Development of the international classification of functioning,disability and health core sets for hand conditions – results of the world health organization international consensus process

Purpose: A formal decision-making and consensus process was applied to develop the first version of the International Classification on Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. Method: To convene an international panel to develop the ICF Core Sets for Hand Conditions (HC), preparatory studies were conducted, which included an expert survey, a systematic literature review, a qualitative study and an empirical data collection process involving persons with hand conditions. A consensus conference was convened in Switzerland in May 2009 that was attended by 23 healthcare professionals, who treat hand conditions, representing 22 countries. Results: The preparatory studies identified a set of 743 ICF categories at the second, third or fourth hierarchical level. Altogether, 117 chapter-, second-, or third-level categories were included in the comprehensive ICF Core Set for HC. The brief ICF Core Set for HC included a total of 23 chapter- and second-level categories. Conclusions: A formal consensus process integrating evidence and expert opinion based on the ICF led to the formal adoption of the ICF Core Sets for Hand Conditions. The next phase of this ICF project is to conduct a formal validation process to establish its applicability in clinical settings.

Implications for Rehabilitation

• The ICF offers a unified language of human functioning, disability and health substantial to describe comprehensively the experience of patients suffering from a determined disease.

• The ICF Core Sets for Hand Conditions provide the basic international standard of what should be measured and reported to describe functioning and disability of patients with hand conditions.

• The ICF Core Sets for Hand Conditions serve as a useful tool to guide clinicians in the assessment of a patient’s functioning in clinical studies, clinical encounters, and multi-professional evaluation.

     

Assessments used in school-aged children with acquired brain injury – Linking to the international classification of functioning,disability and health

Purpose. The aim was to examine widely used assessments within the rehabilitation of school-aged children with acquired brain injury (ABI) with the International Classification of Functioning, Disability and Health (ICF) as a framework.

Method. A survey identified the assessments most widely used in the rehabilitation of school-aged children with ABI in Sweden. The aims of these assessments were linked to the ICF according to previously published linking rules for clinical assessments.

Results. Thirty out of 43 widely used assessments were linked to body functions. The remaining assessments were linked to activities and participation, with no assessments being linked to environmental factors. Many categories within activities and participation were missing, whereas some categories within body functions were covered by numerous assessments.

Conclusions. The widely used assessments within paediatric brain injury rehabilitation do not cover essential aspects of functioning and disability. Specifically, assessments focussing on many crucial categories of activities and participation, and all categories within environmental factors were missing. A better understanding of school-aged children's health and disability might be achieved by using the ICF to identify a set of assessments, illuminating body functions, activities and participation and environmental factors.     

A systematic review of the pain scales in adults: Which to use?

Objective

The study analysed the Visual Analogue Scale (VAS), the Verbal Rating Scale (VRS) and the Numerical Rating Scale (NRS) to determine: 1. Were the compliance and usability different among scales? 2. Were any of the scales superior over the other(s) for clinical use?

Burden of treatment in the light of the international classification of functioning,disability and health: a “best fit” framework synthesis

Purpose: This systematic literature review aimed to (1) summarize and explain the concept of Burden of Treatment (BoT) using the International Classification of Functioning, Disability and Health (ICF) terminology, and (2) inform the development of a future Comprehensive ICF Core Set for BoT.

Method: Searches on EMbase, Medline, CINAHL and PsycINFO were conducted. Only qualitative studies were considered for inclusion. The screening and data extraction stages were followed by a “Best-fit” framework synthesis and content analysis, using the established ICF linking rules. Screening, data extraction, quality appraisal and data analysis were performed by two independent researchers.

Results: Seventeen studies were included in this review. The “Best–fit” framework synthesis generated 179 subthemes which identified that BoT impacts negatively on body functions and structures, restricts valued activities and participation and influences contextual factors through life roles, self-identify and relationships. The identified subthemes were linked to 77 ICF categories.

Conclusions: This study is part of the preparatory phase of a Comprehensive ICF Core Set for BoT and our findings will inform the further needed studies on this phase. The use of ICF terminology to describe BoT provides an accessible route for understanding this complex concept, which is pivotal for rethinking clinical practice.

