Timepoint for return to occupations post-burn injury using the Canadian Occupational Performance Measure (COPM)

INTRODUCTION

The Canadian Occupational Performance Measure (COPM) was implemented at a state-wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'- Chapter 7 Measuring Post-Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re-measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation.

METHODS

A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re-assessment while accessing outpatient services. Time frames for re-assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed.

RESULTS

A total of 37 participants were included, with the timeframe between initial and post-COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post-initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post-injury.

CONCLUSION

Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re-measurement be completed no earlier than 3 months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility.

Disability prevalence: comparing four types of disability measures in the community

Background

There is no general consensus on how to measure disability and disability prevalence rates. The results of previous estimates could not be compared due to the varied nature of the methodologies used and the lack of standardization in the measurement of disability. The primary objective of the study was to estimate the prevalence of disability using a population-based disability survey and questions selected by the National Center for Promotion of Employment for Disabled People (NCPEDP). The secondary objective is to determine whether there was any relationship between the severity of disability and essential sociodemographic factors.

The survey was carried out in the Indian state of Gujarat’s Piplag village. Eight final-year physiotherapy students gathered sociodemographic data and answers to the four disability-related questions—disability question asked in India census 2011, Washington Group (WG)-suggested question, United Nations Convention on the Rights of Persons with Disabilities (UNCRPD)-based question, and National Sample Survey Organization (NSSO)-based question.

Results

A greater percentage of the population was classified as having a functional limitation in the questions based on the UNCRPD (28.29%) (95% CI 25.1–31.3%) and the WG (29.69%) (95% CI 26.0–34.4%). Our findings demonstrated that there were significant relationships between the questions in different questionnaires (p < 0.01). Female gender strongly influences how people self-identify as having a disability (by 5.7 to 12.07 times), and the predictor variables based on the Indian census 2011 questions explained 61.7% of the variation in prevalence of disability.

Conclusions

The prevalence statistics may vary based on the questions used to gather information about disabilities. As gender and socioeconomic status can impact the prevalence of disabilities, it is important to focus on ways to improve economic growth, especially for women.

Activity limitations and participation restrictions among people with non-communicable diseases in Ghana

Anecdotal evidence suggests that non-communicable diseases (NCDs) contribute substantially to mortality, morbidity and disability in Ghana. Nonetheless, no data are presently available on Ghanaians with disability from major NCDs, such as hypertension, diabetes and stroke. Using data from the 2007/2008 Ghana World Health Organization Study on Global Ageing and Adult Health (SAGE) and applying ordinary least squares techniques, the prevalence of and associations between activity limitations and participation restrictions in Ghanaians with NCDs are examined in the present study. The results show stroke is the major contributor to activity limitations and participation restrictions among the Ghanaian population with NCDs. The study results further revealed that respondents with higher education reported high levels of disability compared to those with no education. The results suggest that functioning can be restored by providing assistive technologies, such as wheelchairs, prosthetic limbs, walking aids, etc., that can enhance participation of persons with disability in society.

Leveraging Factors of Self-Efficacy and Motivation to Optimize Stroke Recovery

The International Classification of Functioning, Disability and Health framework recognizes that an individual's functioning post-stroke reflects an interaction between their health condition and contextual factors encompassing personal and environmental factors. Personal factors significantly impact rehabilitation outcomes as they determine how an individual evaluates their situation and copes with their condition in daily life. A key personal factor is self-efficacy-an individual's belief in their capacity to achieve certain outcomes. Self-efficacy influences an individual's motivational state to execute behaviors necessary for achieving desired rehabilitation outcomes. Stroke rehabilitation practice and research now acknowledge self-efficacy and motivation as critical elements in post-stroke recovery, and increasing evidence highlights their contributions to motor (re)learning. Given the informative value of neuroimaging-based biomarkers in stroke, elucidating the neurological underpinnings of self-efficacy and motivation may optimize post-stroke recovery. In this review, we examine the role of self-efficacy and motivation in stroke rehabilitation and recovery, identify potential neural substrates underlying these factors from current neuroimaging literature, and discuss how leveraging these factors and their associated neural substrates has the potential to advance the field of stroke rehabilitation.

