Yvonne Heerkens

The use of the ICF to describe work related factors influencing the health of employees.

Purpose: There are many models describing the responses of the human organism to work. However, the description of the effects on a personal level is rather limited. For this purpose the authors propose to use the concepts and the terminology of the ICF – the International Classification of Functioning, Disability and Health. Method: This article starts with a description of a model from occupational medicine, the Van Dijk model. Subsequently an overview of the health state of employees is presented, including the external and personal factors that may influence participation in work. Results: The schematic representation of the external and personal factors presented in this article is an expansion of the ICF-scheme. The scheme can be useful to describe problems of persons related to the working situation, and to identify the points of application of care for different professionals. Although the scheme does not have the intention to be complete, it might be useful in the development, execution and evaluation of programmes designed to prevent absenteeism in general or in specific groups, and to stimulate the return of people with absence due to illness. It is shown that the items of the Van Dijk model can be described using specific terms of the ICF. Conclusion: With the elaboration of the ICF scheme and the model of Van Dijk, expanded with ICF terms, the gap between the terminology used by professionals in health care, and the terminology used by professionals in occupational medicine is partly filled.

Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health: a mixed methods study

Objective To evaluate among stakeholders the support for the new, dynamic concept of health, as published in 2011: ‘Health as the ability to adapt and to self-manage’, and to elaborate perceived indicators of health in order to make the concept measurable. Design A mixed methods study: a qualitative first step with interviews and focus groups, followed by a quantitative survey. Participants Representatives of seven healthcare stakeholder domains, for example, healthcare providers, patients with a chronic condition and policymakers. The qualitative study involved 140 stakeholders; the survey 1938 participants. Results The new concept was appreciated, as it addresses people as more than their illness and focuses on strengths rather than weaknesses. Caution is needed as the concept requires substantial personal input of which not everyone is capable. The qualitative study identified 556 health indicators, categorised into six dimensions: bodily functions, mental functions and perception, spiritual/existential dimension, quality of life, social and societal participation, and daily functioning, with 32 underlying aspects. The quantitative study showed all stakeholder groups considering bodily functions to represent health, whereas for other dimensions there were significant differences between groups. Patients considered all six dimensions almost equally important, thus preferring a broad concept of health, whereas physicians assessed health more narrowly and biomedically. In the qualitative study, 78% of respondents considered their health indicators to represent the concept. Conclusions To prevent confusion with health as ‘absence of disease’, we propose the use of the term ‘positive health’ for the broad perception of health with six dimensions, as preferred by patients. This broad perception deserves attention by healthcare providers as it may support shared decision-making in medical practice. For policymakers, the broad perception of ‘positive health’ is valuable as it bridges the gap between healthcare and the social domain, and by that it may demedicalise societal problems.

Using intervention mapping (IM) to develop a self-management programme for employees with a chronic disease in the Netherlands.

BackgroundEmployees with a chronic disease often encounter problems at work because of their chronic disease. The current paper describes the development of a self-management programme based on the Chronic Disease Self-Management programme (CDSMP) of Stanford University to help employees with a chronic somatic disease cope with these problems at work. The objective of this article is to present the systematic development and content of this programme.MethodsThe method of intervention mapping (Bartholomew 2006) was used to tailor the original CDSMP for employees with a chronic somatic disease. This paper describes the process of adjusting the CDSMP for this target group. A needs assessment has been carried out by a literature review and qualitative focus groups with employees with a chronic disease and involved health professionals. On the basis of the needs assessment, the relevant determinants of self-management behaviour at work have been identified for the target population and the objectives of the training have been formulated. Furthermore, techniques have been chosen to influence self-management and the determinants of behaviour and a programme plan has been developed.ResultsThe intervention was designed to address general personal factors such as lifestyle, disease-related factors (for example coping with the disease) and work-related personal factors (such as self-efficacy at work). The course consists of six sessions of each two and a half hour and intents to increase the self management and empowerment of employees with a chronic somatic disease.ConclusionIntervention mapping has been found to be a useful tool for tailoring in a systematic way the original CDSMP for employees with a chronic somatic disease. It might be valuable to use IM for the development or adjusting of interventions in occupational health care.

