Die Internationale Klassifikation der Funktionsfähigkeit ... · Jan D. Reinhardt, PhD; Berchtesgaden 1/14 2011 1 Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung

Jan D. Reinhardt, PhD; Berchtesgaden 1/14 2011 1

Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und

Gesundheit (ICF)

als Paradigma, Standard und Werkzeug in der Rehabilitation


Affiliations Dr. Jan D. Reinhardt

Swiss Paraplegic Research, Nottwil, Switzerland

University of Lucerne, Department of Health Sciences and Health Policy

International Society of Physical and Rehabilitation Medicine, Secretary WHO Liaison Committee, Vice Chair Rehabilitation Disaster Relief Committee

WHO ICF Research Branch of the German WHO CC (DIMDI), Munich, Germany & Nottwil, Switzerland

Jan D. Reinhardt, PhD; Berchtesgaden 1/14 2011

Überblick

1. Das ICF Paradigma und Modell

2. Struktur der ICF als Klassifikation

3. ICF Coding

4. Linking Methode und Entwicklung von ICF Core Sets

5. Praktische Anwendung der ICF in der Kinder- und Jugendrehabilitation

6. Ausblick

3

Einführung


Fragen an das Publikum

Wer hat eines dieser Bücher schon einmal in der Hand gehabt bzw. entsprechende Internetressourcen genutzt?

4



Wer benutzt die ICF oder ICF-CY in der klinischen oder epidemiologischen Forschung?

5



Wer benutzt die ICF oder ICF-CY in der (klinischen) Praxis, z.B. für Assessment/Evaluation von Patientenstatus und Therapieerfolg?

6

Assessment Global Goal: Serv.-Progr.-Goal: Increase independence in daily r outine 2 Cycle goal 1: Mobility 2 Cycle goal 2: Self -Care 2

ICF categories ICF Qualifier Goal Re-lation

Goal value

Body functions, body structures, activities and par ticipation

problem 0 1 2 3 4

b152 Emotional function s SPG 1 b280 Sensation of pain CG1 1 b440 Respiration functions b525 Defecation functions b620 Urination functions b710 Mobility of joint functions CG1 0 b730 Muscle power functions CG1 2 b735 Muscle tone functions CG1 1 b810 Protective functions of the skin s120 Structure of the spinal cord and related struc tures s430 Structure of the respiratory system s610 Structure of the urinary system s810 Structure of areas of skin d230 Carrying out daily routine SPG 2 d240 Handling stress and other psychological demand s d410 Changing basic body positions CG1 2 d420 Transferring oneself CG1 2 d440 Fine hand use CG1 1 d445 Hand and arm use d455 Moving around d465 Moving around using equipment CG1 1 d470 Using transportation CG1 2 d520 Caring for bod y parts CG2 1 d530 Toileting CG2 2 d550 Eating d570 Looking after one’s health CG2 1 d710 Basic interpersonal interactions d720 Complex interpersonal interactions d920 Recreation and leisure

Environmental factors facilitator barrier

4+ 3+ 2+ 1+ 0 1 2 3 4 e110 Products or substances for personal consumption e115 Products and techn. for personal use in daily living CG2 +4 e120 Products and techn. for personal…mobility CG1 +4 e150 Design, construction…of buildings for public u se e310 Immediate family e340 Personal care providers 9 e355 Health professionals e460 Social attitudes e580 Health services, systems and policies


Was ist die ICF?

• Ein Paradigma/eine Theorie/ein Modell

• Eine Klassifikation

• Ein Kommunikationsmedium

• Ein Medium der klinischen und populationsbasierten Forschung

• Ein klinisches Werkzeug?

7


1. Das integrative bio-psycho-soziale Model von Funktionsfähigkeit und Behinderung

8

Gesundheitsproblem

Umweltfaktoren Personbezogene Faktoren

Körperfunktionen/-strukturen

Aktivitäten Partizipation

ICF als Paradigma

Understanding Functioning and Disability

Funktionsfähigkeit und Behinderung


ICF integrates individual/medical and social models of

disability.

