ICF and ICF-CY lessons learned: Pandora’s box of personal factors

Using a behavior change toolkit in pediatric physical therapy to support physical activity: A feasibility study

INTRODUCTION

Physical activity levels of children with disabilities are low, as these children and their parents face a wide variety of both personal and environmental barriers. Behavior change techniques support pediatric physical therapists to address these barriers together with parents and children. We developed the What Moves You?! intervention Toolkit (WMY Toolkit) filled with behavioral change tools for use in pediatric physical therapy practice.

OBJECTIVE

To evaluate the feasibility of using the WMY Toolkit in daily pediatric physical therapy practice.

METHODS

We conducted a feasibility study with a qualitative approach using semi-structured interviews with pediatric physical therapists (n = 11). After one day of training, the pediatric physical therapists used the WMY Toolkit for a period of 9 weeks, when facilitating physical activity in children with disabilities. We analyzed the transcripts using an inductive thematic analysis followed by a deductive analysis using a feasibility framework.

RESULTS

For acceptability, pediatric physical therapists found that the toolkit facilitated conversation about physical activity in a creative and playful manner. The working mechanisms identified were in line with the intended working mechanisms during development of the WMY Toolkit, such as focusing on problem solving, self-efficacy and independence. For demand, the pediatric physical therapists mentioned that they were able to use the WMY Toolkit in children with and without disabilities with a broad range of physical activity goals. For implementation, education is important as pediatric physical therapists expressed the need to have sufficient knowledge and to feel confident using the toolkit. For practicality, pediatric physical therapists were positive about the ease of which tools could be adapted for individual children. Some of the design and materials of the toolkit needed attention due to fragility and hygiene.

CONCLUSION

The WMY Toolkit is a promising and innovative way to integrate behavior change techniques into pediatric physical therapy practice.

International Classification of Function, Disability and Health (ICF) Word Mapping to Determine the Human Functioning Associated with Upper Extremity Surgery for Tetraplegia

Understanding human functioning and disablement, the contributing factors and their interactions in individuals with tetraplegia is important since elective upper extremity (UE) reconstructive surgery is now offered earlier after injury prior to full recognition of what lies ahead. Qualitative and quantitative data were available from a prior series of mixed methods studies, including a case series design capturing the patients' lived-experience perspectives of nerve or tendon transfer surgery, or not as the case may be. The objective of this study was to perform secondary data analysis to determine whether the recommended outcome tools being used by clinicians reflect the all important domains of functioning identified by people with tetraplegia who were considering UE reconstructive procedures. The original 18 candidate themes derived from qualitative analysis were reviewed in retrospect, along with a content analysis of the tools' questions, undertaking word mapping links to the ICF taxonomy. The outcomes tools included in the content analysis were the Canadian Occupational Performance Measure, the Capabilities of Upper Extremity Questionnaire, The Personal Wellbeing Index, and the Grasp and Release Test. Comparison between clinical outcomes tools and the patient lived-experience data uniquely identified links to Chapter1 (b) Mental functions, which include consciousness, orientation, temperament/personality, energy/drive, and higher-level cognition.

A systematic scoping review on contextual factors associated with communicative participation among children with developmental language disorder

BACKGROUND

Variations in communicative participation of children with developmental language disorder (DLD) cannot be wholly explained by their language difficulties alone and may be influenced by contextual factors. Contextual factors may support or hinder communicative participation in children, which makes their identification clinically relevant.

AIMS

To investigate which contextual (environmental and personal) factors in early childhood are protective, risk or neutral factors for communicative participation among school-aged children with DLD, and to identify possible gaps in knowledge about this subject.

METHODS & PROCEDURES

A scoping review was conducted based on a systematic search of studies published from January 2007 to March 2022 in Pubmed, Embase (without MEDLINE), CINAHL and PsycINFO. In total, 8802 studies were reviewed using predefined eligibility criteria, of which 32 studies were included for data extraction and critically appraised using the Critical Appraisal Skills Programme (2021) tools.

MAIN CONTRIBUTION

The methodological quality of included studies was adequate to strong. Personal protective factors identified are being a preschool girl, reaching school age and being prosocial, while personal risk factors are becoming a teenager or adolescent, having low socio-cognitive skills and experiencing comorbid mobility impairment or behavioural problems. Gender after the preschool years and non-verbal abilities were not found to be of influence, and the role of socio-emotional skills is inconclusive. Receiving therapy is an environmental protective factor, while the association between socio-economical family characteristics with communicative participation is inconclusive.

