Measuring chronic health condition and disability as distinct concepts in national surveys of school-aged children in Canada: a comprehensive review with recommendations based on the ICD-10 and ICF

Low Level of Well-being in Young People With Physical-Mental Multimorbidity: A Population-Based Study

PURPOSE

We aimed to examine whether wellbeing, health behavior, and youth life among young people (YP) with co-occurrence of physical-mental conditions, that is, multimorbidity differ from YP with exclusively physical or mental conditions.

METHODS

The population included 3,671 YP reported as having a physical or/and mental condition from a Danish nationwide school-based survey (aged 14-26 years). Wellbeing was measured by the five-item World Health Organization Well-Being Index and life satisfaction by the Cantril Ladder. YP's health behavior and youth life were evaluated in seven domains: home, education, activities/friends, drugs, sleep, sexuality, and self-harm/suicidal thoughts, in accordance with the Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety acronym. We performed descriptive statistics and multilevel logistic regression analysis.

RESULTS

A total of 52% of YP with physical-mental multimorbidity reported a low level of wellbeing, compared to 27% of YP with physical conditions and 44% with mental conditions. YP with multimorbidity had significantly higher odds of reporting poor life satisfaction, compared to YP with exclusively physical or mental conditions. YP with multimorbidity had significantly higher odds for psychosocial challenges and health risk behavior, compared to YP with physical conditions, along with increased odds for loneliness (23.3%), self-harm (63.1%), and suicidal thoughts (54.2%), compared to YP with mental conditions.

DISCUSSION

YP with physical-mental multimorbidity had higher odds for challenges and low wellbeing and life satisfaction. This is an especially vulnerable group and systematic screening for multimorbidity and psychosocial wellbeing is needed in all healthcare settings.

The ICF has made a difference to functioning and disability measurement and statistics

AIMS

Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.

METHODS

In a scoping review, we investigated research published 2001-2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.

RESULTS

The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.

CONCLUSION

The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes. Implications for Rehabilitation The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance. Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning. Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.

Do adolescents with long-term illnesses and disabilities have increased risks of sports related injuries?

Background

The aim of this study is to examine the rates of sports related injuries in adolescents based on the severity of their long-term illnesses or disabilities (LTID). Few injury prevention strategies in sports and health promotion have explored disaggregation by disability.

Methods

Data obtained from the 2014 Finnish Health Behaviour in School-aged Children survey (n = 3716, mean age = 14.8, SD = 1.03) were grouped into adolescents with and without LTID. A further indicator or severity was determined when adolescents reported their LTID affected their participation (affected LTID). Odds ratio (95% CI) were used to determine the associations between sports related injuries and LTID, daily moderate to vigorous physical activities (MVPA), being a sports club member, physical competence, and family encouragement, after controlling for age, gender and family affluence.

Results

One in four adolescents (25%) reported to have LTID and one in eight adolescents (12.5%) reported sports injuries. The odds for adolescents with chronic conditions, functional and learning difficulties was the highest (OR 3.55, CI = 2.3–5.4) for overall injuries, when compared with adolescents without LTID. Adolescents with affected LTID (OR = 2.08, CI = 1.5–2.9) were more likely to report medically attended injuries than adolescents without LTID. Sports-related injuries (OR = 0.33, CI = 0.1–0.8) were lower in adolescents with affected LTID than those without LTID after adjusting for personal and environmental factors.

Conclusions

Taking part in sport clubs increases the risk of sports related injuries in adolescents with and without LTID, but not with affected LTID. Few adolescents with affected LTID participate in sports clubs and were less likely to report the most serious type of injury to be from sports. These results could be used for devising sports based injury prevention and health promotion strategies for children with LTID.

The association between medical conditions and gender, well-being, psychosomatic complaints as well as school adaptability

AIM

The aim was to assess the association between medical conditions and gender, well-being, psychosomatic complaints and school adaptability. The second aim was to determine whether self-reported medical conditions should be included in class-room questionnaires that deal with well-being and risk behaviour.