9

Disability

Health

condition

Medical model

Health condition

Environmental factors Personal factors

Body functions/ Body structures

Activities Participation

1. The ICF integrative bio-psycho-social model of functioning and disability

Society/environment

Disability

Health

condition

Social Model

Society/environment


ImpairedBody functions and structures

LimitedActivities

& RestrictedParticipation

Person‘s experience of disability in relation to the

body

Patient‘s experience of disability in relation to the environment

The ICF focuses on the lived experience of persons with health conditions


The lived experience is reflected at the levels of…

11

Body Structures

Activities

Participation

E.g., Joints (hands, fingers)

E.g., Manipulating objects

E.g.,Taking care of others

Body FunctionsE.g., Mobility and stability of joints


…in interaction with the environment.

= Functioning and Disability


Functioning and disability may range from…

12

Functioning and Disability as Continuum

Complete functioning

Complete disability

Integrity in

Body functionsBody structuresActivities andParticipation

Impairments in

Body functions andBody structures

Limitations inActivites and

Restrictions inParticipation


Personal factorsEnvironmental factors

Health condition


An individual’s functioning in a specific domain is an interaction or complex relationship between the health condition and contextual factors.


Health condition

Environmental factors

Personal factors


There is a dynamic and cumulative interaction between the entities: Changes in one entity can modify one or more of the other entities.

Rheumatoid arthritis, ICD M05


Health condition


Personal factors


The interaction works in two directions; the presence of disability may even modify the health condition itself

Coxarthrosis, ICD M16


Health condition


Personal factors


It is important to collect data on these constructs independently and thereafter explore associations and causal links between them.


• Integrates medical and social models

• Integrates various perspectives of functioning (biological, individual and social)

• Is a multidimensional model (Body functions and structures, Activities, Participation)

• Is an interactive model rather than a linear progressive model

• Reflects dynamic interactions among the components

Health condition


Personal factors





ICF is an universal model and applies to all people irrespective of their culture, health condition, gender, or age.

Instead of making disability a distinguishing mark of a discrete

minority group, the ICF describes all the domains of functioning

and disability that are applicable to everyone.

18


?


The ICF original version had neglected some aspects important

to children and youth as well as education and pediatric

rehabilitation. Therefore, the ICF-CY was created.

•The ICF-CY is derived classification.

•ICF-CY has additional categories such as play and preschool education.

•ICF-CY has incorporated developmental delay in definition of impairment and activity limitation qualifiers.

• ICF-CY has modified several exclusion and inclusion criteria

for particular categories.

19



2. ICF als Klassifikation

F:\Bilder\Barcelona 09\Barcelona\DSC_0023.JPG


ICF as classification

2. The structure and codes of the classification

21

Describing Functioning and Disability

b11420 -b51059

s11000 -s76009

b1100 -b7809

s1100 -s8309

d1550 -d9309

e1100 -e5959

b110 -b899

s110 -s899

d110 -d999

e110 -e599

b1 – b8 s1 – b8 d1 – d9 e1 – e5

ICF

Contextual factors

Body functions and Structures

Activities and Participation


Personal factors

Functioning and Disability


Typically, classification is the placing of similar objects into groups

22

2. The structure and codes of the ICF


Hierarchical structure

23


Andere Möglichkeiten?


Health condition

Environmental factors Personal factors



493 384

253

310

0

The integrative bio-psycho-social model of functioning and disability is the basis for the ICF classification.

There are large numbers of factors grouped into the components of the ICF model (except the personal factors).

classified within ICD

Body functions

Body structures

Activites & participation




ICF

Functioning and Disability Contextual factors




Personal factors

Body functions

Body structures

PartsComponents

b11420 -b51059

s11000 -s76009

Fourth-level classification

b1100 -b7809

s1100 -s8309

d1550 -d9309

e1100 -e5959

Third-level classification

b110 -b899

s110 -s899

d110 -d999

e110 -e599

Second-level classification

b1 – b8 s1 – b8 d1 – d9 e1 – e5

Chapters

ICF code = Prefixes + Numeric codes + ICF Qualifiers

bb ss dd ee

Not classified yet!


110110 5400254002 44014401 11011101


An ICF code is composed of a prefix, the numeric code and an ICF Qualifier.

