Are the contents of treatment outcomes in fibromyalgia trials represented in the International Classification Of Functioning, Disability, and Health?

OBJECTIVES: To identify the concepts contained in treatment outcomes of randomized controlled trials (RCTs) for interventions in patients with fibromyalgia (FM) using the International Classification of Functioning, Disability, and Health (ICF) as external reference. METHODS: RCTs between 1992 and 2001 were located in MEDLINE and selected according to predefined eligibility criteria. The outcome measures were extracted and the concepts within the outcome measures were identified and linked to the ICF using a content-analytical approach. RESULTS: Forty-two trials on FM were included. Twenty-seven different questionnaires were extracted. Of all, 79.2% (N=236) of the clinical and physiologic outcomes could be linked to 31 different ICF categories and 84.7% (N=964) of the concepts contained in the health-status questionnaire to 113 ICF categories. CONCLUSIONS: The ICF provides a useful external reference to identify the concepts contained in outcome measures used in RCTs in FM.     

Does the impact of osteoarthritis vary by age,gender and social deprivation? A community study using the International Classification of Functioning,Disability and Health

Abstract

Purpose: The aim of the study was to explore if the impact of osteoarthritis varies with respect to age, gender and social deprivation. Impact was defined as impairment, activity limitations and participation restriction (International Classification of Functioning, Disability and Health (ICF)). Investigating the functioning of the ICF model for subgroups is important both practically and theoretically. Method: The sample comprised a community sample of 763 people diagnosed with osteoarthritis. Uncontaminated measures of the ICF constructs were developed using discriminant content validity from a pool of 134 items, including the WOMAC and SF-36. Multigroup Structural Equation Modelling was used to explore if the same pathways exist for subgroups of gender, age and social deprivation. Results: Different significant paths were found for gender and social deprivation: impairment did not predict participation restriction for women and those most deprived, whereas these paths were significant for men and those less deprived. No difference in the paths was found for age. Conclusions: The impact of osteoarthritis appears to vary with respect to gender and social deprivation but not age. This suggests both that osteoarthritis per se does not adequately explain the health outcomes observed and that different clinical approaches may be appropriate for people of different gender and levels of deprivation.

• Implications of Rehabilitation

• The ICF model appears to vary with respect to gender and social deprivation for people with osteoarthritis.

• The ICF model did not appear to vary with respect to age for people with osteoarthritis.

• Different treatments and interventions for osteoarthritis may need to be targeted for specific gender and social deprivation groups.

     

Is there evidence of the International Classification of Functioning,Disability and Health in undergraduate nursing students’ patient assessments?

This paper reports on a secondary analysis of undergraduate nursing students' patient assessments while on clinical placement in a rehabilitation setting in search of evidence of the International Classification of Functioning, Disability and Health (ICF). It describes the evolution of the original World Health Organization's International Classification of Impairment, Disability and Handicap into the ICF. Data was analysed using the ICF categories of function, activity, participation, environmental factors and personal factors. Some evidence of ICF was revealed. Nurses are encouraged to further explore the relevance of ICF for nursing.     

Portugal’s special education law: implementing the International Classification of Functioning,Disability and Health in policy and practice

Purpose: The International Classification of Functioning, Disability and Health (ICF) was introduced in Portuguese education law as the compulsory system to guide eligibility policy and practice in special education. This paper describes the implementation of the ICF and its utility in the assessment process and eligibility determination of students for special education.

Methods: A study to evaluate the utility of the ICF was commissioned by the Portuguese Ministry of Education and carried out by an external evaluation team. A document analysis was made of the assessment and eligibility processes of 237 students, selected from a nationally representative sample.

Results: The results provided support for the use of the ICF in student assessment and in the multidimensional approach of generating student functioning profiles as the basis for determining eligibility. The use of the ICF contributed to the differentiation of eligible and non eligible students based on their functioning profiles.

Conclusions: The findings demonstrate the applicability of the ICF framework and classification system for determining eligibility for special education services on the basis of student functioning rather than medical or psychological diagnose.