Factors Affecting the Perception of Disability: A Developmental Perspective

Perception of disability is an important construct affecting not only the well-being of individuals with disabilities, but also the moral compass of the society. Negative attitudes toward disability disempower individuals with disabilities and lead to their social exclusion and isolation. By contrast, a healthy society encourages positive attitudes toward individuals with disabilities and promotes social inclusion. The current review explored disability perception in the light of the in-group vs. out-group dichotomy, since individuals with disabilities may be perceived as a special case of out-group. We implemented a developmental approach to study perception of disability from early age into adolescence while exploring cognitive, affective, and behavioral components of children’s attitudes. Potential factors influencing perception of disability were considered at the level of society, family and school environment, and the individual. Better understanding of factors influencing the development of disability perception would allow the design of effective interventions to improve children’s attitudes toward peers with disabilities, reduce intergroup biases, and promote social inclusion. Based on previous research in social and developmental psychology, education, and anthropology, we proposed an integrative model that provides a conceptual framework for understanding the development of disability perception.

Engaging Those Living With Moderate to Severe TBI and Their Caregivers in Research

Despite the fact that millions of individuals living in the United States are coping with disabilities associated with traumatic brain injury (TBI), limited work has explored strategies for patient engagement in research among those with such injuries. The Coalition for Recovery and Innovation in Traumatic Brain Injury Care Across the Lifespan (CRITICAL) brought together those living with TBI, caregivers, clinicians, researchers, and advocates with the goal of developing a new patient-centered research agenda. This platform was also used to explore strategies to engage those with moderate to severe TBI in the research process. The CRITICAL was formed of 6 survivors of moderate to severe TBI, 2 caregivers of survivors of moderate to severe TBI, and 8 TBI professionals. The CRITICAL identified 3 priority topic areas: Relationship Quality, Caregiver Needs, and Thriving. Furthermore, strategies associated with Communication, Preparation, and the Environment facilitated research engagement. Employing the strategies outlined in this article is expected to promote patient engagement in clinical research, which can improve patient-centered interventions and outcomes for individuals living with TBI.

The role of social isolation in physical and emotional outcomes among patients with chronic pain

OBJECTIVE

Social isolation negatively impacts early-disease processes and long-term health. Individuals with chronic pain are more vulnerable to social isolation, which exacerbates symptoms. It is currently unclear whether: 1. group-based programs for chronic pain improve social isolation, 2. improvements in social isolation account for improvements in outcomes. This study involved secondary data analysis of participants in a 10-week mind-body physical activity program. We examined whether social isolation improved during treatment, and whether such improvements accounted for improvements in emotional and physical functioning.

METHODS

Participants (N = 82) with chronic pain were randomized to a group-based mind-body physical activity intervention with (GetActive-Fitbit; n = 41) or without a Fitbit device (GetActive; n = 41). Participants completed self-reported measures of social isolation, emotional functioning (depression and anxiety symptoms), and multimodal physical functioning (self-report, performance-based, and objective). We used linear mixed effects modeling to examine pre-post treatment changes in social isolation and whether these changes accounted for improvements in emotional and physical functioning.

RESULTS

Both interventions were associated with significant and comparable improvements in social isolation from baseline to end of treatment, and improvements in social isolation accounted for significant improvements in self-reported emotional and physical functioning.

CONCLUSION

Interventions may target social isolation in chronic pain to optimize treatment outcomes.

Schizophrenia, recovery and the individual-cultural considerations

OBJECTIVES

The concept of recovery in mental health has been embraced by many services across the world. Placing the individual (self) at the core of service delivery constituted a profound shift from service-driven models of care. However, cultures described as individualistic or collectivist may hold very different views of individuality. In cultures with collectivist orientation, the notion of 'individualism' is integrated into the structure and dynamics of the family. The families in such cultures play a major and lifetime role in caring for its members, making decisions and acting in consideration of the welfare of all. The needs and priorities of individuals, especially women, may be superseded by those of their families. This commentary is on the effect of culture on the identity of self in the recovery process and its relevance to mental health care.

CONCLUSION

In multicultural societies like Australia that include Indigenous people, the process of acculturation may be different. For the Indigenous people, the shift was from a collectivist culture to one that was predominantly individualistic. In the provision of recovery-oriented mental health care, there needs to be an awareness of the cultural variations in the relational dynamics of individualism.

