Podcasts about comprehensive icf core set

Thu, 24 Jun 2010 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/12149/ https://edoc.ub.uni-muenchen.de/12149/1/Berno_Stephanie.pdf Berno, Stephanie ddc:610, d

Objective: 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. The objective of this study was to validate this ICF Core Set from the perspective of physicians. Methods: Physicians experienced in RA treatment were asked about the patients’ problems, patients’ resources and aspects of environment from their scope of practice. This survey was conducted via e-mail in three rounds using the Delphi technique. The responses were linked to the ICF by two trained individuals according to empirically tested linking rules. Consensus of the results was calculated statistically by the statistical Kappa coefficient. Results: 79 physicians in 41 countries named 512 patients’ problems spanning all ICF components. 227 ICF categories were linked to the physicians’ responses. 16 ICF categories were not represented in the Comprehensive ICF Core Set for RA although at least 75% of the participants have rated them as important. 19 issues were not covered by the ICF classification and 26 answers were linked to the not yet developed ICF component Personal factors. Conclusion: The validity of the ICF components Body Structures, Activities and Participation and Environmental Factors was well supported by the physicians whereas there was less support for the validity of the component Body Functions. Several issues arose that are not covered and need to be investigated further.

Hintergrund: Das “Umfassende ICF Core Set für lumbalen Rückenschmerz (LBP)“ dient der klinischen Anwendung der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) und repräsentiert das prototypische Spektrum von Funktionsfähigkeit bei Patienten mit lumbalem Rückenschmerz. Ziel: Das Ziel dieser Studie war, das „Umfassende ICF Core Set für lumbalen Rückenschmerz“ aus der Perspektive der Ärzte zu validieren. Methoden: In der Behandlung von Patienten mit lumbalem Rückenschmerz erfahrene Ärzte wurden nach den Problemen, Ressourcen und Umweltfaktoren gefragt, die für die ärztliche Behandlung eine Rolle spielen. Dabei wurde die so genannte Delphi-Methode angewandt. Die Expertenbefragung erfolgte in drei Runden per elektronischer Postzustellung (E-Mail). Die Antworten wurden nach definierten Übersetzungsregeln in die Sprache der ICF übersetzt. Ergebnisse: 71 Ärzte aus 36 Ländern nannten 707 Konzepte, die alle Komponenten der ICF abdeckten. Diese Antworten wurden in 193 ICF Kategorien übersetzt. Drei ICF Kategorien, namentlich b530 Funktionen der Aufrechterhaltung des Körpergewichts, b6202 Harnkontinenz und b6700 Mit dem Geschlechtsverkehr verbundene Beschwerden sind nicht im „Umfassenden ICF Core Set für lumbalen Rückenschmerz“ enthalten, obwohl wenigstens 75% der Teilnehmer sie als wichtig eingestuft haben. 27 Konzepte wurden der noch nicht entwickelten ICF Komponente Personenbezogene Faktoren zugeordnet, 21 Konzepte sind von der ICF nicht abgedeckt. Konklusion: Die Validität des „Umfassenden ICF Core Sets für lumbalen Rückenschmerz“ wurde von den teilnehmenden Ärzten weitgehend bestätigt. Allerdings zeigten sich einige Ergebnisse, die der weiteren Untersuchung bedürfen.

Objective: To report on the results of a standardised consensus process agreeing on concepts typical and/or relevant when classifying functioning and health in patients with ankylosing spondylitis (AS) based on the International Classification of Functioning and Health (ICF).Methods: Experts in AS from different professional and geographical backgrounds attended a consensus conference and were divided into three working groups. Rheumatologists were selected from members of the Assessment of SpondyloArthritis international Society (ASAS). Other health professionals were recommended by ASAS members. The aim was to compose three working groups with five to seven participants to allow everybody's contribution in the discussions. Experts selected ICF categories that were considered typical and/or relevant for AS during a standardised consensus process by integrating evidence from preceding studies in alternating working group and plenary discussions. A Comprehensive ICF Core Set was selected for the comprehensive classification of functioning and a Brief ICF Core Set for application in trials.Results: The conference was attended by 19 experts from 12 countries. Eighty categories were included in the Comprehensive Core Set, which included 23 Body functions, 19 Body structures, 24 Activities and participation and 14 Environmental factors. Nineteen categories were selected for the Brief Core Set, which included 6 Body functions, 4 Body structures, 7 Activities and participation and 2 Environmental factors.Conclusion: The Comprehensive and Brief ICF Core Sets for AS are now available and aim to represent the external reference to define consequences of AS on functioning.

