A tool for enhancing strategic health planning: a modeled use of the International Classification of Functioning,Disability and Health

This article describes use of the International Classification of Functioning, Disability and Health (ICF) as a tool for strategic planning. The ICF is the international classification system for factors that influence health, including Body Structures, Body Functions, Activities and Participation and Environmental Factors. An overview of strategic planning and the ICF are provided. Selected ICF concepts and nomenclature are used to demonstrate its utility in helping develop a classic planning framework, objectives, measures and actions. Some issues and resolutions for applying the ICF are described. Applying the ICF for strategic health planning is an innovative approach that fosters the inclusion of social ecological health determinants and broad populations. If employed from the onset of planning, the ICF can help public health organizations systematically conceptualize, organize and communicate a strategic health plan. This article is a US Government work and is in the public domain in the USA.     

Enhancing the conceptual clarity of the activity and participation components of the International Classification of Functioning, Disability, and Health

A key area left open in the International Classification of Functioning, Disability, and Health (ICF) is the distinction between activity and participation. This paper suggests characteristics to distinguish between the components in the ICF model which explicitly include the relationship of contextual factors to the different components. Ten distinguishing characteristics are presented which fall into three major groups: the construct of the component, individual effects, and contextual influences. Application of these suggests that there are four distinguishable components of functioning, disability, and health, which are labeled body functions and structures, acts, tasks, and societal involvement. The body functions and structures component is the same as the ICF component. Acts, tasks, and societal involvement are sub-components of the combined ICF components of activity and participation. Contextual influences operate both as facilitators or barriers (as suggested in the ICF) and as scene-setters. An enhanced model of the relationship between the components is presented, suggesting that there are reciprocal relationships between contextual factors acting as scene-setters, contextual factors acting as facilitators or barriers, societal involvement, tasks, and acts. Further research is needed to determine to what extent these characteristics can be operationalized to distinguish between items in the ICF combined activity and participation classification.     

Understanding recovery: Changes in the relationships of the International Classification of Functioning (ICF) components over time

The International Classification of Functioning, Disability and Health framework describes human functioning through body structure and function, activity and participation in the context of a person's social and physical environment. This work tested the temporal relationships of these components. Our hypotheses were: 1) there would be associations among physical impairment, activity limitations and participation restrictions within time; 2) prior status of a component would be associated with future status; 3) prior status of one component would influence status of a second component (e.g. prior activity limitations would be associated with current participation restrictions); and, 4) the magnitude of the within time relationships of the components would vary over time. Participants from Canada with primary hip or knee joint replacement (n = 931), an intervention with predictable improvement in pain and disability, completed standardized outcome measures pre-surgery and five times in the first year post-surgery. These included physical impairment (pain), activity limitations and participation restrictions. ICF component relationships were evaluated cross-sectionally and longitudinally using path analysis adjusting for age, sex, BMI, hip vs. knee, low back pain and mood. All component scores improved significantly over time. The path coefficients supported the hypotheses in that both within and across time, physical impairment was associated with activity limitation and activity limitation was associated with participation restriction; prior status and change in a component were associated with current status in another component; and, the magnitude of the path coefficients varied over time with stronger associations among components to three months post surgery than later in recovery with the exception of the association between impairment and participation restrictions which was of similar magnitude at all times. This work enhances understanding of the complexities of the ICF component relationships in evaluating disability over time. Further longitudinal studies including evaluation of contextual factors are required.     

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.     

Graphical modeling can be used to illustrate associations between variables describing functioning in head and neck cancer patients

Objective

To examine the associations between variables of functioning measured by the International Classification of Functioning, Disability and Health (ICF) in head and neck cancer (HNC) patients by means of graphical modeling.

Study Design and Setting

Graphical modeling was used on a data set of a cross-sectional multicentric study of 145 patients with HNC. Functioning was qualified using the extended ICF checklist. Multiple imputation was used to handle missing data. The least absolute shrinkage and selection operator for generalized linear models was used to identify conditional associations between the ICF categories. Bootstrap aggregating was used to enhance the accuracy and validity of model selection.

Results

The resulting graph shows largely meaningful associations between the ICF categories. One central point could be visualized consisting of a circular path of d330 Speaking, d350 Conversation, b510 Ingestion functions, s320 Structure of mouth, and b310 Voice functions. Another important structure in the graph were the bow-shaped associations beginning with d335 Producing nonverbal messages to b130 Energy and drive functions.