CONCLUSIONS & IMPLICATIONS

Limited research has been conducted on which risk and protective factors present in early childhood are associated with later communicative participation of children with DLD. The influence of co-occurring health conditions, social background variables, individual psychological assets, interpersonal relationships and attitudes of other people represent knowledge gaps. In addition, knowledge about the comparative effectiveness of different types of interventions and service delivery models, and the impact of administrative control, organizational mechanisms and standards established by governments on children's communicative participation is lacking. More longitudinal research is needed focusing on the identification of relevant personal and environmental factors and the interactions between them in relation to communicative participation outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject Children with DLD experience varying degrees of communicative participation restrictions. Insight into contextual factors that influence communicative participation can help to identify children at risk and inform family and child-centred therapy. Systematic research on contextual factors that facilitate or hinder communicative participation in children with DLD is currently lacking. What this paper adds to existing knowledge Knowledge of protective factors can guide the development of interventions for children and young people with DLD that boost resilience and facilitate communicative participation, while insight into the risk factors can help professionals identify the most vulnerable children and develop interventions that can lift or neutralize barriers present in the life of these children. Specific groups potentially at risk are young boys, children with co-morbid mobility impairment, children with conduct problems, and children reaching adolescence. In contrast, potentially protective factors are reaching school age and being prosocial. In addition, the development of socio-cognitive skills may be beneficial for the communicative participation of children with DLD. What are the potential or actual clinical implications of this work? To support communicative participation, it is important that professionals who work with children with DLD understand which groups are at risk for communicative participation restrictions, and which factors can foster resilience. In the absence of evidence-based instruments for the systematic assessment of personal and environmental factors, consulting parents and children on the contextual factors that they perceive as important remains critical.

A roadmap to reduce information inequities in disability with digital health and natural language processing

People with disabilities disproportionately experience negative health outcomes. Purposeful analysis of information on all aspects of the experience of disability across individuals and populations can guide interventions to reduce health inequities in care and outcomes. Such an analysis requires more holistic information on individual function, precursors and predictors, and environmental and personal factors than is systematically collected in current practice. We identify 3 key information barriers to more equitable information: (1) a lack of information on contextual factors that affect a person's experience of function; (2) underemphasis of the patient's voice, perspective, and goals in the electronic health record; and (3) a lack of standardized locations in the electronic health record to record observations of function and context. Through analysis of rehabilitation data, we have identified ways to mitigate these barriers through the development of digital health technologies to better capture and analyze information about the experience of function. We propose 3 directions for future research on using digital health technologies, particularly natural language processing (NLP), to facilitate capturing a more holistic picture of a patient's unique experience: (1) analyzing existing information on function in free text documentation; (2) developing new NLP-driven methods to collect information on contextual factors; and (3) collecting and analyzing patient-reported descriptions of personal perceptions and goals. Multidisciplinary collaboration between rehabilitation experts and data scientists to advance these research directions will yield practical technologies to help reduce inequities and improve care for all populations.

Proposal for an ICF-based methodology to foster the return to work of persons with disability

BACKGROUND

Employment is an essential component of life as it provides income, sense of engagement and opportunities for personal development. Unemployment due to disability following an accident may have dramatic social and psychological consequences on individuals; it is thus fundamental to foster return to work of these persons.

OBJECTIVE

The present work was aimed to develop a methodology determining suitable jobs for people living with disability after a job-related accident.

METHODS

The Occupational Information Network (O*NET) taxonomy was combined with the International Classification of Functioning, Disability and Health (ICF) to match individual resources with specific job requirements. ICF Linking Rules were employed by two independent groups of researchers to associate ICF codes to O*NET skill and ability descriptors.

RESULTS

O*NET descriptors were linked to 92 unique ICF codes. A "Criticality score" combining ICF and O*NET features to assess suitability of selected jobs for persons with disabilities was also proposed.

CONCLUSIONS

The proposed methodology represents a novel instrument to support return to work; the capability to assess specific work-related facets through the lens of both the ICF model and O*NET taxonomy would conceivably provide vocational rehabilitation specialists and occupational therapists with a useful tool fostering job placement of workers with disability.

