Linking osteoarthritis-specific health-status measures to the International Classification of Functioning,Disability, and Health (ICF)

OBJECTIVES: The objective of this study was to link the Western Ontario and McMaster Universities (WOMAC) and Lequesne-Algofunctional indices to the ICF on the basis of linking rules developed specifically to accomplish this aim. The linking process enables the understanding of the relationship between health-status measures and the ICF. METHODS: Since the fifth World Health Organisation/International Liege Against Rheumatism (WHO/ILAR) Task Force and the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group recommend the use of WOMAC and the Lequesne-Algofunctional indices in patients with osteoarthritis of the hip and knee in clinical trials, these two health-status measures have been used in this study.Both health-status measures were linked to the ICF separately by two trained health professionals. Consensus between health professionals was used to decide which ICF category should be linked to each item/concept of the two questionnaires. To resolve disagreements between the two health professionals, a third person trained in the linking rules was consulted. RESULTS: Except for the concept of 'morning stiffness', both health professionals agreed on the ICF category chosen to link all the items/concepts of both questionnaires. Altogether, 29 different ICF categories have been linked. Five ICF categories belong to the ICF component 'body functions', 23 categories to the component 'activities and participation', and one category to 'environmental factors'. Both questionnaires have 10 ICF categories in common. CONCLUSIONS: The results of the linking process reflect both the structure of the two questionnaires studied and the relationship between them, showing that the ICF classification can become the cardinal reference for existing health-status measures.     

Methodological challenges in the use of hip-specific composite outcomes: linking measurements from hip fracture trials to the International Classification of Functioning,Disability and Health Framework

Introduction

The prevalence of hip-specific outcome measures in randomized trials reflects what directs our outcome assessment following a hip fracture. The present study provides an overview on the most commonly-used hip-specific outcome instruments used for postoperative assessment of hip fracture with respect to their covered contents. This can facilitate the selection of appropriate items for specific purposes in clinical as well as research settings.

Methods

We used the International Classification of Functioning, Disability and Health (ICF) model to distinguish concepts within the instrument. All items from the questionnaires were categorized into one of three categories using the ICF linking rules for a standardized approach. The hip-specific composites measures were also compared to other types of prevalent measures: generic and patient-based instruments.

Results

All of the items in the instruments could be mapped to the ICF. We report the highest frequency of ICF activity and participation (71 %) within the Harris hip score (HHS) which is similar to the frequency of ICF content found in the generic measures (82 %). Hip-specific composites focused mostly on walking and moving long and short distances, while in patient-reported measures there was a concentration on the concept of sensation of pain and pain in body parts.

Discussion and conclusion

The prevalent use of the HHS, over the other hip-specific instruments, could be attributed to its likeness in concept to other generic measures. The dominance of the ICF category of activity and participation reflects what is important to clinicians treating a hip fracture. Composite scores remain problematic as they cut across different ICF concepts. As long as the popularity of composite scoring systems continues, an overall score may not represent the true patient preferences and concerns in clinical trials. Future studies could apply the results from this study for the creation of an ICF category-based item banking or investigators could operationalize the ICF categories within these candidate measures for specific interventions.     

Measuring common outcome measures and their concepts using the International Classification of Functioning, Disability and Health (ICF) in adults with burn injury: a systematic review

Purpose

To identify and quantify the health related concepts contained in the most common outcome instruments used in adult burn care, and to compare the content of these instruments based on their linkage to the International Classification of Functioning, Disability and Health (ICF). The ICF has been validated as a reference tool by the World Health Organization and is a framework that incorporates physical, emotional, environmental and social aspects of daily functioning.

Methods

Electronic searches of MEDLINE, EMBASE CINAHL, PsychINFO and the Cochrane Library from 2003 onwards were carried out using a predetermined search strategy. Specific characteristics of the included studies and data pertaining to the outcome instruments were extracted. Two reviewers independently categorised the underlying concepts contained in the most commonly used outcome measures and linked them to ICF categories using standardised linkage rules.

Results

Out of a total 132 included studies, 151 outcome instruments were identified. Of these, 14 frequently used generic and burn-specific instruments were selected for linkage to the ICF. From the 381 items contained in the 14 instruments, 356 concepts were extracted and subsequently linked to 99 ICF categories. Nearly 46% of the concepts were linked to body function and 20% to activities and participation, whereas only a few concepts were formally linked to health condition, body structures and personal or environmental factors.

