WHO ICF Research Articles

Disseminating the F-Words for Child Development to Parents of Children With Developmental Disabilities in Iran: A Qualitative Pilot Feasibility Study.

Attitudes toward childhood disability have historically focused on biomedical efforts on 'fixing'. The introduction of WHO's ICF framework for health and Canadian researchers' 'F-words' (functioning, fitness, fun, friends, family and future) have significantly changed the field. To explore whether the F-words ideas influenced parents' perspectives on their child's abilities and rehabilitation goals, this qualitative pilot study introduced the F-words to Iranian parents with a child with a developmental disability. This study was conducted in Tabriz, Iran, in 2023, using Iranian educational F-words materials built on ideas available on the CanChild F-words Knowledge Hub. Data were collected through semistructured interviews with five mothers of children <5 years old with a developmental disability before and after attending an 'F-words Awareness Session' and analysed using thematic analysis. In the preinterviews, six themes (and 20 subthemes) were identified: (i) routines (5); (ii) challenges (4); (iii) parental concerns (3); (iv) child's needs and priorities (3); (v) the role of parents in satisfying needs and challenges (2); and (vi) expectations of rehabilitation (3). In the postinterview, the same six themes and four additional subthemes emerged. Findings from the pilot study showed that the intervention had an impact on the attitudes and behaviours of participants. Specifically, teaching about the F-words reduced parents' emphasis on the concept of 'normality'. Families' positive response to the 'F-words Awareness Session' indicates their openness to incorporating this approach into their daily lives. These findings highlight the potential benefits of utilizing the F-words in rehabilitation in Iran. Studies like these can serve as a foundation for developing effective strategies for integrating the F-words into existing rehabilitation practices in Iran.

INNOVATION AND DIGITAL TRANSFORMATION IN HEALTHCARE. PROCESS OPTIMIZATION OF REHABILITATION ACTIVITIES IN IN REHABILITATION CARDIOLOGY IN SUPPORT OF PATIENT AND TEAM

Abstract Physical activity is a treatment for preventing and treating a wide range of diseases; its prescription must be precise and accurate in order to optimize the effects avoiding at the same time clinical risks due to frequent patients’ frailty.To deploy a “comprehensive digital rehabilitation” means to digitalize the whole process: from clinical and instrumental evaluations to the subsequent coherent prescriptions of the rehabilitation and care–related activities, from the case management planning – described in the individual rehabilitative project – to the individual rehabilitative program – that takes shape in semi–automated scheduling and in digitalized reporting. The deployed software must be easy to use and reliable, and must ensure safety, guaranteeing the exchange of clinical information among the team members. For all these reasons, we have pre–set pathways that, starting from the main and secondary clinical diagnosis (using the ICD classification) and based thereafter on the WHO ICF classification, the rehabilitation processes are governed in a standardized tailored granularity for each single patient by the aid of a computerized expert system. Even if it what just stated appears an oxymoron, thanks to the digital transformation and the adoption of the Internet of Things, it is possible to easily implement a personalized rehabilitation program through a shared and standardized ontology, providing benefits both to the patient and to the rehabilitation team. Based on this, the rehabilitation services that can be provided have been defined, providing not only those provided for by national and regional nomenclators but also those peculiar to the activities in our Institutes. The digital gym goes beyond the concept of equipment in a gym space; the gym space becomes both physical and virtual. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of IoT, that path of technological development whereby, through the Internet network, potentially every object of daily experience acquires its own identity in the digital world. All this will allow for real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine and cloud computing, begin to enable an integration of people, equipment and data.

Development and validation of a WHO ICF compliant hand and upper limb assessment tool for children: The Reach Out questionnaire

BackgroundCurrent tools for evaluating hand and upper limb function in children do not represent all domains of the World Health Organization International Classification of Disability, Functioning and Health (ICF) framework and may not capture an accurate progression or regression of function over time. PurposeBased on this framework, we have developed an assessment tool (Reach Out) to evaluate function in children aged from 2 to 16 years following consultation with an advisory panel of specialists. Study designPrimary clinical study. MethodsConstruct validity along with test-retest reliability, inter-rater reliability and sensitivity to change have all been analyzed to validate the Reach Out assessment tool. ResultsThe assessment tool has been validated in a total of 231 patients. Significant construct validity of 0.64 (P < .00001, 95% confidence interval = 0.56-0.71, n = 231) for both age groups and diagnostic groups was observed. The Reach Out questionnaire was internally consistent with a Cronbach’s Alpha of > 0.8 for most domains in most age groups. Test re-retest scores showed that the questionnaire was reliable with most domains of the questionnaire achieving high scores of reliability (P ≤ .03). We also received positive feedback from participants and parents. ConclusionsThe use of this new tool will help identify both progression and regression of function, allowing a more tailored and holistic approach to treatment in children with conditions affecting the hand and upper limb through the incorporation of International Classification of Disability, Functioning and Health domains. This tool is quicker to complete and can be applied to a wide range of ages and diagnostic groups compared to previous assessment tools.