Personal factors understood through the Ecological-Enactive Model of Disability and implications for rehabilitation research

The International Classification of Functioning, Disability and Health (ICF) recognizes that disability arises from the interaction between an individual with a medical condition and the context in which they are embedded. Context in the ICF is comprised of environmental and personal factors. Personal factors, the background life and lifestyle of an individual, are poorly understood in rehabilitation. There is limited knowledge about how personal and environmental factors interact to shape the contextual conditions critical for explaining functioning and disability. In this paper, we explore how a newly proposed model of disability, the Ecological-Enactive Model of Disability, can enhance understanding of personal factors across multiple rehabilitation disciplines. We draw from a review of evidence and phenomenological interviews of individuals with Friedreich's Ataxia. We consider the practical impact of this understanding on disability and rehabilitation research and pathways for the future focusing on representative design.

Toward a paradigm shift in healthcare: using the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA) jointly in theory and practice

PURPOSE

Over the past two decades, healthcare systems have shifted to adopt a more holistic, patient-centered care system. However, operationalization in practice remains challenging. Two frameworks have contributed substantially to the transformation toward more holistic and patient-centered care: the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA). Using these frameworks jointly can contribute to improved patient-centered care in clinical practice.

METHODS

This article explores the strengths and weaknesses of the use of the two frameworks in care and investigates whether using them jointly might contribute to more appropriate and patient-centered care. We will present a practical example of this integration in the form of a novel e-health application.

RESULTS

The exploration indicated that if the frameworks are used jointly, the individual weaknesses can be overcome. The application, used to exemplify the joint use of the frameworks, contains all categories of the ICF. It offers a unique tool that allows a person to self-assess, record, and evaluate their functioning and capabilities and formulate related goals.

CONCLUSIONS

Using the ICF jointly with the CA can foster holistic, patient-centered care. The e-health application provides a concrete example of how the frameworks can be used jointly. Implications for rehabilitationUsing the International Classification of Functioning, Disability and Health jointly with the capability approach can foster holistic, patient-centered care.The joint use of the frameworks is demonstrated by an e-health application which enables users to evaluate their functioning in relation to their own goals, provides them with the opportunity to increase control over their health and have a more active role in their care.Tools to record both functioning and goals from a patient's perspective can support professionals in offering patient-centered care in daily practice.Individual recording, monitoring and evaluation of functioning, capabilities and goals regarding functioning can provide a basis for research and quality improvement.

Critically Examining the Person–Environment Relationship and Implications of Intersectionality for Participation in Children's Rehabilitation Services

Participation of children in rehabilitation services is associated with positive functional and developmental outcomes for children with disabilities. Participation in therapy is at risk when the personal and environmental contexts of a child create barriers to accessing services. The International Classification of Functioning, Disability and Health (ICF) provides a framework for conceptualizing the personal and environmental factors linked to a child. However, it does not facilitate critical examination of the person–environment relationship and its impact on participation in children's rehabilitation. This perspective study proposes the use of intersectionality theory as a critical framework in complement with the ICF to examine the impact of systemic inequities on the participation in therapy for children with disabilities. Clinicians are called to be critical allies working alongside children and families to advocate for inclusive participation in children's rehabilitation by identifying and transforming systemic inequities in service delivery.

ICF Personal Factors Strengthen Commitment to Person-Centered Rehabilitation – A Scoping Review

Background: The International Classification of Functioning, Disability and Health (ICF) classification is a biopsychosocial frame of reference that contributes to a holistic understanding of the functioning of a client and the factors involved. Personal factors (PFs) are not currently classified in the ICF due to large societal and cultural diversity and lack of clarity in the scope of such factors.

Aims: To ascertain which factors in the ICF classification have been defined as PFs in different studies and what conclusions have been drawn on their role in the ICF classification.

Methods: The study was a scoping review. A systematic search for articles published in 2010–2020 was performed on the Cinahl, Pubmed, ScienceDirect, and Sport Discus databases. The PFs specified in the articles were classified according to the seven categories proposed by Geyh et al. socio-demographic factors; position in the immediate social and physical context; personal history and biography; feelings; thoughts and beliefs; motives; and general patterns of experience and behavior.

