No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Systematic literature review on ICF from 2001 to 2009: Its use, implementation and operationalisation
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.
... To date, four literature reviews have been conducted on ICF [8][9][10] and ICF core sets [11]. The literature reviews show that most ICF studies have been conducted in Europe or the United States, and almost no studies have been conducted in African countries [9,10]. ...
... To date, four literature reviews have been conducted on ICF [8][9][10] and ICF core sets [11]. The literature reviews show that most ICF studies have been conducted in Europe or the United States, and almost no studies have been conducted in African countries [9,10]. The same trend can be identified for studies focusing on developing ICF core sets [11]. ...
... The literature studies that have been conducted since 2001 have focused on ICF in general [8][9][10] or the development of ICF core sets [11], but thus far, no literature reviews are focusing on the validation of ICF core sets. An initial search of validation literature indicates that the recommended guidelines, described by Grill [4], have been followed differently and that many different methods have been used in validation processes. ...
Objective: To investigate and summarize the literature on the validation of International classification of functioning, disability and health (ICF) core sets from 2001 to 2019 and explore what research methods have been used when validating ICF core sets.
Methods: The current study is a scoping review using a structured literature search.
Results: In total, 66 scientific articles were included, of which 23 ICF core sets were validated. Most validation studies were conducted in Europe using a qualitative methodology and were validated from the perspective of patients. Analysis methods differed considerably between the studies, and most ICF core sets were validated only once for a single target population or from a single perspective. The comprehensive core sets were validated more often than the brief core sets, and core sets for stroke and low back pain were validated most often.
Conclusion: The results of the current study show that only 66% of the existing ICF core sets are validated. Many of the validation studies are conducted in a European context and from a single perspective. More validation studies of ICF core sets from the perspective of both patients and professionals are needed.
• Implications for rehabilitation
• ICF core sets aim to facilitate assessments in clinical settings and research.
• Validation studies indicate in general that the ICF core sets are valid and relevant for patients and professionals in the specific areas explored and thus can be used in rehabilitation settings.
• To improve the quality of ICF core sets, more validation studies are needed for ICF core sets not yet tested and for ICF core sets that have been validated only in one study or for one specific population or target group.
... Apesar do arcabouço teórico no qual a CIF está fundamentada e de sua aplicação em diversos estudos, transpô-la para a rotina clínica dos profissionais de saúde tem sido um outro desafio (CERNIAUSKAITE et al., 2011;BERGMANN;BAHIA, 2014;MARITZ;ARONSKY;PRODINGER, 2017). Dentre os motivos citados estão à carência da formação profissional baseada em novos modelos em saúde, a abrangência da CIF e a falta de clareza para seu uso (CASTANEDA; CASTRO, 2013;BRASILEIRO;MOREIRA;BUCHALLA, 2013;BERGMANN;BAHIA, 2014;MARITZ;ARONSKY;PRODINGER, 2017). ...
... Embora seja crescente o número de publicações que apresentam a utilização da CIF na formação de profissionais de saúde, ainda é muito menor que o de estudos teóricos conceituais, com aplicação da CIF em determinadas condições de saúde, dos de desenvolvimento de instrumentos e listas de categorias baseados na CIF e dos de ligação de instrumentos da prática com a CIF (JELSMA, 2009;CERNIAUSKAITE et al., 2011;BORNBAUN et al., 2015;MADDEN et al., 2019). ...
... Porém, para que a CIF seja aplicada conforme as recomendações da OMS, é essencial que os profissionais aprendam a utilizá-la. Para que esta aprendizagem seja efetiva, é necessário que a CIF esteja inserida na formação do profissional, contexto que parece ser a chave para prover as mudanças culturas vinculadas à transposição do paradigma de saúde (JELSMA, 2009;CERNIAUSKAITE et al., 2011;WIEGAND, et al., 2012;ORGANIZAÇÃO MUNDIAL DA SAÚDE, 2013;MARITZ, et al., 2017;MADDEN, et al., 2019;STUCKI;RUBINELLI;BICKENBACH, 2020;CASTANEDA, 2020). ...
... Furthermore, the ICF was developed to establish a common language in describing health and improve communication between health care workers from different professional backgrounds or segments of the health care system. The implementation of the ICF in clinical practice, however, progresses slowly [2][3][4]. With 1424 categories and a multidimensional structure, the ICF is complex to use. ...
... Since the ICF was developed to facilitate interprofessional communication, we included participants with different professional backgrounds. After an introduction to the study and previous results, we discussed several key issues with the participants: (1) whether a modular Core Set is a sensible modification to suit the structure of SUD health services, or if a Core Set of regular structure (brief and comprehensive Core Sets) would be more suitable, (2) how the modular Core Set should be designed to best meet the needs of potential users, (3) what maximum number of categories the participants deemed feasible, (4) if the MCSS should contain capacity or performance qualifiers within the activities and participation component, and (5) if the MCSS should feature the generic 0-4 rating scale of the ICF or the underlying percentage scale with values from 0% to 100%. After discussion we presented the pool of candidate categories, including all prior ratings by experts and patients. ...
... MCSS. This result is not necessarily to be expectedmost ICF Core Sets contain a substantial share of body functions [2]. The comparison with the treatment goals reported by patients and practitioners showed that the MCSS is well-suited to capture its important aspects. ...
Purpose
We aimed to develop a modular Core Set based on the International Classification of Functioning, Disability and Health (ICF) for describing functioning in patients with substance use disorders (SUDs). To match the structure of the German health service system, the Core Set was split into modules for different service segments.
Methods
We followed a consensus process including several preparatory studies. To identify candidate ICF categories, we performed an ICF linking of guideline-recommended assessments, patient focus groups and patient and expert surveys. Categories were prioritized for different service segments and compiled into preliminary modules. The Core Set was tested in 13 treatment sites. Health professionals rated each category’s relevance, and contents of the Modular ICF-based Core Set for SUDs (MCSS) were compared to patient-reported treatment goals. An advisory board decided on revisions to the MCSS.
Results
The MCSS consists of a basic module (25 categories) and five additional modules for these treatment segments: counselling (8), qualified withdrawal (6), orientation (7), rehabilitation (32), and social integration services (10).
Conclusions
The MCSS provides a framework for harmonizing communication, documentation and interface management in German SUD health services. The basic module, consisting of 25 categories, can be employed as a Brief ICF Core Set.
•
Implications for rehabilitation
• The MCSS can serve as a standard for describing functioning in patients with SUDs in Germany, as well as harmonize communication and reporting of treatment relevant information.
• In clinical practice, the MCSS can be used for the structured assessment of psychosocial problems and participation restrictions, goal setting, and outcome evaluation.
• Although the MCSS was developed in Germany, its proximity to the themes frequently identified in the literature regarding SUDs internationally suggests that it may be of use in other countries as well.
• The basic module may be employed as a Brief ICF Core Set.
... O modelo proposto abarca conhecimentos dos modelos médico e social, combinando-os em uma abordagem biopsicossocial que integra as dimensões biológica, individual e social de saúde e funcionalidade. 1 A CIF propõe a compreensão de saúde e funcionalidade por meio de relações não-lineares entre as estruturas e funções corporais, as atividades do dia a dia e os fatores contextuais, i.e., pessoais e ambientais, que influenciam a participação social. 2,3 Nesse contexto, a funcionalidade é um componente da saúde e o ambiente pode se apresentar como um facilitador ou uma barreira para o desempenho das atividades. 4 A resolução 54.21/2001 da Organização Mundial da Saúde recomenda a seus países membros que a CIF seja utilizada por todos os profissionais da saúde. ...
... A maioria dos estudos incluídos nas revisões (60 a 90%) apresentava descrição conceitual da CIF em contextos clínicos ou análises de sua associação a instrumentos de medida existentes. 2,9 Os demais estudos a utilizavam para nortear a seleção dos desfechos em estudos clínicos (10 a 30%) ou apenas mencionavam a classificação (10%). 2,8 Mais recentemente, um estudo 10 avaliou o perfil e percepções de 1313 fisioterapeutas e terapeutas ocupacionais profissionais da saúde sobre a CIF. ...
... 2,9 Os demais estudos a utilizavam para nortear a seleção dos desfechos em estudos clínicos (10 a 30%) ou apenas mencionavam a classificação (10%). 2,8 Mais recentemente, um estudo 10 avaliou o perfil e percepções de 1313 fisioterapeutas e terapeutas ocupacionais profissionais da saúde sobre a CIF. ...
Objetivo: Identificar os fatores contextuais (i.e., fatores pessoais e fatores relacionados ao trabalho) associados ao uso clínico da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) por fisioterapeutas. Métodos: Foi realizado um estudo exploratório do tipo survey. O questionário Barreiras pessoais e ambientais para implementação da CIF por fisioterapeutas” foi enviado aos fisioterapeutas do Espírito Santo, Brasil. Análise de regressão logística foi usada para explorar associações entre características pessoais e organizacionais com educação, atitudes, crenças, interesses, percepção de suporte e disponibilidade de recursos no ambiente de trabalho para uso da CIF na prática clínica. Resultados: A taxa de resposta para a maioria das análises foi 46% (n= 59). Seis características explicaram 35% da variação associada a interesses, atitudes e crenças para o uso da CIF (X²= 16.6, p= 0.01). Três características explicaram 24% da variação associada à educação para o uso da CIF (X²= 8.9, p= 0.03). Três características explicaram 61% da variação associada à percepção de suporte e disponibilidade de recursos para o uso da CIF (X²= 30.5, p<0.01). A barreira mais citada foi dificuldade ao aplicar a CIF para avaliar pacientes (62%). Conclusão: Os fisioterapeutas possuem atitudes positivas em relação ao uso da CIF, mas a grande maioria não recebeu formação acadêmica adequada e reporta autoeficácia insuficiente para seu uso na prática clínica. É necessária a adoção de uma infraestrutura organizacional que endosse o uso clínico da CIF alinhada à modificação nos currículos de formação e capacitação continuada.
... Additionally, the iCF framework established a common language to improve communication between different stakeholders, such as care providers, receivers, health professionals, issuers, and policymakers (Sagahutu et al., 2021), which may also contribute to a more standardized approach to PCC. A systematic review on iCF from 2001 to 2009 showed that the iCF has been used for a variety of objectives, in research, policy, education, clinical practice, and rehabilitation (Cerniauskaite et al., 2011). Based on the identified research trends, these relatively new areas likely continue expanding (Madden & Bundy, 2019). ...
... Results provide a comprehensive overview of the study characteristics, study design, purposes, and main findings. Since the iCF was approved by the world Health Assembly in 2001, it is increasingly used in healthcare, research, policy and planning, occupational care, and education (Cerniauskaite et al., 2011;Jelsma, 2009). To the best of our knowledge, this was the first study to map the current use of the iCF in persons living with dementia. ...
Objectives:
The International Classification of Functioning, Disability and Health (ICF) endorsed by the World Health Organization provides a conceptual framework for describing functioning and disability based on a biopsychosocial model. Although dementia is one of the leading causes of disability, yet little is known on the extent to how the ICF has been utilized in dementia research and practice. The study aimed to examine and map the current applications of the ICF with dementia from a body of earlier studies and to explore the potential use in person-centred dementia care.
Methods:
The Arksey and O'Malley framework was used to guide the searching, selecting, and synthesizing process. The scoping review was reported following The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines.
Results:
A total of 34 studies were included. The applications of ICF were classified into 4 themes: (1) in clinical practice and the education of health professionals (n = 20); (2) community support services and income support (n = 3); (3) population-based, census, or survey data (n = 10); (4) advocacy and empowerment purposes (n = 1).
Conclusion:
The ICF has made a major impact on dementia in clinical settings. Findings strongly support applying the ICF to person-centered dementia care. In the future, more empirical studies are needed to expand the scope of ICF use in dementia research and practice.
... Clinical Rehabilitation Counseling specialty, which lists the Diagnostic and Statistical Model of Mental Disorders (DSM) as well as the International Classification of Diseases (ICD) but does not mention the ICF. Cerniauskaite et al. (2011) completed a thorough systematic review of 672 papers, spanning 34 countries and 211 different journals. Three electronic databases searched for the following keywords: "ICF," "international classification functioning disability health," "classification functioning," "classification disability," "classification handicap," and "classification health." ...
... Three electronic databases searched for the following keywords: "ICF," "international classification functioning disability health," "classification functioning," "classification disability," "classification handicap," and "classification health." Inclusion criteria ensured a publication date after ICF's release, that ICF was included in the title or abstract, and the language of the abstract was English; book chapters and papers only using persons under 18 years were excluded (Cerniauskaite et al., 2011). The majority of publications were conceptual papers (30.8%) or papers reporting clinical and rehabilitation studies (25.9%). ...
