How to use the International Classification of Functioning, Disability and Health as a reference system for comparative evaluation and standardized reporting of rehabilitation interventions

Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea

BACKGROUND

Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA.

OBJECTIVES

To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA.

METHODS

One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested.

RESULTS

Cronbach's α values indicate good internal consistency (0.91 - 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) CONCLUSIONS: The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.

Development of core sets for deafblindness: an international expert survey on functioning and disability of individuals living with deafblindness using the International Classification of Functioning, Disability, and Health

BACKGROUND

The development of International Classification of Functioning, Disability, and Health (ICF) Core Sets greatly enhances the global recognition of health conditions, thereby advancing research, education, and care provision. Aside from the work of researchers, and the viewpoint of persons with lived experience, the development of Core Sets for deafblindness needs to include the viewpoints of professionals with expertise unique to this condition.

AIM

To represent the perspective of health and social service expert professionals in the development of ICF Core Sets for deafblindness.

DESIGN

Cross-sectional cohort study.

SETTING

Global online survey representing all six regions of the World Health Organization.

POPULATION

One hundred and five professionals providing and health or social service to individuals living with deafblindness with a minimum of 2 years of work experience with this population.

METHODS

An online survey was distributed through professional networks and social media for individuals working with persons living with deafblindness. Demographic items were summarized using descriptive statistics. Six open-ended questions explored the perceptions of body functions and structures that influence activities and participation, as well as environmental and personal factors that facilitate functioning. Data were linked to the ICF codes using established linking rules and procedures.

RESULTS

The 2934 survey response units were linked using IFC categories. Of the 421 unique categories, 133 were used by 5% or more of respondents. Most categories within the Activities and Participation component were equally emphasized. The most frequent Environmental factors were support and relationships, services, systems, and policies, as well as and the physical environment (e.g., hearing aids or noise). Mental functions, including higher level cognitive functions, temperament and personality were frequently emphasized.

CONCLUSIONS

Almost three quarters (73.3%) of the entire ICF classification categories were included in the expert survey results. This proportion emphasizes the importance of a multidimensional tool, such as the ICF, for assessing functioning and health for persons with deafblindness.

CLINICAL REHABILITATION IMPACT

The representation of this professional perspective in Core Set development will improve standardized assessment and documentation, intervention planning, and facilitate interprofessional communication with the goal of improving person-centered care for persons living with deafblindness.

Development of the assessment standards of the International Classification of Functioning, Disability, and Health (ICF) Geriatric Core Set through a modified Delphi method

BACKGROUND

There is currently a lack of functional assessment tools based on the International Classification of Functioning, Disability, and Health (ICF) theoretical framework that are specific for older adults.

OBJECTIVE

The aim of the present study was to develop Chinese assessment standards of the ICF Geriatric Core Set for functional evaluation of older adults.

METHODS

A two-stage study process was conducted to develop the assessment standards of the ICF Geriatric Core Set: establishment of candidate assessment standards, and a modified Delphi consensus process including a pilot survey and two-round formal expert survey. Thirty participants in the field of ICF and geriatric rehabilitation were recruited. The suitability of the assessment standards in the questionnaires was rated using a Likert 5-level scoring method. The arithmetic mean, the full mark ratio and the coefficient of variation (CV) were used as screening indicators for the assessment standards, and modification was made for several standards, in line with the Delphi results and the expert panel discussion.

RESULTS

Thirty-three candidate assessment standards belonging to 17 categories were generated. A total of 26 and 24 experts in the field of ICF and geriatric rehabilitation participated in the two-round survey, respectively. Five standards belonging to four categories entered into the second-round survey directly, five standards belonged to five categories entered with minor modification, and nine standards belonging to seven categories were redesigned based on the literature and discussion of the expert panel. In the second-round survey,15 assessment standards belonging to 15 categories met the screening requirements and four assessment standards belonged to the two remaining categories that needed a criterion and which the expert panel discussed for the final decision.

CONCLUSIONS

Using the modified Delphi method, the assessment standards of the ICF Geriatric Core Set have been developed.Future work should focus on the reliability and validity of the the assessment standards and their application to the health management of older adults.