Results: The search yielded 1,988 studies, of which 226 met the inclusion criteria. The studies had addressed a wide variety of PFs that were linked to all seven categories defined by Geyh et al. Some studies had also defined PFs that were linkable to other components of the ICF or that did not describe functioning. Approximately 22% (51) of the studies discussed the role of PFs in rehabilitation.

Conclusions: The range of PFs in the ICF classification addressed in the reviewed studies is wide. PFs play an important role in rehabilitation. However, according to the reviewed studies, a more precise coding of PFs is not yet warranted.

Assessment of child development in premature babies based on the ICF biopsychosocial model

BACKGROUND

The International Classification of Functionality (ICF) has been recommended to enable a broader and more holistic view of an individual's health condition. In addition, it works as an important reference for multiprofessional teams. In low-income countries, like Brazil, the attempts to systematize and incorporate the ICF model in health services has been a challenge.

AIM

The aim was to analyze the development of premature babies considering the biopsychosocial model of the ICF.

DESIGN

A longitudinal study.

SETTING

Maternity in the northeast Brazil.

POPULATION

Thirty-five premature babies were evaluated in the first stage and 20 in the second.

METHODS

Pre, perinatal, socioeconomic data and environmental factors were collected, and general movements assessed during the 38^th (±1.79) week of corrected gestational age. The Age and Stages Questionnaire (ASQ-3) was used to assess child development, in the 13^th (±1.50) month of life. The instruments were chosen with the objective of evaluating information necessary for the follow-up of premature infants and to represent the five domains of the ICF.

RESULTS

Of the 35 newborns initially evaluated, 20 were reassessed at 1 year of age and 70% were boys. In the function and structure domain, 55% exhibited altered general movements and 35% grade 1 intraventricular hemorrhage; in activity and participation, 15% displayed delayed communication, 20% delayed ample motor coordination, 40% fine motor coordination and problem resolution and 35% personal/social delay in the ASQ-3. Only one item of the personal factors (male sex) and function and structure domain (intraventricular hemorrhage) exhibited an association with atypical child development.

CONCLUSIONS

Given the susceptibility of premature newborn neurodevelopment and the magnitude of the biopsychosocial model of the ICF, even at this early stage of life, it was possible to observe the influence of personal factors, body function and structure domains on atypical child development.

CLINICAL REHABILITATION IMPACT

The care for the premature newborn with global look of the classification of functioning, disability and health.

An International Clinical Study of Ability and Disability in Autism Spectrum Disorder Using the WHO-ICF Framework

This is the fourth international preparatory study designed to develop International Classification of Functioning, Disability and Health (ICF, and Children and Youth version, ICF-CY) Core Sets for Autism Spectrum Disorder (ASD). Examine functioning of individuals diagnosed with ASD as documented by the ICF-CY in a variety of clinical settings. A cross-sectional study was conducted, involving 11 units from 10 countries. Clinical investigators assessed functioning of 122 individuals with ASD using the ICF-CY checklist. In total, 139 ICF-CY categories were identified: 64 activities and participation, 40 body functions and 35 environmental factors. The study results reinforce the heterogeneity of ASD, as evidenced by the many functional and contextual domains impacting on ASD from a clinical perspective.

Linking the behavioral assessment screening tool to the international classification of functioning, disability, and health as a novel indicator of content validity

Purpose: To use the International Classification of Functioning, Disability, and Health (ICF) to classify and describe the concepts of the Behavioral Assessment Screening Tool (BAST), a measure of behavioral disruptions after traumatic brain injury (TBI).Methods: Meaningful concepts in the BAST were linked to the International Classification of Functioning to (1) further explore the validity of the conceptual model of behavior; (2) demonstrate ICF linking as a novel indicator of the content validity; (3) identify International Classification of Functioning concepts that characterize behavior; (4) determine the comprehensiveness of the BAST.Results: The body functions component and the activities and participation component were most frequently addressed in the BAST. The majority of the TBI Core Set categories were included in the BAST and the manifest and latent coders agreed 85% of the time.Conclusions: Linking BAST concepts to the International Classification of Functioning demonstrated the BAST's content validity and comprehensiveness. This approach provides a model for how ICF coding could be used to assess content validity.Implications for RehabilitationICF coding can be used to assess content validity and refine rehabilitation measures.The Behavioral Assessment Screening Tool can be used for clinical and research purposes to assess behavior as it relates to a wide range of ICF TBI Core Set categories.