The WHO's (2001) International Classification of Functioning, Disability, and Health (ICF) model conceptualizes health from an ecological perspective. It has been implemented by many professionals as the standard health classification framework that guides providers' decisions regarding assessment tools and targeted interventions. Despite this model's prevalence among many healthcare providers, the ICF framework remains largely underutilized by many in the counseling fields. This conceptual paper provides an overview of the strengths of the ICF model and ICF-based measurements, and demonstrates its clinical, research, and educational value. A case study is presented to guide counselors and counselor educators through application of the ICF model in various contexts to encourage expanded use of the model. Use of the ICF model among counseling professionals, educators, and researchers is recommended as one way to enhance measurement of clinical outcomes.
... A forma para estabelecer a comparação das informações de saúde com base na CIF se deu através da relação de conteúdo comum entre a avaliação clínica realizada pelo profissional e o modelo da CIF (40,41) . Os checklists são compostos pelo menor número possível de categorias da CIF, mas tantas quantas necessárias para descrever o espectro de problemas que afetam a funcionalidade e saúde dos usuários e o tipo de assistência submetida (42)(43)(44)(45) . ...
... Como usá-la? indicadores mais qualificados (22)(23)(24)(38)(39)(40)(41)(42)(43)50) . ...
Trata-se de estudo de caso sobre a experiência de implementação da CIF em um Centro Especializado em Reabilitação. Relato o pprocesso de operacionalização da CIF na rotina do serviço e a percepção dos profissionais sobre a implementação.
... Complementing the ICF qualifier approach by framing the ICF stem question positively could encourage reflections around empowerment and RTW self-efficacy (27). We believe that the framing modification was important due to the impact ICF have, and will have, on clinical practice (18,30). The usage of ICF-based tools in the present study contributed to making ICF more applicable for clinical practice as well as during RTW follow up (18) where the focus was on opportunities for RTW, improving work ability, RTW expectations and RTW self-efficacy (6). ...
Background
The ICF model is applied as a conceptual framework in occupational rehabilitation in Norway.Objective
To systematically apply the ICF model in rehabilitation this study had the following aims: (1) apply an ICF subset by merging an ICF core set and an ICF set to assess functioning in rehabilitation patients related to work; (2) develop a patient-reported ICF questionnaire and a clinician-friendly ICF report complementing the clinician-rated ICF subset and (3) evaluate whether ICF-based tools (subset, questionnaire, report) support the communication between a clinical team, patient and jobcentre contacts during return to work (RTW) follow up.Methods
Forty-one patients completing four weeks rehabilitation were recruited. The patients were referred from general practitioners and jobcentres. The ICF subset was a combination of the EUMASS core set for disability evaluation and suggested ICF categories by experts in vocational rehabilitation from Iceland. A clinical rehabilitation team interviewed the patients using the ICF subset and problems were quantified on a generic qualifier scale for body functions, activities and participation and environmental factors. The research team and clinical team developed an ICF questionnaire, by cross-culturally adapting the Work Rehabilitation Questionnaire to Norwegian. The same teams also developed an ICF report. The rehabilitation clinic forwarded the report and questionnaire to the patients' jobcentre contact, which was responsible for the RTW follow up. To evaluate the benefits of ICF-based tools, the clinical team, user representative and jobcentre contacts together participated in four workshops. They were asked the degree to which and in what way the tools supported the communication between them.ResultsThe ICF subset captured RTW challenges but was found to be time consuming. The jobcentres experienced the ICF report and questionnaire beneficial in the follow up as it strengthened their RTW decision-making basis and communication with the rehabilitation clinic and the patients about follow-up interventions.Conclusion
The development and implementation of ICF-based tools for clinical practice was a preliminary success in supporting the communication between three stakeholders during RTW follow up. Future applications of ICF-based tools ought to integrate personal factors to capture both facilitators and barriers related to functioning and work, thus, getting closer to a holistic assessment.
... After its introduction in 2001, the ICF was almost immediately adopted in the field of clinical rehabilitation [16]. This is unsurprising, since the ICF provides a scholarly framework from which to approach complex societal problems specific to rehabilitation science [17]. ...
Purpose of the study:
The aim of the study was to describe how healthcare professionals at a neurorehabilitation facility currently use the International Classification of Functioning, Disability and Health (ICF) and to identify further possibilities for its future use.
Methods:
The study followed an interpretive description approach. Data were collected through four focus group discussions with 21 participants, all health care practitioners, at the study facility. Thematic analysis was conducted by coding the transcripts and generating themes.
Findings:
Three themes were generated: (1) Current use and gaps in use of the ICF, (2) a non-conducive environment and (3) using the ICF to facilitate holistic, patient-centred management. Current use of the ICF was limited. Gaps in use of the ICF was especially evident in goal setting practices. Goals were generic in nature and did not address participation and the environment. A lack of knowledge, debilitating interpersonal relationships and an unsupportive organisational culture created an environment non-conducive to the implementation of the ICF. Participants felt that the ICF can assist them to work more patient-centred.
Conclusion:
Participants perceived that the ICF has the potential to improve service delivery at the facility. The implementation process must be well structured, focus on practical use and be supported through an enabling environment created by management.IMPLICATIONS FOR REHABILITATIONThe ICF is not being optimally used in clinical rehabilitation practice, however healthcare practitioners perceive the ICF to have the potential to improve rehabilitation service delivery.Concerted action is required at institutional, interpersonal and individual level to create a conducive environment that facilitates the use of the ICF during rehabilitation service delivery.The ICF can be used to construct a team assessment document that promotes patient-centred goal setting and improves interdisciplinary communication.
... Mbogoni (2003) argued that global variations in disability rates are not related to disparities in rates of impairment (functional limitations residing within a person), but to the social construction of disability (both identification of impairment and the functional limitations resulting from social and environmental barriers to full participation in normative activities and roles). The International Classification of Functioning, Disability, and Health (ICF) attempts to disentangle limitations based on impairments from the functional limitations created by socio-environmental barriers preventing full community participation (Cerniauskaite et al. 2011;Kennedy 2003). The impulsion of creating the ICF was to shift dominant discourse away from degrees of "non-normalcy" towards a value-free description of human functioning and decrements of functioning (Ustun et al. 2003). ...
The objective of this community-based participatory research project was to develop a clinically useful, psychometrically-sound scale to measure community integration for adults with severe mental illness. Two researchers and an administrator of a behavioral health agency (BHA) recruited a group of providers, half with lived-experience of severe mental illness. Through a series of five focus groups, provider participants guided identification of four major domains of community integration and the development of 95 scale items; items and domains were reviewed by three external researchers with subject matter expertise. Initial pilot: BHA providers administered the scale to clients (n = 51) with 19 completing it twice to investigate internal consistency, test–retest reliability, and restricted variance and collinearity of items. Further piloting: providers at two BHAs administered the scale to clients (n = 178) to conduct exploratory factor analysis and analyze internal consistency. After initial pilot, 50 items remained post item reduction for restricted variance and collinearity, with Cronbach’s alpha of .95 and test–retest reliability of .90. After a larger pilot, a four-factor solution emerged, aligning conceptually with the four domains as anticipated; 33 items loaded (factor loadings ≥ .4), with RMSEA of .069 and overall Cronbach’s alpha of .89 (subdomains ranging .78–.86). The scale has good preliminary psychometric properties and appears to be feasible for use in BHAs for the purposes of research and evaluation, with clinical utility for assessment and treatment planning.
... This triggers healthcare professionals to assess all the domains of functioning and participation when working with their clients (31,32). Research demonstrates that ICF can be used directly for collecting data on functioning of clients (33)(34)(35). ...
Primary objective: The objective of this study was to design an instrument to screen for burden in the daily life of both the client with acquired brain injury (ABI) and their nonprofessional caregiver.
Research Design: Exploratory research
Methods and Procedures: Based on a survey amongst stakeholder organizations, the FINAH-instrument is designed as a digital self-assessment questionnaire, based on ICF-framework. A test survey of the FINAH instrument is conducted on both clients, nonprofessional caregivers and healthcare professionals.
Main Outcomes and Results: The relative burden per item for clients and nonprofessional caregivers is most prominent in the domains of fatigue, cognitive and emotional consequences, self-care and mobility. The estimation of burden for clients and nonprofessional caregiver by healthcare professionals showed an overall 65% correct estimation by the healthcare professional. 19% of the items showed underestimation of burden, while 16% showed overestimation.
Conclusions: These results show that FINAH can ameliorate the estimation of the health care professional on the self-assessed burden of clients and nonprofessional caregivers, thus substantiating a more client-centred approach.
... Elsewhere, the human development model has been compared to several disability models. 11 It is worth pausing to compare it to the ICF given how influential the ICF has been as a disability model 34 and in the healthy and successful aging literatures. 16,35 Starting with similarities, both the ICF and the human development model are interactional models with disability arising at the interaction of the individual and the environment. ...
Background: With population aging, there is a growing need to measure and monitor the wellbeing of older people, including older people with disabilities.
Objective: To estimate the extent of wellbeing for individuals age 60+ in the U.S. overall and across disability status, this paper develops a measure of wellbeing at older ages that is multidimensional and disability inclusive.
Methods: Rates of multidimensional wellbeing among American older adults overall and among older adults with disabilities were estimated using multivariate regression analysis and data from the Panel Study of Income Dynamics matched with the 2013 Disability and Use of
Time Supplement. Multidimensional wellbeing was defined as the simultaneous achievement of outcomes in five dimensions: material wellbeing, health status, personal activities, social connections/relationships, and economic security.
Results: Among all older adults, 33% experience multidimensional wellbeing. However, only 4 to 18% of older adults with disabilities experience wellbeing. Wellbeing varies across the dimensions of wellbeing for this subpopulation. Persons with disabilities experience as
much wellbeing as persons without disabilities in terms of health insurance status and social connections/relationships. In contrast, for material wellbeing, health status and personal activities, older persons with disabilities less often experience wellbeing.
Discussion: This paper brings to light a disability gap in the experience of wellbeing among older adults in the U.S. There is a need for research which can inform the development of policies and practices that will enhance wellbeing for older people with disabilities, including material wellbeing, health and personal activities.
... The ICF is applicable to functional entities as outcomes or as starting points for clinical and public health intervention at individual or population level. While this was a significant step forward [31], because abilities and participation are context-dependent and related to quality of life, there are ongoing efforts to improve definitions and measurement [32,33]. As famously stated by Greenwood: "The scientific purist, who will wait for medical statistics until they are nosologically exact, is no wiser than Horace's rustic waiting for the river to flow away" [34]. ...
The principles of etiology and natural history of disease are essential to recognizing opportunities for prevention across the illness spectrum. They have a bearing on how illness is experienced, how differently it can be perceived at time of first contact with the health system, and how it may appear at later stages. Opportunities for prevention arise at every stage in the process; three main levels are described: primary, secondary and tertiary. Prevention strategies include health promotion focused on determinants, clinical prevention to reduce modifiable risk factors, case finding, screening, and addressing functional outcomes relevant to quality of life; the importance of preventing errors is also recognized. The distinction between incidence effects and treatment effects of prevention is explored. The review also examines the differing roles of language in health science and public communication, aspects of disease classification, related issues in patient-centered care, the prevention paradox, and integrated models of disease prevention.
... The ICF is applicable to functional entities as outcomes or as starting points for clinical and public health intervention at the individual or population level. While this was a significant step forward [28] because abilities and participation are context dependent and related to quality of life, there are ongoing efforts to improve definitions and measurement [29,30]. As famously stated by Greenwood: "The scientific purist, who will wait for medical statistics until they are nosologically exact, is no wiser than Horace's rustic waiting for the river to flow away" [31]. ...
The principles of etiology and natural history of disease are essential to recognizing opportunities for prevention across the illness spectrum. They have a bearing on how illness is experienced, how differently it can be perceived at the time of first contact with the health system, and how it may appear at later stages. Opportunities for prevention arise at every stage in the process, and three main levels are described: primary, secondary, and tertiary. Prevention strategies include health promotion focused on determinants, clinical prevention to reduce modifiable risk factors, case finding, screening, and addressing functional outcomes relevant to quality of life; the importance of preventing errors is also recognized. The distinction between incidence effects and treatment effects of prevention is explored. This review also examines the differing roles of language in health science and public communication, aspects of disease classification, related issues in patient-centered care, the prevention paradox, and integrated models of disease prevention.
... Cerniauskaite et al. (2011) conducted a systematic literature review on ICF and explored its use and implementation from 2001 to 2009 and discovered that the concept of participation gained more attention when the World Health Organization introduced its description in the ICF in 2001. The ICF became an important conceptual framework in rehabilitation to describe health-related states; its core components-body functions and structures, activities and participation, environmental factors, and personal factors-provided a global and collective language for health and disability. ...
