Alarcos Cieza

ICF linking rules : an update based on lessons learned

OBJECTIVE Outcome research seeks to understand the end results of health services. Researchers use a wide variety of outcome measures including technical, clinical and patient-oriented measures. The International Classification of Functioning, Disability and Health (ICF) as a common reference framework for functioning may contribute to improved outcome research. The objective of this paper is to provide an updated version of the linking rules published in 2002 and illustrate how these rules are applied to link technical and clinical measures, health-status measures and interventions to the ICF. RESULTS Three specific linking rules have been established to link health-status measures to the ICF and one specific linking rule has been created to link technical and clinical measures and interventions. A total of 8 linking rules have been established for use with all different outcome measures and with interventions. CONCLUSION The newly updated linking rules will allow researchers systematically to link and compare meaningful concepts contained in them. This should prove extremely useful in selecting the most appropriate outcome measures among a number of candidate measures for the applied interventions. Further possible applications are the operationalization of concrete ICF categories using specific measures or the creation of ICF category-based item bankings.

Linking health-status measurements to the International Classification of Functioning, Disability and Health

With the approval of the International Classification of Functioning, Disability and Health by the World Health Assembly in May 2001, the concurrent use of both health-status measures and the International Classification of Functioning, Disability and Health is expected. It is therefore important to understand the relationship between these two concepts. The objective of this paper is to provide a systematic and standardized approach when linking health-status measures to the International Classification of Functioning, Disability and Health. The specific aims are to develop rules, to test their reliability and to illustrate these rules with examples. Ten linking rules and an example of their use are presented in this paper. The percentage agreement between two health professionals for 8 health-status instruments tested is also presented. A high level of agreement between the health professionals reflects that the linking rules established in this study allow the sound linking of items from health-status measures to the International Classification of Functioning, Disability and Health.

Value and application of the ICF in rehabilitation medicine

Context: Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a persons functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on these concepts. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. Issue: However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF core sets. Conclusion: The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.

Development of ICF Core Sets for patients with chronic conditions

OBJECTIVE The objective of the ICF Core Sets project is the development of internationally agreed Brief ICF Core Sets and Comprehensive ICF Core Sets. METHODS The methods to develop both ICF Core Sets, the Comprehensive ICF Core Set and the Brief ICF Core Set, involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies and expert opinion. RESULTS The results regarding the development of the ICF Core Sets for 12 health conditions (chronic widespread pain, low back pain, osteoarthritis, osteoporosis, rheumatoid arthritis, chronic ischemic heart disease, diabetes mellitus, obesity, obstructive pulmonary diseases, breast cancer, depression, and stroke) are presented in this supplement. CONCLUSION Both, the Brief ICF Core Sets and the Comprehensive ICF Core Sets are preliminary and need to be tested in the coming years based on a standardized protocol in close cooperation with the ICF research branch of the WHO FIC CC (DIMDI) in Munich and the CAS team at WHO. The final goals are valid and globally agreed tools to be used in clinical practice, research and health statistics.

Application of the International Classification of Functioning, Disability and Health (ICF) in clinical practice

(2002). Application of the International Classification of Functioning, Disability and Health (ICF) in clinical practice. Disability and Rehabilitation: Vol. 24, No. 5, pp. 281-282.

ICF Core Sets for stroke.

OBJECTIVE To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of the Comprehensive ICF Core Set and the Brief ICF Core Set for stroke. METHODS A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS The preliminary studies identified a set of 448 ICF categories at the second, third and fourth ICF levels with 193 categories on body functions, 26 on body structures, 165 on activities and participation, and 64 on environmental factors. Thirty-nine experts from 12 different countries attended the consensus conference on stroke. Altogether 130 second-level categories were included in the Comprehensive ICF Core Set with 41 categories from the component body functions, 5 from body structures, 51 from activities and participation, and 33 from environmental factors. The Brief ICF Core Set included a total of 18 second-level categories (6 on body functions, 2 on body structures, 7 on activities and participation, and 3 on environmental factors). CONCLUSION A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for stroke. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Content comparison of health-related quality of life (HRQOL) instruments based on the international classification of functioning, disability and health (ICF)