Spinal Cord Injury Veterans' Disability Benefits, Outcomes, and Health Care Utilization Patterns: Protocol for a Qualitative Study

BACKGROUND

An estimated 42,000 people currently living with chronic spinal cord injury (SCI) are veterans. SCI was a common combat-related injury in the World Wars and Vietnam era and now affects more than 11% of military personnel injured in Operation Iraqi Freedom and Operation Enduring Freedom. The Veterans Benefits Administration primarily offers financial compensation for disabilities sustained or re-aggravated during military service, called service-connected disability compensation. With the overwhelming cost of living with an SCI, this monthly financial compensation can provide service-connected veterans and their families with access to additional supportive resources (eg, assistive devices and personal aide) and maintain their quality of life (QOL). Little is known about personal, health, functional, and QOL outcomes associated with service-connected and nonservice-connected status for veterans living with an SCI.

OBJECTIVE

The aim of this study is to compare the ways in which Veterans Affairs' (VA) service-connected and nonservice-connected status may be associated with health and functional outcomes, choice of health care provider, and overall QOL for veterans living with an SCI and their caregivers.

METHODS

This cross-sectional qualitative study will gather data using retrospective chart reviews, semistructured interviews, and focus groups. After obtaining institutional review board (IRB) approval, purposeful sampling techniques will be used to recruit and enroll the following key stakeholders: veterans living with an SCI, family caregivers, and SCI health care providers. Concurrent data collection will take place at 2 sites: Veterans Administration New Jersey Healthcare System and Northern New Jersey Spinal Cord Injury System.

RESULTS

This study was funded in July 2015. IRB approval was obtained by November 2016 at both sites. Enrollment and data collection for phase 1 to phase 4 are complete. A total of 69 veterans, 18 caregivers, and 19 SCI clinicians enrolled in the study. Data analyses for these phases are underway. In phase 5, the follow-up focus group activities are scheduled. The final results are expected by the end of 2019.

CONCLUSIONS

The factors that contribute to veterans living with SCI seeking and not seeking VA disability compensation benefits are not well understood in rehabilitation research. Triangulation of these data sources will allow us to compare, contrast, and integrate the results, which can be used to develop clinical guidelines, caregiver training, and patient education programs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/14039.

Using the International Classification of Functioning, Disability and Health to Document Hospice Eligibility

Hospice documentation is an integral part of patient care as it not only paints the picture of hospice eligibility, but also tells the final chapter of a patient's life. Increasingly, hospices are under scrutiny by regulators to clearly define the admission and ongoing eligibility of the hospice patient. There is a lack of national standardization of documentation. The World Health Organization, in an effort to develop a common language among providers, developed the International Classification of Functioning, Disability and Health (ICF). Utilizing the ICF can assist with the documentation that establishes the eligibility of the hospice patient. Concepts from the ICF are applied to a case study of a patient with Parkinson's disease. The ICF has barriers and limitations for documentation of the eligibility of the hospice patient, but overall, its use is recommended by the hospice interdisciplinary team.

Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded Constraint-Induced Movement therapy

PURPOSE

To evaluate the efficacy of an expanded form of Constraint-Induced Movement Therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper-extremity hemiparesis, suitable for treating severe hemiparesis.

METHODS

Twenty-one adults ≥1 year after stroke with severe upper-extremity hemiparesis (with little or no capacity to make movements with the more-affected hand) were randomly assigned to eCIMT (n = 10), a placebo-control procedure (n = 4), or usual care (n = 7). The participants who received usual care were crossed over to eCIMT four months after enrollment. The CIMT protocol was altered to include fitting of orthotics and adaptive equipment, selected neurodevelopmental techniques, and electromyography-triggered functional electrical stimulation. Treatment was given for 15 consecutive weekdays with 6 hours of therapy scheduled daily for the immediate eCIMT group and 3.5 hours daily for the cross-over eCIMT group.

RESULTS

At post-treatment, the immediate eCIMT group showed significant gains relative to the combination of the control groups on the Grade-4/5 Motor Activity Log (MAL; mean = 1.5 points, P < 0.001, f = 4.2) and a convergent measure, the Canadian Occupational Performance Measure (COPM; mean = 2.3, P = 0.014, f = 1.1; f values ≥0.4 are considered large, on the COPM changes ≥2 are considered clinically meaningful). At 1-year follow-up, the MAL gains in the immediate eCIMT group were only 13% less than at post-treatment. The short and long-term outcomes of the crossover eCIMT group were similar to those of the immediate eCIMT group.