Objective: To report on the results of a standardised consensus process agreeing on concepts typical and/or relevant when classifying functioning and health in patients with ankylosing spondylitis (AS) based on the International Classification of Functioning and Health (ICF). Methods: Experts in AS from different professional and geographical backgrounds attended a consensus conference and were divided into three working groups. Rheumatologists were selected from members of the Assessment of SpondyloArthritis international Society (ASAS). Other health professionals were recommended by ASAS members. The aim was to compose three working groups with five to seven participants to allow everybody's contribution in the discussions. Experts selected ICF categories that were considered typical and/or relevant for AS during a standardised consensus process by integrating evidence from preceding studies in alternating working group and plenary discussions. A Comprehensive ICF Core Set was selected for the comprehensive classification of functioning and a Brief ICF Core Set for application in trials. Results: The conference was attended by 19 experts from 12 countries. Eighty categories were included in the Comprehensive Core Set, which included 23 Body functions, 19 Body structures, 24 Activities and participation and 14 Environmental factors. Nineteen categories were selected for the Brief Core Set, which included 6 Body functions, 4 Body structures, 7 Activities and participation and 2 Environmental factors. Conclusion: The Comprehensive and Brief ICF Core Sets for AS are now available and aim to represent the external reference to define consequences of AS on functioning.

Introduction Functioning 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. Methods The 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. Results Thirty-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. Conclusions Most 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.