Conclusion

Graphical modeling can be used to describe associations between different areas of functioning in HNC patients. They found associations can be the basis for improved rehabilitation and gives a deeper understanding of functioning in HNC patients.     

ICIDH-PR: A potential model for occupational therapy

Occupational therapists frequently work with clients who are challenged by chronic disabilities that may often lead to handicaps. Consequently, chronicity and possible resulting handicaps are matters of concern for occupational therapists in all domains, including: practice, research and education. In 1980 the World Health Organization put forth a classification scheme to capture the long-term consequences of disease: the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Its use within occupational therapy was advocated. They showed that the constructs of this classification system mirrored those of occupational therapy's occupational performance model. More recently, a proposal for the revision of the ICIDH (ICIDH-PR) has been advanced. This proposal is consistent with the enablement and occupational competence models. Within this proposed model, occupational therapy is concerned with enabling clients to interact optimally within their chosen environments. This paper presents a brief review of a selected portion of the international literature on the ICIDH and introduces the proposed revision of the ICIDH for occupational therapy. The structure of this proposed classification is compared with the occupational therapy models. The implications that the use of the ICIDH-PR will have for occupational therapy are also addressed.     

Demystifying disability: a review of the International Classification of Functioning, Disability and Health

The paper describes and evaluates the theoretical underpinnings of the International Classification of Functioning, Disability and Health (ICF), and develops the proposition that its conceptual framework provides a coherent, if uneven, guide through the competing conceptions of disability. To date, however, there has been little evaluation of the theoretical efficacy of the ICF. In seeking to redress this, the paper develops the argument that the ICF fails to specify, in any detail, the content of some of its main claims about the nature of impairment and disability. This has the potential to limit its capacity to educate and influence users about the relational nature of disability. The paper develops the contention that three parts of the ICF require further conceptual clarification and development: (a) (re)defining the nature of impairment; (b) specifying the content of biopsychosocial theory; and (c) clarifying the meaning and implications of universalisation as a principle for guiding the development of disability policies.     

Items from patient-oriented instruments can be integrated into interval scales to operationalize categories of the International Classification of Functioning, Disability and Health

ObjectiveTo exemplify the construction of interval scales for specified categories of the International Classification of Functioning, Disability and Health (ICF) by integrating items from a variety of patient-oriented instruments.Study Design and SettingPsychometric study using data from a convenience sample of 122 patients with rheumatoid arthritis. Patients completed six different patient-oriented instruments. The contents of the instrument items were linked to the ICF. Rasch analyses for ordered-response options were used to examine whether the instrument items addressing the ICF category b130: Energy and drive functions constitute a psychometrically sound interval scale.ResultsNineteen items were linked to b130: Energy and drive functions. Sixteen of the 19 items fit the Rasch model according to the chi-square (χ²) statistic (χ²_df=32 = 38.25, P = 0.21) and the Z-fit statistic (Z_Mean = 0.451, Z_SD = 1.085 and Z_Mean = ?0.223, Z_SD = 1.132 for items and persons, respectively). The Person Separation Index r_β was 0.93.ConclusionThe ICF category interval scales to operationalize single ICF categories can be constructed. The original format of the items included in the interval scales remains unchanged. This study represents a step forward in the operationalization and future implementation of the ICF.     

Psychometric Properties of the Arab Heritage Activity Card Sort

The Activity Card Sort is a valid and reliable assessment tool that was created to assess Participation. It has been translated to several languages and adapted to different international cultures. The most recent version of this tool is the Arabic Heritage Activity Card Sort (A‐ACS). The purpose of this study was to establish the psychometric properties of the new Arabic version in Jordanian adults. Forty three Jordanian patients with multiple sclerosis (MS) and 62 healthy adults were recruited to test the psychometric properties of the tool. The A‐ACS correlated moderately with the participation index of the Mayo‐Portland Adaptability Inventory (r = ?0.458, p < 0.00) (concurrent validity), was able to discriminate between patients and healthy participants on the current and retained levels of participation (F = 5.09, p < 0.03; F = 6.01, p < 0.02, respectively) (discriminative validity), and correlated moderately with the total scores of the Mayo‐Portland Adaptability Inventory (r = ?0.458, p < 0.00) and the total score on the Arabic version of the self‐report Performance Assessment of Self‐care Skills (r = 0.581, p < 0.00) (convergent validity). The tool also showed good test–retest reliability (r = 0.80, p < 0.00) and excellent internal consistency (α = 0.90). The Arabic Heritage of the Activity Card Sort is a valid and reliable tool for Arabic‐speaking occupational therapists to use when assessing participation in Jordanian patients with MS or healthy adults. Limitations of this study include using only one diagnostic group from Jordan and examining only the Recovery and Community Versions of the tool. Future studies are needed to examine further psychometric properties for patients with different diagnoses and from different countries in the Arabic region for all three versions of the A‐ACS. Copyright © 2012 John Wiley & Sons, Ltd.     