“A landmark study showing how empirical work, through the methodology of the social sciences, can come into contact with political philosophy and disability studies so as to make a meaningful contribution to policy. Dr. Victor Santiago Pineda’s work will be read for decades, as a foundation for future research on the application of the capabilities approach to social justice.”
— Anand Jayaprakash Vaidya, Professor of Philosophy San Jose State University, California, USA
This Open Access book is an anthropological urban study of the Emirate of Dubai, its institutions, and their evolution. It provides a contemporary history of disability in city planning from a non-Western perspective and explores the cultural context for its positioning. Three insights inform the author’s approach. First, disability research, much like other urban or social issues, must be situated in a particular place. Second, access and inclusion forms a key part of both local and global planning issues. Third, a 21st century planning education should take access and inclusion into consideration by applying a disability lens to the empirical, methodological, and theoretical advances of the field. By bridging theory and practice, this book provides new insights on inclusive city planning and comparative urban theory. This book should be read as part of a larger struggle to define and assert access; it’s a story of how equity and justice are central themes in building the cities of the future and of today.
... The ICF-Dietetics enlarges the ICF by adding 900 specific categories addressing nutrition and dietetics related issues and could be considered valuable regarding a potential usage in multidisciplinary team care [11]. While the applicability of the NCPT [12][13][14][15] and its implementation [13,[16][17][18][19][20][21] as well as the ICF without its extension specific to dietetics care has been evaluated [22][23][24][25][26][27][28][29][30][31], there is a lack of data on the practicability and applicability of the ICF-Dietetics in clinical dietetic practice. ...
Background & aims:
In order to assure high quality of nutrition and dietetic care as well as research, the implementation of a standardized terminology, such as the World Health Organization (WHO) International Classification of Functioning, Disability and Health for Dietetics (ICF-Dietetics) is indispensable. The aim of this study was to explore the clinical practicability and applicability of the ICF-Dietetics in the field of nutrition and dietetic practice prior to the implementation in order to develop criteria (points to consider) for a targeted implementation strategy.
Methods:
A focus group study including a pretest of the ICF-Dietetics was conducted. Subsequently, facilitators and barriers for a nationwide implementation of the ICF-Dietetics in clinical nutrition and dietetic practice were identified and linked to interventions (combining theory-based and group-based approach) using the Consolidated Framework of Implementation Research (CFIR) to organize and represent data and summarized in a logic model.
Results:
In the pretest 55 clinical documentations which consisted of 248 different ICF-Dietetics categories were received. In four focus groups with 22 health professionals, 66 relevant higher-level themes and implementation strategy criteria (points to consider) were identified. These themes referred to all five domains of the CFIR, namely intervention characteristics, inner setting, outer setting, characteristics of individuals and implementation process and contained important barriers and facilitators that were linked to six implementation objectives as well as six context requirements and five main actors.
Conclusions:
This study provides facilitators and barriers to be addressed when implementing the ICF-Dietetics in clinical practice and shows potential interventions based on this analysis. A nationwide implementation was mainly seen as a great advantage for enhancing quality and continuity of care and for providing comparable data. However, it requires further refinements and a multifaceted implementation strategy where the engagement of leadership of institutions plays a crucial role. These results have provided a foundation for a targeted implementation strategy to increase the success, reproducibility and comparability.
... There are a range of frameworks to describe the devices, infrastructure, systems, and environments incorporated into interventions to enable people with disability in their homes, for example [19,20]. The International Classification of Functioning, Disability and Health (ICF) has been widely adopted in research studies and mapped to policies and interventions, including those related to the CPRD [21]. ...
If human rights begin in small places close to home, technologies that enable people with disability to access and control their home environments are an important human rights instrument. Smart homes exemplify recent advances in design, building construction, and integration of technologies within the built environment. They draw on multiple social and technical disciplines that share a broad vision but lack a common language, creating ambiguity and limiting the usefulness of the evidence base in determining optimal ways to integrate technologies and housing design to meet diverse needs. The convergence of mainstream and assistive technologies offers the potential of accessible and affordable strategies for inclusion, but also risks further exclusion of marginalized sections of the population. Coordination of efforts might accelerate translation of knowledge and diffusion of innovations into the practices of planning, designing, building, and sustaining housing that promotes independent living. This conceptual paper reviews the theoretical frameworks and terminology from fields of research involved in the design and use of technologies in the home environment to enable people with disability and older people. It considers approaches to design and interventions that could inform policies and practices as well as further research and development activities.
... A CIF reforça um debate relevante no cenário da saúde pública e das ciências da reabilitação sobre a necessidade de mensuração da incapacidade. A ampla atividade acadêmica sobre a utilização da classificação não foi acompanhada pela sua efetiva implementação nos ambientes clínicos, seja pela persistência no enfoque biomédico da abordagem do processo saúde-doença, seja pela dificuldade de operacionalização e de suas propriedades psicométricas 36 . As dificuldades apontadas pelos pesquisadores e pelos profissionais não se referem somente às características psicométricas da classificação, mas também ao fenômeno que a CIF se propõe a avaliar ser de difícil mensuração 28 . ...
Introdução
O câncer do colo do útero é o terceiro tipo de câncer mais comum entre as mulheres em todo o mundo. Sua incidência é consideravelmente mais alta em países de baixa e média renda.
Objetivo
Verificar a prevalência de incapacidade em mulheres com câncer do colo do útero (CCU) utilizando a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) como referência.
Método
Estudo observacional transversal realizado com mulheres com CCU em tratamento em um hospital de referência no Rio de Janeiro. Foi aplicado o checklist da CIF e um instrumento específico de avaliação da qualidade de vida (FACT-Cx - Functional Assessment of Cancer Therapy-Cervix Cancer).
Resultados
Foram incluídas no estudo 116 mulheres. A maior parte foi diagnosticada no estádio IB, e mais da metade recebeu como tratamento a quimioterapia conjugada com radioterapia. A maior prevalência de incapacidade foi encontrada para a deficiência das estruturas do sistema reprodutivo (96,6%), seguido de problemas nas funções da energia e do impulso (70,3%), funções emocionais (70,7%) e limitação para carregar e transportar objetos (67,2%). O domínio do bem-estar emocional foi o mais comprometido de acordo coma análise realizada pelo FACT-Cx.
Conclusão
A prevalência de incapacidade em mulheres com CCU foi elevada para todos os componentes da CIF, refletindo o impacto tanto da doença quanto do seu tratamento na funcionalidade. A abordagem biopsicossocial deve ser incorporada nas rotinas de planejamento do cuidado oncológico para mulheres com câncer do colo do útero.
... Como indica Cerniauskaite y sus colaboradores, no existe un método único reconocido internacionalmente para recoger información sobre los estados y resultados de salud de forma consistente, resultando difícil poder medir y definir el funcionamiento y la discapacidad a nivel internacional. 7 Con el fin de poder establecer un marco de evaluación biopsico-social común de la funcionalidad y discapacidad, la OMS desarrolló en 2001 el Sistema Internacional de Clasificación de la Funcionalidad, la Discapacidad y la Salud (CIF). Este sistema organiza la información en dos partes y cada parte se divide en dos componentes separados. ...
Correspondencia: kcampoverde.hbmenni@hospitalarias.es (Karina Campoverde)
Resumen.
Objetivo. Explorar aspectos de funcionalidad y discapacidad, examinar su representación en el conjunto básico (CB) de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) de la esquizofrenia, y explorar la adecuación de la técnica de este estudio piloto.
Método. Para la muestra se contempló la diversidad de los participantes. El tamaño se determinó mediante saturación. Se utilizó la entrevista semiestructurada con cada participante, que fue grabada y posteriormente transcrita. Mediante el paradigma constructivista se realizó el análisis cualitativo del contenido y los conceptos identificados se vincularon con categorías CIF.
Resultados. Participaron veinte familiares, reportando 105 categorías CIF. Un 58,2% coinciden con categorías de la versión completa y un 84% con las de la versión breve, todas ellas incluidas en el CB para la esquizofrenia.
Conclusiones. Con las entrevistas individuales se consigue un alto porcentaje de categorías CIF-CB.
Palabras clave: CIF-CB. Familia. Funcionalidad. Discapacidad. Esquizofrenia.
Assessment of functionality in schizophrenia from the perspective of the relatives: a pilot study
Abstract.
Objective: Explore the most important aspects of functionality and disability described by family members, examine how these aspects are represented within the Core Sets (CS) of the International Classification of Functioning, Disability and Health (ICF) for schizophrenia and explore whether the technique used in this pilot study is appropriate for obtaining information related to functionality. Method: For the selection of the sample, the diversity of the participants was taken into account. The sample size was determined by saturation of the data. Each participant was conducted a semistructured interview that was recorded and subsequent transcribed. From the constructivist paradigm a qualitative analysis of the content was carried out. Finally, the concepts identified were linked to the categories of the ICF.
Results: Twenty family members participated in the interviews conducted, reporting a total of 105 categories of the ICF, of which 58.2% coincide with the categories of the full version and 84% with those of the short version, all of them included in the CS for schizophrenia.
Conclusions: The use of individual interviews, indicate that CS for schizophrenia as a reference framework for obtaining information related to functionality in people diagnosed with schizophrenia. Introducción.
Key-words: ICF Core Sets. Family. Functionality. Disability. Schizophrenia.
... The IRP includes the planned rehabilitative programs and all the health professionals involved the intensity of treatment and the setting from in-patient to out-patient. To formulate the IRP, it is necessary to carry out a multidimensional assessment, typical of the rehabilitative approach, based on measurement tools and the international classification of functioning, disability and health (ICF), an international comprehensive code system promoted by the WHO since 2001 [12,13]. ...
Management of COVID-19 post-acute syndrome is an emerging health issue in rehabilitation. This article aims to present a proposal, based on the principles of clinical governance, health management and information technology (IT), and to respond to the need for a structured organization model for post-acute COVID-19 rehabilitation. The authors present a regional-based model of a network of clinicians and healthcare managers using a dedicated IT platform to achieve both effectiveness and efficiency objectives, to ensure coordination of the available resources and the most appropriate rehabilitative treatment for patients. The proposed post-acute COVID-19 rehabilitation network has been designed according to the model of a clinical management project within the Italian national healthcare system, and its context is an easily adjustable model for the European healthcare systems. The authors base the project on current laws and scientific guidelines in rehabilitation in Italy and in Europe and use the SWOT analysis technique to assess the proposal feasibility. The primary aims of the project are: (1) standardizing the minimum assessment tools of post-COVID-19 patients with disabilities; (2) ensuring an individual rehabilitation project for each patient with international classification of functioning, disability and health (ICF) coding and (3) reporting the activity performance with appropriate indicators. The secondary aims are: (1) developing educational programs for patients and care givers also aimed at acquiring better empowerment and positive behavior; (2) creating a regional database for data collection and (3) improving IT, and specifically tele-rehabilitation, as a suitable approach during the COVID-19 emergency and also in the future. Expected results are: continuum of care; effectiveness, efficacy and appropriateness in the delivery of rehabilitation treatments through a standardized minimum assessment and the wording of the individual rehabilitation project and a precise reporting of performance indicators to measure the effectiveness of clinical activities and the satisfaction of patients and caregivers. The assessment of results will be analyzed at three and six months to implement corrective actions according to the concept of continuous improvement of the Deming cycle. The IT remote approach allows the patient to meet the needs of proximity of care and empowerment, and, at the same time, to contain the spread of infection. This project could have a significant healthcare impact ensuring a more efficient and effective management of the demand of rehabilitation post-acute COVID-19, expanding the professional skills of the rehabilitation team members, improving both clinical and process data, in addition to optimal allocation of available economic resources.
... In particular, participation is important, as this multidimensional concept captures how the patient's health determines his or her participation in daily life, taking into account functional and intellectual disabilities. Assessing the individual's participation rate in terms of education, social activities, and leisure time is required for the development of interventions, which enable a long life with a good QoL (32). In future studies on BOI and QoL, standardized instruments to measure participation such as questionnaires for patients and carers could be used (33,34). ...
Research on tuberous sclerosis complex (TSC) to date has focused mainly on the physical manifestations of the disease. In contrast, the psychosocial impact of TSC has received far less attention. The aim of this study was therefore to examine the impact of TSC on health, quality of life (QoL), and psychosocial well-being of individuals with TSC and their families. Questionnaires with disease-specific questions on burden of illness (BOI) and validated QoL questionnaires were used. After completion of additional informed consent, we included 143 individuals who participated in the TOSCA (TuberOus SClerosis registry to increase disease Awareness) study. Our results highlighted the substantial burden of TSC on the personal lives of individuals with TSC and their families. Nearly half of the patients experienced negative progress in their education or career due to TSC (42.1%), as well as many of their caregivers (17.6% employed; 58.8% unemployed). Most caregivers (76.5%) indicated that TSC affected family life, and social and working relationships. Further, well-coordinated care was lacking: a smooth transition from pediatric to adult care was mentioned by only 36.8% of adult patients, and financial, social, and psychological support in 21.1, 0, and 7.9%, respectively. In addition, the moderate rates of pain/discomfort (35%) and anxiety/depression (43.4%) reported across all ages and levels of disease demonstrate the high BOI and low QoL in this vulnerable population.
