') was used to reconstruct the preceding 24-hour period in terms of activity, social and environmental context, and subjective enjoyment. Data were collected on 40 elderly control subjects and a sample of 99 community based patients diagnosed with either Parkinson's disease without or with dementia, Alzheimer's disease, Dementia with Lewy bodies, Progressive Supranuclear Palsy or Multiple System Atrophy. All participants were seen in their own home. The results were translated hierarchically into the ICF framework of disability domains, and further into a higher level formulation based on the constructs of discretionary/obligatory activity. RESULTS: Disability profiles were obtained for the patient group as a whole and for the individual disorders. Restricted patterns of time-use were noted across a range of domains encompassing both obligatory and discretionary activity, and accompanied by a significant increase in passive activity such as day-time sleeping or sitting in front of the television. The data also illustrated the restrictions in both the social and environmental contexts of the patient's lives, and the diminished levels of subjective enjoyment associated with their pattern of daily time-use. With the exception of time spent on discretionary activities, these various indices were significantly associated with standard clinical measures disability. CONCLUSIONS: With further studies to assess reliability and validity, time-use and contextual data obtained from structured interviews may provide a useful means of measuring disability within the ICF framework in patients with degenerative neurological disease.

Activities of Daily Living↗

PubMed2006

Environmental barriers to health care among persons with disabilities--Los Angeles County, California, 2002-2003.

In 2002, an estimated 51.2 million persons in the United States (approximately 18.1% of the population) had a disability. Recent data suggest that substantial disparities in health behaviors and overall health status exist between persons with and without disabilities. Nonetheless, when they have access to adequate health care, persons with disabilities can lead healthy lives. The World Health Organization's International Classification of Functioning, Disability, and Health stresses the importance of environment (e.g., physical environment, attitudes of others, or policies) as either a barrier or facilitator in the daily activities of persons with disabilities. In addition, increasing access to health and wellness treatment programs for persons with disabilities and reducing the proportion of persons with disabilities who report environmental barriers to participation in daily activities are goals of Healthy People 2010 (objectives 6-10 and 6-12). However, few population-based studies have explored how environment affects the lives of those with disabilities. To determine the prevalence of disability among persons in Los Angeles County, California, and assess the effects of environmental barriers on these persons, residents were surveyed during 2002-2003. The results of that survey suggested that persons with physical or sensory disabilities experienced several environmental barriers and that the prevalence of barriers varied by demographic characteristics, household income, and severity of disability. To improve quality of life among persons with disabilities, public and private health agencies should implement measures to remove environmental barriers to health care and other services.

Adolescent↗

PubMed2006

Life satisfaction after traumatic brain injury and the World Health Organization model of disability.

OBJECTIVE: To determine which components of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) are most predictive of global life satisfaction after traumatic brain injury (TBI). DESIGN: Prospective evaluation of 180 individuals enrolled in a TBI model system project site. RESULTS: Multiple regression analysis indicated that the combination of ICF components (body function and structure, activities, and participation) and demographic factors significantly predicted life satisfaction and accounted for 17% of the variance. Participation was the strongest predictor; activities were a significant, but weaker predictor; and body function and structure did not add to the prediction of life satisfaction. Of all the individual variables evaluated, only social integration and productivity were found to be significant, unique predictors. CONCLUSIONS: When considering the effects of various aspects of disabling conditions on the life satisfaction of individuals who have suffered a TBI, restriction of participation in life activities was found to have the greatest impact. Although the model accounted for a significant percentage in the variation of life satisfaction, a large proportion of the predictive picture (>82%) remains unclear. Doubtless, other variables impinge on life satisfaction that would further clarify the complex relationship between disabling conditions and life satisfaction in TBI.

Activities of Daily Living↗

PubMed2005

Reliability of physical functioning measures in ambulatory subjects with MS.