Conclusion

The ICF proved highly useful for the content comparison of frequently used generic and burn-specific instruments. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in those with burn injury.     

The International Classification of Functioning, Disability and Health (ICF) and rheumatic diseases

Assessment of the impact of the rheumatic disease on the individual patient is necessary to evaluate the outcome of an intervention targeted at the disease process as well as at the restoration of the patient's functioning. The International Classification of Functioning, Disability and Health (ICF) is a comprehensive tool designed to record and organise a wide range of information about health and health related states, based on bio-psycho-social perspective. The ICF components, namely, body functions, body structures, and activities and participation are complemented by the contextual components, environmental factors and personal factors. All of them are in mutual interactions. The ICF contains lists of so-called ICF categories that describe the components of the integrative World Health Organisation model. It uses an alphanumerical model where categories are 'nested' so that broader categories are defined to include more detailed subcategories of the parent categories. Organized in such a way and with more than 1400 categories ICF covers virtually all the spectrum of problems encountered in patients with musculoskeletal conditions. The main practical tools of the ICF include ICF check lists, ICF core sets, ICF categorical profile and ICF assessment sheet. The ICF is likely to become the generally accepted conceptual framework and will be increasingly used in clinical practice to structure patient problems, particularly in multidisciplinary care and for rehabilitation purposes.     

Validation of the brief International Classification of Functioning, Disability, and Health (ICF) core set for hand conditions

Study designCross-sectional multi-centre study.IntroductionThe ICF Core Sets for Hand Conditions (HC) have been developed to describe functioning of patients with HC.Purpose of the studyTo study the content validity of the Brief ICF Core Set for HC.MethodsPatients with HC were interviewed using the Comprehensive ICF Core Set for HC. ICF categories that best explained variation in patients' general health were identified using multiple regression methods.ResultsOverall, 12 of the 23 ICF categories of the Brief ICF Core Set could be validated. Our analyzes further revealed that the categories “b134 Sleep functions”, “s830 Structure of nails”, “e225 Climate” as well as categories referring to “e4 Attitudes” also deserve consideration when assessing functioning in patients with HC.ConclusionsClinicians are encouraged to complement the Brief ICF Core Set for HC by adding sleep functions, structure of nails, climate and attitudes, especially when following patients over time.Level of EvidenceLevel 3.     

Linking commonly used hand therapy outcome measures to individual areas of the International Classification of Functioning: A systematic review

Study DesignSystematic review.IntroductionIdentifying outcome measures that correspond to the International Classification of Functioning (ICF) provides insight into selecting appropriate outcome tools in hand therapy practice.Purpose of the StudyThe objective of this study is to systematically review patient-reported outcome measures commonly used in hand therapy to determine the extent to which the content represents the biopsychosocial view of the ICF.MethodsA comprehensive literature search was conducted. Studies that met inclusion criteria were identified, and outcome measures were extracted. The meaningful concept was determined for each item on the measure and linked to the most specific ICF category. Summary linkage calculations were completed.ResultsEleven patient-reported outcomes were identified from 43 included studies. Activity and participation had the highest content coverage followed by body functions. There was linking to personal factors and not defined–disability and mental health. Environmental factors were not represented in any of the included outcome measures. The core set representation of unique codes ranged from 8.55% to 18.80% (mean: 11.97%) for the Comprehensive ICF Core Set for Hand Conditions and from 30.43% to 47.83% (mean: 31.40%) for the Brief ICF Core Set for Hand Conditions. The percent representation of the Comprehensive ICF Core Set for Hand Conditions for unique disability ranged from 21.62% to 43.24% (mean: 20.33%) and from 62.50% to 87.50% (mean: 72.22%) for the Brief ICF Core Set for Hand Conditions.DiscussionNone of the included measures represent all categories of the ICF Core Sets for Hand Conditions.ConclusionUtilizing the most recent refinement rules for the linking process, this study provides comparisons of measures along with clarity of content coverage for the most commonly used tools in the practice of hand therapy.     

The Patient-Rated Elbow Evaluation and the American Shoulder and Elbow Surgeons—Elbow form capture aspects of functioning that are important to patients with elbow injuries

Study DesignThis is a cross-sectional study.IntroductionThe Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons–elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice.Purpose of the StudyTo use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e.MethodsOne hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement.ResultsA total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475–driving (35%) and D440–fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%.DiscussionThis study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section (‘d’ categories) of the ICF, this validated that these PROMs measure this conceptual domain.ConclusionThe PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e.     

