Reflection on the definition of impairment and disability as defined by the World Health Organization

Summary

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) is gaining wide acceptance inside and outside the field of rehabilitation medicine. Impairment and disability are concepts which are very often used interchangeably or defined differently. The World Health Organization (WHO) has defined impairment and disability in the ICIDH. In this article an analysis is made of these definitions and the characteristics that are given for the definitions. Based on this analysis, modifications for the definitions and characteristics of impairment and disability are suggested.     

Effectiveness of the Mental Health First Aid programme for general nursing students in Hong Kong: A randomised controlled trial

BackgroundInsufficient mental health related knowledge among healthcare professionals and students may lead to higher levels of stigma towards and increased social distance from mentally unwell patients. Moreover, university students enrolled in healthcare programmes are particularly susceptible to stress, depression, anxiety and other mental health problems.ObjectiveThis study evaluated the effectiveness of the Mental Health First Aid (MHFA) Programme for undergraduate general nursing students in improving their mental health literacy, decreasing their social distance from persons with mental health issues, increasing their mental health first-aid intention, and enhancing their confidence in assisting others. The programme was also extended the effectiveness to help students to maintain their own mental wellbeing.MethodsA randomised controlled trial study with a pre-test, post-test, and follow-up research design was conducted. Three hundred and fifty-eight students were recruited. The experimental group comprised 182 students, of whom 168 completed MHFA training and a post-test questionnaire in mid-2017, and 167 students completed a follow-up questionnaire early in 2018. Meanwhile, 175 and 165 of the 176 students in the control group completed the post-test and follow-up questionnaires, respectively.ResultsThe effectiveness of the MHFA programme was supported by the results of repeated measures analysis of variance with Greenhouse-Geisser correction. Significant interaction effects were found in mental health knowledge in recognition of depression (ηp² = 0.17; 95% CI: 0.24, 0.42), recognition of schizophrenia (ηp² = 0.16; 95% CI: 0.33, 0.47), depression social distance (ηp² = 0.20; 95% CI: ?0.41. ?0.22), schizophrenia social distance (ηp² = 0.31; 95% CI: ?0.58, ?0.37), confidence in helping (ηp² = 0.04; 95% CI: 0.11. 0.14), mental first-aid actions (ηp² = 0.08; 95% CI: 1.75, 2.90), and mental wellbeing (ηp² = 0.15; 95% CI: ?0.53, ?0.19).DiscussionMental illnesses present substantial challenges to healthcare professionals worldwide. MHFA training should be promoted locally and integrated within compulsory training and extracurricular activities in curricula developed for healthcare and general university students.ConclusionThis study confirms the benefits of MHFA for general nursing students in developing their professional understanding of and willingness to assist people with mental health problems, and in developing, maintaining, and improving their understanding of their own mental health.     

Implementing recommendations of the World Report on Disability for indigenous populations

Abstract

Typically, the types of services provided for people with communication disorders (PWCD) and the ways the services are provided have been designed for dominant populations in the Minority World. If services are to be truly accessible and equitable, they must be designed to account for cultural variations in beliefs, needs, and desires of PWCD and their families. This article describes the health conditions that put indigenous populations at particular risk for communicative disorders and gives examples of ways in which speech-language pathologists (SLPs) have addressed the recommendations of the World Report on Disability when working with PWCD in indigenous communities in Minority World countries.     

The Pan American Health Organization: its structure and role in the development of a palliative care program for Latin America and the Caribbean

In recent years palliative care has emerged as a major public health care issue, both in developed and developing countries. The rising number of cancer deaths as a result of increased tobacco consumption, control of other diseases, lack of preventive programs, and the difficulties of accessing curative treatments in many countries have made palliative care and pain relief the appropriate, and in many cases, the only option for patients with advanced disease. The World Health Organization (WHO) and its Regional Office for the Americas, the Pan American Health Organization (PAHO), have promoted palliative care as a component of their cancer control program. Some health care workers and policy makers are not adequately informed about the role that intergovernmental agencies such as WHO and PAHO play in the health care field. This has led to confusion and, in some cases, misjudgment of the organization. This paper summarizes the structure and role of PAHO and, specifically, its participation in the development of a palliative care program for Latin America and the Caribbean. Many health care professionals, administrators, and policy makers are unaware of the organization's objectives in this area and the tools available to assist in the implementation and development of national programs to care for patients with advanced cancer. The information in this paper is based on data found in the PAHO and WHO web sites, as well as other technical publications from different sources, including individuals not formally associated with WHO or PAHO.     

