[Show abstract][Hide abstract] ABSTRACT: Study design:This was a prospective cohort study.Objectives:The objective was to describe the incidence, prevalence, characteristics of pressure ulcers (PUs) and the association with specific patient characteristics in a consecutive sample of in-patients with a spinal cord injury (SCI).Setting:An acute care and rehabilitation clinic specialized in SCIs in Switzerland.Methods:The presence and characteristics of PUs for all adult patients with a SCI admitted to the clinic from 1 September 2009 to 28 February 2010 were recorded on a daily basis during their complete hospitalization. Risk factors were analyzed in univariate and multivariate logistic regression models.Results:A total of 185 patients were included in the study and observed for the entirety of their hospitalization. The prevalence of at least one PU was 49.2% in all patients, compared with 25.4% in the group of patients admitted without PUs. The incidence was 2.2 per person and year. In 91 patients, a total of 219 PUs were observed. PUs were most frequently located on the foot (36.1%), and the coccyx/sacrum (15.1%). The risk for occurrence of a PU increased with age (odds ratio (OR)=1.04) and post SCI (OR=1.03). In the multivariate analyses, the risk for PUs was lower for patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) of C or D (ORC=0.25, ORD=0.28) compared with patients with an AIS of A.Conclusion:Using a daily documentation system, PUs were detected as a frequent complication of SCIs. Completeness of injury, age and time since injury were significant risk factors for PUs. The foot was a region at high risk for PUs.Spinal Cord advance online publication, 3 September 2013; doi:10.1038/sc.2013.91.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Medical work capacity evaluations play a key role in social security schemes because they usually form the basis for eligibility decisions regarding disability benefits. However, the evaluations are often poorly standardized and lack transparency as decisions on work capacity are based on a claimant's disease rather than on his or her functional capacity. A comprehensive and consistent illustration of a claimant's lived experience in relation to functioning, applying the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets (ICF-CS), potentially enhances transparency and standardization of work capacity evaluations. In our study we wanted to establish whether and how the relevant content of work capacity evaluations can be captured by ICF-CS, using disability claimants with chronic widespread pain (CWP) and low back pain (LBP) as examples. METHODS: Mixed methods study, involving a qualitative and quantitative content analysis of medical reports. The ICF was used for data coding. The coded categories were ranked according to the percentage of reports in which they were addressed. Relevance thresholds at 25% and 50% were applied. To determine the extent to which the categories above the thresholds are represented by applicable ICF-CS or combinations thereof, measures of the ICF-CS' degree of coverage (i.e. content validity) and efficiency (i.e. practicability) were defined. RESULTS: Focusing on the 25% threshold and combining the Brief ICF-CS for CWP, LBP and depression for CWP reports, the coverage ratio reached 49% and the efficiency ratio 70%. Combining the Brief ICF-CS for LBP, CWP and obesity for LBP reports led to a coverage of 47% and an efficiency of 78%. CONCLUSIONS: The relevant content of work capacity evaluations involving CWP and LBP can be represented by a combination of applicable ICF-CS. A suitable standard for documenting such evaluations could consist of the Brief ICF-CS for CWP, LBP, and depression or obesity, augmented by additional ICF categories relevant for this particular context. In addition, the unique individual experiences of claimants have to be considered in order to assess work capacity comprehensively.
BMC Public Health 12/2012; 12(1):1088. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AIM: To examine whether the International Classification of Functioning, Disability and Health can be used as standard language to express intervention goals on the part of nurses caring for persons with spinal cord injury. BACKGROUND: This classification is multipurpose and is designed to organize a wide range of health-related information that can be used in any healthcare context and especially by interdisciplinary teams. DESIGN: A three-round, consensus-building, electronic-mail survey using the Delphi technique. METHODS: In the Delphi process spinal cord injury nurses were asked to name the problems, resources, and aspects of the environment that they address when treating patients with spinal cord injury. The answers were linked to the categories of the International Classification of Functioning, Disability and Health. The study was carried out in 2007. RESULTS: Nurses (N = 35) from 17 countries provided 823 answers that were linked to a set of 143 categories, 24 personal factors, and 51 concepts categorized as 'Not-covered', of which 32 were areas of fundamental importance to nurses. These were mainly risks that persons with spinal cord injury may face, such as the risk for future impairments. CONCLUSION: The use of the data set resulting from this study should help determine and document the needs that pertain to spinal cord injury nursing on an international level. Future research should confirm the usefulness of such a data set in clinical practice and can contribute to the update process of the International Classification of Functioning, Disability and Health.
