Comprehensive ICF Core Set Research Articles

Validation of the comprehensive ICF Core Sets for patients in early post-acute rehabilitation facilities

To examine the relevance and completeness of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Sets for patients in post-acute rehabilitation facilities. Multi-centre cohort study. A total of 165 patients (46% female; mean age 67.5 years) from post-acute rehabilitation facilities in 2 Austrian and 7 German hospitals. Data on functioning were collected using the respective comprehensive post-acute ICF Core Sets. Data was extracted from patients' medical record sheets and interviews with health professionals and patients. Most of the categories of the comprehensive ICF Core Sets describing impairments, limitations or restrictions occurred in a considerable proportion of the study population. The most outstanding limitations and restrictions of the patients were problems with sleep and blood vessel functions, walking and moving and self-care. Twenty-six aspects of functioning not previously covered by the comprehensive ICF Core Sets were ranked as relevant. Most categories of the comprehensive ICF Core Set for patients in post-acute rehabilitation facilities were confirmed. No significant gaps in the established set could be identified.

Validation of the comprehensive ICF Core Set for patients in geriatric post-acute rehabilitation facilities

To examine the relevance and completeness of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for patients in geriatric post-acute rehabilitation facilities. Multi-centre cohort study. A total of 209 patients (67% female, mean age 80.4 years) in geriatric wards of 2 Austrian and 3 German hospitals. Data on functioning were collected using the respective comprehensive ICF Core Set. Data were extracted from patients' medical record sheets and interviews with health professionals and patients. Most of the categories of the comprehensive ICF Core Set describing impairments, limitations or restrictions occurred in a considerable proportion of the study population. The most outstanding limitations and restrictions of the patients were problems with walking and moving around, and difficulties with self-care. Fourteen aspects of functioning not previously covered by the comprehensive ICF Core Set were reported as relevant. Most categories of the comprehensive ICF Core Set could be confirmed. Limitations in categories of intellectual and seeing functions appeared less frequently than might have been expected for a population of older hospitalized people. Some additional categories not covered by the present version of the comprehensive ICF Core Set emerged from the interviews and should be considered for inclusion in the final version.

Criteria for validating comprehensive ICF Core Sets and developing brief ICF Core Set versions

To describe the empirical processes used to (i) validate the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Sets, and (ii) develop brief ICF Core Sets from the ICF Categories of these more comprehensive ICF Core Sets. Prospective multi-centre cohort study. PATIENTS receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in acute hospitals or early post-acute rehabilitation facilities. Functioning was coded using the ICF. For validation, absolute and relative frequencies (prevalences) of impairment, limitation or restriction were reported at admission and end-point (discharge or 6 weeks after admission). Aspects not covered were extracted and translated into the best corresponding ICF category. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. We present an algorithm to identify candidate categories for brief ICF Core Sets extracted from the comprehensive acute and post-acute ICF Core Sets.

The ICF forms a useful framework for classifying individual patient goals in post-acute rehabilitation

Timely goal setting in close collaboration with the patient is essential to successful rehabilitation. We therefore sought to identify goals of patients in early post-acute rehabilitation as predictors of improved functioning. We conducted a prospective multi-centre cohort study in 5 early post-acute rehabilitation facilities. Patients with musculoskeletal, cardiopulmonary and neurological conditions were recruited between May 2005 and August 2008. A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning. Patients' goals were coded according to the International Classification of Functioning, Disability and Health (ICF). By means of a mixed effects model we examined the association between goal attainment and improved functioning. A total of 116 patients gave 546 statements, of which 426 were linked to 74 ICF categories, which were assigned to the existing comprehensive post-acute ICF Core Sets. Improvements in walking, recreation and leisure, pain, and transfer were the most frequently reported goals. In multivariable analysis patients' goal attainment was not a predictor for improved overall functioning. The ICF can be used to identify and structure patients' goals. Patients' perspective should be considered in the rehabilitation process.

