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.

     

Validation of the Comprehensive ICF Core Set for Multiple Sclerosis from the perspective of occupational therapists

Abstract

Objective: The Comprehensive ICF Core Set for Multiple Sclerosis (MS) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of People with MS (PwMS). The objective of this study was to validate this ICF Core Set from the perspective of occupational therapists (OTs). Method: In a three-round Delphi study, OTs were asked about problems and resources of PwMS, as well as environmental aspects treated by OTs. Statements were linked to the ICF and compared with the categories included in the Comprehensive ICF Core Set for MS. Results: Sixty-one OTs from 21 countries agreed on 71 categories that are included in the Comprehensive ICF Core Set for MS (19 Body Functions, 40 categories of Activities and Participation, 12 Environmental Factors). Eleven ICF categories were identified as not-yet-included ICF categories in the Comprehensive ICF Core Set for MS (6 Body Functions, 2 categories of Activities and Participation, 3 Environmental Factors). Conclusion: This study contributes to the validity of the ICF categories included in the Comprehensive ICF Core Set. It outlines which areas of functioning and health are relevant for PwMS from the perspective of OTs and consequently should be assessed.     

The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation

Objective

Prophylactic salpingo-oophorectomy is recommended to women who carry a BRCA1 or BRCA2 mutation to reduce the risks of breast, ovarian and fallopian tube cancer. We measured the impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual functioning in women with a BRCA mutation.

Methods

Women who underwent prophylactic salpingo-oophorectomy between October 1, 2002 and June 26, 2008 for a known BRCA1 or BRCA2 mutation were invited to participate. Participants completed questionnaires before prophylactic surgery and again one year after surgery. Measures of sexual functioning and menopausal symptoms before and after surgery were compared. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy was evaluated.

Results

114 women who underwent prophylactic surgery completed questionnaires before and one year after surgery. Subjects who were premenopausal at the time of surgery (n = 75) experienced a significant worsening of vasomotor symptoms (hot flashes, night sweats and sweating) and a decline in sexual functioning (desire, pleasure, discomfort and habit). The increase in vasomotor symptoms and the decline in sexual functioning were mitigated by HRT, but symptoms did not return to pre-surgical levels. HRT decreased vaginal dryness and dyspareunia; however, the decrease in sexual pleasure was not alleviated by HRT. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy remained high regardless of increased vasomotor symptoms and decreased sexual function.

Conclusions

Women who undergo prophylactic salpingo-oophorectomy prior to menopause experience an increase in vasomotor symptoms and a decrease in sexual functioning. These symptoms are improved by HRT, but not to pre-surgical levels.     

Parent ratings of executive functioning in children adopted from psychosocially depriving institutions

Background: Previous studies have found that post‐institutionalized (PI) children are particularly susceptible to attention problems and perform poorly on executive functioning (EF) lab tasks. Methods: Parent ratings of EF were examined in 288 school‐age and 130 preschool‐age children adopted from psychosocially depriving Russian institutions that provided adequate physical resources but not one‐on‐one interactions with a consistent set of responsive caregivers. Results: Results revealed a step‐like association between age at adoption and EF deficits; school‐age children adopted after 18 months of age had greater EF difficulties than younger‐adopted children and the never‐institutionalized normative sample. The onset of adolescence was associated with a greater increase in EF deficits for children adopted after 18 months than for younger‐adopted children. Preschool‐age children were not found to have greater EF difficulties than the normative sample. Conclusions: These findings suggest that prolonged early psychosocial deprivation may increase children’s risk of EF deficits and that the developmental stresses of adolescence may be particularly challenging for older‐adopted PI children.     

Gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone

This study examined gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone in Korea, and the variables influencing these symptoms. Data from a total of 317 older adults in the 2011 Korean National Survey were used. Upper limb mobility, lower limb mobility, activities of daily living, instrumental activities of daily living, and depressive symptoms were measured. Data were analyzed using multiple regression analysis. Low‐income older men and women living alone experienced depressive symptoms. Regression analysis showed that lower limb mobility and age together explained 35.4% of the variance in depressive symptoms in men. Subjective health status explained 16.7% of the same in women. These findings suggest that low‐income older adults living alone should be carefully monitored by public healthcare managers to improve their physical and mental health, considering gender‐specific elements.     