CONCLUSIONS

This small, randomized controlled trial (RCT) suggests that eCIMT produces a large, meaningful, and persistent improvement in everyday use of the more-affected arm in adults with severe upper-extremity hemiparesis long after stroke. These promising findings warrant confirmation by a large RCT.

Examining young children's social competence using functional ability profiles

PURPOSE

To explore the use of International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) based profiles of children's functional abilities in relation to their social competence. Subgroups based on shared profiles of functional ability were investigated as an alternative or complement to subgroups defined by disability categories.

METHODS

Secondary analysis of a nationally representative data set of young children identified for special education services in the United States was used for the present study. Using five subgroups of children with shared profiles of functional ability, derived from latent class analysis in previous work, regression analyses were used to examine the relationships between social competence and functional abilities profile subgroup membership. Differences among the subgroups were examined using standardized effect sizes. R² values were used to examine explained variance in social competence in relation to subgroup membership, disability category, and these variables in combination.

RESULTS

Functional ability profile subgroup membership was moderately related to children's social competence outcomes: social skills and problem behaviors. Effect sizes showed significant differences between subgroups. Subgroup membership accounted for more variance in social competence outcomes than disability category.

CONCLUSIONS

The results provide empirical support for the importance of functional ability profiles when examining social competence within a population of young children with disabilities. Implications for Rehabilitation The extent to which children with disabilities experience difficulty with social competence varies by their functional characteristics. Functional ability profiles can provide practitioners and researchers working young children with disabilities important tools to examine social competence and to inform interventions.

Convergent and discriminant validity of quality of life measures used in burn populations

INTRODUCTION

The primary goal of this study was to investigate convergent validity, i.e. overlapping constructs, of the Burn Specific Health Scale-Brief (BSHS-B), the Short Form-36 items Health Survey (SF-36) and the European Quality Of Life Five Dimensions (EQ-5D) within the International Classification of Functioning Disability and Health (ICF) framework. A secondary goal was to examine the discriminant validity of the questionnaires according to burn severity (no surgery versus 1 or more surgeries).

METHODS

A prospective multi-centre study in adult patients with burns was conducted. At the 9 months assessment, two generic questionnaires, i.e. the SF-36 and EQ-5D, and the BSHS-B were completed. Pearson correlations were used to evaluate convergent validity. Linear discriminant analysis was used to evaluate discriminant validity.

RESULTS

At 9 months post-burn data from 184 persons were available of which 131 (71%) were male, mean TBSA burned was 11.8% (SD=10.2). Sixty five (34%) patients did not need surgery, 128 (66%) patients required one or more surgeries. Higher convergence was shown between the generic SF-36 and the condition specific BSHS-B whereas the EQ-5D showed lower convergence with the BSHS-B especially in the domain Activity. The generic scales discriminated across all scales whereas not all BSHS-B scales were able to differentiate problem levels across burn severity groups.

CONCLUSION

This study demonstrates that the ICF is useful to classify scales in order to identify overlapping areas as well as to uncover gaps in relation to patient reported outcomes. Both the SF-36 and EQ-5D showed the ability to distinguish levels of functioning across burn severity groups. As the BSHS-B performed less well and relevant domains of functioning were not addressed, there is room for improvement and modification of this condition specific questionnaire to better capture burn patients' functioning.

Identification of functional domains in developmental measures: An ICF-CY analysis of Griffiths developmental scales and Schedule of Growing Skills II

OBJECTIVE

This study aims to identify functioning categories of the International Classification of Functionality, Disability and Health for Children and Youth covered by the Griffiths developmental scales and the Schedule of Growing Skills II (SGS-II), as well as to analyse levels of agreement between coders when assigning its items to the ICF-CY classification system.

METHODS

Items were linked to the ICF-CY following a content analysis procedure and the published linking rules. Agreement was calculated with Cohen's Kappa Coefficient.

RESULTS

All SGS items assess mostly Activities and Participation, alike most of the Griffiths' scales except for the Language and Eye-hand coordination scales, which assess mostly Body Functions. Consistently with previous studies, agreement levels between coders vary considerably, thus being highly dependent on the nature of the concept analysed.

CONCLUSION

Although necessary from a capacity-driven approach to assessment, information collected with these instruments should be complemented with other assessments in order to cover all aspects of the child's life, in line with a systemic approach.

