Health Core Set Research Articles

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.

Application of the Brief International Classification of Functioning, Disability, and Health Core Set as a Conceptual Model in Distal Radius Fractures

In 2009, the World Health Organization published a conceptual outcome framework for evaluating upper extremity injury and disease, known as the Brief International Classification of Functioning, Disability, and Health (ICF) Core Set for Hand Conditions. The purpose of this study was to apply the ICF conceptual model to outcomes for distal radius fractures (DRFs) and determine the contribution of each ICF domain to patient satisfaction. Patient-rated and objective functional outcome data were collected at 6 weeks, 3 months, and 6 months after surgery. We measured satisfaction using a subsection of the Michigan Hand Outcomes Questionnaire (MHQ) satisfaction score. Measured study variables were linked to their corresponding ICF domain (personal factors, environmental factors, activity and participation, and body function). We then used hierarchical regression to assess the contribution of each ICF domain to variation in overall patient satisfaction at each time point. We enrolled 53 patients with unilateral DRFs treated with the volar locking plating system. Regression analysis indicated that measured study variables explain 93% (6 weeks), 98% (3 months), and 97% (6 months) of variation in patient satisfaction. For all 3 study assessment dates, activity and participation variables (MHQ-Activities of Daily Living, MHQ-Work, and Jebsen-Taylor Score) contributed the most to variation in patient satisfaction, whereas personal and environmental factors had a considerably smaller role in predicting changes in patient satisfaction. The results demonstrated that it is possible to reliably model the relative contributions of each ICF domain to patient satisfaction over time, and the findings are consistent with previous research (ie, that most outcome variation is due to physical or functional factors). These results are strong enough to support continued use and further research using the ICF model for upper extremity outcomes.

Report on the International ICF Consensus Conference on the ICF Core Sets for Hand Conditions

Objective The aim of the conference was to derive the Brief and the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions from the subset of ICF categories selected on the basis of the preparatory phase research. Methods Following a multistage decision process, the experts agreed on the ICF categories to be included in the ICF Core Sets for Hand Conditions. The development of the ICF Core Sets for Hand Conditions involved a formal decision-making and consensus process, integrating evidence gathered from preparatory studies including a qualitative study, a systematic literature review, an expert survey and an empirical multicentre study. Results Twenty-three experts selected a total of 117 categories for the Comprehensive Core Set and 23 categories for the Brief Core Set. The largest number of categories was selected from the ICF component ‘Activities and Participation’. Conclusion The ICF Core Sets for Hand Conditions serve a clinical framework to comprehensively assess patients in acute care hospitals and early postacute rehabilitation facilities. The first versions of the ICF Core Sets will be further tested and validated through empirical studies.

Effect of Psoriatic Arthritis According to the Affected Categories of the International Classification of Functioning, Disability and Health

To determine the categories of the International Classification of Functioning, Disability and Health (ICF) checklist and core sets of rheumatoid arthritis and ankylosing spondylitis frequently occurring in people with psoriatic arthritis (PsA) and to compare the number of such categories with scores on self-report measures of participation restrictions and activity limitations. Data were collected from 94 patients with PsA attending rheumatology clinics in 6 centers. For each ICF category affected by PsA in at least 30% of patients, the percentage of such patients was determined for Body Structures, Body Functions, Activities and Participation, and Environmental Factors. A count of all affected categories by ICF chapter was compared to patient self-report scores on a number of functional and health status instruments using Spearman's correlation. There were 25 categories in the Body Functions section, 6 categories in the Body Structures section, and 51 categories in the Activities and Participation section that were relevant in at least 30% of participants. Thirteen Environmental Factors were facilitating and 1 Environmental Factor (climate) was a barrier in at least 30% of participants. The number of involved Activities and Participation categories by chapter did not correlate in predictable ways with self-report measures of participation restrictions and activity limitations. PsA is associated with a wide range of impairments, limitations, and restrictions across the ICF categories. People with PsA find environmental factors to be helpful more often than to be barriers. The unexpected pattern of correlation between ICF chapters and self-report measures suggests the need for a better way of quantitatively representing the ICF concepts.

