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

Assessing Change in Participation in Clinical Evaluations of Deployed Veterans with Medically Unexplained Symptoms

Many deployed veterans experience issues reintegrating into civilian life. Addressing this in a clinical setting can prove challenging; however, assessing participation, defined as involvement in a life situation by the World Health Organization's International Classification of Functioning, Disability and Health, may be helpful. The Community Reintegration of Injured Service Members-Computer Adaptive Test (CRIS-CAT) is a measure of participation developed and validated in veteran populations. The War Related and Illness and Injury Study Center, which provides comprehensive evaluations to veterans with medically unexplained deployment-related concerns, used the CRIS-CAT as part of their social work evaluations during these visits and follow-up telephone calls. This retrospective review of clinical data examines the link between participation as assessed by the CRIS-CAT and factors that are mutable (such as relationships with others) and immutable (personal characteristics) as assessed in the social work evaluation over 12 months. The findings indicate that these veteran patients did not experience change in their participation as measured by the CRIS-CAT. Multivariable regression models demonstrated relationships only between change in CRIS-CAT scales and baseline scores and race. Article concludes by discussing lessons learned from this evaluation of the utility of the CRIS-CAT in clinical care and in longitudinal evaluation.

Neurological disorders and barriers for neurological rehabilitation in rural areas in Uttar Pradesh: A cross-sectional study

Background:

In India, the majority of individuals with neurological disorders are rural based and cannot even afford the cost of rehabilitation. At the same time, we do not have barrier free environment in India.

Aim:

This study attempts to find out the neurological disorders and barriers for neurological rehabilitation in rural areas in Uttar Pradesh, India.

Setting:

Rural areas in Uttar Pradesh, India.

Design:

It is a cross-sectional study.

Materials and Methods:

The study was done by means of an interview method using a questionnaire. The rural areas in Uttar Pradesh were visited personally and a data from 201 individuals was collected.

Statistical Analysis Used:

Data analysis was done by using descriptive statistics.

Results:

Out of 201 individuals, 76.6% (n=154) individuals were with polio, 12.9% (n=26) were with cerebral palsy, 7.9% (n=16) were with stroke and 2.4% (n=5) were with spinal cord injury. Reasons for not taking the treatment/discontinuation of treatment were financial problem (44%), lack of awareness (43%), family negligence (6%), transportation problem (3.5%) and other environmental barriers (1%).

Conclusion:

In our study, we found polio to be the most prevalent disorder followed by Cerebral Palsy, Stroke and Spinal Cord Injury. Financial problem was the major barrier for neurological rehabilitation followed by lack of awareness, family negligence and transportation problem.

Use of the International Classification of Functioning, Disability, and Health in traumatic brain injury rehabilitation: linking issues and general perspectives

OBJECTIVE

The aims of this study were to summarize the possible benefits of using the International Classification of Functioning, Disability, and Health (ICF) in rehabilitation after traumatic brain injury and to explore the technical aspects of linking existing medical records to the ICF in such cases.

DESIGN

A literature review was conducted using PubMed, Cochrane Collaboration, and Trip. Medical records of 100 patients admitted to University Rehabilitation Institute of Slovenia in 2007-2009 were linked to the ICF.

RESULTS

Fourteen relevant articles were identified from 2002 to 2010, suggesting that in patients with traumatic brain injury, the ICF can contribute to evaluation of disabilities, identification of treatment goals and intervention targets, and categorizing important environmental factors. Linking existing medical records to the ICF proved successful although time-consuming. Identified challenges included need for frequent use of ``unspecified'' qualifier, different scope of reports from different specialists, and mapping of either one Functional Independence Measure to more ICF codes or vice versa.

CONCLUSIONS

Despite some criticism, the literature suggests that the ICF is useful as a model of health and disability and the basis for the development of practical instruments for description and assessment of functioning of persons with traumatic brain injury. Although challenging, time-consuming, and subject to limitations, linking existing medical records to the ICF can provide a clear functional profile of a patient or group with the additional advantage of being able to describe contextual factors.

Vocational rehabilitation from the client's perspective using the International Classification of Functioning, Disability and Health (ICF) as a reference

INTRODUCTION A mixed-methods (qualitative-quantitative), multicenter study was conducted using a focus group design to explore the lived experiences of persons in vocational rehabilitation (VR) with regard to functioning and contextual factors using six open-ended questions related to the ICF components. The results were classified by using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. METHODS The meaningful concepts within the transcribed data were identified and linked to ICF categories according to established linking rules. RESULTS The seven focus groups with 26 participants yielded a total of 4,813 relevant concepts which were linked to a total of 160 different second-level ICF categories. From the client perspective, the ICF components (a) body functions, (b) activities and participation and (c) environmental factors were equally represented, while (d) body structures appeared less frequently. Out of the total number of concepts, 864 concepts (18%) were assigned to the ICF component personal factors which is not yet classified but could indicate important aspects of resource management and strategy development of patients in VR. CONCLUSION Therefore, VR of patients must not be limited to anatomical and pathophysiologic changes, but should also consider a more comprehensive view which includes client's demands, strategies and resources in daily life and the context around the individual and social circumstances of their work situation.

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.