Abstract
BackgroundThe International Classification of Functioning, Disability and Health (ICF) proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P). The ICF model allows for all paths between the constructs to be explored, with significant paths likely to vary for different conditions. The relationships between I, A and P have been explored in some conditions but not previously in people with osteoarthritis prior to joint replacement. The aim of this paper is to examine these relationships using separate measures of each construct and structural equation modelling.MethodsA geographical cohort of 413 patients with osteoarthritis about to undergo hip and knee joint replacement completed the Aberdeen measures of Impairment, Activity Limitation and Participation Restriction (Ab-IAP). Confirmatory factor analysis was used to test the three factor (I, A, P) measurement model. Structural equation modelling was used to explore the I, A and P pathways in the ICF model.ResultsThere was support from confirmatory factor analysis for the three factor I, A, P measurement model. The structural equation model had good fit [S-B Chi-square = 439.45, df = 149, CFI robust = 0.91, RMSEA robust = 0.07] and indicated significant pathways between I and A (standardised coefficient = 0.76 p < 0.0001) and between A and P (standardised coefficient = 0.75 p < 0.0001). However, the path between I and P was not significant (standardised coefficient = 0.01).ConclusionThe significant pathways suggest that treatments and interventions aimed at reducing impairment, such as joint replacement, may only affect P indirectly, through A, however, longitudinal data would be needed to establish this.
Highlights
The International Classification of Functioning, Disability and Health (ICF) proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P)
Problems walking on the flat None Mild Moderate Severe Extreme
This study explored the basic pathways of the ICF model for people with osteoarthritis prior to joint replacement surgery
Summary
The International Classification of Functioning, Disability and Health (ICF) proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P). The relationships between I, A and P have been explored in some conditions but not previously in people with osteoarthritis prior to joint replacement. Some of which target an impairment, such as pain, or restrictions of joint movement, and some on activities limitations, such as reduced walking ability or difficulties with stair climbing (e.g.[2,3,4,5]). The leading model of disability is the International Classification of Functioning, Disability and Health (ICF) [9]. The ICF proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P) together with contextual factors (personal and environmental factors). It has been suggested that for vitiligo the expected significant pathways may be between I and P without an impact on A, whereas, for leprosy, the expected significant pathways may be between all three constructs [10]
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