Assessing the Adequacy of the Physical, Social, and Attitudinal Environment to the Specific Needs of Young Adults With Cerebral Palsy: The European Adult Environment Questionnaire

OBJECTIVES

To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP).

DESIGN

Cross-sectional.

SETTING

Administrative regions in France, Germany, Italy, Portugal, and Sweden.

PARTICIPANTS

Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Physical, social, and attitudinal environment unmet needs.

RESULTS

Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants' needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment.

CONCLUSION

The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framework.

National Health Insurance interprofessional practice implementation in hand rehabilitation service delivery in South Africa

South Africa's current healthcare system is unequal and inefficient, with 71% of the population accessing underfunded public healthcare facilities. The imminent National Health Insurance (NHI) aims to balance the inequality between private and public health services by providing universal healthcare. The high levels of road accidents, violence and injuries in South Africa, being one of the quadruple burdens of diseases frequently causing hand injuries with resultant devastating economic and functional implications without rehabilitation services, are concerning. The plea is that for specialised injuries, such as hand injuries, the NHI implementation requires innovative interprofessional health education and practice when managing individuals who sustained hand injuries optimally to return to preinjury functioning. When considering the devastating burden of mismanaged hand injuries on all levels of the International Classification of Functioning, Disability and Health (ICF) framework, all South Africans deserve rehabilitation by physiotherapists and occupational therapists based on each occupation's unique strengths. Anecdotally, a lack of interprofessional undergraduate and postgraduate hand rehabilitation education and hand-injured patient management exists in South Africa, highlighting the need for urgent change towards future practice and NHI. This commentary aims to apply the ICF core sets to inform interprofessional hand rehabilitation delivery by physiotherapists and occupational therapists.

Clinical implication

Interprofessional rehabilitation framed in the ICF Core Set, accompanied by inclusive interprofessional education opportunities according to the Health Professions Council of South Africa (HPCSAs) scope of practice, will benefit South Africans who sustained hand injuries to fully recover and maximise their functional performance considering the type of injuries sustained.

Biopsychosocial factors associated with the state of disability after hemiparesis in the chronic phase of stroke: exploratory analysis based on the International Classification of Functioning, Disability and Health

OBJECTIVE

To identify the main biopsychosocial factors associated with disability level after stroke using the International Classification of Functioning, Disability and Health (ICF) model.

METHODS

A cross-sectional study was conducted with chronic stroke survivors. Disability was assessed using the World Health Disability Assessment Schedule 2.0. The independent variables were: Body functions: emotional functioning and whether the dominant upper limb was affected. For the Activities & Participation component, satisfaction regarding the execution of activities and participation were assessed using the SATIS-Stroke, as well as the locomotion ability for adults (ABILOCO), manual ability (ABILHAND) and the return to work. For environmental factors, income and facilitators and obstacles were assessed using the Measure of the Quality of the Environment (MQE). Personal factors: age and sex. Multiple Linear Regression was employed.

RESULTS

Limited locomotor ability (β = -0.281; t = -3.231 p = 0.002), dissatisfaction regarding activities and participation (β = -0.273; t = -3.070 p = 0.003), and the non-return to work (β = 0.162; t = 2.085 p = 0.04) were associated with disability.

CONCLUSION

The reduction in locomotor ability, dissatisfaction regarding activities and participation and the non-return to work were associated with disability in the chronic phase following a stroke.

Reliability and Validity of the Avoidance of Daily Activities Photo Scale for Patients With Shoulder Pain (ADAP Shoulder Scale)

OBJECTIVE

The Avoidance of Daily Activities Photo Scale for Patients With Shoulder Pain (ADAP Shoulder Scale) was developed to assess pain-related avoidance behavior during daily activities in people with shoulder pain. However, its measurement properties must be verified according to international guidelines. As such, this study investigated the following 4 measurement properties of the ADAP Shoulder Scale: reliability, measurement errors, convergent validity, and floor and ceiling effects.

METHODS

The sample comprised 100 individuals with chronic shoulder pain (43 men and 57 women; mean duration of symptoms of 29.7 [SD = 89.0] months; mean age of 44.9 [SD = 15.9] years). The mean test-retest reliability range was 5 days via the intraclass correlation coefficient (ICC). Measurement errors included the standard error of measurement and the minimal detectable change. Convergent validity was analyzed by applying the Pearson correlation with the Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, and Shoulder Pain and Disability Index.

RESULTS

The ADAP Shoulder Scale showed excellent test-retest reliability, both in all domains and in the total score [ICC(2,1) = 0.94; 95% CI = 0.92-0.96]. The standard errors of measurement for the free-movement, high-effort, and self-care domains were 8.1%, 6.0%, and 7.6%, respectively. The minimal detectable change for the total score of the ADAP Shoulder Scale was 16.0%. The total score of the ADAP Shoulder Scale was low to moderately correlated with the total scores of the Tampa Scale for Kinesiophobia (r = 0.52), Pain Catastrophizing Scale (r = 0.30), and Shoulder Pain and Disability Index (r = 0.72). No floor or ceiling effects were detected in the total score.

CONCLUSION

The ADAP Shoulder Scale is a reliable, valid instrument for assessing avoidance behavior in adults who have chronic shoulder pain and are not athletes.

IMPACT

This study provides evidence that the ADAP Shoulder Scale is appropriate for clinical and practical use in people with chronic shoulder pain.

Introducing the Dysphagiameter: a novel patient-reported outcome measure for evaluating dysphagia in oculopharyngeal muscular dystrophy - from conceptual framework to initial development

Oculopharyngeal muscular dystrophy (OPMD) is a rare late-onset muscle disease associated with progressive dysphagia. As there was no patient-reported outcome measure specific for the assessment of dysphagia in OPMD, the Dysphagiameter was developed. The Food and Drug Administration guidance was followed. In Phase 1, a systematic literature review and an expert consultation were conducted to identify the concepts of interest. It was decided that the instrument should assess difficulty swallowing using pictures of foods of various textures (part A) and impact of dysphagia on activities and participation (part B), as defined by the International Classification of Functioning, Disability and Health. In Phase 2, focus groups (n = 3) and online surveys (n = 55) were conducted to generate the items. Then, the food items for part A were selected and grouped into 17 textures by a panel of registered dietitians. Cognitive interviews were conducted (n = 23) to refine the instrument and assess its clarity and comprehensiveness. The final draft included 82 food items assessing the capacity to swallow foods and drinks (part A) and 10 items assessing the impact of dysphagia on activities and participation (part B). Item reduction and assessment of psychometrics properties, using Rasch analysis, are ongoing as part of Phase 3.

Linking Intensive Care Unit functional scales to the International Classification of Functioning: proposal of a new assessment approach

BACKGROUND

There are several tools to assess functional and physical status in critical ill patients. These tools can guide rehabilitation strategies in Intensive care units (ICU). However, they are not standardized, and this can compromise their applicability. The aim of the study is to identify common contents between International Classification of Functioning, Disability and Health (ICF) and Medical Research Council sum score (MRC-ss), Functional Status Score for the ICU (FSS-ICU), and Physical Function in ICU Test-scored (PFIT-s). As well as to propose a new assessment approach based on the ICF to ICU patients.

METHODS

Pilot cross-sectional study. ICU in-patients, both genders, aged between 50 and 75 years were assessed with MRC-ss, FSS-ICU, PFIT-s and the linking rules used were proposed by Cieza et al. The inter-rater agreement for the linking process was performed using the Kappa coefficient.

RESULTS

The ICF categories identified in the tools covered a total of 14 items. Common contents were identified in 13 of the 14 and two were related to body functions, six to body structures and five to activities and participation. The inter-rater agreement was considered substantial for the linking of MRC-ss (k = 0.665) and PFIT-s (k = 0.749) to the ICF, and almost perfect for the FSS-ICU (k = 0.832).

CONCLUSIONS

This study synthesizes and categorizes commonly used tools and presents a new proposal based on the ICF to guide future studies. The proposed model combines the ICF with the contents of the most relevant instruments used in critical care.

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.

