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PubMed2006

Scales in Parkinson's disease.

The search for valid instruments to measure different domains of health disturbances becomes increasingly important for the assessment of Parkinson's disease. The most widely used tool is the Unified Parkinson's Disease Rating Scale (UPDRS) which was introduced in 1987 and is currently awaiting revision. In addition, a variety of instruments have been used to capture non-motor aspects of Parkinson's disease but only a minority of these instruments has been validated for this particular disease condition. Measurements of quality of life are being incorporated into an increasing number of studies in order to reflect a more integral view of health and have contributed to a better understanding of the impact of disease and interventions. The International Classification of Functioning, Disability and Health introduced by the WHO in 2001 offers a multidimensional approach to human functioning and participation that can also be applied to the assessment of health status in PD. This workshop report will focus on the present state of clinimetry in PD and discuss future perspectives.

Disability Evaluation↗

PubMedDate not supplied

Identification of relevant ICF categories by patients in the acute hospital.

PURPOSE: To describe functioning and health of patients in the acute hospital and to identify the most common problems using the International Classification of Functioning, Disability and Health (ICF). METHODS: Cross-sectional survey in a convenience sample of neurological, musculoskeletal and cardiopulmonary patients requiring rehabilitation in the acute hospital. The second level categories of the ICF were used to collect information on patients' problems. For the ICF components Body Functions, Body Structures and Activities and Participation absolute and relative frequencies of impairments/limitations in the study population were reported. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. RESULTS: The mean age in the sample was 57.6 years with a median age of 60.5, 49% of the patients were female. In 101 patients with neurological conditions, 115 ICF categories had a prevalence of 30% and more: 32 categories of Body Functions, 13 categories of Body Structures, 32 categories of Activities and Participation and 38 categories of Environmental Factors. In 105 patients with cardiopulmonary conditions, 80 categories had a prevalence of 30% and more: 36 categories of Body Functions, eight categories of Body Structures, 10 categories of Activities and Participation and 26 categories of Environmental Factors. In 90 patients with musculoskeletal conditions, 61 categories had a prevalence of 30% and more: 14 categories of Body Functions, five categories of Body Structures, 16 categories of Activities and Participation and 26 categories of Environmental Factors. CONCLUSION: This study is a first step towards the development of ICF Core Sets for patients in the acute hospital.

Activities of Daily Living↗

PubMed2003

From clinical records to regulatory reporting: formal terminologies as foundation.

Achieving goals of healthy people and populations is dependent on available and relevant data for health care decisions. New technologies enable reuse of data for decisions, however it is clear that uniform data standards and in particular standards around terminological data will be required to achieve reuse. Terminological data related to functioning and disability presents unique challenges because of the conceptual ambiguity within the field. The International Classification of Functioning, Disability, and Health (ICF) provides a clarifying conceptual foundation for functioning and disability data, but is not structured as a formal terminology. The need for a concerted and coordinated effort is emphasized.

Activities of Daily Living↗

PubMed2005

ICF linking rules: an update based on lessons learned.

OBJECTIVE: Outcome research seeks to understand the end results of health services. Researchers use a wide variety of outcome measures including technical, clinical and patient-oriented measures. The International Classification of Functioning, Disability and Health (ICF) as a common reference framework for functioning may contribute to improved outcome research. The objective of this paper is to provide an updated version of the linking rules published in 2002 and illustrate how these rules are applied to link technical and clinical measures, health-status measures and interventions to the ICF. RESULTS: Three specific linking rules have been established to link health-status measures to the ICF and one specific linking rule has been created to link technical and clinical measures and interventions. A total of 8 linking rules have been established for use with all different outcome measures and with interventions. CONCLUSION: The newly updated linking rules will allow researchers systematically to link and compare meaningful concepts contained in them. This should prove extremely useful in selecting the most appropriate outcome measures among a number of candidate measures for the applied interventions. Further possible applications are the operationalization of concrete ICF categories using specific measures or the creation of ICF category-based item bankings.

Activities of Daily Living↗

PubMed2006

Participation survey/mobility: psychometric properties of a measure of participation for people with mobility impairments and limitations.