Implications for Rehabilitation

• The use of the International Classification of Functioning, Disability and Health (ICF) framework in special education policy is as follows:

• The functional perspective of the ICF offers a more comprehensive, holistic assessment of student needs than medical diagnoses.

• ICF-based assessment of the nature and severity of functioning can serve as the basis for determining eligibility for special education and habilitation.

• Profiles of functioning can support decision making in designing appropriate educational interventions for students.

     

Beyond diagnosis: the Core Sets for persons with schizophrenia based on the World Health Organization’s International Classification of Functioning,Disability, and Health

Abstract

Purpose: Based on the International Classification of Functioning, Disability and Health (ICF), this paper presents the results of the process to develop the Comprehensive and Brief Core Sets for schizophrenia that allow to comprehensively describe functioning in persons with schizophrenia.

Methods: Twenty health professionals from diverse backgrounds participated in a formal and iterative decision-making process during an international consensus conference to develop these Core Sets. The conference was carried out based on evidence gathered from four preparatory studies (systematic literature review, qualitative study, expert survey, and empirical study). The first step of this decision-making and consensus process comprised of discussions and voting in working groups and plenary sessions to develop the comprehensive version. The categories of the Comprehensive ICF Core Set for schizophrenia served as the basis for the second step –a ranking and cutoff procedure to decide on the brief version.

Results: Of the 184 candidate categories identified in the preparatory studies, 97 categories were included in the Comprehensive Core Set for schizophrenia. A total of 25 categories were selected to constitute the Brief Core Set.

Conclusions: The formal decision-making and consensus process integrating evidence from four preparatory studies and expert opinion led to the first version of the Core Sets for schizophrenia. Comprehensive and Brief Core Sets for schizophrenia may provide a common language among different health professionals and researchers, and a basic international standard of what to measure, report, and assess the functioning of persons with schizophrenia.

• Implications for rehabilitation

• Schizophrenia is a chronic mental disorder that has a tremendous impact on functioning and daily life of persons living with the disorder. The International Classification of Functioning, Disability and Health (ICF) offers an internationally recognized standard for describing the functioning status of these individuals.

• The Core Sets for schizophrenia have potential use in supporting rehabilitation practice such as for planning mental health services and other interventions or defining rehabilitation goals, and documenting patient care.

• The Core Sets for schizophrenia may also be used to promote interdisciplinary coordination and facilitate communication between members of a multidisciplinary rehabilitation team.

• Rehabilitation research is another potential area of application of the Core Sets for schizophrenia. This is valuable, since rehabilitation research provides crucial evidence for optimizing rehabilitation practice.

     

Two steps forward, one step back? A commentary on the disease-specific core sets of the International Classification of Functioning, Disability and Health (ICF)

PURPOSE: The International Classification of Functioning, Disability and Health (ICF) has been received favourably by health care professionals, disability rights organizations and proponents of the social model of disability. The success of the ICF largely depends on its uptake in practice and is considered unwieldy in its full format. To enhance the application of the ICF in practice, disease and site-specific core sets have been developed. The objective of this paper is to stimulate thought and discussion about the place of the ICF core sets in rehabilitation practice. METHOD: The authors' review of the literature uses the ICF core sets (especially stroke), to debate if the ICF is at risk of taking two steps forward, one step back in its holistic portrayal of health. CONCLUSION: ICF disease specific core sets could be seen as taking two steps forward to enhance the user friendliness of the ICF and evidence-based practice in rehabilitation. However, there is a danger of taking one step back in reverting to a disease-specific classification. It is too early to conclude the efficacy of the disease-specific core sets, but there is an opportunity to debate where the next steps may lead.     

Two steps forward,one step back? A commentary on the disease-specific core sets of the International Classification of Functioning,Disability and Health (ICF)

Purpose. The International Classification of Functioning, Disability and Health (ICF) has been received favourably by health care professionals, disability rights organizations and proponents of the social model of disability. The success of the ICF largely depends on its uptake in practice and is considered unwieldy in its full format. To enhance the application of the ICF in practice, disease and site-specific core sets have been developed. The objective of this paper is to stimulate thought and discussion about the place of the ICF core sets in rehabilitation practice.

