Podcasts about icf core set

Assessing the health of populations is important for various reasons, especially for health policy purposes. Therefore, there exists a substantial need for health comparisons between populations, including the comparison of individuals, groups of persons, or even populations from different countries, at one point in time and over time. Two fundamentally different approaches exist to assess the health of populations. The first approach relies on indirect measures of health, which are based on mortality and morbidity statistics, and which are therefore only available at the population level. The second approach relies on direct measures of health, which are collected – based on health surveys – at the individual level. Based on the needs for comparisons, indirect measures appear to be less appropriate, as they are only available at the population level, but not at the individual or group level. Direct measures, however, are originally obtained at the individual level, and can then be aggregated to any group level, even to the population level. Therefore, direct measures seem to be more appropriate for these comparison purposes. The open question is then how to compare overall health based on data collected within health surveys. At first glance, a single general health question seems to be appealing. However, studies have shown that this kind of question is not appropriate to compare health over time, nor across populations. Qualitative studies found that respondents even consider very different aspects of health when responding to such a question. A more appropriate approach seems to be the use of data on several domains of health, as for example mobility, self-care and pain. Anyway, measuring health based on a set of domains is an extremely frequent approach. It provides more comprehensive information and can therefore be used for a wider range of possible applications. However, three open questions must be addressed when measuring health based on a set of domains. First, a parsimonious set of domains must be selected. Second, health measurement based on this set of domains must be operationalized in a standardized way. Third, this information must be aggregated into a summary measure of health, thereby taking into account that categorical responses to survey questions could be differently interpreted by respondents, and are not necessarily directly comparable. These open questions are addressed in this doctoral thesis. The overall objective of this doctoral thesis is to develop a valid, reliable and sensitive metric of health – based on data collected on a set of domains – that permits to monitor the health of populations over time, and which provides the basis for the comparisons of health across different populations. To achieve this aim two psychometric studies were carried out, entitled “Towards a Minimal Generic Set of Domains” and “Development of a metric of health”. In the first study a minimal generic set of domains suitable for measuring health both in the general population and in clinical populations was identified, and contrasted to the domains of the World Health Survey (WHS). The eight domains of the WHS – mobility, self-care, pain and discomfort, cognition, interpersonal activities, vision, sleep and energy, and affect – were used as a reference, as this set – developed by the World Health Organization (WHO) – so far constitutes the most advanced proposal of what to measure for international health comparisons. To propose the domains for the minimal generic set, two different regression methodologies – Random Forest and Group Lasso – were applied for the sake of robustness to three different data sources, two national general population surveys and one large international clinical study: the German National Health Interview and Examination Survey 1998, the United States National Health and Nutrition Examination Survey 2007/2008, and the ICF Core Set studies. A domain was selected when it was sufficiently explanatory for self-perceived health. Based on the analyses the following set of domains, systematically named based on their respective categories within the International Classification of Functioning, Disability and Health (ICF), was proposed as a minimal generic set: b130 Energy and drive functions b152 Emotional functions b280 Sensation of pain d230 Carrying out daily routine d450 Walking d455 Moving around d850 Remunerative employment Based on this set, four of the eight domains of the WHS were confirmed both in the general and in clinical populations: mobility, pain and discomfort, sleep and energy, and affect. The other WHS domains not represented in the proposed minimal generic set are vision, which was only confirmed with data of the general population, self-care and interpersonal activities, which were only confirmed with data of the clinical population and cognition, which could not be confirmed at all. The ICF categories of `carrying out daily routine´ and `remunerative employment´ also fulfilled the inclusion criteria, though not directly related to any of the eight WHS domains. This minimal generic set can be used as the starting point to address one of the most important challenges in health measurement, namely the comparability of data across studies and countries. It also represents the first step for developing a common metric of health to link information from the general population to information about sub-populations, such as clinical and institutional populations, e.g. persons living in nursing homes. In the second study a sound psychometric measure was developed based on information collected on the domains of the minimal generic set: energy and drive functions, emotional functions, sensation of pain, carrying out daily routine, mobility and remunerative employment. It was demonstrated that this metric can be used to assess the health of populations and also to monitor health over time. To develop this metric of health, data from two successive waves of the English Longitudinal Study of Ageing (ELSA) was used. A specific Item Response Theory (IRT) model, the Partial Credit Model (PCM), was applied on 12 items representing the 6 domains from the minimal generic set. All three IRT model assumptions – unidimensionality, local independency and monotonicity – were examined and found to be fulfilled. The developed metric showed sound psychometric properties: high internal consistency reliability, high construct validity and high sensitivity to change. Therefore, it can be considered an appropriate measure of population health. Furthermore, it was demonstrated how the health of populations can be compared based on this metric, for subgroups of populations, and over time. Finally, it was outlined how this metric can be used as the basis for comparing health across different populations, as for example from two different countries. The developed health metric can be seen as the starting point for a wide range of health comparisons, between individuals, groups of persons and populations as a whole, and both at one point in time and over time. It opens up a wide range of possible applications for both health care providers and health policy, and both in clinical settings and in the general population.

