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PubMed2005

Diagnosis to function: classification for children and youths.

This article provides an overview of a newly approved World Health Organization framework and classification system for human functioning. The International Classification of Functioning, Disability, and Health (ICF) identifies dimensions of human functioning and describes a common language for clinical practice, research, and policy development across disciplines and service systems. This presentation highlights the development of a version of the ICF for children and youths (ICF-CY) and its potential utility in developmental and behavioral pediatrics. Clinical, research, and policy dimensions are described. Limitations related to scope and clarity of the framework are also outlined. The article proposes that serious consideration be given the ICF-CY as an integrated system to clarify constructs, improve communication, and encourage coordination of health services for children and youths.

Adolescent↗

PubMed2007

Development and initial psychometric evaluation of the participation measure for post-acute care (PM-PAC).

OBJECTIVE: To evaluate a patient-reported participation measure constructed within the framework of the International Classification of Functioning, Disability, and Health. DESIGN: The Participation Measure for Post-Acute Care (PM-PAC) contains 51 items that assess participation in nine domains: mobility; role functioning; community, social, and civic life; domestic life/self-care; economic life; interpersonal relationships; communication; work; and education. Self-reported data were collected by interview with 395 noninstitutionalized rehabilitation patients. Psychometric analyses were conducted to test assumptions underlying the scaling and scoring of PM-PAC scales and to evaluate reliability and validity. RESULTS: In general, analyses supported assignment of items to hypothesized scales. However, the community, social, and civic life, interpersonal relationships, and communication domains were highly correlated. Item response theory models indicated that items were directed primarily at people with worse than average limitations in participation than the average patient in this rehabilitation sample. Test and retest scale scores did not differ significantly (intraclass correlation coefficient range, 0.61-0.86). Groups with more severe conditions scored worse on PM-PAC scales, as hypothesized. CONCLUSIONS: PM-PAC is a promising new measure of patient-reported participation as defined by the International Classification of Functioning, Disability, and Health. Information about PM-PAC items from this study will be useful in developing a computerized, adaptive measure of participation.

Adolescent↗

PubMed2005

Identification of relevant ICF categories for indication, intervention planning and evaluation of health resort programs: a Delphi exercise.

Health resort programs have a long tradition, mainly in European countries and Japan. They rely on local resources and the physical environment, physical medicine interventions and traditional medicine to optimise functioning and health. Arguably because of the long tradition, there is only a limited number of high-quality studies that examine the effectiveness of health resort programs. Specific challenges to the evaluation of health resort programs are to randomise the holistic approach with a varying number of specific interventions but also the reliance on the effect of the physical environment. Reference standards for the planning and reporting of health resort studies would be highly beneficial. With the International Classification of Functioning Disability and Health (ICF), we now have such a standard that allows us to describe body functions and structures, activities and participation and interaction with environmental factors. A major challenge when applying the ICF in practice is its length. Therefore, the objective of this project was to identify the ICF categories most relevant for health resort programs. We conducted a consensus-building, three-round, e-mail survey using the Delphi technique. Based on the consensus of the experts, it was possible to come up with an ICF Core Set that can serve as reference standards for the indication, intervention planning and evaluation of health resort programs. This preliminary ICF Core Set should be tested in different regions and in subsets of health resort visitors with varying conditions.

Activities of Daily Living↗

PubMed2003

Are the ICF Activity and Participation dimensions distinct?

OBJECTIVE: To test the hypothesis that distinct Activity and Participation dimensions of the International Classification of Functioning, Disability, and Health could be identified using physical functioning items drawn from the Late Life Function and Disability Instrument. DESIGN: A cross-sectional, survey design was employed. SUBJECTS: The sample comprised 150 community-dwelling adults aged 60 years and older. METHODS: Exploratory factor analysis was used to identify interpretable dimensions underlying 48 physical functioning questionnaire items. RESULTS: Findings revealed that one conceptual dimension underlying these physical functioning items was not sufficient to adequately explain the data (X2 = 2383; p < 0.0001). A subsequent solution produced 3 distinct, interpretable factors that accounted for 61.1% of the variance; they were labeled: Mobility Activities (24.4%), Daily Activities (24.3%), and Social/Participation (12.4%). All 3 factors achieved high internal consistency with coefficient alphas of 0.90 or above. CONCLUSION: Within physical functioning, distinct concepts were identified that conformed to the dimensions of Activity and Participation as proposed in the ICF. We believe this is the first empirical evidence of separate Activity and Participation dimensions within the International Classification of Functioning, Disability, and Health classification.

Activities of Daily Living↗

PubMed2004

Identification of relevant ICF categories in patients with chronic health conditions: a Delphi exercise.

