John L. Melvin

ICF Core Sets for depression.

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 depression. 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 receiving 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 323 ICF categories at the second, third and fourth ICF levels with 163 categories on body functions, 22 on body structures, 91 on activities and participation and 47 on environmental factors. Twenty experts attended the consensus conference on depression. Altogether 121 categories (89 second-level and 32 third-level categories) were included in the Comprehensive ICF Core Set with 45 categories from the component body functions, 48 from activities and participation and 28 from environmental factors. The Brief ICF Core Set included a total of 31 categories with 9 on body functions, 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 depression. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

ICF CORE SETS FOR BREAST CANCER

OBJECTIVE To report on the results of the consensus process to develop the first version of both a Comprehensive ICF Core Set and a Brief ICF Core Set for breast cancer. METHODS A formal decision-making and consensus process integrating evidence gathered from preliminary studies was realized. 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 317 ICF categories at the second, third, and fourth ICF levels with 150 categories on body functions, 44 on body structures, 77 on activities and participation, and 46 on environmental factors. Nineteen experts attended the consensus conference on breast cancer (7 physicians with at least a specialization in physical and rehabilitation medicine, 2 with a specialization in internal medicine and one radiologist, 4 physical therapists, 2 occupational therapists, one psychologist, one epidemiologist and one nurse). Altogether 80 categories (73 second-level and 7 third-level categories) were included in the Comprehensive ICF Core Set with 26 categories from the component body functions, 9 from body structures, 22 from activities and participation, and 23 from environmental factors. The Brief ICF Core Set included a total of 40 second-level categories with 11 on body functions, 5 on body structures, 11 on activities and participation, and 13 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 breast cancer. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were selected.

ICF Core Sets for osteoporosis.

OBJECTIVE To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set and a Brief ICF Core Set for osteoporosis. 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 239 ICF categories at the second, third and fourth ICF levels with 72 categories on body functions, 41 on body structures, 81 on activities and participation, and 45 on environmental factors. Fifteen experts from 7 different countries attended the consensus conference on osteoporosis. Altogether 67 second-level and 2 third-level categories were included in the Comprehensive ICF Core Set with 15 categories from the component body functions, 7 from body structures, 21 from activities and participation, and 26 from environmental factors. The Brief ICF Core Set included a total of 22 second-level categories with 5 on body functions, 4 on body structures, 6 on activities and participation, and 7 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 osteoporosis. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Applying the ICF for the acute hospital and early post-acute rehabilitation facilities

Professor and Chair, Department of Physical Medicine and Rehabilitation, Director, ICF Research Branch, WHO FIC Collaborating Center (DIMDI), Germany, Ludwig-Maximilians University, Munich, Germany, Coordinator Classification, Assessment, Surveys and Terminology Unit, World Health Organization, Geneva, Switzerland, Professor and Chair, Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, USA

Towards a conceptual description of rehabilitation as a health strategy.

OBJECTIVE A proposal for a conceptual description of rehabilitation was made in 2007 based on the International Classification of Functioning, Disability and Health. This conceptual description should foster the development of a common understanding of rehabilitation and its professions. The present paper aims to report on the development and current state of the discussions about this conceptual description and to provide the current version, which has been adopted by different European professional and scientific organizations. METHODS First, the history of the development of the conceptual description of rehabilitation is reported. Secondly, suggestions for modifications or amendments are introduced, and the resulting phrases and terms are presented and discussed. DISCUSSION AND CONCLUSION One major change to the conceptual description of rehabilitation is the explicit integration of the perspective of the disabled person. The relationship between person and provider is characterized as a partnership. However, it is argued that quality of life should not be introduced as a primary goal of rehabilitation. This conceptual description can foster a common understanding of the rehabilitation professions and provide a point of departure for clarifying the role of different professions and services within the broad field of rehabilitation. It can also serve to position rehabilitation as a major health strategy and to sharpen the perception of rehabilitation among external stakeholders.

Developing "Human Functioning and Rehabilitation Research" from the comprehensive perspective.

With the International Classification of Functioning, Disability and Health (ICF) the World Health Organization (WHO) has prepared the ground for a comprehensive understanding of Human Functioning and Rehabilitation Research, integrating the biomedical perspective on impairment with the social model of disability. This poses a number of old and new challenges regarding the enhancement of adequate research capacity. Here we will summarize approaches to address these challenges with respect to 3 areas: the organization of Human Functioning and Rehabilitation Research into distinct scientific fields, the development of suitable academic training programmes and the building of university centres and collaboration networks.

Validation of International Classification of Functioning, Disability, and Health (ICF) Core Sets for early postacute rehabilitation facilities: comparisons with three other functional measures.

