The International classification of functioning,disability and health – children and youth (ICF‐CY): testing its utility in classifying information from eco-cultural family interviews with ethnically diverse families with children with disabilities in Kyrgyzstan

Purpose.?The objective of this study was to test the utility of the International classification of functioning, disability and health – children and youth's (ICF-CY) Environmental Factors component by classifying family interview data from two ethnically and culturally diverse – Kyrgyz and Uzbek – families that have children with various types of disabilities in Kyrgyzstan, Central Asia.

Methods.?The eco-cultural family interview (EFI) was used to interview four Kyrgyz and four Uzbek families. The obtained data were analysed by using manifest content analysis; identified units of meaning named as ‘EFI items’ and ‘EFI concepts’ were then linked to the ICF-CY's codes by application of ten linkage rules.

Results.?The analysis of transcribed interviews identified 669 EFI items and 745 EFI concepts. The linking of EFI items to the ICF-CY showed: 92 EFI items and concepts were linked to nd (not definable); 104 items were linked to nc (not covered by the ICF-CY); 15 items were categorised as pf (personal factors); 21 items were linked to categories found in Activities and Participation; and 3 were linked to Body Functions components. The rest of EFI items and concepts were linked to categories of the Environmental Factors component.

Conclusion.?The codes included into Chapters 1, 2 and 5 of the ICF-CY environmental component can be easily assigned to the relevant EFI items. There is a necessity to add more codes in Chapters 3 and 4 of the Environmental Factors component, and the inclusion of a separate component of Personal Factors into the classification is suggested.     

Patients' experience post-lumbar fusion regarding back problems,recovery and expectations in terms of the international classification of functioning,disability and health

Purpose.?To describe within the context of the International Classification of Functioning, Disability and Health ((ICF)), patient's experiences post-lumber fusion regarding back problems, recovery and expectations of rehabilitation and to contrast with the content of outcome measures and the ICF low back pain ((LBP)) core sets.

Methods.?The study has a cross-sectional and retrospective design and involves 20 lumbar fusion patients. Using the ICF, qualitative content analysis of semi-structured interviews 3–6 months post-surgery was performed. This was compared with the ICF related content of the Oswestry Disability Index ((ODI)), Medical Outcome Study Short Form 36 ((SF-36)), European Quality of Life Questionnaire ((EQ5D)) and the ICF LBP core sets.

Results.?Patient's experiences were most frequently linked to psychological, sensory, neuromusculoskeletal and movement related body function chapters of the ICF. The most frequently linked categories of activity and participation were mobility, domestic activities, family relationships, work, recreation and leisure. Environmental factors frequently linked were the use of analgesics, walking aids, family support, social security systems, health care systems and labour market employment services.

Conclusions.?This study highlights important ICF related aspects of patient's experiences post-lumber fusion. The use of the comprehensive ICF core sets is recommended in conjunction with ODI, SF-36 and the EQ5D for a broader analysis of patient outcomes post-lumbar fusion.     

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.     

Physical strain of comfortable walking in children with mild cerebral palsy

Purpose.?To evaluate the physical strain of comfortable walking in children with mild cerebral palsy ((CP)) in comparison to typically developing ((TD)) children. Physical strain was defined as the oxygen uptake during walking ((VO_2walk)) expressed as a percentage of their maximal aerobic capacity ((VO_2peak)).

Method.?Eighteen children ((aged 8–16 years)) participated, including eight ambulant children ((four girls, four boys)) with mild spastic CP ((three hemiplegia, five diplegia, GMFCS I: n == 7 and II: n == 1)) and 10 TD children. VO_2walk was measured during 5?min of walking on an indoor track at comfortable walking speed. VO_2peak was measured in a shuttle run test.

Results.?VO_2walk was significantly higher in CP ((19.7 ((2.8)) ml//kg//min)) compared to TD ((16.8 ((3.6)) ml//kg//min, p == 0.033)), while walking speed did not differ significantly between groups. VO_2peak was significantly lower in CP ((37.2 ((2.2)) ml//kg//min)) compared to TD ((45.0 ((5.3)) ml//kg//min, p == 0.001)). Consequently, the physical strain during walking was significantly higher in CP ((52 ((7.7)) %%)) compared to TD ((36 ((8.4)) %%, p == 0.001)).

Conclusions.?The higher physical strain during comfortable walking of children with mild CP compared to TD children may be related to reported problems with fatigue in this population, and suggest a need for physical aerobic training programmes.     

Assessing and comparing the outcome measures for the rehabilitation of adults with communication disorders in randomised controlled trials: an International Classification of Functioning,Disability and Health approach

Purpose.?To identify the assessment instruments and relevant outcome measures used in randomised clinical trials (RCTs) relating to interventions for adults with communication disorders, and then examine and compare the domains of the outcome measures using the International Classification of Functioning, Disability and Health (ICF) as a reference tool.