Biotic homogenization can decrease landscape-scale forest multifunctionality

Many experiments have shown that local biodiversity loss impairs the ability of ecosystems to maintain multiple ecosystem functions at high levels (multifunctionality). In contrast, the role of biodiversity in driving ecosystem multifunctionality at landscape scales remains unresolved. We used a comprehensive pan-European dataset, including 16 ecosystem functions measured in 209 forest plots across six European countries, and performed simulations to investigate how local plot-scale richness of tree species (α-diversity) and their turnover between plots (β-diversity) are related to landscape-scale multifunctionality. After accounting for variation in environmental conditions, we found that relationships between α-diversity and landscape-scale multifunctionality varied from positive to negative depending on the multifunctionality metric used. In contrast, when significant, relationships between β-diversity and landscape-scale multifunctionality were always positive, because a high spatial turnover in species composition was closely related to a high spatial turnover in functions that were supported at high levels. Our findings have major implications for forest management and indicate that biotic homogenization can have previously unrecognized and negative consequences for large-scale ecosystem multifunctionality.It is widely established that high local-scale biodiversity increases levels of individual ecosystem functions in experimental ecosystems (1–4), and that biodiversity is even more important for the simultaneous maintenance of multiple functions at high levels (i.e., ecosystem multifunctionality) (5–8). Because the capacity of natural ecosystems to maintain multiple functions and services is crucial for human well-being (9), the positive diversity–multifunctionality relationship is often used as an argument to promote biodiversity conservation (6, 10). However, although society seeks to maximize the delivery of potentially conflicting ecosystem services, such as food production, bioenergy generation, and carbon storage at the landscape scale (11–13), research into the relationship between biodiversity and ecosystem multifunctionality has been largely limited to local-scale studies, where diversity is manipulated in experimental plant communities. Although some studies have focused on more natural communities distributed over larger spatial extents (e.g., 14–16), they examined relationships between local-scale biodiversity and local-scale multifunctionality. The only previous study to investigate multifunctionality at larger scales (17) simulated artificial landscapes using data from experimental grassland communities. It showed that although different aspects of biodiversity affected multifunctionality, local-scale (α-) diversity was a much stronger driver than the turnover of species between sites (β-diversity). However, whether those findings can be extrapolated to real-world (i.e., natural, seminatural) ecosystems, such as forests, is unknown. As a result, we have a poor understanding of how multifunctionality relates to biodiversity at the larger spatial scales that are most relevant to ecosystem managers. This question is of particular concern, given recent findings suggesting that human-driven homogenization of communities [loss of β-diversity (18–21)] may be just as widespread as α-diversity declines (22, 23).Multifunctionality can be measured by a variety of methods, and the most appropriate means of doing so remains unresolved (24–27), particularly at larger scales, where the desired distribution of ecosystem function across the landscape has not been quantified. At local scales, one can quantify ecosystem multifunctionality as the number of ecosystem functions that exceed a given threshold value, where the threshold equals a certain percentage of the maximum observed value of each function (10, 24) (hereafter “threshold-based multifunctionality”; Fig. 1B). This threshold reflects the minimum value of ecosystem functioning that is deemed satisfactory. Because trade-offs between ecosystem functions or services are commonplace (5, 7, 28, 29), it is often impossible to maximize all of the desired functions in a local community (6). However, when different species provide different functions (5, 7) at larger spatial scales, a high spatial turnover in community composition (i.e., a high β-diversity) across the landscape can cause different parts of the landscape to provide different functions at high levels (defined as high threshold-based β-multifunctionality; Fig. 1B). Therefore, high β-diversity might cause all desired ecosystem functions to be provided at high levels in at least one patch within a landscape [and hence promote threshold-based landscape-scale or γ-multifunctionality (30)] (Fig. 1B), but only if (i) species differ in the functions they support and (ii) there is no “superspecies” that supports the majority of functions. This threshold-based γ-multifunctionality may be relevant for cases where forest landscapes are managed for many different services (e.g., timber production, limitation of nutrient runoff, ecotourism), but where each of these services only needs to be provided at high levels in a part of the landscape, not everywhere (31). Alternatively, a manager may seek to promote the total delivery of many summed individual ecosystem functions across a landscape. We define this total delivery as sum-based γ-multifunctionality (Fig. 1B). This metric may be a more appropriate measure of multifunctionality in cases where the benefits of ecosystem services are manifested at large scales, such as carbon sequestration or water purification (32). In this case, β-diversity might only promote sum-based γ-multifunctionality if nonadditive diversity effects, such as resource partitioning, species-environment matching, or spillover effects, operate at relatively large spatial scales (33, 34). It is therefore likely that the importance of β-diversity for γ-multifunctionality varies depending on the desired pattern of ecosystem service provision.Open in a separate windowFig. 