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PubMed2006

Preliminary results for the PAR-PRO: a measure of home and community participation.

OBJECTIVE: To develop a measure of home and community participation related to the World Health Organization's International Classification of Functioning, Disability and Health. DESIGN: Cross-sectional analysis of survey data. SETTING: Nine medical inpatient rehabilitation facilities from 6 states. PARTICIPANTS: A total of 594 patients of mixed impairment type admitted for inpatient rehabilitation in 2002. Mean age was 74.0 years and 61.4% were women. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reliability and validity of the participation instrument. RESULTS: A 20-item instrument of home and community participation was developed (PAR-PRO). The instrument showed good internal consistency and good Rasch person and item fit statistics. Four subfactors were identified beyond the unidimensional construct of participation including domestic management, socialization, physical vigor, and generative activities. The PAR-PRO total participation score correlated inversely with age (r=-.31, P<.001) but did not differ by sex. CONCLUSIONS: The 20-item PAR-PRO instrument of home and community participation displayed good psychometric characteristics. The instrument shows promise as a broad measure of home and community involvement for persons with disabilities. Further work is needed to support its application for people without disability.

Activities of Daily Living↗

PubMed2005

An outcome measure for Japanese people with knee osteoarthritis.

OBJECTIVE: We describe a new outcome measure for Japanese patients with knee osteoarthritis, the Japanese Knee Osteoarthritis Measure (JKOM). METHODS: The outcome measure was designed to incorporate the concepts of the World Health Organization's International Classification of Functioning, Disability and Health 2001, and to reflect the specific Japanese cultural lifestyle, which differs from Western countries. To examine the validity and reliability of this measure and to determine the underlying set of measures, psychometric measurements including factor analysis were conducted in comparison with 2 other health related scales, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The following psychometric properties were tested with this new measure: test and retest reliability, internal consistency, content validity, construct validity, and criterion related validity. RESULTS: The measure was proved to have sufficient reliability and validity by means of statistical evaluation and comparison with other health related scales. Three domains are clearly separated on the loading pattern by factor analysis: pain, limitation in mobility related to daily activity, and restriction of participation in social life and health perception. CONCLUSION: The JKOM, a new knee OA measure, has sufficient reliability and validity for studies of the clinical outcomes of Japanese people with knee OA.

Activities of Daily Living↗

PubMed2003

Rites of passage: understanding participation of children with developmental coordination disorder.

Children with developmental coordination disorder (DCD) experience difficulty participating in the typical activities of childhood and are known to have a more sedentary pattern of activities than their peers. Little research has been done to investigate the impact of these deficits on the lives of children with DCD and the importance of their participation in the typical activities of childhood. This qualitative study explored the impact of the disorder and the importance of participation for children with DCD from the perspective of the parent. Twelve in-depth interviews were conducted with parents of children with DCD who attended a university clinic specializing in using the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, a cognitive-based intervention. Findings revealed that incompetence in everyday activities had serious negative effects for the children. Conversely, intervention that was focused on enablement at the activity and participation level had a significant positive impact on the children's quality of life. Emerging themes highlighted the notion that performance competency played an important role in being accepted by peers and being able "to be part of the group". As well, parents reported that successful participation built confidence in their children and allowed them to try other new activities. The World Health Organization's International Classification of Functioning, Disability, and Health provides a unique framework for analyzing and understanding the impact of the physical disability on the lives of families with children with DCD. Results illustrate how intervention that focuses on enabling children to choose their own functional goals in the area of physical activity has important implications for enabling participation and building the social networks of children with DCD.