Understanding care plans in a psychiatric mother-baby unit

ABSTRACT Introduction Care plans outline collaborative goals and strategies for recovery. While care planning is recommended across international mental health guidelines, scant attention has examined the unique nature of care planning within psychiatric mother-baby units. This retrospective audit aims to explore the content of care planning goals, compare against the World Health Organisation’s (WHO) International Classification of Functioning, Disability, and Health (ICF), and devise a care plan framework to support development of admission goals. Methodology A total of 63 care plans across admission, mid-admission and discharge were analysed. Using deductive content analysis, care plan goals were compared to the WHO ICF codes. Inductive content analysis was used to generate a framework for care plans. Results When compared to the WHO ICF codes, care plans were most commonly coded against d570 (looking after one’s health) and d7600 (parent-child relationships). Care plans covered six main themes: mental health recovery, physical health, connecting with baby, caring for baby, relationships, and community supports. Discussion This study is the first to examine the nature of recovery goals in care plans within a mother-baby unit. The results inform a framework to support care planning and thereby facilitate holistic well-being and recovery for a mother with mental illness.

Outcomes of an interprofessional intensive comprehensive aphasia program’s first five years

ABSTRACT Background and Objectives This ICAP program is a collaboration between an institute of health professions and a rehabilitation hospital. It was a 6-week intensive treatment program for people with post-stroke aphasia designed to maximize recovery and return to activities. This retrospective study investigated outcomes of this program offered annually from 2015 to 2019. Methods This is an analysis of existing data collected for other purposes. While conducting a therapeutic program for people with aphasia, data were not collected for the purpose of conducting research. The treatment components addressed the activity participation goals of 35 participants. Programming consisted of individual and group speech-language and occupational therapy, adaptive sports, swimming, music therapy, and a wellness mindfulness group.. Participants received a comprehensive evaluation and a treatment plan addressing their individual participation goals, delivered primarily by SLP and OT graduate students under faculty supervision. Pre- and post-treatment outcomes were measured within four WHO ICF domains: impairment, participation, environment, person. Each cohort consisted of seven or eight community-dwelling participants seen four days/week. Results Significant post-treatment changes were observed on measures within the impairment domain and on self-perception measures of participation, functional communication, and communication confidence. Subsequent analyses found a subset of 15 responders (WAB Aphasia Quotient change of ≥5) drove most significant effects seen on performance-based impairment measures, but that patient-reported self-perception measures showed significant changes in both responders and non-responders. Conclusions Results support research indicating that short-term intensive, interprofessional comprehensive aphasia programs (ICAPs) are effective treatment options for people with moderate-to-severe aphasia.

Characterizing gaze and postural stability deficits in people with multiple sclerosis

