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PubMed2006

Issues in selecting outcome measures to assess functional recovery after stroke.

Most patients who survive a stroke experience some degree of physical recovery. Selecting the appropriate outcome measure to assess physical recovery is a difficult task, given the heterogeneity of stroke etiology, symptoms, severity, and even recovery itself. Despite these complexities, a number of strategies can facilitate the selection of functional outcome measures in stroke clinical trial research and practice. Clinical relevance in stroke outcome measures can be optimized by incorporating a framework of health and disability, such as the International Classification of Functioning, Disability, and Health (ICF). The ICF provides the conceptual basis for measurement and policy formulations for disability and health assessment. All outcome measures selected should also have sound psychometric properties. The essential psychometric properties are reliability, validity, responsiveness, sensibility, and established minimal clinically important difference. It is also important to establish the purpose of the measurement (discriminative, predictive, or evaluative) and to determine whether the purpose of the study is to evaluate the efficacy or effectiveness of an intervention. In addition, when selecting outcome measures and time of assessment, the natural history of stroke and stroke severity must be regarded. Finally, methods for acquiring data must also be considered. We present a comprehensive overview of the issues in selecting stroke outcome measures and characterize existing measures relative to these issues.

Humans↗

PubMed2004

Enhancing participation for children with disabilities: application of the ICF enablement framework to pediatric physical therapist practice.

PURPOSE: This paper describes how pediatric physical therapists can utilize the enablement framework, embraced by the World Health Organization in the current International Classification of Functioning, Disability, and Health (ICF). The ICF can guide clinical reasoning related to enhancing participation in desired activities for children with disabilities. In the ICF framework, participation reflects the person's engagement in important life situations. By emphasizing what the person can do in valued contexts, the enablement framework is a positive complement to a focus on functional limitations and disability of the disablement model. SUMMARY OF KEY POINTS: Current conceptual frameworks and policies advocate attention to children's participation. Legislation (Individuals with Disabilities Education Act, Amendments of 1991 and 1997 and the Americans with Disabilities Act of 1990), the Guide to Physical Therapist Practice, and motor control and action perspectives all support the inclusion of children with disabilities in natural environments. These frameworks and laws can guide therapists' clinical reasoning to focus on children's participation in desired activities during the evaluation, goal-setting, and intervention process. A case study of a child with spastic diplegia illustrates how pediatric physical therapists can apply the enablement framework to develop meaningful goals and interventions focused on enhancing the child's participation in desired activities. CONCLUSIONS: Adoption of an enablement perspective may help pediatric physical therapists to focus their evaluations and interventions on promoting children's participation as well as the specific functional activities that enhance participation.

Journal Article↗

PubMed2005

What are the consequences of early rheumatoid arthritis for the individual?

Rheumatoid arthritis (RA) has important impacts on health that can be related to the World Health Organization's new International Classification of Functioning, Disability and Health (ICF framework). The physical consequences of RA for the individual relate to body functions and structures in the ICF framework. The functional consequences of RA are related to activity in the ICF framework, and the impact of RA on society relates to participation in the ICF framework. Despite conventional treatment, early RA continues to result in significant physical consequences for most patients. From the patients' perspective, this primarily results from persistent pain, although symptoms such as fatigue and depression are also relevant. This is confirmed from the clinician's perspective by the infrequency of remission, persistence of disease activity and unrelenting radiographic progression in early RA. Patients with early RA often progress, within only a few years, to significant disability. This has mainly been shown in studies using the Health Assessment Questionnaire as the disability measure, although a small number of studies using generic health measures such as Short Form-36 have reached similar conclusions. RA patients and their friends and families incur the majority of costs associated with early RA. Many patients are not able to continue to work at the same level as they would have anticipated had they not developed RA. Later on, society bears an increased load, especially in patients with higher levels of disability; this results from major social care costs and interventions such as surgery. However, the evidence favouring expensive biological therapies, even in early RA, is likely to turn this analysis on its head in the near future.