OBJECTIVES: To identify the most typical and relevant categories of the International Classification of Functioning, Disability and Health (ICF) for patients with low back pain, osteoporosis, rheumatoid arthritis, osteoarthritis, chronic generalized pain, stroke, depression, obesity, chronic ischaemic heart disease, obstructive pulmonary disease, diabetes mellitus, and breast cancer. METHODS: An international expert survey using the Delphi technique was conducted. Data were collected in 3 rounds. Answers were linked to the ICF and analysed for the degree of consensus. RESULTS: Between 21 (osteoporosis, chronic ischaemic heart disease, and obstructive pulmonary disease) and 43 (stroke) experts responded in each of the conditions. In all conditions, with the exception of depression, there were categories in all ICF components that were considered typical and/or relevant by at least 80% of the responders. While all conditions had a distinct typical spectrum of relevant ICF categories, there were also some common relevant categories throughout the majority of conditions. CONCLUSION: Lists of ICF categories that are considered relevant and typical for specific conditions by international experts could be created. This is an important step towards identifying ICF Core Sets for chronic conditions.

Activities of Daily Living↗

PubMed2006

[The ICF classification system--a problem oriented inventory on behalf of the German Society of Rehabilitation Sciences].

With the International Classification of Functioning, Disability and Health, ICF and its adoption by the World Health Organization in May 2001, the concept of "functional health" reached a new dimension. Prepared and developed further over many years, the concept of a comprehensive and internationally consented classification system completed the shifting of paradigm in our notion of disease and disablement, bringing along far-reaching consequences for theory and practice in particular in rehabilitation. Symbolizing this paradigmatic shift, destigmatization, resource orientation, context factors, and participation are among the central notions of the concept. The ICF is a foundation for seeking international agreement across the bounds of disciplines and is amidst an intensive transfer and implementation process, also in Germany. Due to the multitude of actors and activities involved, it has become almost impossible even for those taking a strong interest in the matter to keep up with developments and fields of applications, let alone to achieve consensus in these respects. The German Society of Rehabilitation Sciences therefore initiated a problem-oriented stocktaking of the present situation. This article seeks to point out a number of important developments and trends in order to provide initial orientation and overview. The stocktaking is intended to contribute to further disseminating the ICF, at the same time however to outline several crucial fields of application and development. To be continued and deepened, this preliminary stocktaking underlines several core developments along with a number of conceptual issues still unresolved for the time being. Notwithstanding a high degree of acceptance of the concepts underlying the ICF, continued and, as far as possible, coordinated efforts toward implementation will be required at all levels.

Disability Evaluation↗

PubMed2006

Towards an international framework for communication disorders: use of the ICF.

UNLABELLED: There has been an interest in the World Health Organization's framework of functioning and disability by those in communication disorders since the original 1980 International Classification of Impairments, Disabilities, and Handicaps (ICIDH). In 2001, WHO published the substantially revised International Classification of Functioning, Disability, and Health (ICF). This framework is gaining in acceptance as a system that would be beneficial for the field and for our clients. This article describes the basics of the ICF and how it differs from the ICIDH; the possible applications of the ICF to communication disorders; some of the work done with the ICF in communication disorders internationally; and the benefits to the field from increased interdisciplinary and international collaboration using the ICF as a common framework. LEARNING OUTCOMES: As a result of this activity the reader will be able to: (1) describe the basics of the ICF, (2) describe the applications of the ICF to communication disorders, and (3) describe the possible impact upon the field internationally.

Communication Disorders↗

PubMed2005

Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients' sickness absence and gross income: experience from the FIN-RACo trial.

OBJECTIVE: To explore the monetary value of rheumatoid arthritis related loss of productivity in patients with early active disease. METHODS: In a prospective cohort substudy of the FIN-RACo Trial, 162 patients with recent onset rheumatoid arthritis, aged 18 to 65 years and available to the workforce, were followed up for five years. Loss of work productivity in euros 2002 was estimated by data on absence for sickness and on income (human capital approach) from official databases. Treatment responses were evaluated by area under the curve (AUC) of the ACR-N measure and by increase in number of erosions in radiographs of hands and feet. The health assessment questionnaire (HAQ) at six months was linked to the International Classification of Functioning, Disability and Health (ICF). RESULTS: In all, 120 (75%) patients, women more often (82%) than men (61%) (p=0.002), lost work days. The mean lost productivity per patient-year was euro7217 (95% confidence interval (CI), 5561 to 9148): for women, euro6477 (4858 to 8536) and for men, euro8443 (5389 to 12,898). There was an inverse correlation with improvement: euro1101 (323 to 2156) and euro14 952 (10,662 to 19,852) for the highest and lowest quartiles of AUC of ARC-N, respectively. Lost productivity was associated with increase in the number of erosions and with disability in "changing and maintaining body position" subcategory of the ICF. CONCLUSIONS: Despite remission targeted treatment with disease modifying antirheumatic drugs, early rheumatoid arthritis results in substantial loss of productivity. A good improvement in the disease reduces the loss markedly.