1. Background Stroke is a frequently occurring condition and a common cause of death and disability. Many stroke survivors are facing long-term disability. The consequences of stroke on patients’ functioning are usually complex and heterogeneous. Precise knowledge of patients’ stroke related disability is necessary in health services provision and research. Clinical stroke management, but also epidemiological and clinical research, depend on the careful detection of functioning problems, as well as resources, in patients with stroke. Two conceptual approaches to describe patients’ disability can be distinguished: the health status measurement and the classification approach. Health status measures, like standardized performance tests, rating scales, and questionnaires are used to operationalize and to assess patients’ burden of disease, functioning and health. The classification approach towards the description of patients’ health state is represented by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). The ICF provides a comprehensive conceptual framework and a unified standardized language to describe health and health related states, both at the individual, as well as at population levels. To enhance the applicability of the classification, ICF Core Sets for specific health conditions have been developed in an evidence based and consensus based process. The ICF Core Sets for Stroke are selections of salient ICF categories out of the whole classification, which describe the spectrum of problems in stroke patients’ functioning based on the universal language of the ICF. The ICF Core Sets for Stroke represent the practical implementation of the classification approach in clinical practice and research. The two approaches to represent stroke related disability, the health status measurement and the classification approach, can be regarded as complementary principles. From the classification perspective, the ICF and the ICF Core Sets can serve as standards to define what to measure. From the perspective of health status measurement the question how to measure can be answered. An explicit connection between the two approaches can be established by the so-called linking method. Thereby, using the ICF’s category system the contents of measures can be mapped, explored and compared in a standardized, transparent and straightforward way. The linking method can be useful for various purposes. The application of the linking method along with the ICF Core Sets constitutes a new approach for examining health status measures’ content validity. However, beyond content validity, meaningful measurement essentially depends on the psychometric quality of the applied instruments. Techniques based on modern test theory, especially Rasch analysis, are increasingly adopted to ensure instruments’ psychometric properties. 2. Objectives In the following, the doctoral thesis is subdivided into four parts. The first three parts present different studies performed to pursue the objectives named below. Each of the three studies contains a respective discussion section referring to the results of the study. The fourth part of the doctoral thesis refers to aim four, namely the discussion of the relationship between the methods presented in the previous three parts. The current doctoral thesis aims (1) to illustrate, how the connection between the health status measurement approach and the classification approach can be established by the application of the linking method, (2) to demonstrate, how this approach can be used to select health status measures based on their content validity, (3) to show, how the psychometric features of health status measures can be examined based on Rasch analyses, and (4) to discuss the relationship between the demonstrated methods in the context of the connection of the health status measurement and the classification approach. 3. Applying the linking method: Content comparison of patient-centered health status measures used in stroke based on the International Classification of Functioning, Disability and Health (ICF) The first study, “Content comparison of patient-centered health status measures used in stroke based on the International Classification of Functioning, Disability and Health (ICF)” illustrates the application of the linking method in stroke measurement. The objective of this study was to examine and to compare the contents of patient-centred health status measures used in stroke. The specific aims of the study included the identification of generic and condition-specific patient-centred health status measures applied in stroke patients, the examination of the contents of the single measures based on their linking to the ICF, and the comparison of the contents of generic and stroke-specific measures. A systematic literature review was conducted to identify current generic and condition-specific patient-centred health status measures applied in stroke. The most frequently used instruments were selected. The contents of the selected measures were examined by linking the concepts within the instruments’ items to the ICF. Six generic and seven stroke-specific health status measures were selected. Within the selected instruments 979 concepts were identified. 200 different ICF categories were used to map these concepts. No single ICF category is contained in all instruments. Out of the total 200 different ICF categories used, 77 (40%) applied to only one of the 13 selected measures. Overall, the most frequently used category is b152 emotional functions’ contained in 53 items from 10 instruments. Stroke-specific measures more often address mental functions, while the selected generic instruments more often include Environmental Factors. The study provides an overview on current patient-centered health status measures in stroke and their covered contents. The results of the content comparison provide valuable information to facilitate and to account for the selection of appropriate instruments for specific purposes in clinical as well as research settings. 4. Selecting health status measures based on content validity: Comparison of stroke-specific health status measures with the Comprehensive ICF Core Set for Stroke The aim of the second study is to demonstrate how the ICF as a fundamental reference can be used to select health status measures according to their content validity. The specific aims are (1) to examine the content validity of the selected stroke-specific health status measures by comparing them with the Comprehensive ICF Core Set for Stroke, and (2) to discuss the selection of measures based on their coverage of the ICF Core Set. Taking the results from the previous study, the seven stroke-specific patient-centered health status measures are involved in the current analyses and compared to the Comprehensive ICF Core Set for Stroke. Descriptive frequency analyses are conducted to indicate the instruments’ bandwidth and specificity of content coverage regarding the ICF Core Set. 67 (52%) out of the 130 categories of the ICF Core Set are covered by at least one of the examined instruments. The single measures cover in total between 29% and 14% of the Comprehensive ICF Core Set for Stroke. Overall, 31 categories of the ICF Core Set are measured at the more specific 3rd and 4th levels by at least one of the seven instruments. All instruments cover Activity and Participation and Body Functions, but only two instruments address Environmental Factors. No categories of the ICF component Body Structures are contained in the examined instruments. In contrast the Comprehensive ICF Core Set for Stroke contains categories from all ICF components. The Quality of Life Instrument for Young Haemorrhagic Stroke Patients (HSQuale), the Stroke-specific Quality of Life Scale (SSQoL), and the Stroke Impact Scale(SIS) represent the top three instruments according to bandwidth as well as specificity of content coverage. The comparison of instruments against the Comprehensive ICF Core Set for Stroke can be used to characterize and compare measures’ content validity. The examination and comparison of patient-centered health status measures’ content validity accounting for the bandwidth and the specificity of content coverage can serve as a first step of selecting a measure. However, further features of the measures have to be considered. Especially, their psychometric properties have to be carefully examined to accomplish the well-founded choice of appropriate measures to assess stroke related health status. 5. Applying the Rasch method: Evaluation of the Stroke Impact Scale using Rasch Analyses The third study, the “Evaluation of the Stroke Impact Scale using Rasch Analyses” undertakes the psychometric evaluation of the Stroke Impact Scale 2.0 (SIS), in a German sample adopting Rasch based techniques. The specific aims of the study were to examine (1) the unidimensionality of the SIS domains and item fit, (2) the structure of the response scales, (3) the targeting of the domains, (4) reliability, (5) differential item functioning (DIF) or item bias for relevant patient groups, and (6) to compare the fit results of this study with the Rasch analysis results of the SIS 2.0 in a North American sample which led to the creation of the most current version of the SIS, the SIS 3.0. The Rasch analyses based on Master’s Partial Credit model has been carried out using data collected from stroke patients in Germany within an ongoing multicentric international study. 196 stroke patients from 16 study centers participated in the study and completed the Stroke Impact Scale. Unidimensionality of the eight SIS domains was confirmed according to the mean infit statistics (.97 to 1.02). 7 items displayed model misfit. Response categories of 25 items showed threshold disordering. For the domains Communication and Memory/Thinking ceiling effects (>3 logits) became apparent. Reliability values lay above .80 in six domains. No DIF was found as to age, gender, disability severity, and rehabilitation setting. Item fit results in the current study differed from those in the reference study of the SIS 2.0 in a North American sample. The SIS is according to its psychometric qualities a sufficiently robust, valid and reliable measure of stroke-specific quality of life. It seems suitable to capture consequences of stroke in patients’ with different levels of disability severity, within an inpatient as well as an outpatient setting, across age groups and genders. However, the response categories currently used with the SIS should be object to further study and revision. The fit results of the reference study of the SIS 2.0 could not be replicated and therefore, an item reduced version of the German SIS equivalent to the most current SIS 3.0 can not be created. Thus, the SIS needs to prove its cross-cultural validity in future. 6. Discussion: Towards a unified measurement approach in stroke Two complementary principles towards the description of disability have been introduced: the health status measurement and the classification approach. Connected to these conceptual approaches two methodological procedures have been regarded: the linking method and the Rasch method. The application of both methods has been illustrated. The connection of the classification approach with the health status measurement approach entails advantages reaching beyond the applications presented here. Rasch analysis and the linking method, representing qualitative and quantitative methods, may shed light on different facets of stroke measurement, which combined increase information value and lead to a complete picture of functioning and health. Advances of the classification approach, like the development of the ICF Core Sets for Stroke, and advances in health status measurement, like the application of Rasch analyses can be concatenated by the linking method. From this concatenation of different conceptual and methodological approaches, unified and comparable, conceptually sound, high quality measurement of functioning can emerge. The integration of a common reference framework with the merits of objective measurement within the proceedings of item banking and adaptive testing can contribute to compass a common standard and agreement on what and how to measure. A unified measurement approach could thereby be achieved in stroke. Advanced measurement can serve to promote precise, comprehensive, and efficient knowledge of stroke disability at the individual and at population levels, to enable better decisions for treatment and action, in the long run improving stroke care and relieving the burden to the patients.