• Implications for rehabilitation

• Health professionals applying the ICF should consider the negative impact of interventions on patient’s life roles and self-identity, body functions and structures and on valued activities and participation.

• Health professionals who may be concerned about the treatment burden being experienced by their patients can now use the ICF terminology to discuss this with the multidisciplinary team.

• Poor adherence to rehabilitation programs may be explained by an increased BoT. This phenomenon can now be mapped to the ICF, and coded using a framework well known by multidisciplinary teams.

     

Do neck kinematics correlate with pain intensity,neck disability or with fear of motion?

PurposeThis study aimed to investigate the relationship between cervical kinematics and subjective measures, including pain intensity, disability, and fear of motion.MethodsTwenty-five patients (19 females, 6 males; mean age 39 ± 12.7 years) with chronic neck pain participated in this cross-sectional study. A customized virtual reality system was employed to evaluate cervical range of motion (ROM) and kinematics, using an interactive game controlled by cervical motion via electromagnetic tracking. Self-reported outcome measures included pain intensity (visual analogue scale); disability (Neck Disability Index); and fear of motion (TAMPA scale of kinesiophobia). Kinematic measures included cervical ROM, mean and peak velocity, and number of velocity peaks (NVP) reflecting smoothness of motion.ResultsResults showed significant correlations of approximately 0.4–0.6 between ROM and fear of motion, pain intensity, and disability. All 12 kinematic measures were correlated with fear of motion, but only a few were correlated with pain intensity, and with disability.ConclusionsThe results emphasise fear of motion as a subjective measure primarily correlated with neck kinematics, including range, velocity, and smoothness of cervical motion. The level of neck disability was found to be partly related to ROM or to other kinematic impairments. However, ROM by itself remains a valid measure related to pain intensity and to fear of motion in patients with chronic neck pain. All correlations demonstrated were moderate, indicating that these measures involve other factors in need of further research.     

Use of the international classification of functioning,disability and health to describe patient-reported disability: A comparison of motor neurone disease,Guillain-Barré syndrome and multiple sclerosis in an Australian cohort

Purpose: To compare patient-reported disability across three long-term neurological conditions [motor neurone disease (MND), Guillain-Barré syndrome (GBS) and multiple sclerosis (MS)] using the International Classification of Functioning, Disability and Health (ICF). Methods: A prospective cross-sectional survey of Australian community-based persons with MND (n?=?44). Their MND-related problems were linked with ICF categories (second level) using open-ended questionnaires and ‘linkage rules’ and compared to similar data collected for GBS (n?=?77) and MS (n?=?101) participants. Results: MND participants were older (mean age 61 years, GBS 55, MS 49) with more males (66%, GBS 59%, MS 29%). Seventy ICF categories in MND were identified (GBS 41, MS 63): “body function” 15 (GBS 7; MS 18); “body structure” 5 (GBS 3, MS 5); “activities and participation” 40 (GBS 25, MS 30); “environmental factors” 10 (GBS 6, MS 10). The main areas linked in “activities and participation” were mobility, self care, general tasks and demands, domestic life, interpersonal interactions and relationships, major life areas and community, social and civic life; environmental factors included products and technology, natural environment, support and relationships, services, systems and policies. Conclusions: Comparison of three long-term neurological conditions will assist with development of a core set of categories to optimise consensus of care and communication amongst treating clinicians.

Implications for Rehabilitation

• Motor Neurone Disease causes diverse and challenging symptoms and disability.

• A set of relevant ICF categories in Motor Neurone Disease would be useful in both clinical and research settings for optimising care given the rare incidence of Motor Neurone Disease.

• Motor Neurone Disease can be compared to other long-term neurological conditions (Multiple Sclerosis and Guillain-Barré Syndrome) to assist with development of a core set of categories to optimise consensus of care and communication amongst treating clinicians.

