Supporting the clinical use of the ICF in Japan - development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 set, its operationalization through a rating reference guide, and interrater reliability study

Standardization use of the international classification of functioning, disability and health in the determination of health status in patients with post-acute COVID-19 syndrome

PURPOSE

To propose a standardized method for the use of the International Classification of Functioning, Disability and Health (ICF) to describe the health status in Post-Acute COVID-19 Syndrome (PACS) and investigate interrater agreement in the linking process in instruments and clinical exams using the ICF categories.

MATERIALS AND METHODS

Cross-sectional and interrater agreement study that followed the Guidelines for Reporting Reliability and Agreement Studies. Two raters performed the linking coding process in instruments of quality of life, anxiety and depression, fatigue and pulmonary function, inspiratory muscle strength and cardiopulmonary exercise testing. The codes were qualified by standards defined to each instrument and exams.

RESULTS

The instrument with the lowest Cohen's Kappa coefficient was anxiety and depression (k = 0.57). Forty ICF codes were linked to clinical instruments and exams. The fatigue instrument presented a higher degree of disability by the qualification process, from severe to complete, in the linked codes.

CONCLUSION

The study presents a standardized method for the assessment of the health status of patients with PACS through ICF. Restriction in work performance, socialization and family relationships as well as disabilities in physical endurance, fatigue and exercise tolerance were found in the sample. The agreement between the raters was moderate to perfect, demonstrating that the method can be reproducible.

Development of a Conversion Table Linking Functional Independence Measure Scores to International Classification of Functioning, Disability, and Health Qualifiers: Insights from a Survey of Healthcare Professionals

In clinical practice, patient assessments rely on established scales. Integrating data from these scales into the International Classification of Functioning, Disability, and Health (ICF) framework has been suggested; however, a standardized approach is lacking. Herein, we tested a new approach to develop a conversion table translating clinical scale scores into ICF qualifiers based on a clinician survey. The survey queried rehabilitation professionals about which functional independence measure (FIM) item scores (1-7) corresponded to the ICF qualifiers (0-4). A total of 458 rehabilitation professionals participated. The survey findings indicated a general consensus on the equivalence of FIM scores with ICF qualifiers. The median value for each item remained consistent across all item groups. Specifically, FIM 1 had a median value of 4; FIM 2 and 3 both had median values of 3; FIM 4 and 5 both had median values of 2; FIM 6 had a median value of 1; and FIM 7 had a median value of 0. Despite limitations due to the irreconcilable differences between the frameworks of existing scales and the ICF, these results underline the ICF's potential to serve as a central hub for integrating clinical data from various scales.

Development of a Korean version of simple, intuitive descriptions for clinical use of the generic functioning domains in the ICD-11 Chapter V

PURPOSE

To develop a Korean version of simple, intuitive descriptions (SIDs) for clinical use of the generic functioning domains in the International Classification of Disease 11th revision (ICD-11) Chapter V.

METHODS

The initial Korean SID version proposal for the International Classification of Functioning, Disability, and Health (ICF) Rehabilitation set was translated following the Italian version. The remaining 17 codes were developed using original ICF descriptions; WHO Disability Assessment Schedule, Model Disability Survey, Korean Classification of Functioning, Disability, and Health; and previous studies. The final proposal for the Korean version of SIDs was selected through virtual conferences and three rounds of voting.

RESULTS

This study developed SIDs for the 47 generic functioning domains in the Chapter V of ICD-11. However, the SID for 20 of the 47 codes was confirmed in vote A, for 23 codes in vote B and for the remaining 4 in the final vote. All experts agreed with the final SID proposal.

CONCLUSIONS

This is the first study in South Korea to attempt the development of SIDs for ICD-11 Chapter V. Therefore, the findings of this study could be used to evaluating of disability, functioning when ICD-11 is adopted for use in Korean clinical settings.

Characterization of an Italian population with neurological disorders in a rehabilitation setting using ClinFIT

OBJECTIVE

To examine the functioning profile of people with neurological disorders who access rehabilitation services through ClinFIT Generic-30.

METHODS

The functioning profile of people with neurological disorders accessing rehabilitation services was examined using the ClinFIT Generic-30, and the results compared with existing core set (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury).