Journal of Advanced Nursing 07/2012; · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article was to describe and to apply a comprehensive set of guiding principles in the selection of measurement instruments for a longitudinal epidemiologic study focusing on functioning using the International Classification of Functioning, Disability, and Health (ICF) as reference framework. Based on the literature, the ICF linkage rules, and the definition of ICF categories to be measured, the following guiding principles for selecting measurement instruments are defined: redundancy, efficiency, level of detail of information, comparability, feasibility, and truth and discrimination. Examples illustrate that the application of guiding principles allows for a systematic and reasoned process of measurement instrument selection and thus offers a potential solution for the multifaceted challenges that one encounters in the selection of measurement instruments. It is transparently demonstrated how the ICF linkage rules enable researchers to address issues such as efficiency, comparability, and redundancy and how the definition of a set of ICF categories to be measured allows assessing inefficiencies in measurement instruments. Because of the ICF linkage rules and the definition of ICF categories to be measured, new guiding principles for selecting measurement instruments emerge. The main challenges lie in the difficulty to quantify and prioritize the applicability of guiding principles and the fact that they strongly interact. Notably, the prioritization and application of guiding principles must be defined considering the specific characteristics and aims of the specific study.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 11/2011; 90(11 Suppl 2):S29-38. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The overall goal of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) is to gain a better understanding of how to support functioning, health maintenance, and quality-of-life of persons with spinal cord injury (SCI) along the continuum of care, in the community, and along their life span. The purpose of this study was to present the SwiSCI study design. SwiSCI is composed of three complementary pathways and will include Swiss persons 16 yrs or older who have diagnoses of traumatic or nontraumatic SCI. Pathway 1 is a retrospective study of medical files of patients admitted to one of the collaborating SCI centers between 2005 and 2009. Pathway 2 is a nationwide survey of persons with chronic SCI. Pathway 3 is an inception cohort study including persons with newly acquired SCI. SwiSCI is conducted in collaboration with the Swiss Paraplegic Association and the major specialized rehabilitation centers in Switzerland. Measurement instruments that are to be used in Pathway 2 and 3 cover body structures and functions, activities, participation, life satisfaction, and personal and environmental factors. SwiSCI is a prospective cohort study that will contribute to a comprehensive understanding of the lived experience of persons with SCI.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 11/2011; 90(11 Suppl 2):S5-16. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this article were to (1) answer the question of what to measure in a cohort study in which the main focus is the understanding of functioning over time for a specific population and to (2) describe the process of determining what to measure using a theory-informed selection of domains of functioning based on the International Classification of Functioning, Disability and Health (ICF). The Swiss Spinal Cord Injury Cohort Study, a cohort study being carried out in Switzerland for a population of persons with spinal cord injury, was used as an example. A set of domains for the Swiss Spinal Cord Injury Cohort Study was identified demonstrating the application of the methodology. This set consisted of 45 categories of the ICF. Defining what to measure using the ICF is a valuable technique for the cohort researcher because it guarantees comparability of data and comprehensiveness of scope, enhancing the prospects of the study results being understood and is consequently used by health professionals as well as in other contexts, such as in health and social policy.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 11/2011; 90(11 Suppl 2):S17-28. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this paper was to examine whether large longitudinal studies have comprehensively covered the functioning of persons with spinal cord injuries (SCI), using the International Classification of Functioning, Disability and Health (ICF) as reference framework. First, the literature was reviewed to select relevant studies. Second, category specifications measured in the included studies were linked to the ICF and compared with the Brief ICF Core Sets for postacute and chronic situations. Finally, all measurement instruments used to assess these category specifications were listed according to the corresponding ICF category. Four studies were included: the National SCI Database in the United States, the Australian SCI Register, the European Multicenter Study about SCI, and the Dutch research program "Restoration of mobility in SCI rehabilitation." All measures could be linked to the ICF Core Sets. However, all studies only partly covered (range, 14-27) the 49 categories of the Brief ICF Core Sets. Least well covered were categories of body structures and environmental factors. Besides the International Standards for Neurological Classification of SCI (American Spinal Injury Association Impairment Scale), the areas of functioning were measured using the same measurement instruments in all studies. None of the included longitudinal studies comprehensively cover functioning. There is the need to develop truly comprehensive longitudinal studies in SCI.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 11/2011; 90(11 Suppl 2):S39-49. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The FIM instrument is broadly applied in varying rehabilitation services for outcome assessment. Thus, it is important to examine its applicability for services which may differ from the situations and patients for which it was originally developed. The aims of the present study were to examine 1) whether the four FIM dimensions "activities of daily living", "sphincter management", "mobility", and "executive function" can be retrieved by Latent Class Factor Analysis (LCFA); and 2) whether the four dimensions show floor effects in patients with acquired brain injuries undergoing intensive post-acute rehabilitation.