Adolescent↗

PubMed2003

The ICF: Applications of the WHO model of functioning, disability and health to brain injury rehabilitation.

The traditional disease and diagnostic medical model is not always useful to brain injury professionals who need to describe, measure, and compare deficits associated with neurologic insult. Professionals in neurorehabilitation are in need of new systems that will assist them in identifying impairments and areas of intervention. The aim of this article is to present the International Classification of Functioning, Disability and Health (ICF), and its applications to brain injury rehabilitation. This taxonomy, developed by the WHO, allows the classification and assessment of functioning and disability in everyday activities and social involvement for individuals with medical conditions. Multi-disciplinary teams from 65 countries have collaborated in the development of the ICF to develop a tool that serves different purposes and disciplines with high trans-cultural validity. It can be of great value for professionals working in the field of brain injury who need to describe and quantify in detail neurocognitive, emotional, and sensory-motor functions as well as their impact on activities and participation in life situations. Its applications also extend to the domains of epidemiology, public health and public policy.

Activities of Daily Living↗

PubMed2006

Broadening the scope on health problems among the chronically neurologically ill with the International Classification of Functioning (ICF).

PURPOSE: The aim of this study was to determine ICF items indicating health problems for patients with a chronic neurological disorder such as multiple sclerosis, Parkinson's disease and neuromuscular disease. METHOD: A Delphi study using three disease-specific panels composed of patients and proxies, medical and non-medical health professionals (N = 98). Panels were asked to select items from the International Classification of Functioning, Disability and Health (ICF) reflecting relevant disease-specific health problems. Items appraised as relevant by the panel members were compared with items in established measures namely: the Minimal Record of Disability (MRD) and the Disability and Impact Profile (DIP). RESULTS: Sixty-eight ICF items were considered to be the most relevant, and belonged to four ICF domains. No significant differences were found between the appraisal of items by patients/proxies and health professionals. Agreement across the disease panels appeared to be (very) strong. Differences between the three disease-specific panels were found for the 'Body Functions and Structures' domain: consensus was reached by extension of the inclusion criteria. The ICF-item selection covers almost all items of the established measures. The largest contrast was shown in the item selection for the 'participation' and 'environmental factors' domains. CONCLUSIONS: Selected items indicate a broader scope in studying health problems compared with widely used health status measures in neurology, especially for the ICF domains 'Participation' and 'Environmental Factors'.

Chronic Disease↗

PubMed2004

The Walter J. Zeiter lecture. Global initiatives in rehabilitation medicine.

Global initiatives in rehabilitation medicine. Global initiatives in rehabilitation medicine present significant challenges, as well as great opportunities for the field of physical medicine and rehabilitation. These initiatives are international in focus, from multiple countries, include many different medical specialties, and will impact physiatrists. The Bone and Joint Decade is a global multidisciplinary initiative that aims to reduce the burden of musculoskeletal disorders. Its aim is to improve the health-related quality of life of people with or at risk of musculoskeletal disorders. The International Classification of Functioning, Disability and Health (ICF) is a unified and standard classification system for describing health domains and health-related states with quantifiable assessment measures. The ICF is a significant change from current medical models to patient- and rehabilitation-oriented models of evaluating function, disability, and health status. Medical Professionalism in the New Millennium: A Physician Charter helps define medicines contract with society. The demand for medical professionalism is the result of unparalleled challenges facing the physician on a daily basis. The Physician Charter provides a reaffirmation of the Hippocratic oath in modern terms. The Maintenance of Certification is a response of organized medicine to the demand for physician competence during an entire career. This is a means of establishing safeguards to protect the public and of delivering a criterion standard for health care. These initiatives will have a profound influence on our future. I encourage each of you to participate in your own future through these activities.

Certification↗

PubMed2004

A multidimensional view of health.