     

Is acupuncture effective for the treatment of chronic pain? A systematic review

Pain is the major complaint of the estimated one million U.S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. Our aim was to assess the effectiveness of acupuncture as a treatment for chronic pain within the context of the methodological quality of the studies. MEDLINE (1966-99), two complementary medicine databases, 69 conference proceedings, and the bibliographies of other articles and reviews were searched. Trials were included if they were randomized, had populations with pain longer than three months, used needles rather than surface electrodes, and were in English. Data were extracted by two independent reviewers using a validated instrument. Inter-rater disagreements were resolved by discussion. Fifty one studies met inclusion criteria. Clinical heterogeneity precluded statistical pooling. Results were positive in 21 studies, negative in 3 and neutral in 27. Three fourths of the studies received a low-quality score and low-quality trials were significantly associated with positive results (P=0.05). High-quality studies clustered in designs using sham acupuncture as the control group, where the risk of false negative (type II) errors is high due to large sample size requirements. Six or more acupuncture treatments were significantly associated with positive outcomes (P=0.03) even after adjusting for study quality. We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, we have found an important relationship between the methodology of the studies and their results that should guide future research.     

Does rain really cause pain? A systematic review of the associations between weather factors and severity of pain in people with rheumatoid arthritis

Objective: To examine the association between weather and pain in rheumatoid arthritis (RA). Methods: Systematic review of longitudinal observational studies (up to September 2009) with data on the association between weather variables and severity of pain in RA. The methodological quality was rated independently by the two authors according to an adapted Newcastle–Ottawa Scale. We analyzed the data on an aggregated (group) level with a meta‐analysis of correlations between pain and weather, and at an individual level as the proportion of patients for whom pain was significantly affected by the weather. Results: Nine studies were included. Many different weather variables have been studied, but only three (temperature, relative humidity and atmospheric pressure) have been studied extensively. Overall group level analyses show that associations between pain and these three variables are close to zero. Individual analyses from two studies indicate that pain reporting in a minority (<25%) of RA patients is influenced by temperature, relative humidity or atmospheric pressure. We were not able to relate the findings to methodological quality or other aspects of the studies. Conclusion: The studies to date do not show any consistent group effect of weather conditions on pain in people with RA. There is, however, evidence suggesting that pain in some individuals is more affected by the weather than in others, and that patients react in different ways to the weather. Thus, the hypothesis that weather changes might significantly influence pain reporting in clinical care and research in some patients with RA cannot be rejected.     

Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis

BackgroundA growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined.ObjectivesThe aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain.MethodsFor this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsMeta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain.ConclusionsMovement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.     

Effects of meditation on pain intensity,physical function,quality of life and depression in adults with low back pain – A systematic review with meta-analysis

BackgroundLow back pain (LBP) is a common biopsychosocial health problem. Meditation may provide a complementary treatment option for LBP patients.ObjectivesThe aim of this systematic review with meta-analysis was to examine the effects of meditation on pain intensity, functional disability, quality of life, and depression in LBP populations.MethodsThis systematic review was conducted according to the PRISMA Guidelines. PubMed, Web of Science, CENTRAL, CamQuest and PubPsych were searched up to a publication date of June 2020. Inclusion criteria were RCTs or non-RCTs with LBP patients, aged at least 18 years, the application of a specific meditation technique, and pain intensity and/or functional disability as outcomes. Pooled SMDs were calculated at post-treatment and follow up. The Cochrane risk-of-bias tool was used to estimate risk of bias. The overall quality of evidence was assessed using the GRADE approach.Results12 studies with a total of 1005 participants were included in this review. Compared to controls, meditation solely showed a significant positive effect on pain intensity (SMD = −0.27 [CI −0.43; −0.11]; p = 0.001; based on 10 studies with 934 participants) and physical quality of life (SMD = 0.21 [CI 0.07; 0.36]; p = 0.005; based on 5 studies with 756 participants) at post-treatment. At follow up (mean 20 weeks, range 4–52) there were no significant effects anymore. The quality of the evidence was moderate due to study limitations and imprecision.ConclusionsMeditation seems to be promising with regard to reducing short-term pain intensity in patients with LBP. However, additional well-designed and large trials are required in order to draw more reliable conclusions.     

Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review

Objective: To assess if manual therapy (MT) in the treatment of plantar fasciitis (PF) patients improves pain and function more effectively than other interventions.

