Comparing contents of functional outcome measures in stroke rehabilitation using the International Classification of Functioning,Disability and Health

Purpose. To examine the content of outcome measures that are frequently used in stroke rehabilitation and focus on activities and participation, by linking them to the International Classification of Functioning, Disability and Health (ICF).

Method. Constructs of the following instruments were linked to the ICF: Barthel Index, Berg Balance Scale, Chedoke McMaster Stroke Assessment Scale, Euroqol-5D, Functional Independence Measure, Frenchay Activities Index, Nottingham Health Profile, Rankin Scale, Rivermead Motor Assessment, Rivermead Mobility Index, Stroke Adapted Sickness Impact Profile 30, Medical Outcomes Study Short Form 36, Stroke Impact Scale, Stroke Specific Quality of Life Scale and Timed Up and Go test.

Results. It proved possible to link most constructs to the ICF. Most constructs fitted into the activities and participation component, with mobility being the category most frequently covered in the instruments. Although instruments were selected on the basis of their focus on activities and participation, 27% of the constructs addressed categories of body functions. Approximately 10% of the constructs could not be linked.

Conclusions. The ICF is a useful tool to examine and compare contents of instruments in stroke rehabilitation. This content comparison should enable clinicians and researchers to choose the measure that best matches the area of their interest.     

Evaluating pain in cerebral palsy: comparing assessment tools using the International Classification of Functioning,Disability and Health

Abstract

Purpose: Pain is prevalent and affects functioning and quality of life of children with cerebral palsy (CP). However, pain in CP is under recognized. The International Classification of Functioning, Disabiity and Health (ICF) guides the selection of comprehensive chronic pain assessment tools. Our objectives were to identify measures addressing pain in children with CP, characterize the content of each measure using the ICF, and identify gaps and overlaps.

Materials and methods: Measures were identified from: (1) a systematic review of outcome measures (1998–2012) and (2) a scan of chronic pain measures (2013–2015). Included measures were those published in English, used in children and youth with CP, and contained an item/domain addressing pain. Constructs of the measures were linked to the ICF.

Results: Overall, 31 measures addressing chronic pain in CP were included. Considerable variability was found in the degree to which their content represented the ICF. Most of pain measures address pain intensity and pain location (body functions) as opposed to functional impact of pain (activities and participation).

Conclusions: Functional dimensions are poorly represented in pain measures. Our findings may guide the selection of measures for research and clinical needs for comprehensive chronic pain management in children with CP.

• Implications for Rehabilitation

• Chronic pain is prevalent among children with cerebral palsy and significantly interfere with functional activities.

• To effectively manage chronic pain in children with cerebral palsy, measures capturing functional-based information need to be part of routine chronic pain assessment.

     

Assessing the impact of musculoskeletal health conditions using the International Classification of Functioning,Disability and Health

Purpose.?To propose the joint use of the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) and to illustrate this proposal using musculoskeletal (MSK) conditions.

Method.?In light of the MSK conditions as classified in the ICD, categories from existing ICF core sets for MSK conditions were pooled to specify functioning. Another approach was to consider other categories from measures or instruments already linked in the literature.

Results.?ICF Categories have been pooled from six core sets for MSK conditions, two specific care settings, one MSK clinical trial setting and eight instrument linkage papers.

Conclusions.?The ICD–ICF joint use would be able to capture the impact of a health condition by taking into account the disease and functioning status which would facilitate clinical care. Therefore, there is reasonable ground to demonstrate the operational linkage and complementary role of the ICD and the ICF in the context of the ICD revision.     

Use of the International Classification of Functioning,Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis

Purpose. To identify the preliminary comprehensive and brief core sets for multiple sclerosis (MS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF).

Method. Focus groups and a consensus process were used to identify ICF core sets for MS. This included: preliminary ICF studies; empirical patient data collection for 101 MS participants; review of the evidence base and treatment in MS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia.

Results. One hundred and forty-four (40%) second level ICF categories were selected by 23 participants in three rounds. The comprehensive MS ICF core set includes 34 (24%) categories from the component ‘body function’, six (4%) categories from ‘body structures’, 68 (47%) from ‘activities and participation’ and 36 (25%) from the component ‘environmental’ factors. Ten categories in ‘personal factors’ in MS were also suggested by the participants after intensive discussions. The brief set comprises 30 categories, 21% of categories in the comprehensive core set.