Intermediate outcomes for clinical trials of multiple sclerosis rehabilitation interventions: Conceptual and practical considerations

BACKGROUND

Rehabilitation is an essential health care service and a critical component of comprehensive multiple sclerosis (MS) care.

OBJECTIVE

As part of a 2-day meeting hosted by the International Advisory Committee on Clinical Trials in MS in December 2022, a panel initiated a discussion on the conceptual and practical issues related to selecting intermediate outcomes for clinical trials of MS rehabilitation interventions.

RESULTS

The overarching goal of rehabilitation - optimal functioning - was acknowledged as a complex biopsychosocial phenomenon that varies with patient priorities and environmental context. This complexity means that multiple causal pathways and potential intermediate outcomes must be carefully considered during the design of clinical trials in MS rehabilitation that aim to improve functioning. In addition, practical issues must be considered such as psychometric properties of outcome measures, measure type, and characteristics of the target population, including severity of dysfunction.

CONCLUSION

This article uses the International Classification of Functioning, Disability and Health as a foundation for determining relevant intermediate outcomes for clinical trials of MS rehabilitation interventions.

Determinants of Physical Activity in Older Adults in South-Eastern Poland

The aim of our study is to assess factors determining the uptake of physical activity (PA) by older people living in south-eastern Poland. This is a cross-sectional study. The study included 858 older people aged 75 and over living in south-eastern Poland. PA was assessed by asking about the time spent on any at least moderate PA per week and about doing planned strengthening exercises to improve muscle strength and muscular endurance. Functional status, disability and quality of life in older people were also assessed. Logistic regression models were used to identify the factors related to PA. In the study group, only 25.64% performed a minimum of 150 min of moderate-intensity exercise, while strengthening exercises were performed by 22.49%. The most important factors influencing the uptake of PA were age, number of chronic diseases, place of residence, education, social activity, housing conditions, quality of life and health status. In summary, the study population represents a low level of PA uptake, with the majority not meeting the World Health Organization recommendations for PA uptake by older people. Our findings suggest individualized efforts to promote public health and increase PA among older people over 75 years of age.

Hipervigilância postural e percepção da postura correta sentada em indivíduos com e sem dor lombar

Objetivos Verificar se há diferença na hipervigilância postural sentada em indivíduos com e sem dor lombar. Além disso, observar se há diferença na percepção da postura correta sentada entre indivíduos com dor lombar e sem dor lombar.

Métodos O presente estudo possui delineamento observacional transversal, como tamanho amostral de 92 indivíduos, posteriormente divididos igualmente em dois grupos (com dor lombar e sem dor lombar). Foram utilizados dois instrumentos: a escala de hipervigilância para analisar a frequência que voluntários corrigem a postura sentada no dia; e o quadro de posturas para investigar a percepção dos voluntários sobre a postura correta sentada. Os dados foram submetidos ao teste de Normalidade de Shapiro-Wilk. Para comparar os valores da Escala de Hipervigilância foi utilizado o teste de Mann-Whitney e o teste Qui-quadrado e exato de Fisher para avaliação da postura correta sentada.

Resultados Não houve diferença significativa entre a hipervigilância postural sentada entre indivíduos com dor lombar e sem dor lombar. Não houve diferença significativa entre a escolha da postura correta sentada entre o grupo de indivíduos com e sem dor lombar.

Conclusão Não há diferença entre a escolha da postura correta sentada e quantidade de hipervigilância postural em indivíduos com ou sem dor lombar.

Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City

Objective

This study aimed to introduce bed-day payment for rehabilitation services in City S, China, and analyze the cost of inpatient rehabilitation services. Key issues were defined and relevant countermeasures were discussed.

Methods

The data about the rehabilitation cost of 3,828 inpatient patients from June 2018 to December 2019 was used. Descriptive statistics and the Kruskal–Wallis test were employed to describe sample characteristics and clarify the comparity of cost and length of stay (LOS) across different groups. After normalizing the distribution of cost and LOS by Box–Cox transformation, multiple linear regression was used to explore the factors influencing cost and LOS by calculating the variance inflation factor (VIF) to identify multicollinearity. Finally, 20 senior and middle management personnel of the hospitals were interviewed through a semi-structured interview method to further figure out the existing problems and countermeasures.