The letter denotes the component of the classification and the number of digits indicates the level of detail of the category.

Component sChapter

7

2nd level

30

3rd level

2

4th level

0



The classification provides a standard language and a common framework for the description of health and health related domains

“ICF does not classify people, but describes the situation of each person within an array of health or health-related domains.”(WHO 2001:8)

27



b3

b5

b8

b2

b4

b7

b6

b1

28

ICF





Personal factors

Body functions

Body structures

Chapters

Body functions

Mental functions

Sensory functions and pain

Voice and speech functions

Functions of the cardiovascular, haematological, immunological and respiratory functions

Functions of the digestive, metabolic and endocrine system

Genitourinary and reproductive functions

Neuromusculoskeletal and movement-related functions

Functions of the skin and related structures



ICF

s2

s3

s4

s5

s6

s7

s8

s1





Personal factors

Body functions

Body structures

Structures of the nervous system

The eye, ear and related structures

Structures involved in voice and speech

Structures of the cardiovascular, immunological and respiratory

system

Structures related to the digestive, metabolic and endocrine system

Structures related to the genitourinary and reproductive system

Structures related to movement

Skin and relates structures

Body structures

Chapters2. The structure and codes of the ICF


b3

b5

b8

b2

b4

b7

b6

b1Mental functions

s2

s3

s4

s5

s6

s7

s8

s1 Structures of the nervous system


Body functions Body structures

The eye, ear and related structures

Structures involved in voice and speech

Structures of the cardiovascular, immunological and respiratory system

Structures related to the digestive, metabolic and endocrine syste

Structures related to the genitourinary and reproductive system

Structures related to movement

Skin and related structures

Sensory functions and pain

Voice and speech functions

Functions of the cardiovascular, haematolo-gical, immunological and respiratory functions

Functions of the digestive, metabolic and endocrine system

Genitourinary and reproductive functions

Neuromusculoskeletal and movement-related functions

Functions of the skin and related structures


ICF





Personal factors

Body functions

Body structures d1

d2

d3

d4

d5

d6

d7

d8

d9

Learning and applying knowledge

General tasks and demands

Communication

Mobility

Self-care

Domestic life

Interpersonal interactions and relationships

Major life areas

Community, social and civic life

Activity and participation



ICF





Personal factors

Body functions

Body structures

e2

e1

e3

e4

e5

Products and technology

Natural environment/human-made changes to the environment

Support and relationship

Attitudes

Services, systems and policies




The hierarchical structure of the classification allows either a broader (chapter or 2nd level classification) or a more specific (3rd or 4thlevel classification) description of functioning. Broader categories include the more detailed categories of the parent category.

Within each domain, the specificity of the description of an ICF category increases.

For each category (2nd, 3rd or 4th level) you can find a definition(except in the component of Body structures) together with inclusion and exclusion criteria.

33




Example:


b210b210 Seeing functions

b2102b2102 Quality of vision

b2100

b2101

b2108

b2109

ICF

b3

b5

b8

b2

b4

b7

b6

b1





Personal factors

Body functions

Body structures

b21020 Light sensitivity

b21021 Colour vision

b21022 Contrast sensitivity

b21023 Visual picture quality

b21028 Quality of vision, other specified

b21029 Quality of vision, unspecified

b280

b215

b220

b229

b230

b235

b240

b249

b250

b255

b260

b265

b270

b2 Sensory functions and pain

b21020 Light sensitivity

Seeing functions of sensing a minimum amount of light (light minimum), and the minimum difference in intensity (light difference)

Inclusion: functions of dark adaptation; impairments such as night blindness (hyposensitivity to light) and photophobia (hypersensitivity to light)



The WHO provides an online ICF Web-Browser where the classification can be searched for ICF categories:

http://www.who.int/classifications/icfbrowser



ICF as Classification

3. Coding with the ICF

37

Component s

Chapter2nd level

30

3rd level

2

4th level

07 .4

1st qualifier

22nd qualifier

3 3rd qualifier


3. Coding with ICF qualifiers

38

The use of any ICF category should be accompanied by at least one qualifier. Without qualifiers, codes have no inherent meaning.