Conclusion. Consensus expert opinion can use ICF categories to identify the core set for MS which reflects disease complexity and care burden for persons' with MS. Further research is needed to identify ICF categories of relevant personal factors to improve our understanding of the large social and cultural variance associated with them.     

Use of the International Classification of Functioning,Disability and Health to identify preliminary comprehensive and brief core sets for Guillain Barre syndrome

Purpose.?To identify the preliminary comprehensive and brief core sets for Guillain Barre syndrome (GBS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF).

Method.?Focus groups and a consensus process were used to identify ICF core sets for GBS. This included: preliminary ICF studies; empirical patient data collection for 77 GBS participants; review of the evidence base and treatment in GBS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia.

Results.?The expert consensus selected 99 second level ICF categories (in three rounds) which identify health domains relevant to GBS for multidisciplinary assessment. These domains were consistent with current practice and existing GBS literature. The comprehensive core set includes: 27 (23%%) categories from the component ‘body function’, 7 (12%%) categories from ‘body structures’, 43 (36%%) from ‘activities and participation’ and 22 (29%%) from the component ‘environmental’ factors. The brief set comprised 20 categories, 20%% of categories in the comprehensive core set.

Conclusion.?The core set categories for GBS-related health need to be addressed in multidisciplinary care programs. Future clinical ‘rating’ of this set may facilitate scale development using the ICF in GBS. Further research is needed to confirm the generalisability of this set in clinical settings.     

The contribution and impact of the International Classification of Functioning,Disability and Health on quality of life in communication disorders

Past discussions of the International Classification of Functioning, Disability and Health (ICF) have focused minimally, if at all, on quality of life. This paper critically discusses the contribution of the ICF to quality of life concept development, and the impact that the ICF has had thus far on health-related quality of life measurement. “Contribution” focuses on modelling the relationship between disablement and quality of life, evaluating the content of existing instruments, and thinking holistically about the individual. “Impact” relates to the association of quality of life with functioning, pathology and outcomes, the trend towards life compartmentalization, and the disproportionate emphasis on individuals' functioning at the expense of their life context. Examples are drawn from adult acquired conditions (mainly aphasia), and terminology used in the paper reflects a rehabilitation stage of service provision. The World Health Organization's approach to quality of life definition and measurement is also discussed. An operational definition of quality of life for adults with acquired communication and swallowing disorders is presented, alongside an alternative conceptualization of quality of life. This paper ends with recommendations for future research concerning the importance of context, the subjective or personal perspective, and having a goals orientation for life as well as rehabilitation. It is also argued here that the ICF and quality of life are different constructs and that quality of life should be the starting point for understanding the client's perspective of his/her goals and/or his/her disability.     

Mapping two measures to the International Classification Of Functioning,Disability and Health and the brief ICF core set for spinal cord injury in the post-acute context

Objective: To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the post-acute context. Methods: Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI. Results: Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42?second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of ‘activities and participation’ included as the candidate categories of the brief version. Conclusion: In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific ‘activity’ aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects.

• Implications for Rehabilitation

• Rehabilitation professionals should select appropriately validated outcome measures specific to the health condition in order to evaluate the effectiveness of rehabilitation.

• Rehabilitation professional working with outcome measures should be aware of the limitations of measures, in terms of content, and supplement the evaluation with appropriate standardised measures or the use of the Core Sets.

• To enhance evidence-based practise in routine clinical practise, standardised outcome measures should be used.

     

Goals of physiotherapy interventions can be described using the International Classification of Functioning, Disability and Health

Objective

To provide an example of how goals of physiotherapy interventions and their typical patterns can be described using the International Classification of Functioning, Disability and Health (ICF).

Design

Cross-sectional study.

Setting

Acute hospital.

Participants

One hundred patients with neurological, musculoskeletal or cardiopulmonary conditions requiring physiotherapy interventions in University Hospital Zurich between January 2003 and October 2003.

Main outcome measures

The case record form consisted of two parts: a standardised questionnaire for functioning and health of the patient; and a standardised record form for physiotherapy interventions. Both parts were based on the ICF.

Results

The mean age of the subjects was 58.2 years (standard deviation 15.9), the median age was 60.5 years and 44% were female. The most frequent intervention goals in patients with neurological conditions were: muscle power functions; muscle tone functions; control of voluntary movement functions; changing basic body position; maintaining a body position; and transferring oneself. The most frequent intervention goals for cardiopulmonary patients were: functions of the cardiovascular system; and respiration functions. The most frequent intervention goals in patients with musculoskeletal conditions were: sensation of pain; stability of joint functions; muscle power functions; muscle tone functions; and muscle endurance functions.