Linking hand therapy outcome measures used after carpal tunnel release to the International Classification of Functioning,Disability and Health: A systematic review

IntroductionThe goal of hand therapy after carpal tunnel release (CTR) is restoration of function. Outcome assessment tools that cover the concepts contained in the International Classification of Functioning, Disability and Health (ICF), a framework for describing functioning and disability, are appropriate for hand therapy treatment of this diagnosis.Purpose of the StudyTo identify and review outcome measures used in studies on rehabilitation after CTR and link these to the concepts contained in the ICF.MethodsA comprehensive literature search was conducted. Outcome measures in the included studies were linked to the ICF. For data calculation purposes, outcome measures were linked to the specific ICF category, which matched the majority of assessment items if there were components that fit into more than 1 category. The quality of the studies was evaluated, and effect sizes for the treatment interventions were calculated for a comprehensive systematic review.ResultsSeven studies met the inclusion criteria. Eleven outcomes (68.75%) were linked to body function, 1 (6.25%) to body structure, 3 (18.75%) to activity and participation, and 1 (6.25%) to environmental factors. No outcomes were associated with environmental factors or personal factors. Structured Effectiveness for Quality Evaluation of Study scores of the included studies ranged from 23 to 43/48.DiscussionThe predominant outcome tools in the current research on rehabilitation after CTR are impairment measures and are linked to the category of body structures and body functions.ConclusionsFunctional measures, associated with the activity and participation category, are only modestly represented, and there is a lack of representation of environmental and personal factors for outcome measures used following CTR.     

住院患者护理相关《国际功能、残疾和健康分类》类目的初步研究

目的初步确定住院患者护理相关《国际功能、残疾和健康分类》(ICF)类目,以此构建住院患者护理相关ICF框架。方法从世界卫生组织ICF中初筛出护理类目,编制专家咨询问卷;对36名护理专家进行问卷咨询,按专家意见一致性>80%的标准筛选类目;按临床实用性原则对咨询结果再次筛选。结果初筛出护理类目211个,专家咨询后提取79个,再次筛选后初步确定意识功能、定向功能等74个护理类目。结论初步确定的护理类目在ICF中分布比较合理,具有系统性、有效性和方便交流的特点,可作为住院患者护理干预措施和结局评价的框架。     

Exploring the Relation Between Impairment Rating by AMA Guide and Activity and Participation Based on ICF in the Patients with Hand Injuries

The aim of this paper is to analyze the relation between components of disability with distinguished score of impairment, activity and participation questionnaire based on clinical data of persons with hand injuries. Impairment was evaluated by use of AMA guide 6th edition and disability by DASH questionnaire on Convenience sample of patients (N = 117), with chronic hand injuries. Linking and allocating items of the DASH were done based on the ICF Core Set for Hand Conditions and the opinions of a group of experts from different related fields. Data was analyses by using Kappa index, Chi square test and a set of Pearson, Part and Partial correlations coefficient. Most of the DASH items were allocated to the activity; one to four of the items could not be classified and 0 to 22 were classified as having overlap. Participation and activity scores correlated positively with each other (r > 0.80). Impairment had high correlation with activity and participation scores (>73). With controlling the effect of each or both construct, this relation between them with impairment diminished but still significant between activity and impairment. There is a huge overlap in definition of activity and participation. The most effecting item in relation of disability and impairment is activity restriction. Participation had no relation with impairment.     

The Disabilities of the Arm,Shoulder and Hand Questionnaire (DASH) can measure the impairment,activity limitations and participation restriction constructs from the International Classification of Functioning,Disability and Health (ICF)

Background  

The International Classification of Functioning, Disability and Health (ICF) model of the consequences of disease identifies three health outcomes, impairment, activity limitations and participation restrictions. However, few orthopaedic health outcome measures were developed with reference to the ICF. This study examined the ability of a valid and frequently used measure of upper limb function, namely the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), to operationalise the ICF.     

Quantitative Adjustment of the Influence of Depression on the Disabilities of the Arm,Shoulder, and Hand (DASH) Questionnaire

Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18–100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson''s correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0–91), and the average CES-D score was 10 points (SD, 8; range, 0–42). Thirteen of the 30 items of the DASH demonstrated correlation greater than r = 0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p < 0.01) and standard deviation (0.8 points; p < 0.01) of DASH scores. Adjustment for depression alone had a significant but perhaps clinically marginal effect on the variance of DASH scores. Additional research is merited to determine if DASH score adjustments for the most important subjective and psychosocial aspects of illness behavior can improve correlation between DASH scores and objective impairment.     