METHODS

A cross-sectional class-room questionnaire was given to all 15- to 16-year-olds within a Swedish county. The questionnaire included background factors, subjective health, well-being, psychosomatic complaints, self image, drug use and also several themes from the school context. In addition, there were 13 medical conditions/problems to tick (yes or no) and an open alternative for other problems/medical conditions.

RESULTS

3108 questionnaires (response rate 84%) were analysed. The majority of the girls and the boys reported no medical conditions; however, 49% of the girls and 39% of the boys reported at least one medical condition. The medical conditions were associated with gender, well-being, psychosomatic complaints and school adaptability. The association was stronger for girls than for boys.

CONCLUSION

Medical conditions among these teenagers were associated with gender, well-being, psychosomatic complaints and school adaptability, particularly for girls. Our results suggest that medical conditions could preferably be included in regular classroom questionnaires.

Implementation of ICF in goal setting in rehabilitation of children with chronic disabilities at Beitostolen Healthsports Centre

PURPOSE

Develop an International Classification of Functioning, Disability and Health (ICF) Code Set, useful in goal oriented rehabilitation of a study population of children with chronic disabilities.

METHOD

A triangulation of methods, using an interview to identify the main needs and goals of the study population, and a questionnaire to identify the main problems, with a registration of the frequency within each category. After qualitative and quantitative analyses this resulted in two sets of ICF categories. These two sets were then compared and merged into a proposed ICF Code Set for goal setting.

RESULTS

Thirty categories were identified from the interviews and the following linking process. Problems were reported in all suggested categories within the ICF questionnaire, resulting in 49 categories. The comparison of the two sets of categories resulted in a proposed ICF Code Set of 40 categories.

CONCLUSIONS

Through a triangulation of methods, we developed a tailored code set for the goal setting process in rehabilitation for children with a disability, taking into account both individual preferences and the health professionals' perspective. Although the external validity is limited, our methodological procedures may have relevance for the implementation of ICF in other clinical settings and populations.

Participation and environmental aspects in education and the ICF and the ICF-CY: findings from a systematic literature review

BACKGROUND

This paper presents findings from a systematic review of the literature related to participation and the ICF/ICF-CY in educational research.

OBJECTIVES

To analyse how and investigate the application of participation in educational research. Specifically, how participation is related to the environmental dimensions availability, accessibility, affordability, accommodability and acceptability.

METHODS

A systematic literature review using database keyword searches and refinement protocols using inclusion and exclusion criteria at abstract, full-text and extraction.

RESULTS

Four hundred and twenty-one initial works were found. Twenty-three met the inclusion criteria. Availability and accommodations are the most investigated dimensions. Operationalization of participation is not always consistent with definitions used.

CONCLUSION

Research is developing a holistic approach to investigating participation as, although all papers reference at least one environmental dimension, only four of the 11 empirical works reviewed present a fully balanced approach when theorizing and operationalizing participation; hopefully this balanced approach will continue and influence educational policy and school practice.

Application of the International Classification of Functioning, Disability, and Health–Children and Youth Version (ICF-CY) to Cleft Lip and Palate

Objective

In recent health policy discussions, the World Health Organization has urged member states to implement the International Classification of Functioning, Disability, and Health: Children and Youth Version in their clinical practice and research. The purpose of this study was to identify codes from the International Classification of Functioning, Disability, and Health: Children and Youth Version relevant for use among children with cleft lip and/or palate, thereby highlighting the potential value of these codes for interprofessional cleft palate-craniofacial teams.

Design

The scope of recent published research in the area of cleft lip and/or palate was reviewed and compared with meaningful terms identified from the International Classification of Functioning, Disability, and Health: Children and Youth Version. In a five-step procedure, a consensus-based list of terms was developed that was linked separately to International Classification of Functioning, Disability, and Health: Children and Youth Version categories and codes. This provided a first draft of a core set for use in the cleft lip and/or palate field.