We analyzed the FIM data of 269 patients with acquired brain injuries undergoing intensive post-acute rehabilitation. To examine the dimensional structure of the FIM instrument we carried out LCFA. Cronbach's alpha was used to measure the internal consistency. We examined the distribution of the dimension scores to identify floor effects.
LCFA confirmed the postulated four dimensions. The explained variance of items assigned to the four dimensions ranged from 46% to 89%. Cronbach's alpha coefficients of the four subscales ranged from 0.94 to 0.96. The percentage of patients scoring the minimum possible score in each of the retrieved dimensions ranged from 22.3% to 47.9%.
When applying the FIM instrument to patients undergoing intensive neurological rehabilitation its dimensionality should be kept in mind. For some patients this outcome measure might not be discriminative enough due to floor effects.
European journal of physical and rehabilitation medicine 03/2011; 47(1):25-34. · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study is to identify relevant aspects of functioning as well as related environmental factors from the perspective of health professionals worldwide experienced in treating persons with any kind of (primary) sleep disorder.
A structured email survey was sent to 174 selected international experts. Using six open-ended questions, physicians, nurses, therapists, technicians, biologists and psychologists were asked to indicate the problems in functioning experienced by individuals with (primary) sleep disorders including contextual factors like environmental and personal factors which influence functioning. The International Classification of Functioning, Disability and Health (ICF) was used as a frame of reference to analyse the data. All answers were translated ("linked") to the ICF based on established coding rules. Absolute and relative frequencies of the linked ICF categories were reported.
One hundred and twenty-three experts (70.7%) from six World Health Organization (WHO) regions (54 countries) mentioned 5200 themes which were linked to 7256 ICF categories. The majority of these linkings (33.3%) were attributed to 58 different ICF categories of the ICF component body functions, followed by 21.8% of linkings to 52 categories of environmental factors, 16.1% of linkings to 49 different categories in activities and participation, and 9.7% of linkings to 29 categories of body structures.
Health professionals addressed a large variety of functional problems reflecting the complexity of sleep disorders. The ICF provided a comprehensive framework in order to integrate answers from different professional backgrounds and different world regions.
Sleep Medicine 01/2011; 12(1):97-101. · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001.
The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application.
A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009.
The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.
Disability and Rehabilitation 11/2010; 33(4):281-309. · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite of the patients' individual health status, particularly with respect to functioning status, individual need for nursing care, and severity of symptoms. The International Classification of Functioning, Disability and Health (ICF) and the derived subsets, the so-called ICF Core Sets, are a standardized approach to describe patients' functioning status. The objectives of this study were to (1) examine the association between patients' functioning, as encoded by categories of the Acute ICF Core Sets, and nursing workload in patients in the acute care situation, (2) compare the variance in nursing workload explained by the ICF Core Set categories and with the Barthel Index, and (3) validate the Acute ICF Core Sets by their ability to predict nursing workload.
Patients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression.
In patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%).
A substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial.