Erratum to: Quantitative Adjustment of the Influence of Depression on the Disabilities of the Arm,Shoulder, and Hand (DASH) Questionnaire

Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18–100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson's correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0–91), and the average CES-D score was 10 points (SD, 8; range, 0–42). Thirteen of the 30 items of the DASH demonstrated correlation greater than r = 0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p < 0.01) and standard deviation (0.8 points; p < 0.01) of DASH scores. Adjustment for depression alone had a significant but perhaps clinically marginal effect on the variance of DASH scores. Additional research is merited to determine if DASH score adjustments for the most important subjective and psychosocial aspects of illness behavior can improve correlation between DASH scores and objective impairment.     

Do patient-reported outcome measures capture functioning aspects and environmental factors important to individuals with injuries or disorders of the hand?

Study designQualitative study.IntroductionClinical outcome evaluation needs to consider the patient perspective for an in-depth understanding of functioning and disability.Purpose of the studyTo explore whether patient-reported outcome measures (PROMs) used in the field of hand injuries or hand disorders, capture functioning aspects and environmental factors important to the patients.MethodsWe performed a qualitative study and a systematic literature review. The focus group sessions were recorded, transcribed verbatim, and the identified concepts were linked to the ICF. We searched in MEDLINE for reviews, related to injuries or disorders of the hand, reporting on PROMs. We linked the items of the identified PROMs to the ICF and compared the qualitative data with the content of the PROMs.ResultsStatements from 45 individuals who participated in eight focus groups were linked to 97 categories of the ICF. From 15 reviews included, eight PROMs were selected. The selected PROMs capture 34 of the categories retrieved from the qualitative data.ConclusionsPROMs used in the context of hand injuries or hand disorders capture only in parts the functioning aspects important to the patients.Level of evidenceN.A.     

Psychometric evaluation of the disabilities of the arm,shoulder and hand (DASH) in patients with orthopedic shoulder impairments seeking outpatient rehabilitation

Study DesignThis is a cross-sectional, observational study.IntroductionThe disability of the arm, shoulder and hand (DASH) questionnaire is an upper-extremity specific outcome measure commonly used in routine clinical care and clinical trials.Purpose of the StudyOur purposes were to: (1) examine the psychometric properties of the DASH questionnaire using factor analysis, one- and two-parameter item response theory models, and (2) develop a functional staging map illustrating the relationships between the item difficulty hierarchy of the DASH items and the patient's DASH total score.MethodsData from 2724 patients with orthopedic shoulder impairments seeking outpatient physical therapy in 79 clinics in the US were analyzed.ResultsFactor analysis supported a general factor, explaining 62.2% of the total variance. The coverage of DASH items was suitable for patients with shoulder impairments with no ceiling or floor effect. Endorsed items representing the most difficult items were related to feeling less capable, executing recreational activities with force or impact, and performing recreational activities in which you move your arm freely. Items with higher discriminating abilities were those related to do heavy household chores, garden/yard work, and change a light bulb overhead. With a separation index equaled to 4.94, the DASH can differentiate persons into at least 6 statistically distinct person strata. None of the DASH items exhibited differential item functioning by gender or symptom acuity, except two items by age group.DiscussionBesides a total (summed) final score obtained from a specific measure, the keyform and functional staging plots/maps can be used to assist clinicians in clinical interpretation of the scores.ConclusionsResults supported the clinical usage of the DASH questionnaire in patients with orthopedic shoulder impairments seeking outpatient rehabilitation.     