Grill E, Stucki G, Scheuringer M, Melvin J: Validation of International Classification of Functioning, Disability, and Health (ICF) Core Sets for early postacute rehabilitation facilities: Comparisons with three other functional measures. Am J Phys Med Rehabil 2006;85:640–649. Objective:Short lists of International Classification of Functioning, Disability, and Health (ICF) categories, ICF Core Sets, have been developed as reference standards for clinical practice and research. The objective of this study was to validate the ICF Core Sets for early postacute rehabilitation facilities against the measures most commonly used in early postacute rehabilitation, the FIM™ instrument, the Functional Assessment Measure, and the Barthel index. Design:Linking study matching the concepts of three commonly used outcome measures to corresponding ICF categories. Results:Corresponding ICF categories could be found for all of the items of the FIM™ instrument + Functional Assessment Measure and Barthel index. The 40 items of these three measures were linked to 33 different ICF categories. Four items could be linked to ICF categories that were not part of any of the Postacute ICF Core Sets. Conclusions:The Postacute ICF Core Sets cover the concepts of the most frequently used measures in early postacute rehabilitation. Yet, many aspects of human functioning are not measured by the FIM™ instrument + Functional Assessment Measure and the Barthel index. If this information is considered relevant, these items would have to be added by using supplementary measures. Our comparison demonstrates the benefit of using a common language when comparing items using different wordings and concepts.

Towards a conceptual description of Physical and Rehabilitation Medicine.

Physical and Rehabilitation Medicine (PRM) is an independent medical specialty focusing on the improvement of functioning. A shared understanding of concepts is of vital importance for integrated action in this field. The aim of the present paper is to provide a conceptual model of PRM, to give background on its development and adoptions, and to explain the choice of terms, phrases, and concepts. It is based on the terms and concepts of the International Classification of Functioning, Disability and Health (ICF) that provides a widely accepted conceptual model and taxonomy of human functioning. Based on the White Book on Physical and Rehabilitation Medicine in Europe of 2006 a first proposal for a conceptual description of rehabilitation has been published in 2007. This proposal has been subjected to comments for modifications and amendments. E.g. it was underlined that PRM can apply both a health condition perspective including curative approaches and measures aiming at body functions and structures and a multi-dimensional and multi-professional team approach aiming to optimize functioning from a comprehensive functioning and disability perspective. The interaction between the PRM specialist and the person should be characterized as a partnership. PRM specialists work across all areas of health services and across all age groups. In summary, the specialty of PRM is characterized as the medicine of functioning.

Physical medicine and rehabilitation workforce study: The supply of and demand for physiatrists☆☆☆

OBJECTIVE Analysis, results, and implications of a supply and demand workforce model for physical medicine and rehabilitation. Explicit issues addressed include: (1) the supply implications of maintaining current (1994-1995) output of physiatrists from residency programs; (2) the implications of continued growth in managed care on the demand for the services of physiatrists; (3) likely future supply and demand conditions; and (4) strategies to adapt to future conditions. DESIGN A workforce model of the supply and demand for physiatrists was developed. Parameters of the model are estimated using econometric models and by applying the judgments of a consensus panel. The model evaluated several different scenarios regarding managed care growth, competition from other providers and other factors. RESULTS Based on the analysis, physiatrists will continue to be in excess demand through the year 2000. More aggressive growth in managed care can affect this result. CONCLUSIONS Based on an overall assessment of supply and demand conditions, and under the assumption that the supply of new entrants each year remains in the range of 1994-1995 levels, demand for physiatrists will continue to exceed supply, on average, through the year 2000. Excess supply has, and will, emerge in selected geographic areas. If the profession is successful in informing the market regarding the advantages of physiatry, the profession can continue to grow without experiencing excess supply, in the aggregate, for the foreseeable future.

Chapter 6: The policy agenda of ISPRM.

This paper suggests a comprehensive policy agenda and first steps to be undertaken by the International Society of Physical and Rehabilitation Medicine (ISPRM) in order to realize its humanitarian, professional and scientific mandates. The general aims of ISPRM, as formulated in its guiding documents, the relations with the World Health Organization (WHO) and the United Nations system, and demands of ISPRMs constituency herein form the basis of this policy agenda. Agenda items encompass contributions to the establishment of rehabilitation services worldwide and the development of rapid rehabilitation disaster response, the enhancement of research capacity in Physical and Rehabilitation Medicine (PRM), and the development of PRM societies. ISPRMs possible input in general curricula in disability and rehabilitation, and in fighting discrimination against people experiencing disability are discussed. Moreover, the implementation of the International Classification of Functioning, Disability and Health (ICF) in medicine, contributions to WHO guidelines relevant to disability and rehabilitation, the provision of a conceptual description of the rehabilitation strategy and the outline of a rehabilitation services matrix are seen as important agenda items of ISPRMs external policy. With regard to its constituency and internal policy, a definition of the field of competence and a conceptual description of PRM, as well as the development of a consistent and comprehensive congress topic list and congress structure appear to be crucial items. The proposed agenda items serve as a basis for future discussions.