BMC Health Services Research 10/2010; 10:295. · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper presents a discussion of the conceptual and practical relationships between the International Classification of Functioning, Disability and Health and the NANDA-International Taxonomy II for nursing diagnoses, and their use in nursing practice.
The ICF provides a common classification framework for all healthcare professionals, including nurses. Nursing care plans can be broadly based on NANDA-I taxonomies. No published attempt has been made to systematically compare the NANDA-I Taxonomy II to the ICF.
The most recently published descriptions of both classifications and a case example presenting the combined use of both classifications. The work was carried out in 2009.
There are conceptual commonalities and differences between the ICF and the NANDA-I Taxonomy II. In the case example, the overlap between the ICF categories and NANDA-I nursing diagnoses reflects the fact that the ICF, focusing on functioning and disability, and the NANDA-I Taxonomy II, with its functioning health patterns, are similar in their approaches.
The NANDA-I Taxonomy II permits the fulfilment of requirements that are exclusively nursing issues. The application of the ICF is useful for nurses to communicate nursing issues with other healthcare professionals in a common language. For nurses, knowledge shared with other healthcare professionals may contribute to broader understanding of a patient's situation.
The ICF and the NANDA-I Taxonomy II should be used in concert by nurses and can complement each other to enhance the quality of clinical team work and nursing practice.
Journal of Advanced Nursing 08/2010; 66(8):1885-98. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Worldwide Internet survey.
The specific aims of the study were (1) to identify problems of individuals with SCI in the early post-acute and the long-term context, respectively, addressed by health professionals and (2) to summarize these problems using the ICF.
Physicians, nurses, physical therapists, occupational therapists, social workers and psychologists were asked for problems in the functioning and contextual factors of individuals with SCI using open-ended questions. All answers were translated ('linked') to the ICF based on established rules. Absolute and relative frequencies of the linked ICF categories were reported stratified by the context.
Out of 243 selected experts, 144 (59.3%) named 7.650 different themes, of which 78.8% could be linked to ICF categories. In the early post-acute context, 30.7% of the 88 categories belonged to the component Body Functions, 14.8% to Body Structures, 30.7% to Activities and Participation and 23.9% to Environmental Factors. In all, 16 ICF categories were unique for the early post-acute context. In the long-term context, 27.2% of the 92 categories belonged to the component Body Functions, 13.0% to Body Structures, 35.9% to Activities and Participation and 23.9% to Environmental Factors. A total of 20 ICF categories were unique for the long-term context.
Health professionals identified a large variety of functional problems reflecting the complexity of SCI. Unique aspects of functioning exist for the early post-acute and the long-term context, respectively. The ICF provided a comprehensive framework to integrate answers from different professional backgrounds and different world regions.
[Show abstract][Hide abstract] ABSTRACT: 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.
The objective of this study was to validate this ICF Core Set from the perspective of nurses.
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.
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.
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.
International journal of nursing studies 06/2009; 46(10):1320-34. · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The recovery of patients after an acute episode of illness or injury depends both on adequate medical treatment and on the early identification of needs for rehabilitation care. The process of early beginning rehabilitation requires efficient communication both between health professionals and the patient in order to effectively address all rehabilitation goals. The currently used nursing taxonomies, however, are not intended for interdisciplinary use and thus may not contribute to efficient rehabilitation management and an optimal patient outcome. The ICF might be the missing link in this communication process. The objective of this study was to identify the categories of the International Classification of Functioning, Disability and Health (ICF) categories relevant for nursing care in the situation of acute and early post-acute rehabilitation.
First, in a consensus process, "Leistungserfassung in der Pflege" (LEP) nursing interventions relevant for the situation of acute and early post-acute rehabilitation were selected. Second, in an integrated two-step linking process, two nursing experts derived goals of LEP nursing interventions from their practical knowledge and selected corresponding ICF categories most relevant for patients in acute and post-acute rehabilitation (ICF Core Sets).