Pilot evaluation of a protocol and a clinical tool developed to assess the audiological needs of adults with hearing loss

OBJECTIVE

To evaluate the Québec Audiological Assessment Protocol for Younger and Older Adults (QAAP-YOA) and its accompanying clinical tool efficacy to assess the needs of individuals with hearing loss in a simulated context. This study is the Phase 2 in the development of the QAAP-YOA.

DESIGN

Participants completed two needs assessments with simulated clients and wrote audiological reports, while applying the QAAP-YOA with and without the use of its clinical tool. Interviews were filmed, and reports collected. Both were scored by two independent evaluators. A qualitative analysis of reports was also conducted.

STUDY SAMPLE

Eleven audiology students and four early-career audiologists (n = 15).

RESULTS

The clinical tool did not influence the interview process since both experimental conditions had similar compliance rates to the protocol (p = 0.114). Compliance rates for assessment reports were higher with the clinical tool (p < 0.001). Participants' conclusions after applying the QAAP-YOA were consistent across participants. The information provided in the reports was more comprehensive and coherent with the client's needs when participants used the clinical tool.

CONCLUSIONS

The QAAP-YOA can lead to a greater standardisation of needs assessments and to more comprehensive reports, which may lead to intervention programs more closely aligned with clients' needs.

Measuring oral health-How can the International Classification of Functioning help?

There is a need for a theoretically informed, contextualized approach to measuring oral health from a multidisciplinary perspective that goes beyond the commonly used clinical indices and sociodental measures. This commentary aims to discuss the potential for the WHO's International Classification of Functioning, Disability and Health (ICF) to provide a model for the development of indicators for oral health. It is suggested that the ICF might provide both a theoretical model and an operational classification for indicators of oral health. The ICF model states that human experience of physical, cognitive and social functioning is universal and, thus, can be described and qualified. Human function is given social and environmental context within the model at both an individual and population level. The ICF can not only capture data regarding oral health and function at the physiological level (e.g. chewing) but also at the social level (e.g. sharing meals). It is able not only to capture aspects of preventive behaviour (e.g. caring for teeth) but also aspects of social facilitation (e.g. economic self-sufficiency) or ability to fulfil a social role (e.g. remunerative employment). It also includes aspects of social environment, such as healthcare services or political, economic and legal systems. Case studies are given as examples of the potential use of the ICF in the oral health domain. Examples are also given of the first steps that have been made towards operationalization of the ICF in data collection and oral health research. The challenges of encompassing such a comprehensive model into a practical oral health measure are discussed.

Translation and cross-cultural adaptation of the Brazilian version of the PM-Scale: A specific measure of participation after stroke

BACKGROUND

The PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French.

OBJECTIVE

To translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version.

METHODS

The translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC_2,1). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale.

RESULTS

The final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC_2,1 = 0.91; 95%CI: 0.83, 0.95 and ICC_2,1 = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05).

CONCLUSION

The Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.

Development of the Gross Motor Function Family Report (GMF-FR) for Children with Cerebral Palsy

Purpose: To describe the initial steps in the development of a family-completed, modified version of the Gross Motor Function Measure (GMFM-88) to report gross motor function of young people with cerebral palsy in their natural environments. Methods: Development of the Gross Motor Function - Family Report (GMF-FR) was based on expert opinion involving 13 experienced clinicians and researchers, in four steps: (1) item identification to target items that reflect functional gross motor performance; (2) item selection; (3) critical analysis of the items; and (4) item and scoring modification. Results: Several modifications to existing items and scoring were made, including wording changes to optimize ease of families' understanding, the addition of photographs to illustrate all items, changes to the items to enable use of furniture instead of specialized equipment, and modifications to scoring criteria to ensure a focus on functional motor skills. Ultimately, 30 items were selected, and specific testing/scoring instructions were created for each item. Conclusions: GMF-FR is a new family-report tool, based on the GMFM-88. When validated, it can be used as a telehealth outcome measure to capture family-reported functional motor skill performance in home and community environments.

Application of the International Classification of Functioning, Disability and Health (ICF) in dementia research and practice: A scoping review

OBJECTIVES

The International Classification of Functioning, Disability and Health (ICF) endorsed by the World Health Organization provides a conceptual framework for describing functioning and disability based on a biopsychosocial model. Although dementia is one of the leading causes of disability, yet little is known on the extent to how the ICF has been utilized in dementia research and practice. The study aimed to examine and map the current applications of the ICF with dementia from a body of earlier studies and to explore the potential use in person-centred dementia care.

METHODS

The Arksey and O'Malley framework was used to guide the searching, selecting, and synthesizing process. The scoping review was reported following The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines.

RESULTS

A total of 34 studies were included. The applications of ICF were classified into 4 themes: (1) in clinical practice and the education of health professionals (n = 20); (2) community support services and income support (n = 3); (3) population-based, census, or survey data (n = 10); (4) advocacy and empowerment purposes (n = 1).

CONCLUSION

The ICF has made a major impact on dementia in clinical settings. Findings strongly support applying the ICF to person-centered dementia care. In the future, more empirical studies are needed to expand the scope of ICF use in dementia research and practice.

Mapping the focus of research conducted with adults with cerebral palsy: an overview of systematic reviews

PURPOSE

To map research conducted with adults with cerebral palsy (CP) to the International Classification of Functioning, Disability and Health (ICF) to understand the array of research available, identify key clinical messages and inform future research.

MATERIALS AND METHODS

An overview of systematic reviews was conducted. Comprehensive searches (to December 2021) were conducted in PsycINFO, Web of Science, MEDLINE, CINAHL, Cochrane, JBI, and EMBASE. Eligible studies were systematic reviews that included primary studies of adults with CP. Included reviews were assessed for study quality and mapped to the ICF components and chapters. A narrative synthesis of commonly reported outcomes within the component/s and chapter/s was conducted.

RESULTS

All 24 included reviews were published since 2010. Thirteen focused on body functions: movement related functions and cardiovascular and respiratory systems. Although nine reviews focused on gait and mobility, considerable overlap of included studies limited the volume of evidence and variability in review quality limited generalisability of findings.

CONCLUSIONS

Research involving adults with CP is growing; however, this overview of reviews found a predominant focus on mobility and gait. Future research, informed by consumer priorities, is needed to address a broader range of key health and participation outcomes.Implications for rehabilitationFitness, mobility, and gait were the most common research topics found in these systematic reviews suggesting a narrow research focus in adults with CP.There are significant gaps in our knowledge to inform clinical messages for practice about broad long-term outcomes of CP and how best to support their activity performance and participation.There is very limited evidence with which to guide and support rehabilitation professionals working in this field.

Do the WHO-ICF personal factors "age" and "sex" impact limited activity and restricted participation category profiles differently between younger and older women and men in multimodal chronic back pain rehabilitation?

PURPOSE

To investigate if the International Classification of Functioning and Health (ICF) context factors "age" and "sex" would impact the disablement and respective improvement with rehabilitation defined with the ICF core set for chronic low back pain (cLBP). Furthermore, associations between limitations/restrictions and measures of body function or quality of life were of interest.

MATERIALS AND METHODS

One thousand five hundred and twelve employed cLBP patients who completed 6 months of outpatient rehabilitation and for whom complete assessments were available before and after rehabilitation. Rehabilitation comprised of progressive resistance training, psychological counseling, and educational sessions. Main outcome measures were the ICF-activity/participation core categories automatically predicted from random forests and utilizing information from the Roland Morris Disability Questionnaire and Pain Disability Index.

RESULTS

Generalized linear-mixed models revealed that upon completion of rehabilitation the presence of a limitation within the ICF activity "walking" significantly decreased with significant between-group differences. The category "doing housework" demonstrated gender-specific differences, and both gender- and age-specific differences were observed for work-related participation categories. There were no meaningful associations between ICF limitation/restriction categories and body function measures (point-biserial/Spearman's correlations).

CONCLUSIONS

The personal factors "age" and "sex" impact some ICF limitation/restriction categories in cLBP; appropriately addressing these personal features could further improve phase III rehabilitation outcome.Implications for rehabilitationConsistent with calls to explore the age and sex/gender influence on health and disease, little is known how these factors affect the disablement of individuals with chronic back pain.The factors "age" and "sex" drive differences in some categories within the ICF activity/restriction categories.If age- and gender-specific features in activities and participation are not appropriately addressed through interventions, rehabilitation outcome may remain suboptimal in cLBP.