Past and future use of the ICF (former ICIDH) by nursing and allied health professionals.

Purpose : This study describes the use of the ICIDH by allied health professionals and the nursing professions in The Netherlands. It is an example for showing how in recent years the application of the ICIDH has developed within professions. The data elements of patient descriptors documented by nurses and allied health professionals using the ICIDH, as a shared terminology, are presented. Method : The study contains an overview of former and present application of the ICIDH and a systematic description of (possible) use of the ICIDH and its successor, the ICF. Results and conclusion : Although former and present use prove to be valuable, the level of detail needed for a richer description of the functioning of a patient does not yet exist within the ICIDH nor within the ICF. This and other arguments are given for the innovation process of the ICF and the need for the development of a (multidisciplinary) clinical modification, the ICF-CM.

Classification of employment factors according to the International Classification of Functioning, Disability and Health in patients with neuromuscular diseases: A systematic review

Purpose. A systematic evaluation of the literature to identify health and contextual factors associated with employment in patients with neuromuscular diseases (NMD) and to perform a best evidence synthesis, taking into account the design of studies, methodological quality and the statistical significance of findings. Method. Publications were retrieved by a computerised search in medical and psychological databases. Two reviewers assessed titles and abstracts first and assessed the quality of the remaining full text publications independently as well. Of the residual publications, health and contextual factors associated with employment in patients with NMD were extracted. The factors found were included in a recently developed expanded International Classification of Functioning, Disability and Health scheme. Results. Six hundred and sixty-two titles and abstracts were screened. The main reason to exclude a title and/or abstract was the absence of the study population selected: Facioscapulohumeral Muscular Dystrophy (FSHD), Hereditary Motor and Sensory Neuropathy (HMSN) & Myotonic Dystrophy (MD). Of the remaining 20 full-text publications, eight publications fulfilled the inclusion criteria: two repeated survey designs and six cross-sectional studies. Factor extraction resulted in 94 factors related to employment. Ten factors in five publications were indicative for an association with employment status: Disease related factors HMSN, MD & NMD in general), factors related to functions (physical functions, muscle power functions), general personal factors (age, gender and education), work related personal factors (type of occupation, and expressed interest in employment by patients with NMD). Conclusion. In the best evidence synthesis ten factors were indicative for an association with employment status in patients with NMD in five publications with good to excellent methodological quality.

Factors influencing work participation of adults with developmental dyslexia: a systematic review

BackgroundEvidence has been synthesized to determine hindering and facilitating factors associated with the work participation of adults with developmental dyslexia (DD), classified according to the International Classification of Functioning, Disability and Health (ICF).MethodsA systematic literature review has been performed. Two search strings were used to determine the population and the context of work. The ICF was expanded with two subdivisions: one that made the environmental factors more work-related and a subdivision of personal factors. For data extraction the method known as qualitative metasummary was used and the manifest frequency effect size (MFES) for each category in the ICF was calculated.ResultsFrom 33 included studies 318 factors have been extracted and classified in the ICF. In the classification the frequency of occurrences and the consistency in direction (i.e., hindering or facilitating) have been made visible. The ICF categories with the highest MFES were mental functions with factors like feelings and emotions about dyslexia; activities like reading or writing/spelling; participation with factors like acquiring and keeping a job; social relationships at work where the attitudes and support of the employer and co-workers are important; working conditions with factors like the availability of assistive technology and accommodations on the job; and personal factors like self-disclosure and coping strategies.ConclusionsIn the context of work DD affects nearly all domains of functioning, mostly in a negative way. Within each domain the impact of DD increases over the course of life. To overcome that negative influence, many forms of adaptation, compensation, or coping are mentioned. Also notable is the lack of positive attitudes toward DD of the participants with DD—with the exception of the attitudes of teachers with DD—as well as on the part of colleagues, supervisors, and employers.