Arthritis, Rheumatoid↗

PubMed2006

On health, ability and activity: comments on some basic notions in the ICF.

PURPOSE: The purpose of this article is to highlight and at the same time criticize the holistic view of health expressed in the "International Classification of Functioning, Disability and Health (ICF)". Particular attention will be paid to the idea suggested in the ICF that not only the ability to perform a specified action but also its actual performance is included in the person's health. My argument intends to show that this is an untenable position. METHOD: The theoretical platform of this paper is philosophical action theory. My argument makes particular use of the distinctions between ability, opportunity, activity and will. My analysis also uses some insights from the contemporary philosophical discussion of health concepts. CONCLUSIONS: Ability (or capacity) and its opposite disability (or incapacity) are essential ingredients in the implicit philosophy of health of the ICF. However, the ICF also puts an emphasis on the actual performance of actions. This is entailed by the performance qualifier that is included in the ICF. I give some arguments for questioning the relevance of this qualifier if it is intended to have a place in the concept of health or have a general function for decisions in health care or rehabilitation. Instead I suggest the introduction of an opportunity qualifier, which could fulfill some of the purposes intended for the performance qualifier.

Persons with Disabilities↗

PubMedDate not supplied

'I can play!' young children's perceptions of health.

Health is today viewed as a multi-dimensional concept partly conceptualized independent from not being ill. The aim of this study was to gain knowledge of how young children perceive health. Interviews were conducted with 68 children (4-5 years), within their pre-school setting, with the help of a semi-structured interview guide. A multi-dimensional perspective represented by the health dimensions of the International Classification of Functioning, Disability and Health (ICF) was used in a manifest deductive content analysis. The children's statements were categorized and placed under one of the four health dimensions, body, activity, participation and environment. A latent content analysis was applied to identify underlying themes in the manifest categories. The results revealed that young children perceive health as a multi-dimensional construct, largely related to being engaged, i.e. to be able to perform wanted activities and participate in a supportive every-day context. This implies that improvements of child engagement should be emphasized in health promotion and to a greater extent be the central focus of health interventions for young children.

Child, Preschool↗

PubMed2005

What do osteoarthritis health outcome instruments measure? Impairment, activity limitation, or participation restriction?

OBJECTIVE: To explore whether commonly used osteoarthritis (OA) health outcome instruments (and items) are measuring single or multiple health outcomes using the International Classification of Functioning, Disability and Health (ICF) definitions. METHODS: Ten expert judges allocated 342 items from 13 instruments to one or more ICF construct, i.e., Impairment (I), Activity Limitation (A), and Participation Restriction (P). One-sample t tests were used to classify each item as measuring uniquely I, A, or P or some combination (i.e., IA, IP, AP, or IAP). RESULTS: Overall, 12 of the 13 instruments had items that measured a combination of outcome domains (i.e., IA, IP, AP, or IAP). Only the American Knee Society Score (AKS) had all items uniquely measuring either I or A. The instrument with the best representation of items for Impairment was the AKS, for Activity Limitation the WOMAC and Lequesne knee index, and for Participation Restriction the Disease Repercussion Profile. CONCLUSION: All the existing OA outcome instruments, except one, had some items that were assessing more than one health outcome. Use of these instruments may either mask true treatment effects or make an effect difficult to attribute if the content is unclear. We determined which instruments were the best for measuring each health outcome. To improve the assessment of health outcomes in OA, new instruments that uniquely measure the 3 ICF constructs should be developed and all 3 should be included in relevant studies.

Activities of Daily Living↗

PubMed2005

The WHO-DAS II: psychometric properties in the measurement of functional health status in adults with acquired hearing loss.