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 feasibility of using International Classification of Functioning, Disability and Health core set for Chinesebreast cancer patients

Objective To determine the reliability, validity and feasibility of using International Classifica-tion of Functioning, Disability and Health (ICF) core set for breast cancer in Chinese patients. Methods Quality of life (QOL) of 110 patients with breast cancer were investigated using ICF breast cancer core set and SF-36 scale. Statistical analysis tested their reliability, validity and feasibility. Results It was shown that the ICF core set for breast cancer had good reliability, validity and feasibility. Conclusions The ICF core set for breast cancer is a re-liable and valid instrument for Chinese breast cancer patients. Key words: Breast cancer; Quality of life ; Scale ; Reliability ; Validity ; Feasibility

ICF Core Sets for individuals with spinal cord injury in the long-term context

A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. The objective of the 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 long-term 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. Relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. The preparatory studies identified a set of 595 ICF categories at the second, third or fourth level. A total of 34 experts from 31 countries attended the consensus conference (12 physicians, 6 physical therapists, 5 occupational therapists, 6 nurses, 3 psychologists and 2 social workers). Altogether, 168 second-, third- or fourth-level categories were included in the Comprehensive ICF Core with 44 categories from body functions, 19 from body structures, 64 from activities and participation and 41 from environmental factors. The Brief Core Set included a total of 33 second-level categories with 9 on body functions, 4 on body structures, 11 on activities and participation and 9 on environmental factors. A formal consensus process integrating evidence and expert opinion based on the ICF led to the definition of the ICF Core Sets for individuals with SCI in the long-term context. Further validation of this first version is needed.

Outcome parameters in spinal cord injury research: a systematic review using the International Classification of Functioning, Disability and Health (ICF) as a reference

This study is part of the development of an International Classification of Functioning, Disability and Health (ICF) Core Set for spinal cord injury (SCI). Its specific objectives were to identify outcome parameters reported in published studies on individuals with SCI in the early post-acute and chronic situation, and to identify and quantify the concepts of the reported parameters using the ICF as a reference. Electronic searches of Medline, EMBASE, PsycINFO and CINAHL from 2001 to 2005 were carried out. All outcome parameters and their underlying concepts were retrieved from the included studies. These concepts were linked to categories of the ICF using standardized rules. From the 6681 abstracts retrieved, 2205 were randomly selected (33.0%) and 281 studies met the inclusion criteria (12.7%). A total number of 5217 concepts were retrieved from standardized and non-standardized measures, of which 4049 (77.6%) could be linked to 175 different ICF categories: 56 out of 114 Body Functions, 19 out of 56 Body Structures, 62 out of 118 Activities and Participation and 38 out of 74 Environmental Factors categories. Second-level categories reported in >20% of all studies were pain, remunerative employment, health services, systems and policies, school education and higher education. The ICF provides a valuable reference to identify and quantify the concepts of measures focusing on SCI in the early post-acute and chronic situation. The findings show a great diversity in the consequences of SCI and underscore the importance of social participation and environment for people with SCI.

International classification of functioning, disability, and health core sets for hearing loss: A discussion paper and invitation