Results

(1) During 2015–2019: both discharges and the cost of rehabilitation hospitalization in City S rose rapidly. (2) The highest number of discharges were for circulatory system diseases (57.65%). Endocrine, nutritional, and metabolic diseases were noted to have the longest average length of stay (ALOS) reaching 105.8 days. The shortest ALOS was found to be 24.2 days from the diseases of the musculoskeletal system and connective tissue. Neurological, circulatory, urological, psychiatric, infectious, and parasitic diseases were observed to be generally more costly. (3) The cost of rehabilitation was determined to mainly consist of the rehabilitation fee (23.63%), comprehensive medical service fee (22.61%), and treatment fee (19.03%). (4) Type of disease, age, nature of the hospital, and grade of the hospital have significant influences both on cost and LOS (P < 0.05). The most critical factor affecting the cost was found to be the length of stay (standardized coefficient = 0.777). (5) The key issues of City S's rehabilitative services system were identified to be the incomplete criteria, imperfections in the payment system, and the fragmentation of services.

Conclusions

Bed-day payment is the main payment method for rehabilitation services, but there is a conflict between rapidly rising costs and increasing demand for rehabilitation. The main factors affecting the cost include the length of stay, type of disease, the grade of the hospital, etc. Lack of criteria, imperfections in the payment system, and the fragmentation of services limit sustainability. The core approach is to establish a three-tier rehabilitative network and innovate the current payment system.

Predicting Outcome for Early Attention Training After Acquired Brain Injury

Background

The training of impaired attention after acquired brain injury is central for successful reintegration in daily living, social, and working life. Using statistical process control, we found different improvement trajectories following attention training in a group of relatively homogeneous patients early after acquired brain injury (ABI).

Objective

To examine the contribution of pre-injury factors and clinical characteristics to differences in outcome after early attention training.

Materials and Methods

Data collected in a clinical trial comparing systematic attention training (APT) with activity-based attention training (ABAT) early after brain injury were reanalyzed.

Results

Stroke patients (p = 0.004) with unifocal (p = 0.002) and right hemisphere lesions (p = 0.045), and those with higher mental flexibility (TMT 4) (p = 0.048) benefitted most from APT training. Cognitive reserve (p = 0.030) was associated with CHANGE and APT as the sole pre-injury factor. For TBI patients, there was no statistical difference between the two treatments.

Conclusion

Our study identifies indiscernible factors predicting improvement after early attention training. APT is beneficial for patients with right-hemispheric stroke in an early recovery phase. Knowledge of prognostic factors, including the level of attention deficit, diagnosis, and injury characteristics, is vital to maximizing the efficiency of resource allocation and the effectiveness of rehabilitative interventions to enhance outcomes following stroke and TBI.

The prevalence and symptoms of temporomandibular disorders in head and neck cancer patients

OBJECTIVES

This retrospective patient survey aimed to assess the prevalence of temporomandibular disorders (TMD) before and after curative oncological treatment and to identify possible risk factors.

MATERIALS AND METHODS

Patients with squamous cell carcinoma in the tonsil or base of the tongue were included (n = 217). Medical records were collected to assess TMD prevalence before oncological treatment and at 6- and 12-month follow-up. Fisher's test and Pitman's test were used.

RESULTS

Significantly reduced mouth opening was observed after oncological treatment at 6- and 12-month follow-up (p < .001). Symptoms from the temporomandibular joint and jaw muscles plus pain upon palpation (p = .0083, p < .001, respectively) and self-reported pain upon chewing (<0.001) and opening the mouth (<0.001) increased 12 months following radiotherapy. Pain and degree of mouth opening prior to treatment, self-reported depression, overall health status, brachytherapy and jaw exercise during radiotherapy were factors affecting the increase of TMD symptoms.

CONCLUSION

All TMD symptoms escalated significantly one year after radiotherapy except self-reported sounds from the temporomandibular joint. Reduction in the degree of mouth opening and pain in the jaw muscles and the temporomandibular joint when opening the mouth and upon chewing were commonly reported symptoms following radiotherapy. Several potential risk factors were identified.