Thu, 16 Jan 2014 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/16623/ https://edoc.ub.uni-muenchen.de/16623/1/Mueller_Silvia_Margarete.pdf Müller, Silvia Margarete

Background: The World Health Organization (WHO) has argued that functioning, and, more concretely, functioning domains constitute the operationalization that best captures our intuitive notion of health. Functioning is, therefore, a major public-health goal. A great deal of data about functioning is already available. Nonetheless, it is not possible to compare and optimally utilize this information. One potential approach to address this challenge is to propose a generic and minimal set of functioning domains that captures the experience of individuals and populations with respect to functioning and health. The objective of this investigation was to identify a minimal generic set of ICF domains suitable for describing functioning in adults at both the individual and population levels. Methods: We performed a psychometric study using data from: 1) the German National Health Interview and Examination Survey 1998, 2) the United States National Health and Nutrition Examination Survey 2007/2008, and 3) the ICF Core Set studies. Random Forests and Group Lasso regression were applied using one self-reported general-health question as a dependent variable. The domains selected were compared to those of the World Health Survey (WHS) developed by the WHO. Results: Seven domains of the International Classification of Functioning, Disability and Health (ICF) are proposed as a minimal generic set of functioning and health: energy and drive functions, emotional functions, sensation of pain, carrying out daily routine, walking, moving around, and remunerative employment. The WHS domains of self-care, cognition, interpersonal activities, and vision were not included in our selection. Conclusions: The minimal generic set proposed in this study is the starting point to address one of the most important challenges in health measurement - the comparability of data across studies and countries. It also represents the first step in developing a common metric of health to link information from the general population to information about sub-populations, such as clinical and institutionalized populations.

Thu, 9 Dec 2010 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/12558/ https://edoc.ub.uni-muenchen.de/12558/1/Fritz_Andrea.pdf Fritz, Andrea

Das „Umfassende ICF Core Set für obstruktive Lungenerkrankungen (OPD)“ wurde für die klinische Anwendung der Internationalen Klassifikation von Funktionsfähigkeit, Behinderung und Gesundheit (ICF) entwickelt und beinhaltet das typische Spektrum von Problemen der Funktionsfähigkeit bei Patienten mit obstruktiver Lungenerkrankung. Ziel dieser Studie war es, das „Umfassende Core Set für obstruktive Lungenerkrankungen“ aus der Perspektive von Ärzten zu validieren. Erfahrene Ärzte wurden zu Problemen, Ressourcen und Umweltfaktoren befragt, welche bei der ärztlichen Behandlung von Patienten mit obstruktiven Lungenerkrankungen eine Rolle spielen. Die Befragung wurde in drei Runden per elektronischer Post (E-Mail) durchgeführt. Dabei wurde die sogenannte Delphi-Methode angewandt. Die Antworten wurden nach festgelegten Regeln von zwei darin erfahrenen und unabhängig voneinander arbeitenden Mitarbeiterinnen in ICF-Begriffe übertragen. Der Grad der Übereinstimmung dieser Ergebnisse wurde durch Berechnung des Kappa-Koeffizienten überprüft. Insgesamt 76 Ärzte aus 44 Ländern nannten eine Gesamtzahl von 1330 Antworten, die dann 148 verschiedenen ICF-Kategorien zugeordnet wurden. 40 dieser Antworten wurden der noch nicht in der ICF enthaltenen Komponente der Personenbezogenen Faktoren zugeordnet oder als sogenannte Gesundheitszustände eingeordnet, 17 Antworten waren nicht durch ICF-Kategorien abgedeckt. Im Gesamten waren 66% der ICF-Kategorien, denen die Antworten der Teilnehmer zugeordnet worden waren, im ICF Core Set für obstruktive Lungenerkrankungen enthalten. Einige Antworten, die der Komponente Körperfunktionen zugeordnet wurden, und noch nicht im ICF Core Set für obstruktive Lungenerkrankungen enthalten sind, müssen noch weiter untersucht werden.

