The International Classification of Functioning, Disability and Health (ICF) and rheumatic diseases

Assessment of the impact of the rheumatic disease on the individual patient is necessary to evaluate the outcome of an intervention targeted at the disease process as well as at the restoration of the patient's functioning. The International Classification of Functioning, Disability and Health (ICF) is a comprehensive tool designed to record and organise a wide range of information about health and health related states, based on bio-psycho-social perspective. The ICF components, namely, body functions, body structures, and activities and participation are complemented by the contextual components, environmental factors and personal factors. All of them are in mutual interactions. The ICF contains lists of so-called ICF categories that describe the components of the integrative World Health Organisation model. It uses an alphanumerical model where categories are 'nested' so that broader categories are defined to include more detailed subcategories of the parent categories. Organized in such a way and with more than 1400 categories ICF covers virtually all the spectrum of problems encountered in patients with musculoskeletal conditions. The main practical tools of the ICF include ICF check lists, ICF core sets, ICF categorical profile and ICF assessment sheet. The ICF is likely to become the generally accepted conceptual framework and will be increasingly used in clinical practice to structure patient problems, particularly in multidisciplinary care and for rehabilitation purposes.     

基于国际功能残疾健康分类的参与测评工具的研究现状

介绍了《国际功能残疾健康分类》中参与概念及测评意义,并对参与测评工具进行综述,旨在为社区康复工作者及研究者选择和使用相关工具提供参考。提出尝试引进及修订国外成熟的参与测评量表,以满足我国康复护理领域的科研及实践需求。     

Review of participation measuring instruments according to the International Classification of Functioning, Disability and Health (ICF)

介绍了《国际功能残疾健康分类》中参与概念及测评意义,并对参与测评工具进行综述,旨在为社区康复工作者及研究者选择和使用相关工具提供参考.提出尝试引进及修订国外成熟的参与测评量表,以满足我国康复护理领域的科研及实践需求.     

The relevance of the International Classification of Functioning,Disability and Health (ICF) to mental disorders and their treatment

This article examines the potential usefulness of the ICF in the treatment of mental disorders. We suggest that there is a poor fit between the nature of mental disorders and the dominant model of health care based on the treatment of acute medical illness. An overemphasis on diagnosis has contributed to a bias toward pharmacotherapy and underuse of psychological treatments for people with mental disorders. Mental disorders are more accurately conceptualized as chronic conditions, in which the person's pattern of functioning rather than diagnosis is most important in determining what services are needed. This is particularly the case for people with serious mental illness, who may have lost the ability to carry out daily tasks, live independently, work, have interpersonal relationships, and engage in leisure pursuits. The ICF is a universal framework for describing the full range of human functioning that is highly consistent with the perspective and treatment approaches of psychiatric rehabilitation. The ICF provides a broad, transdisciplinary framework for treatment planning, defining goals, assessing progress and outcomes, and allocating resources for people with mental disorders. Extended clinical examples are provided to illustrate the potential application of the ICF in this context.     

Validation of the brief International Classification of Functioning, Disability, and Health (ICF) core set for hand conditions

Study designCross-sectional multi-centre study.IntroductionThe ICF Core Sets for Hand Conditions (HC) have been developed to describe functioning of patients with HC.Purpose of the studyTo study the content validity of the Brief ICF Core Set for HC.MethodsPatients with HC were interviewed using the Comprehensive ICF Core Set for HC. ICF categories that best explained variation in patients' general health were identified using multiple regression methods.ResultsOverall, 12 of the 23 ICF categories of the Brief ICF Core Set could be validated. Our analyzes further revealed that the categories “b134 Sleep functions”, “s830 Structure of nails”, “e225 Climate” as well as categories referring to “e4 Attitudes” also deserve consideration when assessing functioning in patients with HC.ConclusionsClinicians are encouraged to complement the Brief ICF Core Set for HC by adding sleep functions, structure of nails, climate and attitudes, especially when following patients over time.Level of EvidenceLevel 3.     