... Similarly, personal factors (pf) were contemplated only by two instruments (International Consultation on Incontinence Questionnaire -Short Form and Incontinence Quality of Life Questionnaire). Since personal factors such as age and lifestyle are closely related to urinary incontinence and its outcomes [4] and considering that the components interact and influence each other [44], it is necessary for the professional to adopt other instruments and evaluation measures that contemplate the other components of human functioning (body structures, activities and participation and contextual factors). ...
Aims
To analyze the association between urinary incontinence and disability status in premenopausal women.
Materials and Methods
The study included 120 premenopausal women recruited from six Basic Family Health Units to participate in this study. We assessed sociodemographic, gynecological, and obstetric data by using specific questions. The International Continence Society's definitions were applied to determine the presence and type of urinary incontinence, and the disability was assessed by using the 36‐item version of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0.
Results
The WHODAS scores showed that women with urinary incontinence had a worse disability in cognition (P = .023) and mobility (P = .020) domains, in addition to the total score (P = .23). Women with mixed urinary incontinence had a worse disability in mobility domain (P = .039) than those with stress or urgency incontinence. Qualitative analyses of disability showed a significant difference between women with and without urinary incontinence (P = .033), with higher percentages of incontinent women with moderate and severe disability. Women who reported urinary incontinence had 7.69 more points on the final score of WHODAS than those who did not report this outcome.
Conclusions
Urinary incontinence in women of reproductive age is associated with disability and worse scores of WHODAS when we compare them to women without urine leakage. The results presented can be useful for designing and adapting strategies for comprehensive care of women with urinary incontinence and disability, and developing rehabilitation programs based on functioning.
... However, by design, the ICHI codes are not selfexplanatory, and the codes do not follow an intuitive hierarchical order. Furthermore, studies have shown that users of WHO classifications are mostly located in North America and Europe (18). Health systems without particular use of comprehensive classification systems will need the support to implement ICHI and reduce the risk of miscoding. ...
Introduction: An important requirement for successful public health interventions is a standardized classification in order to make these health technologies comparable in all contexts and recognized by all parties. The WHO International Classification of Health Interventions (ICHI), including an integrated public health component, has been developed to propose such an international standard.
Methods: To test (a) the translation of public health interventions to ICHI codes and (b) the technical handling and general coding in public health, we used a set of public health interventions from a recent cross-sectional survey among Health Technology Assessment professionals.
Results: Our study showed that handling of the ICHI interface is stable, that there is a need for specificity and adequate detail of intervention descriptions and desired outcomes to code adequately with ICHI and that the professional background of the coder, as well as his/her sex might influence the selection of codes.
Conclusion: International Classification of Health Interventions provides a good coverage of public health interventions. However, the broader character of system wide interventions, often involving a variety of institutions and stakeholders, may present a challenge to the application of ICHI coding. Based on this experience, we would tailor future surveys more specifically to the needs of the classification and we advise training for health professionals before coding with ICHI. Standards of reporting will likely strengthen insights about the efficiency of primary prevention interventions and thus benefit long-term health of populations and structured HTA reporting process.
... Reference lists of all studies included in the qualitative analysis were examined manually to identify additional studies that could meet the inclusion criteria. We selected three publication types: conceptual (including commentaries, editorials, and viewpoints); review (excluding systematic reviews (12)) and original research papers (longitudinal, quasiexperimental and experimental studies). Editorials, correspondence and commentaries are frequently excluded from systematic literature reviews, but in other studies, they were deemed acceptable for inclusion if they reported data on the impact of economic crisis on EU healthcare, so we included them (13). ...
Background: We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe.
Methods: We developed a systematic review of scientific literature for the period 2008-2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed.
Results: Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services.
Conclusion: Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health.
... 5 Past studies have shown improved communication across multi-professional medical disciplines within institutions via implementation of the ICF in clincal practice. 6,7,8 According to Fayed, Cieza, and Bickenbach, the usage of the ICF classification as a database for inter-institutional or international quality assurance of interventions seems also promising for describing, comparing, and contrasting international health-related quantitative data. 9 Since it serves as a uniform and comprehensive language on human functioning, it became an international standard to describe a person's medical and rehabilitation status over the past years. ...
Background:
Scientific investigation and documentation of equine-assisted therapy has increased over the past several years. Yet there are no standardized and validated tools for evidence-based measurement of processes and outcomes to assess equine-assisted interventions.
Aim:
The objective of this cross-sectional survey study was to develop a standardized assessment tool for the effective measurement of equine-assisted therapy based on the common language of the International Classification of Functioning, Disability and Health (ICF) framework of the World Health Organization (WHO).
Design:
Cross-sectional study.
Setting:
Six equine-assisted therapy rehabilitation centers in Germany.
Population:
Persons with indications for equine-assisted therapy.
Methods:
In a qualitative conceptual portion of the study, four semi-structured focus group interviews were conducted and analyzed with a total of 17 experts and therapists according to the aims, content, and sphere of influence of equine-assisted therapy via structured content analysis. Based on these findings and a linkage to the classification system of ICF, a standardized assessment tool (a general module and three specialized submodules) for equine-assisted therapy was developed. It was field-tested with 116 participants at six locations in a multicenter practical field approach and statistically analyzed via explorative factor analyses and reliability tests.
Results:
Explorative factor analysis provided support for a three-factor structure for the general module, including psychosocial, motor, and mental functioning scales. For both submodules, i.e., the individual and group settings, a two-factor structure was indicated. Reliability was in the good to excellent range for all modules.
Conclusions:
A global 80-item assessment tool, divided into a general and three submodules, provides a first step toward a standardized ICF-based assessment of the effects of equine-assisted therapy. A common language in measuring therapy outcomes could increase synchronization and integration of equine-assisted therapy interventions into the international healthcare system. By applying the ICF in multidisciplinary services in rehabilitation management, improved coordination and networking of all necessary services can be provided.
Clinical rehabilitation impact:
The developed assessment tool contributes to evidence-based outcome-measurement and therapy monitoring of equine-assisted interventions. Prospectively, it could enable cost-effectiveness analyses and comparability with other health system interventions.
... The ICF is useful for identifying the effects of contextual factors on a person's activities and domains of life participation, such as work and education (WHO, 2001). Religious and spiritual practices are clearly detailed within the ICF (Cerniauskaite et al., 2011;Mathisen & Threats, 2018) (see Table 7). The ICF also explicitly describes communication considerations, including voice (Hopf, 2018;Oates, 2011;Threats & Worrall, 2004;World Health Organization, 2001). ...
Abstract: https://doi.org/10.1007/s10943-021-01444-x :
Systems thinking approaches can benefit the occupational vocal health of vocally reliant workers. This paper explores community faith leaders as an example of a highly vocally reliant occupation, who may benefit from systems thinking being used to support their vocal occupational health and safety. A scoping review of the current literature regarding faith leaders’ occupational voice use and vocal health is detailed, including recognised occupational hazards. This article then discusses the unique and potential use of systems thinking for facilitating faith leaders’ vocal occupational health and safety. Rather than using a solely clinical perspective, the sociotechnical systems approach and the biopsychosocial–spiritual approach are noted as particularly pertinent for this occupational group. https://rdcu.be/cz4XO
... This scheme indicates that a more detailed, high-level category covers all the aspects applicable for the low-level category, of which it is a member, but not vice versa. Numerous reports on the use of the ICF have been published both in theoretical and clinical context (Cerniauskaite et al. 2011;Maribo et al. 2016). There is a trend towards development of ICF-based assessment tools through identification of relevant categories. ...
Stroke-associated impairments display a wide variety of clinical signs and symptoms. Therefore, a multidisciplinary team with different experts working closely together is necessary for effective stroke rehabilitation. In rehabilitation of stroke patients, a holistic view on functioning and disability is necessary to establish an individualized and comprehensive treatment program. The WHO International Classification of Functioning, Disability and Health (ICF) provides a common language to describe individual functioning in a given context suitable for a shared documentation system. Goal setting has become a central component of effective communication and decision-making in rehabilitation practice, both as part of the process and as a person-centred outcome measure for stroke rehabilitation. Nevertheless, agreed standards on goal setting and evaluation still need to be defined. Here, we highlight some aspects with relevance for multidisciplinary team building and coordination and for using the ICF in the context of stroke rehabilitation; how to describe individual levels of functioning and disability and to set treatment goals as well as to identify barriers and facilitators to individual functioning and health.
... This review focused on identifying measures that used the ICF for the initial conception, rather than the measures that have only considered the ICF post-publication or in an "after-the-fact" exploration. With the linking process, the developers of non-ICF based measures undergo the steps required in understanding the ICF to link certain items of their measure to the most relevant domains of the framework (58). However, the use of linking individual concepts of a measure to the ICF framework may not be as effective in demonstrating the interaction between the concepts, especially between activities/participation and contextual factors (59). ...
Clinical measures in health and rehabilitation settings are often used to examine child functioning to better support the diverse needs of children with neurodevelopmental disorders (NDD) and their families. The WHO's International Classification of Functioning, Disability, and Health (ICF) framework reflects a focus of health beyond biomedical deficits, using the concept of functioning to create opportunities for measurement development involving this construct. In the measures developed in the field of childhood NDD, it is unclear whether and how these tools measure and incorporate the ICF framework and its domains within health care contexts. Understanding how these measures utilize the ICF will enable researchers and clinicians to operationalize function-focused concepts in studies and clinical practice more effectively. This narrative review aims to identify and describe function-focused measures that are based on the ICF for children with NDD, as described in the peer-reviewed literature. This review used a systematic search strategy with multiple health-focused databases (Medline, PsycInfo, EMBASE, EMCARE), and identified 14 clinical measures that provide direct support for children (aged 0-21) with NDD in pediatric health (and other) settings. Results described the measures that were primarily developed for three main diagnostic populations [cerebral palsy, autism spectrum disorder, and communication disorders]; had varying contextual use (clinical-only or multiple settings); and for which authors had conducted psychometric tests in the measure's initial development studies, with the most common being content validity, interrater reliability, test-retest reliability. Participation (79%, n = 11) & Activities (71%, n = 10) were the most common ICF domains captured by the set of measurement tools. Overall (71%, n = 10) of the identified measures utilized multiple ICF domains, indicating that the “dynamic nature” of the interactions of the ICF domains was generally evident, and that this result differentiated from “linking rules,” commonly used in research and clinical practice. The implications of these findings suggest that clinical measures can be an effective application of the ICF's defined concepts of functioning for children with NDD.
... Mittlerweile liegen eine Reihe von Publikationen zur theoretischen und klinischen Anwendung der ICF vor (Cerniauskaite et al. 2011, Maribo et al. 2016 Aufgrund der besonderen Bedeutung in der Rehabilitation erscheint es sinnvoll, ein eigenes Dokument zur Erfassung/Verfolgung der Ziele der Rehabilitation ("Zielblatt") vorzuhalten. ...
... Limitations related to implementing the ICF are demonstrated in relation to the utility of the ICF for routine practice (15). Tools that are simple to use are mentioned as an important step in this process (16,17). ...
Background: A hematopoietic stem cell transplantation (HSCT) has a major impact on the functioning and perceived quality of life of patients. To describe the functioning of patients, a preliminary set of 53 categories of the International Classification of Functioning, Disability and Health (ICF) as relevant for HSCT patients has been selected earlier by a Delphi study. For the implementation of this preliminary ICF core set for patients after HSCT in clinical practice, a feasibility study was requested.
Methods: A feasibility study was conducted in an explanatory mixed-methods research design. Qualitative data were collected cross-sectionally by semi-structured interviews based on specific topics related to feasibility regarding the use of the preliminary ICF core set for HSCT patients from the perspective of nurses (five in ICF-trained nurses and five regular, untrained, nurses). Quantitative data, were collected longitudinally by using a mobile health application based on ICF in which the ICF trained nurses registered HSCT patients' functioning.
Results: Qualitative analysis indicated that using the preliminary ICF core set is practical and acceptable for providing information about the functioning of HSCT patients from the perspective of nurses. In addition, nurses indicated a demand for this information due to its impact on multidisciplinary meetings and clinical decision-making by involving relevant aspects of the functioning of patients. Management support, trained staff, and designated time to focus on functioning are mentioned as requirements for successful implementation. Quantitative analysis demonstrated that the most used 30% ( n = 17) ICF categories are included in the preliminary ICF core set for HSCT patients ( n = 24). Energy (b130) was the most used ICF category. Family relationships (d760) was the most frequently and highly positively associated ICF category.