Rehabilitation Through Physical Activity and Sport in Light of the International Classification of Functioning, Disability, and Health–Current Research Perspectives

The implementation of functioning by the World Health Organization (WHO) as the third global health indicator, along with mortality and morbidity, represents a promising advancement for a comprehensive assessment of international health systems and health strategies. The description of a person's health state operationalized by both biological and lived health via functioning provides a holistic picture of an individual's life situation and proved to be successful in building a framework for formulating therapy goals, achievable activities, and participational aspects against the background of an individual's life situation. Furthermore, improving an individual's functional ability and wellbeing could potentially affect the health indicators of morbidity and mortality and will be codable beyond the ICF in ICD-11. This methodological perspective emphasizes the use of ICF applications on the wider and narrower level of international rehabilitation systems and highlights the incorporation of the term functioning in rehabilitation through physical activity and sport. Current research perspectives in applying the ICF and functioning in clinical and rehabilitation practices are discussed and a current explorative study is presented, which applies the holistic orientation of functioning and the biopsychosocial model to the specific case by an individualized sports coaching intervention in rehabilitation. Subsequently, a unifying ICF- oriented language in rehabilitation is considered as a powerful foundation for a consistent international research strategy concerning increased international collaborations and future research perspectives.

Organization of rehabilitation services in randomized controlled trials - which factors influence functional outcome? A systematic review

Objective

To identify factors related to the organization of rehabilitation services that may influence patients’ functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions.

Data Sources

A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019.

Study Selection

In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0.

Data Synthesis

In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results.

Conclusions

Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.

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.

Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review

Objective

Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities.

Methods

We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted.

Results

Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy ( n = 11), occupational therapy ( n = 2), prosthetics ( n = 1), exercise physiology ( n = 1) and multidisciplinary ( n = 4) services. The methodological quality varied ( n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services.

Conclusions

This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.

Identification and Description of Balance, Mobility, and Gait Assessments Conducted via Telerehabilitation for Individuals With Neurological Conditions: Protocol for a Scoping Review

BACKGROUND

The COVID-19 global pandemic pushed many rehabilitation practitioners to pivot their in-person practice to adopt telerehabilitation as their main method of delivery. In addition to documenting information on interventions used with clients, it is best practice for therapists to use reliable and validated outcome measures to inform their interventions.

OBJECTIVE

Through this scoping review, we aim to identify (1) which outcomes are being used remotely to assess balance, mobility, and gait in patients with neurological conditions, and (2) what psychometric data (validity, reliability, etc.) for remotely administered outcomes are available.

METHODS

Three main concepts will be included in our search: (1) neurological conditions; (2) administration by telerehabilitation; and (3) outcome measures for balance, mobility, and gait. Studies reporting remote assessment of neurological conditions published since 1990 will be included. The database search will be completed in MEDLINE (Ovid), CINAHL, PubMed, PsycINFO, EMBASE, and Cochrane. Gray literature including dissertations, conference papers, and protocol papers will also be sourced. Two reviewers will independently screen each title and abstract using pre-established inclusion and exclusion criteria. Manuscripts that appear to meet the criteria will be subject to further review, and full-text extraction using a pre-piloted extraction sheet if all criteria are met. The data will be categorized by assessment types describing impairments (such as balance, strength, and mobility) or activity limitations or participation restriction (such as functional mobility, ambulatory functions, and activities of daily living).

RESULTS

This scoping review will document outcome measures currently used in the remote assessment of neurological conditions. To date, 235 titles and abstracts were screened. We are in the process of finalizing the full text screening for the inclusion of articles. We expect the full screening to be completed in November 2021 and data analysis in January 2022. Our results are expected to be published in early 2022.

CONCLUSIONS

The optimal use of telerehabilitation as a mode to deliver rehabilitation intervention should be coupled with the completion of validated outcome measures. Therefore, it is crucial to further our knowledge on remote outcome measures and therapeutic assessments.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/27186.

Patients recovering from exacerbations of COPD with and without hospitalization need: could ICF score be an additional pulmonary rehabilitation outcome?

OBJECTIVE

To compare disability changes measured with the Respiratory ICF Maugeri core set on COPD patients, recovering from acute exacerbation with and without hospitalization, submitted to pulmonary rehabilitation (PR).