BACKGROUND AND PURPOSE: One of the primary reasons for measuring outcomes during rehabilitation is to determine the effect of physiotherapy. Repeated measurement situations are susceptible to several sources of error, including inconsistencies caused by the subject, the procedure, the instrument and the examiner. Therefore, the reliability of the measures needs to be examined. METHOD: The present study used a repeated-measures design. Two studies were undertaken to examine the test-retest and inter-rater reliability for physical functioning measures. The interval between the measurements was one week. The sample consisted of 19 ambulatory subjects with multiple sclerosis (MS) in the test-retest and nine subjects in the inter-rater reliability study. The measures were selected to assess different domains of the World Health Organization International Classification of Functioning, Disability and Health (WHO, 2001). Several parameters of the Box and Block Test (BBT), the Berg Balance Scale (BBS), the Kela Coordination test, the postural stability test, the timed 10-metre gait test, the six-minute walk test, the shoulder tug test, grip strength, maximal isometric force of the knee extensors, muscle endurance tests, the modified Ashworth Scale and passive straight leg raise test were examined in terms of reliability. RESULTS: The intra-class coefficient (ICC) values for test-retest reliability were >0.80 in 17 of 23 parameters, and correspondingly so in 20 out of 26 parameters for inter-rater reliability. Poor reliability (defined as ICC < or = 0. 60) was obtained only for the patient classification index (PCI) of the six-minute walk test in the test-retest reliability study. In general, the coefficient of variation was good. A moderate amount of variability was discovered for the Kela Coordination test, and for postural stability and muscle endurance tests. The data obtained from the modified Ashworth Scale and the shoulder tug test were highly skewed and the percentage of agreement ranged between 63.9% and 93.4%. CONCLUSIONS: The study revealed acceptable test-retest and inter-rater reliability of these measures in ambulatory subjects with MS, with the exception of the Modified Ashworth Scale and the shoulder tug test.

Adult↗

PubMed2006

Building an interprofessional curriculum framework for health: a paradigm for health function.

There is an increasing call for curricula in health care to facilitate interprofessional client-centred evidence-based decision making through a reflective and reflexive framework. This discussion paper proposes that adoption of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) as a framework for curricula of health professionals promotes the necessary paradigm shift needed to legitimise a broad evidence base as the foundation of interprofessional dialogue. Client function is seen as the product of an open system incorporating the individual, social and environmental influences on behaviour, with the role of the professional being to acknowledge the context of individual behaviour through an understanding of individual's functioning in their environment. It is concluded that client focused practice and an iterative process of clinical reasoning based on a broad evidence base that conceptualises health care as the maintenance and promotion of health across the lifespan requires a re-conceptualising of health. The emerging concept shifts the primary emphasis of health care away from post-diagnosis tertiary care towards clients who maintain a life-long independence in the community.

Curriculum↗

PubMed2006

Advancing rehabilitation research: an interactionist perspective to guide question and design.

The purpose of this position statement is to propose an interactionist framework to bring together the existing literature and provide a unifying direction for rehabilitation research. The framework comprises three components: the conceptual model, the research question, and the research design. The interactionist conceptual model has been adapted from the World Health Organization International Classification of Functioning, Disability, and Health. The model forms the starting point that guides the specification of the research question, which, in turn, guides the selection of research design. This approach demands that the question takes precedence and that there be an extensive repertoire of research designs, each of which is valued for its 'goodness-of-fit' with the question, rather than an a priori, single hierarchical ordering of designs. Research designs must be appropriate for questions that examine the disability experience, development over the lifespan, multifaceted interventions, low incidence conditions, and development of new interventions. Analytical challenges include dealing with confounding, mediating, and moderating variables. Rehabilitation researchers--and those who fund their work--should consider and value the use of diverse research methods to best answer the questions posed from the interactionist perspective.

Biomedical Research↗

PubMed2005

Risk factors for participation restriction in leprosy and development of a screening tool to identify individuals at risk.