Long-term self-reported health and disability after COVID-19 in public employees

BACKGROUND

Although the symptomatology has been assessed in multiple studies among persons recovering from coronavirus disease 2019 (COVID-19), less is known regarding long-term general health and disability. We aimed to assess long-term self-reported disability in public employees after predominantly mild COVID-19 in comparison with individuals who had negative COVID-19 polymerase chain reaction (PCR) test results.

METHODS

Public employees within Region Västra Götaland were offered tests to identify SARS-CoV-2 infection (n = 56,221) and were invited to complete an online survey that included the World Health Organization Disability Assessment Schedule. Questionnaires were sent out between January 26 and March 5, 2021. A total of 14,222 (25.3%) employees responded, of which 10,194 (18%) were included (women n = 8749, 85.8%). Of these, 7185 (70.5%) participants had a negative PCR test result (controls). A total of 1425 (14%) had a positive PCR result and were categorized in the sub-acute phase (4-12 weeks post COVID-19), and 1584 (15.5%) had a positive PCR test and were categorized in the post COVID-19 phase (> 12 weeks).

RESULTS

Fifty-two percent of controls rated disability of varying degrees, versus 73% and 64% of participants in the sub-acute and post COVID-19 phase, respectively. Being "emotionally affected" was the most frequently reported disability in the sub-acute phase, the post COVID-19 phase, as well as in controls. The proportion of participants reporting difficulties for 20-30 days was higher in the sub-acute phase than in the post COVID-19 phase (27.9% vs. 21.8%, p < 0.001) as well as in a comparison between participants in the post COVID-19 phase and controls (21.8% vs 14.2%, p < 0.001). Compared with controls, severe disability was more common in the post COVID-19 phase among both women (15.8% vs. 10.7%,), and men (9.8% vs. 6.8%).

CONCLUSIONS

Disability was present in all groups; however, reported disability was greater in the sub-acute phase than in the post COVID-19 phase. The higher levels of disability reported in the COVID-19 patient population may indicate a persisting need for rehabilitation and recovery. In general, women reported a greater degree of disability than men in the sub-acute and post COVID-19 phases.

Use of the International Classification of Functioning, Disability and Health (ICF) to expand and standardize the assessment of quality-of-life following a stroke: proposal for the use of codes and qualifiers

PURPOSE

Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF).

METHODS

An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 - no impairment to .4 - complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers.

RESULTS

The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations.

CONCLUSIONS

The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health.Implications for rehabilitationProposal for qualifying concepts related to body functions, activity & participation, and environmental factors in a simple, standardized manner.The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors.Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care.The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.

Reproducibility of Assessment Tests Addressing Body Structure and Function and Activity in Older Adults With Dementia: A Systematic Review

OBJECTIVE

The purpose of this study was to analyze the relative and absolute reliability of assessment tests addressing body structure and function and activity in older adults with dementia.

METHODS

Medline, Embase, Web of Science, The Cochrane Library, and Scielo were searched from inception until March 2021. Two independent reviewers performed the selection process based on titles, abstracts, and full text. Reliability studies of assessment tests in older adults with dementia were included. Methodological quality of the studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist. Relative reliability was analyzed using the intraclass correlation coefficient (ICC) interpreted based on Munro classification. Absolute reliability was analyzed using the minimal detectable change (MDC) and standard error of measurement.

RESULTS

Fifteen studies involving a total of 560 older adults with dementia were included. Nineteen assessment tests were identified: 13 addressing body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and 6 addressing activity (walking and mobility). Studies determined test-retest and interrater reliability. Fifteen studies evaluated relative reliability using the ICC, with values ranging from no or small correlation to very high correlations. Ten studies evaluated absolute reliability using the MDC or standard error of measurement or both.

CONCLUSION

Relative reliability of the assessment tests for body structure and function and activity was high to very high based on ICCs, demonstrating good reproducibility. Regarding absolute reliability, the analysis of the MDC values revealed the need for substantial change to determine that a real change had occurred. Future investigations should consider the type of dementia and standardization of verbal encouragement during the assessment.

IMPACT

This review identified the good reproducibility of assessment tests of body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and activity (walking and mobility) domains in older adults with dementia. Clinically important values may differ when older adults with dementia of diverse etiologies are analyzed together and older adults specifically with Alzheimer disease. Identifying the type of dementia, analyzing types of dementia separately, and standardizing verbal commands during the execution of tests is of considerable clinical importance for this population of older adults.

Impact of Environmental Factors on Post-Stroke Disability: An Analytical Cross-Sectional Study

OBJECTIVES

Identify how environmental barriers and facilitators are associated with disability in stroke survivors.

MATERIALS AND METHODS

An analytical, cross-sectional study was conducted involving individuals in the chronic stage of stroke. The dependent variable was disability, which was assessed using the World Health Organization Disability Assessment Schedule (WHODAS-2.0). Environmental factors (independent variable) were evaluated using the Measure of the Quality of the Environment (MQE). Multiple linear regression analysis was performed to estimate the impact of the environment on disability following a stroke.

RESULTS

Seventy-five individuals (mean age: 54.2 + 9.8 years) were analyzed. The most frequent environmental facilitators were related to technology, social networks, and public services. The main barriers were related to the physical environment. Environmental barrier was a predictor of both overall disability [F(1.73) = 4.24; R²=0.06; β = -0.23; t = -2.06; p=0.04] and participation [F(1.73) = 10.45; R²=0.13; β = -0.35; t = -3.23; p = 0.01]. Environmental facilitators were not correlated with disability.

CONCLUSION

Environmental barriers explained 13% of the variation in restrictions to social participation and were also a significant predictor of overall disability. The main barriers were related to the physical environment. Identifying environmental factors related to disability in stroke victims can assist in the planning of guided therapy.

[Innovative concept of aging prevention for modern Russia.]

The article presents an innovative concept for aging prevention of older citizens based on using elements of the International Classification of Functioning, Disability and Health which taking into account the influence of aging processes on changes in health and social adaptation of older citizens. The functional features of the departmental systems of health care and social protection of the population operating in Russia that impede their integration within the framework of providing comprehensive medical and social assistance to citizens of older age groups are analyzed. The biopsychosocial model of functioning and disability has advantages in comparison to another models given possibility of developing a social adaptation and implementation of an integrated systematic approach to the prevention of aging. A set of measures is proposed and justified to improve the efficiency, quality and accessibility of services health care for elderly by restructuring the functional interaction of departmental structures, attraction of resources and potential of non-governmental, public organizations, scientific and educational centers, professional communities and volunteers.

International Classification of Functioning, Disability, and Health augmented by telemedicine and artificial intelligence for assessment of functional disability

The concept of functional disability is aligned with the biopsycho-social model of disability. However, there are reasons why the antiquated measurement of medical impairment continues to be in use. We propose solutions for a fairer process using the International Classification of Functioning, Disability, and Health (ICF) at the level of the medical boards augmented by telemedicine and artificial intelligence (AI). The proposed technologies (Level 1 and Level 2 AI) need to be tried in pilot projects. It will accomplish two goals, the first being the measurement of disability and not merely the impairment. Second, and perhaps more importantly, making the process more transparent in creating a "just" society.