Conclusions

Adopting International Classification of Functioning, Disability, and Health: Children and Youth Version domains in cleft lip and/or palate may aid experts in identifying appropriate starting points for assessment, counseling, and therapy. When used as a clinical tool, it encourages health care professionals to go beyond treatment and outcome perspectives that are focused solely on the child and to include the children's environment and their familial/societal context. In order to establish improved, evidence-based interdisciplinary treatments for children with cleft lip and/or palate, more studies are needed that seek to identify all the influencing conditions of activities, children's participation, and barriers/facilitators in their environments.

Relação entre a Avaliação da Coordenação e Destreza Motora (Acoordem) e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF)

INTRODUÇÃO: A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) visa a proporcionar uma base científica para a compreensão e o estudo da saúde e das condições relacionadas, podendo ser utilizada para nortear a criação e utilização de medidas de desfecho em reabilitação. A Avaliação da Coordenação e Destreza Motora (Acoordem) é um teste brasileiro, criado para detectar atraso motor em crianças de 4 a 8 anos. OBJETIVOS: Os objetivos deste estudo foram: a) associar as subcategorias da CIF aos itens da Acoordem; e b) determinar se os itens da Acoordem se encaixam na estrutura da CIF. MATERIAIS E MÉTODOS: Uma terapeuta ocupacional e um fisioterapeuta codificaram independentemente os itens contidos na Acoordem, fazendo o linking com a CIF. Para os itens em que não houve concordância entre os pesquisadores, foi usada a opinião de outras duas pesquisadoras, uma terapeuta ocupacional e uma fisioterapeuta. RESULTADOS: Os itens da Acoordem foram associados aos componentes b (funções do corpo), d (atividades e participação), e (fatores ambientais) e f (fatores pessoais). Não houve itens relacionados com o componente s (estrutura do corpo) e apenas três itens foram codificados como nc (não coberto pela CIF). DISCUSSÃO E CONCLUSÃO: Os itens da Acoordem puderam ser relacionados à estrutura da CIF. Profissionais e pesquisadores da área de reabilitação podem usar a Acoordem para obter dados acerca da atividade e participação em crianças com problemas de coordenação motora, pois sua terminologia e abrangência está de acordo com a perspectiva biopsicossocial da OMS.

Employing the International Classification of Functioning, Disability and Health to enhance services for children and youth with chronic physical health conditions and disabilities

PURPOSE

In 2001, the World Health Organization published the International Classification of Functioning, Disability and Health (ICF). The ICF is just beginning to be used in a variety of clinical and research settings in Canada and worldwide. The purpose of the present article is to describe the initial use of the ICF at an Ontario children's rehabilitation centre, and to consider further uses both within and outside the centre for enhancing services for children and youth with chronic physical health conditions and disabilities, as well as for their families.

METHOD

A description is provided on how the ICF has been used at the centre to guide clinical thinking and practice, and to justify and steer research directions. Plans underway to use the ICF to collect and record functional data at the centre are also described. Finally, recommendations for the use of the ICF to enhance communication among child health professionals across service settings are provided.

CONCLUSIONS

Used in conjunction with the International Classification of Diseases - Tenth Revision, the ICF's conceptual framework and classification system shows great promise for enhancing the quality of services for children with chronic conditions and their families. This information may assist paediatric specialists, other child health professionals, researchers and administrators to use the ICF in similar settings. It may also stimulate exploration of the use of the ICF for general paediatricians and other service providers in the larger community.

Hip and spine surgery is of questionable value in spina bifida: an evidence-based review

BACKGROUND

Although many children with spina bifida and associated scoliosis or dislocated hips undergo spine or hip surgery, the benefits are uncertain.

QUESTIONS/PURPOSES

The purpose was to perform an evidence-based review on the benefits and risks of surgery for dislocated hips and scoliosis in spina bifida.

METHODS

I performed a Medline(®) and Embase(®) search from 1950 to 2009 for Level I to Level III studies investigating the benefits and risks of surgery for scoliosis and hip dislocation in patients with spina bifida. When available, I extracted types of surgery, complication rates, functional outcomes of seating, walking, and overall physical function. All treatment recommendations received a Grade of Recommendation: Grade A (consistent Level I studies); Grade B (consistent Level II and III studies); Grade C (consistent level IV and V studies); or Grade I (insufficient or contradictory studies).