BackgroundPeople with Multiple Sclerosis (PwMS) experience a wide range of symptoms that can alter function and limit activity and community participation. Symptoms including sensory changes, weakness, fatigue and others have been well documented. However, symptoms related to changes in vestibular related function, including gaze and postural stability have not been fully explored. While some recent studies have begun to provide insight into these deficits in PwMS and have explored the use of rehabilitation paradigms for their management, much remains unknown about the full extent of these deficits. Therefore, this study aimed to characterize the presence of gaze and postural stability deficits in measures across the World Health Organization International Classification of Functioning, Disability, and Health (WHO ICF) and to examine how deficits in domains of body structure and function and activity contribute to participation level limitations. MethodsBaseline data from 41 PwMS (mean(SD) age = 53.9(11.2), 78% female) enrolled as part of a randomized clinical trial were used in this analysis. Measures of gaze and postural stability from the ICF domains of body structure and function (Vestibular ocular reflex [VOR] gain and postural sway area), activity (computerized dynamic visual acuity [cDVA] and MiniBEST test), and participation (Dizziness handicap inventory [DHI] and Activities Balance Confidence [ABC] scale) along with demographic data were used to characterize the sample. To explore relationships between ICF domains for gaze and postural stability, univariate correlations were performed between measures from each domain using Pearson's correlations. Separate multivariate regression models examined how measures from the body structure and function and activity domains contributed to the variance in the participation level outcomes. Variance explained by the models was quantified using R-squared statistic and contribution of the independent variables were quantified using the beta coefficient (p < 0.05). ResultsCorrelation analysis demonstrated significant relationships in the postural stability measures across domains. Specifically, between postural sway area on a firm surface and MiniBEST test score (r = -.48;p < 0.01) and MiniBEST test score and ABC score (r = 0.5;p < 0.01). Significant correlations were also found between the gaze stability measures of horizontal and vertical VOR gain (r = .68;p < 0.001), horizontal VOR gain and dynamic visual acuity (r = .38;p = 0.02), and vertical VOR gain and dynamic visual acuity (r = .54;p < 0.001). Regression models assessing postural stability, found that only the MiniBEST score significantly contributed to the variance in ABC score (p = 0.01) and the full model explained 34% of the variance in ABC score. Regression modeling of gaze stability outcomes did not produce any variable that significantly contributed to the variance in DHI score and the full model explained 18% of the variance in DHI score. ConclusionsPwMS in this sample demonstrated deficits in gaze and postural stability across the domains of the WHO ICF compared to past samples of PwMS and healthy cohorts. Correlation between measures in the different domains were present, but no strong relationship between measures of body structure and function, activity and participation level outcomes were observed. This lack of relationship across the domains is likely contributed to the relatively small sample size, the high level of variability observed in the outcomes, and the diverse presentation often seen in PwMS.

The self-report version and digital format of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) for Long Covid or Post-COVID syndrome assessment and monitoring

The C19-YRS was the first scale reported in the literature for patient assessment and monitoring in Long Covid or Post-COVID syndrome. The scale has demonstrated content validity in a previous COVID-19 follow-up study. The growing number of patients with Post-COVID syndrome required the development of a self-report version (and a digital format) so that the scale can be completed by patients themselves. Individuals with Long Covid and clinicians providing care were involved in iterative changes to the scale. The self-report version of the scale captures symptom severity, functional disability and global health status. The C19-YRS digital format comprises a smartphone application for the patient and a web portal for the clinician to assess, triage and monitor patients remotely. The items have been shown to span all the components of the WHO ICF Framework for health condition.

Psychometric properties of the International Classification of Functioning, Disability and Health Rehabilitation Set: a Rasch analysis.

The International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set was proposed by the WHO ICF Research branch as a minimum standard for assessing and reporting functioning in a wide range of clinical settings. This study investigates the psychometric properties of ICF Rehabilitation Set using Rasch analysis. It was a multicenter, cross-sectional study involving 515 inpatients in the subacute or chronic phase of recovery from various health conditions selected by quota sampling (stratified by neurological, cardiopulmonary, musculoskeletal and other conditions). Registered physicians or nurses used the developed operational items of the ICF Rehabilitation Set to rate patients' functioning. A Rasch model was performed in assessing the psychometric properties of the ICF Rehabilitation Set. Good reliability was observed in the activity and participation components, but the body functions component needs additional items to distinguish among people with moderate or severe problems. After recalibration, the body functions, activities and participation components showed fit to the Rasch model. However, deletions mandated by the Rasch model decreased the functioning information reflected by the ICF Rehabilitation Set.

WHO ICF as an Assessment Tool For Evaluation of Selfcare Activities of the Child With Cerebral Palsy

The study was conducted in two stages. At the first stage, quantitative methods were chosen as methodologies, since the object that is studied by this method is a quantitative unit, which in the future allows to draw conclusions, based on the results, using certain numerical models to develop or confirm new hypotheses, or/and refute existing ones. At the second stage, a qualitative study was conducted on the basis of the results of the first stage, accordingly developing recommendations on ergotherapy for each code issue. According to the study results, in today's Armenia, it is possible to issue all the problems that children with Cerebral Palsy face in self-care and life by using certain assessing tools of occupational therapy. In this case, the study shows that the evaluation of the World Health Organization International Classification of Functioning and Disability, Children and Youth (2008) allows to observe and issue the existing problems of this sphere in a more accurate and comprehensive way․ It also provides an objective basis for identifying the problems in the field of children's self-service and life, which, in its turn, allows the occupational therapist to conduct a detailed assessment to find out which self-service actions are available to the child, to what extent the child’s actions and personal roles are compatible with the current state of the disease, and to what extent the actions correspond to their age.