The World Health Organization's (WHO) Disability Assessment Scale II (WHO-DAS II) is a generic health-status instrument firmly grounded in the WHO's International Classification of Functioning, Disability and Health (WHO-ICF). As such, it assesses functioning for six domains: communication, mobility, self-care, interpersonal, life activities, and participation. Domain scores aggregate to a total score. Because the WHO-DAS II contains questions relevant to hearing and communication, it has good face validity for use as an outcome measure for audiologic intervention. The purpose of the present study was to determine the psychometric properties of the WHO-DAS II on a sample of individuals with adult-onset hearing loss, including convergent validity, internal consistency, and test-retest stability. Convergent validity was established by examining correlations between the WHO-DAS II (domain and total scores) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Hearing Aid Handicap for the Elderly (HHIE), two disease-specific measures, as well as with the Short Form-36 for veterans (SF-36V), a second generic measure. Data on all four measures were collected from 380 older individuals with adult-onset hearing loss who were not hearing aid users. The results of the convergent validity analysis revealed that the WHODAS II communication domain score was moderately and significantly correlated with scores on the APHAB and the HHIE. WHO-DAS II interpersonal and participation domain scores and the total scores were also moderately and significantly correlated with HHIE scores. These findings support the validity of using the WHO-DAS II for assessing activity limitations and participation restrictions of adult-onset hearing loss. Several WHO-DAS II domain scores and the total score were also significantly and moderately-markedly correlated with scores from the SF-36V. These findings support the validity of the WHO-DAS II as a generic health-status instrument. Internal consistency reliability for all the domain scores was adequate for all but the interpersonal domain. Test-retest stability for all the domain scores was adequate. Critical difference values were calculated for use in clinical application of the WHO-DAS II. From these findings, we concluded that the WHO-DAS II communication, participation, and total scores can be used to examine the effects of adult-onset hearing loss on functional health status. Further work examining the utility of the WHO-DAS II as an outcome measure for hearing aid intervention is warranted.

Activities of Daily Living↗

PubMed2003

Concepts in occupational therapy in relation to the ICF.

Occupational therapists need an acceptable terminology to describe a client's clinical performance. The language or terminology must be in harmony with common language in the health care system but also reflect occupational therapists' professional responsibility. The aim of this paper is to help clarify similarities and differences between concepts in occupational therapy and the International Classification of Functioning, Disability and Health (ICF). Two studies were completed in which items in the International Classification of Impairments, Disabilities and Handicaps (ICIDH-2) were compared with concepts from the Swedish version of the assessment of Motor and Process Skills (AMPS) and the Assessment of Communication and Interaction Skills (ACIS-S). An expert panel of occupational therapists served as raters and 33 clients with learning disabilities and mental health problems were assessed. The result showed that 12 (60%) of the skills items from the ACIS-S were found to be equivalent to items in then ICIDH-2. In total, 41% (n = 23) of the items in the AMPS or ACIS-S have a correlation higher then 0.60 with the ICIDH-2. The classification can serve as a useful tool for occupational therapists and supports communication between professions, but is not sufficient as a professional language for occupational therapists. Further research is indicated to examine how the ICF can be applied in occupational therapy and its implications on clinical practice.

Disability Evaluation↗

PubMed2003

WHO's ICF and functional status information in health records.

A common framework for describing functional status information (FSI) in health records is needed in order to make this information comparable and of value. The World Health Organization's (WHO's) International Classification of Functioning, Disability and Health (ICF), which has been approved by all its member States, provides this common language and framework. The biopsychosocial model of functioning and disability embodied in the ICF goes beyond disease and conceptualizes functioning from the individual's body, person, and lived experience vantage points, thereby allowing for planning interventions targeted at the individual's body, the individual as a whole or toward the environment. This framework then permits the evaluation of both the effectiveness and cost effectiveness of these different interventions in devising programs at the personal or societal level.

Activities of Daily Living↗

PubMed2003

Assessment of the impact of disease on the individual.