Conclusions: From the perspective of nurses, the preliminary ICF core set for HSCT patients is feasible and relevant in gaining information regarding functioning. Applying this preliminary ICF core set for HSCT patients in the anamnesis and the nursing consultations contributes to this information. Further research is needed to look at the perspective of other professionals and HSCT patients themselves.
... Application of the ICF has largely focused on classifying human functioning in clinical and rehabilitation domains. Clinical applications have focused on description of disability, and identification of relevant ICF categories relevant to health professionals (Cerniauskaite et al., 2011). Our study, however, aims to assess utility of ICF Environmental factors to categorize and analyze transportation barriers. ...
The International Classification of Functioning, Disability, and Health (ICF) is a universal framework used to classify human functioning in clinical and rehabilitative domains. The objective of this study was to examine the utility of the ICF as a framework to categorize and measure barriers to public transportation reported by older adults. ICF coding techniques were applied to sixty paratransit applications for analyzing user-reported barriers to public transportation. Paratransit users were divided into groups based on age (young old vs. oldest old) and ambulatory level (non- vs. ambulatory). Analysis identified 119 instances of user- reported environmental barriers ranging from technology requirements to system/service-based factors, though the prevalence of different barriers differed across groups. Overall, the methodology appears promising. Understanding the complex relationships between functioning and different transportation barriers experienced by specific sub-populations could help identify unmet transportation needs, generate precise research questions, and support the development of inclusive transportation technologies and systems.
La Classificazione Internazionale del Funzionamento, della Disabilità e della Salute (ICF) è stata promossa e divulgata dal 2001 dall'Organizzazione Mondiale della Sanità, dopo un lungo lavoro preparatorio che ha coinvolto studiosi e professionisti di tutto il mondo e di diversa formazione. Aggiornata periodicamente, l'ICF completa la "famiglia delle classificazioni OMS" che comprende anche l'ICD (International Classification of Diseas and Related Health Problems), analogo al DSM V. Se l'ICD ha lo scopo di classificare le malattie secondo precisi criteri diagnostici, l'ICF permette di descrivere lo stato di salute complessivo e, in particolare, le conseguenze delle diverse patologie sulla qualità di vita delle persone. Tali esiti possono essere descritti attraverso i significati che l'ICF attribuisce ai termini functioning e disability, i quali definiscono il tipo di interazione presente tra condizioni di salute, i fattori di tipo personale e sociale, le attività della vita quotidiana e la partecipazione sociale. La condizione di disabilità emerge ogni volta che nell'influenza reciproca di tali componenti si vengono a generare limitazioni nelle attività e restrizioni nella partecipazione sociale. L'analisi del funzionamento consente di evidenziare che non sono le condizioni di salute che in sé e per sé a causare le disabilità, ma la modalità con cui esse impattano con il contesto di vita, dal quale la persona può ricevere sostegni ed impedimenti.
L'articolo presenta gli esiti di una sperimentazione che ha prodotto un modello di Profilo di Funzionamento dal formato grafico, che mette immediatamente in evidenza i punti di forza ed i bisogni della persona per il quale è stato realizzato e le sue relazioni con l'ambiente in cui vive. L'elaborazione dei dati avviene sulla piattaforma www.icfapplicazioni.it, messa a disposizione gratuitamente dall'Università di Verona nell'ambito delle iniziative di Terza Missione.
ABSTRACT
Following the changes introduced by Legislative Decree no. 66/2017, the Multidisciplinary Evaluation Unitses-tablished at the local health districts are mandated to draft a Functioning Profile (FP) based on the ICF Classification , for the purposes of establishing an Individual Project (Law No. 328 / 2000, art.14), as well as thepreparation of the Individualized Educational Plan (PEI) (Legislative Decree no. 66/2017, art. 5). The innovation introduced by the legislation is far-reaching, not only for the impact it has on the organization of the Services and on the procedures relating to school support and accompaniment towards the Life Project. Particularly relevant is the change of perspective brought by the adoption of the anthropological model of the International Classification of Functioning, Disability and Health (ICF). If, so far, the condition of disability hasbeen assessed on the basis of clinical parameters , the Functioning Profile now requires a biopsychosocial assessment of the person which will consider not only deficits and impairments, as well as its effect on the development process of personal experiences (personal factors) and the setting of daily life (environmental factors). Indeed, this threefold focal lens is the only means to comprehend the overall condition of a person with disability-encompassing their needs and wishes-which is intertwined to the quality and the complexity of the social networkto which they belong. Accordingly, the regulation foresees that drafting of the FP be jointly carried forth by physicians, rehabilitationprofessionals, evolutional age psychologists, evolutionary psychologists, social workers, paedagogists, specializedteachers, parents, and not least the very individual as by the principal of autodetermination. Following the modifications introduced with such Decree, the University of Verona began a trial aimed at developing n ICF-based FP model that is both sustainable an organizational level and functional to planning the Individual Projects and the PEI. Such trial has involved the Scaligera local health district 'ULSS Company no. 9 a delegation of family Pediatricians of the province and the Local School Office in Verona. The FP model produced in the pilot experience which is still active, contains some particular features that allow is formal as well as dynamic use in both the design and the monitoring and evaluation of educational, rehabilitation and care interventions. For this purpose, we created an online platform that processes the data collected and makes it available to the user in real time providing a series of qualitative and quantitative graphs and indicators, describing the biopsychosocial functioning of the subject and his/her needs for social inclusion. The present article describes the main elements of this pilot experience and the results obtained.
Purpose: To classify short-term and long-term rehabilitation goals and analyse how they capture functioning in a biopsychosocial International Classification of Functioning, Disability and Health (ICF) perspective.
Materials and methods: A retrospective study was conducted at two specialised outpatient multidisciplinary rehabilitation centres for polio survivors and accident victims. Rehabilitation goals extracted from patient journals were linked to the ICF according to linking rules.
Results: One hundred patients were included. Four hundred and eighty-seven short-term and long-term rehabilitation goals were linked to the ICF. Fifty-seven per cent were linked to Activity and Participation, 22% to Body Functions, 1% to Body Structure, 4% to Environmental Factors, 4% to Personal Factors, whereas 11% were not defined and 1% was not covered. The identified categories covered all ICF domains. The most frequent categories for short-term goals were d450 “Walking” and d570 “Looking after one’s health.” For long-term goals, d850 “Remunerative Employment” and d920 “Recreation and Leisure” were the most frequent.
Conclusion: The study showed challenges in capturing all aspects of biopsychosocial functioning in rehabilitation goals, particularly Contextual Factors. This study indicates that rehabilitation goals capture capacity rather than performance. Further research could highlight if functioning is captured in the rehabilitation plan, and in this way include both capacity and performance.
• Implications for rehabilitation
• Health professionals in a post-acute or long-term rehabilitation setting should pay attention to capacity and performance when rehabilitation goals are set.
• The rehabilitation plan should contain goals and a description of patient’s contextual factors and both should be equally valued and combined in a description of functioning.
• In a post-acute or long-term rehabilitation setting short-term and long-term goals are affected by the context. A longer rehabilitation intervention lead to goals linked to activity and participation.
Background:
Despite unclear evidence of effectiveness or safety, airway clearance therapy (ACT) is frequently performed in infants and children with acute pulmonary disease.
Objectives:
The aim of this review was to critically synthesise published evidence, expert opinion and pathophysiological principles to describe the indications, effects, precautions and application of commonly used ACT modalities for managing infants and children with acute pulmonary disease.
Method:
A comprehensive narrative review of published literature was conducted. Articles describing paediatric populations were prioritised, but adult and animal studies were also considered where appropriate.
Results:
There is a dearth of high-level evidence supporting the use of ACT in acutely ill infants and children. Conversely, studies have highlighted the lack of effect of different modalities for a variety of conditions, and in some cases serious associated complications have been reported.Airway clearance therapy may be considered when there is retention of pulmonary secretions, and the consequential airway obstruction impacts either acutely on respiratory mechanics and gaseous exchange and/or has the potential for long-term adverse sequelae [a condition that is the consequence of a previous disease or injury]. However, it should not be considered a routine intervention.
Conclusion:
Airway clearance therapy should not be performed routinely in children admitted to hospital with acute respiratory conditions. Patients should be clinically assessed and treatment planned according to individual presentation, in those with signs and symptoms that are potentially amenable to ACT.
Clinical implications:
This review can serve as a guide for physiotherapists in the respiratory management of children with acute respiratory illness, as well as identifying areas for clinical research.
Background and objective:
The aim of this study is to examine the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy.
Methods:
Seventy-five adolescents (M:45, F:30) ages between 14-18 yrs (mean: 15.52±1.60 yrs) were included in the study. Participants were divided into three groups: Level I, Level II and Level III according to the Gross Motor Function Classification System. Gross Motor Function Classification System, Gross Motor Function Measure, Functional Independence Scale, Manuel Ability Classification System, Pediatric Quality of Life Inventory and International Classification of Functioning, Disability and Health Child-Youth version Short Form (ICF-CY) (14-18 yrs) were used for assessments.
Results:
It is found that there is a moderate and high level of correlation between quality of life and activity participation and body functions; moderate and high level of correlation between quality of life and activity participation and body functions with the gross motor function levels; moderate and low level correlation between environmental factors and gross motor function levels (p < 0,05).
Conclusions:
The fact that the ICF-CY short form used for cerebral palsied children is compatible with other assessment scales suggests that the use of ICF-CY short forms may be useful in assessing the health status of individuals.
The relationship between pain and functional disability with local and global selected trunk muscles activity and comparison the activity of these muscles between men and women with non-specific chronic low back pain Please cite this paper as: Ahmadnezhad L, Yalfani A[The relationship between pain and functional disability with local and global selected trunk muscles activity and comparison of the activity of these muscles between men and women with non-specific chronic low back pain(Persian)]. AbsTrACT Aims and background: The low back pain is a highly prevalent in all societies, with the majority of people experiencing back pain at least once in their lifetime. If a definite diagnosis of low back pain is not detectable by recent radiological instruments, it is classified as chronic low back pain. This study evaluates the relationship between pain and functional disability with the level of activity of the trunk muscles and comparison the activity of these muscles in men and women. Materials and methods: forty-seven strength-training athletes (25 female, 22 male) with non-specific chronic low back pain were selected to participate in this study. Surface electromyography device was used to record the activity of Multifidus muscle, Erector Spine, Transverse abdominal, Rectus abdominis. All statical analyses were performed using SPSS statical sotware version 20 and Pearson correlation method to determine the relationship between pain and functional disability with muscle activity and independent t-test to compare the activity of these muscles in men and women, and the significant level was set at 0.05. Findings: The results of Pearson correlation showed that there was a reverse and significant correlation between local trunk muscle activity and pain and functional disability, and there was no significant difference in the level of local and trunk global trunk muscle activity between men and women with chronic low back pain (p>0.05). Conclusion: The results of this study showed that the activity of local muscles decreased and as a results pain and functional disability increased in low back pain patient. This situation leads to spinal instability. Therefore, local muscles should be strengthened in rehabilitation process.
Obstructive pulmonary diseases (OPDs) are the leading causes of mortality and disability worldwide. The International Classification of Functioning, Disability and Health (ICF) provides a framework for systematically assessing functioning and disability in patients with chronic diseases. To date, the ICF core sets for OPDs have not been validated by respiratory physicians in China’s mainland. This study was aimed at validating the brief ICF core set for OPDs from the perspective of Chinese respiratory physicians. A three-round, consensus-building survey was conducted with Chinese respiratory physicians from Shanghai, Jiangsu, and Zhejiang from December 2 to December 16, 2017, using the Delphi technique. Their answers were analyzed for consensus degree. In this study, 52 experts (about 67.3% men) with a mean working experience of (19.3 ± 6.3) years completed the consensus process. After 3 rounds, the following 13 ICF categories were considered crucial for the assessment of OPDs, with an agreement of over 70%: 4 in body functions (b410-heart functions, b440-respiratory functions, b455-exercise tolerance functions, and b460-sensations associated with cardiovascular and respiratory functions), 2 in body structures (s410-structure of cardiovascular system, and s430-structure of respiratory system), 4 in activities and participation (d230-carrying out daily routine, d450-walking, d455-moving around, and d640-doing housework), and 3 in environmental factors (e110-products or substances for personal consumption, e225-climate, and e260-air quality). Twelve (70.6%) categories in the current brief ICF core set were validated, and one additional category, b410-heart functions, was added. In conclusion, Chinese respiratory physicians largely supported the current brief ICF core set for OPDs. However, the newly added and unconfirmed categories need further investigation.