RESULTS

Data for 364 people were analysed. The 10 most commonly impaired ICF categories included 3 for Body Functions (exercise tolerance functions (b455), mobility of joint functions (b710), and muscle power functions (b730)) and 7 for Activities and Participation (carrying out daily routine (d230), handling stress and other psychological demands (d240), changing basic body position (d410), maintaining a body position (d415), transferring oneself (d420), walking (d450), and moving around (d455)), while the ICF categories that were severely impaired (ICF qualifiers 3 and 4) in more than 30% of the study cohort were: muscle power functions (b730), carrying out daily routine (d230), walking (d450), moving around (d455), doing housework (d640), and assisting others (d660).

DISCUSSION

The current study data suggests that  ClinFIT Generic-30 appears to effectively identify impairments and/or restrictions, as perceived by individuals affected by selected health conditions.

CONCLUSION

ClinFIT Generic-30 is a tool that can be used to characterize functioning profile in people with different neurological disorders and to collect important information not addressed by the disease-specific core sets (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury).

Agreement Between Single Raters and Team Rating When Applying the International Classification of Functioning, Disability and Health's Rehabilitation Set

OBJECTIVE

To quantify the agreement between functional assessments by a single rater and a team using the Chinese version of the International Classification of Functioning, Disability and Health Rehabilitation Set in a clinical situation.

DESIGN

Inter-rater, multi-centre agreement study.

SUBJECTS

A total of 193 adult inpatients admitted to 5 rehabilitation centres at 5 hospitals in China Methods: The Chinese version of the International Classification of Functioning, Disability and Health Rehabilitation Set was used by either a single rater or a team to assess 193 patients at 5 Chinese hospitals. Percentage of agreement and quadratic-weighted kappa coefficients were computed. Evaluation times were compared with paired t-tests.

RESULTS

The mean team and individual evaluation times were not significantly different. The percentage of agreement ranged from 46.1% to 94.2% depending on the item, and the quadratic-weighted kappas ranged from 0.43 to 0.92. Eight categories (26.6%) showed a weighted kappa exceeding 0.4, 11 others (36.7%) exceeded 0.6, and another 11 (36.7%) produced kappas of more than 0.8.

CONCLUSION

Either a single rater or a team of raters can produce valid and consistent ratings when using the Chinese version of the International Classification of Functioning, Disability and Health Rehabilitation Set to assess patients in a rehabilitation department. The team rating approach is suitable for clinical application.

Use of artificial intelligence large language models as a clinical tool in rehabilitation medicine: a comparative test case

OBJECTIVE

To explore the potential use of artificial intelligence language models in formulating rehabilitation prescriptions and International Classification of Functioning, Disability and Health (ICF) codes.  Design: Comparative study based on a single case report compared to standard answers from a textbook.

SUBJECTS

A stroke case from textbook.  Methods: Chat Generative Pre-Trained Transformer-4 (ChatGPT-4)was used to generate comprehensive medical and rehabilitation prescription information and ICF codes pertaining to the stroke case. This information was compared with standard answers from textbook, and 2 licensed Physical Medicine and Rehabilitation (PMR) clinicians reviewed the artificial intelligence recommendations for further discussion.

RESULTS

ChatGPT-4 effectively formulated rehabilitation prescriptions and ICF codes for a typical stroke case, together with a rationale to support its recommendations. This information was generated in seconds. Compared with standard answers, the large language model generated broader and more general prescriptions in terms of medical problems and management plans, rehabilitation problems and management plans, as well as rehabilitation goals. It also demonstrated the ability to propose specified approaches for each rehabilitation therapy. The language model made an error regarding the ICF category for the stroke case, but no mistakes were identified in the ICF codes assigned.  Conclusion: This test case suggests that artificial intelligence language models have potential use in facilitating clinical practice and education in the field of rehabilitation medicine.