Participation as an outcome measure in psychosocial oncology: content of cancer-specific health-related quality of life instruments

PurposeTo examine to what extent the concept and the domains of participation as defined in the International Classification of Functioning, Disability and Health (ICF) are represented in general cancer-specific health-related quality of life (HRQOL) instruments.MethodsUsing the ICF linking rules, two coders independently extracted the meaningful concepts of ten instruments and linked these to ICF codes.ResultsThe proportion of concepts that could be linked to ICF codes ranged from 68 to 95%. Although all instruments contained concepts linked to Participation (Chapters d7–d9 of the classification of ‘Activities and Participation’), the instruments covered only a small part of all available ICF codes. The proportion of ICF codes in the instruments that were participation related ranged from 3 to 35%. ‘Major life areas’ (d8) was the most frequently used Participation Chapter, with d850 ‘remunerative employment’ as the most used ICF code.ConclusionsThe number of participation-related ICF codes covered in the instruments is limited. General cancer-specific HRQOL instruments only assess social life of cancer patients to a limited degree. This study’s information on the content of these instruments may guide researchers in selecting the appropriate instrument for a specific research purpose.

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

Abstract Purpose: The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe ‘functioning’ and ‘disability’), including the ICF scheme (visualization of functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes. Method: Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes. Results:The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of ‘health condition’ at the top and role of ‘contextual factors’). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme. Conclusions: There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health. Implications for Rehabilitation We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm. We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health. We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases). We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.

An empirical exploration of the relations between the health components of the International Classification of Functioning, Disability and Health (ICF)

Purpose: The aim of this study was to investigate the relations between the ICF components from a subjective perspective. Method: Data on health condition and perceived functioning were collected among 2941 individuals with at least one chronic disease or disorder. Path analysis was used with perceived level of participation as the final denominator. Three models were tested: one with the number of chronic diseases and disorders as an indicator of health condition, one with perceived health as indicator of health condition, and one with perceived health as part of the personal factors. Results: Although all models showed a good fit, the model with the best fit was that with perceived health as an indicator of health condition. Conclusions: From a patient’s perspective, components of the ICF scheme appear to be associated with each other, with perceived health being the best indicator of the health condition. Implications for Rehabilitation The International Classification of Functioning, Disability and Health (ICF) is a international accepted framework to describe human functioning from a health perspective. In research the ICF components are mostly operationalized using objective measures, for instance Performance tests. This large scale study shows that also with perceived measures and independent of a specific health condition relations between the ICF components can be found.

An Innovative Peer Assessment Approach to Enhance Guideline Adherence in Physical Therapy: Single-Masked, Cluster-Randomized Controlled Trial

Background Clinical practice guidelines (CPGs) are not readily implemented in clinical practice. One of the impeding factors is that physical therapists do not hold realistic perceptions of their adherence to CPGs. Peer assessment (PA) is an implementation strategy that aims at improving guideline adherence by enhancing reflective practice, awareness of professional performance, and attainment of personal goals. Objective The purpose of this study was to compare the effectiveness of PA with the usual case discussion (CD) strategy on adherence to CPGs for physical therapist management of upper extremity complaints. Design A single-masked, cluster-randomized controlled trial with pretest-posttest design was conducted. Intervention Twenty communities of practice (n=149 physical therapists) were randomly assigned to groups receiving PA or CD, with both interventions consisting of 4 sessions over 6 months. Both PA and CD groups worked on identical clinical cases relevant to the guidelines. Peer assessment focused on individual performance observed and evaluated by peers; CD focused on discussion. Outcomes Guideline adherence was measured with clinical vignettes, reflective practice was measured with the Self-Reflection and Insight Scale (SRIS), awareness of performance was measured via the correlation between perceived and assessed improvement, and attainment of personal goals was measured with written commitments to change. Results The PA groups improved more on guideline adherence compared with the CD groups (effect=22.52; 95% confidence interval [95% CI]=2.38, 42.66; P=.03). The SRIS scores did not differ between PA and CD groups. Awareness of performance was greater for the PA groups (r=.36) than for the CD groups (r=.08) (effect=14.73; 95% CI=2.78, 26.68; P=.01). The PA strategy was more effective than the CD strategy in attaining personal goals (effect=0.50; 95% CI=0.04, 0.96; P=.03). Limitations Limited validity of clinical vignettes as a proxy measure of clinical practice was a limitation of the study. Conclusions Peer assessment was more effective than CD in improving adherence to CPGs. Personal feedback may have contributed to its effectiveness. Future research should address the role of the group coach.