Method.?Published RCTs with primary focus on the effectiveness of rehabilitation for adults with communication disorders were systematically reviewed. Identified RCTs were examined for all the assessments used as outcome measures. Distinctions were made between the use of standardised assessment tools and non-standardised empirical measures. The key concepts examined by the outcome measures were then linked to the ICF using the established ICF linking rules.

Results.?The systematic review included 24 RCTs in which 11 trials used non-standardised empirical assessment as the outcome measure, and 18 trials included standardised instruments as the outcome measure. It is clear that all the identified items and meaningful concepts from the assessment used in the included studies can be linked to the ICF categories. Of the 108 linked level-two ICF categories, 53%% were linked to ‘body functions’, 36%% to ‘activity and participation’ and 9%% to ‘environmental factors’.

Conclusions.?A wide range of outcome measures have been used in RCTs of interventions for adults with communications disorders. The ICF provides a clarifying framework for systematically gathering and examining the information about the content of outcome measures and then can be used as a common reference to identify and compare the domains of the outcome measures. The high proportion of elements relating to body functions raises some questions about the purpose and aims of the interventions.     

Are satisfaction with and self-management of personal assistance services associated with the life satisfaction of persons with physical disabilities??

Purpose.?To examine the relationships between satisfaction with and self-management of personal assistance services ((PAS)) and the quality of life ((QoL)) of persons with disabilities. To test the postulate that consumer-directed PAS can fulfil the human need for control and contribute to a satisfactory life.

Method.?A survey compared the perspectives of persons using consumer-directed PAS versus those using agency-directed. A Personal Data Form obtained demographics and PAS characteristics. The Quality of Life Inventory measured life satisfaction. A PAS questionnaire measured perceptions about the management of, desire for control of, and satisfaction with PAS. Data were analysed using SPSS®? 14.

Results.?Significant relationships were found between QoL and satisfaction with PAS ((p < 0.001)) and between perceived control of PAS and satisfaction with PAS ((p < 0.001)). Significant group differences were also found. Consumer-directed participants reported higher satisfaction with their PAS ((p < 0.01)), greater control over services ((p < 0.001)) and greater QoL than agency-directed participants, ((p == 0.001)).

Conclusions.?The relationships found between self-management, PAS satisfaction, and QoL support the value of consumer-directed programmes. Rehabilitation professionals can use this knowledge to develop, implement and research practises that enable self-management.     

Health-related quality of life among informal caregivers assisting people with multiple sclerosis

Objective.?To identify factors affecting the health-related quality of life (HRQOL) of informal caregivers assisting people with (multiple sclerosis) MS who have greater functional impairment.

Methods.?Data were collected in a national survey of 530 people who provided informal care to people with MS. Multiple linear regression models analyzed these data.

Results.?Poorer overall health for the person with MS, stronger agreement by caregivers that care giving was burdensome or emotionally draining, and the caregiver's need for mental health counseling in the past 12 months were associated with lower mental dimensions of HRQOL for the informal caregiver. Greater caregiver satisfaction with the access the person with MS had to MS-focused care was associated with higher mental dimensions of HRQOL among caregivers.

Conclusions.?Increasing access to MS-focused care could improve not only the health of people with MS, but also improve the mental dimensions of caregiver HRQOL. Our findings highlight the importance of addressing the mental health needs of informal caregivers assisting people with MS.     

Do Multidimensional Pain Inventory Scale score changes indicate risk of receiving sick leave benefits 1 year after a pain rehabilitation programme??

Purpose.?To study whether scale score changes in the Multidimensional Pain Inventory ((MPI)) can predict which persons disabled by pain will receive sick leave benefits 1 year after completing a pain rehabilitation programme.

Method.?An observational study of MPI data derived from 1468 patients, 388 men and 1080 women, who had participated in multidisciplinary cognitive-behavioural oriented pain rehabilitation programmes in Sweden, collected from the Swedish Quality Register for Pain Rehabilitation, before, at the end and 1 year after the programme.

Results.?Most MPI scale scores showed improvements after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, we found that a decrease in MPI scales scores for Pain severity and Interference immediately after the pain rehabilitation programme decreased the risk of being on full-time sick leave 1 year later [[OR 0.85, ((95%% CI 0.73–0.99)) and OR 0.73, ((95%% CI 0.61–0.87)), respectively]]. The Interference scale, which may be considered to include ICF components of both activities and participation, might represent the core of suffering among persons disabled with pain.

Conclusions.?A rehabilitation intervention directed to combating the consequences of pain in activities and participation rather than against pain per se might lead to improved working capacity.     