OBJECTIVE: To describe the development and psychometric properties of a self-report survey of participation by people with mobility limitations, the Participation Survey/Mobility (PARTS/M). DESIGN: The information obtained during interviews and focus groups was used to develop items for the PARTS/M. Demographics and measures of disability, health, and functioning were collected. The PARTS/M was administered twice. SETTING: Primarily in the midwestern United States. PARTICIPANTS: Purposeful sample of 604 people with mobility limitations having a diagnosis of spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or postpoliomyelitis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: PARTS/M is composed of 20 major life activities that are placed in 6 domains used in the activity/participation component of the International Classification of Functioning, Disability and Health: self-care; mobility; domestic life; interpersonal interactions and relationships; major life areas; and community, social, and civic life. For each activity, questions were asked about components of participation including frequency, health-related limitations, importance, choice, satisfaction, use of assistive technology, and use of personal assistance. RESULTS: PARTS/M domains and components of participation had good internal consistency and stability. Composite participation scores were developed for participation components and domains. CONCLUSIONS: PARTS/M is a reliable measure of some aspects of participation in major life activities for people with mobility impairments and limitations living in community settings.

Activities of Daily Living↗

PubMed2002

Work disability in The Netherlands: data, conceptual aspects, and perspectives.

Data on work disability lack a standardized approach when defining the main variables. As a consequence, these data do not usually provide reliable information about health problems and related outcome measures. Examples of this unreliability are provided by the rather different approaches used in Dutch social security compared with the national statistics on disability. Several authors have tried to cope with this by introducing concepts that recognize disability as the multifaceted phenomenon it is and still provide reliable data. We recommend the development and global use of one concept so as to make data comparable. The recently presented International Classification of Functioning, Disability, and Health seems to be a sound base for further exploration of the possibilities for standardization in occupational health and social security.

Adolescent↗

PubMed2005

Physical health, depression and cognitive function as correlates of disability in an older Korean population.

BACKGROUND: The World Health Organisation Disability Assessment Schedule II (WHODAS II) measures functioning and disability in concordance with the bio-psycho-social model of the WHO's International Classification of Functioning, Disability, and Health. Our objectives were to investigate the independent associations of physical health, depression and cognitive function with WHODAS II disability in an older Korean population. METHODS: The WHODAS II was administered to a community sample of 1204 residents age 65 or over. Data on demographic characteristics (age, gender, living area, marital state, and religion), socio-economic state (education, type of accommodation, number of rooms, previous occupation, current employment, monthly income), social support, number of physical illness, depression (GMS), and cognitive function (MMSE) was gathered. A subsample (n = 746) received a clinical examination for dementia. RESULTS: Scores on the WHODAS II were significantly and independently associated with worse physical health, depression, and lower cognitive function. Associations with other factors were no longer apparent after adjustment for these. These associations persisted in the absence of dementia. In participants with dementia (n = 110), WHODAS II scores were principally associated with physical health and accommodation type. CONCLUSIONS: Level of disability, as measured by the WHODAS II, was principally associated with physical health, depression and cognitive function, rather than socio-demographic factors.

Aged↗

PubMedDate not supplied

Identification of relevant ICF categories by geriatric patients in an early post-acute rehabilitation facility.

PURPOSE: To describe functioning and health of elderly patients in an early post-acute rehabilitation facility and to identify the most common problems using the International Classification of Functioning, Disability and Health (ICF). METHODS: Cross-sectional survey in a convenience sample of elderly patients requiring rehabilitation in an early post-acute rehabilitation facility. The second-level categories of the ICF were used to collect information on patients' problems. For the ICF components Body Functions, Body Structures and Activities and Participation, absolute and relative frequencies of impairments/limitations in the study population were reported. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. RESULTS: The mean age in the sample was 79.9 years. Sixty-nine percent of the patients were female. In 150 patients, 82 ICF categories (34%) had a prevalence of 30% or above. The 82 categories included 22 categories (45%) of the component Body Functions, six categories (15%) of the component Body Structures, 25 categories (34%) of the component Activities and Participation and 29 (57%) categories of the component Environmental Factors. CONCLUSION: This study is a first step towards the development of ICF Core Sets for geriatric patients in early post-acute rehabilitation facilities.

Activities of Daily Living↗

PubMed2005

Reliability in assigning ICF codes to children with special health care needs using a developmentally structured interview.

PURPOSE: The purpose of this study was to determine if two teams of raters could reliably assign codes and performance qualifiers from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to children with special health care needs based on the results of a developmentally structured interview. METHOD: Children (N = 40), ages 11 months to 12 years 10 months, with a range of health conditions, were evaluated using a structured interview consisting of open-ended questions and scored using developmental guidelines. For each child, two raters made a binary decision indicating whether codes represented an area of need or no need for that child. Raters assigned a performance qualifier, based on the ICF guidelines, to each code designated as an area of need. Cohen's kappa statistic was used as the measure of inter-rater reliability. RESULTS: Team I reached good to excellent agreement on 39/39 codes and Team II on 38/39 codes. Team I reached good to excellent agreement on 5/5 qualifiers and Team II on 10/14 qualifiers. CONCLUSIONS: A developmentally structured interview was an effective clinical tool for assigning ICF codes to children with special health care needs. The interview resulted in higher rates of agreement than did results from standardized functional assessments. Guidelines for assigning performance qualifiers must be modified for use with children.

