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.     

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.

     

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.     

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.

     

Classification of employment factors according to the International Classification of Functioning,Disability and Health in patients with neuromuscular diseases: A systematic review

Purpose.?A systematic evaluation of the literature to identify health and contextual factors associated with employment in patients with neuromuscular diseases (NMD) and to perform a best evidence synthesis, taking into account the design of studies, methodological quality and the statistical significance of findings.

Method.?Publications were retrieved by a computerised search in medical and psychological databases. Two reviewers assessed titles and abstracts first and assessed the quality of the remaining full text publications independently as well. Of the residual publications, health and contextual factors associated with employment in patients with NMD were extracted. The factors found were included in a recently developed expanded International Classification of Functioning, Disability and Health scheme.

Results.?Six hundred and sixty-two titles and abstracts were screened. The main reason to exclude a title and/or abstract was the absence of the study population selected: Facioscapulohumeral Muscular Dystrophy (FSHD), Hereditary Motor and Sensory Neuropathy (HMSN) & Myotonic Dystrophy (MD). Of the remaining 20 full-text publications, eight publications fulfilled the inclusion criteria: two repeated survey designs and six cross-sectional studies. Factor extraction resulted in 94 factors related to employment. Ten factors in five publications were indicative for an association with employment status: Disease related factors HMSN, MD & NMD in general), factors related to functions (physical functions, muscle power functions), general personal factors (age, gender and education), work related personal factors (type of occupation, and expressed interest in employment by patients with NMD).

Conclusion.?In the best evidence synthesis ten factors were indicative for an association with employment status in patients with NMD in five publications with good to excellent methodological quality.     

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.

     

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.     

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.     

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。     

The Personal Factors of the International Classification of Functioning,Disability and Health in the literature – a systematic review and content analysis

Purpose.?This review provides an overview of the literature on the conceptualisation of the Personal Factors (PF) component of the International Classification of Functioning, Disability and Health (ICF).

Method.?A systematic literature review was carried out. Electronic searches were performed in Pubmed, Embase, PsycINFO, CINAHL and SSCI. Qualitative content analysis of statements about PF was conducted using inductive coding.

Results.?The searches yielded 353 citations, 79 papers were eligible for analyses. Five hundred thirty-eight statements about PF were extracted, condensed and coded. Beside conceptual statements, 238 examples of potential PF as well as five attempts at classifying PF were found in the literature. PF were considered in relation to clinical service provision, assessment and intervention, in research and social security contexts. PF were seen to be related to various aspects of health, functioning, disability and the environment.

Conclusions.?The analysis of the literature shows that PF is seen as relevant to the application of the ICF in various settings. The review revealed a need for standardisation of PF. The literature points to the potential of PF in enhancing the understanding of functioning, disability and health, in facilitating interventions and services for people with disabilities, and strengthening the perspective of individuals in the ICF.     

The Burn Model Systems outcome measures: a content analysis using the International Classification of Functioning,Disability, and Health

Background: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems (BMS) is a nationwide database that uses patient-reported outcome measures to collect data. Though the outcome measures demonstrate good psychometric properties, the question remains whether or not these measures collect data that encompass the entire experience of burn patients over time.

Methods: Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also determined.

Results: The body function component was most frequently addressed overall followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective.

Conclusion: This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery.

• Implications for Rehabilitation

• A better understanding of the data collected through the Burn Model Systems (BMS) project may contribute to improve data collection tools and ultimately lead to clinical practice innovations and improvements.

• Clinicians interested in using BMS data for research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed.

• This study highlights the need for burn clinicians around the world to lend their expertise to the WHO for the development of a much needed burn injury International Classification of Functioning, Disability and Health Core Set.

     

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.     

The Environment in the International Classification of Functioning,Disability and Health

Background The World Health Organization has adopted two classifications relating to disability, one was published in 1980 and the more recent one in 2001. Although the international classification of functioning, disability and health (ICF) was drafted as a revision of the international classification of impairments, disabilities and handicaps (ICIDH), the ICF is based on major changes when compared with the ICIDH. One of them has to do with the environment. Method Quotations from the classification manuals and related articles are presented in order to make clear the scope of the environment in the ICF. Results The ICF has a universal application. The gap between capacity and performance reflects the barriers created by the environment. Conclusions In the ICF, universalism and barriers have specific meanings, reflecting specific policy choices.     

Physiotherapists' clinical reasoning about patients with non-specific low back pain,as described by the International Classification of Functioning,Disability and Health

Purpose.?To explore and describe what physiotherapists experience they need to know about patients with non-specific low back pain (NSLBP) to make decisions about intervention.

Method.?Four focus groups containing a total of 21 physiotherapists were carried out in Sweden. Interviews were transcribed and qualitative content analysis performed. The manifest content was coded and categorised, and a theme emerged. Extracted symptoms and signs were linked to ICF codes.

Result.?Physiotherapists' clinical reasoning represented a broad view on low back pain (LBP) including codes from all ICF components. The participants argued for individualisation of intervention to a specific patient's problems. A theme of case complexity emerged, involving three levels: easy case, characterised by impairment in body function with close relation to specific body structures; complex case, characterised by impairments in body function, particular mental functions, activity limitations and participation restrictions, particular management of activity level and very complex case, characterised by impairments in body function, activity limitations and participation restrictions, and contextual factors, with help-seeking behaviour as a particular feature.

Conclusion.?The physiotherapists' clinical reasoning reflected a broad view on patients with NSLBP, with variations related to case complexity. The use of ICF codes contributed to understanding that the physiotherapists applied a broad perspective on NSLBP as a health condition as well as to knowledge about how physiotherapists' understand patients with NSLBP. Physiotherapists' use of the ICF in clinical practice might facilitate identification and assessment of specific patient's back pain problem as they occur in daily life and therefore be helpful in rehabilitation planning. Findings might also have an educational value.     

《国际功能、残疾和健康分类》研究总论

世界卫生组织 (ＷＨＯ)根据当代世界各国卫生事业发展的状况 ,从 1996开始制定了新的残疾与健康分类体系———《国际功能、残疾和健康分类》(ＩｎｔｅｒｎａｔｉｏｎａｌＣｌａｓｓｉｆｉｃａｔｉｏｎｏｆＦｕｎｃｔｉｏｎｉｎｇ ,ＤｉｓａｂｉｌｉｔｙａｎｄＨｅａｌｔｈ ,简称ＩＣＦ)。在 2 0 0 1年 5月第 5 4届世界卫生大会上 ,各成员国通过了将《国际损伤、残疾和障碍分类》(第 2版 )改名为《国际功能、残疾和健康分类》的决议 ,并鼓励各成员国考虑其具体情况 ,在研究、监测和报告中应用ＩＣＦ。ＩＣＦ已经正式由ＷＨＯ颁布 ,在世界各…