RESULTS

Combined anterior and posterior surgery had lower rates of nonunion for scoliosis. Although there may be some benefit in seating, overall physical function measured in a different and nonstandardized fashion was not much changed and major complication rates, including nonunion and infections for scoliosis surgery, exceed 50% in several studies. For dislocated hips, the impact on walking ability appears related to contracture (not dislocation). Surgery for hip dislocation did not improve walking ability. The literature provides no guidance on the best treatment for unilateral dislocation.

CONCLUSIONS

The benefits of scoliosis surgery are uncertain (Grade I). Spine surgery, if performed, should be anterior and posterior (Grade B). An all-pedicle approach for scoliosis surgery may be effective (Level I). Hip reduction surgery did not improve walking (Grade B) but may be appropriate in low-level unilateral dislocation (Level I).

Musculoskeletal comorbidities in cardiovascular disease, diabetes and respiratory disease: the impact on activity limitations; a representative population-based study

Background

The purpose of this study was to quantify the contribution of comorbidity to activity limitations in populations with chronic cardiovascular disease, diabetes or respiratory disease (index conditions), with emphasis on musculoskeletal comorbidity (arthritis or back problems).

Methods

Analysis of the 2005 Canadian Community Health Survey 3.1 (age 20+ years, n = 115,915). Prevalence ratios for activity limitations in people with the index conditions and co-occurring musculoskeletal disease, adjusted for age, gender, and socioeconomic factors, were used to estimate population associated fractions (PAF).

Results

Comorbid arthritis and back problems significantly increased the risk of activity limitations across all index conditions with prevalence ratios of 1.60 and 1.46 for cardiovascular disease, 1.51 and 1.36 for diabetes, and 1.38 and 1.44 for respiratory disease for arthritis and back problems respectively. Arthritis and back problems accounted for at least 13% and 9% of activity limitations in the index populations.

Conclusions

While chronic musculoskeletal conditions are not always considered priorities in chronic disease prevention, they account for a substantial proportion of activity restrictions seen in people with cardiovascular disease, diabetes and respiratory disease, with implications for prevention and control strategies.

Psychosocial issues in children and adolescents with HIV infection evaluated with a World Health Organization age-specific descriptor system

OBJECTIVES

After active antiretroviral therapy, children with HIV are clinically well, whereas psychosocial issues continue to influence their quality of life. The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization evaluates health status and environmental and social factors associated with health. We investigated the efficacy of the ICF to describe the health status and needs of a cohort of children and adolescents with HIV seen at a reference center for pediatric AIDS in Europe.

METHODS

A quantitative analysis of structured interviews was performed. Caregivers of children and adolescents with HIV infection in follow-up at 2 reference centers for pediatric AIDS were enrolled. Four major areas included in the ICF instrument were investigated: impairments of body structures; impairments of body functions; environmental factors; and activity limitations and restrictions to social life.

RESULTS

Forty-one families of children with HIV were enrolled. Body structures and functions were marginally impaired, whereas environmental factors and psychosocial issues had a relevant impact on quality of life. Most families considered environmental factors to be "barriers"; these were poverty, unemployment, and single-parent family structure. Activity limitations and social restrictions were also reported in a few cases. Almost all parents reported problems in disclosing their child's HIV status because of the fear of social stigma.

CONCLUSION

Psychosocial issues are part of the well-being of children with HIV. The ICF is a standard tool to evaluate the clinical and psychosocial status of children and adolescents with HIV infection and to measure the impact of therapeutic interventions and strategies on psychosocial functioning.

Applying the ICF framework to study changes in quality-of-life for youth with chronic conditions

OBJECTIVE

The objective of this paper is to describe how the ICF framework was applied as the foundation for a longitudinal study of changes in quality-of-life (QoL) for youth with chronic conditions.