One aspect that characterises the twenty-first century is its accomplishments such as better health-care systems, improved economies, a reduction in infant mortality and a growing number of adults living longer. However, these accomplishments can have a downside. For example, people are living longer while at the same time dementia rates are increasing significantly. With the increase in demand for high-dependency-related services, while at the same time costs are spiralling possibly out of control of societal budgets, there is a need for a shift in the care model. Additionally, difficulties in defining a clear dividing line between normal ageing and pathological ageing have led to a stigmatisation of older adults as a social and economic burden. This type of segregation and stigmatisation must be addressed to ensure future care delivery is inclusive. The positive benefits of an inclusive care system are both social and economic, and at an individual level it can positively impact upon an older adult’s mental and physical well-being.
Background and objective:
The aim of this study is to examine the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy.
Methods:
Seventy-five (75) adolescents (M:45, F:30) aged between 14-18 years (mean: 15.52±1.60 yrs) were included in the study. Participants were divided into three groups: Level I, Level II and Level III according to the Gross Motor Function Classification System. Gross Motor Function Classification System, Gross Motor Function Measure, Functional Independence Scale, Manual Ability Classification System, Pediatric Quality of Life Inventory and International Classification of Functioning, Disability and Health Child-Youth version Short Form (ICF-CY) (14-18 yrs) were used for assessments.
Results:
It is found that there is a moderate and high level of correlation between quality of life and activity participation and body functions, a moderate and high level of correlation between quality of life and activity participation and body functions with gross motor function levels, and a moderate and low level correlation between environmental factors and gross motor function levels (p < 0.05).
Conclusions:
The fact that the ICF-CY short form used for cerebral palsied children is compatible with other assessment scales suggests that the use of ICF-CY short forms may be useful in assessing the health status of individuals.
The demand for rehabilitation has increased, and evidence is rapidly growing; however, a rehabilitative health strategy receives less attention than treatment. Knowledge of what is being researched, who are the target groups and who contributes to rehabilitation research is deficient. We did not find any reviews mapping rehabilitation research regarding the research questions. The objective was to identify and synthesize existing scientific evidence on rehabilitation research published by Danish institutions between 2001 and 2021. The research questions to be explored were: Among which study groups has rehabilitation research been published?. Which types of studies on rehabilitation have been published?. Which institutions have been involved in rehabilitation research?
Methods
The process was guided according to the Joanna Briggs Institute's (JBI's) scoping review methodology. Four databases were searched. All types of peer-reviewed studies on any target group and rehabilitation setting, with any affiliation to a Danish institution, were eligible to be included. Studies referring to population and the type of design were categorized. Institutions were counted as Danish first authorship.
Results
The search revealed 3,100 studies, and following screening 1,779 were included. A total of 24 broad study groups were identified, mostly diagnosis-based health conditions. Musculoskeletal, cancer, and cardiac had 342, 228, and 174 studies, respectively. A total of 1,545 had a Danish first authorship, most of the Danish publications came from hospitals (56.6%) and universities (28.4%). The publication trend showed an almost linear development, with a 10–15% increase during the period.
Conclusion
Following screening 1,779 studies were included involving 24 broad study groups. Most categories were diagnosis-based; musculoskeletal, cancer, and cardiac health conditions encompassed most studies. All study designs were represented, and 1/10 were secondary studies. The majority (87%) of studies had a Danish first authorship. The majority of first affiliations were among hospitals followed by universities. A few municipalities were presented although they are yet to have research responsibility. Publication trends showed an increase primarily from 2013.
Systematic Review Registration
https://osf.io/ , identifier [10.17605/OSF.IO/2AENX].
The EquiAmi Training Aid (ETA) is a popular training and rehabilitation tool, however knowledge about its effect on the equine gait is lacking. Understanding of its effects on equine kinematics, and the clinical relevance of these effects is vital to promote optimal use of training aids within training and rehabilitation programmes. Therefore, this study aimed to determine how the ETA influences horses’ gait kinematics at walk and trot. Eight horses walked and trotted in-hand with and without the ETA. Optical motion capture was used to measure forelimb and hindlimb pro- and retraction angles, withers-croup angle, and stride length. Separate repeated-measures ANOVAs in each gait were used to assess the differences between gait kinematics and stride length variability with and without the ETA. The ETA did not significantly influence the horses’ kinematics in walk or trot, however, individual differences in the effect of the ETA on the horses’ angular and linear kinematics were found, with variation between gaits within the same horse observed. The ETA does not have the same effect on every horse, and its effect can vary within the same horse between gaits. Therefore, the individual characteristics and needs of the horse must be considered when applying training aids.
The COVID-19 pandemic has had a significant impact on the operation of medical facilities. In this period, they have seen increased absence of medical staff from work, a decrease in the number of hospitalizations and in the value of healthcare services provided. We assess the impact of this pandemic on the operation of a non-COVID-19 orthopedic and rehabilitation hospital using International Classification of Functioning, Disability and Health (ICF) categories. The authors analyzed these parameters in relation to the operation of a non-COVID-19 orthopedic, rehabilitation and rheumatological hospital in Q1 2020 compared to Q1 2019. For the analysis, the categories and qualifiers of the ICF were used, allowing for a simple and easily readable data analysis. In March 2020, in comparison to March 2019, the average working time of medical workers (p < 0.001) and the number of hospitalizations (p < 0.034) decreased significantly. In April 2020, compared to April 2019, the average working time of medical workers (<0.001) and the number of hospitalizations (0.002) also decreased significantly. In addition, in April 2020, the percentage value of the contracted services provided decreased significantly (p = 0.017), which was not observed in March of that year. The COVID-19 pandemic has affected the operation of a non-COVID-19 hospital, causing an increase in staff absences from work, a decrease in the number of hospitalizations and a decrease in the value of the revenue generated from health services provided. The ICF is a useful tool for the evaluation of a hospital’s healthcare services.
The experience of people with disabilities living in different countries varies significantly from place to place. Why do some countries excel in ensuring rights for people with disabilities, while others struggle? The answers are linked not only to laws, governance, and accountability but also to salience and the participation of people with disabilities in the issues that most affect them. Successful outcomes for disability-related policies have been inspired by the influential work of authors including Peter Evans, Amartya Sen, Sophie Mitra, and Kay Nagata. This chapter first explores dominant paradigms in social justice and development in planning theory and examines the conceptual pitfalls and failures to address disability-related justice. It then expands on theories proposed by Evans, Sen, Mitra, and Nagata to elaborate on the urban-focused Capability Model of Disability (CMD). The integrative CMD framework effectively addresses a range of nuanced challenges found when cities work to implement inclusive urban policies and programs. The concept of salience is also explored as a novel, more inclusive, and culturally relative development-based framework.
A disszertáció célja annak körüljárása, hogy miként jellemezhető a társadalombiztosítási rendszeren keresztül támogatott gyógyászati segédeszközök hozzáférhetősége Magyarországon, a felhasználók választási szabadsága szempontjából. A feltáró elemzés elméleti kerete az Amartya Sen nevéhez kötődő képességszemlélet (Capability Approach), a jóllét és a fejlődés normatív elmélete, ami a fejlődést az emberek képességeinek és arra való tényleges lehetőségeinek – szabadságainak – bővülésében látja, hogy olyan életet éljenek, amilyet okkal tartanak értékesnek.
A segédeszköz elosztást amentén vizsgáltam, hogy az mennyiben személyre szabott, és mennyiben bővíti a felhasználók tényleges lehetőségeit a számukra értékesnek tartott, jó életre: a segédeszközhöz jutás folyamatában mennyiben jelennek meg az érintettek véleményei, értékei, hangja, a „semmit rólunk nélkülünk” elv, milyen garanciákat vállal a jogalkotó és a folyamatban résztvevő többi szereplő annak érdekében, hogy az érintettek tudatában legyenek a valódi választási lehetőségeiknek.
A kutatás során – szociálpolitikai alapelveken, nemzetközi tapasztalatokon, három európai tanulmányúton és a képességszemléleten alapulva – elemzési indikátorrendszer készült. A szakirodalom áttekintésén és a jogszabályelemzésen túl, a támogatórendszer gyakorlati működését szakértői és érintetti interjúk (n=52) segítettek feltárni.
Magyarországon nincs nemzeti stratégia vagy program, ami bizonyos mértékben biztosítéka volna a támogató technológia hozzáférhetőségének. Több mint ötven jogszabály érinti a gyógyászati segédeszközöket, ezek ugyanakkor kevésbé védik a felhasználókat. A jogalkotó elsődleges célja, hogy megelőzze a túlköltekezést. A gyógyászati segédeszközök mellől elmaradnak a kapcsolódó szolgáltatások, ami nem csak az egyén szintjén teremt problémát, és eredményezi sok esetben az eszközök kihasználatlanságát, hanem csökkenti a gazdaságilag racionális működés valószínűségét is. A támogatott gyógyászati segédeszközök rendszerének jelenlegi működésében az akadályozottság orvosi-medikális modelljének jegyei fedezhetők fel: a szakemberek dominanciája mellett az érintettek valódi részvétele, és valódi választási szabadsága esetleges.
Kulcsszavak: Támogató-segítő eszközök és technológia; asszisztív megoldások; képességszemlélet, a fogyatékosság, egészség és jóllét emberi fejlődés modellje
Since its publication in 2001 the International Classification of Functioning, Disability and Health (ICF) has attracted debate about the content and the model presented. After almost 20 years use, regular updating since 2008 and with the prospect of a new edition in 2020 there is increasing interest in the ICF as a tool to meet contemporary information requirements. Information on functioning is important across not only health systems, but all areas where change in functioning is important: education, employment, and social welfare for example. This commentary responds to the issues raised in a commentary by Mitra & Shakespeare in 2019 and supports review of the ICF in the current context by informing users and providers of data on human functioning how they might engage in the maintenance, updating, and modernisation of the ICF.
Purpose:This study aimed to evaluate prevalence of type of disability, and environmental barriers faced by PWD in
urban slum of delhi, India.
Method:A cluster sample of 1200 children,was done where age less than 18 years. In collected data, 295 disabled children were
identified.Questionnaire filled which consisted of questions pertaining to the 7 components of environmental barriers faced by
PWD:Accessibility, Accommodation, Resource availability, mobility, self care, interpersonal relationship and Social life.
Results:The disability related to vision stands high in order followed by intellectual and locomotion disability. The results showed that 60% faced
problem in Accessibility, 58% of urban slum PWDs faced problems in accommodation, and most of them requires assistance from others. With
respect to Resource availability 40% had lack of awareness about the health services. The participants did not face problems in interpersonal
relationship (43%).
Conclusion:An understanding of the environmental barriers faced by PWD in urban slum can provide guidance in mapping policies and
strengthening laws which would help to improve their QOL.
Jede Auseinandersetzung mit den Themen Gesundheit und Krankheit stößt angesichts der Heterogenität von Verläufen im hohen Alter unweigerlich auf zwei elementare Grundfragen: Wie lassen sich systematische Muster von Krankheit und Gesundheit exakt für diese Gruppe differenzieren und wer genau ist gemeint, wenn vom hohen Lebensalter die Rede ist? Zur Beantwortung dieser beiden Kernfragen sind in den nachfolgenden Ausführungen zunächst allgemeine Mechanismen herauszuarbeiten, die zu einer Krankheitsanfälligkeit mit steigendem Alter beitragen. Darauf aufbauend skizziert und bündelt der Beitrag in dem Wissen kontextbedingter Definitionsprobleme des Alters prototypische Erkrankungsrisiken und Diagnosen. Abschließend sollen individuelle Voraussetzungen einerseits und strukturell gesellschaftliche Bedingungen anderseits diskutiert werden, die ein gelingendes Altern trotz Krankheit befördern oder aber gefährden können.
Sexual health is an important but often neglected field in health and welfare practice. Using structured documentation in a systematic work process can promote sexual health care including rehabilitation. Objectives: To present an overview of the usefulness of International Classification of Functioning, Disability and Health (ICF) and International Classification of Health Interventions (ICHI) concerning sexual health in the care process, in the electronic health record (EHR) and for follow-up of results. Using experience from practice and research to identify relevant information in health care processes related to sexual health, which are coded by using ICF and ICHI. The ICF and ICHI can be useful tools to describe functioning, patient´s goals, results, planned and performed interventions for investigation, treatment, prevention, and follow-up at individual level in care processes concerning sexual health with unified and unambiguous terms, concepts, and codes in the EHR. Using the ICF and ICHI can support improvement of individual sexual health care including rehabilitation, and also support follow-up and quality management at local to global level within the domain of sexual health.