Conclusion

By using the ICF as a framework and linguistic support, intervention goals can serve as standardised documentation for physiotherapy interventions, their evaluation and planning.     

The International Classification of Functioning,Disability and Health (ICF) in vocational rehabilitation and disability assessment in Slovenia: state of law and users' perspective

Objective. This study illustrates the use of the ICF in vocational rehabilitation and disability assessment in Slovenia.

Method.?A review of the Slovenian law about vocational rehabilitation was performed. A survey was developed and group and individual interviews were conducted with professionals involved in vocational rehabilitation who use the ICF.

Results.?The vast majority of the respondents believe that ICF helps to create a common language for multidisciplinary communication. The main advantages of the ICF identified by the respondents are that it provides a holistic view of the person, assesses complexities of functioning, provides a unified language and offers a quick and easy insight into functioning. The disadvantages of ICF are complicated terminology and subjectivity of the assessor. A difficulty encountered by the users is that by law, only body functions of the ICF are assessed. Additional qualitative analysis of the users' understanding of ICF and its purpose revealed heterogeneity. Significant differences between public and private organisations were found.

Conclusion.?ICF is a promising tool for use in vocational rehabilitation and disability assessment in Slovenia. A major challenge is the lack of interface between ICF and policies on vocational rehabilitation in Slovenia.     

A review of participation instruments based on the International Classification of Functioning,Disability and Health

Purpose. To identify and review instruments which assess participation as defined by the International Classification of Functioning, Disability and Health (ICF).

Methods. A systematic search of the literature was conducted. Data related to the content, administration, scoring, reliability, validity and responsiveness was abstracted.

Results. Eleven instruments met the inclusion criteria. Seven instruments include questions with content from Chapters 4 to 9 in the ICF activities and participation component. Four instruments exclude Chapter 5 (self-care). Most of the instruments assess subjective aspects of participation. Evidence on reliability was available for 10 instruments and the majority met the criteria for group level comparisons for internal consistency and reproducibility in the health conditions assessed. In terms of validity, dimensionality was assessed in eight instruments, with six using modern measurement methods. Participation instruments have been compared with various generic and/or disease-specific instruments, but they have not been compared with each other. Evidence on responsiveness was only available for four instruments.

Conclusions. There has been considerable interest in developing instruments to measure participation. To date, the World Health Organisation Disability Assessment Schedule II has undergone the most psychometric testing. Future research must continue to assess these instruments in persons with various health conditions to advance the conceptualisation and measurement of participation.     

Spirituality and the International Classification of Functioning,Disability and Health: content comparison of questionnaires measuring mindfulness based on the International Classification of Functioning

Purpose.?To identify and compare the concepts contained in questionnaires measuring mindfulness using the International Classification of Functioning (ICF) as external reference.

Method.?Questionnaires which are published in peer-reviewed journals and listed in Pubmed or PsycInfo were included. The questionnaires were analysed and, using a content-analytical approach, the respective items were categorised and linked to the ICF.

Results.?Ten questionnaires were included. Ninety-four per cent (N == 341) of the concepts could be linked to 37 different ICF categories. One hundred and seventy-one (50.1%%) concepts were linked to ICF categories of the component Body Function, 74 (21.7%%) to categories of the component Activity and Participation and none to categories of the component Environmental Factors. In total, 28.2%% of the linked concepts belonged to Personal factors, which are not yet classified in the ICF. The questionnaires exhibited considerable differences regarding content density (i.e. the average number of concepts per item) and content diversity (i.e. the number of ICF categories per concept).

Conclusions.?The ICF provides an useful external reference to identify and compare the concepts contained in mindfulness questionnaires. Also, mindfulness questionnaire concepts suggest potentially useful factors for classification within the ICF.     