An international clinical study of ability and disability in ADHD using the WHO-ICF framework

This is the fourth and final study designed to develop International Classification of Functioning, Disability and Health (ICF, and children and youth version, ICF-CY) core sets for attention-deficit hyperactivity disorder (ADHD). To investigate aspects of functioning and environment of individuals with ADHD as documented by the ICF-CY in clinical practice settings. An international cross-sectional multi-centre study was applied, involving nine units from eight countries: Denmark, Germany, India, Italy, Portugal, Saudi Arabia, Sweden and Taiwan. Clinicians and clinical researchers rated the functioning level of 112 children, adolescents and adults with ADHD using the extended ICF-CY checklist version 2.1a. The ratings were based on a variety of information sources, such as medical records, medical history, clinical observations, clinical questionnaires, psychometric tests and structured interviews with participants and family members. In total, 113 ICF-CY categories were identified, of which 50 were related to the activities and participation, 33 to environmental factors and 30 to body functions. The clinical study also yielded strengths related to ADHD, which included temperament and personality functions and recreation and leisure. The study findings endorse the complex nature of ADHD, as evidenced by the many functional and contextual domains impacted in ADHD. ICF-CY based tools can serve as foundation for capturing various functional profiles and environmental facilitators and barriers. The international nature of the ICF-CY makes it possible to develop user-friendly tools that can be applied globally and in multiple settings, ranging from clinical services and policy-making to education and research.

The ICF has made a difference to functioning and disability measurement and statistics

AIMS

Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.

METHODS

In a scoping review, we investigated research published 2001-2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.

RESULTS

The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.

CONCLUSION

The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes. Implications for Rehabilitation The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance. Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning. Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.

A content analysis of peripheral arterial disease patient-reported outcome measures using the International Classification of Functioning, Disability and Health

BACKGROUND

The purpose of this study was to link, classify and describe the content of peripheral arterial disease (PAD)-specific patient-reported outcome measures using the International Classification of Functioning. The results were then analyzed to determine if these assessments provide clinicians and researchers with a comprehensive understanding of the lived experience of patients with PAD.

METHODS

Each meaningful concept in identified PAD assessments was linked to the International Classification of Functioning, Disability and Health to determine included and excluded content areas. An overall perspective was assigned to each assessment item. Inter-rater reliability was established using a kappa statistic.

RESULTS

The body functions component is most frequently addressed overall followed by the activities and participation component. International Classification of Functioning chapter and category distribution vary greatly between assessments and no assessment comprehensively examines community participation and relationships. The majority of the assessment items are of the health status-disability and quality of life perspectives.

CONCLUSIONS

The results of this study suggest the need for the development of a comprehensive PAD assessment that includes a more even distribution of International Classification of Functioning topics and subtopics. A more comprehensive assessment would better capture the lived experience of this patient population. Implications for Rehabilitation A better understanding of the data collected using the current peripheral arterial disease-specific patient-reported outcome measures may contribute to the development of more comprehensive assessment tools that will ultimately lead to improved patient care. This study contributes to the preliminary foundation for the development of a peripheral arterial disease International Classification of Functioning, Disability and Health Core Set. Clinicians and researchers interested in using peripheral arterial disease-specific patient-reported outcome measures for clinical and research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed.

Reconsideration of the scheme of the international classification of functioning, disability and health: incentives from the Netherlands for a global debate

PURPOSE

The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe 'functioning' and 'disability'), including the ICF scheme (visualization of functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes.

METHOD

Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes.

RESULTS

The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of 'health condition' at the top and role of 'contextual factors'). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme.

CONCLUSIONS

There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health. Implications for Rehabilitation We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm. We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health. We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases). We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.

The significance of social rules in group training sessions

PURPOSE

To identify what types of social rules are involved in group interventions led by physiotherapists (PTs), and how these rules influence individual recovery.

METHODS

Eight patients; six women and two men, which had recently undergone elective hip or knee replacement surgery, were recruited as informants from an intervention group that investigated effect of task specific exercise. The data comprise observational notes from group training sessions and one-on-one semi-structured interviews with the eight patients. Observational notes contributed to the development of the research questions. The interviews were audio-recorded and transcribed, and a theoretically-oriented analytical approach guided by performance theory was conducted to identify the rules.