MATERIALS AND METHODS

All COPD inpatients admitted for rehabilitation in 9 Respiratory Units (January-August 2019) were considered eligible. 2066 patients were included (540 discharged from an acute Hospital = Hospital group and 1526 coming from their home = Home group). Healthcare professionals filled, in a digitalized chart, the Respiratory ICF Maugeri core set (26 items), assessing ICF categories at admission and discharge.

RESULTS

The baseline distribution of the more severe ICF qualifiers was higher in the Hospital group (p < .001) when compared to the Home group. After rehabilitation, all patients -irrespective of hospitalization need- statistically decreased the rate of the higher ICF qualifiers (p < .0001). Hospital group improved more both the rate of qualifiers ≥2 [Δ: -21.32 (22.41) vs -15.48 (17.32), p < .001] and the rate of qualifiers 0-1 [Δ: + 18.38 (24.67) vs 13.25 (19.13), p < .001] than Home group.

CONCLUSIONS

Disability measured with the "Respiratory ICF Maugeri core set" after PR improves in COPD patients recovering from acute exacerbation irrespective of hospitalization need. Its use an additional outcome remains to be further elucidated.KEY MESSAGESRoutine implementation of an ICF set for chronic respiratory diseases can enhance a patient-centered approach in rehabilitation for different severity conditions.Pulmonary rehabilitation (PR) seems to improve global disability measured with the Respiratory ICF Maugeri core set in COPD patients recovering from acute exacerbation irrespective of hospitalization need, suggesting the use of ICF set as additional PR outcome.The description, through the ICF language, of rehabilitative needs of patients, coming "from-Home" and "from-Hospital" settings, could help staff and instrument organization.

Management of motor rehabilitation in individuals with muscular dystrophies. 1st Consensus Conference report from UILDM - Italian Muscular Dystrophy Association (Rome, January 25-26, 2019)

Muscular dystrophy (MD) is a group of neuromuscular diseases characterized by progressive muscle weakness due to various mutations in several genes involved in muscle structure and function. The age at onset, evolution and severity of the different forms of MD can vary and there is often impairment of motor function and activities of daily living. Although there have been important scientific advances with regard to pharmacological therapies for many forms of MD, rehabilitation management remains central to ensuring the patient's psychophysical well-being. Here we report the results of an Italian consensus conference promoted by UILDM (Unione Italiana Lotta alla Distrofia Muscolare, the Italian Muscular Dystrophy Association) in order to establish general indications and agreed protocols for motor rehabilitation of the different forms of MD.

Reporting of patients' characteristics in rehabilitation trials: an analysis of publications of RCTs in major clinical rehabilitation journals

BACKGROUND

The reporting of patients' characteristics in randomized-controlled trials (RCTs) is one important dimension to improve the clinical replicability or transferability of study results into clinical practice.

AIM

Based on a previously developed framework for reporting on patient characteristics, the aim of this study was to determine whether and how patients' characteristics are presented in RCTs of major rehabilitation journals.

DESIGN

A literature search in eight high-impact medical rehabilitation journals was conducted.

SETTING

Any setting.

POPULATION

A rehabilitation patient group.

METHODS

Papers were included if they presented results on a RCT on rehabilitation patients. We excluded pilot or feasibility studies. We extracted information related to the description of personal, clinical and diagnosis-specific characteristics, comorbidities, and functioning according to the ICF (body functions and structures, activities and participation and context personal/environmental factors).

RESULTS

From a total of 129 papers initially identified we finally included 100 papers. Patient groups were almost exclusively defined by clinical diagnostic groups. Age and gender were the most prominent persons' characteristics (100% / 99% reported), followed by marital (22%), educational (15%) and occupational status (14%). Clinical characteristics usually relate to the respective diagnosis; general characteristics were reported on the duration of illness or symptoms (62%), to a lesser degree on BMI (45%) and/or weight (32%) and height (27%). One out of five papers report on comorbidities of the patients (20%). Information of body functions were present in almost every paper (98%), and nearly two third reported at least some aspect of activities and participation at baseline (63%).

CONCLUSIONS

The present analysis shows that there is a need to further the development of appropriate standards for the reporting of patient characteristics in rehabilitation trials.