Comparing contents of functional outcome measures in stroke rehabilitation using the International Classification of Functioning, Disability and Health

PURPOSE: To examine the content of outcome measures that are frequently used in stroke rehabilitation and focus on activities and participation, by linking them to the International Classification of Functioning, Disability and Health (ICF). Method. Constructs of the following instruments were linked to the ICF: Barthel Index, Berg Balance Scale, Chedoke McMaster Stroke Assessment Scale, Euroqol-5D, Functional Independence Measure, Frenchay Activities Index, Nottingham Health Profile, Rankin Scale, Rivermead Motor Assessment, Rivermead Mobility Index, Stroke Adapted Sickness Impact Profile 30, Medical Outcomes Study Short Form 36, Stroke Impact Scale, Stroke Specific Quality of Life Scale and Timed Up and Go test. Results. It proved possible to link most constructs to the ICF. Most constructs fitted into the activities and participation component, with mobility being the category most frequently covered in the instruments. Although instruments were selected on the basis of their focus on activities and participation, 27% of the constructs addressed categories of body functions. Approximately 10% of the constructs could not be linked. CONCLUSIONS: The ICF is a useful tool to examine and compare contents of instruments in stroke rehabilitation. This content comparison should enable clinicians and researchers to choose the measure that best matches the area of their interest.     

Use of the International Classification of Functioning,Disability and Health (ICF) in social services for elderly in Sweden

Purpose: To examine the content of health information in acts of social services of elderly people in relation to the International Classification of Functioning, Disability and Health (ICF) and to describe the health information in the different parts of the acts according to the ICF. Method: Health information of 25 acts from four municipalities was analysed and the concepts were linked to ICF codes, using the established coding rules. Results: The health information consisted of 372 concepts, which were linked to 122 specific ICF codes. The concepts in the acts were mostly linked to the ICF component Activities and Participation, except for the current functioning concepts where the ICF component Body functions was the most frequent. The 3rd level was most frequent in Activities and Participation and in Environmental factors, and the 2nd level was most frequent in Body functions. Conclusions: The ICF covers the concepts and terms contained in the acts to a large extent. Furthermore, the results show that the ICF codes differ in the different parts of the acts. The ICF provides a coherent and structured documentation, which contributes to a legally secure assessment of assistance. The selection of ICF codes can be used in development of “code sets” for social services for elderly.

Implications for Rehabilitation

• The ICF covers, to a large extent, the concepts of health information used in the acts of the social service management process in Sweden.

• The concepts in the acts were mostly linked to the ICF component Activities and Participation.

• The ICF seems to be useful in the Electronic Health Record of social service management process for elderly people in Sweden.

     

Applications of the International Classification of Functioning,Disability and Health in goal-setting practices in healthcare

Abstract

Purpose: While evidence exists to support the adoption of collaborative goal-setting in healthcare, some clinicians feel that it is not feasible. This article proposes that the development of a standardized collaborative goal-setting approach using the framework and classification system of the International Classification of Functioning, Disability and Health (ICF) could address these feasibility issues. It is the objective of this article to understand the extent to which the ICF has been integrated into current goal-setting literature in order to assess its potential use in a standardized collaborative goal-setting approach. Methods: A scoping review of the literature published in English since 2001 was conducted in EMBASE, Medline and CINAHL. Articles were included in this review if they integrated the ICF into goal-setting practices in any healthcare discipline. Results: Nineteen articles were included in this review. Analysis of these articles revealed that the ICF has been integrated into goal-setting practices. The benefits associated with this integration suggest that integrating the ICF into goal-setting practices can standardize collaborative goal-setting. Conclusion: Evidence from this scoping review supports the use of the ICF in healthcare goal-setting practices because it provides clinicians and patients with specific steps to follow when attempting to set goals collaboratively.

• Implications for Rehabilitation

• Collaborative goal-setting.

• Collaborative goal-setting involves patients working with their clinicians to develop health outcome goals together and is a fundamental component of patient-centered care.

• Some rehabilitation disciplines have yet to fully embrace collaborative goal-setting due to feasibility issues.

• This article proposes that the integration of the International Classification of Functioning, Disability and Health (ICF) into goal-setting practices could standardize collaborative goal-setting in a way that would address these feasibility issues.

     

Between the ideal and the real: Reconsidering the International Classification of Functioning,Disability and Health

Abstract

Purpose. The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) is a disability classification and framework that was endorsed in 2001. Despite its endorsement from WHO member states, some rehabilitation researchers have argued that the ICF has been used and requires further inquiry. The purpose of this article is to examine the ICF critically using a feminist theoretical perspective.

Method. In this commentary, I apply a feminist perspective to identify some of die assumptions that limit the ICF and to illustrate how the principles of feminist science could enhance the ICF.