Rehabilitation of Executive Functions in Patients with Chronic Acquired Brain Injury with Goal Management Training, External Cuing, and Emotional Regulation: A Randomized Controlled Trial

Executive dysfunction is a common consequence of acquired brain injury (ABI), causing significant disability in daily life. This randomized controlled trial investigated the efficacy of Goal Management Training (GMT) in improving executive functioning in patients with chronic ABI. Seventy patients with a verified ABI and executive dysfunction were randomly allocated to GMT (n=33) or a psycho-educative active control condition, Brain Health Workshop (BHW) (n=37). In addition, all participants received external cueing by text messages. Neuropsychological tests and self-reported questionnaires of executive functioning were administered pre-intervention, immediately after intervention, and at 6 months follow-up. Assessors were blinded to group allocation. Questionnaire measures indicated significant improvement of everyday executive functioning in the GMT group, with effects lasting at least 6 months post-treatment. Both groups improved on the majority of the applied neuropsychological tests. However, improved performance on tests demanding executive attention was most prominent in the GMT group. The results indicate that GMT combined with external cueing is an effective metacognitive strategy training method, ameliorating executive dysfunction in daily life for patients with chronic ABI. The strongest effects were seen on self-report measures of executive functions 6 months post-treatment, suggesting that strategies learned in GMT were applied and consolidated in everyday life after the end of training. Furthermore, these findings show that executive dysfunction can be improved years after the ABI.

Relationships Between World Health OrganizationInternational Classification of Functioning, Disability and HealthConstructs and Participation in Adults With Severe Mental Illness

Purpose:To examine the World Health OrganizationInternational Classification of Functioning, Disability and Health(ICF) constructs as correlates of community participation of people with severe mental illnesses (SMI).

Methods:Quantitative descriptive research design using multiple regression and correlational techniques was used to analyze 193 persons with SMI.

Results:This study examined the unique relationships between each of the ICF constructs and participation in a series of simultaneous regression analyses. Age, schizophrenia/schizoaffective diagnosis, insight, self-care activity, social competency, and social support from friends were significant predictors of participation when compared to variables in the same ICF constructs. In addition, these significant ICF predictors of participation were entered in a hierarchical regression, and only insight, social competency, and social support from friends were found to be significant predictors of participation after controlling for the effect of other ICF variables.

Conclusion:In this ICF model, insight, social competency, and social support from friends were found to be associated with participation and mediated the individual contributions of types of psychiatric disabilities and self-care activity to participation. Rehabilitation practitioners should focus on interventions that increase these factors for people with SMI. Rehabilitation researchers should continue to use the ICF as a model from which to predict participation in specific life activities (e.g., employment) for people with SMI. Continued application and validation of the ICF model could positively impact recovery-oriented outcomes for individuals with SMI.

Barriers experienced by service providers and caregivers in clubfoot management in Kenya

Aim

Disability in childhood remains a challenge globally. Linked to this disability is an apparent increase in the prevalence of infants born with congenital clubfoot. Clubfoot can, however, be effectively managed but this management faces various challenges. This study aims at exploring the barriers experienced in Kenya.

Methods

In-depth interviews were conducted with 20 participants. Informed consent was sought. Field notes were taken and the interviews tape-recorded. The interviews took 45 minutes to 1 hour. They were transcribed verbatim and analysed by thematic content.

Results

Missed diagnosis, poor referral system, shortage of staff, long travelling distance, poverty, stigmatisation and lack of support among other were highlighted as the major challenges in clubfoot management.

Conclusion

The challenges facing children with disability start at birth but are little different from those faced throughout their life. Action to remove these challenges is warranted

Conceptualization and Rehabilitation of Executive Functions

Publications on executive functions have increased in the last few years, reflecting the importance of this area of study. The scientific output on executive functions is now extremely diverse, comprising variations around terminology, assessment, and rehabilitation practices, and ranging in topics from neuroanatomical correlates of executive functions to effects of executive dysfunction. This review seeks to explore this diversity around executive functions in order to provide an integrative overview of the topic that systematizes the current knowledge in this area, and to point to trends and future directions for research and practice. The literature review was conducted in the ISI Web of Knowledge databases. The analysis was conducted in NVivo9. Two independent coders applied an inductive analysis to all relevant papers, building a hierarchical model with categories and subcategories of themes emerging from the literature. A confirmatory analysis followed, with the same independent coders applying the model to the papers. The process was validated by a third expert researcher. Out of 187 titles and abstracts, 91 were analyzed. The outcomes were structured in six main categories: central nervous system, diagnosis, population, assessment, intervention, and theoretical models. Key findings included promising trends in executive function assessment and rehabilitation as well as potential implications for current health approaches and future research.