International Classification of Functioning, Disability and Health (ICF) in the most important diseases and conditions of rheumatology practice

Musculoskeletal conditions are common throughout the world and their impact on individuals and society is enormous. The integrative and bio-psycho-socialy based model, the International Classification of Functioning, Disability and Health (ICF) is highly useful for structuring determinants of disability in these conditions. ICF encompasses health and health-related domains: body functions and structure, activity and participation and environmental factors. In clinical settings ICF is used for functional status assessment, goal setting and treatment planning and monitoring, as well as outcome measurement. In clinical practice the implementation of ICF is facilitated by the use of the ICF-based applications, such as ICF sheets or ICF Core Sets. In this article it is reported on the most important musculoskeletal conditions in rheumatology practice from the point of view of ICF and is complementary to the article by the same author that appeared in the previous issue of this journal.     

Linking hand therapy outcome measures used after carpal tunnel release to the International Classification of Functioning,Disability and Health: A systematic review

IntroductionThe goal of hand therapy after carpal tunnel release (CTR) is restoration of function. Outcome assessment tools that cover the concepts contained in the International Classification of Functioning, Disability and Health (ICF), a framework for describing functioning and disability, are appropriate for hand therapy treatment of this diagnosis.Purpose of the StudyTo identify and review outcome measures used in studies on rehabilitation after CTR and link these to the concepts contained in the ICF.MethodsA comprehensive literature search was conducted. Outcome measures in the included studies were linked to the ICF. For data calculation purposes, outcome measures were linked to the specific ICF category, which matched the majority of assessment items if there were components that fit into more than 1 category. The quality of the studies was evaluated, and effect sizes for the treatment interventions were calculated for a comprehensive systematic review.ResultsSeven studies met the inclusion criteria. Eleven outcomes (68.75%) were linked to body function, 1 (6.25%) to body structure, 3 (18.75%) to activity and participation, and 1 (6.25%) to environmental factors. No outcomes were associated with environmental factors or personal factors. Structured Effectiveness for Quality Evaluation of Study scores of the included studies ranged from 23 to 43/48.DiscussionThe predominant outcome tools in the current research on rehabilitation after CTR are impairment measures and are linked to the category of body structures and body functions.ConclusionsFunctional measures, associated with the activity and participation category, are only modestly represented, and there is a lack of representation of environmental and personal factors for outcome measures used following CTR.     

Linking the Disabilities of Arm, Shoulder, and Hand to the International Classification of Functioning, Disability, and Health.

The objective of this study was to explore whether the items from a specific outcome measure, that is, Disabilities of the Arm, Shoulder, and Hand (DASH), for quantifying limb symptoms and functions in musculoskeletal disorders fit into the framework of the International Classification of Functioning, Disability and Health (ICF). All DASH items were compared to the ICF according to eight linking rules. Two groups of researchers performed the linking independently, and the results were compared by correlation. The 30 DASH items and four items from the optional modules were linked to 63 ICF categories and 11 chapters: 15 categories belong to the ICF body functions component and 48 to the activities and participation component. There were no items coded under the components body structure or environmental factors. Kappa index showed an agreement of 0.73 (p<0.001). The results showed that the content of the DASH does link well with the ICF framework. Clinicians and researchers must attend to the fact that certain domains and categories from the ICF are not covered by the DASH. Limitations of the instrument may be overcome by simultaneously using other instruments that address the intended content.     

Measuring common outcome measures and their concepts using the International Classification of Functioning, Disability and Health (ICF) in adults with burn injury: a systematic review

Purpose

To identify and quantify the health related concepts contained in the most common outcome instruments used in adult burn care, and to compare the content of these instruments based on their linkage to the International Classification of Functioning, Disability and Health (ICF). The ICF has been validated as a reference tool by the World Health Organization and is a framework that incorporates physical, emotional, environmental and social aspects of daily functioning.