Methods: A systematic review of all randomized control trials (RCTs) investigating the effects of MT in the treatment of human patients with PF, plantar fasciosis, and heel pain published in English on PubMed, CINAHL, Cochrane, and Web of Science databases was conducted. Research quality was appraised utilizing the PEDro scale. Cohen’s d effect sizes (ES) and associated 95% confidence intervals (CI) were calculated between treatment groups.

Results: Seven RCTs were selected that employed MT as a primary independent variable and pain and function as dependent variables. Inclusion of MT in treatment yielded greater improvement in function (6 of 7 studies, CI that did not cross zero in 14 of 25 variables, ES = 0.5–21.5) and algometry (3 of 3 studies, CI that did not cross zero in 9 of 10 variables, ES = 0.7–3.0) from 4 weeks to 6 months when compared to interventions such as stretching, strengthening, or modalities. Though pain improved with the inclusion of MT, ES calculations favored MT in only 2 of 6 studies (3 of 13 variables) and was otherwise equivalent in effectiveness to comparison interventions.

Discussion: MT is clearly associated with improved function and may be associated with pain reduction in PF patients. It is recommended that clinicians consider use of both joint and soft tissue mobilization techniques in conjunction with stretching and strengthening when treating patients with PF.

Level of Evidence: Treatment, level 1a.     

Are opioids associated with sleep apnea? A review of the evidence

Chronic opioid use for nonmalignant pain has increased dramatically; nonillicit unintentional deaths have also increased. This article reviews the physiology of breathing, effects of sleep on respiration, effects of opioids on respiration, potential interactions between sleep and opioids on respiration, and current evidence that chronic opioid use is associated with sleep-disordered breathing.     

Can corticosteroids reduce the mortality of patients with severe sepsis? A systematic review and meta-analysis

BackgroundThe effects of corticosteroids on clinical outcomes of patients with sepsis remains controversial. We aimed to further determine the effectiveness of corticosteroids in reducing mortality in adult patients with severe sepsis by comparison with placebo.MethodsPubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all controlled studies that compared corticosteroids and placebo in adult patients with severe sepsis. The primary outcome was the mortality 28-day mortality and the secondary outcomes were mortality at longest follow up, occurrence, and reoccurrence of septic shock.ResultsA total of 19 trials involving 7035 patients were pooled in our final analyses. No significant heterogeneity was found in any of the outcome measures. Compared with placebo, corticosteroids were associated with a lower 28-day mortality (RR 0.91, 95% CI 0.85–0.98, Z = 2.57, P = 0.01) both in patients having sepsis and in those who developed septic shock (RR 0.92, 95% CI 0.85–0.99, Z = 2.19, P = 0.03), while no significant difference was found in mortality with the longest follow up in patients either having sepsis (RR 0.94, 95% CI 0.89–1.00, Z = 1.93, P = 0.05), or occurrence (RR 0.83, 95% CI 0.56–1.24, Z = 0.90, P = 0.37) or reoccurrence of septic shock (RR 1.08, 95% CI 1.00–1.16, Z = 1.89, P = 0.06).ConclusionsCorticosteroids were effective in reducing the 28-day mortality in patients with severe sepsis and in those with septic shock.     

Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature

OBJECTIVES: The chest pain observation unit (CPOU) has been developed in the United States to allow rigorous assessment of patients presenting with chest pain, thus expediting their discharge if assessment is negative. This review aims to examine the evidence for effectiveness and economic efficiency of the CPOU and to explore whether data from the United States can be extrapolated to the UK. METHOD: Search of the literature using Medline and critical appraisal of the validity of the data. RESULTS: Five studies comparing outcomes of CPOU care with routine practice showed no significant difference in objective measures including mortality or missed pathology. Eleven studies described outcomes of a cohort of CPOU patients. Follow up was comprehensive and demonstrated no clinically significant evidence of missed pathology. Nine studies comparing CPOU costs with routine care demonstrated impressive cost savings that were more modest when randomised comparisons were made. CONCLUSION: CPOU care is safe and costs are well defined. There is no strong evidence that a CPOU will improve outcomes if routine practice is good. Cost savings have been shown when compared with routine care in the United States but may not be reproduced the UK.