RESULTS

Several implicit rules for behavior when attending this group intervention were identified. The compulsory style enhances recovery in an explicit manner.

CONCLUSION

When giving advice and home exercise PTs must acknowledge that the roles patients are subtly exposed to during the actual clinical encounter are probably quite different from the roles the patients can merge into outside the therapy context. This might shed some light on the notion of patient adherence/concordance. The significance of social rules in group training sessions. Implications for Rehabilitation Health professionals should be aware of the implicit social regulations of the clinical encounter. They will influence whether and how patients adhere to advice. By acknowledging that patients have different roles to merge into, depending on context, health professionals may significantly broaden our understanding of patient adherence and compliance. The social rules identified in this study contribute to individual recovery processes. We encourage health professionals to regard "group dynamics" as something that is going on during the group session, and worthwhile taking advantage of when planning and implementing group interventions.

Psychological adjustment to chronic disease and rehabilitation - an exploration

PURPOSE

Psychological adjustment has a major impact on chronic disease health outcomes. However, the classification of psychological adjustment is unclear in the current version of the International Classification of Functioning, Disability and Health (ICF). We aim (i) to characterize the process of psychological adjustment to chronic disease, and (ii) to analyze how various categories of the psychological adjustment process could be incorporated into the ICF.

METHOD

We provide a summary of models of psychological adjustment to chronic disease. We also evaluate various options for incorporating categories of psychological adjustment into the ICF.

RESULTS

Acute and ongoing illness stressors; emotional, cognitive and behavioral responses; personal background; and social and environmental background are major categories in the adjustment process. These categories could, in principle, be integrated with various components of the ICF. Any future revision of the ICF should explicitly incorporate psychological adjustment and its (sub)categories.

CONCLUSION

The ICF could incorporate categories of psychological adjustment to chronic disease, although several adaptations and clarifications will be required. Implications for Rehabilitation In the context of an ageing society and large numbers of people living with chronic diseases, it is essential to understand psychological adjustment to chronic disease. However, the classification of psychological adjustment to chronic disease is unclear in the current version of the International Classification of Functioning, Disability and Health (ICF). We demonstrate that the ICF could incorporate categories of psychological adjustment to chronic disease, although several adaptations and clarifications would first be required. We suggest that these adaptations and clarifications should be considered in any future revision of the ICF.

The Burn Model Systems outcome measures: a content analysis using the International Classification of Functioning, Disability, and Health

BACKGROUND

The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems (BMS) is a nationwide database that uses patient-reported outcome measures to collect data. Though the outcome measures demonstrate good psychometric properties, the question remains whether or not these measures collect data that encompass the entire experience of burn patients over time.

METHODS

Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also determined.

RESULTS

The body function component was most frequently addressed overall followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective.

CONCLUSION

This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery. Implications for Rehabilitation A better understanding of the data collected through the Burn Model Systems (BMS) project may contribute to improve data collection tools and ultimately lead to clinical practice innovations and improvements. Clinicians interested in using BMS data for research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed. This study highlights the need for burn clinicians around the world to lend their expertise to the WHO for the development of a much needed burn injury International Classification of Functioning, Disability and Health Core Set.

[Personal factors and participation - How should professionals address them?]

Controversy exists around the application of personal factors within the International Classification of Functioning, Disability and Health. In the framework, they are represented by one of the boxes, but without content. They are part of the model, but cannot be coded or collected statistically. This article clarifies the rationale for the inclusion of personal factors in the classification, describes the controversies related to it and provides a personal statement about the utility of personal factors in clinical practice.

A comprehensive scoping review of ability and disability in ADHD using the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY)