The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) has adopted a multifactorial understanding of functioning and disability, merging a biomedical paradigm with a social paradigm into a wider understanding of human functioning. Altogether there are more than 1400 ICF-categories describing different aspects of human functioning and there is a need to developing short lists of ICF categories to facilitate use of the classification scheme in clinical practice. To our knowledge, there is currently no such standard measuring instrument to facilitate a common validated way of assessing the effects of hearing loss on the lives of adults. The aim of the project is the development of an internationally accepted, evidence-based, reliable, comprehensive and valid ICF Core Sets for Hearing Loss. The processes involved in this project are described in detail and the authors invite stakeholders, clinical experts and persons with hearing loss to actively participate in the development process.SumarioLa Clasificación sobre Funcionalidad, Discapacidad y Salud de la Organización Mundial de la Salud (ICF) ha adoptado un acercamiento multifactorial de la funcionalidad y la discapacidad, fusionando un paradigma biomédico con un paradigma social de una forma más amplia. En su conjunto hay más de 1400 categorías ICF que describen diferentes aspectos de la funcionalidad humana y existe la necesidad de desarrollar una lista corta de categorías ICF para facilitar el uso de la clasificación en un esquema para la práctica clínica. Es de nuestro conocimiento que actualmente no existe un instrumento de medición estándar que facilite una forma válida y cómoda para evaluar los efectos de la hipoacusia en la vida de los adultos. El propósito de este proyecto es desarrollar un conjunto básico de condiciones de salud ICF para la hipoacusia que sea internacionalmente aceptado, basado en evidencia, confiable e integral. Se describen en detalle los procesos implicados en este proyecto y los autores invitan a las personas interesadas, a los expertos clínicos y a las personas con hipoacusia a participar activamente en el desarrollo de este proceso.

Assessing stroke patients with the International Classification of Functioning, Disability and Health core sets

Objective To investigate the functional states of stroke patients using the International Classification of Functioning, Disability and Health (ICF) core sets for stroke. Methods Fifty in-patients with stroke participated in this study. Twenty-five patients less than one month after a stroke were assigned to the acute group, and another 25 patients with more than one month since their stroke were assigned to the sub-acute and chronic group. All the patients were assessed using the Glasgow coma scale, Rankin grading and the Barthel index. The ICF core set for stroke assessment was also used with both groups. The data was analyzed by using a Chi squared frequency test. Results Rankin grades and Barthel indices were significantly different between the two groups, and the functional states in the acute group were better than those in the sub-acute and chronic group. Some of the items, such as consciousness state, functions of structures adjoining the eyes, hearing, substitutive sound, accessory respiration, temperature regulation and protection function of the skin had no significant difference between the groups. The number of patients suffering from disorders of joint motion, joint stability, muscle endurance and control of voluntary movement was significantly greater in the sub-acute and chronic group than in the acute group. Both groups were influenced to different degrees by most of the environmental factors. Conclusion The ICF core sets correctly indicated joint motion, joint stability, muscle endurance and control of voluntary movement difficulties of stroke patients. Key words: International Classification of Functioning, Disability and Health; Stroke; Motor function

Functioning of stroke survivors – A validation of the ICF core set for stroke in Sweden

Purpose. To validate the body functions and activities and participation part of the extended International Classification of Functioning, Disability, and Health (ICF) core set for stroke with a Swedish population in the first 3 months post-stroke.Method. At 6 weeks and at 3 months post-stroke, stroke survivors were evaluated by 59 ICF categories of body functions, 59 categories of activities and participation from the stroke ICF core set (extended version).Results. The study sample included 99 stroke survivors (54% women) with an average age of 72 years. Statistical significant problems were identified in 28 ICF categories of body functions and in 41 ICF categories of activities and participation at both time points, at 6 weeks and at 3 months. About 17 ICF categories were reported as problems in independent (i.e. modified Rankin Scale (mRS) ≤2) and about 34 categories in dependent (i.e. mRS > 2) stroke survivors.Conclusions. The results suggest a possible reduction of the stroke ICF core set from 59 to 28 categories of body functions and from 59 to 41 categories of activities and participation. Hence, feasibility of the core set for multiprofessional assessment increases and the core set might find more integration in clinical practice. The number of problems in mobility and self-care mainly distinguished between independent and dependent stroke survivors.

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.