Environmental Factors Affecting Early Mobilization and Physical Disability Post-Intensive Care: An Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health.

Early mobilization (EM) is one of few potential protective factors associated with reduced physical disability post-intensive care (PD PIC). However, only 45% of intensive care units (ICUs) in the United States routinely practice EM despite its recognized benefits. To analyze the evidence on the relationship between critical care EM, PD PIC, and environmental factors, using the theoretical lens of the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF). The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the WHO ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized. Early mobilization was related to improved functioning on the disability continuum of the WHO ICF. Early mobilization was influenced by several WHO ICF environmental factors. Dedicated physical and occupational therapy teams in the ICU, interdisciplinary rounds, and positive family and staff perception of EM facilitated intervention delivery. However, poor staffing levels, negative unit culture, perceived workload burden, and lack of equipment, education, and financial support impeded delivery of EM. Early mobilization is a promising intervention that may reduce PD PIC. However, environmental factors negatively influence delivery of EM in the ICU. Several gaps in EM research limit its acceptability in ICU practice. Existing EM research is challenged by poor methodological quality. Further study is necessary to better understand the role of EM on PD PIC and improve patient outcomes following critical illness.

Applying the WHO ICF Framework to the Outcome Measures Used in the Evaluation of Long-Term Clinical Outcomes in Coronavirus Outbreaks.

(1) Objective: The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up studies of coronavirus outbreaks and make recommendations for future studies. (2) Methods: EMBASE, MEDLINE, CINAHL and PsycINFO were systematically searched for original studies assessing clinical outcomes in adult survivors of severe acute respiratory distress syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease-19 (COVID-19) after hospital discharge. Individual items of the identified outcome measures were linked to ICF second-level and third-level categories using ICF linking rules and categorized according to an ICF component. (3) Results: In total, 33 outcome measures were identified from 36 studies. Commonly used (a) ICF body function measures were Pulmonary Function Tests (PFT), Impact of event scale (IES-R) and Hospital Anxiety and Depression Scale (HADS); (b) ICF activity was 6-Minute Walking Distance (6MWD); (c) ICF participation measures included Short Form-36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ). ICF environmental factors and personal factors were rarely measured. (4) Conclusions: We recommend future COVID-19 follow-up studies to use the ICF framework to select a combination of outcome measures that capture all the components for a better understanding of the impact on survivors and planning interventions to maximize functional return.

105 Functional Recovery in Older Women Undergoing Surgery for Gynaecological Malignancies: A Systematic Review and Narrative Synthesis

Abstract Introduction Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. However older people are both more vulnerable to changes in function and often prioritise function over survival. There is limited published research examining function outside of context of sexual or urodynamic function following gynaeoncology surgery but a large body or research exists examining health-related quality of life (HrQOL) both as a pre-operative risk factor for survival and as a post-treatment outcome measure in its own right. HRQOL tools may report on physical function as a subcomponent within composite tools. This systematic review and narrative synthesis describes functional recovery after gynae-oncology surgery with respect to baseline characteristics which - if identified – could enable pre- or post-operative risk reduction. Methods Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974-2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria:Mean/median age &amp;gt;60Gynaeoncological treatment includes surgery (RCTs, observational or mixed methods studies).Any measure of functional ability as defined by WHO ICF classification section D1–D7 inclusive, D855, D860-79 and D9 using validated tool.Minimum pre-operative and one post-operative measure. Results analysed and presented using narrative synthesis. Results Sixteen studies identified (7 Endometrial, 2 Ovarian, 2 Vulval, 6 mixed cancer types). 1/16 used a standalone functional assessment tool, 15/16 used Health-Related Quality of Life tools (EORTC QLQ C30 (10), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline (n=11) than incomplete recovery (n=5 including 2 reporting age as a negative association). Recovery was more likely and occurred faster in minimally-invasive surgery. 1 study demonstrated failure to recover baseline functional independence by 12 months.

