Podcasts about icf core sets

Traumatische Rückenmarksverletzungen führen - bedingt durch die Zerstörung der Integrität des Rückenmarks und den daraus resultierenden Funktionsstörungen - zu erheblichen Änderungen in der bisherigen Lebensführung der meist jungen, vormals gesunden Betroffenen und ihrer Familien. Umso wichtiger ist die adäquate Versorgung in spezialisierten Zentren durch multidisziplinäre Teams aus Ärzten, Kranken- und Gesundheitspflegern, Physio- und Ergotherapeuten sowie Psychologen und Sozialarbeitern. Bestehende Funktionsfähigkeit und ihre Störungen müssen detailliert und standardisiert erfasst werden, um Therapiefortschritte und Verschlechterungen des Zustands erfassen zu können. Die „Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit“ (ICF) bietet eine solche einheitliche Sprache. Zur Vereinfachung und Verbesserung der Anwendbarkeit wurden Kurzversionen der ICF – sogenannte ICF Core Sets – für verschiedene Erkrankungen entwickelt. Zu diesen zählen unter anderem die „Umfassenden ICF Core Sets für Rückenmarksverletzungen“. Sie enthalten die typischerweise im Rahmen einer spinalen Läsion zur Beschreibung der Funktionsfähigkeit benötigten ICF-Kategorien und liegen jeweils in einer Fassung für die frühe post-akute sowie die Langzeit-Phase vor. Die vorliegende Arbeit stellt ein Teilprojekt der Inhaltsvalidierung der bestehenden „Umfassenden ICF Core Sets für Rückenmarksverletzungen“ dar. Hierbei wurde mittels einer E-Mail-basierten, weltweiten Delphi-Befragung überprüft, ob die in den bestehenden „Umfassenden ICF Core Sets für Rückenmarksverletzungen“ enthaltenen ICF-Kategorien auch tatsächlich die von Ärzten behandelten Probleme, Ressourcen und Umweltfaktoren enthalten. Dabei wurden bis auf sechs Ausnahmen, die eher dem Aufgabenbereich anderer Berufsgruppen zuzuordnen sind, sämtliche derzeit enthaltene ICF-Kategorien von den Teilnehmern bestätigt. Jedoch scheinen sowohl das „Umfassende ICF Core Set für Rückenmarksverletzungen“ für den frühen post-akuten als auch den Langzeit-Kontext aus der Sicht der Ärzte unvollständig zu sein. Insgesamt wurden 32 ICF-Kategorien der Komponenten „Körperfunktionen und -strukturen“ und 2 der ICF-Komponente „Aktivität und Partizipation“ genannt, die bisher nicht Bestandteil der „Umfassenden ICF Core Sets für Rückenmarksverletzungen“ sind, aber eine Zustimmungsrate von über 75 Prozent durch die ärztlichen Teilnehmer erhielten. Basierend auf den Ergebnissen dieser Studie sowie der eindeutigen wissenschaftlichen Diskussion in der Literatur ist eine Aufnahme in Fällen wie beispielsweise den ICF- Kategorien s140 Struktur des sympathischen Nervensystems und s150 Struktur des parasympathischen Nervensystems dringlich zu empfehlen. Dahingegen sollten die Ergebnisse bezüglich ICF-Kategorien wie beispielsweise b147 Psychomotorische Funktionen mit denen der anderen Teilprojekte zur Validierung der „Umfassenden ICF Core Sets für Rückenmarksverletzungen“ verglichen werden. Zur näheren Überprüfung ihrer tatsächlichen Relevanz ist gegebenenfalls die Durchführung weiterer Studien indiziert. Die von den Teilnehmern genannten und bewerteten personenbezogenen Faktoren sollten im Falle einer zukünftigen Kategorisierung dieser ICF-Komponente ebenfalls in das jeweilige entsprechende „Umfassende ICF Core Set für Rückenmarksverletzungen“ eingefügt werden. Grundsätzlich ist die Praktikabilität der „Umfassenden ICF Core Sets für Rückenmarksverletzungen“ nach Integration der zur Vollständigkeit fehlenden ICF- Kategorien in Anwendungsstudien zu überprüfen.

Thu, 29 Mar 2012 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/14543/ https://edoc.ub.uni-muenchen.de/14543/1/Hoerl_Sarah.pdf Hörl,

This doctoral project seeks to answer the question about the essence of functioning, disability and health in the lived experience of persons with any kind of primary sleep disorder. Its overall objective is the development of a first version of Core Sets of categories of the International Classification of Functioning, Disability and Health (ICF) in an evidence- and consensus-based process. To this end, four separate studies exploring different perspectives (researcher, clinical, patient, health professional) have been conducted and their results provided the evidence basis for selecting the relevant categories for the ICF Core Sets for Sleep Disorders during an international consensus conference. The doctoral thesis first-authored by the doctoral candidate therefore consists of five separate publications (1 Systematic Review, 2 Patient Studies, 1 Expert Survey, 1 Conference Results) that describe the different steps in the development process.

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.

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.

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

Mon, 21 Jan 2008 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/8038/ https://edoc.ub.uni-muenchen.de/8038/1/Coenen_Michaela.pdf Coenen, Michaela ddc:600, ddc:610, Medizini

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.