Interactive Effects of Physical Disability Severity and Age of Disability Onset on RIASEC Self-Efficacies

In this study, the authors focused on the context of physical disabilities (i.e., one’s age when a disability manifests and the severity with which it impacts major life activities) to better understand how disabilities influence vocational self-efficacies. Consistent with Social Cognitive Career Theory, age of onset moderated the relationship between disability severity and self-efficacies in the Realistic, Artistic, Social, and Conventional vocational domains. Specifically, disability severity had a strong, negative impact on self-efficacies for people who became physically disabled later in life. In contrast, the relationship between disability severity and self-efficacy was nonsignificant for people who became disabled in early childhood. These findings held across Holland’s Realistic, Investigative, Artistic, Social, Enterprising, and Conventional domains when controlling for a variety of other person inputs and domain-specific learning experiences.

Vocational rehabilitation evaluation and the International Classification of Functioning, Disability, and Health (ICF)

PURPOSE

To identify the most frequent functional limitations according to the International Classification of Functioning, Disability, and Health (ICF) obtained by unstandardised clinical assessment of patients with chronic musculoskeletal disorders who underwent vocational rehabilitation evaluation; and to compare the obtained list with simplified versions of ICF.

METHODS

The descriptions of functional limitations were retrospectively identified for 32 patients. The original vocational rehabilitation evaluation was conducted by a multi-professional team in an out-patient clinic of a university hospital. The obtained descriptions were converted to ICF codes, the most frequent being compared with the ICF Checklist of the World Health Organization (WHO) and the ICF Comprehensive and Brief Core Sets suggested by the ICF Research Branch.

RESULTS

In the study population (53 % women), 141 ICF codes were identified with a preciseness of three or more digits, the average being 21 codes/subject (median 20.0, range 9-40). When truncated to three digits, 84 ICF codes remained (average 18 codes/subject, range 9-25), 45 of which appeared in over 10 % of the study population, 24 also being found in the ICF Comprehensive, 5 in the ICF Brief Core Sets, and 33 in the WHO ICF Checklist.

CONCLUSIONS

The list of most frequent ICF codes retrospectively obtained in this study from unstandardised records showed a similarity with ICF Comprehensive and Brief Core Sets by ICF Research Branch and the ICF Checklist by WHO, but with a bias towards the identification of body structures and functions. The results support the use of ICF in vocational rehabilitation evaluation to ensure comprehensiveness of evaluation. The ICF Comprehensive Core Set seems to be the most useful for the needs of multiprofessional team when assessing functioning of patients.

A conceptual definition of vocational rehabilitation based on the ICF: building a shared global model

BACKGROUND

The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF.

METHOD

We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models.

RESULTS

Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary.

CONCLUSIONS

VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participation.

International Classification of Functioning, Disability, and Health: Implications for School Psychologists

The International Classification of Functioning, Disability and Health (ICF) provides a framework for describing behaviors by viewing them from three broad and different perspectives: (1) physiologic, physical, and psychological functions; (2) a person’s engagement in functional life activities; and (3) their participation in social settings. The ICF Framework aligns well with current efforts in school psychology to adopt population-based models of service delivery, reflect public health models of service delivery, promote mental health, and prevent disorders or problem behaviors. Essential features of the ICF together with implications important to service delivery in general and psychoeducational assessment in particular are described.

Assessing executive performance during cognitive rehabilitation

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002). Impairment in executive functioning disrupts a person's ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a person's executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.

Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation

PURPOSE

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.

METHOD

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.

RESULTS

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.

CONCLUSIONS

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.

Implications of the International Classification of Functioning, Disability and Health (ICF) for Test Development and Use

Implications of the International Classification of Functioning, Disability and Health (ICF) on the development and use of tests in school settings are enumerated. We predict increased demand for behavioural assessments that consider a person’s activities, participation and person-environment interactions, including measures that: (a) address contextual features; (b) rely on third-party respondents; (c) depend on observational approaches; (d) comprise batteries of tests developed simultaneously or co-normed and (e) emphasize process and progress monitoring. We review some tests from the United States that respond to each emerging demand and describe the international implications of these demands. We close by describing the implications of the ICF model and its associated changes in testing practices for service delivery and student outcomes.