Qualifiers denote the magnitude of the level of health or severity of the problem at issue. Qualifiers are coded as one, two or more numbers after a point.

Having a problem may mean an impairment, limitation or restriction or barrier depending on the ICF construct.

s73020.4

1st qualifier

22nd qualifier

3 3rd qualifier


ICF

Functioning and Disability



Body functions

Body structures

XXX.0 NO problem (none, absent, negligible,…) 0 – 4%

XXX.1 MILD problem (slight, low,...) 5 – 24%

XXX.2 MODERATE problem (medium, fair...) 25 – 49%

XXX.3 SEVERE problem (high, extreme,...) 50 – 95%

XXX.4 COMPLETE problem (total,...) 96 – 100%

XXX.8 not specified (the available information does not suffice to specify the

severity of the problem)

XXX.9 not applicable (it is inappropriate or not possible to apply the code)

Contextual factors




ICF


Body functions and structures



Body functions

Body structures

XXX.0 NO barrier

XXX.1 MILD barrier

XXX.2 MODERATE barrier

XXX.3 SEVERE barrier

XXX.4 COMPLETE barrier

XXX+0 NO facilitator

XXX+1 MILD facilitator

XXX+2 MODERATE facilitator

XXX+3 SEVERE facilitator

XXX+4 COMPLETE facilitator

XXX.8 barrier, not specified XXX+8 facilitator, not specifiedXXX.9 not applicable XXX+9 not applicable



Here are some examples of the use of the generic ICF Qualifier:

41

Eating is a fair problem (it takes much more time)

My mother is an extreme support for me

The mobility in the ankle joints is severely impaired

I am able to work only part-time as a translator

d550.2 b7101.3

d850.2 e310+4




ICF qualifier for activities and participation

PerformanceDescribes what an individual does in his current environment. This context includes the environmental factors – all aspects of the physical, social and attitudinal world which can be coded using the environmental factors component

CapacityDescribes an individual’s ability to

execute a task or an action. This construct aims to indicate the highest probable level of functioning that a person may reach in a given domain at a given moment in a standard environment, i.e. without environmental factors such as assistive devices.

d4552.XX=Running

s7501.413=Complete impairment with total absence of structures of both lower

legs

40



ICF qualifier for activities and participation

PerformanceDescribes what an individual does in his current environment. This context includes the environmental factors – all aspects of the physical, social and attitudinal world which can be coded using the environmental factors component

CapacityDescribes an individual’s ability to

execute a task or an action. This construct aims to indicate the highest probable level of functioning that a person may reach in a given domain at a given moment

d310.XXCommunicating with –receiving – spoken

messages

b230.3=Severe impairment in Hearing

functions

30


Using the ICF Qualifiers a functioning profile can be created. This gives a description of the complete experience of functioning.

ICF categories ICF Qualifier problem

0 1 2 3 4 b134 Sleep functions b152 Emotional functions b28013 Pain in back b4350 Immune response b610 Urinary excretory fucntions b710 Mobility of joint functions b735 Muscle tone functions b755 Involuntary movement reaction functions b810 Protective functions of the skin s810 Structure of areas of skin d230 Carrying out daily routine d240 Handling stress and other psychological demands d410 Changing basic body positions d4153 Maintaining a sitting position d420 Transferring oneself d465 Moving around using equipment d475 Driving d540 Dressing d920 Recreation and leisure

facilitator barrier 4+ 3+ 2+ 1+ 0 1 2 3 4 e110 Products or substances for personal consumption e115 Assistive products… for personal use in daily living e120 Assistive products…for personal mobility e155 Design, construction…of buildings for private use e310 Immediate family

44



The linking methodology allows the use the ICF

standard vocabulary to facilitate

• understanding the meaning of health and health

related information

• comparsion of information from different

sources

4.1 Linking health and health related information to the ICF


J Rehabil Med 2002~ 34: 205-210

SPECIAL REPORT

LINKING HEALTH-STATUS MEASUREMENTS TO THE INTERNATIONALCLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH

Alarcos Cieza, Thomas Brockow , Thomas Ewert, Edda Amman, Barbara Kollerits,Somnath Chatterj , T. Berdihan Üstün and Gerold Stucki

From the Department of Physical Medicine and Rehabilitation, University of Munich, Munich, Spa Medicine ResearchInstitute, Bad Elster, Germany and Classification, Assessment, Surveys and Terminology Team, World Health Organization,

Switzerland.

