Mirjam Brach

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.

Design of the Swiss Spinal Cord Injury Cohort Study.

The overall goal of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) is to gain a better understanding of how to support functioning, health maintenance, and quality-of-life of persons with spinal cord injury (SCI) along the continuum of care, in the community, and along their life span. The purpose of this study was to present the SwiSCI study design. SwiSCI is composed of three complementary pathways and will include Swiss persons 16 yrs or older who have diagnoses of traumatic or nontraumatic SCI. Pathway 1 is a retrospective study of medical files of patients admitted to one of the collaborating SCI centers between 2005 and 2009. Pathway 2 is a nationwide survey of persons with chronic SCI. Pathway 3 is an inception cohort study including persons with newly acquired SCI. SwiSCI is conducted in collaboration with the Swiss Paraplegic Association and the major specialized rehabilitation centers in Switzerland. Measurement instruments that are to be used in Pathway 2 and 3 cover body structures and functions, activities, participation, life satisfaction, and personal and environmental factors. SwiSCI is a prospective cohort study that will contribute to a comprehensive understanding of the lived experience of persons with SCI.

ICF Core Set for patients with musculoskeletal conditions in the acute hospital

Purpose: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in the acute hospital. Methods: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. Results: Twenty-one experts selected a total of 47 second-level ICF categories. The largest number of categories was selected from the ICF component Body Functions (17 categories or 36%). Nine (19%) of the categories were selected from the component Body Structures, 11 (23%) from the component Activities and Participation, and 10 (21%) from the component Environmental Factors. Conclusion: The Acute ICF Core Set for patients with musculoskeletal conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

ICF Core Set for patients with musculoskeletal conditions in early post-acute rehabilitation facilities

Purpose: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in early post-acute rehabilitation facilities. Methods: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. Results: Fifteen experts selected a total of 70 second-level categories. The largest number of categories was selected from the ICF component Body Functions (23 categories or 33%). Seven (10%) of the categories were selected from the component Body Structures, 22 (31%) from the component Activities and Participation, and 18 (26%) from the component Environmental Factors. Conclusion: The Post-acute ICF Core Set for patients with musculoskeletal conditions is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

The ICF categories identified in nursing interventions administered to neurological patients with post-acute rehabilitation needs.

Purpose: The objectives of this study were (1) to determine whether the ICF covers the goals of nursing interventions and (2) to identify the areas of functioning, disability and health most relevant to nursing practice of neurological patients with early post-acute rehabilitation needs. Methods: This cross-sectional study on nursing interventions is part of a larger multicentric cross-sectional study describing functioning, disability and health. The nursing interventions were recorded by nurses in charge of the patient. According to established rules, the recorded nursing interventions were linked to the ICF. Results: One hundred and eighteen different nursing interventions were documented by the nursing staff. The intervention goals were linked to 67 different second-level ICF categories. Thirty belong to the component Body Functions, 19 to the component Body Structures, 13 to the component Activities and Participation, and five to the component Environmental Factors. Conclusions: The fact that all nursing interventions in early post-acute rehabilitation facilities could be linked to ICF categories supports the usefulness of the ICF in nursing. Initial problems in adapting profession-specific terminology to the ICF framework can be overcome, as shown by our linking exercise. Further analyses will be needed to show if these theoretical findings are supported by empirical evidence.

Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients

Anxiety and fear are often associated with chronic conditions such as cancer. This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy (CBT) in comparison to a client-centered, supportive-experiential group therapy (SET) in cancer patients with dysfunctional fear of progression. An incremental cost-effectiveness analysis was performed using data from a randomized controlled trial among cancer patients receiving inpatient rehabilitation. The means, 95% confidence intervals [95% CI], incremental cost-effectiveness graphic and acceptability curve were obtained from 1,000 bootstrap replications. A total of 174 patients were included in the economic evaluation. The estimated means [95% CI] of direct costs and reduction of fear of progression were €9,045.03 [6,359.07; 12,091.87] and 1.41 [0.93; 1.92] for patients in the SET and €6,682.78 [4,998.09; 8,440.95] and 1.44 [1.02; 1.09] for patients in the CBT. The incremental cost-effectiveness ratio [95% CI] amounts to minus €78,741.66 [−154,987.20; 110,486.32] for an additional unit of effect. Given the acceptability curve, there is a 92.4% chance that the CBT, compared with the SET, is cost-effective without the need of additional costs to payers. Our main result is the superior cost-effectiveness of the cognitive-behavioral intervention program in comparison to the non-directive encounter group for our sample of cancer patients with high levels of anxiety.

Determinants of major direct medical cost categories among patients with osteoporosis, osteoarthritis, back pain or fibromyalgia undergoing outpatient rehabilitation.

