Use of ICF to describe functioning and disability in children with brain tumours

Individual patterns of problems with participation, activity, body function and environment in everyday life for children who completed brain tumor treatment

PURPOSE

The study purpose was to, with the help of ICF and the CPS model, describe and explain patterns of co-occurring problems with participation in everyday life activities, body functioning and environment for children who completed brain tumor treatment.

MATERIALS AND METHODS

Hospital, habilitation and school records for nine children (5-11 yrs.) diagnosed with brain tumor, were retrospectively reviewed for everyday problems after treatment completion. These problems were linked to ICF codes. Median code distribution within ICF constructs participation, body function, body structure, activity, and environment were calculated to generate typical (close to median) and atypical (distant from median) patterns of problems on individual and group levels. Two children were in-depth analyzed with collaborative problem-solving (CPS) model to identify participation problems and plausible explanations.

RESULTS

In total, 4543 ICF linked codes revealed similarities and differences between individuals. The selected child-cases displayed educational challenges and peer-relational problems. The ICF codes related to activity, body function and environment revealed plausible explanations for the children's documented problems with participation in everyday life.

CONCLUSIONS

The combination of ICF and CPS can provide a comprehensive view of the child's problems and guide development of participation in everyday life-focused interventions for children treated for brain tumors.Implications for rehabilitationCare should be guided by interventions and support directed at individual children and their everyday life.The International Classification of Functioning, Disability and Health (ICF) framework can support identification of the individual child's patterns of problems and how these affects the child's everyday life.It is recommended to start by identifying participation problems when using ICF to identify and describe problems in children's natural settings.The collaborative problem-solving model can guide healthcare, habilitation and school services when identifying and acting on typical and atypical problem patterns experienced by these children.

Using ICF to Describe Problems With Functioning in Everyday Life for Children Who Completed Treatment for Brain Tumor: An Analysis Based on Professionals' Documentation

Background: Children treated for brain tumors often experience persistent problems affecting their activity performance and participation in everyday life, especially in school. Linking these problems to the International Classification of Functioning, Disability and Health (ICF) classification system can be described as affecting body function, activity performance, and/or participation. Services involved in the everyday life of the child have different focus and goals when meeting the child in context, which advantage the use of ICF to overcome this impediment to follow-up and provide comprehensive support for children who have completed treatment for a brain tumor.

Aim: The aim of the study was to use the ICF classification system to describe how professionals in healthcare, habilitation, and school document problems with everyday life functioning at body, activity, and participation levels for children who completed treatment for a brain tumor.

Materials and Methods: A retrospective review of records from healthcare, habilitation, and school concerning nine children completed treatment for brain tumor was implemented. Identified problems in everyday life were linked to ICF codes. Descriptive statistics of ICF-linked code frequency supplemented by network visualization diagrams viewing the co-occurrence between codes within the body, activity participation, and environmental components were performed.

Results: Most documented problems were found in healthcare records, whereas the documentation in habilitation and school was sparse. The frequently occurring codes, independent of record source, were linked to the body function component, and ICF-linked problems in habilitation and school were salient in the activity and participation component. To gain a holistic picture of relations between ICF codes and problems, network visualization diagrams were used to illustrate clusters of problems.

Conclusion: Code prevalence likely reflects where healthcare professionals and educators focus their attention when meeting the needs of children treated for a brain tumor in context. To maximize the comprehensive view of functioning and participation of children in everyday life, the full range of difficulties regarding body impairments, activity limitations, and participation restrictions must be identified and linked to each other in patterns of co-occurrence, which the ICF facilitate. However, ICF provides no guidance on how to identify networks of problems within the body, activity, and participation. Identifying such networks is important for building comprehensive interventions for children.

Quality of life in long-term survivors treated for metastatic medulloblastoma with a hyperfractionated accelerated radiotherapy (HART) strategy

PURPOSE

An intensive therapeutic strategy for metastatic medulloblastoma was launched in 1998 in our Institution. The aim of this study was to examine the long-term quality of life (QoL) in survivor patients at least 3 years after the end of the treatment.

METHODS

Patients were asked to complete self-administered QoL questionnaires. An index of physical impairment (IPI) was scored (range 0-100; the lower the score the better) based on clinical objective observations. Patients were divided into two groups (lower IPI group, and higher IPI group) and descriptively compared accordingly.