Development of a clinical tool for rating categories of the ICF Rehabilitation Set in Polish practice

Rehabilitation is considered a key health strategy in the 21st century. The aim of rehabilitation is to optimize the functioning of patients. The International Classification of Functioning, Disability and Health (ICF) is a framework for describing and organizing information on functioning and disability. Current international efforts to implement ICF in rehabilitation practise include the implementation of ICF Core Sets and operationalize ICF tools for clinics. The aim of the study is to create simple, intuitive descriptions and an initial reference guide for the assessment of the ICF Rehabilitation Set in Polish practice. The development of the Polish version of ICF Rehabilitation Set involved the following steps: (1) identification of ICF Rehabilitation Set categories; (2) development simple, intuitive descriptions; (3) the drafting of the rating reference guide by a multidisciplinary panel following the process employed to develop the Japanese version. The Polish version of ICF Rehabilitation Set, the simple, intuitive descriptions for 29 categories and the rating reference guides were successfully developed. The Polish version of ICF Rehabilitation Set proposed by us is a reference framework for the harmonization of existing information on the functioning and disability of people participating in the rehabilitation process.

Development of the Polish Version of the ICF Core Set for the Environment of Older People

INTRODUCTION

The percentage of older people in Polish society increases every year. The interaction between the individual health condition and the barriers in the environment of the elderly leads to the development of disability and the limitation of activity and participation in daily activities.

AIM

This study was aimed at selecting the category of the International Classification of Functioning, Disability, and Health (ICF) to assess the environment of older adults in Poland in the context of their daily functioning.

MATERIALS AND METHODS

The study was designed to develop a user-friendly tool collecting ICF-based data on the living environment of older people, consisting of five phases: (1) the systematic review of the literature, (2) the empirical multicenter study, (3) the qualitative study based on interviews conducted among the elderly, (4) the experts' study-an assessment of selected codes from the perspective of experts, (5) the consensus conference.

RESULTS

Consensus was reached for 20 ICF categories, creating a comprehensive core set for the assessment of the living environment of older people, which included six codes from chapter 1, Products and technology, three codes from chapter 2, Natural environment and human-made changes to the environment, four codes from chapter 3, Support and relationships, four codes from Chapter 4, Attitudes, and three codes from Chapter 5, Services, systems, and policies.

CONCLUSIONS

The core set for the assessment of the living environment of older people living in Poland is a comprehensive and important set of 20 ICF codes that reflect the most important elements of the environment affecting the health and functioning of the elderly. This set can contribute to the optimal management of care services and support in the area of adapting the environment to the older population. The core set for environmental assessment was developed for use by medical and care facilities, as well as by social workers, who should also pay attention to the elements of the environment that affect the level of functioning of older people. In the future, it may also form the basis of national surveys and screening tests for the assessment of the living environment of older people. Optimizing and enhancing the surrounding environment can contribute to a greater degree of independence, even with existing health problems in the older population.

Development and appropriateness of a scoring method for International Classification of Functioning, Disabilities, and Health assessment in older patients with heart failure: a Delphi survey of expert panel in Japan

OBJECTIVE

The number of older patients with heart failure (HF) is increasing in Japan and has become a social problem. There is an urgent need to develop a comprehensive assessment methodology based on the common language of healthcare; the International Classification of Functioning, Disability and Health (ICF). The purpose of this study was to develop and confirm the appropriateness of a scoring methodology for 43 ICF categories in older people with HF.

DESIGN

Cross-sectional survey. We applied the RAND/University of California at Los Angeles (UCLA) Appropriateness Method with a modified Delphi method.

SETTING AND PARTICIPANTS

We included a panel of 26 multidisciplinary experts on HF care consisting of home physicians, cardiovascular physicians, care managers, nurses, physical therapists, a pharmacist, occupational therapist, nutritionist and a social worker.

MEASURES

We conducted a literature review of ICF linking rules and developed a questionnaire on scoring methods linked to ICF categories in older people with HF. In the Delphi rounds, we sent the expert panel a questionnaire consisting of three questions for each of the 43 ICF categories. The expert panel responded to the questionnaire items on a 1 (very inappropriate) - 9 (very appropriate) Likert scale and repeated rounds until a consensus of 'Appropriate' and 'Agreement' was reached on all items.

RESULTS

A total of 21 panel members responded to all the Delphi rounds. In the first Delphi round, six question items in four ICF categories did not reach a consensus of 'Agreement', but the result of our modifications based on panel members' suggestions reached to a consensus of 'Appropriate' and 'Agreement' on all questions in the second Delphi round.