Assessing long-term rehabilitation needs in COVID-19 survivors using a telephone screening tool (C19-YRS tool)

The COVID-19 pandemic has caused more than 5 million infections and 300,000 deaths worldwide. Many survivors of the illness are likely to have long-term symptoms and disability that will pose a significant burden to the healthcare systems and economies all over the world. Given the scale of the burden and lockdown measures in most countries, there is a need for a pragmatic tele-assessment tool to screen for needs and target rehabilitation interventions in time. A comprehensive multi-system telephone screening tool called COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) tool has been developed by multi-disciplinary-rehabilitation teams from Leeds, Airedale and Hull NHS Trusts to assess and capture symptoms and guide rehabilitation interventions for these individuals. The tool has been shown to cover all the components of the WHO ICF Framework.

PATTERNS OF SOCIAL ENGAGEMENT AMONG OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT

Promoting engagement in social activities may be an intervention that prevents or delays cognitive impairment. Nevertheless, little is known about social engagement among people with mild cognitive impairment. We aim to examine patterns of social engagement among people with mild cognitive impairment and to assess whether factors under four domains of the WHO's ICF model (personal factors, environmental factors, body functions and structures, and health condition) are associated with patterns. Data were drawn from the 2010 Health and Retirement Study. The final sample comprised 1,227 people with Cognitive Impairment No Dementia (CIND). Latent class analysis and multinomial logistic regression were utilized. Three patterns of social engagement were identified: informal social engagement only, formal and informal social engagement, and low social engagement. At least one factor from each domain was associated with the probability of class membership. Our findings suggest that social engagement is heterogeneous among people with CIND and that some groups of people with CIND have possibilities of engaging in more social activities, especially in formal social activities. Results also indicate that providing informal social resources may be essential for social programs designed specifically for people with CIND to promote their formal social engagement. Future study is needed to examine possible differences in outcomes across groups with similar patterns of social engagement.

ClinFIT

ClinFIT

The efficacy of an inter-disciplinary community aphasia group for living well with aphasia

ABSTRACTBackground: Community aphasia groups (CAGs) are argued to have various benefits for people with chronic aphasia. However, there is a paucity of evidence regarding the feasibility of conducting an interdisciplinary programme with content and outcome measures encompassing ICF domains, making it difficult to ascertain the full potential of this service option. As another key population living with aphasia, family members have received little attention in CAG research to date.Aim: To determine potential efficacy of a speech-language pathologist- and social worker-led CAG model for four people with aphasia (PWA) and their spouses on living well with aphasia within a proof-of-concept trial.Methods & Procedures: Informed by extensive study of the existing CAG literature, we developed a comprehensive 12-week interdisciplinary CAG model and trial protocol (the InterD-CAG). We used a Phase I pre-post design with a follow-up phase. The group was co-facilitated by a speech-language pathologist and social worker with support from aide staff. The group met at a university clinic for 2 h per week over 12 consecutive weeks. The protocol comprised a combination of communication therapy; conversation practice; social, peer, and psychological support; stroke and aphasia information; and participation in meaningful and accessible activities. Group session time was split into two formats: (1) concurrent sessions dedicated to members with aphasia alone/spouses alone and (2) mixed sessions with both members with aphasia and spouses together. The Therapeutic Factors Inventory was administered at regular intervals during the programme to ascertain participants’ perceptions of group process. Pre, post, and follow-up outcome measures spanned all WHO ICF domains for PWA, with measures for spouses addressing supported conversation skills, psychological health, and carer burden.Outcomes & Results: Both PWA and spouses perceived the presence of therapeutic factors to be medium or high by Week 12 in the programme. Our hypotheses for significant improvement for PWA in quality of life, aphasia impairment, activity & participation, and contextual factors were partially supported and maintenance of gains was observed in some cases. No clear changes were evident for spouses.Conclusions: This study contributes preliminary evidence for the efficacy of the InterD-CAG model for people with chronic aphasia. Larger-scale studies with comparison groups are required to build on the present findings with specific attention to spouse support needs.

Towards a Common Understanding of the Health Sciences.