自杀相关心理健康服务倾向问卷的编制及信效度检验

目的 编制自杀相关心理健康服务倾向问卷并检验其信效度。方法 基于计划行为理论,在文献分析及半结构式访谈的基础上,通过专家函询、预调查形成问卷初稿。2020年5月—7月选取542名医护人员进行调查,检验问卷的信效度。结果 问卷包括4个维度、26个条目。探索性因子分析提取4个公因子,累计方差贡献率为65.525%。验证性因子分析结果显示,拟合指数卡方自由度比值为2.584,近似误差均方根为0.074,比较拟合指数为0.904,拟合优度指数为0.875,调整拟合优度指数为0.881,问卷的平均内容效度指数为0.924。问卷的Cronbach’s α系数为0.930,分半信度为0.910,重测信度为0.905。结论 该研究编制的自杀相关心理健康服务倾向问卷具有较好的信效度,可作为测评医护人员为自杀患者实施心理健康服务倾向的工具。     

基于世界卫生组织康复胜任力架构的康复人力资源管理理论与应用

目的 探讨世界卫生组织(WHO)康复胜任力架构(RCF)在康复人力资源管理中的应用路径及方法,为康复人力资源管理提供理论参考和实践借鉴.方法 以国际劳工组织颁布的国际标准职业分类为基础,系统分析RCF应用范围;结合基于胜任力的人力资源管理框架构建基于RCF的康复人力资源管理理论架构.以康复护理岗位为例,从人力资源管理中...     

世界卫生组织国际健康分类家族在康复中系统应用的方案与路线图

目的 研究世界卫生组织国际健康分类家族(WHO-FICs)在康复领域宏观层面的政策和理论架构、中观层面的治理与管理机制,以及微观层面的系统应用。方法 基于国际康复政策文件,主要是世界卫生组织《世界残疾报告》、《全球残疾行动计划》和《健康服务体系中的康复》等分析康复发展的政策理论架构;探讨WHO-FICs,包括《国际疾病分类》(ICD-11)、《国际功能、残疾和健康分类》(ICF)和《国际健康干预分类》(ICHIβ-2)三大参考分类在康复领域的系统应用。结果 基于WHO-FICs构建康复宏观政策和理论架构,明确现代康复服务的内涵和原则。康复服务是现代健康服务的重要组成部分,涉及6大要素,包括领导力与治理能力、筹资、健康人力资源、服务提供、医药技术和健康信息系统。要求在康复服务中依据ICD、ICF和ICHI的架构和知识体系,对康复领域的疾病、功能和干预的分类、命名规则、内涵、外延、术语体系和编码系统进行标准化,并完成康复相关的评估和统计。基于WHO-FICs构建康复治理与管理的中观机制。康复服务基于生物-心理-社会模式,坚持以人为本和功能定向原则;情景要素包括服务地点、服务设施和服务场景三个方面。在康复领域系统应用WHO-FICs推荐采用“评定(ICHI)–功能分类、评定、说明和编码(ICF)–疾病分类、诊断、编码(ICD-11)–康复干预(ICHI)”系统应用模式,遵循“评估(功能和需求)和诊断(疾病和功能)–确定康复目标和康复方案–实施康复干预–康复结局评价(功能评定)”的标准化流程。基于WHO-FICs构建康复的微观应用模式,明确康复涉及的主要疾病有28大类,主要功能障碍有7大类,康复干预有6大类。根据ICD-11和ICF推荐的整体功能评估工具有WHO残疾评定方案(WHODAS 2.0)、WHO示范残疾评估表简明版(MDS-B)和VB40通用功能领域(VB40),同时推荐ICF核心分类组合用于康复功能和康复结局的评估。WHO-FICs在康复病案管理和病案首页报告中的应用,可实现康复病案管理的标准化,基于康复病案首页的疾病、功能和干预编码以及康复绩效报告的标准化为康复付费和支付管理提供了工具。基于WHO-FICs构建标准康复数据集,建立标准化康复大数据,实现功能相关的诊断相关分类和case-mix统计。结论 将WHO-FICs分类系统应用于康复领域,在宏观层面构建康复理论和政策架构,在中观层面明确康复治理与管理的机制,在微观层面建立康复应用模式,可进一步提升康复服务的科学化、规范化、精细化和信息化水平,提升康复服务的治理水平和治理能力,提高康复服务的质量、安全性和覆盖率,提供科学有效的整体解决方案。     