RESULTS

The study was completed by 25/33 eligible patients. Despite patients with a higher IPI reported worse perceived health condition, they had better emotional and psychological scores than those with a lower IPI in all QoL questionnaires.

CONCLUSION

In our sample, patients with more severe objective and perceived physical impairments reported a better psychosocial QoL, possibly because the greater attention paid to them by society and family contributes to a better adjustment in long-term survivors. On this base, it should be recommended that all survivors receive a strong support as the most impaired patients.

Applying the International Classification of Functioning-Children and Youth Version to Pediatric Neuro-oncology

Given the increased survival rates in patients with pediatric central nervous system tumors, late effects such as treatment- and/or illness-related neurologic sequelae as well as neuropsychological deficits and social difficulties have moved into focus in follow-up care. In order to provide personalized treatment recommendations for pediatric brain tumor survivors, it is crucial not only to assess cognitive impairments but also to measure a patient's functional deficiencies, for example, restricted participation in everyday social activities. Thus, this article introduces the International Classification of Functioning-Children and Youth version (ICF-CY) as a conceptual framework for quantifying functional limitations and informing long-term care in pediatric neuro-oncology. A standardized self-report and proxy-report questionnaire for measuring participation is briefly discussed and specific recommendations based on so-called core sets for clinical practice in pediatric neuro-oncology are provided.

Assessing Children With Disabilities Using WHO International Classification of Functioning, Disability and Health Child and Youth Version Activities and Participation D Codes

AIM

Evaluation of the International Classification of Functioning, Disability and Health child and youth version (ICF-CY) activities and participation d code functions in clinical practice with children across diagnoses, disabilities, ages, and genders.

METHODS

A set of 57 codes were selected and worded to describe children's support needs in everyday life. Parents of children aged 1 to 15 years participated in interviews to discuss and rate their child's disability.

RESULTS

Of 367 invited parents, 332 (90.5%) participated. The mean age of their children with disability was 9.4 years. The mean code scores were 50.67, the corrected code-total correlations were .76, intercode correlations had the mean of 0.61, and Cronbach's α was .98. As a result of Rasch analysis, graphical data for disability measures paralleled clinical expectations across the total population of 332 children.

CONCLUSION

The World Health Organization International Classification of Functioning, Disability and Health child and youth version d code data can provide a coherent measure of severity of disability in children across various diagnoses, ages, and genders.

Health and functioning in the everyday lives of young children with cancer: documenting with the International Classification of Functioning, Disability and Health--Children and Youth (ICF-CY)

BACKGROUND

Health care focus is shifting for children from surviving childhood cancer to living with it on a daily basis. There is a need to document health and function in the everyday lives of young children with cancer using the multidimensional framework and language of the International Classification of Functioning, Disability and Health--Children and Youth (ICF-CY).

AIMS

The aims of this study were (1) to document health and functioning in the everyday lives of young children with cancer using ICF-CY codes and (2) to identify a comprehensive code set that can aid clinical assessment.

METHOD

Interviews with children diagnosed with cancer and their parents, were transcribed, reviewed for content and coded to the ICF-CY using linking procedures.

RESULTS

A comprehensive code set (n = 70) for childhood cancer was identified. The majority of content identified to codes was related to activity and participation describing social relations with family, peers and professionals, preschool attendance and play, as well as issues related to support and independence.

CONCLUSIONS

The ICF-CY can be used to document the nature and range of characteristics and consequences of cancer experienced by children. The identified comprehensive code set could be helpful to health care professionals, parents and teachers in assessing and supporting young children's health and everyday life through the cancer trajectory. The comprehensive code set could be developed as a clinical assessment tool for those caring for young children with cancer. The universal language of the ICF-CY means that the utility of a clinical assessment tool based on identified codes can have wide reaching effects for the care of young children with cancer.

Functioning and disability after stroke in children: using the ICF-CY to classify health outcome and inform future clinical research priorities

AIM

The International Classification of Functioning Disability and Health, Child-Youth version (ICF-CY) provides a framework for describing and evaluating health, intervention outcomes, and needs assessment. It can, however, also serve as a system for classifying the focus of outcome studies and identification of gaps in current knowledge.

METHOD

The paediatric arterial ischaemic stroke (AIS) population was targeted. Multiple databases were systematically searched for AIS outcome studies focussing on functioning or disability. Findings were rated using the ICF-CY framework.