METHOD

This article will describe the study's aims, methods, measures and data analysis techniques. It will point out how the ICF framework was used--and expanded upon--to provide a model for studying the impact of factors on changes in QoL for youth with chronic conditions. Further, it will describe the instruments that were chosen to measure the components of the ICF framework and the data analysis techniques that will be used to examine the impact of factors on changes in youths' QoL.

CONCLUSIONS

Qualitative and longitudinal designs for studying QoL based on the ICF framework can be useful for unraveling the complex ongoing inter-relationships among functioning, contextual factors and individuals' perceptions of their QoL.

Assessing psychological well-being in mothers of children with disability: evaluation of the Parenting Morale Index and Family Impact of Childhood Disability scale

Objective Process model of stress and coping guided psychometric assessment of two brief measures of psychological well-being: Parenting Morale Index (PMI); Family Impact of Childhood Disability (FICD) scale. Methods Canadian mothers (N = 195) of children with disability (CWD) completed PMI, FICD, and validation measures (Brief Family Assessment Measure [FAM], Personal Well-Being Index, Positive and Negative Affect Schedule, General Self-Efficacy Scale, Social Desirability Scale) via computer-assisted telephone interview. Of these, 154 completed additional validation measures (Center for Epidemiological Studies—Depression Scale, Parenting Stress Index, Family Hardiness Index, Brief FAM) 1 year later. Results Factor structures of PMI and FICD were supported; both demonstrated internal consistency, temporal stability, and convergent and discriminant validity. After 1 year, PMI and FICD jointly predicted depressive symptoms, parenting stress, family hardiness, and family adjustment. Conclusion PMI and FICD can identify mothers of CWD at risk for poor psychological well-being to increase the specificity of supports.

Constructing and testing a disability index in a US sample of preschoolers with disabilities

PURPOSE

To develop and test an index of disability severity in a heterogeneous population of preschoolers with disabilities.

METHOD

Using a nationally representative sample of 3,104 children receiving special education services in the US, questions from a parent interview were used to develop an index of disability severity consisting of domains of functioning defined by gradients of severity. Regressions were used to examine the association between 15 functional domains and 8 cognitive, social/behavioural, and functional outcomes. Full and abbreviated versions of this disability index were compared. Correlations with proxy measures of disability in this population were used to establish concurrent validity, and the predictive ability of this measure was compared with that of the federally defined disability categories.

RESULTS

Of the 15 domains examined, most were significant predictors of at least two outcomes. A shortened index of only six variables was found to be as effective as the longer version in characterising children's level of severity. The index was significantly correlated with intervention variables such as the age at which children began receiving special education or therapy service, r(2802) = -0.22, p <or= 0.0001, the extent of modification of curriculum materials needed for the child, r(248) = 0.42, p <or= 0.0001 and the number of services the child received in the school, r(2014) = 0.37, p <or= 0.0001. Adding severity to special education category significantly increased the amount of variance in outcomes over special education category alone.

CONCLUSIONS

These results provide evidence for the importance of the construct of severity of disability and its measurement, particularly when conducting research with very young children.

O papel das Classificações da OMS - CID e CIF nas definições de deficiência e incapacidade

A Organização Mundial de Saúde tem hoje duas classificações de referência para a descrição dos estados de saúde: a Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, que corresponde à décima revisão da Classificação Internacional de Doenças (CID-10) e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). A utilização da CIF vem sendo aguardada com grande expectativa pelas organizações de pessoas com deficiências e instituições relacionadas. A falta de definição clara de "deficiência" ou "incapacidade" tem sido apontada como um impedimento para a promoção de saúde de pessoas com deficiência. É importante que essas definições, especialmente no âmbito legislativo e regulamentar, sejam consistentes e se fundamentem num modelo coerente sobre o processo que origina as situações de incapacidade. Este artigo tem como objetivo apresentar elementos da CID-10 e da CIF, e o papel que desempenham para definir deficiência e incapacidade. Os componentes da CIF podem contribuir para diferentes campos de aplicabilidade no que diz respeito ao entendimento das definições de deficiência ou incapacidade a partir do conceito de funcionalidade e dos fatores contextuais.