The increasing recognition of the patient perspective and, more specifically, functioning and health, has led to an impressive effort in research to develop concepts and instruments to measure them. Health-Related Quality of Life (HRQOL) and the International Classification of Functioning Disability and Health (ICF) represent two different perspectives from which to look at functioning and health. Therefore, it is expected that both will often be used concurrently in clinical practice, research and health reporting. The objective of our study was to examine the relationship between six HRQOL instruments (the SF-36, the NHP, the QL-I, the WHOQOL-BREF, the WHODASII and the EQ-5D) and the ICF. All six HRQOL instruments were linked to the ICF separately by two trained health professionals according to ten linking rules developed specifically for this purpose. The degree of agreement between health professionals was calculated by means of the kappa statistic. Bootstrapped confidence intervals were calculated. In the 148 items of the 6 instruments a total of 226 concepts were identified and linked to the ICF. The estimated kappa coefficients range between 0.82 and 0.98. The concepts contained in the items of the HRQOL instruments were linked to 91 different ICF categories, 17 categories of the component body functions, 60 categories of the component activities and participation, and 14 categories of the component environmental factors. Twelve concepts could not be linked to the ICF at all. In the component body functions, only emotional functions are covered by all examined instruments. In the component activities and participation, all instruments cover aspects of work, but the half of them scarcely cover aspects of mobility. Only four of the six instruments address environmental factors. The ICF proved highly useful for the comparison of HRQOL instruments. The comparison of selected HRQOL instruments may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies.

ICF CORE SETS FOR RHEUMATOID ARTHRITIS

OBJECTIVE To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive ICF Core Set and a Brief ICF Core Set for rheumatoid arthritis. METHODS A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF, and based on these preliminary studies, relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS The preliminary studies identified a set of 530 ICF categories at the second, third and fourth ICF levels with 203 categories on body functions, 76 on body structures, 188 on activities and participation, and 63 on environmental factors. Seventeen experts from 12 different countries attended the consensus conference on rheumatoid arthritis (7 physicians with at least a specialization in physical and rehabilitation medicine, 7 rheumatologists, one nurse, one occupational therapist, and one physical therapist). Altogether 96 categories (76 second-level and 20 third-, and fourth-level categories) were included in the Comprehensive ICF Core Set with 25 categories from the component body functions, 18 from body structures, 32 from activities and participation, and 21 from environmental factors. The Brief ICF Core Set included a total of 39 second-level categories, with 8 on body functions, 7 on body structures, 14 on activities and participation, and 10 on environmental factors. CONCLUSION A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for rheumatoid arthritis. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

ICF Core Sets for low back pain

OBJECTIVE To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive ICF Core Set and a Brief ICF Core Set for low back pain. METHODS A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review and an empirical data collection. After training in the ICF and based on these preliminary studies, relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS The preliminary studies identified a set of 503 ICF categories at the second, third and fourth ICF levels with 211 categories on body functions, 47 on body structures, 190 on activities and participation and 55 on environmental factors. Eighteen experts from 15 different countries attended the consensus conference on low back pain. Altogether 78 second-level categories were included in the Comprehensive ICF Core Set with 19 categories from the component body functions, 5 from body structures, 29 from activities and participation and 25 from environmental factors. The Brief ICF Core Set included a total of 35 second-level categories with 10 on body functions, 3 on body structures, 12 on activities and participation and 10 on environmental factors. CONCLUSION A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for low back pain. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Identification of the most common patient problems in patients with chronic conditions using the ICF checklist

OBJECTIVE To identify the most common patient problems in patients with 12 different chronic conditions using the ICF checklist. METHODS A multi-centre, cross-sectional study with convenient samples of patients who had received a clinical diagnosis of any of 12 different chronic conditions undergoing inpatient or outpatient rehabilitation. To describe the population, age, gender, and the SF-36 were recorded. Data for 917 patients from 33 rehabilitation centres were analysed. RESULTS Most of the ICF-checklist categories were common to at least 1 condition. Pain was the sole category of 125 ICF-checklist categories that was common to all chronic conditions. Patients with low back pain, rheumatoid arthritis, and diabetes mellitus did not often experience the problems listed in the ICF-checklist. CONCLUSION The main finding, that in most conditions categories from each component were common, underscores the need to address all components when assessing functioning and health in patients with chronic conditions.