简易智力测试量表的效度及信度研究

目的　探讨简易智力测试量表 (AMT)的效度和信度 ,为临床应用提供客观依据。方法　 2组受试对象参加了测试 ,一组为病例组 (38例 ) ,另一组为对照组 (30例 )。 1周内对 2组对象用AMT和简易精神状态量表 (MMSE)进行 2次评估。将AMT结果与MMSE作相关性检验来验证AMT的效度 ;对 2次AMT结果作组间相关性分析来测试AMT的重复测试信度。结果　AMT和MMSE的总分和各分项分的Pearson相关系数r =0 .70 6～ 0 .833;AMT各项内容 2次重复测试结果的组间相关系数ICC =0 .810～ 0 .996;病例组和对照组的AMT总分分别为 (7.60± 2 .5 5 )分、(9.64± 0 .81)分 ,2者间差异有显著性 (P <0 .0 5 )。结论　AMT具有良好的效度和信度 ,可对受试者的认知功能进行快速筛选和初步评价     

基于WHO-FICs的重症患者活动康复：Scoping综述

基于世界卫生组织国际健康分类家族(WHO-FICs)架构,分析重症患者活动功能康复。     

Strengthening global midwifery education to improve quality maternity care: Co-designing the World Health Organization Midwifery Assessment Tool for Education (MATE)

AimsTo describe a three-phase co-designed project to develop a culturally appropriate and relevant education assessment tool, and report on pilot and field-testing phases.BackgroundHigh-quality midwifery education is essential for high-quality maternity care (WHO 2019); however midwifery education and maternity care vary in quality throughout Europe. To support countries in strengthening their midwifery education, World Health Organization (WHO) European Region commissioned development of the Midwifery Assessment Tool for Education (MATE). The tool was developed over three years, using an iterative, collaborative process with regional experts. Published by WHO in May 2020, MATE provides focused questions and evidence-informed resources to stimulate and inform discussions within country.DesignThree-phase co-design approach to develop, pilot and field-test an education assessment tool.MethodsPhase 1: initial development of MATE with expert midwifery support; Phase 2: MATE piloting workshops in Czech Republic and Lithuania focusing on clarity, usability and relevance; Phase 3: MATE field-testing workshop in Bulgaria exploring the process of using MATE and its effectiveness for generating discussion. Purposive selection of workshop participants ensured a broad range of perspectives: clinicians, educators, students, policy makers and service users. All participants were invited to give narrative feedback during workshops and via completion of a post-workshop online survey. The XX University Research Ethics Committee advised that formal ethical review was unnecessary.ResultsFeedback from collaborators in all phases indicated that engaging with MATE co-design and testing was a positive experience. A ‘bottoms up’ approach ensured that MATE content was relevant to regional needs, culturally acceptable and appropriate.Seventy-nine individuals participated in Phases 2 and 3 and all were sent a post-workshop online survey, with 31 responses (39 %). Qualitative and quantitative data indicated that the aim of MATE was well understood, and its usability and relevance were evaluated positively. In Phase 2, improvements to wording and format were suggested. MATE was subsequently amended prior to field testing. Phase 3 feedback indicated that MATE was highly effective for generating in-country dialogue and frank discussions about the future of midwifery education and practice.ConclusionsUsing a co-design approach has ensured that MATE is culturally relevant, accessible and appropriate. This initial evaluation indicates that MATE can facilitate in-country dialogue and support the strengthening of midwifery education in accordance with WHO aims.Next steps are a fully evaluated trial of MATE in a selected partner country, where we will continue to work collaboratively to optimise engagement and ensure cultural appropriateness.     