[Application of the ICF in assessing the effectiveness of magnetotherapy in patients with viral pneumonia associated with COVID-19]

The number of patients who have had pneumonia caused by COVID-19 is increasing every month. However, despite the ongoing treatment, the consequences of this disease are possible, which may appear in the short term or after a while. Pneumonia associated by the new coronavirus infection COVID-19 is characterized by the presence of such complications as cough, shortness of breath, fatigue, sleep disturbances, appetite disorders, etc. Often, pneumonia leads to dysfunctions of the respiratory system, higher mental functions, functions of the cardiovascular system and, unfortunately, possible disability. The search and implementation of new methods of physical rehabilitation is an urgent task of modern medicine. Low-frequency magnetotherapy is one of the safest and most commonly recommended treatments for pneumonia. The development of new methods of medical rehabilitation for patients with pneumonia associated with COVID-19, using physical factors such as low-frequency magnetotherapy, laser therapy is one of the leading fields. Magnetotherapy is included in the recommendations of the Ministry of Health of the Russian Federation for the purpose of anti-inflammatory, decongestant, reparative-regenerative action; improvement of microcirculation, acceleration of the resorption of infiltrative changes (Temporary methodological recommendations «Medical rehabilitation for a new coronavirus infection (COVID-19)», version 2 of 31.07.2020). International rehabilitation practice of using the International Classification of Functioning, Disability and Health (ICF) advises to use it as a tool that allows you to objectively determine the state of health of patients, determine the prognosis of impaired functions and evaluate the effectiveness of ongoing rehabilitation measures.

OBJECTIVE

To assess the effectiveness of the use of low-frequency magnetotherapy in the complex medical rehabilitation of patients who have had pneumonia in the phase of convalescence according to the International Classification of Functioning, Disability and Health.

MATERIAL AND METHODS

The study included 200 patients who had suffered from pneumonia associating by COVID-19 and whose average age was 54.3±5.8 years. 1^st (main) group (n=100), against the background of standard therapy on the 16th day after discharge from the hospital, received low-frequency magnetotherapy on the ALMAG-02 apparatus («Elamed», Russia) daily for 10-20 minutes, a course of 15 procedures. The 2^nd group(control) included 100 patients who underwent low-frequency placebo-magnetotherapy on the ALMAG-02 apparatus («Elamed», Russia). In order to assess the dynamics of clinical and laboratory data and the effectiveness of treatment, control methods were used in this study in accordance with the Temporary Clinical Recommendations of the Ministry of Health of the Russian Federation. Each patient was evaluated for the severity of the initial manifestations of respiratory failure using the mMRC scale (Degree of Shortness of breath) and the Borg scale, and the quality of life of patients was assessed on the EQ-5D scale. Also, at the time of inclusion in the study and during the control examination after the completion of prospective follow-up, the Individual profile of patients was determined in accordance with the international classification of functioning (ICF) with the data of the «Individual Registration Card of the clinical trial participant».

RESULTS AND DISCUSSION

In 43% (43 people) of patients of the 1th group, an improvement in respiration functions was noted with lung auscultation and with spirometry, an increase in the vital capacity of the lungs by 28.2% (p=0.0021), an increase in chest excursion by 53.1% (p=0.0019) a decrease in the level of shortness of breath by 50% and Borg by 33.3% (p=0.0016). According to the data of the quality of life questionnaire (EQ-5D), the patients of the main group showed an improvement in the quality of life by 23% (p=0.0019). In the 1^st group of patients, there was a decrease in moderate disorders in the domains «b152 - emotion functions» in 45% of patients; «b440 - respiratory functions» in 87% of patients; «b455 - exercise tolerance functions» in 74% of patients; «b134 - sleep functions» in 30% of patients; «d450 - walking» in 100% of patients. In the general blood analysis of patients of the 1^st (main) group, there was a relief of leukocytosis, normalization of the erythrocyte sedimentation rate (ESR). In the 1^st group a decrease in the duration of being on the sick list was observed for 3.4±0.2 days.

CONCLUSION

The inclusion of low-frequency magnetic therapy in the complex rehabilitation of patients who have suffered pneumonia associated by COVID-19 contributes to improving the function of external respiration of patients, regression of residual infiltrative changes in the lungs after pneumonia, relief of residual manifestations of the inflammatory process, reducing the duration of the rehabilitation period and the duration of disability, improving the general well-being of patients, increasing tolerance to physical exertion, normalization of the psycho-emotional state and, as a result,, restoring activity in everyday life and improving the quality of life of patients. The researchers did not register any side effects and side effects of magnetic therapy from ALMAG-02 apparatus (Elamed, Russia).

Limitations in functioning in climacteric syndrome: a systematic literature review using the ICF

INTRODUCTION

This study is the first of four preparatory studies in the process to develop an International Classification of Functioning, Disability and Health (ICF) Core Set for climacteric syndrome. The aim was to identify perimenopausal and postmenopausal limitations in functioning reported in the scientific literature.

METHODS

A systematic literature review was performed on MEDLINE, PsycInfo, Embase and CINAHL including publications from 2010 to 2020. Meaningful concepts were identified from the included studies and linked to the ICF using standardized linking rules.

RESULTS

From the 6935 unique publications found, 300 articles were randomly selected for abstract screening and 48 studies met the inclusion criteria. From these, 1836 meaningful concepts were identified and linked to 158 different ICF categories. Most of them could be linked to the ICF chapter 'Body Functions'. Emotional, sleep, energy and drive as well as thermoregulatory functions and sensation of pain were addressed in >80% of all publications.

CONCLUSION

Climacteric syndrome involves all four components of the ICF, but the focus of scientific research lies on limitations in body functioning. Limitations in body structures, activities and participation and environmental factors were less frequently assessed. The ICF is a valuable tool to describe the multidimensional phenotype of climacteric syndrome.

Assessment of functioning and disability in patients with low back pain - the low back pain assessment tool. Part 1: development

PURPOSE

To present the process used to develop the low back pain (LBP) assessment tool including evaluation of the initial content validity of the tool.

METHODS

The development process comprised the elements: definition of construct and content, literature search, item generation, needs assessment, piloting, adaptations, design, and technical production. The LBP assessment tool was developed to assess the construct "functioning and disability" as defined by the International Classification of Functioning, Disability and Health (ICF). Involvement of patients and health professionals was essential.

RESULTS

The elements were collapsed into five steps. In total, 18 patients and 12 health professionals contributed to the content and the design of the tool. The LBP assessment tool covered all ICF components shared among 63 ICF categories.

CONCLUSIONS

This study presents the process used to develop the LBP assessment tool, which is the first tool to address all ICF components and integrate biopsychosocial perspectives provided by patients and health professionals in the same tool. Initial evaluation of content validity showed adequate reflection of the construct "functioning and disability". Further work on the way will evaluate comprehensiveness, acceptability, and degree of implementation of the LBP assessment tool to strengthen its use for clinical practice.Implications for RehabilitationA biopsychosocial and patients-centred approach is a strong foundation for identifying the many relevant aspects related to low back pain (LBP).Responding to a lack of tools to support a biopsychosocial and patients-centred approach the LBP assessment tool was developed using a robust, multi-step process with involvement of patients and health professionals.The LBP assessment tool is a strong candidate for a user-friendly tool to facilitate use of the International Classification of Functioning, Disability and Health in routine clinical practice.

Assessment of functioning and disability in patients with low back pain - the low back pain assessment tool. Part 2: field-testing

PURPOSE

To evaluate comprehensiveness and acceptability of the patient-reported outcome instrument (PRO-LBP) and the clinician-reported outcome instrument (ClinRO-LBP) included in the low back pain (LBP) assessment tool. Second, to assess degree of implementation after three months.

METHODS

Feasibility-testing, training of health professionals, field-testing, and a feedback meeting was undertaken. Field-testing provided data to evaluate comprehensiveness, acceptability, and degree of implementation.

RESULTS

Feasibility-testing and training of health professionals revealed that the LBP assessment tool was usable and ready for field-testing. In total, 152 patients participated in the field-testing of whom 95% considered the PRO-LBP comprehensive and 59% found it acceptable. Health professionals found the ClinRO-LBP comprehensive and acceptable. The feedback meeting revealed that the LBP assessment tool broadened the health professionals' approach to functioning and facilitated a consultation based on the patient perspective. The degree of implementation reached 79%.

CONCLUSIONS

The PRO-LBP and the ClinRO-LBP covered key concepts of LBP and were found acceptable by patients and health professionals. Despite the reduced degree of implementation after three months the LBP assessment tool allowed the health professionals to apply a biopsychosocial and patient-centred approach. Future research should investigate whether the LBP assessment can enhance patient-centred care.Implications for rehabilitationThe low back pain (LBP) assessment tool is the first evidence-based tangible tool to cover biopsychosocial aspects related to LBP as defined by the International Classification of Functioning, Disability and Health (ICF).The LBP assessment tool allowed health professionals to apply a biopsychosocial and patients-centred approach and has the potential to be used in rehabilitation planning.Awareness to continuous facilitation and training of health professionals is important to facilitate and maintain implementation of new procedures into routine clinical practice.