From the medical or disease perspective, patients' functioning, disability and health are seen primarily as the consequences or the impact of a disease or condition. In this perspective, self-administered health status instruments are used primarily to evaluate the effects of drug treatments or surgical interventions. The interpretation of these measures is generally based on scales and scores and not on individual items. Currently used instruments are reviewed and an algorithm for the selection of instruments is provided. In the rehabilitation or disability perspective, patients' functioning and health is associated with and not merely a consequence of, a condition or disease. The basis for the understanding of functioning, disability and health--in association with the condition but also the personal and contextual factors--is WHO's International Classification of Functioning, Disability and Health or ICF. This chapter illustrates the use of the ICF framework for structuring patients' problems, and the use of condition-specific ICF-Core-Sets to check for problems typically encountered in patients with a given condition.

Disability Evaluation↗

PubMed2006

[Development and use of the ICF from the nursing point of view--a position statement of the German speaking working group "ICF and Nursing"].

The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive and internationally acknowledged framework for the description of human functional health, which covers all aspects of health and some health-related elements of well-being. The ICF is part of the classification family of the World Health Organisation (WHO) and can be used by different health care disciplines as well as for different purposes. In order to promote the discussion about ICF within the nursing profession, the German speaking working group "ICF and Nursing" developed a position statement that critically reflects both the potentials and the restrictions of the ICF for use in nursing care, particularly for diagnostical purposes.

Activities of Daily Living↗

PubMed2006

Functioning and subjective health among stroke survivors after discharge from hospital.

AIM: This paper reports a study exploring functioning (functions, activities and participation) and subjective health among stroke survivors 6 months after discharge from hospital. A further aim was to investigate patterns of functions and activities, and associations between functioning and subjective health. BACKGROUND: Nurses tend to emphasize functional and activity outcomes and rarely look to people's participation in their social world. By integrating individual and social contextual factors in their assessments, nurses will have a powerful tool to broaden their outlook. The International Classification of Functioning, Disability and Health can be used as a framework for understanding the consequences of stroke. Studies are needed, however to make the International Classification of Functioning operational for practical use. METHODS: A cross-sectional and explorative design was used using structured interviews and assessments with a number of scales with 89 stroke survivors 6 months after their hospital stay. The measures used were Personal Activities of Daily Living, including cognitive ability, transfer, dressing, bathing, energy to eat, ingestion, swallowing, going to the toilet, faecal continence, and urinary continence; and Instrumental Activities of Daily Living, including washing clothes, cooking, cleaning, transport and shopping. Factor analysis was performed for functions and activities and the final solution had an explained variance of 70%. The data were collected during autumn 2003 and spring 2004. FINDINGS: Close associations (r(s) > 0.5) were found between Activities of Daily Living in relation to participation and subjective physical health. CONCLUSION: Existing Activities of Daily Living scales were expanded and found to relate to a participation scale and a subjective health scale. Using these scales in nursing care has the potential to correct current bias towards functions and activities by broadening the focus to include the social as well as the physical.

Activities of Daily Living↗

PubMed2005

Rehabilitation in HIV/AIDS: development of an expanded conceptual framework.

In industrialized countries where HIV infection is becoming a chronic, episodic condition, rehabilitation services have the potential to play an expanded role for people living with HIV/AIDS (PLHAs). However, little is known about rehabilitation in the context of HIV. This paper documents the development of an enhanced, multidisciplinary conceptual framework of rehabilitation in the context of HIV, using the perceptions of PLHAs and rehabilitation professionals. Rehabilitation, broadly defined, is a dynamic process that includes all prevention and/or treatment activities and/or services that address body impairments, activity limitations and participation restrictions for an individual. The framework was developed through broad consultation and interviews with thirteen key informants. Themes that emerged from analysis of interviews related to concepts of rehabilitation in the context of HIV, rehabilitation professionals' roles in the context of HIV, and barriers to access and delivery of rehabilitation services. While there was some variation, key informants generally viewed rehabilitation as a goal-oriented and client-centered process with the potential to impact a range of life domains. Themes were presented to members of a national advisory committee (including PLHAs and health care providers), who produced the foundation of the HIV rehabilitation framework. The framework uses the perspective of the person living with HIV/AIDS, and includes individual life domains that may be affected by HIV, drawing and expanding upon the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health.