CONTEXT: Emergence and burgeoning of specialized health care structures have contributed to the diversity in health services. Inadvertently, the separation and resultant independent functioning of health and rehabilitation organizations have impeded opportunities for health care workers to interact with one another. Consequently, providers may lack knowledge on available health services within communities in which they preside. Educational approaches that can assist health professionals improve awareness of services across organizational divides are needed. OBJECTIVES: The new International Classification of Functioning Disability and Health (ICF), offers a multidimensional view of health, which can be used in education sessions to increase provider awareness of how health is mediated across health paradigms. This paper explores the conceptual basis of the ICF and its use in promoting a broader view of health essential for treating consumers with complex health problems and enhancing knowledge sharing amongst professionals. METHODS: A single case study design is used to demonstrate how the ICF's conceptual framework offers providers a means to promote mutual understanding of differences in health services and to assist them in sharing knowledge on the services provided with others. CONCLUSION: Conceptually, the ICF can be used as a basis for structuring inter-organizational educational initiatives to increase knowledge sharing amongst organizations and health care workers. In addition, introducing health professionals to a multidimensional view of health can assist them to understand the breadth of health services in the community and to consider a more comprehensive set of health determinants and dimensions in caring for consumers.

Delivery of Health Care, Integrated↗

PubMed2006

Functioning and preferences for improvement of health among patients with juvenile idiopathic arthritis in early adulthood using the WHO ICF model.

OBJECTIVE: To evaluate functioning and preferences for health among young adult patients with juvenile idiopathic arthritis (JIA) and controls. The WHO International Classification of Functioning, Disability and Health (ICF) was used as a framework. METHODS: The patient files of a rheumatology hospital were screened to identify patients with juvenile arthritis born 1976 to 1980. Functioning was measured by the Finnish version of the Multidimensional Health Assessment Questionnaire (MDHAQ) within the framework of the ICF. Preferences in improvement of health were measured by the Finnish version of the Arthritis Impact Measurement Scales 2. Age and sex matched controls from the community were selected from the Finnish population registry. RESULTS: In all, 123 patients with a mean age of 23 (SD 21-26) years participated in the followup study. The mean time from diagnosis to followup was 16.2 years. Among them, 35% (n = 43) were in remission at followup. Lower levels of functioning for 3 ICF components were found in patients with active disease compared to controls. JIA patients with active disease had more pain and lower levels of mobility, self-care, and domestic and social life compared to controls. Patients with active disease differed from those in remission with pain in preferences for improvement of health. CONCLUSION: Patients with active disease need active treatment and rehabilitation to maintain functioning and decrease pain. The ICF offers a promising model to examine the outcomes of adult patients with JIA. Application of the MDHAQ is supported by our evaluation studies in young adults with JIA.

Activities of Daily Living↗

PubMed2006

An existential model of oral health from evolving views on health, function and disability.

OBJECTIVE: This study explores the evolution of conceptual frameworks and models of health and disability to construct an explanatory model of oral health. RESULTS: The International Classification of Impairments, Disabilities, and Handicaps adopted by the WHO is based largely on social role theory and a utilitarian tradition portraying disablement as a negative and socially unacceptable consequence of impairment. It has been the major conceptual influence on the construction of psychometric tools for dentistry. However current views of chronic disease are refocused on the influence of coping strategies used by people to prevent or limit disability and handicap. Consequently, the WHO adopted the International Classification of Functioning, Disability and Health (ICF) as an alternative description of health and health-related states based on an existentialist view of the body, the person and society. In addition, an ethnographic exploration has identified three major domains of oral health--oral hygiene, comfort and general health--that dominate the opinions of people with oral impairments. CONCLUSIONS: Application of the framework and language of the ICF to the major domains of oral health provides the basis for a new biopsychosocial model of oral health, function and disablement.

Disability Evaluation↗

PubMed2006

Health status of lymphatic filariasis assessed from patients using seven domains five levels (7D5L) instrument.

Health status is the standardized description of health condition of individuals either normal or ill due to diseases and is presented as multidimentional profiles. In an effort to develop an indicator to assess the impact of morbidity intervention against lymphatic filariasis (LF), we assessed the health status of seven different clinical manifestations (health states) of LF from the patient's perspective. One hundred and seventy-four filarial patients either with hydrocele or lymphoedema were involved in the study. Acute episode of adenolymphangitis (ADL) among chronic patients was considered as co-morbidity. Severity levels, focusing on physical, mental and social dimensions of health were defined and quantified, using seven domains and five levels (7D5L) instrument, an extended form of EuroQol (5D3L). All the seven domains of health are affected by filarial disease, with the levels of severity varying with health states. The mean severity score of ADL (25.8) was significantly higher compared to lymphoedema (10.7) and hydrocele (6.9) (P<0.05). In males, the mean score of lymphoedema (11.6) was significantly higher in comparison to hydrocele (P<0.05). The severity scores increase with the progression of filarial disease but independent of gender. The health states of LF were further classified based on the percentage of severity according to International Classification of Functioning, Disability and Health (ICF) on impairments. Lymphoedema grade 4 (oedema with skin changes) and ADL were ranked as severe. The importance of these findings is discussed in view of priority setting and evaluating the morbidity management under Global Programme for Elimination of Lymphatic Filariasis (GPELF).