Method. The authors' review of the literature uses the ICF core sets (especially stroke), to debate if the ICF is at risk of taking two steps forward, one step back in its holistic portrayal of health.

Conclusion. ICF disease specific core sets could be seen as taking two steps forward to enhance the user friendliness of the ICF and evidence-based practice in rehabilitation. However, there is a danger of taking one step back in reverting to a disease-specific classification. It is too early to conclude the efficacy of the disease-specific core sets, but there is an opportunity to debate where the next steps may lead.     

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis capture nursing practice? A Delphi survey

Background

The “Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)” is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA.

Objectives

The objective of this study was to validate this ICF Core Set from the perspective of nurses.

Method

Nurses experienced in RA treatment were asked about the patients’ problems, patients’ resources and aspects of environment that nurses take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF.

Results

57 nurses in 15 countries named 1170 concepts that covered all ICF components. 20 concepts were linked to the as yet undeveloped ICF component Personal Factors. 19 ICF categories are not represented in the Comprehensive ICF Core Set for RA.

Conclusion

The validity of the Comprehensive ICF Core Set for RA was largely supported by the nurses. However, a number of body functions which address side effects of drug therapies were not included in the Comprehensive ICF Core Set for RA. Furthermore, several issues arose which were not precisely covered by the ICF like “dry mucous”, “risk for decubitus ulcers” and “height” and need to be investigated further.     

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer capture the problems in functioning treated by physiotherapists in women with breast cancer?

Objective

The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer is an application of the ICF, and represents the typical spectrum of problems in functioning and contextual factors that may influence functioning of patients with breast cancer. The objective of this study was to examine the content validity of this ICF core set from the perspective of physiotherapists.

Design

Physiotherapists from around the world experienced in the treatment of patients with breast cancer were interviewed about patients’ problems, patients’ resources and environmental aspects that physiotherapists take care of in a three-round survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated by means of the Kappa statistic.

Participants

Physiotherapists experienced in breast cancer treatment.

Results

Fifty-nine physiotherapists from 19 countries named 769 problems treated by physiotherapists in patients with breast cancer. One hundred and sixty-six ICF categories were linked to these answers. Nineteen ICF categories reached >75% agreement among the physiotherapists but are not represented in the Comprehensive ICF Core Set for Breast Cancer. Ten concepts were linked to the not-yet-classified personal factors component. Eleven concepts are not covered by the ICF. The Kappa coefficient for the agreement between the two persons who performed the linking was 0.66 (95% bootstrapped confidence interval 0.63 to 0.68).

Conclusions

The content validity of the Comprehensive ICF Core Set for Breast Cancer was largely supported by the physiotherapists. However, several issues were raised which were not covered and these need to be investigated further.     

Comparative Content Review of Children's Participation Measures Using the International Classification of Functioning,Disability and Health–Children and Youth

Objective

To evaluate to what extent instruments that intend to measure children's participation actually do so, and to what extent their items can be classified according to the International Classification of Functioning, Disability and Health–Children and Youth (ICF-CY).

Data Sources

A systematic search was conducted in MEDLINE, CINAHL, PsycINFO, ERIC, and EMBASE and was limited to the period between January 2000 and May 2011. The search terms of participation, outcome measure, and children were used to identify potential children's participation measures.

Data Selection

Instruments were included if they (1) evaluated children's participation based on assessment purpose; (2) were suitable for use with children aged 2 to 12 years; (3) were generic assessments that could be used with a range of disabilities; and (4) involved self-report, proxy report, or interview administrations.

Data Extraction

Instruments were obtained from identified full-text articles and were evaluated for inclusion through group discussion. Two researchers further independently reviewed each included instrument to determine which of the items measured participation based on a contemporary definition. These items were also classified using the ICF-CY linking rules to reflect each instrument's content coverage.