Activities of Daily Living↗

PubMed2005

Developing a national integrated classification of health care interventions in Sweden.

BACKGROUND: Existing classifications in Sweden of health care interventions used for quality assurance issues and for decisions on resource allocation does not capture all types of health care interventions. The work of professional groups like nurses, physiotherapists, and occupational therapists is partly invisible. There is a need to develop a classification of health care interventions that comprise all activity within the health care sector. AIM: To describe a multi-professional collaborative work on classification development and to provide suggestions for an organizing structure that can capture interventions in the health care services incorporating different professional perspectives. RESULTS: The professional groups reached a common understanding about the use of the classification of The International Classification of Functioning, Disability and Health (ICF) as a unifying framework in the classification of health care interventions. Proposal was made for a revised structure of a current classification of interventions using ICD as unifying framework. CONCLUSION: The use of ICF as a unifying framework is seen as a fruitful way of overcoming professional differences, and by that supporting the process of reaching a common understanding and use of a common language when describing interventions in health care.

Delivery of Health Care, Integrated↗

PubMedDate not supplied

Identification of relevant ICF categories by patients with neurological conditions in early post-acute rehabilitation facilities.

PURPOSE: To describe functioning and health of patients with neurological conditions in early post-acute rehabilitation facilities and to identify the most common problems using the International Classification of Functioning, Disability and Health (ICF). METHODS: Cross-sectional survey in a convenience sample of patients with neurological conditions requiring rehabilitation in early post-acute facilities. The second-level categories of the ICF were used to collect information on patients' problems. For the ICF components Body Functions, Body Structures and Activities and Participation absolute and relative frequencies of impairments/limitations in the study population were reported. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. RESULTS: The mean age in the sample was 56.6 years with a median age of 60 years. Forty percent of the patients were female. In 292 neurological patients 125 categories (51%) had a prevalence of 30% and above: 39 categories (49%) of Body Functions, 11 categories (28%) of Body Structures, 64 categories (88%) of Activities and Participation and 10 (20%) categories of Environmental Factors. CONCLUSION: This study is a first step towards the development of ICF Core Sets for of patients with neurological conditions in early post-acute rehabilitation facilities.

Activities of Daily Living↗

PubMed2003

Rehabilitation approaches for children with cerebral palsy: overview.

This article reviews the use of the World Health Organization classification framework for assessing children and adolescents with cerebral palsy and the use of outcome measures as they relate to the International Classification of Functioning, Disability and Health. Various intervention philosophies and approaches are discussed, including the evidence to support their use with children with cerebral palsy. Therapists will be able to use this information to formulate an assessment plan, incorporate the use of outcome measures, and employ evidence-based intervention methods.

Cerebral Palsy↗

PubMed2004

Measuring impairment caused by leprosy: inter-tester reliability of the WHO disability grading system.

This paper reports the results of a study on the inter-tester reliability of the WHO disability grading system. The WHO disability grading system is the most frequently used method of grading impairment in leprosy patients. With this method, a grade of 0-2 is assigned to each of six individual body sites (both eyes, hands and feet). The maximum grade of any of these sites is used as an overall indicator of the person's impairment status. To date, the WHO disability grading scale has not been subjected to reliability testing. The reliability of the grading system depends on the operational definitions of the grades, the way the tester interprets these definitions and the skill of the tester. It is therefore important that the definitions are unambiguous and leave as little room as possible for multiple interpretations. Three testers with varying degrees of experience did paired assessments on a total of 150 leprosy patients in the Leprosy Mission Hospital Purulia, India, using recently published operational definitions of the WHO disability grades. For every patient, they determined the maximum grade (minimum 0, maximum 2), and calculated the impairment sum-score (EHF score), adding up the six grades for eyes, hands and feet (minimum 0, maximum 12). The weighted Kappa statistic (Kw) was used as the coefficient of inter-tester reliability. A kappa of 0 represents agreement no better than chance, and 1.0 complete (chance-corrected) agreement. Kw values of > or = 0.80 are considered very good and adequate for monitoring and research. Weighted Kappa analysis yielded a reliability coefficient of 0.89 (95%CI 0.84-0.94) for the maximum grade and a Kw of 0.97 (95%CI 0.96-0.98) for the EHF score. We concluded that, when using standard operational definitions, the WHO disability grading system can be used reliably in the hands of both experienced and inexperienced testers, provided adequate training has been given. Reliability should be evaluated further in a field setting, when used by primary health care workers. It is recommended that the 'WHO disability grading' be renamed 'WHO impairment grading', using the terminology as defined by the International Classification of Functioning, Disability and Health (ICF).