Outcomes of primary total knee arthroplasty: the impact of patient-relevant factors on self-reported function and quality of life

Purpose.?To identify factors associated with functional recovery and outcome 1 year after total knee arthroplasty (TKA).

Methods.?In the prospective follow-up study, all the patients (n == 75, aged 60–80 years) underwent primary TKA. Assessments were performed preoperatively and 12 months after surgery. The main measures were the Western Ontario and McMaster Universities OA Index (WOMAC) and the 15D. The clinical examination included analyses of comorbidity and a detailed knee examination. Age-standardised population values of the 15D and the Outcome Measures in Rheumatology–Osteoarthritis Research Society International (OMERACT-OARSI) criteria were used as indices of response.

Results.?Osteoporosis, pain, gender, age and preoperative function of the opposite knee accounted for 29.9%% of the variance in the change in the WOMAC function score. A preoperative score of the 15D below the age-standardised population level, pain, higher age and pulmonary disease reduced the possibility to reach the HRQOL level of the general population. Osteoporosis decreased the likelihood of achieving responder status according to the OMERACT-OARSI criteria.

Conclusion.?The baseline preoperative score of the 15D strongly associated with the achieved level of HRQOL after TKA. The findings of the present study highlight the multifactorial nature of health status in TKA.     

The influence of participation on health-related quality of life in stroke patients

Purpose.?Limitations in participation may have independent influences on health-related quality of life (HRQOL) at early and late phases of stroke recovery.

Methods.?Consecutive stroke patients were interviewed at months 3 and 12 after stroke for modified Barthel Index (MBI), geriatric depression scale (GDS) and WHO QOL questionnaire (abbreviated Hong Kong version). London handicap scale (LHS) was used to measure limitations in participation. The influence of the six LHS domains on the four HRQOL domains, adjusted for MBI and GDS was analysed by structural equation modelling with a two-component analysis.

Results.?Complete data were collected in 500 and 433 subjects at months 3 and 12, respectively. On multivariate analysis, after adjustment for MBI and GDS, the independence and social integration domains of LHS had significant influence on physical and social HRQOL, respectively, at both 3 and 12 months post-stroke. The occupation domain was a significant factor of physical and environmental HRQOL at month 12, but not at month 3. Economic sufficiency had more influence on HRQOL at month 3 than at month 12. The mobility and orientation domains had no significant negative influence on HRQOL.

Conclusions.?In stroke patients, participation had significant independent influences on HRQOL.     

Health-related and subjective quality of life of older adults with visual impairment

Purpose.?To document health-related quality of life (HRQOL) and subjective quality of life (SQOL) and explore their correlates in older adults seeking services for visual impairment (VI).

Method.?A convenience sample of 64 participants (79.3?±?5.9 years) with VI was interviewed at home. HRQOL was measured with the Visual Function Questionnaire-25 and SQOL with the Quality of Life Index. The potential correlates were as follows: personal factors (sociodemographic characteristics, co-morbidity, depressive symptoms, activity level), environmental factors (technical aids, social support) and participation in daily activities and social roles (level and satisfaction).

Results.?Compared to normative data from previous studies of older adults, the participants had lower HRQOL but similar SQOL. Greater level of participation in social roles, higher perceived activity level, use of a writing aid and greater satisfaction with participation in social roles together explained better HRQOL (R²?=?0.66). Fewer depressive symptoms, greater satisfaction with participation in social roles and with social support and fewer co-morbidities together explained better SQOL (R²?=?0.70).

Conclusions.?HRQOL of older adults with VI is mainly explained by level of participation correlates, while their SQOL is mainly explained by depressive symptoms and satisfaction variables. The results also underscore the importance of social roles for HRQOL and SQOL of this population.     

Suicidal thinking in multiple sclerosis

Purpose.?Studies demonstrate that suicidal ideation ((SI)) is greater in persons with multiple sclerosis ((MS)) than in the general population. SI may offer some MS patients a mechanism for feeling in control of their lives, in the face of a daunting, unpredictable disease. In this study, we determined what specific mental constructs or perceptual themes occur for MS patients experiencing SI, while also examining the construct of ‘control’ as a central theme.

Methods.?Individual interviews ((N == 16)) were audiotaped, transcribed and qualitatively analysed by two independent raters to test for key themes in MS patients reporting SI.

Results. In relation to SI, eight key themes were identified by both raters as having been expressed in interviews: perceived loss of control, increased family tension, loneliness, hopelessness and frustration, physical and psychological impact of MS, loss of perceived masculinity or femininity, regaining control and failure to achieve desired or expected role functioning. We created a model to explain the emergence of these themes as they contribute to SI among patients with MS. All participants indicated that perceived loss of control elicited thoughts of suicide.