RESULTS

Twenty-eight studies were identified. Most were cross-sectional and age range at assessment varied widely. Sixty-seven different standardized measures were used, predominantly evaluating body functions. The most common domains of activity and participation reported were learning and applying knowledge, general tasks and demands, and self-care skills. Health-related quality of life was measured in nine papers. Environmental factors were rarely evaluated.

INTERPRETATION

AIS outcome studies addressing the relationship between body structures and functions (e.g. brain lesion characteristics, neurological examination findings) and activities, participation, and quality of life have emerged in recent years. Comparison of findings across studies is complicated by design and tool selection. The relationship between components of activity limitation and participation restriction is rarely explored.

ICF, quality of life, and depression in breast cancer: perceived disability in disease-free women 6 months after mastectomy

GOAL OF WORK

Aim of the present observational study is to focus on health-related quality of life (HRQL), mood and everyday life of breast cancer affected women disease-free 6 months after mastectomy, paying particular attention to the International Classification of Functioning, Disability and Health (ICF) framework contribution.

MATERIALS AND METHODS

Sixty-five breast cancer-affected women disease-free 6 months after mastectomy hospitalized for reconstructive surgery (mean age 46.3 ± 7.3) were enrolled. Their depressive symptoms (Beck Depression Inventory-BDI-II), HRQL, and every day life functioning/barriers and facilitators (ICF) were assessed.

RESULTS

At the BDI-II, 6 patients (9.2 %) reported mild depression and 6 (9.2 %) severe depression; when the subscales were considered, 7 (10.8%) resulted depressed at the somatic-affective factor and 16 (24.6 %) at the cognitive factor. Compared to normative data no differences emerged at the HRQL Physical Component Summary (46.4 ± 9.3 vs 49.1 ± 10.1), whereas patients reported lower scores at the Mental HRQL Component Summary (45.9 ± 10.1 vs 51.5 ± 9.1; p = 0.00001 t = -4.3). As for the activity and participation domain, 11 of the 42 categories investigated were compromised in at least 20% of the sample: lifting and carrying objects (d430), acquisition of goods and services (d620), doing housework (d640), remunerative employment (d850), and many categories relating to interpersonal relationships; moreover the caregiver seems to be perceived as an important and positive modulator of disability.

CONCLUSIONS

The addition of the ICF evaluation to the usual psychological assessment gives a more complete picture, enabling a broader perspective of the psychological-clinical implications. Mainly, the women that we have evaluated continue to function in their everyday lives, thanks in part to their ability to accept help from their own families. However, they inevitably carry signs of their disease which some translating into problems with interpersonal relationships, depressive thoughts and negative ideation. Only the synergistic use of all these assessment instruments can one truly perceive all the nuances relating to the social and psychological conditions of the assessed patients' life, overcoming a binomial vision of well-being and ill-being.

A critical exploration of the International Classification of Functioning, Disability, and Health (ICF) framework from the perspective of oncology: recommendations for revision

BACKGROUND

In 2001, the World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) framework in an effort to attend to the multidimensional health-related concerns of individuals. Historically, although the ICF has frequently been used in a rehabilitation-based context, the World Health Organization has positioned it as a universal framework of health and its related states. Consequently, the ICF has been utilized for a diverse array of purposes in the field of oncology, including: evaluating functioning in individuals with cancer, guiding assessment in oncology rehabilitation, assessing the comprehensiveness of outcome measures utilized in oncology research, assisting in health-related quality of life instrument selection, and comparing the primary concerns of health professionals with those of their patients.

DISCUSSION

Examination of the ICF through the lens of cancer care highlights the fact that this framework can be a valuable tool to facilitate comprehensive care in oncology, but it currently possesses some areas of limitation that require conceptual revision; to this end, several recommendations have been proposed. Specifically, these proposed recommendations center on the following three areas of the ICF framework: (1) the replacement of the term "health condition" with the more inclusive and dynamic term "health state;" (2) the continuing development and refinement of the personal factors component to ensure issues such as comorbidities can be accounted for appropriately; and (3) the inclusion of a mechanism to account for the subjective dimension of health and functioning (eg, quality of life).

SUMMARY

It is through the expansion of these conceptual parameters that the ICF may become more relevant and applicable to the field of oncology. With these important revisions, the ICF has the potential to provide a broader biopsychosocial perspective of care that captures the diverse range of concerns that arise throughout the continuum of care in oncology.