Data Synthesis

Sixteen instruments were identified with 11 found to have more than half of their items measuring participation, but only the School Function Assessment–Participation section comprised 100% participation items. The participation items in each instrument captured between 3 and 9 ICF-CY Activities and Participation domains. Only the Child and Adolescent Scale of Participation and the Participation and Environment Measure for Children and Youth covered all domains. Among the ICF-CY Activities and Participation domains, the interpersonal interactions and relationships domain was addressed the least.

Conclusions

This review revealed differences in the inclusion of participation items in existing children's participation measures and their classification according to the ICF-CY. These differences need to be considered when selecting an instrument.     

Are current mental health assessment formats consistent with contemporary thinking and practice?

Conducting and documenting a mental health assessment is considered a central activity from a clinical and organizational perspective. In recent years, thinking and practice in mental health service delivery has changed considerably to embrace principles of recovery, trauma‐informed care, and strengths‐based approaches. The aim of the present study was to determine the degree to which these concepts are reflected in the content of assessment formats across mental health services in Australia and New Zealand. Copies of mental health assessments used in each state and territory in Australia, and three District Health Boards in New Zealand were obtained. Assessment formats were compared for similarities and differences, and to determine whether concepts of recovery, trauma‐informed care, and strengths‐based approaches were incorporated. The assessment formats analysed (n = 11) contained many traditional features targeted at identifying harms, problems, risks, and pathology. Some attempts to redress this discrepancy were evident. Overall, assessment formats did not adequately voice the individual’s perspective or promote a truly comprehensive assessment through an exploration of individual strengths, skills and abilities, past successes, and future hopes. Assessment formats across Australia and New Zealand are not currently aligned with contemporary thinking and practice in mental health care. Given the heavy influence that mental health assessment has on clinical decision making in particular, a reappraisal of the focus and content of formats used is urgently required.     

Impact of environmental factors in home rehabilitation – a qualitative study from the perspective of older persons using the International Classification of Functioning,Disability and Health to describe facilitators and barriers

Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

Implications for Rehabilitation

• Environmental factors can be considered as obstacles or facilitators depending on each unique individual’s need.

• In a relatively small sample, this study shows the importance of the impact of the social environment on activities and participation among older people receiving home rehabilitation.

• Using ICF “linking rules” to link environmental factors as facilitators or barriers reported by older people can identify potentially important areas in home rehabilitation service described in the ICF categories. This can facilitate to improve rehabilitation service for older people.

• Reveals health care professionals as one central environmental factor for older people’s rehabilitation.

     

Patients’ view on health-related aspects of functioning and disability of joint contractures: a qualitative interview study based on the International Classification of Functioning,Disability and Health (ICF)

Abstract

Purpose: The aim of this study was to identify health-relevant aspects of functioning and disability of persons aged 65 years or older with joint contractures, to link the findings to corresponding ICF categories and to describe the patients’ perspective. Methods: We conducted 43 qualitative, semi-structured, face-to-face interviews with affected persons in two different locations (Witten, Munich) and in three different settings. Data were analyzed using the “meaning condensation procedure” and then linked to ICF categories. Results: From all interviews a total of 2499 single meaning-concepts were extracted which were linked to 324 different ICF categories. The participants in all settings mainly reported problems related to “Mobility of a single joint (b710)”, “Sensation of pain (b280)” and problems related to “Walking (d450)”. Almost all participants reported “Products and technology for personal indoor and outdoor mobility and transportation (e120)” as a relevant environmental factor. Conclusions: From the patients’ perspective, joint contractures have an impact on multifaceted aspects of functioning and disability, mainly body functions, environmental factors and activities and participation. The results of this study will contribute to the development of a standard instrument for measuring functioning, disability and health-relevant aspects for patients with joint contractures.

• Implications for Rehabilitation

• Joint contractures are a major cause for the development of disability in older people.

• Patients’ perspectives and their personal experiences have to be considered when assessing the impact of joint contractures.

• The International Classification of Functioning, Disability and Health (ICF) is an appropriate framework for describing the patients’ multifaceted experience of joint contractures.

     

Are Children with Cerebral Palsy and Developmental Disability Living Longer?