The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke

Purpose: Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. Methods: A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM^?). Results: Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed “activities” and “participation” components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach’s α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM^?. Conclusions: WHODAS-II provides a reliable and valid instrument for measuring disability and components of “activities” and “participation” in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs.

Implications for Rehabilitation

• The impact of stroke on patients’ functioning in terms of activities and participation is important in the postacute and long-term rehabilitation phase.

• The World Health Organization Disability Assessment Schedule (WHODAS-II) was developed specifically to measure activities and participation.

• Psychometric properties of the WHODAS-II in stroke have received some attention recently, mostly using classical approaches.

• This study has tested the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis and it has been found that WHODAS-II provides a reliable and valid instrument for measuring functioning and components of “activities” and “participation” in stroke survivors.

     

The use of the ICF in speech-language pathology research: Towards a research agenda

The International Classification of Functioning, Disability and Health (ICF) facilitates a wide range of research in speech-language pathology. In addition to framing the development of assessment tools and evaluating interventions, the ICF can also be used to evaluate concepts such as third party disability or environmental factors that prevent or facilitate communication accessibility. In this paper, a model proposed by Stucki and Grimby is used to describe research on a continuum from basic to professional, and from cell to society. We translate this model to speech-language pathology by using examples from our programme of research in the Communication Disability Centre. The model also allows the identification of broad gaps in speech-language pathology research to date. The paper concludes with recommendations for a research agenda for the ICF in speech-language pathology. In particular, it is argued that unless speech-language pathology researchers fully understand the constructs of the ICF as applied to communication disability, valid measures for professional practice research cannot be developed.     

Use of the ICF for clinical practice in speech-language pathology

The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) (WHO, ) states that one of its five possible applications is for clinical use. The ICF is both a conceptual framework and a classification system with a complex numerical coding system and operational definitions. Thus, the practical and useful application of the classification system for recording assessment results could prove difficult. However, an agreed upon clinical interpretation of the ICF by clinicians is essential for it to be able to communicate complex clinical assessments to other professionals, third party payers, administrators, health care policy makers, and the consumers of our services. The American Psychological Association and the World Health Organization are working on finalizing the Procedural Manual and Guide for the Standardized Application of the ICF: A Manual for Health Professionals. This Procedural Manual is being designed to provide health professionals with directions for clinical use of the ICF, including additional information about the clinical interpretation of each code, to facilitate reliable and valid clinical use of the ICF. This article addresses issues discussed in the Procedural Manual and a range of complex issues regarding the clinical use of the ICF by speech-language pathologists.     