Conceptualizing childhood health problems using survey data: a comparison of key indicators

Background

Many definitions are being used to conceptualize child health problems. With survey data, commonly used indicators for identifying children with health problems have included chronic condition checklists, measures of activity limitations, elevated service use, and health utility thresholds. This study compares these different indicators in terms of the prevalence rates elicited, and in terms of how the subgroups identified differ.

Methods

Secondary data analyses used data from the National Longitudinal Survey of Children and Youth, which surveyed a nationally representative sample of Canadian children (n = 13,790). Descriptive analyses compared healthy children to those with health problems, as classified by any of the key indicators. Additional analyses examined differences between subgroups of children captured by a single indicator and those described as having health problems by multiple indicators.

Results

This study demonstrates that children captured by any of the indicators had poorer health than healthy children, despite the fact that over half the sample (52.2%) was characterized as having a health problem by at least one indicator. Rates of child ill health differed by indicator; 5.6% had an activity limitation, 9.2% exhibited a severe health difficulty, 31.7% reported a chronic condition, and 36.6% had elevated service use. Further, the four key indicators captured different types of children. Indicator groupings differed on child and socio-demographic factors. Compared to children identified by more than one indicator, those identified only by the severe health difficulty indicator displayed more cognitive problems (p < 0.0001), those identified only by the chronic condition checklist had a greater likelihood of reporting allergies or asthma (p < 0.0001), and those identified as having elevated service use only were more affluent (p = 0.01) and showed better overall health (p < 0.0001). Children identified by only a single indicator were less likely to have serious health problems than those identified by two or more indicators.

Conclusion

We provide information useful to researchers when selecting indicators from survey data to identify children with health problems. Researchers and policy makers need to be aware of the impact of such definitions on prevalence rates as well as on the composition of children classified as being in poor health.

[Prevalence and characteristics of children and youth with special health care needs (CSHCN) in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

In order to arrive at population-based estimates on the prevalence and characteristics of children and adolescents with specific health care needs (CSHCN), screening instruments focussing on the consequences of physical, mental and behavioral problems rather than on medical diagnoses have been developed. One of the most feasible and widely tested instruments, the CSHCN screener was added to the self-administered questionnaire for parents of children participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The overall weighted prevalence of CSHCN was 16.0% among boys and 11.4% among girls. Children at kindergarten or school age were more than 2-3 times more likely to screen positive compared to toddlers. Up to 14 years, the sex difference persisted through all age groups and was most pronounced between the ages of 3 and 10 years. Children with a migrant background had significantly lower rates of CSHCN compared to non-migrants. This was particularly true for boys (8.0% vs. 17.1%). CSHCN status was not related to social status, urbanization or residence in former West vs. former East Germany. Except for the lack of association with social status, these results are in good accordance with observations from the US National Survey of CSHCN.

The DISABKIDS generic quality of life instrument showed cross-cultural validity

OBJECTIVE

The aim was to test the performance of a cross-culturally developed disease-generic quality of life (QoL) measure for children with chronic diseases in a multinational clinical study.

STUDY DESIGN AND SETTING

The study was conducted in pediatric hospitals across seven European countries in a sample of 1,153 children with seven chronic conditions, aged 8-16. The design included test and retest on child, parent, and clinical measures concerning health status, functioning, and quality of life.

RESULTS

The condition-generic QoL measure showed satisfactory item and scale performance, as well as structural validity across the seven countries. There was a high agreement between the child and proxy assessment across the different countries in all subscales of the condition-generic instrument, except for socioemotional dimensions in some countries. Gender, age, and severity-adjusted covariance analyses showed significant country differences in QoL. The discriminative potential of the condition-generic measure to distinguish between clinical characteristics was higher than that of a generic measures.

CONCLUSION

The psychometric performance of both items and scales of the DISABKIDS condition oriented measure was good across cultures, despite a range of cross-cultural differences. The condition-generic measure performs better in discriminating with respect to clinical characteristics than the generic measures; however, results need replication in representative studies.