Validation of the International Classification of Functioning, Disability and Health (ICF) core set for diabetes mellitus from the patient perspective using focus groups

The Comprehensive ICF Core Set for diabetes mellitus (DM) is a specific application of the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization for clinical and research purposes involving the disorder. It represents the typical spectrum of functional problems in patients with DM. The objective of the study was to validate the Comprehensive ICF Core Set for DM from the perspective of patients. The specific aims were to explore the aspects of function and health important to patients with DM using focus group methodology and to examine to what extent these aspects are represented by the Comprehensive ICF Core Set for DM. A qualitative study using focus group methodology was conducted. Sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The focus group discussions were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for data analysis. The resulting meaningful concepts were linked to ICF categories according to established linking rules. Forty patients participated in eight focus groups. Seventy-five of the 85 ICF categories contained in the Comprehensive ICF Core Set for DM were identified by the patients. Forty-seven additional categories that are not covered by the Comprehensive ICF Core Set for DM were identified. The Comprehensive ICF Core Set for DM could be largely confirmed by the focus groups. Categories currently not covered by the Comprehensive ICF Core Set for DM should be investigated further.

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis capture nursing practice? A Delphi survey

Background The “Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)” is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA. Objectives The objective of this study was to validate this ICF Core Set from the perspective of nurses. Method Nurses experienced in RA treatment were asked about the patients’ problems, patients’ resources and aspects of environment that nurses take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF. Results 57 nurses in 15 countries named 1170 concepts that covered all ICF components. 20 concepts were linked to the as yet undeveloped ICF component Personal Factors. 19 ICF categories are not represented in the Comprehensive ICF Core Set for RA. Conclusion The validity of the Comprehensive ICF Core Set for RA was largely supported by the nurses. However, a number of body functions which address side effects of drug therapies were not included in the Comprehensive ICF Core Set for RA. Furthermore, several issues arose which were not precisely covered by the ICF like “dry mucous”, “risk for decubitus ulcers” and “height” and need to be investigated further.

Developing Core Sets for Persons With Traumatic Brain Injury Based on the International Classification of Functioning, Disability, and Health

The authors outline the process for developing the International Classification of Functioning, Disability, and Health (ICF) Core Sets for traumatic brain injury (TBI). ICF Core Sets are selections of categories of the ICF that identify relevant categories of patients affected by specific diseases. Comprehensive and brief ICF Core Sets for TBI should become useful for clinical practice and for research. The final definition of the ICF Core Sets for TBI will be determined at an ICF Core Sets Consensus Conference, which will integrate evidence from preliminary studies. The development of ICF Core Sets is an inclusive and open process and rehabilitation professionals are invited to participate.

The use of the comprehensive International Classification of Functioning, Disability and Health Core Set for low back pain in clinical practice: a reliability study

The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for low back pain (LBP) can be used to describe functioning and the influence of the environment of patients with LBP with a selection of 78 categories, from the ICF components 'body functions', 'body structures', 'activities and participation' and 'environmental factors'. The reliability of the qualifiers' scale of the ICF Core Set for LBP has not yet been studied. Reliability study was conducted in three study centres in the German-speaking part of Switzerland. In the first step, two physiotherapists independently assessed 31 patients with LBP with the original qualifier scale of the 78 ICF categories from the comprehensive ICF Core Set for LBP. After the first 31 patients, inter-rater reliability was assessed and the response options were reduced based on a Rasch analysis. The second sample (n = 30) was assessed by the physiotherapists with the modified qualifier scale and inter-rater reliability was calculated again. The percentage agreement for the ICF categories ranged from 19% to 87%, mean 44% (nominal kappa from -0.73 to 0.54, median 0.22; weighted kappa -0.2 to 0.69, median 0.38) in the first round with the original qualifier scale. In the second round with the reduced response options, the percentage agreement ranged from 23% to 90%, mean 49% (nominal kappa from -0.15 to 0.71, median 0.24; weighted kappa -0.16 to 0.81, median 0.25). The overall percentage agreement was 44% in the first round and 49% with the reduced response categories. The overall kappa value in the first round was 0.29 and in the second round 0.32. There was a small but statistically significant improvement in the agreement. The low-to-moderate reliability found in this study requires an improved operationalization (e.g. the definition and description of each response category) and improved instructions for the ICF Core Set for LBP.