CLINICAL REHABILITATION IMPACT

In future it should help rehabilitation practitioners to decide whether the patients in a study and their own patients share features similar enough to allow for transferability of results.

The influence and added value of a Standardized Assessment and Reporting System for functioning outcomes upon national rehabilitation quality reports

OBJECTIVE

To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric.

DESIGN

Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets.

SETTING

Swiss national public rehabilitation outcome quality reports on the clinic level.

PARTICIPANTS

A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18 047 patients.

INTERVENTIONS

Neurological or musculoskeletal rehabilitation.

MAIN OUTCOME MEASURES

Functional Independence Measure™ or Extended Barthel Index.

RESULTS

Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric's content with ICF Core Sets suggests to include 'energy and drive functions' or 'maintaining a basic body position' to enhance the content of functioning as an indicator.

CONCLUSIONS

A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS' ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation.

Assessment of the effects of a multi-component, individualized physiotherapy program in patients receiving hospice services in the home

BACKGROUND

The interest in physiotherapy programs for individuals in hospice is increasing. The aim of our study was to assess the impact of a multi-component, individualized physiotherapy program on the functional and emotional conditions and quality of life of patients receiving hospice services in the home.

METHODS

The study included 60 patients (mean 66.3 years) receiving hospice services in the home. A model of a physiotherapy program was designed, including breathing, strengthening, transfer, gait, balance, functional, and ergonomic exercises, as well as an adaptation of the patient's living environment to functional needs. The tests were performed before and after the intervention. The study used the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, the World Health Organization Quality of Life - Bref (WHOQOL-BREF), the Visual Analogue Scale (VAS) pain scale, the Tinetti POMA Scale, and the Geriatric Depression Scale (GDS). To enable comparison of our results worldwide, a set of International Classification of Functioning, Disability and Health (ICF) categories was used.

RESULTS

The average functional level of the ADL (mean 2.9) and the IADL (mean 11.9), as well as the WHOQOL-BREF (mean 46.4) of the patients before the intervention were low, whereas the intensity of pain (VAS mean 5.8), the risk of falling (Tinetti mean 8.2), and depression (GDS mean 16.7) were recorded as high. After the completion of the intervention program, a significant improvement was found in the ADL (mean 4.0), IADL (mean 13.9), WHOQOL-BREF (mean 52.6), VAS (mean 5.1), risk of falling (Tinetti mean 12.3), and GDS (mean 15.7) scores.

CONCLUSIONS

The physiotherapeutic intervention had a significant impact on improving the performance of ADL, as well as the emotional state and quality of life of patients receiving hospice services in the home. The results of our research provide evidence of the growing need for physiotherapy in individuals in hospice and for comprehensive assessment by means of ICF. Registered 02.12.2009 in the Research Registry ( https://www.researchregistry.com/why-register ) under the number research registry 5264.

A mobile app implementing the international classification of functioning, disability and health rehabilitation set

BACKGROUND

The Chinese assessment standards of the International Classification of Functioning, Disability and Health Rehabilitation Set is available now. It is coming to be used as a basic functional evaluation tool in China. With data accumulating, a mobile application is needed to eliminate the extra cost of data entry, storage, and graphical presentation of trends. This study aimed to design, develop and test a mobile app based on the International Classification of Functioning, Disability and Health Rehabilitation Set Rehabilitation Set.

METHODS

The study had three phases. The first involved specifying the functional requirements of the app. Then an app was designed and refined to meet those requirements. In a pilot test, the app was used by rehabilitation professionals in clinical practice and their comments were collected for its further modification in one-on-one interviews.

RESULTS

The app met the initial requirements, and the pilot study showed it worked as designed. The pilot study also showed that the app is user-friendly and convenient to use in rehabilitation practice. Some feedback was given to improve the app.

CONCLUSION

An Android mobile app implementing the International Classification of Functioning, Disability and Health Rehabilitation Set was successfully developed.