The aim of health sciences is to maintain and improve the health of individuals and populations and to limit disability. Health research has expanded astoundingly over the last century and a variety of scientific disciplines rooted in very different scientific and intellectual traditions has contributed to these goals. To allow health scientists to fully contextualize their work and engage in interdisciplinary research, a common understanding of the health sciences is needed. The aim of this paper is to respond to the call of the 1986 Ottawa Charter to improve health care by looking both within and beyond health and health care, and to use the opportunity offered by WHO's International Classification of Functioning, Disability and Health (ICF) for a universal operationalization of health, in order to develop a common understanding and conceptualization of the field of health sciences that account for its richness and vitality. A critical analysis of health sciences based on WHO's ICF, on WHO's definition of health systems and on the content and methodological approaches promoted by the biological, clinical and socio-humanistic traditions engaged in health research. The field of health sciences is presented according to: 1) a specification of the content of the field in terms of people's health needs and the societal response to them, 2) a meta-level framework to exhaustively represent the range of mutually recognizable scientific disciplines engaged in health research and 3) a heuristic framework for the specification of a set of shared methodological approaches relevant across the range of these disciplines. This conceptualization of health sciences is offered to contextualize the work of health researchers, thereby fostering interdisciplinarity.

Functional swallowing outcomes following treatment for oropharyngeal carcinoma: a systematic review of the evidence comparing trans-oral surgery versus non-surgical management.

Trans-oral surgical and non-surgical management options for oropharyngeal squamous cell carcinoma (OPSCC) appear to offer similar survival outcomes. Functional outcomes, in particular swallowing, have become of increasing interest in the debate regarding treatment options. Contemporary reviews on function following treatment frequently include surrogate markers and limit the value of comparative analysis. A systematic review was performed to establish whether direct comparisons of swallowing outcomes could be made between trans-oral surgical approaches (trans-oral laser microsurgery (TLM)/trans-oral robotic surgery (TORS)) and (chemo)radiotherapy ((C)RT). Systematic review. MEDLINE, Embase and Cochrane databases were interrogated using the following MeSH terms: antineoplastic protocols, chemotherapy, radiotherapy, deglutition disorders, swallowing, lasers, and trans-oral surgery. Two authors performed independent systematic reviews and consensus was sought if opinions differed. The WHO ICF classification was applied to generate analysis based around body functions and structure, activity limitations and participation restriction. Thirty-seven citations were included in the analysis. Twenty-six papers reported the outcomes for OPSCC treatment following primary (C)RT in 1377 patients, and 15 papers following contemporary trans-oral approaches in 768 patients. Meta-analysis was not feasible due to varying methodology and heterogeneity of outcome measures. Instrumental swallowing assessments were presented in 13/26 (C)RT versus 2/15 TLM/TORS papers. However, reporting methods of these studies were not standardised. This variety of outcome measures and the wide-ranging intentions of authors applying the measures in individual studies limit any practical direct comparisons of the effects of treatment on swallowing outcomes between interventions. From the current evidence, no direct comparisons could be made of swallowing outcomes between the surgical and non-surgical modalities. Swallowing is a multidimensional construct, and the range of assessments utilised by authors reflects the variety of available reporting methods. The MD Anderson Dysphagia Inventory is a subjective measure that allows limited comparison between the currently available heterogeneous data, and is explored in detail. The findings highlight that further research may identify the most appropriate tools for measuring swallowing in patients with OPSCC. Consensus should allow their standardised integration into future studies and randomised control trials.

The Use of Validated Clinical Outcome Measures in Spinal Surgery: An Analysis of Recent Annual Meeting Abstracts