The World Health Organisation International Classification of Functioning, Disability and Health defines participation as involvement in a life situation. Participation restrictions are problems experienced in any life situation, for example, in relationships or in employment. Our research explored risk factors for participation restrictions experienced by people affected by leprosy. Our objective was to develop a screening tool to identify individuals at risk. An initial round of qualitative fieldwork in eight centres in Nepal, India and Brazil identified 35 potential risk factors for participation restriction. These were then further assessed through quantitative fieldwork in six centres in India and Brazil. In all, 264 individuals receiving leprosy treatment or rehabilitation services made a retrospective assessment of their status at time of diagnosis. Their level of participation restriction was assessed using the Participation Scale. Regression analysis identified risk factors for participation restriction including fear of abandonment by family members (odds ratio 2.63, 95% CI 1.35-5.13) and hospitalization at diagnosis (3.98, 1.0-7.32). We recommend four consolidated items as the basis for a simple screening tool to identify individuals at risk. These are the physical impact of leprosy, an emotional response to the diagnosis, female gender and having little or no education. Such a tool may form the basis for a screening and referral procedure to identify newly diagnosed individuals at risk of participation restrictions and in need of actions that may prevent such restrictions.

Adolescent↗

PubMed2002

Use of the SF-36 and other health-related quality of life measures to assess persons with disabilities.

This article evaluates the appropriateness of existing approaches to the assessment of health-related quality of life (HRQOL) for persons with disabilities. We compare the conceptual model of HRQOL from the Medical Outcomes Study with the World Health Organization's International Classification of Functioning, Disability and Health. In addition, we examine the attitudes toward disease "burden" that arise from these 2 models. We note how values or the importance attached to domains of health can change with fluctuations in physical health. Further, we summarize arguments in favor of developing targeted measures of persons with disabilities. Finally, we discuss some methodologic issues in assessing physical functioning, attributions to health versus disability, and mode of administration. We conclude that users of "standard" HRQOL measures need to be aware of their limitations for assessing persons with disabilities.

Attitude to Health↗

PubMed2005

Sexuality in children and adolescents with disabilities.

This review presents a discussion of the sexual development of children and adolescents with disabilities, described in the framework of body structure and function, individual activities, and societal perspectives presented in the World Health Organization's International Classification of Functioning, Disability and Health. Issues of sexual development, gynecological care and contraception, sexual functioning, societal barriers, sexual victimization, and sexuality education are presented. Overall, adolescents with disabilities seem to be participating in sexual relationships without adequate knowledge and skills to keep them healthy, safe, and satisfied. Although their sexual development may be hindered both by functional limitations and by intentional or unintentional societal barriers, the formal and informal opportunities for teenagers with disabilities to develop into sexually expressive and fulfilled persons do exist. Health care providers are urged to increase their awareness of this unmet need and to implement strategies that promote the physical, emotional, social, and psychosexual independence of children, teenagers, and young adults with disabilities.

Adolescent↗

PubMed2004

Rehabilitation and quality-of-life issues in patients with extremity soft tissue sarcoma.

The current standard of care for soft tissue sarcoma (STS) is limb salvage surgery and adjuvant radiotherapy, with long-term survival rates of approximately 70%. However, the extensive surgical resection and subsequent reconstruction result in 50% of survivors living with chronic disability. Rehabilitation aims to optimize functional independence and quality of life, and is routinely offered to patients undergoing surgical treatment for STS. Unfortunately, there is a dearth of research related to rehabilitation in this area. We propose a model for assessing disability, for designing treatment interventions and for evaluating rehabilitative outcomes in STS. The World Health Organization's (WHO) international classification of functioning, disability, and health (ICF) is divided into three domains: 1) impairments (related to body structure and function), 2) activity limitations (related to usual self-care activities/activities of daily living), and 3) participation restrictions (related to social roles). A literature review of STS rehabilitation reveals that most studies have focused on disability assessment, with few papers describing or evaluating rehabilitation interventions commonly employed in STS. Clinicians are forced to extrapolate findings from other patient populations in order to evaluate the effectiveness of specific rehabilitation strategies (ie, those used for particular sequelae of STS, such as lymphedema or impaired exercise tolerance). There is strongest support for complex decongestive physiotherapy (targeting lymphedema) and aerobic exercise interventions (aimed at alleviating cancer-related fatigue and psychosocial sequelae). The most poorly researched topic is rehabilitation for genitourinary disability (both incontinence and sexual dysfunction). Most studies related to oncologic rehabilitation are restricted to the impairment level (eg, affecting range of motion, muscle strength) of the ICF, with only a small minority addressing activity limitations (eg, affecting activities of daily living) experienced by patients. A consideration of participation restrictions (eg, fulfillment of vocational roles) is almost wholly absent from the literature. Yet social role reintegration is of fundamental importance to patients. Further research is required in these two domains. The ICF provides a comprehensive framework for future research into rehabilitation interventions for STS.