Patient goals in post-acute geriatric rehabilitation - goal attainment is an indicator for improved functioning

To identify goals of older patients in geriatric rehabilitation and to measure their improvement in overall functioning. A prospective multi-centre cohort study. A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning from patients' and health professionals' perspectives. Patients' goals were linked to the International Classification of Functioning, Disability and Health (ICF). Using a residualized change score, we identified patients who improved more than statistically expected. A total of 209 patients gave 476 statements. Of these, 346 (72.7%) statements were linked to 58 different ICF categories. More than 90% of the ICF categories were part of the comprehensive geriatric ICF Core Set. "Walking", "getting rid of pain", "autonomy" and "returning home" were the most frequently reported goals. Multivariable analysis identified shorter length of inpatient stay and goal attainment to be significant predictors for an improvement in overall functioning from the patients' perspective. The ICF can be used to identify and structure patients' goals in geriatric rehabilitation. The association between goal attainment and improved overall functioning underlines the necessity of considering the patients' perspective in the rehabilitation process.

Brief ICF Core Set for patients in geriatric post-acute rehabilitation facilities

To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and clinical measurement of functioning in older patients in early post-acute rehabilitation facilities. Prospective multi-centre cohort study. Older patients receiving rehabilitation interventions in early post-acute rehabilitation facilities. Functioning was coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. A total of 209 patients were included in the study, mean age 80.4 years, 67.0% female. Selection yielded a total of 29 categories for the functioning part and 9 categories for the contextual part of the ICF. The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the clinical assessment and monitoring of functioning in older patients undergoing early post-acute rehabilitation.

ICF Core Sets for early post-acute rehabilitation facilities.

To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in early post-acute rehabilitation facilities. Prospective multi-centre cohort study. Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in early post-acute rehabilitation facilities. Functioning was coded using the ICF. The criterion for selecting candidate categories for the ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. A total of 165 patients were included in the study (67 neurological, 37 cardiopulmonary, 61 musculoskeletal), mean age 67.5 years, 46.1% female. Selection yielded 38 cate-gories for neurological, 32 for cardiopulmonary, and 31 for musculoskeletal. The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the assessment and monitoring of functioning in patients undergoing early post-acute rehabilitation for neurological, cardiopulmonary, and musculoskeletal conditions.

Patients' experience post-lumbar fusion regarding back problems, recovery and expectations in terms of the international classification of functioning, disability and health

Purpose. To describe within the context of the International Classification of Functioning, Disability and Health ((ICF)), patient's experiences post-lumber fusion regarding back problems, recovery and expectations of rehabilitation and to contrast with the content of outcome measures and the ICF low back pain ((LBP)) core sets.Methods. The study has a cross-sectional and retrospective design and involves 20 lumbar fusion patients. Using the ICF, qualitative content analysis of semi-structured interviews 3–6 months post-surgery was performed. This was compared with the ICF related content of the Oswestry Disability Index ((ODI)), Medical Outcome Study Short Form 36 ((SF-36)), European Quality of Life Questionnaire ((EQ5D)) and the ICF LBP core sets.Results. Patient's experiences were most frequently linked to psychological, sensory, neuromusculoskeletal and movement related body function chapters of the ICF. The most frequently linked categories of activity and participation were mobility, domestic activities, family relationships, work, recreation and leisure. Environmental factors frequently linked were the use of analgesics, walking aids, family support, social security systems, health care systems and labour market employment services.Conclusions. This study highlights important ICF related aspects of patient's experiences post-lumber fusion. The use of the comprehensive ICF core sets is recommended in conjunction with ODI, SF-36 and the EQ5D for a broader analysis of patient outcomes post-lumbar fusion.

Brief ICF Core Sets for the acute hospital

To identify candidate categories for brief International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in the acute hospital. Prospective multi-centre cohort study. Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in acute hospitals. Functioning and contextual factors were coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. A total of 391 patients were included in the study (91 neurological, 109 cardiopulmonary, 191 musculoskeletal), mean age 63.4 years, 50.1% female. Selection yielded 33 cate-gories for neurological, 31 for cardiopulmonary, and 30 for musculoskeletal. The present selection of categories can be considered an initial proposal, serving to identify the ICF cate-gories most relevant for the practical assessment and monitoring of functioning in patients with acute neurological, cardiopulmonary, and musculoskeletal conditions.