Activities of Daily Living↗

PubMed2006

ICF and ICD codes provide a standard language of disability in young children.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the utility of a hierarchical algorithm incorporating codes from the International Classification of Functioning, Disability and Health--ICF (WHO, 2001) and the International Statistical Classification of Diseases-ICD (WHO, 1994) to classify reasons for eligibility of young children in early intervention. METHODS: The database for this study was a nationally representative enrollment sample of more than 5,500 children in a longitudinal study of early intervention. Reasons for eligibility were reviewed and matched to the closest ICF or ICD codes under one of four major categories (Body Functions/Structures, Activities/Participation, Health Conditions, and Environmental Factors). RESULTS: The average number of reasons for eligibility provided per child was 1.5, resulting in a population summary exceeding 100%. A total of 305 ICF and ICD codes were used with most (77%) of the children having codes in the category of Body Function/Structures. Forty-one percent of the sample had codes of Health Conditions, whereas the proportions with codes in the Activities/Partipication and Environmental Categories were 10 and 5%, respectively. CONCLUSIONS: The results demonstrate that ICD and ICF can be jointly used as a common language to document disability characteristics of children in early intervention.

Activities of Daily Living↗

PubMedDate not supplied

The validity of functional assessments of communication and the Activity/Participation components of the ICIDH-2: do they reflect what really happens in real-life?

UNLABELLED: This paper aims to provide a better understanding of the nature of functional communication activities so that assessment and treatment efforts are based on a theoretical framework and empirical data. Three sources of information are discussed. The first is the Activity/Participation dimensions of the World Health Organization's International Classification of Functioning, Disability, and Health. The second source is existing assessments of functional communication. The final source is data obtained from observational studies conducted in our research unit. The studies have observed the everyday communication of people with aphasia, people with Traumatic Brain Injury (TBI), and patients in hospital. The simplification of real-life communication in the WHO classification scheme, the variability of item sampling in existing assessments, and the complexity of communication observed in real-life settings has led to the conclusion that there are three levels of functional communication assessment: generic, population-specific, and individualized. Clinicians may choose which level suits their purpose. When clinicians routinely choose from a range of sophisticated functional assessments to inform their therapy, the seed that Martha Taylor Sarno planted and nourished for the past 30 years or more will truly flourish throughout the world of speech-language pathology. LEARNING OUTCOMES: As a result of this activity, participants will (1) understand the theoretical framework and data base that motivates assessment and treatment of functional communication activities, (2) be able to discuss the World Health Organization's Classification of Functioning, Disability and Health and (3) gain information about functional assessment and observational sampling of real world communication activities across three levels.

Aphasia↗

PubMed2006

Role of conceptual models in a physical therapy curriculum: application of an integrated model of theory, research, and clinical practice.

The Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada, recently implemented a Master of Physical Therapy (MPT) entry-level degree program. As part of the curriculum design, two models were developed, a Model of Best Practice and the Clinical Decision-Making Model. Both models incorporate four key concepts of the new curriculum: 1) the concept that theory, research, and clinical practice are interdependent and inform each other; 2) the importance of client-centered practice; 3) the terminology and philosophical framework of the World Health Organization's International Classification of Functioning, Disability, and Health; and 4) the importance of evidence-based practice. In this article the general purposes of models for learning are described; the two models developed for the MPT program are described; and examples of their use with curriculum design and teaching are provided. Our experiences with both the development and use of models of practice have been positive. The models have provided both faculty and students with a simple, systematic structured framework to organize teaching and learning in the MPT program.

Biomedical Research↗

PubMed2004

Living with a chronic deteriorating disease: the trajectory with muscular dystrophy over ten years.

PURPOSE: The aim of the study was to elucidate experiences of living with muscular dystrophy in terms of consequences for activity over 10 years. METHODS: The study population was identified in a prevalence study in a county of Sweden. Forty-six persons of this cohort with MD were interviewed. A qualitative research approach was chosen. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) was used for categorization. RESULTS: Nearly all the subjects experienced a deterioration of physical capacity. Most obvious were the restrictions on mobility and increased fatigue and feebleness. The persons described psychosocial consequences of the muscular dystrophy as well as stigma when the disability had become more obvious. In spite of reported distress several persons experienced better psychological adaptation over time. The image of the future was often dark but several focus on today and avoid thoughts about the future. ICF showed some limitation with regard to temporal aspects, emotions and the subjective perspective. CONCLUSIONS: The knowledge of the trajectory with MD is important in order to offer the best possible treatment and support. Repeated assessment by ICF can serve as a valuable source of such knowledge, and a development of the classification would increase its usefulness in future analysis of functioning and disability.