This is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Attention Deficit Hyperactivity Disorder (ADHD). The objective here was to use a comprehensive scoping review approach to identify the concepts of functional ability and disability used in the scientific ADHD literature and link these to the nomenclature of the ICF-CY. Systematic searches were conducted using Medline/PubMed, PsycINFO, ERIC and Cinahl, to extract the relevant concepts of functional ability and disability from the identified outcome studies of ADHD. These concepts were then linked to ICF-CY by two independent researchers using a standardized linking procedure. Data from identified studies were analysed until saturation of ICF-CY categories was reached. Eighty studies were included in the final analysis. Concepts contained in these studies were linked to 128 ICF-CY categories. Of these categories, 68 were considered to be particularly relevant to ADHD (i.e., identified in at least 5 % of the studies). Of these, 32 were related to Activities and participation, 31 were related to Body functions, and five were related to environmental factors. The five most frequently identified categories were school education (53 %), energy and drive functions (50 %), psychomotor functions (50 %), attention functions (49 %), and emotional functions (45 %). The broad variety of ICF-CY categories identified in this study underlines the necessity to consider ability and disability in ADHD across all dimensions of life, for which the ICF-CY provides a valuable and universally applicable framework. These results, in combination with three additional preparatory studies (expert survey, focus groups, clinical study), will provide a scientific basis to define the ICF Core Sets for ADHD for multi-purpose use in basic and applied research, and every day clinical practice.

Ability and Disability in Autism Spectrum Disorder: A Systematic Literature Review Employing the International Classification of Functioning, Disability and Health-Children and Youth Version

Objective: This study is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Autism Spectrum Disorder (ASD). The objective was to use a systematic review approach to identify, number, and link functional ability and disability concepts used in the scientific ASD literature to the nomenclature of the ICF‐CY (Children and Youth version of the ICF, covering the life span). Methods: Systematic searches on outcome studies of ASD were carried out in Medline/PubMed, PsycINFO, ERIC and Cinahl, and relevant functional ability and disability concepts extracted from the included studies. These concepts were then linked to the ICF‐CY by two independent researchers using a standardized linking procedure. New concepts were extracted from the studies until saturation of identified ICF‐CY categories was reached. Results: Seventy‐one studies were included in the final analysis and 2475 meaningful concepts contained in these studies were linked to 146 ICF‐CY categories. Of these, 99 categories were considered most relevant to ASD (i.e., identified in at least 5% of the studies), of which 63 were related to Activities and Participation, 28 were related to Body functions, and 8 were related to Environmental factors. The five most frequently identified categories were basic interpersonal interactions (51%), emotional functions (49%), complex interpersonal interactions (48%), attention functions (44%), and mental functions of language (44%). Conclusion: The broad variety of ICF‐CY categories identified in this study reflects the heterogeneity of functional differences found in ASD—both with respect to disability and exceptionality—and underlines the potential value of the ICF‐CY as a framework to capture an individual's functioning in all dimensions of life. The current results in combination with three additional preparatory studies (expert survey, focus groups, and clinical study) will provide the scientific basis for defining the ICF Core Sets for ASD for multipurpose use in basic and applied research and every day clinical practice of ASD. Autism Res2015, 8: 782–794. © 2015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research

The ambiguity of the concept of participation in measurement instruments: operationalization of participation influences research outcomes

Objective:

This study explores, based on the International Classification of Functioning, Disability and Health, the consequences of different operationalizations of participation in regression models predicting participation in one sample of patients.

Design:

Cross-sectional, comparative study.

Setting:

Department of Neurology of a University Hospital.

Subjects:

A total of 677 patients with a Neuromuscular Disease.

Measures:

Participation was measured using the Neuromuscular Disease Impact Profile questionnaire, the RAND-36 Item Health Survey (social functioning, role limitations—physical, role limitations—emotional) and the Impact on Participation and Autonomy questionnaire (autonomy outdoors, social relations). Potential predictors of participation included type of neuromuscular disease, body functions (measured with Neuromuscular Disease Impact Profile), activities (measured with Neuromuscular Disease Impact Profile), environmental factors (measured with Neuromuscular Disease Impact Profile), and personal factors (measured with the 13-item Sense of Coherence questionnaire). The results were controlled for patient characteristics.

Results:

Participation was statistically predicted by different determinants depending on the operationalization used for participation. Additionally, the regression coefficients differed significantly. Body functions and activities were predictors in five out of six operationalizations of participation. Sense of coherence predicted participation in all of the operationalizations. The explained variance of the different models ranged from 25% (RAND-36 role limitations—emotional) to 65% (Neuromuscular Disease Impact Profile).

Conclusions:

Different operationalizations of participation result in different prediction models. Lack of conceptual consensus makes participation an ambiguous concept in research, and this ambiguity makes evidence-based decisions directed at enhancing participation difficult. Participation needs to be operationalized in an unambiguous and standard way in order to improve the comparability of outcomes.