Conclusion.?Perceived loss of control appears to be a major disease related burden associated with SI in MS patients.     

Linking the Bournemouth Questionnaire for low back pain to the International Classification of Functioning,Disability and Health

Purpose: Understanding the content of health-related quality of life (HRQOL) questionnaires can facilitate comparison and selection of the most appropriate tool in the assessment of patients with low back pain. The International Classification of Functioning, Disability and Health (ICF), as part of the WHO-FIC, can be used as a standardised method for mapping and comparing HRQOL questionnaire content. The purpose of this study was to link the Bournemouth Questionnaire (BQ) to the ICF in order to assess and compare the content of the BQ to the brief ICF core sets for low back pain. Methods: The BQ was linked to the ICF following the rules described by Cieza and Stuki. Following the linking process, the results were further linked to the brief ICF core sets for low back pain. Results: The BQ covered 21 ICF categories within the domains of body functions and activities and participation. Only five meaningful concepts could not be linked to the ICF. The brief core sets for low back pain contain 35 categories, identified as important concepts in back pain patients. The BQ covered 10 of the categories of the brief core sets. Conclusion: HRQOL tools provide valuable information about the health status of patients. Content comparison based on ICF provides relevant information about the concepts covered and enables selection of the appropriate clinical tools. The BQ is easy to administer and is linked to a number of important concepts contained within the ICF and to concepts considered to be important in the assessment of patients with LBP.

• Implications for Rehabilitation

• Selecting appropriate health-related quality of life (HRQOL) tools can prove difficult, with such a variety of them available, and each with varying content.

• ICF provides a standardised framework for the content assessment of HRQOL tools.

• Understanding the content of HRQOL tools can facilitate better tool selection and assist in the accurate assessment of patients with low back pain.

     

Dignity,rights and capabilities in clinical rehabilitation

Purpose.?The purpose of this article is to explore three concepts namely dignity, human rights and capabilities and to argue for their relevance in advancing the theory and practice of rehabilitation.

Method.?A narrative review of selected academic writing on the three constructs is considered with respect to the rehabilitation literature.

Results.?Each concept is defined and technical terms are explained for readers unfamiliar with these topics. Salient aspects of academic or scientific writing on each of these three topics is summarised and attempts are made to integrate these with rehabilitation.

Conclusions.?Dignity, rights and capabilities are three concepts that have the potential to enhance theory development in rehabilitation.     

Measuring participation in people living with multiple sclerosis: A comparison of self-reported frequency,importance and self-efficacy

Purpose.?To compare three dimensions related to participation in everyday situations in community-dwelling adults with multiple sclerosis (MS).

Methods.?Mail survey was obtained from 112 respondents. Data were analyzed using Kendall's tau-b correlation coefficients between responses to participation items relative to three question dimensions (importance, frequency, and self-efficacy) and criterion variables (mobility, depression, general health, fatigue and pain).

Results.?No significant associations were found between item responses in the importance dimension and the criterion variables. Weak associations were found for items in the frequency dimension, and stronger associations were found for items in the self-efficacy dimension.

Conclusions.?Different dimensions of participation in specific life situations yielded different responses and associations of those responses with key criterion measures. Subjective importance of participating in everyday situations is relatively independent of measures of mobility, general health, depression, fatigue and pain. Subjective judgments of self-efficacy for participation are more closely linked to these criterion measures. Caution is warranted when interpreting scales of participation because participation is a complex construct, potentially composed of several dimensions.     

Swedish rehabilitation professionals' perspectives on work ability assessments in a changing sickness insurance system

Purpose.?Changes in the Swedish sickness insurance system shifts focus from return-to-work to labour market reintegration. This article analyses Swedish rehabilitation professionals' perspectives on how the changed regulations affect practice, with a special focus on work ability assessments.

Methods.?Two groups of representatives ((n == 15)) from organizations involved in rehabilitation and return-to-work met at seven occations. The groups worked with a tutor with a problem-based approach to discuss how their practice is influenced by the changed regulations. The material was analysed inductively using qualitative content analysis.

Results.?The new regulations require developed cooperation among insurance, health care, employers and occupational health care; however, these demands are not met in practice. In work ability assessments, several flaws regarding competence and cooperation are identified. An increasing number of people previously assessed as work disabled are required to participate in labour market reintegration, which puts demands on professionals to engage in motivational activities, although this is perceived as hopeless due to the group's lack of employability.

Conclusions.?The possibility for employers to sidestep their responsibility has increased with changed regulations. The overall lack of cooperation between relevant actors and the lack of relevant competence undermine the ambitions of activation and reintegration in the reform.