Accidental Falls↗

PubMed2003

A review of conceptual models for assistive technology outcomes research and practice.

Conceptual models provide a theoretical basis for advancing scientific knowledge and improving professional practice. Although numerous assistive technology-related models have appeared in the literature, there has been no systematic effort to assess them. Six conceptual models are reviewed here: Cook and Hussey's Human-Activity-Assistive Technology model; the World Health Organization's International Classification of Functioning, Disability, and Health; Scherer's Matching Person and Technology model; Gitlin's model of an AT user's "career"; social cognition decision-making theories; and Rogers' Perceived Attributes Theory. The models are reviewed in terms of six domains: background and goals; descriptive characteristics; indication of outcome measures; predictive characteristics; validation in the literature; and utility to assistive technology practitioners, developers, and consumers. The salient strengths and limitations are highlighted for each. Application of the models to advance theory, research, and practice is discussed.

Ergonomics↗

PubMedDate not supplied

An evaluation of the responsiveness of a comprehensive set of outcome measures for children and adolescents with traumatic brain injuries.

The relative responsiveness of nine outcome measure scales was evaluated with 33 children and adolescents (aged 4-18 years) who had sustained traumatic brain injuries. Scales were selected to evaluate outcomes from each of the World Health Organization (WHO) International Classification of Functioning, Disability and Health domains. The outcome measures were administered to all participants during their inpatient rehabilitation stay and again at a follow-up clinic visit. No single outcome measure captured the diversity of improvement in this sample. The measures agreed that improvement had occurred, but did not agree about which children were improving. This result suggests that the scales were measuring different skills and outcomes. Three of the measures used in combination, either the Child Health Questionnaire or the Functional Independence Measure for Children, the American Speech-Language-Hearing Association National Outcome Measures System (Birth to Kindergarten NOMS/School-aged Health Care) and the Gross Motor Function Measure, are sufficient to detect change in each of the children where change occurred. The Pediatric Evaluation of Disability Inventory and the MultiAttribute Health Status Classification were the least responsive of the nine measures used.

Activities of Daily Living↗

PubMedDate not supplied

Latent factors in measures of rehabilitation outcomes after traumatic brain injury.

OBJECTIVES: To determine whether there is a latent structure among measures used to evaluate rehabilitation outcomes for persons with traumatic brain injury and if the construct of participation is discernible within this structure. DESIGN: Exploratory factor analyses of 2 cross-sectional cohorts of rehabilitation patients who sustained a traumatic brain injury up to 5 years prior to assessment. PRIMARY MEASURES: Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Satisfaction With Life Scale (SWLS). RESULTS: Both factor analyses suggested a latent structure composed of 3 factors that were interpreted as representing the Activities and Participation dimensions of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), and a third representing Subjective Well-Being. Low to moderate correlations were found between factors. CONCLUSIONS: The World Health Organization's ICF excludes subjective well-being; however the factor analyses indicate that it is a distinct domain not incorporated into Activities and Participation. The SF-36, CIQ, and CHART can, in combination, evaluate all 3 domains, but not alone. The SF-36 appears to be sensitive to the affective, but not the cognitive, aspect of Subjective Well-Being. A measure of life satisfaction would be a useful supplement to traditional measures of rehabilitation outcome.

Adult↗

PubMed2005

Child or family assessed measures of activity performance and participation for children with cerebral palsy: a structured review.