ICF and ICD codes provide a standard language of disability in young children

BACKGROUND AND OBJECTIVES

The aim of this study was to examine the utility of a hierarchical algorithm incorporating codes from the International Classification of Functioning, Disability and Health--ICF (WHO, 2001) and the International Statistical Classification of Diseases-ICD (WHO, 1994) to classify reasons for eligibility of young children in early intervention.

METHODS

The database for this study was a nationally representative enrollment sample of more than 5,500 children in a longitudinal study of early intervention. Reasons for eligibility were reviewed and matched to the closest ICF or ICD codes under one of four major categories (Body Functions/Structures, Activities/Participation, Health Conditions, and Environmental Factors).

RESULTS

The average number of reasons for eligibility provided per child was 1.5, resulting in a population summary exceeding 100%. A total of 305 ICF and ICD codes were used with most (77%) of the children having codes in the category of Body Function/Structures. Forty-one percent of the sample had codes of Health Conditions, whereas the proportions with codes in the Activities/Partipication and Environmental Categories were 10 and 5%, respectively.

CONCLUSIONS

The results demonstrate that ICD and ICF can be jointly used as a common language to document disability characteristics of children in early intervention.

Why, what and how? - Questions for psychological research in medicine

PURPOSE

The purpose with this paper is to make an analysis of some different ways of putting questions in the field of medical psychology.

METHOD

Four questions are raised regarding the scientific development of knowledge related to human beings, with special emphasis on the fields of psychology and medical psychology. Such questions concerning the world differ from one another and are consequently investigated and answered in different ways.

CONCLUSIONS

Psychology includes aspects of how and why human beings feel, think, act and appraise as they do, and the extent to which they do so. Two complementary pairs of concepts are introduced to aid in understanding this scientific development of knowledge: nomothetic versus ideographic knowledge and synchronic versus diachronic knowledge. These dimensions of special interest are combined in a figure which can be used as a tool for analysis. Psychology concerns not only finding explanations for psychological phenomena or psychological explanations for physiological, social or cultural phenomena. It also concerns describing, characterising and understanding the content of these phenomena and the meaning they have for the individual. Through these kinds of questions we learn more about the general, specific and unique aspects of persons, as well as of scientific knowledge.

Health measurement using the ICF: test-retest reliability study of ICF codes and qualifiers in geriatric care

Background

The International Classification of Functioning, Disability and Health (ICF) was published by the World Health Organization (WHO) to standardize descriptions of health and disability. Little is known about the reliability and clinical relevance of measurements using the ICF and its qualifiers. This study examines the test-retest reliability of ICF codes, and the rate of immeasurability in long-term care settings of the elderly to evaluate the clinical applicability of the ICF and its qualifiers, and the ICF checklist.

Methods

Reliability of 85 body function (BF) items and 152 activity and participation (AP) items of the ICF was studied using a test-retest procedure with a sample of 742 elderly persons from 59 institutional and at home care service centers. Test-retest reliability was estimated using the weighted kappa statistic. The clinical relevance of the ICF was estimated by calculating immeasurability rate. The effect of the measurement settings and evaluators' experience was analyzed by stratification of these variables. The properties of each item were evaluated using both the kappa statistic and immeasurability rate to assess the clinical applicability of WHO's ICF checklist in the elderly care setting.

Results

The median of the weighted kappa statistics of 85 BF and 152 AP items were 0.46 and 0.55 respectively. The reproducibility statistics improved when the measurements were performed by experienced evaluators. Some chapters such as genitourinary and reproductive functions in the BF domain and major life area in the AP domain contained more items with lower test-retest reliability measures and rated as immeasurable than in the other chapters. Some items in the ICF checklist were rated as unreliable and immeasurable.

Conclusion

The reliability of the ICF codes when measured with the current ICF qualifiers is relatively low. The result in increase in reliability according to evaluators' experience suggests proper education will have positive effects to raise the reliability. The ICF checklist contains some items that are difficult to be applied in the geriatric care settings. The improvements should be achieved by selecting the most relevant items for each measurement and by developing appropriate qualifiers for each code according to the interest of the users.