An evaluation of participation restrictions and associated factors via the ICF-CY framework in children with acute lymphoblastic leukemia receiving maintenance chemotherapy

Our aim was to determine impairments in physical functions, activity limitations, and participation restrictions with the International Classification of Functioning, Disability and Health version for Children and Youth (ICF-CY) framework in children with acute lymphoblastic leukemia (ALL) receiving treatment. Physical functions were assessed in terms of pain level, fatigue level, handgrip strength, and motor proficiency. Fine motor activities and lower extremity performance were assessed to determine activity limitations. Participation was assessed with a patient-reported questionnaire. Thirty children with ALL (mean age: 8.45 ± 3.33 years) were included. Pain and fatigue level were mild. Poor handgrip strength was found; their mean handgrip strength was 60% of the normative. Fifty-six percent of the children had below-average motor performance. Participation scores were considerably high, except for sport and physical functioning sub-score. Participation level was positively associated with bilateral coordination and duration after diagnosis, while negatively correlated with pain and fatigue level (p ˂ 0.05).Conclusion: The ICF-CY-based evaluation was useful to understand children's limitations in everyday life. Children with ALL need supportive interventions during treatments in terms of physical functioning and participation in activities. Children with ALL with higher pain and fatigue, poor bilateral coordination, and who were in earlier period after diagnosis had higher risk for participation restriction. What is Known: • Children with ALL had physical functioning limitations on treatments. • Participation restrictions were described in children with ALL off treatment. What is New: • The ICY-CY-based health and functioning evaluation allows health care professionals to globally determine limitations of everyday life in children with ALL on treatment. • Impairments in physical functions, pain severity, fatigue severity, and duration after diagnosis are associated with participation to everyday life in children with ALL on treatment.

Twelve tips for teaching the International Classification of Functioning, Disability and Health with a view to enhancing a biopsychosocial approach to care

The World Health Organization International Classification of Functioning, Disability and Health has the power to shape professional behaviour and positively influence all aspects of health and social care practice. The visual depiction of the ICF framework belies the complexity of this multifaceted classification and coding system which students and practitioners can find challenging to grasp. This guide offers twelve integrated practical tips to help health and social care educators embed the ICF throughout the curriculum with a view to supporting student learning and ultimately interprofessional and inclusive practice.

Development International Classification of Functioning, Disability and Health Core Set for Post Total Knee Replacement Rehabilitation Program: Delphi-Based Consensus Study in Taiwan

Osteoarthritis is one of the leading causes of disability. Total knee arthroplasty (TKA) is a surgical intervention for patients with severe osteoarthritis. Post TKA rehabilitation is crucial for improving patient's quality of life. However, traditional rehabilitation has only focused on physical function; a systemic analysis of other dimensions such as social participation and environmental factors of post TKA rehabilitation is lacking. The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) to create a comprehensive rehabilitation program for patients with osteoarthritis post TKA. Before the Delphi-based consensus process, a literature review process was performed for related ICF categories selection. We used a three-round Delphi-based consensus among 20 physical therapists with orthopedic rehabilitation expertise in a university-based hospital. A five-point Likert scale was used to rate the importance of each item. The consensus of ratings was analyzed using Spearman's rho and semi-interquartile range indices. The ICF core set for post TKA rehabilitation was determined based on a high level of consensus and a mean score of ≥4.0 in the third Delphi-based consensus round. The ICF core set comprised 32 categories, with 13 regarding body function, four regarding body structures, nine regarding activities and participation, four regarding environmental factors, and two regarding personal factors. Our ICF core set for post TKA rehabilitation can provide information on effective rehabilitation strategies and goal setting for patients post TKA. However, further validation and feasibility assessments are warranted.

Challenges of Guidelines: A Look at the Systematic Review of Clinical Guidelines Related to the Care of Individuals With Cerebral Palsy

This essay is an invited commentary on the report "Systematic Review of Clinical Guidelines Related to Care of Individuals With Cerebral Palsy as Part of the World Health Organization Efforts to Develop a Global Package of Interventions for Rehabilitation" published in this journal. As a blinded reviewer of the original and revised versions of this interesting article, I was stimulated to reflect on several ideas about "clinical guidelines" and to take the opportunity to share concerns I have long held and that this article identified. Having said that, the thoughts expressed are mine alone and should not be ascribed to the authors of the article that provoked them. The case I offer is that guidelines may in some ways risk being outdated, insofar as they are crafted based on what we already know from research done in "earlier" times and with different conceptual frameworks than we now apply. I use the example of 20th century concerns about spasticity to illustrate my argument. I also suggest that they may be too prescriptive and restrictive. Instead, I raise for consideration the idea that we should turn the guidelines process on its head and use best available valid data to build toward contextualized problem-focused approaches to issues that are relevant to the individuals for whom they are meant to be useful- in this case, individuals with cerebral palsy, their families, and the service providers who work with them. It is my hope that these ideas stimulate discussion and reflection.

Validation of the Brief International Classification of Functioning, Disability and Health (ICF) core set for hearing loss: an international multicentre study

OBJECTIVE

Hearing loss (HL) affects the everyday functioning of millions of people worldwide. The Brief International Classification of Functioning Disability and Health (ICF) core sets for HL was developed to meet the complex health care needs of adults with HL. Because the brief core set for HL has not yet been validated internationally, this study aimed to investigate its validity from an international perspective.

DESIGN

A cross-sectional validation study based on data from structured interviews with adults with HL.

STUDY SAMPLE

Participants (n = 571) from India, South Africa, Sweden and the US were included.

RESULTS

A six-factor solution explained 71% of the variance, focussing on issues related to communication, the social environment, participation in society, health care services, support, relationships and emotions (α = 0.915). Three ICF categories demonstrated low reliability - temperament and personality functions, seeing functions and school education.

CONCLUSION

The Brief ICF core set for HL is valid for adults with HL internationally. However, to further increase its international validity, we recommend adding the categories d920 recreation and leisure and replacing d850 school education with the more inclusive block, d810-d839 education.

Scale-Banking for Patient Reported Outcome Measures (PROMs) Measuring Functioning in Rheumatoid Arthritis: A Daily Activities Metric

OBJECTIVE

Functioning is an important outcome for rheumatoid arthritis (RA) management. Heterogeneity of respective patient-reported outcome measures (PROMs) challenges direct comparisons between their results. This study aimed to standardize reporting of such PROMs measuring functioning in RA to facilitate comparability.

METHODS

Common Item Non-Equivalent Groups Design (NEAT) with the Health Assessment Questionnaire (HAQ) as a common scale across data sets from various countries (incl. UK, Turkey and Germany) to establish a common metric. Other PROMs included are the Physical Function items of the Multidimensional Health Assessment Questionnaire (MDHAQ), Disabilities of Arm, Shoulder and Hand (DASH), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), World Health Organization Disability Assessment Schedule Version 2.0 (WHODAS 2.0), and four short forms (20, 10, 6, and 4 physical function items) from the Patient-Reported Outcomes Measurement Information System (PROMIS). As the HAQ includes mobility, self-care and domestic life items, this study focuses on these three domains. PROMs were described using Standard Error of Measurement (SEM) and Smallest Detectable Difference (SDD). Rasch Measurement model was used to create the common metric.

RESULTS

Range of SEM is 0.2 (MDHAQ) to 7.4 (SF36-PF). SDD revealed a range from 9.7 % (WOMAC-RAT) to 33.5 % (WHODAS-PF). PROMs co-calibration revealed fit to the Rasch measurement model. A transformation table was developed to allow exchange between PROMs scores.

DISCUSSION

Scores between the Daily Activity PROMs commonly used in RA can now be compared. Factors such as SEM and SDD help determine choice of PROM in clinical practice and research.