Eighty-seven percent of ICF Core Set categories could be linked to goals of at least one nursing intervention variable of LEP. The ICF categories most frequently linked with LEP nursing interventions were respiration functions, experience of self and time functions and focusing attention. Thirteen percent of ICF Core Set categories could not be linked with LEP nursing interventions. The LEP nursing interventions which were linked with the highest number of different ICF-categories of all were "therapeutic intervention", "patient-nurse communication/information giving" and "mobilising".
The ICF Core Sets for the acute hospital and early post-acute rehabilitation facilities are highly relevant for rehabilitation nursing. Linking nursing interventions with ICF Core Set categories is a feasible way to analyse nursing. Using the ICF Core Sets to describe goals of nursing interventions both facilitates inter-professional communication and respects patient's needs. The ICF may thus be a useful framework to set nursing intervention goals.
[Show abstract][Hide abstract] ABSTRACT: ObjectiveTo provide an example of how goals of physiotherapy interventions and their typical patterns can be described using the International Classification of Functioning, Disability and Health (ICF).DesignCross-sectional study.SettingAcute hospital.ParticipantsOne hundred patients with neurological, musculoskeletal or cardiopulmonary conditions requiring physiotherapy interventions in University Hospital Zurich between January 2003 and October 2003.Main outcome measuresThe case record form consisted of two parts: a standardised questionnaire for functioning and health of the patient; and a standardised record form for physiotherapy interventions. Both parts were based on the ICF.ResultsThe mean age of the subjects was 58.2 years (standard deviation 15.9), the median age was 60.5 years and 44% were female. The most frequent intervention goals in patients with neurological conditions were: muscle power functions; muscle tone functions; control of voluntary movement functions; changing basic body position; maintaining a body position; and transferring oneself. The most frequent intervention goals for cardiopulmonary patients were: functions of the cardiovascular system; and respiration functions. The most frequent intervention goals in patients with musculoskeletal conditions were: sensation of pain; stability of joint functions; muscle power functions; muscle tone functions; and muscle endurance functions.ConclusionBy using the ICF as a framework and linguistic support, intervention goals can serve as standardised documentation for physiotherapy interventions, their evaluation and planning.
[Show abstract][Hide abstract] ABSTRACT: The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive and internationally acknowledged framework for the description of human functional health, which covers all aspects of health and some health-related elements of well-being. The ICF is part of the classification family of the World Health Organisation (WHO) and can be used by different health care disciplines as well as for different purposes. In order to promote the discussion about ICF within the nursing profession, the German speaking working group "ICF and Nursing" developed a position statement that critically reflects both the potentials and the restrictions of the ICF for use in nursing care, particularly for diagnostical purposes.
[Show abstract][Hide abstract] ABSTRACT: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with cardiopulmonary conditions in the acute hospital.
The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients.
Twenty-two experts selected a total of 48 second-level categories. The largest number of categories was selected from the ICF component Body Functions (21 categories or 44%). Four (8%) of the categories were selected from the component Body Structures, 10 (21%) from the component Activities and Participation, and 13 (27%) from the component Environmental Factors.
The Acute ICF Core Set for patients with cardiopulmonary conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.
Disability and Rehabilitation 01/2005; 27(7-8):375-80. · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were (1) to determine whether the ICF covers the goals of nursing interventions and (2) to identify the areas of functioning, disability and health most relevant to nursing practice of neurological patients with early post-acute rehabilitation needs.
This cross-sectional study on nursing interventions is part of a larger multicentric cross-sectional study describing functioning, disability and health. The nursing interventions were recorded by nurses in charge of the patient. According to established rules, the recorded nursing interventions were linked to the ICF.
One hundred and eighteen different nursing interventions were documented by the nursing staff. The intervention goals were linked to 67 different second-level ICF categories. Thirty belong to the component Body Functions, 19 to the component Body Structures, 13 to the component Activities and Participation, and five to the component Environmental Factors.
The fact that all nursing interventions in early post-acute rehabilitation facilities could be linked to ICF categories supports the usefulness of the ICF in nursing. Initial problems in adapting profession-specific terminology to the ICF framework can be overcome, as shown by our linking exercise. Further analyses will be needed to show if these theoretical findings are supported by empirical evidence.
Disability and Rehabilitation 01/2005; 27(7-8):431-6. · 1.54 Impact Factor