Validity and reliability of the Swedish version of the Patient Specific Functional Scale in patients treated surgically for carpometacarpal joint osteoarthritis

DesignCross-sectional clinical measurements.IntroductionActivity limitation is often persistent after surgically treated carpometacarpal (CMC) joint osteoarthritis (OA).PurposeTo describe content and concurrent validity, test–retest reliability and internal consistency of the Swedish version of the Patient Specific Functional Scale (PSFS) in patients with surgically treated CMC joint OA.MethodsFifty-eight patients were assessed ten weeks after surgical treatment of CMC joint OA. PSFS, the shorter version of Disabilities of the Arm, Shoulder and Hand (Quick DASH), EuroQol-5Dimensions (EQ-5D), pain intensity, joint movement of CMC joint, grip and pinch strength were assessed. Classification of activities was done according to the International Classification of Functioning, Disability and Health (ICF). Spearman correlation, intra-class correlation coefficient (ICC) and Kappa were calculated to assess validity, test–retest reliability and internal consistency. The PSFS was administered twice, 2–3 days apart.ResultsAll of the activity limitations stated in the PSFS could be classified according to the activity component in the ICF. Significant correlations for the PSFS were obtained with pain at rest (r_s = ?0.36) and the Quick DASH (r_s = ?0.28). Test–retest reliability was good, ICC (0.79) and the three items of the PSFS correlated 0.69–0.83 with the total score of PSFS.ConclusionContent validity was excellent, concurrent validity was low-moderate, as in earlier studies. The PSFS could be a valuable supplement to existing measures in measuring activity limitations in individuals with surgically treated CMC joint OA.Level of evidenceNot applicable.     

Validity and responsiveness of the patient evaluation measure as an outcome measure for carpal tunnel syndrome

The aim of this study was to assess the validity of the Patient Evaluation Measure questionnaire (PEM) as an outcome measure in carpal tunnel syndrome. The PEM was compared to the DASH questionnaire and to objective measurements of hand function. We also compared its responsiveness to changes following carpal tunnel release with that of the DASH score. Twenty-four patients completed the PEM and DASH questionnaires before and 3 months after open carpal tunnel release. Grip strength, static two-point discrimination and the nine-hole peg test were measured. There was a significant correlation between individual items of the PEM and the objective measures. There was also strong correlation between PEM and DASH scores. The PEM showed a greater responsiveness to change (effect size 0.97) than the DASH score (effect size 0.49). The PEM correlates well with objective measures of hand function and the DASH score when used in carpal tunnel syndrome. It is more responsive to change than the DASH score. It is very simple to complete and score and is an appropriate and practical outcome measure in carpal tunnel syndrome.     

Identifying content gaps in health status measures for intermittent claudication using the International Classification of Functioning,Disability and Health

Objective

The Walking Impairment Questionnaire (WIQ) and Intermittent Claudication Questionnaire (ICQ) are commonly used patient-reported functional outcome measures for intermittent claudication, but their functional representation has not been characterized. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework comprehensively describes health-related function and has been used to evaluate health status and quality of life (QOL) measures. We applied a content analysis technique commonly used in functional rehabilitation research to evaluate ICF domains represented by WIQ and ICQ to characterize their health status and functional representation.

Developing core sets for persons with spinal cord injuries based on the International Classification of Functioning, Disability and Health as a way to specify functioning

OBJECTIVE: The objective of this paper is to outline the proposed development process for the ICF Core Sets for Spinal Cord Injury (SCI) and to invite clinical and consumer experts to actively participate in this process. ICF Core Sets are selections of categories of the International Classification of Functioning, Disability and Health (ICF) that are relevant to persons with a specific condition or in a specific setting. METHOD: The project is a cooperation between the ICF Research Branch of the World Health Organization (WHO) Collaboration Centre of the Family of International Classifications (DIMDI, Germany), the Classification, Assessment and Terminology (CAT) team and the Disability and Rehabilitation (DAR) team at WHO, the International Spinal Cord Society (ISCoS) and International Society for Physical and Rehabilitation Medicine (ISPRM) and partner institutions across the world. The project will consist of four worldwide studies to be conducted from 2006 to 2007 with a proposed ICF Core Set Consensus Conference to be held in 2007. ICF categories relevant for SCI are to be identified by means of (I) an empirical study, (II) a systematic review of outcomes and measures used in SCI research (III) an expert survey and (IV) focus groups and semistructured interviews with persons with SCI. Consensus about items that have to be part of a Comprehensive and of a Brief ICF Core Set for SCI will be reached in a final ICF Core Set Consensus Conference. Subsequent field testing will be necessary to validate this first version of ICF Core Sets for SCI. INVITATION FOR PARTICIPATION: The development of ICF Core Sets is an inclusive and open process. Anyone who wishes to actively participate in this process is invited to contact the project coordinator (Monika.Scheuringer@med.uni-muenchen.de or http://www.icf-research-branch.org/research/spinalcord-injuries.htm). Individuals, institutions and associations can be formally associated as partners of the project.