The International Classification of Functioning, Disability and Health-Children and Youth as a framework for the management of spinal muscular atrophy in the era of gene therapy: a proof-of-concept study

BACKGROUND

Management of spinal muscular atrophy (SMA) has progressed enormously and reached unprecedented levels with nusinersen gene therapy. We are finally able to counter the progression of this devastating genetic disease, contributing to the definition of new trajectories in its natural history and the identification of new SMA phenotypes post-gene therapy. The aim of this paper was to use the The International Classification of Functioning, Disability and Health-Children and Youth as a framework for the management of spinal muscular atrophy in the era of gene therapy: a proof-of-concept study (ICF-CY) as a comprehensive documentation tool to better understand and improve care provided to a child with SMA and to illustrate its use in a multidisciplinary perspective with a proof-of-concept study.

CASE REPORT

An SMA child under gene therapy receiving a rehabilitation program. Clinical and functional outcome measures assessed at all levels of the ICF-CY, including impairment by Hammersmith Infant Neurological Examination, activity by Hammersmith Functional Motor Scale and Functional Independence Measure for Children, and participation by Pediatric Quality of Life Inventory™ - PedsQL™ and Neuromuscular Module™ as well as by parent report. Treatment outcomes were assessed at two main time points: at T0: prior to administration of nusinersen, and T1: immediately before the first administration of maintenance doses, 6 months after the first administration of nusinersen. A significant clinical improvement was seen on all domains between T0 and T1. The patient improved especially in motor skills and motor disability severity. The HRQOL showed a substantial improvement, too. ICF-CY codes were used to document change in body functions or structures, performance of activities or participation in social roles both in terms of gradient and hierarchy of change. This proof-of-concept study is the first attempt to explore SMA in a comprehensive manner from the perspective of the ICF-CY using a selected set of codes. These codes define essential child dimensions that can make up an ICF-CY core set, as identified by a trained multidisciplinary team, to guide assessment, treatment and rehabilitation.

CLINICAL REHABILITATION IMPACT

Although limited to a single patient, this study makes nonetheless a strong point: we suggest using the ICF-CY as an essential tool in SMA management at a time when gene therapy with nusinersen is changing the phenotypes of activity and functioning in these children.

Is multidisciplinary biopsychosocial rehabilitation effective on pain, disability, and work outcomes in adults with subacute low back pain? A Cochrane Review summary with commentary

The aim of this commentary is to discuss, in a rehabilitation perspective, the Cochrane Review "Multidisciplinary biopsychosocial rehabilitation for subacute low back pain" (Marin et al., 2017)¹ published under the supervision of the Cochrane Back and Neck Group. This "Cochrane Corner" is produced in agreement with Musculoskeletal Science and Practice by Cochrane Rehabilitation.

Determinants of ADL and IADL disability in older adults in southeastern Poland

Background

The extension of the life span has led to an increase in the number of older people and an increase in the prevalence of disability in people over 60 years of age. The aim of this study was to assess the prevalence of ADL and IADL disability and to analyze its determinants among people aged 60 and older living in southeastern Poland.

Methods

This cross-sectional study was carried out among a randomly selected, representative population of people aged 60 and older living in southeastern Poland. Disability was assessed using the Katz Index of Independence in Basic Activities of Daily Living and Instrumental Activities of Daily Living. Logistic regression models were used to identify the factors related to ADLs and IADLs. For the variables that were included in the above models, their clustered influence on the increase in the odds ratio for the occurrence of an ADL or IADL limitation was also examined.

Results

The research results show that 35.75% of the participants reported at least one problem with IADLs. At least one problem with ADLs was reported by 17.13% of the participants. The most significant modifiable factors influencing the occurrence of disability were the presence of barriers in the participant’s environment, poor relations with relatives, a lack of social contacts, multimorbidity and pain. A multiple increase in the odds ratio of disability was found with the presence of pairs of analyzed factors. The highest odds ratio of at least one ADL limitation was observed for the combination of barriers in the participant’s environment with multimorbidity (OR 74.07). With regard to IADL disability, the highest odds ratio was observed for the combination of pain on the VAS scale ≥3 points with older age (OR 19.47).

Conclusions

The study showed a high prevalence of ADL and IADL disability in older people living in southeastern Poland. It also indicated the extent to which modifiable factors influenced the occurrence of disability and the extent to which the risk of disability increased with the presence of pairs of factors, especially those that included environmental barriers in the participant’s environment.