Perspectives on the International Classification of Functioning, Disability, and Health: Child and Youth version (ICF-CY) and occupational therapy practice

Classifying disability for children and youth has typically meant describing a diagnosis or developmental lag. The publication of the International Classification of Functioning, Disability and Health: Child & Youth version (ICF-CY) marks a global paradigm shift in the conceptualization and classification of childhood disability. Knowledge and awareness of the ICF-CY has been slow to diffuse within occupational therapy.

PURPOSE

The purpose of this paper is to foster the integration of the ICF-CY into occupational therapy practice with children and youth.

KEY ISSUES

Research describes positive trends in using the ICF-CY for cross-disciplinary communication; further clarity and development is warranted around activity and participation categories and functional profiles.

IMPLICATIONS

Occupational therapy can contribute to the evolution of the ICF-CY, but must clarify its complementary perspective and knowledge base. If the ICF-CY can be further integrated into occupational therapy systems, it holds promise for shifting practice patterns and creating professional opportunities.

Quality-of-life, mood and executive functioning after childhood craniopharyngioma treated with surgery and proton beam therapy

PRIMARY OBJECTIVE

Childhood craniopharyngioma, a benign tumour with a good survival rate, is associated with important neurocognitive and psychological morbidity, reducing quality-of-life (QoL).

METHOD

This retrospective study analysed QoL, mood disorders, everyday executive functioning and disease's impact on family life in 29 patients (mean age at diagnosis 7 years 10 months (SD = 4.1); mean follow-up period 6 years 2 months (SD = 4.5)) treated for childhood craniopharyngioma by surgery combined with radiotherapy using proton beam. Assessment included a semi-structured interview and standardized scales evaluating self-report of QoL (Kidscreen 52) and depression (MDI-C) and proxy-reports of QoL (Kidscreen 52), executive functioning (BRIEF) and disease's impact (Hoare and Russel Questionnaire).

RESULTS

Twenty-three families answered the questionnaires completely. Overall QoL self-report was within the normal range. QoL proxy-report was lower than self-report. Eleven patients reported depression; 24-38% had dysexecutive symptoms. A majority of families felt 'very concerned' by the disease. Depression and low parental educational level were associated with lower QoL and higher levels of executive dysfunction.

CONCLUSION

Given the high morbidity of childhood craniopharyngioma, screening for psychosocial outcome, cognitive functioning, including executive functions, mood and QoL should be systematic and specific interventions should be developed and implemented.

Stroke in Swedish children II: long-term outcome

AIM

To evaluate the long-term outcome of childhood stroke in a population-based cohort of Swedish children.

METHODS

We followed up children with stroke over 7 years from 2000 to 2006 in a health care region covering one-fifth of the Swedish population. Children aged between 28 days and 18 years, who had arterial ischaemic stroke, cerebral sinus venous stroke or nontraumatic haemorrhagic stroke, were included. The long-term outcome study 1.6-8.6 years later included a clinical investigation, evaluation of school performance, everyday activities and participation and health-related quality of life questionnaires (International Classification of Functioning, Disability and Health, Child Health Questionnaire and Short-Form General Health Survey).

RESULTS

Of 51 children, 4 (8%) had died and 85% of the long-term survivors had some acquired impairment: 65% of the children had neurological impairment, and 59% had deficits affecting school activity and participation. The parents experienced the negative effect of the stroke on their child's general health, daily life activities and participation and also on their own family life.

CONCLUSION

Childhood stroke results in serious long-term functional deficits in 85% of survivors affecting their everyday life, the child's performances and the life of the family as a whole.

ICF and ICF-CY for an innovative holistic approach to persons with chronic conditions

This introduction presents a brief review of projects carried out in Italy applying ICF model. ICF allows to capture and appropriately describe human functioning and disability in terms of body functions and body structures, life activities, participation in society, modulating contextual factors. ICF framework allows to have a complex profile of persons with different medical conditions. Several clinical studies have been performed using ICF and ICF-CY, in Italy from the publication of ICF in 2001 and ICF-CY in 2007. Most of them highlight the utility and feasibility of using ICF to describe the functional profiles of patients with different health conditions. The clinical applications of ICF clearly show that ICF-based functional profiles are useful in designing better interventions - directed not only to patients' health condition and symptoms but also to the most important activities of their daily living and environmental factors that may act as barriers or facilitators to the patients' recovery, well-being and participation in society.