Extremities↗

PubMed2004

Individual, science, and society: ACRM's mission and the body politic.

The core mission of the American Congress of Rehabilitation Medicine (ACRM)-using interdisciplinary research to "enhance the lives of persons living with disabilities"-has a role to play in the world. This mission draws on rehabilitation's origins in a strong belief system about the value of all individuals, regardless of the state of the body structure and function. This address draws on Scheper-Hughes and Lock's use of the body as a metaphor for a way in which society can think about its beliefs of the human body and disability; a body of science contributing to the evolution of rehabilitation; organizational bodies, both rehabilitation service organizations and ACRM as an organization; and the body politic, a concept used to talk about our engagement in society and its rules, policies, and priorities including research funding. In addition to highlighting excellent interdisciplinary clinical research, ACRM should continue development of a taxonomy of the rehabilitation process; it should endorse the World Health Organization's International Classification of Functioning, Disability and Health as a conceptual framework for research development; it should continue increasing attention on research on participation and the environment; and it should embrace the scientific community of people engaged in evidence-based policy and health services research.

Humans↗

PubMed2005

Functional status and disability questionnaires: what do they assess? A systematic review of back-specific outcome questionnaires.

STUDY DESIGN: A systematic literature review of outcome questionnaires designed for assessing functional status or disability in patients with low back pain. OBJECTIVES: To provide a comprehensive overview of all functioning/disability questionnaires used in recent years and to explore how the main concept(s) was described or defined in the original paper, the content or the domains of disability, and the measurement properties of the questionnaires. SUMMARY OF BACKGROUND DATA: A number of clinical tools designed for evaluating the functional status of patients with low back pain have been developed. Only a few have been reviewed earlier, and there has been little focus on the content reflected in the questionnaires. METHODS: Papers including questionnaires for assessing disability, function, activity limitations, or participation restrictions in adult patients with low back pain were searched in the MEDLINE and CINAHL databases for the period from January 1996 to January 2002. Two independent and blinded researchers read and selected abstracts and questionnaires. The content of the included questionnaires was classified according to World Health Organization's International Classification of Functioning, Disability and Health. The measurement properties were analyzed according to recommended guidelines. RESULTS: A total of 36 back-specific questionnaires were identified. When distinguishing among a bodily, personal, and social perspective of functioning, 4 main types of content were identified. Most of the outcome questionnaires had a mixed content reflecting various constructs such as pain and symptoms, sleep disturbances, psychological dysfunctions, physical impairments, and social functions. Nine questionnaires assessed solely activities of daily living. For one-third of the questionnaires, the measurement properties were reported in only the original study. CONCLUSIONS: Although most questionnaires had their main focus on activity limitations, a considerable variation with respect to the main concept and content was found. Only a few of the questionnaires can be considered acceptably validated.

Disability Evaluation↗

PubMed2005

Extending a medical language processing system to the functional status domain.

The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) provides a common framework for describing functional status information (FSI) in health records. Given the expense of manual coding, we are investigating the use of natural language processing (NLP) for automated FSI coding. We used an existing NLP system that was originally designed to encode clinical information. The system's lexicon and coding table were modified and preprocessing and postprocessing programs were created, allowing for automated assignment of selected ICF codes.

Activities of Daily Living↗