Effectiveness of a self-rehabilitation program to improve upper-extremity function after stroke in developing countries: A randomized controlled trial

BACKGROUND

About two-thirds of stroke patients present long-term upper-limb impairment and limitations of activity, which constitutes a challenge in rehabilitation. This situation is particularly true in developing countries, where there is a need for inexpensive rehabilitation solutions.

OBJECTIVE

This study assessed the effectiveness of a self-rehabilitation program including uni- or bi-manual functional exercises for improving upper-limb function after stroke with respect to the context in Benin, West Africa.

METHODS

In this single-blind randomized controlled trial, chronic stroke individuals (>6 months post-stroke) performed a supervised home-based self-rehabilitation program for 8 weeks (intervention group); the control group did not receive any treatment. Participants were assessed before treatment (T0), at the end of treatment (T1) and 8 weeks after the end of treatment (T2). The primary outcome was the manual ability of the upper limb, assessed with ABILHAND-Stroke Benin. Secondary outcomes were grip force, motor impairment (Fugl-Meyer Assessment - Upper Extremity), gross manual ability (Box and Block test, Wolf Motor Function test) and quality of life (WHOQOL-26).

RESULTS

We included 28 individuals in the intervention group and 31 in the control group. Adherence to the program was 83%. After 8 weeks of self-rehabilitation, individuals in the intervention group showed significantly improved manual ability and grip force as compared with the control group (P<0.001), with effect size 0.75 and 0.24, respectively. In the intervention group, the difference in average scores was 10% between T0 and T1 and between T0 and T2. Subscores of physical and psychological quality of life were also significantly improved in the intervention group. The other variables remained unchanged.

CONCLUSIONS

A self-rehabilitation program was effective in improving manual ability, grip force and quality of life in individuals with stroke in Benin. More studies are needed to confirm these results in different contexts.

Postural control in Down syndrome and relationships with the dimensions of the International Classification of Functioning, Disability and Health - a systematic review

PURPOSE

Postural control assessment in children with Down syndrome (DS) may contribute to understanding the impact of impairments in Body Structures and Functions on Activities and Participation, providing a biopsychosocial approach to support clinical practice. The present study aimed to systematically review the literature addressing postural control in children and adolescents with Down syndrome, with a focus in the interactions among the components of the International Classification of Functioning (ICF).

METHODS

We conducted a tailored search in PubMed; Web of Science, SCOPUS and Science Direct databases.

RESULTS

We identified 20 full-texts that fulfilled the inclusion and exclusion criteria. Children and adolescents with DS showed lower postural stability across studies. The ICF components most commonly addressed were Body Structure and Function and Activity. Although the studies measured these components, they did not analyze the interrelationships of components when describing the determinants of postural control in this population.

CONCLUSIONS

Overall, the studies indicate that children and adolescents with DS show decreased postural stability and greater vulnerability to sensory changes than their typical peers. There is a lack of studies using the biopsychosocial approach. Only few studies have related the activity level of the participants with the variables of postural control. None of them addressed components of Participation and Environmental Factors. The poor methodological quality of the included studies limits the translation of results to clinical practice. Further studies addressing children with disabilities, such as DS, should utilize the ICF framework, thus providing a biopsychosocial approach of health in these individuals.IMPLICATIONS FOR REHABILITATIONChildren with Down syndrome show decreased postural stability and greater vulnerability to sensory changes than their typical peers.In clinical practice, when assessing postural control of individuals with DS, rehabilitation professionals should not only address components of Body Structures and Functions, but also investigate their impact on Activity and Participation.Training of postural control should address strategies that include natural environments and participation situations.The biopsychosocial approach provided by the ICF framework should be implemented in clinical practice.

Linking the patient experience of foot involvement related to psoriatic arthritis to the International Classification of Functioning, Disability and Health

Objective

The aim was to categorize the patient experience of PsA-related foot involvement by linking it to the International Classification of Functioning, Disability and Health (ICF) framework.

Methods

Concepts, obtained from a previous qualitative investigation of people with PsA and health professionals into their perspective of PsA-related foot involvement, were linked to the full version of the ICF classification. Concepts were linked to the most appropriate ICF category using established linking rules, which enable a systematic and standardized linking process. All concepts were linked independently to the ICF by two investigators, followed by a third investigator for adjudication. The professional backgrounds of the investigators included occupational therapy and podiatry.

Results

More than 100 distinct ICF categories were linked to the interview concepts. The most represented ICF category was body functions (35%), followed by environmental factors (31%), activities and participation (19%) and body structure (15%). Concepts that could not be linked to the ICF were related to coping, aspects of time and knowledge. Health professionals identified a greater proportion of body functions and fewer activity and participation categories compared with patients, indicating a possible mismatch of key concerns. Interdisciplinary group analysis demonstrated merit.

Conclusion

A list of ICF categories was generated, defining aspects of functioning important and relevant to the impact of PsA-related foot involvement. Despite the localized anatomical focus of this study, the effect of foot problems in PsA was linked to all components of the ICF, confirming the profound impact on functioning and daily life.

Parental perspectives of functioning in their children with autism spectrum disorder: A global scoping review

LAY ABSTRACT

No paper to date has summarized parents' views on the functional challenges and/or strengths of their children with autism spectrum disorder. In this review we set out to perform a scoping review aiming to (a) find and compare existing research from around the globe on parental perception of functioning and (b) summarize results from these papers using the International Classification of Functioning Disability and Health-Child and Youth version framework. Since we know that the place and circumstances we live in can have a significant influence on our functioning in daily life, we were specifically interested in comparing perceptions from high-income countries and low-/middle-income countries. Two researchers conducted a comprehensive search of English studies published between 1990 and June 2016. Papers were summarized and key findings were linked to International Classification of Functioning Disability and Health-Child and Youth categories. Thirty-three studies were identified, of which most were conducted in high-income countries (n = 25/33, 76%) with only six studies in low/middle-income countries (n = 6/33, 18%). Two studies compared views from low/middle-income and high-income countries (n = 2/33, 6%). Functional themes from high-income countries included a range across the International Classification of Functioning Disability and Health-Child and Youth framework while functional themes from low-/middle-income countries were mostly focused on environmental factors. It was difficult to directly compare studies from low/middle-income and high-income countries because they investigated and discussed such different parts of functioning. We suggest that future research should use an approach that will allow researchers to directly compare functional categories in order to get a more accurate impression of the impact of context on functioning.

Goal analysis in patients with limb spasticity treated with incobotulinumtoxinA in the TOWER study

PURPOSE

To map spasticity-related goals using the International Classification of Functioning, Disability and Health (ICF) linking rules, and review goal syntax to direct future goal setting.

MATERIALS AND METHODS

1633 treatment goals, set during the TOWER study, were linked to the ICF framework and EQ-5D domains. Goals were mapped independently by two investigators with expertise in ICF linking rules.

RESULTS

In total, 1630 (99.8%) goals could be mapped to the ICF (inter-rater agreement on the main ICF category 96.1%). Most goals (80.2%) were mapped to a single ICF category and were related to activities/participation (54.9%). 170 (10.4%) goals were related to general tasks and activities, such as positioning, stretching, and strengthening. In total, 1072 goals (65.6%) mapped to the EQ-5D domains (inter-rater agreement 90.8%). Analysis of the goal syntax highlighted the need to include a verb in patient-centered goals to direct active behavior.

CONCLUSIONS

The ICF offers a broad framework for setting patient-centered, easily understandable goals for patients with spasticity, including goals related to (guided) self-management activities. This analysis sheds new light on patient needs and could direct future goal-driven botulinum toxin spasticity treatment focused on enabling patients to better manage activity limitations imposed by their body function impairments.Trial registration: NCT01603459 registered with ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT01603459).Implications for RehabilitationThe ICF offers a broad framework for setting patient-centered, easily understandable goals for patients with spasticity.ICF domains that include general tasks and demands can be used to establish goals relating to (guided) self-management of spasticity.An ICF-based goal-setting framework may increase the comparability of clinical data across studies.

Parents' Assessment of Disability in Their Children With Down Syndrome

Aim:

To describe a population of children with Down syndrome and evaluate their parents’ assessment of disability.