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.

Background: Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite of the patients' individual health status, particularly with respect to functioning status, individual need for nursing care, and severity of symptoms. The International Classification of Functioning, Disability and Health (ICF) and the derived subsets, the so-called ICF Core Sets, are a standardized approach to describe patients' functioning status. The objectives of this study were to (1) examine the association between patients' functioning, as encoded by categories of the Acute ICF Core Sets, and nursing workload in patients in the acute care situation, (2) compare the variance in nursing workload explained by the ICF Core Set categories and with the Barthel Index, and (3) validate the Acute ICF Core Sets by their ability to predict nursing workload. Methods: Patients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression. Results: In patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%). Conclusions: A substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial.

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 functioning of patients with RA. Objectives: To study the responsiveness of the ICF Core Set for RA in rheumatological practice. Methods: A total of 46 patients with RA (72% women, mean (SD) age 53.6 (12.6) years, disease duration 6.3 (8.0) years) were interviewed at baseline and again after 6 months treatment with a disease-modifying antirheumatic drug (DMARD), applying the ICF Core Set for RA with qualifiers for problems on a modified three-point scale (no problem, mild/moderate, severe/complete). Patient-reported outcomes included Modified Health Assessment Questionnaire (MHAQ) and Short-Form 36 (SF-36) health survey, and disease activity was calculated. Responsiveness was measured as change in qualifiers in ICF categories, and was also compared with change in patient-reported outcomes. Results: After 6 months of DMARD treatment, improvement by at least one qualifier was seen in 20% of patients (averaged across all ICF categories), 71% experienced no change and 9% experienced worsening symptoms. Findings were similar across the different aspects of functioning. Mainly moderate effect sizes were seen for 6-month changes in the ICF Core Set for RA, especially in patients with improved health status, with similar effect size for disease activity. The components in the ICF Core Set for RA were only weakly associated with patient-reported outcomes and disease activity. Conclusions: The ICF Core Set for RA demonstrated moderate responsiveness in this real-life setting of patients where minor changes occurred during treatment with DMARDs.

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.

Background: The comprehensive ICF Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the International Classification of Functioning, Disability and Health (ICF), representing relevant aspects in the functioning of RA patients. Objectives: To study the reliability of the ICF Core Set for RA in rheumatological practice, and to explore the metric of the qualifiers’ scale. Methods: 25 RA patients from an outpatient department of rheumatology were interviewed using the ICF Core Set for RA (76% females, mean (SD) age 57.5 (12.5) years, disease duration 15.9 (14.6) years). Interviews were performed independently by both a physiotherapist and an occupational therapist on the same day and again after one week by one of them. The severity of the patients’ problems was quantified on a qualifier scale ranging from 0 (no problem) to 4 (complete problem). Analyses of intra-rater and inter-rater agreement, kappa statistics, and Rasch analyses were applied. Results: Mean intra-rater (inter-rater) complete agreement for all categories was seen in 59% (47%) of observations, ranging from 29% (0%) to 96% (80%) for individual categories. Weighted kappa statistics with value >0.4 showed reliability in 86% of categories within raters, and in 43% of categories between raters. Improved inter-rater and intra-rater reliability was observed with a reduced number of qualifiers for the categories. Conclusions: Inter-rater and intra-rater reliability of the ICF Core Set of RA was low to moderate. The metric of the qualifiers’ scale may be improved by reducing the number of qualifiers to three for all components.

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.