Validation of the Comprehensive ICF Core Set for rheumatoid arthritis: The perspective of psychologists

Functioning in schizophrenia from the perspective of psychologists: A worldwide study

Schizophrenia is a severe mental disorder associated with impairment in functioning. A multidisciplinary approach is essential to help individuals with this health condition, and psychological interventions are considered a priority. The International Classification of Functioning, Disability and Health (ICF) offers a theoretical framework for assessing functioning and disability. The ICF Core Sets for schizophrenia are a list of ICF categories describing the most common problems in functioning of persons affected by this health condition. This study aimed to explore the content validity of these ICF Core Sets and to identify the most common problems in people with schizophrenia from the perspective of psychologists. Psychologists with experience of schizophrenia treatment were recruited for a three-round Delphi study in order to gather their views regarding the problems commonly presented by these patients. A total of 175 psychologists from 46 countries covering the six WHO regions answered the first-round questionnaire, and 137 completed all three rounds. The 7,526 concepts extracted from first-round responses were linked to 412 ICF categories and 53 personal factors. Consensus (≥75% agreement) was reached for 76 ICF categories and 28 personal factors. Seventy-three of the 97 ICF categories that form the Comprehensive ICF Core Set for schizophrenia achieved consensus, and only three categories that yielded consensus do not feature in this Core Set. These results support the content validity of these ICF Core Sets from the perspective of psychologists. This provides further evidence of the suitability of the ICF framework for describing functioning and disability in persons with schizophrenia.

Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis

BACKGROUND

Crohn's disease (CD) and rheumatoid arthritis are chronic, progressive and disabling conditions that frequently lead to structural tissue damage. Based on strategies originally developed for rheumatoid arthritis, the treatment goal for CD has recently moved from exclusively controlling symptoms to both clinical remission and complete mucosal healing (deep remission), with the final aim of preventing bowel damage and disability.

AIM

To review the similarities and differences in treatment goals between CD and rheumatoid arthritis.

METHODS

This review examined manuscripts from 1982 to 2016 that discussed and/or proposed therapeutic goals with their supportive evidence in CD and rheumatoid arthritis.

RESULTS

Proposed therapeutic strategies to improve outcomes in both rheumatoid arthritis and CD include: (i) evaluation of musculoskeletal or organ damage and disability, (ii) tight control, (iii) treat-to-target, (iv) early intervention and (v) disease modification. In contrast to rheumatoid arthritis, there is a paucity of disease-modification trials in CD.

CONCLUSIONS

Novel therapeutic strategies in CD based on tight control of objective signs of inflammation are expected to change disease course and patients' lives by halting progression or, ideally, preventing the occurrence of bowel damage. Most of these strategies require validation in prospective studies, whereas several disease-modification trials have addressed these issues in rheumatoid arthritis over the last decade. The recent approval of new drugs in CD such as vedolizumab and ustekinumab should facilitate initiation of disease-modification trials in CD in the near future.

Social participation in early and established rheumatoid arthritis patients

PURPOSE

The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients.

METHOD

Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere-Terpstra test.

RESULTS

Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group.

CONCLUSIONS

The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA.

IMPLICATIONS FOR REHABILITATION

Supporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life. Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation.

Do patient-reported outcome measures cover personal factors important to people with rheumatoid arthritis? A mixed methods design using the International Classification of Functioning, Disability and Health as frame of reference

Background

Personal factors (PFs) are internal factors that determine functioning and the individuals’ experience of disability. Their coverage by patient-reported outcome measures (PROMs) has not been examined in rheumatoid arthritis (RA) so far. The aims of this study were to identify PFs important in the life stories of people with RA and to determine their coverage by PROMs used in RA.

Methods

The qualitative data of people with RA was explored to identify PFs. Additionally a systematic literature search was conducted to find PROMs used in RA. PROMs items were linked to the components, domains and categories of the International Classification of Functioning, Disability and Health (ICF) to determine the coverage of important PFs by PROMs.

Results

Twelve PFs were found to be important in the life stories of people with RA. The PFs coping and reflecting about one’s life in an optimistic way were covered most frequently, each by 14 of the 42 explored PROMs, while job satisfaction was not covered at all. The London Coping with Rheumatoid Arthritis Questionnaire, General Self-Efficacy Scale, Arthritis Self-Efficacy Scale, Rheumatoid Arthritis Self-Efficacy Questionnaire and Revised Ways of Coping Inventory covered most PFs. Nineteen PROMs did not cover any of the PFs.

Conclusion

Several PFs were identified as important in the life stories of people with RA, but only 55% of the PROMS covered some of these PFs. When evaluating PFs important to people with RA, health professionals should be alert on which PROMs can be used to assess which PFs.

Validation of the comprehensive ICF core set for multiple sclerosis from the perspective of physical therapists

BACKGROUND

The Comprehensive ICF Core Set for Multiple Sclerosis (MS) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in the functioning of people with MS.