The comprehensive ICF core sets for spinal cord injury from the perspective of occupational therapists: a worldwide validation study using the Delphi technique

To validate the International Classification of Functioning, Disability and Health (ICF) core sets for individuals with spinal cord injury (SCI) in the early post-acute and long-term context from the perspective of occupational therapists (OTs). International. OTs experienced in the treatment in SCI were asked about problems, resources and aspects of the environment treated by them, in a three-round electronic mail survey using the Delphi technique. Responses were linked to the ICF by two researchers; kappa coefficient was calculated as statistical measure of agreement. In total, 67 experts from 27 countries named 2586 different concepts. For the early post-acute context, 223 concepts were linked to ICF categories. Three ICF categories from the component body function, three ICF categories from the component body structures and five ICF categories from the component activities and participation were not represented in the ICF core set for the early post-acute context with an expert agreement of more than 75%. For the long-term context, 205 concepts were linked to ICF categories. Two ICF categories from the component body function, four ICF categories from the component body structures and two ICF categories from the component activities and participation were not represented in the ICF core set with an expert agreement of more than 75%. OTs addressed a vast variety of problems that they take care of in their interventions in persons with SCI. The Comprehensive ICF core sets covered a high percentage of these problems. Further research is necessary on a few aspects that are not included in the ICF core sets for SCI.

The Comprehensive ICF core sets for spinal cord injury from the perspective of physical therapists: a worldwide validation study using the Delphi technique

To validate the International Classification of Functioning, Disability and Health (ICF) Core Set for individuals with spinal cord injury (SCI) in the early post-acute and long-term context from the perspective of physical therapists. International. Physical therapists experienced in the treatment of SCI were asked about problems, resources and aspects of the environment treated by them, in a three-round electronic mail survey using the Delphi technique. Responses were linked to the ICF by two researches; κ-coefficient was calculated as statistical measure of agreement. In all, 81 experts from 27 countries named 3694 concepts. They were linked to 187 ICF categories for the early post-acute context. Three ICF categories from the component body function, five ICF categories from the component body structures and two ICF categories from the component activities and participation were not represented in the ICF Core Set for the early post-acute context. In all, 207 ICF categories were linked for the long-term context. Four ICF categories from the component body function, five ICF categories from the component body structures and two ICF categories from the component activities and participation were not represented in the ICF Core Set for the long-term context. Physical therapists addressed a vast variety of problems that they take care of in their interventions in patients with SCI. The Comprehensive ICF Core Sets covered a high percentage of these problems. Further research is necessary on several responses not covered in the ICF.

Part 1. International Classification of Functioning, Disability and Health (ICF) Core Sets for persons with sleep disorders: Results of the consensus process integrating evidence from preparatory studies

Background/objectivesThe International Classification of Functioning, Disability and Health (ICF) provides a comprehensive and universally accepted framework to classify changes in functioning related to health conditions. Comprehensive and Brief Core Sets have been defined for various disorders but not for sleep disorders. Such a Core Set would greatly enhance the techniques available to describe the impact of sleep disorders on patients. The overarching purpose of this paper is to report on phase 1 of the international and World Health Organization (WHO) endorsed consensus process in identifying ICF Core Sets for sleep disorders. MethodsA formal decision-making and consensus process which integrated evidence gathered from preparatory studies was carried out. Relevant ICF categories were selected by a sample of international experts from different backgrounds using the nominal group technique. ResultsTwenty-six experts from 22 countries and different professional backgrounds attended the consensus conference. Altogether 120 second- or third-level ICF categories were included in the Comprehensive ICF Core Set with the following ICF component split: 49 categories from body functions, 8 from body structures, 31 from activities and participation and 32 from environmental factors. The Brief ICF Core Set included a total of 15 second-level categories: 5 body functions (sleep, energy and drive, attention, consciousness, respiration functions); 3 body structures (brain, respiratory system, pharynx); 4 activities and participation (focusing attention, driving, handling stress and other psychological demands, carrying out daily routine); and 3 environmental factors (immediate family; health services, systems, and policies; and health professionals). ConclusionA formal consensus process integrating evidence and expert opinion led to the first version of the ICF Core Sets for persons with sleep disorders. Further validation of the Core Set is needed.

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer capture the problems in functioning treated by physiotherapists in women with breast cancer?