Methods:

Medical records of a population of 80 children with Down syndrome aged 5 to 17 years were analyzed for genetic background and associated diagnoses. And 27 parents to their children agreed to assess disability by employing a set of 26 International Classification of Functioning, Disability and Health body function (b) codes and activity and participation (d) codes. Clinical data were gathered and analysis of parents’ assessment of disability using psychometric and Rasch analysis was performed.

Results:

Clinical data on 27 children assessed by their parents and 53 children not assessed had identical associated diagnoses. The 26 International Classification of Functioning, Disability and Health codes and qualifiers had a mean score of 2.67 (range 1.26-4.11) and corrected code-total correlations mean of 0.55 (range −1.17 to 0.82). Rasch analysis showed proper code MNSQ infit and outfit values with mean 1.03 and 1.06.

Conclusion:

Clinical data on 27 children assessed were similar to 53 children that were not evaluated. Parents’ assessment of the 27 children showed good psychometric and Rasch analysis properties. Similar results might be expected in the total population of 80 children.

Differences in Rehabilitation Needs after Stroke: A Similarity Analysis on the ICF Core Set for Stroke

Background: Successful rehabilitation is associated with physical, psychological, environmental, social, and personal factors based on the International Classification of Functioning, Disability and Health (ICF) framework. The influence of age has been suggested as crucial personal factors that may affect rehabilitation needs in post-stroke survivors. The aim of this study was to investigate the qualifiers of the ICF core set for stroke to detect differences in rehabilitation needs and goals between older (O, >65 years old) and younger (Y, ≤65 years old,) post-stroke individuals. Materials and methods: In this observational study, the comprehensive core set for stroke was filled during the rehabilitation period. Patient information was obtained using disability scales was translated into certain ICF categories using linking rules. Frequency, similarity, and linear regression analyses were performed for ICF qualifier profiles among Y and O patients. Results: Forty-eight ICF variables were significantly different between Y (n = 35, 46.17 ± 11.27 years old) and O (n = 35, 76.43 ± 6.77 years old) patients. Frequency analysis showed that activity of daily living and basic needs were more prevalent in O patients, whereas regaining of social role and social life were more prevalent in Y patients. The average Jaccard Index result (similarity analysis) was more homogeneous in O than in Y patients. Conclusions: ICF qualifiers are useful to design patient-centered care. Y patients have more heterogeneous needs and require more personalized program than O patients.

Older Adults' Perspectives on Fall Risk: Linking Results to the ICF

The aim of this study is to establish the perceptions of older adults in the South African context regarding falls and to link these perceptions to the International Classification of Functioning, Disability and Health (ICF). Data were analyzed by a summative, conventional, and deductive approach. The analysis indicated that the Body Function and Structure codes were most frequently used during the discussions, but the contextual analysis of the most frequently used categories indicated that Activities and Participation were the participants' main focus. The main focus of fall assessment in older adults should therefore be on Activities and Participation, as this can assist them in decreasing their fall risk, irrespective of whether they had a previous fall. Contrary to the majority of current literature on falls, this study included both participants who had fallen and those who hadn't, resulting in richer data and themes gathered from the focus groups.

Influence of peer-based rehabilitation interventions for improving mobility and participation among adults with mobility disabilities: a systematic review

Purpose: The prevalence of mobility disability reaches up to 20.5% among older adults. Mobility is a key factor of participation, thus rehabilitation interventions often aim to improve mobility and participation. Peer-based approaches to intervention delivery have become increasingly common. This study aims to identify peer-based rehabilitation interventions and summarize their influence on mobility and participation among individuals with mobility disabilities.Method: A systematic review was conducted using CINALH, EMBASE, MEDLINE, and PsycINFO. Articles that evaluated peer-based rehabilitation interventions for individuals with a mobility disability and assessed mobility or participation, as defined in the International Classification of Functioning, Disability and Health framework, were included. Study quality was assessed using the Physical Therapy Evidence Database and the Quality Assessment Tool for Before-After Studies With No Control Group.Results: Thirteen peer-based studies were identified. Six peer-led studies evaluated participation and two evaluated mobility. Seven professional-led studies evaluated participation and six evaluated mobility. Randomized controlled trials had fair to high quality. The quality of pre-post studies ranged from poor to good.Conclusion: Peer-based interventions should not be overlooked as a potential intervention strategy, but further research is needed to establish their influence on mobility and participation.Implications for rehabilitationPeers offer a unique model of intervention that could support clinicians in their effort to improve mobility and participation outcomes for individuals with disabilities.There are currently two main models of peer-based interventions in rehabilitation: professional-led (peers assist professionals to facilitate the intervention) and peer-led interventions (peers facilitate the intervention).Both professional-led and peer-led models of intervention could be helpful in facilitating participation and in increasing mobility.

A qualitative study of persons with persistent postconcussion symptoms and clinicians with concussion expertise to inform the development of a concussion-specific questionnaire

PURPOSE

To explore the experiences of adults with persistent postconcussion symptoms and clinicians to inform the development of a concussion-specific questionnaire.

METHODS

Using a qualitative descriptive design, we conducted 10 focus groups with persons with persistent post-concussion symptoms (n = 35; female 66%; age range 19.0-65.1 years) and semi-structured interviews with clinicians with concussion expertise (n = 16; female 81%). Thematic analysis was used to identify themes within their narratives. The International Classification of Functioning, Disability and Health (ICF) provided a standardized language for coding.

RESULTS

Three overarching themes emerged from the data: Functioning, Environmental and Personal Factors, and Capacity. Functioning mapped closely onto Activities and Participation within the ICF. Contextual factors, both Environmental and Personal, had a significant influence on functioning following concussion. Capacity was a unique finding that described how long a person is able to engage in a task before the onset or worsening of symptoms.

CONCLUSIONS

Capacity is fundamental to measuring limitations in functioning based on symptom threshold and time to recovery. The impact of contextual factors on functioning needs to be considered on a continuum from barrier to facilitator. These findings provide the basis for the development of a concussion-specific questionnaire.Implications for RehabilitationClinicians should explore with their patients limitations across all areas of functioning.Clinicians should explore and address support and relationships, attitudes of others, access to affordable and high-quality healthcare, coping strategies, and a patient's own knowledge of concussion as these influence functioning.Current guidelines recommend a symptom-based approach to concussion management, whereas persons with concussion emphasize the importance of measuring functional capacity.Capacity is defined as the length of time one can perform a task before symptom onset, primarily fatigue.Currently, no concussion-specific measure of functioning exists.

Knowledge translation strategies to support service providers' implementation of the "F-words in Childhood Disability"

Purpose: Service providers are adopting the "F-words" in practice as a strengths-based approach to childhood disability. This study aimed to gain insight into service providers' uses of the "F-words", associated barriers, and knowledge translation strategies needed to support implementation.Methods: Service providers were invited to participate in an interview after completing an online survey on their clinical implementation of the "F-words". Content analysis provided insight into use of the "F-words" and perceived barriers; and to identify knowledge translation strategies to facilitate implementation.Results: Twenty-one service providers from nine countries participated in interviews. Applications of the "F-words" included its use as a conceptual framework, directly in practice, and in teaching/training. Barriers included conflicting attitudes, insufficient funding, language, and misalignment with organizational/government priorities. To support the adoption of the "F-words", participants recommended knowledge translation strategies including local opinion leaders, linkage and exchange, educational outreach and meetings, and distribution of educational materials.Conclusions: Understanding uses, barriers to use, and knowledge translation strategies will inform future directions to move the "F-words" into practice. A critical step in bridging the research-to-practice gap and encouraging more widespread adoption requires collaboration with service providers to tailor knowledge translation strategies to fit the local context.Implications for RehabilitationService providers around the world are interested in the ICF-based "F-words" and are adopting them in clinical practice to support a holistic, strengths-based approach to childhood disability.While there is considerable uptake of the "F-words", service providers have experienced barriers including conflicting attitudes of families and colleagues, insufficient funding, lack of translations, and misalignment with organizational and government priorities.To further support implementation and overcome perceived barriers, service providers recommended using four knowledge translation strategies: (i) local opinion leaders; (ii) linkage and exchange; (iii) educational outreach/meetings; and (iv) the distribution of educational materials.Service providers and researchers must partner together to tailor knowledge translation strategies to the local context in order to address the needs and priorities of service providers' specific settings and bridge the gap between research evidence and practice.