BACKGROUND: There is a need to measure children's 'activity performance and participation' as defined in the World Health Organization's International Classification of Functioning, Disability and Health for Children and Youth (WHO ICF). The aim of this review is to identify instruments that are suitable for use in postal surveys with families of children with cerebral palsy. METHODS: We conducted a structured review of instruments that use child or family self-assessment of 'activity performance and participation'. The review involved a systematic search for instruments using multiple published sources. Appraisal of the instruments used the predefined criteria of appropriateness, validity, reliability, responsiveness, precision, interpretability, acceptability and feasibility. RESULTS: There are relatively few child or family assessed instruments appropriate for measuring children's activities and participation. Seven instruments were identified that could potentially be administered by mail. The Assessment of Life Habits for Children (LIFE-H) was the most appropriate instrument as assessed by its content but the reliability of child or family self-assessment is not known. If the LIFE-H were shown to be a reliable self-report measure then the LIFE-H would be the recommended choice. Currently, the Activities Scale for Kids and the condition-specific Lifestyle Assessment Questionnaire for cerebral palsy (LAQ-CP) provide the broadest description of what and how frequently children with cerebral palsy perform a range of activities and thereby indicate participation. The LAQ-CP also provides additional contextual information on the impact of any disability on the participation of the family unit. CONCLUSION: There remains much scope for developing valid and reliable self-assessed measures corresponding to the WHO ICF dimensions of activities and participation.

Activities of Daily Living↗

PubMed2005

Older women's health priorities and perceptions of care delivery: results of the WOW health survey.

BACKGROUND: As women get older, their health priorities change. We surveyed a sample of older Canadian women to investigate what health priorities are of concern to them, their perceptions about the care delivered to address these priorities and the extent to which priorities and perceptions of care differ across age groups and provinces. METHODS: The WOW (What Older women Want) cross-sectional health survey was mailed in October 2003 to 5000 community-dwelling women aged 55-95 years from 10 Canadian provinces. Women were asked questions on 26 health priorities according to the World Health Organization's International Classification of Functioning, Disability and Health, and their perceptions of whether these priorities were being addressed by health care providers through screening or counselling. Differences in priorities and perceptions of care delivery were examined across age groups and provinces. RESULTS: The response rate was 52%. The mean age of the respondents was 71 (standard deviation 7) years. The health priorities identified most frequently by the respondents were preventing memory loss (88% of the respondents), learning about the side effects of medications (88%) and correcting vision impairment (86%). Items least frequently selected were counselling about community programs (28%), counselling about exercise (33%) and pneumonia vaccination (33%). Up to 97% of the women recalled being adequately screened for heart disease and stroke risk factors, but as little as 11% reported receiving counselling regarding concerns about memory loss or end-of-life issues. Women who stated that specific priorities were of great concern or importance to them were more than twice as likely as those who stated that they were not of great concern or importance to perceive that these priorities were being addressed: osteoporosis (odds ratio [OR] 2.6, 95% confidence interval [CI] 2.1- 3.2), end-of-life care (OR 2.6, 95% CI 2.0-3.4), anxiety reduction (OR 2.2, 95% CI 1.8-2.6), fall prevention (OR 2.1, 95% CI 1.6-2.7), stroke (OR 2.1, 95% CI 1.4-3.0), depression (OR 2.1, 95% CI 1.7-2.7) and urinary incontinence (OR 2.1, 95% CI 1.7-2.5). The respondents' perceptions of care delivery varied across age groups and provinces. INTERPRETATION: According to the perceptions of surveyed women, health care providers are addressing many, but not all, of their health concerns, especially those that are of great concern or importance to these women.

Aged↗

PubMed2003

Investigating lifestyle factors affecting hearing aid candidature in the elderly.

Within this presentation, the authors consider briefly the published data on the effects of hearing impairment on lifestyle in the elderly, and suggest that the World Health Organization's International Classification of Functioning, Disability and Health (ICF) would provide a framework for standardizing the study of effects of impairments. This is followed by two studies. In the first study, we asked a consecutive sample of elderly patients (hearing aid candidates and users) to list the activities, transactions and interactions in which they participated, and classified these using the ICF. We then took the main categories, and, in a second study, explored how often individuals participated in them, how much difficulty they had because of their hearing loss, and how much they enjoyed them. This highlighted the considerable difficulties that most such individuals experience in common activities and communication situations, and which seem to be little influenced by whether or not they use hearing aids.