基于WHO-FICs心肺运动试验在肺癌患者中应用的Scoping综述

目的 基于世界卫生组织国际健康分类家族(WHO-FICs)理论,分析心肺运动试验(CPET)在肺癌患者中的应用。方法 检索2013年1月至2021年4月,PubMed、Web of Science、中国知网和万方数据库关于CPET在肺癌患者中应用的研究。采用Scoping综述方法分析CPET应用于肺癌患者时的适应证与禁忌证、运动功能障碍、肺康复干预措施、评价方法和指标以及环境因素等。结果 基于WHO-FICs框架,本文主要从5个方面对纳入文献进行分析。主要疾病为不同病理类型的非小细胞肺癌(NSCLC)(2C25),肺癌最常见的并发症是慢性阻塞性肺疾病(COPD)(CA22);肺癌患者进行CPET的障碍主要包括身体结构和功能、活动和参与障碍;基于CPET的肺康复运动训练方法被划分为治疗类、预防类和健康促进类;评价工具及指标采用摄氧量、二氧化碳排出量、氧脉搏、心率、血压、心电图、Borg量表、6分钟步行测试、健康调查简表(SF-36)等,并提供环境因素的分类和描述。结论 CPET在肺癌中的应用主要包括术前评估及预后预测、运动处方制定及运动效果评估、抗癌治疗影响评估三个方面。基于WHO-FICs理论体系,CPET应用对象主要为NSCLC,肺癌最常见的并发症是COPD;肺癌肺康复是以功能障碍和需求为导向,基于CPET评估结果进行个体化治疗类、预防类和健康促进类的肺康复运动训练,旨在提高患者整体功能,优化肺癌患者健康结局。     

Establishment of predictive validity and reliability of a newly developed fear of falling scale in Hong Kong

Fall events and fear of falling increase with age in healthy and frail older people. Fear of falling has been identified as a significant falls risk factor. The aims of this study were to establish the interrater and test-retest reliability and predictive validity of the fear of falling scale (FOFS). Sixty-nine subjects, 55 female and 14 male subjects, aged 65–97 years were included. Subjects were asked to respond to the FOFS on three occasions to test interrater and test-retest reliability. In the absence of a suitable comparative test for concurrent validity, balance predictive formulae were developed and relationship to Functional Reach Test, Timed up & go, and Step Test performance were compared. Intraclass coefficient (2,1) of interrater and test-retest reliability was 0.96 and 0.94, respectively. The Cronbach α for the FOFS scores collected ranged from 0.94 to 0.97. From the results of the multiple regression analyses, prediction formulae for Functional Reach Test, Timed up & go test, and Step Test from the FOFS scores were generated. These formulae then predicted balance performance by the subjects. The interrater and test-retest reliability and the predictive validity of the FOFS were established.     

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.     

Impact of Mental Disorders on Cost and Reimbursement for Patients in Inpatient Rehabilitation Facilities

Dobrez D, Heinemann AW, Deutsch A, Durkin EM, Almagor O. Impact of mental disorders on cost and reimbursement for patients in inpatient rehabilitation facilities.

Objective

To determine whether comorbid mental disorders affect inpatient rehabilitation facility (IRF) costs and to examine the extent to which Medicare's prospective payment system reimbursement sufficiently covers those costs.

Design

Secondary analysis of Medicare IRF Patient Assessment Instrument files and Medicare Provider and Review files. Payment was compared with costs for patients with and without reported mood, major depression, substance use, or anxiety disorders. The relationships among payment group assignment, comorbidity-related adjustments in payment, and the presence of mental disorders were estimated.

Setting

IRFs (N=1334) in the United States.

Participants

Medicare fee-for-service beneficiaries (N=1,146,799) discharged from IRFs from 2002 to 2004.

Interventions

Not applicable.

Main Outcome Measure

IRF costs.

Results

Mental disorders were reported for 13% of the Medicare fee-for-service beneficiaries. After controlling for payment group and comorbidity classifications, patients with mood, major depression, or anxiety disorders had significantly greater costs of $433, $1642, and $247 compared with patients without these disorders. The higher cost for patients with major depression (14.9% higher) is sufficient to justify a tier 2 comorbidity classification.

Conclusions

A reimbursement adjustment for the presence of a major depressive disorder would bring Medicare reimbursement in line with facility costs. The failure to compensate facilities directly for providing care to patients with major depression may result in reduced access to care for these patients. It also may create a disincentive to meet mental health treatment needs during the rehabilitative episode. Further work is needed to compare costs between patients with and without confirmed mental health disorders, given concerns about the accurate reporting of mental health disorders.