Introduction
Cutaneous burns can have a catastrophic effect on people’s lives and may restrict opportunities for employment due to physical impairment and psychosocial deficits. Failure or delay in return to work can result in loss of income and support for the family unit. It can also negatively affect life role and identity and present difficulties with future opportunities. Current literature indicates multiple discrete influences on return to work as a result of burn injury but an understanding of how working-aged adults resume employment after burn injury is lacking. This scoping review will provide a comprehensive overview of the current literature by mapping and consolidating knowledge in this area of burn recovery and thus provide an informative basis for developing return-to-work programmes for survivors of burn injury.
Methods and analysis
This scoping review protocol will follow the Arksey and O’Malley’s (2005) methodological framework. A comprehensive search strategy has been developed with subject expert librarians. These databases were used: OvidSP: Medline, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials and EBSCOhost: CINAHL and Scopus. Reference lists of selected full text will be hand searched for additional literature. To enhance consistency and rigour, all reviewers will undertake a calibration exercise before paired reviewers independently screen all records using Rayyan. Full-text articles meeting the study inclusion criteria will be retrieved and examined. Extracted data will be analysed using the International Classification of Functioning, Disability and Health.
Ethics and dissemination
Ethics approval is generally not required for scoping reviews. Findings of this scoping review will be reported in a peer-reviewed journal and presented at conferences.
The International Classification of Functioning, Disability, and Health (ICF) is a revision of the International Classification of Impairment, Disabilities, and Handicaps developed by the World Health Organization, that reflects a universal, integrative, and interactive approach to functioning, disability, and health. The ICF was endorsed by the 54th World Health Assembly on May 22, 2001 for international use, is supported by a number of health-related disciplines, and will likely be implemented in clinical settings in the near future. The ICF is a global model that provides classifications of health and functioning while allowing for a holistic approach to well-being, as well as provides a common language for health-care disciplines to describe health related states. The ICF is a tool that can be utilized in therapeutic recreation research and practice, as well as in the education of students. Thus, the purpose of this article is to introduce the ICF model and its components, as well as highlight how it can be incorporated into therapeutic recreation practice.
Background: Testamentary capacity (the capacity to make a will) is recognised in the literature as an important issue for speech-language pathologists' assessment of people with aphasia, but current guidelines for clinical practice lack an empirical base.Aims: The research aimed to suggest some guidelines for clinical practice based on information considered relevant for the court in determining testamentary capacity.Methods & Procedures: A recent legal case involving a challenge to the will of a woman with severe aphasia was critically examined with reference to current guidelines in the literature regarding assessment of testamentary capacity.Outcomes & Results: Examination of the information available on the case indicated that the judge gave priority to accounts of the everyday communication of the person with aphasia (including reported discourse samples) over the information provided by expert medical witnesses. The extent to which communication effectiveness could be maximised was found to be a matter of key significance to the determination of capacity.Conclusions: This study has implications for speech-language pathologists' assessment practices and reports, as well as for scope of practice with regard to legal decision making of people with aphasia. These issues are discussed in relation to the World Health Organisation's ICF framework of functioning for social participation.
Disability has often been associated with poverty, but few studies examine the relationship empirically in developing countries. For example, a review of World Bank Poverty Assessments finds that while most countries acknowledge the issue, few have the data to investigate it. This paper sets forth a preferred methodology for examining disability and poverty that is in line both with a more functional approach to disability incorporated in the WHO's International Classification of Functioning and Sen's Capabilities Model. Applying that methodology to two developing countries reveals the strong connection between poverty and disability and the need for a separate poverty line for families with disabled members.RésuméOn a souvent associé le handicap à la pauvreté, mais rares sont les études qui analysent empiriquement ce lien dans les pays en développement. Ainsi, un rapport de la Banque mondiale sur les estimations de la pauvreté montre qu’en dépit de la reconnaissance du problème par la plupart des pays, peu d’entre eux disposent des données nécessaires à son étude. Cet article présente une méthodologie pour analyser le handicap et la pauvreté concordante tant avec l’approche fonctionnelle contenue dans la Classification internationale du fonctionnement, du handicap et de la santé de l’OMS qu’avec le modèle des « capabilités » de Sen. L’application de cette méthodologie à deux pays en voie de développement montre la relation forte entre pauvreté et handicap et la nécessité de disposer d’un seuil de pauvreté différent pour les familles dont certains membres sont handicapés.
The definition of disability is of interest to disability policymakers and analysts because it has fundamental implications for eligibility for public programs, for the scope of legislation, and for the way disability prevalence is measured. The purpose of this article is to assess how an approach developed in economics to analyze issues related to the standard of living, the so-called capability approach, may help us understand disability at the conceptual level. The article first summarizes different theoretical models of disability (the medical model, the social model, the Nagi model, and the International Classification of Functioning, Disability and Health of the World Health Organization) and then presents the main components of the capability approach. The capability approach allows researchers to analyze (a) disability at the capability level; (b) potential disability; and, at the functioning level, (c) actual disability. This framework also helps explain how disability may result from three types of factors: the individual's personal characteristics (e.g., impairment, age, race, gender), the individual's resources, and the individual's environment (physical, social, economic, political). The article explores some implications of the capability approach for analyzing the employment and the standard of living of persons with disabilities.
Purpose. Third-party disability is defined as the disability of family members due to the health condition of their significant other and was identified as a direction for future development by the World Health Organization in 2001. The aim of this article is to identify the International Classification of Functioning, Disability and Health (ICF) domains and categories that describe third-party disability of spouses of older people with hearing impairment.
Method. Ten spouses of older people with hearing impairment participated in individual semi-structured in-depth interviews. Themes identified by participants were linked according to ICF instructions to deliver a set of ICF category codes relevant to the study of third-party disability in spouses of older people with hearing impairment.
Results. A total of 18 themes and 50 sub-themes emerged from analysis of the interviews. The majority of these themes were able to be linked to the ICF, with the majority linking to codes in the activities and participation component. A number of contextual factors also emerged in the interviews that impacted on the spouses’ third-party disability. Difficulties arose when attempting to link themes to the body function component.
Conclusions. The ICF appears to be a useful tool in describing the effects of hearing impairment on the significant other; however, further research is necessary to clarify the applicability of some codes to third-party disability, especially the relevance of body functions to third-party disability.
Purpose. Guided by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), a measure of activity and participation (MAP) was developed and incorporated into the National Physical and Sensory Disability Database in Ireland. The aims of this article are to investigate and explore the relationship between the barriers, participation restriction and functioning levels experienced by people with disabilities.
Method. Seven thousand five hundred and sixty-two personal interviews with people meeting specific eligibility criteria for registering onto the database were conducted across four health service executive regions in Ireland.
Results. Overall, differences in barriers, participation restriction and activity limitations experienced by people with different types of disabilities were found to be significant. Furthermore, low functioning and experience of barriers were indicators of participation restriction.
Conclusions. This article has shown that elements of the ICF have been successfully operationalised in a service planning tool through the development of the MAP. This provides a more holistic view of disability and will enable the impact of service interventions to be measured over time.
Context: Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a person's functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on these concepts. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. Issue: However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF core sets. Conclusion: The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.
This paper is intended to provide a practical overview for clinicians and researchers involved in assessing upper limb function. It considers 25 upper limb assessments used in musculoskeletal care and presents a simple, straightforward comparative review of each. The World Health Organization International Classifi cation on Functioning, Disability and Health (WHO ICF) is used to provide a relative summary of purpose between each assessment. Measurement properties of each assessment are provided, considering the type of data generated, availability of reliability estimates and normative data for the assessment.
Background. Occupational therapists need tools to identify barriers and facilitators to participation in societal roles. Purpose. The purpose of this study was to examine the potential of the International Classification of Functioning, Disability and Health (ICF) two-level classification for use in occupational therapy. Methods. A secondary analysis of an existing dataset was conducted to identify participation barriers and facilitators that mapped to the ICF and those that did not. Results. A broad range of factors was captured across the components of the ICF. Findings also revealed enabling and disabling factors that were not evident in the ICF. Practice Implications. The ICF can support the identification of a broad range of external barriers and facilitators relevant to participation and of interest to occupational therapy. However, therapists must use other strategies to gain a comprehensive understanding of the nature, extent and consequences of barriers and facilitators that may exist in a given context.
Background. The Disability Tax Credit (DTC) Certification is an assessment tool used to provide Canadians with disability tax relief. The International Classification of Functioning, Disability and Health (ICF) provides a universal framework for defining disability. Purpose. The purpose of this study was to evaluate the DTC and familiarize occupational therapists with the process of mapping measures to the ICF classification system. Method. Concepts within the DTC were identified and mapped to appropriate ICF codes (Cieza et al., 2005). Results. The DTC was linked to 45 unique ICF codes (16 Body Functions, 19 Activities and Participation, and 8 Environmental Factors). Implications: The DTC encompasses various domains of the ICF; however, there is no consideration of Personal Factors, Body Structures, and key aspects of Activities and Participation. Refining the DTC to address these aspects will provide an opportunity for fair and just determinations for those who experience disability.
Background. The International Classification of Functioning, Disability and Health (ICF) model presents an opportunity to better understand previously neglected longterm social outcomes after traumatic spinal cord injury (SCI), especially the experience of participation. Purpose. The study explored the relationship between perceived environmental barriers and perceived community integration (a participation proxy) in a sample of adults with traumatic SCI. Methods. The study interviewed African American and White women and men (n=136) who had lived with SCI for an average of 11.5 years. Results. Participants reported environmental barriers at twice the level indicated by previous studies; the natural environment and the policies of government were the most problematic. Levels of community integration were also high. Data suggest a significant relationship (p<.01) between perceived environmental barriers and community integration for adults with SCI, providing support for the ICF model. Implications. Improved measures and more sophisticated concepts and theories are needed to explicate the relationship between environmental factors and participation concepts in the ICF. With respect to practice, occupational therapists need to be aware that removal of environmental barriers is only a first step in the more complex effort to facilitate optimal community integration after SCI.
Background. The conceptualisation of participation is important for both clinicians and researchers. Purpose. Analyse and compare two conceptual models, the Disability Creation Process (DCP) and the International Classification of Functioning, Disability and Health (ICF), with particular emphasis on the participation component. Method. Conceptual comparative analysis of the DCP and ICF models focused on participation. Results. We found more differences than similarities between the DCP and ICF models. Similarities concerned approaches, objectives, elements of the models' components, and, to some extent, the participation component itself. Differences were mainly in the underlying models, conceptualisation of components including participation, and the measurement tools of participation. Practice Implications. Based on the results of this conceptual comparison, occupational therapists working in clinical and research settings are encouraged to consider using the DCP, which is an excellent model to choose in regard to participation. Empirical studies are still needed to clarify the concept of participation.
The endorsement of the International Classification of Functioning, Disability and Health (ICF) by the 54th World Health Assembly in May 2001 mirrors an important shift in the priorities by the World Health Organization (WHO). Although WHO has traditionally focused on infection control and mortality reduction WHO now also emphasizes the importance of reducing the burden associated with non-fatal health conditions. WHO has developed the ICF to provide a unified, international and standardized language for describing and classifying health and health-related domains and hence to provide a common framework for health outcome measurement. With the approval of the ICF the WHO member states are now called upon to implement the ICF in the health, education, labour and social sector. The ICF has found immediate interest in the health sciences with currently more than 600 ICF related publications reflecting the interest, relevance, and impact of its application in health research worldwide.
The ICF categories are the discrete, meaningful, universally shared and understood elements which allow users to comprehensively classify and measure
functioning, disability and health of individuals and populations. They are thus the building blocks for the construction of ICF-based practical tools such as the
ICF Checklist
and the
ICF Core Sets
as well as clinical measurement instruments such as the ICF Core Set Indices and self-reported measurement instruments such as the World Health Organization Disability Assessment Schedule II (WHODAS II).
While ICF-based practical tools such as the ICF Core Sets allow the classification of functioning states, clinical and self-reported measurement instruments allow the measurement and hence the estimation of functioning status or aspects of it in relation to specific purposes. Vice versa, the ICF categories serve as meaningful and universal reference units for reporting and communicating results of measurements of aspects of functioning made with any measurement instrument from the infinite universe of measurement instruments including health-status measures or health-related quality of life measures.
Achieving goals of healthy people and populations is dependent on available and relevant data for health care decisions. New technologies enable reuse of data for decisions, however it is clear that uniform data standards and in particular standards around terminological data will be required to achieve reuse. Terminological data related to functioning and disability presents unique challenges because of the conceptual ambiguity within the field. The International Classification of Functioning, Disability, and Health (ICF) provides a clarifying conceptual foundation for functioning and disability data, but is not structured as a formal terminology. The need for a concerted and coordinated effort is emphasized.