Beyond diagnosis: understanding the healthcare challenges of injured veterans through the application of the International Classification of Functioning, Disability and Health (ICF)

Psychiatric and neurological disorders brought about by exposure to combat can create serious obstacles to community reintegration. Effective therapeutic and rehabilitative methods designed to address disorders that arise from combat are available. Yet there continues to be a need to develop both a deeper understanding of veterans' needs and best-practice methods to alleviate distress and facilitate community participation. Awareness of these needs served as the catalyst for the International Conference on Behavioral Health and Traumatic Brain Injury and is the basis for developing numerous new programs and service refinements across government and non-government organizations. Despite advances, community reintegration remains a complicated endeavor for many veterans returning home who are experiencing traumatic brain- and stress-related disorders. Accurately conceptualizing and codifying symptoms and barriers to community participation, beyond impairment analysis and diagnostic inclusion, is necessary to guide treatment planning and inform programmatic refinements. The International Classification of Function, Disability and Health (ICF) offers a useful taxonomic tool that can assist in refining an understanding of the challenges confronting our returning veterans. In turn, resources can be appropriately allocated, and neuropsychological therapies and other rehabilitation interventions, which assist veterans to resume productive and satisfying lives, will more likely be developed and implemented.

The ICF: A Classification System and Conceptual Framework Ideal for Audiological Rehabilitation

In 2001, the World Health Organization (WHO) adopted the International Classification of Functioning, Disability, and Health, commonly referred to as the ICF (WHO, 2001), which is a biopsychosocial classification system of health. It provides a common framework for describing consequences of health conditions and specifically for understanding the dimensions of health and functioning. The ICF is particularly relevant for rehabilitation sciences because the health conditions of people seeking rehabilitation services are typically chronic and the associated impairments cannot be cured. The present article highlights some key differences between a curative and a rehabilitative approach to health services. Then, the components of the IFC are defined, described, and illustrated. The main characteristics of the classification system are outlined. Finally, some important features associated with the use of the ICF as a conceptual framework for clinical services in rehabilitative audiology are presented.

Impairment versus deficiency in neuropsychological assessment: Implications for ecological validity

Neuropsychological test interpretation has relied on pre- and postmorbid comparisons, as exemplified by the use of demographically adjusted normative data. We argue that, when the assessment goal is to predict real-world functioning, this interpretive method should be supplemented by "absolute" scores. Such scores are derived from comparisons with the general healthy adult population (i.e., demographically unadjusted normative data) and reflect examinees' current ability, that is, the interaction between premorbid and injury/disease-related factors. In support of this view, we found that substantial discrepancies between demographically adjusted and absolute scores were common in a traumatic brain injury sample, especially in participants with certain demographic profiles. Absolute scores predicted selected measures of functional outcome better than demographically adjusted scores and also classified participants' functional status more accurately, to the extent that these scores diverged. In conclusion, the ecological validity of neuropsychological tests may be improved by the consideration of absolute scores. (JINS, 2009, 15, 94-102.).

Multiple health disparities among minority adults with mobility limitations: san application of the ICF framework and codes

PURPOSE

To examine the interface between mobility limitations and minority status and its effect on multiple health and health-related domains among adults, using the framework of the International Classification of Functioning, Disability and Health (ICF).

METHODS

We combined 8 years of data from the 1997-2004 US National Health Interview Survey to investigate health disparities among minorities with mobility limitations as defined by the ICF. A total of 79,739 adults surveyed met these criteria.

RESULTS

Adults with both mobility limitations and minority status experienced the greatest disparities (p<0.001) in worsening health (adjusted odds ratio [AOR]=8.5), depressive symptoms (AOR=17.2), diabetes (AOR=5.5), hypertension (AOR=3.4), stroke (AOR=7.2), visual impairment (AOR=4.6), difficulty with activities of daily living (AOR=42.7) and instrumental activities of daily living (AOR=27.7), use of special equipment (AOR = 28.1), obesity (AOR=3.3), physical inactivity (AOR=2.7), and low workforce participation (AOR=0.35).

CONCLUSIONS

For most outcome measures, findings supported our hypothesis that persons with both mobility limitations and minority status experience greater health disparities than do adults with minority status or mobility limitations alone.