Supervised teaching and feedback improve physiotherapists' reporting of the International Classification of Functioning, Disability and Health in physiotherapeutic electronic patient records: A proof-of-concept randomized controlled trial

RATIONALE, AIMS, AND OBJECTIVES

The International Classification of Functioning, Disability and Health (ICF) is a landmark for physiotherapy to describe the full spectrum of human functioning, but ICF patient record completion could improve. In this study, we examine the effect of supervised teaching and personalized feedback on physiotherapists' completion and reporting of ICF in electronic patient records.

METHOD

In this proof-of-concept randomized controlled trial, the intervention group (10 physiotherapists) received supervised teaching and four rounds of personalized feedback on reporting of ICF components in electronic patient records. In the intervention group, review on patient record completion (n = 670 records) was performed at baseline, after teaching, after each of four feedback rounds, and at long-term follow-up. In the control group (five physiotherapists), which received no supervised teaching nor personalized feedback, review (n = 140 records) was performed at baseline, after the third feedback round of the intervention group, and at follow-up.

RESULTS

After the third round of feedback (95% vs 72% completion; β, 2.68; 95% CI, 0.62-4.74), patient record completion was significantly higher in the intervention group. This was also true for following ICF components: "activity" (93% versus 64% completion; β, 3.03; 95% CI, 1.52-4.54), "participation" (50% versus 14% completion; β, 3.67; 95% CI, 1.79-5.55), and "personal factors" (35% versus 20% completion; β, 2.10; 95% CI, 0.63-3.57). These statistically significant and clinically relevant effects persisted at long-term follow-up. For "environmental factors," effects after the third round of feedback (75% vs 30% completion; β, 1.88; 95% CI, 0.63-3.13) disappeared at follow-up. Reporting of "body functions and structures" improved similarly across groups.

CONCLUSIONS

Supervised teaching and personalized feedback are active ingredients of an intervention to improve reporting of ICF components in physiotherapeutic patient records.

Embedding the International Classification of Functioning, Disability and Health in Health Professions Curricula to Enable Interprofessional Education and Collaborative Practice

The World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) is a comprehensive and highly adaptable framework that provides a universal language and shared health concepts to articulate human functioning across the lifespan and from individual to population health settings. It provides a global, biopsychosocial, and holistic structure for conceptualising the human experience of health and health service provision. Consequently, the ICF framework offers hope for a universal map for health service providers that bridges professional, cultural, economic, and geographical variations. While the use of the ICF is typically mandated by health professions accreditation bodies, integration of the ICF in medical and health professional education programmes has been slow. In addition, its potential for scaffolding interprofessional education for collaborative practice has not been maximised. In this Perspective paper, we draw on our extensive experience in developing curricula and teaching within a range of health professions programmes (medicine, occupational therapy, physiotherapy, and speech-language pathology) to provide advice on conceptual, theoretical, and practical dimensions of embedding the ICF framework within curricula to support interprofessional education and collaborative practice.

Development of a validated Chinese version of the inflammatory bowel disease disability index

OBJECTIVE

The inflammatory bowel disease disability index (IBD-DI) has been used to evaluate functional status for patients with inflammatory bowel diseases (IBD). The study aimed to develop a reliable Chinese version of IBD-DI (C-IBD-DI).

METHODS

Consecutive patients with IBD and healthy controls were recruited from June 2016 to July 2017 in the First Affiliated Hospital, College of Medicine, Zhejiang University (Hangzhou, Zhejiang Province, China) to complete an inflammatory bowel disease questionnaire-32 (IBDQ-32), Hamilton's anxiety rating scale (HAMA) and Hamilton's depression rating scale-24 items (HAMD-24). The validation process included item reduction, reliability and validity tests.

RESULTS

Altogether 122 patients with IBD completed the validation process. Factor analysis reduced the C-IBD-DI to 13 items. Cronbach's α coefficient was 0.90. The C-IBD-DI scores were correlated with IBDQ-32 score (r = -0.79, P < 0.001), HAMA (r = 0.78, P < 0.001) and HAMD-24 (r = 0.81, P < 0.001). The total score of C-IBD-DI was significantly higher in patients with active IBD than in those in remission. The intraclass correlation coefficient was 0.83 in the stable IBD group, representing a good test-retest reliability. Those with improved disease activity had a significantly lower C-IBD-DI score at the follow-up visit than at baseline. Patients with IBD had worse disability levels and quality of life than the controls, and were more likely to be anxious and depressed, especially those with active IBD.

CONCLUSIONS

The validated C-IBD-DI comprising 13 questions has highly acceptable reliability and validity. Multicenter studies including large sample sizes are needed to further confirm our results.

The relationship between stigma and a rehabilitation framework [international classification of functioning, disability and health (ICF)]: three case studies of women living with HIV in Lusaka, Zambia

PURPOSE

To explore how the International Classification of Functioning, Disability and Health, a rehabilitation framework, can provide a holistic understanding of stigma experiences of three women living with human immunodeficiency virus in Lusaka, Zambia.

METHODS

A secondary analysis of three cases by drawing on interview transcripts collected as part of a larger longitudinal study with eighteen women living with the virus. The interview tool used the rehabilitation framework to ask questions about the impact of the virus on the body, daily activities, social participation and the future. Vignettes were produced for each of the eighteen women including information on stigma and the rehabilitation framework. Three case studies were developed from women who provided comprehensive accounts of stigma and the International Classification of Functioning, Disability and Health.

RESULTS

Stigma experiences aligned well with three dimensions of the International Classification of Functioning, Disability and Health: participation restrictions, environmental and personal factors. These domains were used to understand stigma in three forms (i.e. enacted, self and structural stigma) as experienced by these women.

CONCLUSIONS

More research is needed to ascertain how stigma and rehabilitation are related in other environments and populations and to explore how to mitigate stigma within the rehabilitation context.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals deal with aspects of stigma and discrimination in their clinical work and this analysis offers a way to consider HIV-related stigma within rehabilitation in an organized and theoretically-informed way.The insights from this study are important for the field of HIV and for advancing understanding of the complexities of stigma in the context of rehabilitation more broadly.This analysis offers guidance to rehabilitation providers about the nuanced and multi-faceted ways that stigma can occur in the context of rehabilitation, including within their own clinical practice.

Content Comparison of Aquatic Therapy Outcome Measures for Children with Neuromuscular and Neurodevelopmental Disorders Using the International Classification of Functioning, Disability, and Health

Currently, aquatic exercise is among the most common physical activity modalities for children with neuromuscular and neurodevelopmental disorders. However, the outcome measures that should be routinely used by therapists working in this specific health-care context have not been widely studied. The purpose of the study was to identify and compare the content of outcome measures used in aquatic physiotherapy for children, employing the International Classification of Functioning, Disability and Health (ICF) as a framework. A literature review was used to identify aquatic functioning outcome measures for children with neuromuscular and neurodevelopmental disorders. Content comparison of outcome measures identified was linked to the ICF following the linking guidelines, and content-related metrics were used to analyze them. Four outcome measures were identified (HAAR, Conatser, WOTA 1 and 2, and SWIM), which contained a total of 116 meaningful concepts and were linked to 35 ICF 2nd level categories. The greatest number of items assessed activity and participation categories. Large differences were found in reference to the density of content. For content diversity, the measures were all below 0.5. The identified outcome measurements showed homogeneity with respect to the theoretical foundation; however, some differences were found in terms of content analysis.

Status Analysis of Nursing Assessment Terminology of Neurological Conditions and Its Cross-Mapping with the International Classification of Functioning, Disability, and Health (ICF)

Patients with nervous system disorders with an accurate nursing assessment can experience an improved prognosis and promotion of health. The lack of uniform terminology limits the accuracy of nursing in China. ICF constitutes a unified and standard language can help standardize nursing assessment terms. This study show that ICF is suitable for Chinese nursing practice by using ICF Clinical Checklist and ICF-linking-rules to map the nursing assessment terminology of neurological conditions with ICF.