The International Classification of Functioning, Disability and Health (ICF) is considered to be a big step forward in relation to the possibilities for describing disabilities. The aim of this paper is to l h f p e highlight some strengths and limitations in the ICF that have been found during a study deafblindness. Thirty-two adults aged 19-92 years, totally deaf and blind, as well as those with some remaining vision and hearing, were included. Questionnaires and personal interviews were used. The participants had difficulties in activities and participation on almost all investigated items. The following five circumstances could not be taken account of: fast variation in functioning due to different personal and environmental factors; choosing not to do an activity because of a health condition; time loss impacting on quality of life; health risks related to particular impairments; and obligations. The ICF needs to address these questions and needs to be further developed.
Objectives The purpose of the study was to investigate the physical and psychological prerequisites of functioning, as well as the social environment at work and personal factors. in relation to work, ability and general subjective well-being in a group of office workers. Methods The study was a descriptive cross-sectional investigation. using path analysis. of office workers, The subjects comprised 88 volunteers, 24 men and 64 women. from the same workplace [mean age 45.7 (SD 8.6) years]. The independent variables were measured using psychosocial and physical questionnaires and physical measurements. The first dependent variable, work ability, was measured by a work ability index. The second dependent variable, general subjective well-being. was assessed by life satisfaction and meaning of life, The variables were structured according to a modified version of the International Classification of Functioning. Disability and Health. Results For-ward flexion of the spine. intensity of musculoskeletal symptoms, self-confidence. and mental stress at work explained 58% of work ability and had indirect effects on general subjective well-being. Self-confidence, mood, and work ability had a direct effect on general subjective well-being. The model developed explained 68% of general subjective well-being. Age played a significant role in this study population. Conclusions The prerequisites of physical functioning are important in maintaining work ability. particularly among aging workers. and psychological prerequisites of functioning are of even greater importance in maintaining general subjective well-being.
Study Design. A systematic literature review of outcome questionnaires designed for assessing functional status or disability in patients with low back pain. Objectives. To provide a comprehensive overview of all functioning/disability questionnaires used in recent years and to explore how the main concept(s) was described or defined in the original paper, the content or the domains of disability, and the measurement properties of the questionnaires. Summary of Background Data. A number of clinical tools designed for evaluating the functional status of patients with low back pain have been developed. Only a few have been reviewed earlier, and there has been little focus on the content reflected in the questionnaires. Methods. Papers including questionnaires for assessing disability, function, activity limitations, or participation restrictions in adult patients with low back pain were searched in the MEDLINE and CINAHL databases for the period from January 1996 to January 2002. Two independent and blinded researchers read and selected abstracts and questionnaires. The content of the included questionnaires was classified according to World Health Organization’s International Classification of Functioning, Disability and Health. The measurement properties were analyzed according to recommended guidelines. Results. A total of 36 back-specific questionnaires were identified. When distinguishing among a bodily, personal, and social perspective of functioning, 4 main types of content were identified. Most of the outcome questionnaires had a mixed content reflecting various constructs such as pain and symptoms, sleep disturbances, psychological dysfunctions, physical impairments, and social functions. Nine questionnaires assessed solely activities of daily living. For one-third of the questionnaires, the measurement properties were reported in only the original study. Conclusions. Although most questionnaires had their main focus on activity limitations, a considerable variation with respect to the main concept and content was found. Only a few of the questionnaires can be considered acceptably validated.
The Ministry of Health, The Ministry of Labor and Social Affairs and The Ministry of Education, Youth and Physical Education established working group on the 1st June 1999. The goal of this group was to prepare the concept of rehabilitation law in the Czech Republic. The new concept contains: Introduction; Analysis of current status; Current legislation and its deficiencies; Access to the system, tools, output from the system and its deficiencies; Financial system and its deficiencies; Specification of the term "Rehabilitation" in the international documents signed by Czech Republic and its obligation in this field; Proposals of definition of "Rehabilitation"; Proposals of basic terms and specification of people which belong to the rehabilitation process; Proposals of securing the rehabilitation process; Conclusion.
This paper describes the design of a Dutch study of long term outcome after traumatic brain injury (TBI). The study was designed in 1984 to explore disablement at the level of 'Handicap' as defined by the International Classification of Impairments, Disabilities and Handicaps (ICIDH), now the International Classification of Functioning, Disability and Health (ICF) (WHO 1980, 2002). This paper describes how it came to include measurement of elements of Quality of Life (QoL), before both generic and specific measures of QoL after TBI had been validated.
Evidence-based practice is a method of incorporating research into clinical decision making. The use of this research would help ensure that clinicians are providing therapy that has scientifically been shown to be effective. The World Health Organization's recently approved International Classification of Functioning, Disability, and Health (ICF) has the potential to help bridge the gap between clinicians and researchers by providing a common framework and language. The ICF structure can encourage innovative clinical research among researchers and a better understanding of clinical research among clinicians. This article provides a description of the main parts and components of the ICF and then an argument for the application of the ICF to evidence-based practice research concerning a population with neurogenic communication disorders. In addition, the article briefly outlines the challenges to the development of a specialized version of the ICF for clinical research needs.
Objectives. The aims of this article are threefold. First, a short overview is given of the content and development of the International Classification of Impairments, Disabilities and Handicaps (ICIDH), and particularly of the revision of the ICIDH classification, leading to the International Classification of Functioning Disability and Health (ICF). Second, the degree to which questionnaires measure the different domains of the ICF classification in chronic diseases is considered, in particular regarding rheumatic disorders. Third, a framework based on the ICF is proposed for the selection of questionnaires. Methods. For the second aim a computer-aided literature search (1982-2001) in several databases was performed to identify studies focusing on the clinimetric properties of instruments to assess impairments, disabilities and problems in participation in patients with rheumatic disorders. Results. Of the total of measurement instruments and questionnaires, 57.1% are inventories of (impairments in) body function and structure, 37.4% are inventories of (disabilities in) activities, and 5.5% measure problems in participation (handicap). A majority of 59,9% of instruments is intended as a diagnostic tool. 3.8% as a prognostic tool and 36,3% as an evaluative instrument. The distinction between biomedical and biopsychosocial models implies that clinical observation of a patient should distinguish the symptoms and signs of physical disease from those of distress and illness behavior. Conclusions. It is concluded that there are no instruments or questionnaires available which cover all the domains of the ICF-classification. Furthermore, the ICF provides a very useful conceptual framework as the starting point for analyses domains of available assessment instruments and questionnaires, particularly for patients with chronic diseases. However, many questionnaires do not fit the ICF classification and a framework is presented for selecting optimal instrument(s) in a clinical situation.
Caring for chronic patients is a major challenge for society in the Western world. All governments are introducing measures to benefit chronic patients. The question here is: what are chronic diseases and who is chronically ill? A chronic disease in general practice is an episode of treatment for a defined disease that extends over a long period and is so serious that without treatment "ordinary" everyday activities for the patient's age and sex will be hindered by it to a significant extent and over a long period. The term "chronic" does not say anything about the seriousness of the condition or the stage of disease that has been reached: the patient might have diabetes mellitus which is effectively controlled by oral antidiabetics. A chronic patient is a person with a chronic disease which has a major impact on the everyday activities which are normal for his/her age and sex. There are a number of important principles when it comes to taking measures and making decisions. 1. A positive approach must be taken to the care situation. The starting point should be self-reliance, not the need for care. The new International Classification of Functioning from the World Health Organisation is a useful starting point for this purpose. 2. Clear goals must be established. 3. These must be linked to the real need for care. 4. All this must be assessed on a multidisciplinary basis. 5. Re-evaluation over a period of time is necessary.
Aim. During the acute phase of spinal cord lesions, clinical evolution is evaluated through procedures of the neurological type, whereas during rehabilitation measures finalised to define functional assessment become more important. The study analyses the relationship between neurological level and functional outcome in a population of spinal cord injury (SCI) patients in the post-acute phase at the completion of an overall rehabilitation programme. Methods. The retrospective study was conducted at the Spinal Unit of the Physical Medicine and Rehabilitation Hospital, Udine, Italy, on a population of 71 patients with traumatic and non-traumatic spinal cord lesions, all in the post-acute phase, with entrance neurological lesions corresponding to grade A, B or C of the American Spinal Injury Association ASIA impairment scale. The spinal cord injury patients were evaluated on discharge for completion of spinal cord damage (A, B, C, D) and subdivided by neurological level into 5 groups (C4, C5, C6-C7, D1-D6, D7-L1). Results. Motor Functional Independence Measure (FIM) scores at discharge showed a progressive and constant increase as the neurological level descended in the caudal sense. Gains in motor FIM score between entrance and discharge were found to be significant on comparing groups of patients belonging to different neurological levels. A significant difference in score of the individual items in the motor FIM scale between adjacent neurological groups was only found in some cases. Conclusion. The study shows an inverse relationship between scores obtained with the motor FIM and neurological level, such that high functional scores corresponded to a condition of less neurological damage. The FIM scale successfully discriminated for most items between tetraplegia and paraplegia but, without a from cervical to lumbar SCI patients continuum. Lastly, in our opinion in the evaluation of items relating of mobility and locomotion contextual, environmental and personal factors should also be analysed, as proposed recently in the International Classification of Functioning, Disability and Health (ICF).
This article is an attempt to add to the discussion on the actual state of art in the field of psychiatric social functioning and social disability measurement concerning research tools in Poland. Proceedings in Polish psychometric research in psychiatry with such instruments as Medical Outcomes Study SF-36, tools related to the International Classification of Impairments, Disabilities and Handicaps and its revisions (GSDSII) and Health Related Quality of Life (WHO-DASII) are included in the paper. The need for assessment of practical utilization in the broader health care system context is underscored. Therefore the demand for further intensive studies in Poland still remains valid.
Background. In 1980 the World Health Organization (WHO) published the ICIDH, International Classification of Impairments, Disabilities and Handicap. The ICIDH is considered as a precise coding of impairments, disabilities and handicaps and/or as a conceptual framework for understanding disablement. Despite its acceptance, the ICIDH model and classification scheme has received its share of criticism. In 1993 a revision process of the 1980 ICIDH was begun by WHO and in 1999 a "β-2" draft of the ICDH-2 has been completed. Aim of our study is to verify the applicability of ICIDH-2 in the field of Communication Disorders in developmental and adult populations. Methods. A prospective study was conducted. Patients were interviewed and clinically examined as out-patient at the "S. Giovanni Battista" Hospital of Turin. Ten adults and 10 children, with communication disorders of different kind took part in the study. Time needed to code each subject, intra-rater and inter-rater agreement were calculated. Easiness and pertinence of the classification were subjectively judged. Results. Mean time used in coding was 48 min in adult population and 67 min in children population. Overall inter-rater agreement was 70% and intra-rater agreement 80%. Pertinence and easiness were considered medium. Conclusions. ICIDH-2 it is not only a clinical tool, but also a communication tool between health care workers and health care administrators; its applicability to outcome research makes it useful for different professions of the rehabilitation world. Our study shows that ICIDH-2 is a useful tool for research purposes, but cannot be used as such in clinical practice because of the amount of time needed in coding. The conceptual framework is highly appreciated because of the holistic view it gives.
Data from the Second Supplement on Aging (1994) were analyzed to evaluate the presence of selected medical conditions, performance of basic and instrumental activities of daily living, and participation in life situations in two groups of visually impaired elders (persons aged 70-74 and persons aged 85 years or older) and two other groups of elders in the same age groups who are not visually impaired. Results indicated that, for both age groups, visual impairment is a significant risk factor for additional medical conditions, activity limitations, and participation restrictions.
Background: Disability grants in South Africa increased from 600 000 in 2000 to almost 1.3 million in 2004. This rise can be attributed to the HIV/AIDS epidemic, South Africa's high rate of unemployment and possibly an increased awareness of constitutional rights. The Western Cape, which has a disability prevalence of 3.8%, has also experienced an influx of applications. The study was conducted at Bishop Lavis Community Health Centre (BLCHC) in the Cape Town Metropole, Western Cape.
Acute damage to the brain may lead to many changes in a patient's behaviour and some of these behavioural changes will lead to the involvement of a psychiatrist. This article emphasizes that the usual clinical psychiatric approach is still appropriate, within the constraints of the situation. The specific skill needed is to analyze the behaviour in terms of all the potential causative factors. This is best done within the illness model derived from the World Health Organization's International Classification of Functioning (outlined in this article). In essence, one needs to establish whether the person has any ‘hidden’ specific neurological impairments, and to consider their context (physical, social and personal). The main fact to bear in mind is that brain injury is rarely the specific direct cause of irrational or unacceptable behaviour. The important influences are usually the environment, the person's pre-existing behavioural patterns, drugs (licit and illicit), and less commonly perceptual or cognitive losses. Management of difficult behaviour occurring in the early stages after brain damage is largely one of preserving safety through providing a suitable environment, including one-to-one care if needed while recovery occurs. Later it is likely that the brain injury is a specific factor, and management will be as it would be for anyone else presenting with similar problems. Time spent understanding why a behaviour arises will usually ensure the optimal management.