CONCLUSION

The ICF-based scoring method for older people with HF developed in this study was found to be appropriate. Future work is needed to clarify whether comprehensive assessment and information sharing based on ICF contributes to preventing readmissions.

Validation of a Disability Assessment Tool Based on the International Classification of Functioning, Disability, and Health in the Chinese Context

Background:

The common standards of disability assessment for long-term care (LTC) insurance are currently absent. The International Classification of Functioning, Disability and Health (ICF) was designed for a better description of health and functioning, which could fill the demand gap for the standards of disability assessment and be a promising tool for the development of LTC insurance system.

Objectives

To validate a disability assessment scale for disabled elderly individuals based on the ICF for LTC in the Chinese context.

Methods

The present study is a cross-sectional study. A disability assessment tool based on the ICF was developed by referring to other assessment tools and an expert consensus meeting in the initial phase of the study. The developed tool was used to evaluate 1,610 elderly individuals in the LTC institutions. The Cronbach's α coefficient and split-half reliability were applied to test the internal consistency of the tool, while the Interclass correlation coefficients (ICCs) were used to evaluate the interrater reliability (IRR). Factor analysis was performed to verify the construct validity of the tool. The scores from the Medical Outcomes Short Form-12 (SF-12) were correlated with that from the disability assessment tool, to assess the criterion-related validity.

Results

The Cronbach's α coefficient and split-half reliability of the disability assessment tool were 0.969 and 0.877, respectively. The ICCs of the sum scale was 0.85, and the ICCs of each of the 20 items in the scale ranged from 0.78 to 0.94. The items were divided into three factors through analysis, which is consistent with the structure expectation. The scores of each item and the sum score of the disability assessment scale were negatively correlated with the scores of the physical and psychological fields in SF-12 (p < 0.001). Overall, the data indicated that the tool was characterized by good internal consistency, IRR, construct validity, and criterion-related validity.

Conclusions

The disability assessment tool based on the ICF is a reliable and valid tool for the collection of information on functioning across various LTC settings. The information of disability provided evidence for the distribution of LTC service and guided the development of LTC insurance standards.

Responsiveness of the International Classification of Functioning, Disability And Health (ICF) Clinical Functioning Information Tool (ClinFIT) in Routine Clinical Practice in an Australian Inpatient Rehabilitation Setting

OBJECTIVE

To examine the responsiveness of the International Classification of Functioning, Disability and Health (ICF) Clinical Functioning Information Tool (ClinFIT) in routine clinical practice in an Australian context.

METHODS

A prospective observational study with consecutive recruitment of inpatients at a tertiary rehabilitation facility. The assessments were at admission (T0), discharge (T1) and 3-month postdischarge (T2), using the following questionnaires: ClinFIT, Functional Independence Measure (FIM) and European Quality of Life (EQ-5D-5L). Extension Indices (EI) were calculated for the ClinFIT set, and responsiveness measured as a change in scores over time. The association between FIM and ClinFIT scores was explored.

RESULTS

Participants (n = 91, mean age 66.8±13.0 years, 52% male, 48% following stroke) reported ≥ 1 issue related to ClinFIT categories. ClinFIT total raw scores improved significantly across all health conditions compared with T0 (median (interquartile range): 196 (110, 228)) at both T1: 69 (37, 110); p < 0.001 and T2: 46.5 (20.8, 77); p < 0.001, with a medium effect size (r = 0.61 for both). There were significant changes in EI in the entire ClinFIT set from T0 to T1, and from T0 to T2 (p < 0.001 for both), with small to medium effect sizes. Analyses confirmed significant correlation in improvements between ClinFIT and FIM scores.

CONCLUSION

ClinFIT is useful in evaluating patient functioning and can detect changes in functioning over time and across different health conditions.