OBJECTIVE To identify determinants of direct medical costs among patients with osteoporosis, osteoarthritis, back pain or fibromyalgia. DESIGN Cross-sectional study. PARTICIPANTS Convenience sample of 410 patients undergoing outpatient rehabilitation. METHODS Resource use was assessed with a self-report retrospective questionnaire, and direct medical costs were calculated considering outpatient physician services, non-physician health services, medication and inpatient treatment. Non-parametric bootstrap techniques with 1,000 replications were used to estimate means of costs and their 95% confidence intervals (CI). To identify determinants of costs, a generalized linear model with log link function and gamma distribution, as well as a multivariate logistic regression analysis, were performed. RESULTS Medical indication (p < 0.001), age (p = 0.034) and the scales of the Short Form-36 (SF-36) role physical (p < 0.001), physical functioning (p = 0.036), social functioning (p = 0.047) and vitality (p = 0.005) were significant predictors of direct medical costs, whereas the medical indication fibromyalgia (odds ratio (OR) = 5.74, 95% CI 2.051-16.066, p = 0.001), the Short-Form 36 (SF-36) scale role physical (OR = 0.988, 95% CI 0.980-0.996, p = 0.002) and comorbidity (OR = 1.161, 95% CI 1.043-1.292, p = 0.006) were statistically significant determinants of high direct medical costs beyond the median. CONCLUSION Our work confirms known predictors of direct medical costs and broadens the understanding of determinants of direct medical costs beyond the median.

Combined application of the International Classification of Functioning, Disability and Health and the NANDA-International Taxonomy II

AIM This paper presents a discussion of the conceptual and practical relationships between the International Classification of Functioning, Disability and Health and the NANDA-International Taxonomy II for nursing diagnoses, and their use in nursing practice. BACKGROUND The ICF provides a common classification framework for all healthcare professionals, including nurses. Nursing care plans can be broadly based on NANDA-I taxonomies. No published attempt has been made to systematically compare the NANDA-I Taxonomy II to the ICF. DATA SOURCES The most recently published descriptions of both classifications and a case example presenting the combined use of both classifications. The work was carried out in 2009. DISCUSSION There are conceptual commonalities and differences between the ICF and the NANDA-I Taxonomy II. In the case example, the overlap between the ICF categories and NANDA-I nursing diagnoses reflects the fact that the ICF, focusing on functioning and disability, and the NANDA-I Taxonomy II, with its functioning health patterns, are similar in their approaches. IMPLICATIONS FOR NURSING The NANDA-I Taxonomy II permits the fulfilment of requirements that are exclusively nursing issues. The application of the ICF is useful for nurses to communicate nursing issues with other healthcare professionals in a common language. For nurses, knowledge shared with other healthcare professionals may contribute to broader understanding of a patients situation. CONCLUSION The ICF and the NANDA-I Taxonomy II should be used in concert by nurses and can complement each other to enhance the quality of clinical team work and nursing practice.

TOWARD STANDARDIZED REPORTING FOR A COHORT STUDY ON FUNCTIONING: THE SWISS SPINAL CORD INJURY COHORT STUDY

OBJECTIVE Functioning is an important outcome to measure in cohort studies. Clear and operational outcomes are needed to judge the quality of a cohort study. This paper outlines guiding principles for reporting functioning in cohort studies and addresses some outstanding issues. DESIGN Principles of how to standardize reporting of data from a cohort study on functioning, by deriving scores that are most useful for further statistical analysis and reporting, are outlined. The Swiss Spinal Cord Injury Cohort Study Community Survey serves as a case in point to provide a practical application of these principles. METHODS AND RESULTS Development of reporting scores must be conceptually coherent and metrically sound. The International Classification of Functioning, Disability and Health (ICF) can serve as the frame of reference for this, with its categories serving as reference units for reporting. To derive a score for further statistical analysis and reporting, items measuring a single latent trait must be invariant across groups. The Rasch measurement model is well suited to test these assumptions. CONCLUSION Our approach is a valuable guide for researchers and clinicians, as it fosters comparability of data, strengthens the comprehensiveness of scope, and provides invariant, interval-scaled data for further statistical analyses of functioning.

Developing Swiss Paraplegic Research: Building a research institution from the comprehensive perspective

Purpose. To illustrate the conceptualization and development of a research institution from the comprehensive perspective based on the integrative model of functioning provided by the World Health Organizations (WHO) International Classification of Functioning, Disability and Health (ICF). The newly founded research institution Swiss Paraplegic Research which focuses on the comprehensive study of spinal cord injury (SCI) serves as an example. Method. Description of organizational development and structure. Results. The creation of specialized research institutions which develop their core competence from the comprehensive perspective poses unique challenges. It is depicted how these challenges can be met through several approaches. These encompass the identification and specification of a common mission and research goals, the organization of research along distinct scientific fields, the set-up of a respective core competence, and the design of research structures suited to conduct studies of high methodological and organizational complexity. Finally, they comprise the development of a transdisciplinary workforce and the integration into a research landscape which is organized along scientific disciplines and not along interdisciplinary themes. Conclusion. The ideas and approaches described in this paper may serve as an example for creating integrative research institutions dedicated to human functioning and rehabilitation research from the comprehensive perspective.