Objective The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer is an application of the ICF, and represents the typical spectrum of problems in functioning and contextual factors that may influence functioning of patients with breast cancer. The objective of this study was to examine the content validity of this ICF core set from the perspective of physiotherapists. Design Physiotherapists from around the world experienced in the treatment of patients with breast cancer were interviewed about patients’ problems, patients’ resources and environmental aspects that physiotherapists take care of in a three-round survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated by means of the Kappa statistic. Participants Physiotherapists experienced in breast cancer treatment. Results Fifty-nine physiotherapists from 19 countries named 769 problems treated by physiotherapists in patients with breast cancer. One hundred and sixty-six ICF categories were linked to these answers. Nineteen ICF categories reached >75% agreement among the physiotherapists but are not represented in the Comprehensive ICF Core Set for Breast Cancer. Ten concepts were linked to the not-yet-classified personal factors component. Eleven concepts are not covered by the ICF. The Kappa coefficient for the agreement between the two persons who performed the linking was 0.66 (95% bootstrapped confidence interval 0.63 to 0.68). Conclusions The content validity of the Comprehensive ICF Core Set for Breast Cancer was largely supported by the physiotherapists. However, several issues were raised which were not covered and these need to be investigated further.

Measurement: function and mobility (focussing on the ICF framework)

While several instruments and measures are available to assess function and mobility, there was no exhaustive list of impairments, limitations and restrictions that are the consequence of ankylosing spondylitis (AS). The International Classification of Functioning, Disability and Health (ICF) facilitates agreement on a comprehensive description of aspects of functioning that are relevant and typical for a specific disease by using ICF categories. The Comprehensive ICF Core Set for AS is the selection of 80 ICF categories that are typical and relevant for AS. Physical functioning and mobility have an essential but partial role in the broad view of functioning and health in AS. Consistent with the bio-psycho-social model, the ICF Core Set for AS also recognises the role of contextual factors, either environmental or personal, when understanding functioning. This new reference for functioning is now available for clinical practice and research. It can help to increase insight into the complexity of functioning and can serve as the starting point for the development of new instruments that address either global functioning or aspects of functioning.

Validation of the Comprehensive ICF Core Set for Osteoarthritis: the perspective of physical therapists

Background and purpose Osteoarthritis is a common chronic disease associated with functional impairments and activity limitations, as well as participation restrictions. The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Osteoarthritis is an application of the ICF and represents the typical spectrum of problems in functioning of patients with osteoarthritis. Objective To validate the Comprehensive ICF Core Set for Osteoarthritis from the perspective of physical therapists. Methods Physical therapists experienced in the treatment of patients with osteoarthritis were asked about patients’ problems, resources and aspects of the environmental factors treated by physical therapists in patients with osteoarthritis in a three-round, electronic-mail survey using the Delphi technique. Responses were linked to the ICF. Results Seventy-two experts from 22 countries named 744 meaningful concepts that covered all ICF components. One hundred and fifty-two ICF categories were linked to these answers, 32 concepts were linked to the not-yet-developed personal factors component, and 14 issues were not covered by a single ICF category. Twelve ICF categories were not represented in the Comprehensive ICF Core Set for Osteoarthritis, although at least 75% of the participants rated them as important. Discussion and conclusion The content validity of the ICF was widely supported by the physical therapists. However, several issues were raised that were not covered and need to be investigated further.

The Development of ICF Core Sets for Hearing Loss

The International Classification of Functioning, Disability and Health (ICF), adopted by the World Health Organization (WHO) in 2001, offers a framework for a comprehensive understanding of health. One of the main goals of the ICF is to provide a conceptual framework of health that can be applied both for research purposes and in clinical settings. In order to promote the use of the ICF in clinical settings, the WHO initiated the Core Sets project. Core Sets, targeting a specific health condition, consist of a set of ICF categories that can serve as minimal standards (Brief ICF Core Set) or as standards for comprehensive assessment (Comprehensive ICF Core Set). In 2009, a process of developing ICF Core Sets for Hearing Loss was initiated. This process involves three phases of development. In the first phase, four scientific studies are conducted to collect evidence for relevant ICF categories to be used in the Core Sets. In phase two, a consensus conference is held to establish relevant ICF categories, and in the third phase, the Core Sets that are retained are tested and validated. This paper describes the process of developing ICF Core Sets for Hearing Loss as well as an invitation to participate in the project.