Acquired Immunodeficiency Syndrome↗

PubMed2006

The assessment of disability associated with osteoarthritis.

PURPOSE OF REVIEW: Disability (activity limitation) is an important and common health outcome for patients with osteoarthritis, making accurate measures essential. This paper explores self-report measures of activity limitation associated with osteoarthritis and reports on recent conceptual advances that impact on the measurement of activity limitation. RECENT FINDINGS: The Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form-36, the most commonly used measures to assess activity limitation, continue to be validated in osteoarthritis. There has been little consensus, however, about which measure to use across different types of osteoarthritis. While new measures have been developed to assess activity limitation, it remains unclear whether or not these are an improvement over existing measures. The International Classification of Functioning, Disability and Health is becoming an important consideration. Commonly used measures do not map directly onto individual constructs of this classification, however a new measure for Japanese people with knee osteoarthritis was developed based on these constructs. SUMMARY: There have been significant developments in the conceptual approach to measuring activity limitation. Measures are needed that operationalize activity limitation as defined by the International Classification of Functioning, Disability and Health (within or ideally across cultures), providing a common underlying construct for measures and hence facilitating comparability across studies.

Disability Evaluation↗

PubMed2005

Functional status measures for integrating medical and social care.

PURPOSE: Identify standard self-report questions about functioning suitable for measuring disability across integrated health and social services. THEORY: Functional activities can be validly grouped according to the International Classification of Functioning, Disability and Health (ICF) chapters of mobility, self-care, and domestic life. METHODS: Cross-sectional analysis using information on 112,601 persons interviewed as part of the United States National Health Interview Survey on Disability. We combined related sets of questions and tested the appropriateness of their groupings through confirmatory factor analyses. Construct validity was addressed by seeking to confirm clinically logical relationships between the resulting functional scales and related health concepts, including number of physician contacts, number of bed days, perception of illness, and perception of disability. RESULTS: Internal consistency for the summed scales ranged from 0.78 to 0.92. Correlations between the functional scales and related concepts ranged from 0.12 to 0.52 in directions consistent with expectations. CONCLUSIONS: Analyses supported the 3 ICF chapters. DISCUSSIONS: The routine collection of this core set of functions could enhance decision-making at the client, professional, organizational, and policy levels encouraging cooperation among the medical and social service sectors when caring for people with disabilities.

Journal Article↗

PubMedDate not supplied

Value and application of the ICF in rehabilitation medicine.

Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a person's functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on this concept. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF Core Sets. The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.

Activities of Daily Living↗

PubMed2002

Value and application of the ICF in rehabilitation medicine.

CONTEXT: Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a person's functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on these concepts. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. ISSUE: However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF core sets. CONCLUSION: The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.

Activities of Daily Living↗

PubMed2005

[Value of activities and participation of patients with circulation diseases].

The aim of our study was to evaluate the disturbances of activities and participation of inpatients after stroke and myocardium infarction. Activities and participation disorders were evaluated by international classification of functioning, disability and health. Our study material consisted of inpatients after stroke (I group) and inpatients after myocardium infarction (II group). The age average was 70.4+/-7.4 years in the first group and 65.7+/-11.7 years in the second group. Activities and participation were respected by the following scale: 0--no difficulty, 1--mild difficulty, 2--moderate difficulty, 3--severe difficulty, 4--complete difficulty. We determined, that changing and maintaining body position, learning to write, moving around activities were the most confused (3-4); thinking and copying were confused moderately (2) in the first group. Changing and maintaining body position, focusing attention, calculating and handling stress activities were confused moderately (2) in the second group. International classification of functioning, disability and health allows evaluating activity limitations and participation restrictions in blood circulation disorders. We noticed, that basic learning, applying knowledge, general tasks and demands, communication, maintaining a body position, and self-care were more confused in patients after stroke. Moving around, focusing attention, and handling stress were more confused in patients after myocardium infarction. It is important to evaluate activity limitation and participation restrictions for determining the extent of rehabilitation.

Activities of Daily Living↗