The World Health Organization’s International Classification of Function (ICF) is a tool to characterize and illuminate better the full of array of problems a patient faces when affected by disease. Specifying these problems is a particular challenge in a disease like systemic lupus erythematosus (SLE) because of the wide variety in organ systems involved, its variable activity and severity, and considerable ethnic and local differences. The authors of this manuscript believe, however, that a broader understanding will prove essential for optimal patient care, and that there is sufficient experience now in defining ICF Core Sets to successfully complete core sets for SLE. Therefore, we will embark on an international project for developing ICF Core Sets for SLE, which we here delineate. This development will include two versions: 1) The Brief ICF Core Set for SLE will be a very focused list of categories essential for SLE clinical trials; and 2) The Comprehensive ICF Core Set will be much broader and useful for guiding multidisciplinary assessment in patients with SLE. Both Core Sets will be developed in a formal decision-making and consensus process of health professionals integrating evidence gathered from preliminary studies. The final definition of the Core Sets will occur at a consensus conference which will integrate: i) a systematic review of the literature regarding the outcome measures used in clinical trials and selected observational studies; ii) focus groups or semi-structured interviews with SLE patients; iii) a Delphi exercise with world wide involvement of experts; and iv) the evidence from empirical studies. The development of these SLE ICF Core Sets is designed to be an inclusive, open, worldwide process. We therefore invite both SLE clinical experts and SLE patients to participate actively.

Functioning is recognized as an important study outcome in rheumatoid arthritis ( RA). The Comprehensive ICF Core Set for RA is an application of the International Classification of Functioning, Disability and Health ( ICF) of the World Health Organisation with the purpose of representing the typical spectrum of functioning of patients with RA. To strengthen the patient perspective, persons with RA were explicitly involved in the validation of the Comprehensive ICF Core Set for RA using qualitative methodology. The objective of the study was twofold: to come forward with a proposal for the most appropriate methodology to validate Comprehensive ICF Core Sets from the patient perspective; and to add evidence to the validation of the Comprehensive ICF Core Set for RA from the perspective of patients. The specific aims were to explore the aspects of functioning and health important to patients with RA using two different focus group approaches ( open approach and ICF-based approach) and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for RA. The 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 the data analysis. After qualitative data analysis, the resulting concepts were linked to ICF categories according to established linking rules. Forty-nine patients participated in ten focus groups ( five in each approach). Of the 76 ICF categories contained in the Comprehensive ICF Core Set for RA, 65 were reported by the patients based on the open approach and 71 based on the ICF-based approach. Sixty-six additional categories ( open approach, 41; ICF-based approach, 57) that are not covered in the Comprehensive ICF Core Set for RA were raised. The existing version of the Comprehensive ICF Core Set for RA could be confirmed almost entirely by the two different focus group approaches applied. Focus groups are a highly useful qualitative method to validate the Comprehensive ICF Core Set for RA from the patient perspective. The ICF-based approach seems to be the most appropriate technique.