Validation of the comprehensive ICF Core Set for rheumatoid arthritis: The perspective of physicians

The "Comprehensive ICF Core Set for rheumatoid arthritis" represents the typical spectrum of problems in functioning of patients with rheumatoid arthritis according to the International Classification of Functioning, Disability and Health (ICF). The objective of this study was to validate this ICF Core Set from the perspective of physicians. Physicians experienced in rheumatoid arthritis treatment were asked about the problems they commonly treat in patients with rheumatoid arthritis in a 3-round survey using the Delphi technique. Responses were linked to the ICF. Seventy-nine physicians in 41 countries named 512 patients' problems. Two hundred and 27 ICF categories were linked to these answers. Twenty-six ICF categories were not represented in the Comprehensive ICF Core Set for rheumatoid arthritis and 19 aspects were not covered by the ICF. The content validity of 3 ICF components was well supported. However, several body functions were identified that are not covered and need to be investigated further.

Funcionamiento y discapacidad: la Clasificación Internacional del Funcionamiento (CIF)

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) has provided a new foundation for our understanding of health, functioning, and disability. It covers most of the health and health-related domains that make up the human experience, and the most environmental factors that influence that experience of functioning and disability. With the exhaustive ICF, patients' functioning -including its components body functions and structures and activities and participation-, becomes a central perspective in medicine. To implement the ICF in medicine and other fields, practical tools (= ICF Core Sets) have been developed. They are selected sets of categories out of the whole classification which serve as minimal standards for the assessment and reporting of functioning and health for clinical studies and clinical encounters (Brief ICF Core Set) or as standards for multiprofessional comprehensive assessment (Comprehensive ICF Core Set). Different from generic and condition-specific health-status measures, the ICF Core Sets include important body functions and structures and contextual factors. The use of the ICF Core Sets provides an important step towards improved communications between healthcare providers and professionals, and will enable patients and their families to understand and communicate with health professionals about their functioning and treatment goals. Specific applications include multi- and interdisciplinary assessment in clinical settings and in legal expert evaluations and use in disease or functioning-management programs. The ICF has also a potential as a conceptual framework to clarify an interrelated universe of health-related concepts which can be elucidated based on the ICF and therefore will be an ideal tool for teaching students in all medical fields and may open doors to multi-professional learning.

Mapping an obesity clinical evaluation protocol to the International Classification of Functioning, Disability and Health

Purpose. To evaluate a multidisciplinary clinical protocol for obesity treatment by mapping it against the International Classification of Functioning, Disability and Health (ICF) and to determine the areas, defined by the ICF, in which no standardized assessment tools are available.Method. Assessment instruments used by a multidisciplinary team were linked to ICF categories and compared with a list of ICF categories composed by the ICF checklist and the comprehensive ICF core-set for obesity. Other relevant ICF categories were added, and not relevant ones were deleted when appropriate.Results. Five ICF categories were deleted and 11 were added, and 166 ICF categories were linked to assessment tools and to semi-structured interviews. The majority were linked to assessment tools, but within the domain of the environmental factors all ICF categories were mapped using semi-structured interviews.Conclusions. Our results show that an extended list of ICF categories is adequate to cover a wide spectrum of clinical and functional information, and it could be employed to describe, disability profiles of obese patients, to develop preventive measures and to identify what factors in the environment need to be changed to improve rehabilitation's outcomes.

ICF Core Sets for individuals with spinal cord injury in the early post-acute context

A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. The aim of this study was to report on the results of the consensus process 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 individuals with spinal cord injury (SCI) in the early post-acute context. The consensus conference took place in Switzerland. Preparatory studies were performed worldwide. Preparatory studies included an expert survey, a systematic literature review, a qualitative study and empirical data collection involving people with SCI. ICF categories were identified in a formal consensus process by international experts from different backgrounds. The preparatory studies identified a set of 531 ICF categories at the second, third and fourth levels. From 30 countries, 33 SCI experts attended the consensus conference (11 physicians, 6 physical therapists, 5 occupational therapists, 6 nurses, 3 psychologists and 2 social workers). Altogether 162 second-, third- or fourth-level categories were included in the Comprehensive ICF Core Sets with 63 categories from the component Body Functions, 14 from Body Structures, 53 from Activities and Participation and 32 from Environmental Factors. The Brief Core Set included a total of 25 second-level categories with 8 on Body Functions, 3 on Body Structures, 9 on Activities and Participation, and 5 on Environmental Factors. A formal consensus process-integrating evidence and expert opinion based on the ICF led to the ICF Core Sets for individuals with SCI in the early post-acute context. Further validation of this first version is needed.