Scales could be developed based on simple clinical ratings of International Classification of Functioning, Disability and Health Core Set categories

ObjectiveThe aim of the study was to examine whether clinical ratings of International Classification of Functioning, Disability and Health categories can be integrated into parametric scales, which provide a reliable estimation of specified patient problems and rehabilitation goals using the example of mobility of the upper and lower extremities in the acute hospital situation.Study Design and SettingPsychometrical study based on data from a prospective multicentric cohort study in patients with musculoskeletal conditions in the acute hospital.ResultsTwo hundred thirty-four patients were included (mean age 56, 50% female. Forty-four percent with a diagnosis involving lower extremities, 18% with a diagnosis involving the hip, 18% with a diagnosis involving upper extremities, 16% with a diagnosis involving the spine). After adjustment for differential item functioning two separate scales for upper and lower extremity mobility could be constructed. The constructed scales had 10 (upper) and eight (lower) items displaying adequate to good fit.ConclusionThe results of this study indicate that it could be possible to develop scales based on categories of the International Classification of Functioning, Disability and Health Core Sets. This may be a promising approach for areas where psychometrically sound measures are not available.     

Existing models and instruments for the selection of assistive technology in rehabilitation practice

Objectives: To review models and instruments for the selection and advisory process of assistive technology in the rehabilitation field as reported in the current scientific literature. Design: Systematic literature review. Methods: A systematic literature search was conducted in MEDLINE (2003–2007). In a peer-review process with four independent investigators, studies were selected according to predefined inclusion and exclusion criteria. Because of the poor publication situation, non-research sources were included as well. The data extracted and compared are: information concerning the selection process for assistive technology, whether a client-centred approach is used during the selection procedure, the use of models and instruments, and their compatibility with the ICF. Results: The search resulted in 16 papers. None of the studies had an experimental design; nine of the publications were literature reviews. There is a lack of reliable and valid models and instruments for the selection process of assistive technology in the scientific literature. The prevalence of the Matching Person and Technology Model from Scherer (1998) is explicit in the publications. The ICF and ISO 9999 are the only classification systems mentioned in relation to assistive technology, although rarely. Conclusion: This is a poorly developed field resulting in a lack of evidence-based procedures for AT selection. Such procedures are important to increase consumer satisfaction and the efficiency of AT provision. There is clearly a need for further research in this field.     

Supporting a person‐centred approach in clinical guidelines. A position paper of the Allied Health Community – Guidelines International Network (G‐I‐N)

Background

A person‐centred approach in the context of health services delivery implies a biopsychosocial model focusing on all factors that influence the person''s health and functioning. Those wishing to monitor change should consider this perspective when they develop and use guidelines to stimulate active consideration of the person''s needs, preferences and participation in goal setting, intervention selection and the use of appropriate outcome measures.

Objective

To develop a position paper that promotes a person‐centred approach in guideline development and implementation.

Design, setting and participants

We used three narrative discussion formats to collect data for achieving consensus: a nominal group technique for the Allied Health Steering Group, an Internet discussion board and a workshop at the annual G‐I‐N conference. We analysed the data for relevant themes to draft recommendations.

Results

We built the position paper on the values of the biopsychosocial model. Four key themes for enhancing a person‐centred approach in clinical guidelines emerged: (i) use a joint definition of health‐related quality of life as an essential component of intervention goals, (ii) incorporate the International Classification of Functioning, Disability and Health (ICF) as a framework for considering all domains related to health, (iii) adopt a shared decision‐making method, and (iv) incorporate patient‐reported health outcome measures. The position statement includes 14 recommendations for guideline developers, implementers and users.

Conclusion

This position paper describes essential elements for incorporating a person‐centred approach in clinical guidelines. The consensus process provided information about barriers and facilitators that might help us develop strategies for implementing person‐centred care.