OBJECTIVES

The objective of this study was to validate the Comprehensive ICF Core Set for MS from the perspective of physical therapists.

DESIGN

A 3-round survey based on the Delphi technique was used.

METHODS

Physical therapists experienced in the management of MS were asked about problems and resources of people with MS as well as environmental aspects treated by physical therapists (eg, use of assistive devices, support). Statements were linked to the ICF and compared with the Comprehensive ICF Core Set for MS.

RESULTS

Eighty physical therapists from 23 countries mentioned 2,133 issues that covered all of the ICF components. Two hundred thirty-eight ICF categories were linked to the statements. Forty-six categories in the Comprehensive ICF Core Set for MS were confirmed by physical therapists at the same level or a more specific level of classification. Nineteen additional ICF categories were reported by at least 75% of the participants.

CONCLUSIONS

The results of this study support the content and face validity of the Comprehensive ICF Core Set for MS. Areas of functioning and health that physical therapists believe should be assessed were identified. The findings of this study as well as the results of completed and ongoing validation studies will further elucidate the validity of the Comprehensive ICF Core Set for MS from different perspectives.

Content validity of the Extended ICF Core Set for stroke: an international Delphi survey of physical therapists

BACKGROUND

The "Extended ICF Core Set for stroke" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of people with stroke.

OBJECTIVE

The objective of this study was to validate this ICF Core Set from the perspective of physical therapists.

DESIGN AND METHODS

Physical therapists experienced in stroke intervention were asked about their patients' problems and resources and about aspects of the environment that physical therapists treat in people with stroke in a 3-round electronic-mail survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated using the kappa statistic.

RESULTS

One hundred twenty-five physical therapists from 24 countries named 4,793 problems treated by physical therapists in people with stroke. They identified 10 second-level ICF categories that currently are not represented in the Extended ICF Core Set for stroke. Twelve responses of the participants were linked to the ICF component personal factors, and 15 responses were not covered by the current version of the classification. The kappa coefficient for the linking agreement was 0.39 (95% bootstrapped confidence interval=0.34-0.41).

LIMITATIONS

Two World Health Organization regions were not represented in the sample of physical therapists.

CONCLUSIONS

According to the physical therapists, the current version of the Extended ICF Core Set for stroke largely covers the types of problems that their interventions address. However, some aspects of functioning emerged that are not yet covered and may need further investigation.

Content validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for stroke: the perspective of occupational therapists

BACKGROUND

The "ICF Core Set for stroke" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in the functioning of patients with stroke.

PURPOSE

The objective of this study was to validate this ICF Core Set from the perspective of occupational therapists.

METHODS

In a three-round electronic mail survey using the Delphi technique, occupational therapists experienced in stroke treatment were asked about patients'problems, patients' resources, and aspects of environment they take care of. Two health professionals linked responses to the ICF.

FINDINGS

Sixty-nine occupational therapists in 21 countries named 1,747 concepts that occupational therapists treat in patients with stroke. These concepts were linked to 347 different ICF categories. Twenty-three concepts were linked to the ICF component Personal Factors.

CONCLUSION

The content validity of the "ICF Core Set for stroke" was largely supported by occupational therapists.

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.

Identification of problems in individuals with spinal cord injury from the health professional perspective using the ICF: a worldwide expert survey

STUDY DESIGN

Worldwide Internet survey.

OBJECTIVES

The specific aims of the study were (1) to identify problems of individuals with SCI in the early post-acute and the long-term context, respectively, addressed by health professionals and (2) to summarize these problems using the ICF.

SETTING

International.

METHODS

Physicians, nurses, physical therapists, occupational therapists, social workers and psychologists were asked for problems in the functioning and contextual factors of individuals with SCI using open-ended questions. All answers were translated ('linked') to the ICF based on established rules. Absolute and relative frequencies of the linked ICF categories were reported stratified by the context.

RESULTS

Out of 243 selected experts, 144 (59.3%) named 7.650 different themes, of which 78.8% could be linked to ICF categories. In the early post-acute context, 30.7% of the 88 categories belonged to the component Body Functions, 14.8% to Body Structures, 30.7% to Activities and Participation and 23.9% to Environmental Factors. In all, 16 ICF categories were unique for the early post-acute context. In the long-term context, 27.2% of the 92 categories belonged to the component Body Functions, 13.0% to Body Structures, 35.9% to Activities and Participation and 23.9% to Environmental Factors. A total of 20 ICF categories were unique for the long-term context.

CONCLUSION

Health professionals identified a large variety of functional problems reflecting the complexity of SCI. Unique aspects of functioning exist for the early post-acute and the long-term context, respectively. The ICF provided a comprehensive framework to integrate answers from different professional backgrounds and different world regions.