Adolescent↗

PubMed2005

Health measurement using the ICF: test-retest reliability study of ICF codes and qualifiers in geriatric care.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) was published by the World Health Organization (WHO) to standardize descriptions of health and disability. Little is known about the reliability and clinical relevance of measurements using the ICF and its qualifiers. This study examines the test-retest reliability of ICF codes, and the rate of immeasurability in long-term care settings of the elderly to evaluate the clinical applicability of the ICF and its qualifiers, and the ICF checklist. METHODS: Reliability of 85 body function (BF) items and 152 activity and participation (AP) items of the ICF was studied using a test-retest procedure with a sample of 742 elderly persons from 59 institutional and at home care service centers. Test-retest reliability was estimated using the weighted kappa statistic. The clinical relevance of the ICF was estimated by calculating immeasurability rate. The effect of the measurement settings and evaluators' experience was analyzed by stratification of these variables. The properties of each item were evaluated using both the kappa statistic and immeasurability rate to assess the clinical applicability of WHO's ICF checklist in the elderly care setting. RESULTS: The median of the weighted kappa statistics of 85 BF and 152 AP items were 0.46 and 0.55 respectively. The reproducibility statistics improved when the measurements were performed by experienced evaluators. Some chapters such as genitourinary and reproductive functions in the BF domain and major life area in the AP domain contained more items with lower test-retest reliability measures and rated as immeasurable than in the other chapters. Some items in the ICF checklist were rated as unreliable and immeasurable. CONCLUSION: The reliability of the ICF codes when measured with the current ICF qualifiers is relatively low. The result in increase in reliability according to evaluators' experience suggests proper education will have positive effects to raise the reliability. The ICF checklist contains some items that are difficult to be applied in the geriatric care settings. The improvements should be achieved by selecting the most relevant items for each measurement and by developing appropriate qualifiers for each code according to the interest of the users.

Activities of Daily Living↗

PubMed2004

The World Health Organisation's terminology and classification: application to severe disability.

PURPOSE: The purpose of this article is to describe the international classification system proposed by the World Health Organisation for describing individuals with disability. Initially the 'International classification of impairment, disability and handicap' (ICIDH) was used. This has been replaced by the 'International classification of functioning, disability and health' (ICF). Both of these systems will be described and followed by a discussion of the advantages and disadvantages of using the WHOs classification framework. An application to the field of severe disability will be made throughout. METHOD: Providing a theoretical framework for classification of disability in accordance with the system proposed by the WHO. RESULTS: The ICF is a useful tool that contributes to uniformity of international terminology and standardization in the disability field. It is not a minority model, and focuses on strengths and skills. CONCLUSIONS: An international classification system such as the ICF offers a conceptual framework for information that is relevant to the long-term consequences of disability. Although any type of classification system has certain limitations, the advantages present within the ICF outweigh the limitations.

Persons with Disabilities↗

PubMed2006

The ICF comprehensively covers the spectrum of health problems encountered by health professionals in patients with musculoskeletal conditions.

OBJECTIVES: The objective of this study was to investigate, whether the International Classification of Functioning, Disablity and Health (ICF) comprehensively covers the spectrum of health problems encountered by medical doctors and physiotherapists in patients with musculoskeletal conditions. METHODS: A worldwide e-mail survey with questionnaires that requested lists of relevant areas in the ICF components-body functions, body structures, activities and participation, and environmental factors-in patients with rheumatoid arthritis, osteoarthritis, low back pain and osteoporosis was conducted. The suitability of linking the named concepts to the ICF as well as the precision of the linking was characterized by assigning the concepts to six groups. RESULTS: All concepts that were named by the experts could be linked to the ICF, with the exception of personal factors. Between 32% (environmental factors) and 51% (activities and participation) of the named concepts were linked to an ICF category with an identical meaning and the same grade of precision. All other named concepts were linked to ICF categories with a lower level of precision, or encompassed more than one ICF category, or were linked to an ICF category with a related, but not identical meaning. CONCLUSIONS: The ICF covers comprehensively the spectrum of problems encountered in patients with musculoskeletal conditions by clinical experts throughout the world. This strengthens the validity of the ICF in the view of the users and will encourage the use of ICF-based applications such as the ICF checklist and the now-developed ICF Core Sets.

Activities of Daily Living↗