Methods

Electronic searches of MEDLINE, EMBASE CINAHL, PsychINFO and the Cochrane Library from 2003 onwards were carried out using a predetermined search strategy. Specific characteristics of the included studies and data pertaining to the outcome instruments were extracted. Two reviewers independently categorised the underlying concepts contained in the most commonly used outcome measures and linked them to ICF categories using standardised linkage rules.

Results

Out of a total 132 included studies, 151 outcome instruments were identified. Of these, 14 frequently used generic and burn-specific instruments were selected for linkage to the ICF. From the 381 items contained in the 14 instruments, 356 concepts were extracted and subsequently linked to 99 ICF categories. Nearly 46% of the concepts were linked to body function and 20% to activities and participation, whereas only a few concepts were formally linked to health condition, body structures and personal or environmental factors.

Conclusion

The ICF proved highly useful for the content comparison of frequently used generic and burn-specific instruments. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in those with burn injury.     

The benefits of an unsupervised exercise program in persons with well-healed burn injuries within the International Classification of Functioning,Disability and Health (ICF)

Vast improvements in the survival rates following burn injuries has led to a greater number of patients living with a wide range of long-term impairments, activity limitations, and participation constraints. Therefore, long-term care is critical in this clinical population and necessitates appropriate rehabilitation strategies to maximize an individual’s overall health. The purpose of this study was to test the hypothesis that the extent to which outcomes within the International Classification of Functioning, Disability, and Health (ICF) framework are improved following 6 months of unsupervised exercise training is influenced by the severity of a burn injury (i.e., percent body surface area injured). Outcome variables representing the dimensions of the ICF, body functions & structure, activity, and participation, were collected pre- and post- 6 months of exercise training in three groups of participants: non-injured control subjects (N = 11), subjects with moderate-level well-healed burn injuries (N = 13, 26 ± 6% body surface area burned), and subjects with high-level well-healed burn injuries (N = 20, 58 ± 15% body surface area burned). Exercise training improved lower extremity strength (changes in peak torque/kg body mass at 90 degrees/sec flexion: 30 ± 5% and extension: 36 ± 4%, p < 0.05) and functional activities (changes in sit to stand: -9 ± 4% and ascend stairs: -4 ± 1%; p < 0.05) in all groups. For outcome variables representing ICF levels of body functions & structure and activity, there were no differences at baseline or improvements made between the groups after training. That said, with the exception of the domain of functional activity (reported 17 ± 34% improvement in the high-level burn cohort, p < 0.05), no changes were revealed in the participation level of ICF indexed by health-related quality of life questionnaires. These findings support the utilization of a 6-month unsupervised exercise training program in the long-term rehabilitation of individuals with burn injuries; that is, improvements in body functions & structure and activity can be achieved with an exercise regimen regardless of the severity of burn injury.     

Identifying content gaps in health status measures for intermittent claudication using the International Classification of Functioning,Disability and Health

Objective

The Walking Impairment Questionnaire (WIQ) and Intermittent Claudication Questionnaire (ICQ) are commonly used patient-reported functional outcome measures for intermittent claudication, but their functional representation has not been characterized. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework comprehensively describes health-related function and has been used to evaluate health status and quality of life (QOL) measures. We applied a content analysis technique commonly used in functional rehabilitation research to evaluate ICF domains represented by WIQ and ICQ to characterize their health status and functional representation.

Outcome evaluation of the hand and wrist according to the International Classification of Functioning,Disability, and Health

This article is a brief review of the outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health. Several tools currently exist to quantify outcome in hand surgery at the impairment level (eg, mobility, hand strength, cutaneous sensation, dexterity). According to the World Health Organization's paradigm, however, activity limitations and participation restrictions are also clinically relevant. The authors have recently built a measure of an upper limb-impaired individual's ability to manage manual activities in daily life. Participation and quality of life are difficult outcomes to measure because they are multidimensional and depend on such factors as functional abilities, general physical health, financial security, and stability of the social and familial environment.     