Disability Evaluation↗

PubMed2004

Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning.

OBJECTIVES: We investigated the health, activity, and social participation of people aged 70 years or older with vision impairment, hearing loss, or both. METHODS: We examined the 1994 Second Supplement on Aging to determine the health and activities of these 3 groups compared with those without sensory loss. We calculated odds ratios and classified variables according to the International Classification of Functioning, Disability and Health framework. RESULTS: Older people with only hearing loss reported disparities in health, activities, and social roles; those with only vision impairment reported greater disparities; and those with both reported the greatest disparities. CONCLUSIONS: A hierarchical pattern emerged as impairments predicted consistent disparities in activities and social participation. This population's patterns of health and activities have public health implications.

Activities of Daily Living↗

PubMed2007

Content comparison of health-related quality of life instruments for COPD.

BACKGROUND: Due to the increasing importance of quality of life assessments in chronic obstructive pulmonary disease (COPD) patients, and the increased use of the International Classification of Functioning, Disability and Health (ICF) for comparative purposes it is essential to understand the relationship between health-related quality of life (HRQL) instruments and the ICF. OBJECTIVE: The objective of this study was to compare the content of recommended COPD-specific HRQL instruments using the ICF as reference. COPD-specific instruments mentioned in widely accepted guidelines were linked to the ICF using standardized linking rules. The degree of agreement between various health professionals was assessed by calculating the kappa statistic. RESULTS: Eleven instruments were included. They varied strongly in the number of concepts contained and the number of ICF categories used to map these concepts. A total of 548 concepts were identified and linked to 60 different ICF categories. Only the single category 'dyspnea' was covered by all instruments, whilst 21 categories were unique to specific instruments. The relationships of the measures with the ICF were identified. CONCLUSIONS: This study may aid researchers and clinicians to choose the most appropriate instrument for a specific purpose as well as help compare studies that have used different instruments for HRQL assessment.

Activities of Daily Living↗

PubMed2003

[Aspects of expertising which are jointly valid for German sociomedicine and statutory health care].

A project group of the Medical Advisory Board of the German Federal Rehabilitation Council (BAR) developed fundamental joint principles on experts' opinions according to the social law code no. IX (SGB IX). The principles aim at medical experts working in different social organisations and statutory health care insurances. It was intended to create a "sociomedical language" which should be used as jointly as possible by experts in rehabilitation and social medicine and which is based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). Its stringent application will increase the utility of medical expertise across different institutions. The authors recommend to evaluate whether this model could provide a tool in the communication and cooperation between different sectors of the health system. Part I describes the theoretical model, Part II its application to a virtual individual case history.

Delivery of Health Care↗

PubMed2004

[Aspects of expertise which are jointly valid for German sociomedicine and statutory health care].

A project group of the Medical Advisory Board of the German Federal Rehabilitation Council (BAR) developed fundamental joint principles on experts' opinions according to the social law code no. IX (SGB IX). The principles aim at medical experts working in different social organisations and statutory health care insurance. It was intended to create a "sociomedical language" which should be used as jointly as possible by experts in rehabilitation and social medicine and which is based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). Its stringent application will increase the utility of medical expertise across different institutions. The authors recommend to evaluate whether this model could provide a tool in the communication and cooperation between different sectors of the health system. Part I describes the theoretical model, Part II its application to a virtual individual case history.

Delivery of Health Care↗

PubMed2004

The use of the ICF to describe work related factors influencing the health of employees.

PURPOSE: There are many models describing the responses of the human organism to work. However, the description of the effects on a personal level is rather limited. For this purpose the authors propose to use the concepts and the terminology of the ICF - the International Classification of Functioning, Disability and Health. METHOD: This article starts with a description of a model from occupational medicine, the Van Dijk model. Subsequently an overview of the health state of employees is presented, including the external and personal factors that may influence participation in work. RESULTS: The schematic representation of the external and personal factors presented in this article is an expansion of the ICF-scheme. The scheme can be useful to describe problems of persons related to the working situation, and to identify the points of application of care for different professionals. Although the scheme does not have the intention to be complete, it might be useful in the development, execution and evaluation of programmes designed to prevent absenteeism in general or in specific groups, and to stimulate the return of people with absence due to illness. It is shown that the items of the Van Dijk model can be described using specific terms of the ICF. CONCLUSION: With the elaboration of the ICF scheme and the model of Van Dijk, expanded with ICF terms, the gap between the terminology used by professionals in health care, and the terminology used by professionals in occupational medicine is partly filled.

Employment↗