Aged↗

PubMed2003

Capturing and classifying functional status information in administrative databases.

The health care delivery system aims to improve the functioning of Americans, but little information exists to judge progress toward meeting this goal. Administrative data generated through running and overseeing health care delivery offer considerable information about diagnoses and procedures in coded formats comparable across settings of care. This article explores the issues raised when considering adding coded information about functional status to administrative databases throughout the health care system. The National Committee on Vital and Health Statistics (NCVHS) identified the International Classification of Functioning, Disability and Health (ICF) as the only viable code set for consistently reporting functional status.

Activities of Daily Living↗

PubMed2005

A new classification for outcomes in illness and injury.

Illness and injury can lead to complex problems for patients and clinicians. A new approach from the World Health Organization (WHO), the International Classification of Functioning, Disability and Health (ICF), may help manage such patients, and evaluate the success of the interventions used. The authors discuss the application of the ICF model.

Activities of Daily Living↗

PubMed2006

Activity limitations in the lower extremities in patients with osteoarthritis: the modifying effects of illness perceptions and mental health.

OBJECTIVES: Using the International Classification of Functioning, Disability and Health as framework, we evaluated modifying effects of illness perceptions and mental health on the association between impairments in body structures and functions due to osteoarthritis (OA) and limitation in activities in the lower extremities. METHODS: Self-reported limitation in activities was assessed by the Western Ontario and McMaster Universities OA index (WOMAC) function subscale in 316 patients with knee or hip pain or evidence of OA on knee or hip radiographs. Body structures and functions were evaluated during clinical and radiological assessments. Illness perceptions and mental health were assessed with the revised Illness Perception Questionnaire (IPQ-R) and the mental component summary score of the RAND 36-item Health Survey, respectively. For each patient an expected WOMAC function score was calculated, using an equation based on a multivariate model of the association of body structures and functions with limitation in activities. RESULTS: The median (interquartile) self-reported WOMAC function score was 22.2 (9.6-43.5). Ninety-one patients reported more and 120 patients reported less limitation in activities than expected. Patients with lumbar spine degeneration, physical or exercise therapy and high IPQ-R identity, consequences and chronic timeline scores had an increased risk to report more limitation in activities than the expected range. Low IPQ-R identity, consequences and emotional representation scores and better mental health were associated with reporting less limitation in activities than the expected range. CONCLUSION: Illness perceptions and mental health modify the association between self-reported limitation in activities and calculated limitation in activities based on impairments in body structures and functions due to OA.

Adult↗

PubMed2006

Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities.

Many health professionals have expressed difficulty finding ways to keep people with disabilities engaged in community-based physical activity/rehabilitation programs. A major reason for this low adherence may be that the recommended intervention plan does not match well with the specific needs of the individual. Various personal and/or environmental factors along with the person's level of functioning can impede participation in healthful physical activity/rehabilitation. The International Classification of Functioning, Disability and Health (ICF) can be a useful tool for identifying key factors associated with participation in community-based physical activity/rehabilitation. The ICF allows health professionals to identify the level of functioning at the body, person and societal level, as well as understand the person-environment contextual factors that may impede or enhance participation. This paper describes how the ICF can assist health professionals in identifying a broader constellation of factors when prescribing physical activity/rehabilitation programs for persons with varying levels of disability.

Activities of Daily Living↗

PubMed2005

Frame semantics and the domain of functioning, disability and health.

We explore the use of FrameNet (FN) frames and their frame elements to represent content from the International Classification of Functioning, Disability and Health (ICF) Self-Care chapter. Terms were extracted from the ICF and mapped to FN frames. The mappings were validated by an expert. FN provided relevant and nearly complete coverage of ICF terms, suggesting FN may be an important resource to leverage for semantic language processing and knowledge representation in this domain.

Activities of Daily Living↗