Exploring the relationships between International Classification of Functioning, Disability and Health (ICF) constructs of Impairment, Activity Limitation and Participation Restriction in people with osteoarthritis prior to joint replacement

Background

Hip arthroscopies are often used in the treatment of intra-articular hip injuries. Patient-reported outcomes (PRO) are an important parameter in evaluating treatment. It is unclear which PRO questionnaires are specifically available for hip arthroscopy patients. The aim of this systematic review was to investigate which PRO questionnaires are valid and reliable in the evaluation of patients undergoing hip arthroscopy.

Methods

A search was conducted in Pubmed, Medline, CINAHL, the Cochrane Library, Pedro, EMBASE and Web of Science from 1931 to October 2010. Studies assessing the quality of PRO questionnaires in the evaluation of patients undergoing hip arthroscopy were included. The quality of the questionnaires was evaluated by the psychometric properties of the outcome measures. The quality of the articles investigating the questionnaires was assessed by the COSMIN list.

Results

Five articles identified three questionnaires; the Modified Harris Hip Score (MHHS), the Nonarthritic Hip Score (NAHS) and the Hip Outcome Score (HOS). The NAHS scored best on the content validity, whereas the HOS scored best on agreement, internal consistency, reliability and responsiveness. The quality of the articles describing the HOS scored highest. The NAHS is the best quality questionnaire. The articles describing the HOS are the best quality articles.

Conclusions

This systematic review shows that there is no conclusive evidence for the use of a single patient-reported outcome questionnaire in the evaluation of patients undergoing hip arthroscopy. Based on available psychometric evidence we recommend using a combination of the NAHS and the HOS for patients undergoing hip arthroscopy.     

Preliminary study on International Classification of Functioning, Disability and Health categories relevant to nursing of inpatients

目的 初步确定住院患者护理相关《国际功能、残疾和健康分类》(ICF)类目,以此构建住院患者护理相关ICF框架.方法 从世界卫生组织ICF中初筛出护理类目,编制专家咨询问卷;对36名护理专家进行问卷咨询,按专家意见一致性＞80％的标准筛选类目;按临床实用性原则对咨询结果再次筛选.结果 初筛出护理类目211个,专家咨询后提取79个,再次筛选后初步确定意识功能、定向功能等74个护理类目.结论 初步确定的护理类目在ICF中分布比较合理,具有系统性、有效性和方便交流的特点,可作为住院患者护理干预措施和结局评价的框架.     

住院患者护理相关《国际功能、残疾和健康分类》类目的初步研究

目的初步确定住院患者护理相关《国际功能、残疾和健康分类》(ICF)类目,以此构建住院患者护理相关ICF框架。方法从世界卫生组织ICF中初筛出护理类目,编制专家咨询问卷;对36名护理专家进行问卷咨询,按专家意见一致性>80%的标准筛选类目;按临床实用性原则对咨询结果再次筛选。结果初筛出护理类目211个,专家咨询后提取79个,再次筛选后初步确定意识功能、定向功能等74个护理类目。结论初步确定的护理类目在ICF中分布比较合理,具有系统性、有效性和方便交流的特点,可作为住院患者护理干预措施和结局评价的框架。     

The Disabilities of the Arm,Shoulder and Hand Questionnaire (DASH) can measure the impairment,activity limitations and participation restriction constructs from the International Classification of Functioning,Disability and Health (ICF)

Background  

The International Classification of Functioning, Disability and Health (ICF) model of the consequences of disease identifies three health outcomes, impairment, activity limitations and participation restrictions. However, few orthopaedic health outcome measures were developed with reference to the ICF. This study examined the ability of a valid and frequently used measure of upper limb function, namely the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), to operationalise the ICF.