1.Quantifying biodiversity and multifunctionality across spatial scales. The light yellow areas represent hypothetical landscapes, consisting of (white) local communities. In these communities, some species are present (colored icons in A and C), whereas others are absent (gray icons). Similarly, some functions are performing above a hypothetical threshold of 0.5 (colored icons in B), whereas others are not (gray icons). Diversity and threshold-based multifunctionality are quantified at (i) the local plot (α-) scale as the number of species present (two and three in A) or functions performing above a given threshold (two and three in B), (ii) the β-scale as the turnover in species composition [ = 1 ? log((a + b + 2c)/(a + b + c)) = 1 ? log((1 + 2 + 2)/(1 + 2 + 1)) = 0.90 in A (49)] or functions [ = 1 ? log((a + b + 2c)/(a + b + c)) = 1 ? log((1 + 2 + 2)/(1 + 2 + 1)) = 0.90 in B (49)] across plots, and (iii) the landscape (γ-) scale as the number of functions (four in B) present in at least one plot. Sum-based γ-multifunctionality is defined as the sum of all standardized ecosystem values in a landscape (= 0.8 + 0.2 + 0.7 + 0.4 + 0.9 + 1.0 + 0.1 + 0.6 = 4.7). In contrast to threshold-based multifunctionality, sum-based multifunctionality is not analogous to biodiversity (where species are either present or absent), and can therefore not be partitioned into α- or β-components. (C) This framework allows investigation of whether γ-multifunctionality is promoted by α- and/or β-diversity.Forests provide many ecosystem services, including wood production, regulation of water quality and climate, and recreation (35, 36). Most present-day European forests and almost all forest plantations worldwide are dominated by only one or a few tree species (15, 37), although their diversity could be promoted relatively easily by planting more species or by encouraging natural regeneration. This fact makes the understanding of diversity–multifunctionality relationships in these ecosystems highly relevant for forest management.We therefore assessed the importance of α- and β-diversity of tree species in driving γ-multifunctionality in mature European forests. To do so, we used data taken from a pan-European forest dataset consisting of 209 forest plots, specifically selected to investigate relationships between tree diversity and ecosystem functioning by maximizing variation in dominant “target” species richness and minimizing (i) variation in other potential drivers of ecosystem function (e.g., soil and climatic conditions) and (ii) covariation between tree α-diversity, species composition, and environmental variables as much as possible (38). Our plot selection therefore aimed to mimic biodiversity experiments to investigate relationships between biodiversity and ecosystem functioning in mature forests, which are difficult to undertake with manipulative approaches due to the longevity of tree species. The plots were widely distributed across six European countries, spanning boreal to Mediterranean zones and representing six major European forest types (38). In each plot, 16 ecosystem processes, functions, or properties (termed “functions” hereafter) were measured. These functions represented a wide range of supporting, provisioning, regulating, and cultural ecosystem services (sensu 9) (SI Appendix, Table S3). Next, we created simulated landscapes by randomly drawing plots from a country to generate a “landscape” of five plots, from which γ-multifunctionality was calculated. We then explored relationships between α- and β-diversity and different measures of γ-multifunctionality: threshold-based γ-multifunctionality, quantified as the number of functions with levels above a threshold [a certain percentage of maximum functioning observed across all plots (10)] in at least one plot of the landscape (quantification is shown in Fig. 1B), and sum-based γ-multifunctionality, quantified as the sum of scaled values of all functions across all plots within a landscape (quantification is shown in Fig. 1B). To demonstrate how α- and β-diversity can promote threshold-based γ-multifunctionality, we also measured the relationships between both α- and β-diversity and threshold-based α- and β-multifunctionality (quantification is shown in Fig. 1B).     

Different pathways to children’s enjoyment of participation in daily activities

Background: The enjoyment arising from participating in an activity is considered to be related to health and well-being. However, only a few studies have focused on children’s enjoyment of participation.

Aim: To assess the contribution of various individual factors to the total explained variance of children’s enjoyment of participation from the perspectives of parents and children.

Methods: Ninety-eight typically developed children were evaluated using motor and cognitive tests; they completed the Children’s Assessment of Participation and Enjoyment. Their parents completed the Children Participation Questionnaire, the Performance Skills Questionnaire, and the Strengths and Difficulties Questionnaire.

Results: Age and gender were found to be significant predictors. Parents perceived enjoyment to be associated with their child’s performance skills and the efficient execution of daily tasks. Children perceived enjoyment to be associated with their psychosocial functioning.

Conclusions: The contribution of performance skills exceeds the contribution of motor or cognitive ability to the total explained variance of a child’s enjoyment of participation. A gap exists, however, between the perspectives of children and parents regarding enjoyment of participation. Enhancing participation is a central goal of the occupational therapy domain and process; our findings may provide insights into possible pathways to accomplish this goal.