A robust literature addresses life expectancy (LE) for children with cerebral palsy (CP) and developmental disability (DD). A Medline data search was completed using the terms CP, DD, LE, survival, as well as other pertinent terms. Further articles were gleaned from bibliographies of pertinent literature. Key disabilities accurately predict LE in children with CP and DD: (1) presence and severity of developmental disability, (2) inability to speak intelligible words, (3) inability to recognize voices, (4) inability to interact with peers, (4) severity of physical disability, (5) use of tube feeding, (6) incontinence, (7) cortical blindness, and (8) presence and severity of seizures. Children with CP and DD have a diminished LE, which can be accurately assessed based on simple clinical examination findings. Over the last 50 years there has been improvement in life expectancy based on comparison of newer and older studies. However in approximately the last 20 years, there has been only slight improvement in LE, and this has been found only in the most profoundly impaired children with CP and DD.     

How does stigma affect people with mental illness?

People with mental health problems experience many different types of stigma. This article explores the attitudes and beliefs of the general public towards people with mental illness, and the lived experiences and feelings of service users and their relatives.     

Mental Health Nurse Incentive Program: Facilitating physical health care for people with mental illness?

People with serious mental illness have increased rates of physical ill‐health and reduced contact with primary care services. In Australia, the Mental Health Nurse Incentive Program (MHNIP) was developed to facilitate access to mental health services. However, as a primary care service, the contribution to physical health care is worthy of consideration. Thirty‐eight nurses who were part of the MHNIP participated in a national survey of nurses working in mental health about physical health care. The survey invited nurses to report their views on the physical health of consumers and the regularity of physical health care they provide. Physical health‐care provision in collaboration with general practitioners (GPs) and other health‐care professionals was reported as common. The findings suggest that the MHNIP provides integrated care, where nurses and GPs work in collaboration, allowing enough time to discuss physical health or share physical health activities. Consumers of this service appeared to have good access to physical and mental health services, and nurses had access to primary care professionals to discuss consumers’ physical health and develop their clinical skills in the physical domain. The MHNIP has an important role in addressing physical health concerns, in addition to the mental health issues of people accessing this service.     

The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness?

The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the “Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey” developed by Robson and Haddad (2012). The 28‐item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.     

Are falls in people with multiple sclerosis related to the severity of urinary disorders?

BackgroundLower urinary tract symptoms (LUTSs), especially overactive bladder, are frequent in people with multiple sclerosis (PwMS). Urinary urgency and urge urinary incontinence could lead to precipitation and thus could increase the risk of falling in these individuals.ObjectiveWe aimed to assess the association between severity of LUTSs and risk of falling in PwMS.MethodsPwMS with LUTSs were recruited in a neuro-urology department. Participants were asked about the number of falls in the past 3 months and their circumstances. Severity of LUTSs was assessed by the Urinary Symptoms Profile (USP) score, and individuals were classified as with or without urinary incontinence.ResultsThis cross-sectional study included 154 patients (69% women); the mean (SD) age was 50.1 (11.5) years and median EDSS was 5 (interquartile range 3–6). Overall, 20 (13%) patients reported one fall during the past 3 months, and 43 (28%) reported at least 2 falls. Only 9 (6%) patients reported a fall on the way to the toilet, 6 during a urinary urgency. No link was found between falls and urinary incontinence (P = 0.71), type or severity of urinary symptoms (overactivity, voiding dysfunction or stress incontinence, P > 0.05). Falls on the way to the bathroom was associated with high USP score related to overactive bladder (P = 0.03) and severe nocturia (> 2 nocturnal micturitions) (P < 0.01). Falling at night was also associated with severe nocturia (P < 0.001).ConclusionsThe severity of LUTSs and presence of urinary incontinence do not appear related to the risk of falling in PwMS and urinary disorders but rather to the specific risk of falling on the way to the bathroom. Severe nocturia increases the risk of falling at night. Further studies are needed to assess the impact of LUTS treatment on the risk of falling. ClinicalTrials.gov (NCT04338646).