Integrating a New Dietetic Care Process in a Health Information System: A System and Process Analysis and Assessment

Managing routinely collected data in health care and public health is important for evaluation of interventions and answering research questions using “real life” and ”big data”. In addition to the technical requirements of information systems, both standardized terminology and standardized processes are needed. The aim of this project was to analyse and assess the integration of standardized terminology and document templates for a dietetic care process (DCP) into the health information system (HIS) in a hospital in Austria. Using an action research approach, the DCP was analysed through four expert interviews and the integration into the HIS through two expert interviews with observations. Key strengths and weaknesses for the main criteria (“integration of the ICF catalogue”, “adaption of the document templates”, “adaption of the DCP”, and the “adaption of the user authorizations”) were presented and proposals for improvement given. The system and process integration of the DCP is possible, and the document templates can be adapted with the software currently in use. Although an increase in resources and finances required is to be expected initially, the integration of a standardized dietetic terminology in combination with a standardized process is likely to improve the quality of care and support outcomes management and research.

A process evaluation of patient care needs using the Post- Stroke Checklist: a prospective study

Objective

To assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of patients with stroke (PwS) in an inpatient rehabilitation setting.

Methods

Prospective observational design with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. The post-stroke checklist was administered at hospital discharge (T1) and 3 months post-discharge (T2). Furthermore, validated questionnaires assessed function and participation, including the Clinical Functioning Information Tool (ClinFIT) on admission (T0), T1 and T2.

Results

Participants’ mean age was 67.7 years (standard deviation; SD) 14.6), 58% of participants were female, and the mean length of inpatient stay was 32.7 days (SD 22.4). At T1, 80% and at T2 only 60% of participants reported ≥1 strokerelated problem (mean 5.3 (SD 3.3) and 3.6 (SD 2.8), respectively). Half of participants were referred to physiotherapy/occupational therapy, and 36% to specialist clinics following discharge. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living, and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed improved function at T1 and T2 (Extension Index, ClinFIT set), from T0 to T1 and T0 to T2 (p<0.001, with large effect sizes).

Conclusion

The mPSC is feasible to implement in an inpatient rehabilitation setting and community. It can identify relevant stroke-related problems, and hence facilitate targeted intervention.

ICF-Based Assessment of Functioning in Daily Clinical Practice. A Promising Direction Toward Patient-Centred Care in Patients With Low Back Pain

Background: Patient-centred care has received increased attention in recent years. Patient-Reported Outcomes (PROs) and shared decision-making are key components of Patient-Centred care. Low back pain (LBP) is a complex symptom affected by multiple, interacting factors. Therefore, evidence strongly recommend a biopsychosocial and patient-centred approach in the assessment and management. The International Classification of Functioning, Disability and Health (ICF) provide a biopsychosocial model for describing functioning and disability. ICF is widely acknowledged, but implementation into clinical practice is lacking. To support the use of a biopsychosocial and patient-centred approach in daily clinical practice among patients with LBP we developed a practice-friendly tool based on ICF; the LBP assessment tool.

Objective: To compare an ICF-based assessment facilitated by the LBP assessment tool with standard care in terms of the use of PROs and shared decision-making in order to promote patient-centred care in patients with LBP.

Methods: A non-randomized controlled design was used. Eligible patients were allocated to one of two groups: the ICF group, assessed with the LBP assessment tool or the control group, assessed with a conventional LBP assessment. Primary outcome includes use of PROs. Secondary outcomes include use of a graphical overview displaying the patient profile and shared decision-making. A patient evaluation questionnaire was used to collect data.

Results: Seven hundred ten patients were assessed for eligibility of whom 531 were allocated to the ICF group (n = 299) or the control group (n = 232). A significantly higher use of PRO data (p < 0.00) and the patient profile (p < 0.00) was reported in favor of the ICF group. Patients in the ICF group also experienced being more involved in decision-making (p = 0.01).

Conclusions: This study showed that a functioning assessment, by means of the LBP assessment tool, increased use of PROs and shared decision-making when compared to a conventional LBP assessment. Additionally, this study demonstrated that routine use of ICF-based PRO data and shared decision-making promoted patient-centred care in patients with LBP. The LBP assessment tool may be a strong candidate for a user-friendly ICF-based tool with the potential to support health professionals in a shift toward a biopsychosocial and patient-centred approach to patients with LBP.

Development of a clinical tool for rating the body function categories of the ICF generic-30/rehabilitation set in Japanese rehabilitation practice and examination of its interrater reliability

Background

The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component “body functions” and 21 from the component “activities and participation”. This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide.

Methods

The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters’ feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights.

Results

The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher.

Conclusions

In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.