Construct dimensionality and properties of the categories in the ICF Core Set for low back pain

The aim of this study was to explore by Rasch analysis whether the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set might represent a future clinical tool for measuring functioning of patients with low back pain. Material and methodsThe Comprehensive ICF Core Set for low back pain was scored by health professionals for 118 patients with low back pain. Qualifier levels, invariance, construct validity and ordering of the categories in the components of Body function, Body structure, Activities and participation and Environmental factors were explored by Rasch analysis. The number of qualifier levels had to be reduced. Categories within Body functions and within Environmental factors reflected a single underlying construct. The categories within the component of Activities and Participation did not meet the requirements of a single underlying construct in the present population. Few categories covered the problems reported by patients with a relatively high level of function. Rasch analysis indicated that the Comprehensive ICF Core Set for low back pain may be used with some modification of categories as a common tool for assessing problems within the components Body functions, and Activity and Participation. However, detecting ICF categories that reflect the higher functional levels in patients with low back pain, and revision of the qualifier levels may be necessary.

Validation of the International Classification of Functioning, Disability and Health Core Set for chronic widespread pain from the perspective of fibromyalgia patients

IntroductionFunctioning is recognized as an important study outcome in chronic widespread pain (CWP). The Comprehensive ICF Core Set for CWP is an application of the International Classification of Functioning, Disability and Health (ICF) with the purpose of representing the typical spectrum of functioning of patients with CWP. The objective of the study was to add evidence to the validation of the Comprehensive ICF Core Set for CWP from the patient perspective. The specific aims were to explore the aspects of functioning and health important to patients with fibromyalgia, and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for CWP.MethodsThe sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for qualitative data analysis. After qualitative data analysis, the identified concepts were linked to ICF categories.ResultsThirty-three patients participated in six focus groups. Fifty-four ICF categories out of 67 categories of the Comprehensive ICF Core Set for CWP were reported by the patients. Forty-eight additional categories that are not covered in the Comprehensive ICF Core Set for CWP were raised.ConclusionsMost ICF categories of the existing version of the Comprehensive ICF Core Set for CWP could be confirmed from the patient perspective. However, several categories not included in the Core Set emerged and should be considered for inclusion.

Retaining the patient perspective in the International Classification of Functioning, Disability and Health Core Set for low back pain

To examine the relationship between health problems as rated by the health professionals in the Norwegian form of the Core Set for low back pain and the patients' self-reported health problems in Oswestry Disability Index (ODI) and World Health Organization Disability Assessment Schedule II (WHODAS II). This was part of an international multicenter study where a convenience sample of 118 Norwegian patients with low back pain (LBP) participated. The ICF Core Set for LBP was filled in by the health professionals. The patients reported their health problems in the WHODAS II and ODI. The items in WHODAS II and ODI were linked to the ICF. The problems reported in WHODAS II and ODI were compared to the problems scored by the health professionals in the linked ICF categories in the Comprehensive ICF Core Set for LBP. All items in ODI could be linked the ICF. Four items in WHODAS II could not be linked to the ICF and additionally two items could not be linked to specific ICF categories. All ICF categories linked to the ODI were included in the Comprehensive Core Set for LBP, whereas six items in WHODAS II could not be linked, and additionally 11 of the items were not represented in the Core Set. With the exception of sexual function, above three quarter of the patients' reported problems within body functions was captured by the health professionals. Within several of the activities and participation categories the health professionals scores in the ICF reflected the patients' reported problems well. Surprisingly some of the problems in activities of daily living were poorly reflected. The Comprehensive ICF Core Set for LBP covers most of the items in ODI and WHODAS II in areas where patients report significant problems, with some exceptions. The subjective dimension related to the impact of the health condition as well as the feeling of being a burden to their family appeared to be important to these patients and not covered in the ICF. Problems with sexual functions and relationship were poorly reflected in the health professionals' scores in the Comprehensive ICF Core Set for LBP. In clinical practice it is a challenge to assess the individual patients' broad spectrum of problems precisely.

Responsiveness of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis

Background:The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the ICF, representing relevant aspects in the...