Results. The analysis reveals that although the ICF is premised on the assumptions of biopsychosocial theory (BPS), there are aspects of the classification that contradict the tenets of BPS. Moreover, although the ICF is purported to represent a change in thinking about disability, the stated principles of rehabilitation medicine have the potential to limit die ICF in this regard.

Conclusion. The ICF has the potential to be a powerful tool for changing the way that we think about disability and to improve the lives of individuals of all abilities. Bringing the ICF into closer alignment with BPS theory is an important step in moving the ICF forward.     

Between the ideal and the real: Reconsidering the International Classification of Functioning,Disability and Health

Purpose.?The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) is a disability classification and framework that was endorsed in 2001. Despite its endorsement from WHO member states, some rehabilitation researchers have argued that the ICF has been used and requires further inquiry. The purpose of this article is to examine the ICF critically using a feminist theoretical perspective.

Method.?In this commentary, I apply a feminist perspective to identify some of the assumptions that limit the ICF and to illustrate how the principles of feminist science could enhance the ICF.

Results.?The analysis reveals that although the ICF is premised on the assumptions of biopsychosocial theory (BPS), there are aspects of the classification that contradict the tenets of BPS. Moreover, although the ICF is purported to represent a change in thinking about disability, the stated principles of rehabilitation medicine have the potential to limit the ICF in this regard.

Conclusion.?The ICF has the potential to be a powerful tool for changing the way that we think about disability and to improve the lives of individuals of all abilities. Bringing the ICF into closer alignment with BPS theory is an important step in moving the ICF forward.     

European validation of The Comprehensive International Classification of Functioning,Disability and Health Core Set for Osteoarthritis from the perspective of patients with osteoarthritis of the knee or hip

Abstract

Purpose: To validate the International Classification of Functioning, Disability and Health Comprehensive Core Set for Osteoarthritis from the patient perspective in Europe.

Materials and methods: This multicenter cross-sectional study involved 375 patients with knee or hip osteoarthritis. Trained health professionals completed the Comprehensive Core Set, and patients completed the Short-Form 36 questionnaire. Content validity was evaluated by calculating prevalences of impairments in body function and structures, limitations in activities and participation and environmental factors, which were either barriers or facilitators. Convergent construct validity was evaluated by correlating the International Classification of Functioning, Disability and Health categories with the Short-Form 36 Physical Component Score and the SF-36 Mental Component Score in a subgroup of 259 patients.

Results: The prevalences of all body function, body structure and activities and participation categories were >40%, >32% and >20%, respectively, and all environmental factors were relevant for >16% of patients. Few categories showed relevant differences between knee and hip osteoarthritis. All body function categories and all but two activities and participation categories showed significant correlations with the Physical Component Score. Body functions from the ICF chapter Mental Functions showed higher correlations with the Mental Component Score than with the Physical Component Score.

Conclusions: This study supports the validity of the International Classification of Functioning, Disability and Health Comprehensive Core Set for Osteoarthritis.

• Implications for Rehabilitation

• Comprehensive International Classification of Functioning, Disability and Health Core Sets were developed as practical tools for application in multidisciplinary assessments.

• The validity of the Comprehensive International Classification of Functioning, Disability and Health Core Set for Osteoarthritis in this study supports its application in European patients with osteoarthritis.

• The differences in results between this Europe validation study and a previous Singaporean validation study underscore the need to validate the International Classification of Functioning, Disability and Health Core Sets in different regions of the world.

     

中国（武汉）地区应用慢性缺血性心脏病的ICF核心功能组合的研究

目的：研究适应中国（武汉）地区慢性缺血性心脏病（CHID）患者的简明国际功能、残疾与健康分类（ICF）的核心功能组合类目,使其能广泛应用于临床医疗实践、为CIHD患者健康状况的测量提供可靠的依据。方法：使用CIHD的ICF调查表同时对58例CIHD患者和32名心血管以及康复专家做面访或电邮调查,统计CIHD患者出现明显问题的频率和专家一致认为有显著意义的类目的频率。结果：得到患者阳性率≥30％的ICF类目30个,专家组意见显著性≥50％的ICF类目22个,合计得到具有显著性意义的ICF核心功能组合类目共有37个,其中身体功能13个,身体结构2个,活动与参与8个,环境因素14个。结论：本次研究所得的简明核心功能组合类目与已报道的简明ICF核心功能组合类目相比一致性较好,地域、调查对象等因素的影响也能对少数有差别的类目进行很好的解释,尚有部分类目确定有待更大样本的再次检验。