Introduction Recently, the field of outcome assessment for patients undergoing spinal surgery has become the focus of investigation. Health-related quality of life outcome measures are fundamental to our understanding of the impact of surgical intervention on patients. Major spine academic groups have placed increasing emphasis on the use of HRQOL outcome measures, and this is no more obvious that in the requirements for abstract submissions to annual scientific meetings. The purpose of our study was to analyze the use of clinical outcome measures in abstracts accepted to the North American Spine Society (NASS) and Canadian Spine Society (CSS) annual meetings from 2010 to 2013 inclusively. We investigated the disease populations studied, the HRQOL outcome measures used, determined whether those measures had been validated in the specific patient population, and finally, whether the outcome measures used could be linked to the current WHO International Classification of Functioning, Disability, and Health (ICF). Material and Methods Accepted abstracts to NASS and CSS annual meetings from 2010 to 2013 were read. The frequency of abstracts containing clinical outcome measures and the frequency of validated versus non-validated outcome measures were analyzed. A systematic literature search was then performed using the Cochrane Library Database, PubMed, and the NASS evidence-based clinical guidelines. The concepts contained in the items of the 10 most commonly used outcome measures were selected and linked to the most specific ICF categories. Each concept of the outcome measure was linked to the ICF in a step-wise fashion. Results A total of 1,663 abstracts were read from the CSS and NASS from 2010 to 2013 inclusively. Of the abstracts accepted to CSS and NASS, 71 and 53% contained validated outcome measures, respectively. The 10 most commonly used outcome measures were the ODI, VAS, NDI, Eq. 5D, mJOA, AIS, and RMDQ. A total of 40 spinal conditions/surgical approaches were described among the 10 most commonly used health-related outcome measures. The NASS evidence-based clinical guidelines provided validity recommendations for spondylolisthesis, radiculopathy, and spinal stenosis. The Cochrane Library Database published systematic reviews for disc arthroplasty, degenerative disc disease, vertebral fractures, spinal fusion, disc replacement, back pain, cervical spondylotic myelopathy, and thoracolumbar burst fractures. All validity analyses for the remaining conditions/surgical approaches were found through PubMed and Google Scholar. All of the concepts for each outcome measure were linkable to the ICF. Conclusion According to this study, all of the 10 most commonly used outcome measures in abstracts accepted to CSS and NASS from 2010 to 2013 inclusive were validated in the field of spinal surgery. There is, however, still a need for one universal database to determine which outcome measures would be most useful for a given spinal condition or surgical approach. All of the 10 most commonly used outcome measures were linked to the WHO ICF. This provides evidence that over the past 4 years, researchers and clinicians in spinal surgery have identified the importance of utilizing validated HRQOL outcome measures as their health predictors.

Mick Power: Madness Cracked

This book is a psychological interpretation of mental disorder proposing a theory-grounded classification system as an alternative primarily to the DSM that became atheoretical with its 3rd edition in 1980. To begin, the author distinguishes objective, subjective, and socially constructed versions of madness and continues with an interesting history of diagnostic classification in psychiatry and clinical psychology. Weaknesses of current DSM and WHO ICF approaches are identified and the author proposes his own theory-grounded alternative based on a schematic, propositional, analogical, and associative representational systems (SPAARS) model of cognitive science. The author then integrates the constructs of drives, emotions, and cognitions (DEC) by how one of these constructs defines primary disorder and the other two affect (and are affected) interactively to produce secondary features of disorder. Chapters are devoted to a description of disorders of biological and social drives with disorders of emotion and cognition in a DEC profile detailing the many ways disorder can individualize drawing on research from cognitive science, most notably Five Factor Personality Theory, Basic Emotion Theory, and Developmental Theories, particularly from the constructs of attachment and temperament. The goal of the book was to ground classification in theory, generating a more thorough understanding of ‘‘madness’’ that is more collectively inclusive of objective, subjective, and socially constructed viewpoints, hence, the title, Cracking Madness. This is a work of extraordinary scholarship drawing on carefully chosen areas of extensive human developmental research supporting a theoretical approach to classification that is vastly more sophisticated than the system used in DSM since 1980. There is no question that a useful diagnostic system based on sound empirical research will generate consistency and validity in classification efforts that improve our ability to understand mental disorder in ways that lead to logically-based treatment decisions. Almost completely, the reader is encouraged to believe that this is a work that will nudge the paradigm shift necessary to re-capture psychological disorder as a primarily psychologic phenomenon producing a proper alternative to today’s dominant and flawed reductionistic, biologic model. The author provides us with an approach that is provocative, complex, and refreshingly comprehensive compared to the over-simplified descriptive approach of a pervasively flawed DSM-5 and its predecessors. Most exciting about this scholarly work is that it provides a groundwork for returning to science-based practices in which well-researched theories feed understanding and decision-making in our attempts to help alleviate suffering of those who are distressed and/or dysfunctional. DEC profiling is truly a potential mechanism for productively enabling a vastly more sophisticated and informative classification system. The approach respects human complexity in a fashion clearly superior to the simple descriptive approach of the medical diagnostic model. This book is recommended as a ‘‘must-read’’ for academicians and clinicians to remind both groups how we profess to function as science-based disciplines. This reviewer finds disappointment only in the unnecessary embracement of the medical model in which the proposed approach is embedded, i.e., an illness-bound one that has failed miserably in producing a safe and effective approach to alleviating suffering in those who are distressed and/or dysfunctional. Nothing in the brilliance of & Fred Ernst fernst@utpa.edu