With the approval of the International Classification of Functioning, Disability and Health by the World Health Assembly in May 2001,the concurrent use of both healthstatus measures and the International Classification of Functioning, Disability and Health is expected.It is therefore important to understand the relationship between these two concepts. The objective of this paper is to provide asystematic and standardized approach when linking healthstatus measures to the International Classification of Functioning, Disabilityand Health. The specific aims are to develop rules, to test their reliability and to illustrate these rules with examples. Ten linking rulesand an example of their use are presented in this paper. The percentage agreement between two health professionals for 8 healthstatusinstruments tested is also presented. A high level of agreement between the health professionals reflects that the linking rulesestablished in this study allow the sound linking of items from health-status measures to the International Classification of Functioning,Disability and Health.

Keywords: ICF, health-status measures, linking rules.

J Rehabil Med 2002; 34: 205-210Correspondence address: Alarcos Cieza, Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians Universit , Munich,Germany E-mail: Alarcos.Cieza @ phys.med.uni-muenchen.deSubmitted June 18, 2002; Accepted June 20, 2002

© 2002 Taylor & Francis. ISSN 10-50-/977J Rehabil Med 34

Taylor&Francishealthsciences


b134 Sleep functions

Disability QoL / Satisfaction

Needs Dependency

Nordic Sleep Questionnaire

Q1. Have you had any

difficulties in falling asleep?

WHOQoL-BREF

F3.3 How satisfied are you

with your sleep?

What was your level of needfor help with not sleeping well?Supportive Care Needs Survey

I didn`t lose any sleep, but I needed tablets.

Aberdeen Low Back Pain Scale

Introduction to the ICF

4.1 Linking health and health related information to the ICF


4.2 Development of ICF Core Sets

48

From ICF to clinical practice

s110s120s130s430s510s710…b110b114b117b130b152b144b730...d110d240d410d415d520d630d920…e110e115e120e125e130e150…

s110s430s710b110b130b152b730d240d410d415d920e110e120e130

Health conditions specific, situation specific


ICF Core Sets

Ein ICF Core Set ist eine Liste von ICF Kategorien, die so wenig Kategorien wie möglich, jedoch so viele wie nötig umfasst, um alle relevanten Aspekte der Funktionsfähigkeit von Menschen mit einer spezifischen Gesundheitstörung und in einem spezifischen Kontext für ein umfassendes und multidisziplinäres Assessment zu beschreiben.

Entwicklung von ICF Core Sets


ClinicalPerspective

Researchers’Perspective

Patients’Perspective

Health professionals’

Perspective

What problems of persons with the

health condition are measured and

reported in the literature?

What problems of persons with the

health condition are found in clinical

practice?

What are the problems that persons

with the health condition experience

from their perspective?

What problems of persons with the health condition are considered relevant by the health professionals that treat them?

Empirical multicenter study

Systematic literature review

Qualitative study

Experts’ survey via email

International ICF

consensus

conference

1st version of the

ICF Core Set

Phase I Phase IIPreparatory Phase

Year 1 Year 2

Testing and

Validation of the

1st version of the

ICF Core Sets



�

nkylosing spondylitis�

reast cancer�

hronic ischemic heart disease�

hronic widespread pain�

epression�

iabetes�

and conditions�

ead and Neck Cancer�

ow back pain�

ultiple sclerosis�

Health conditions



� Amputees� Bipolar disorders� Burns� Cerebral Palsy� Inflammatory bowel Diseases� Traumatic Brain Injury� Vocational Rehabilitation

Current developments



List of ICF categories that includes as few categories as possible to be practical, but as many as necessary to describe the aspects of functioning relevant to persons with a specific condition in a comprehensive, multi-disciplinary assessment

• Comprehensive ICF Core Set



List of ICF categories that serves as the minimal standard for reporting the functioning of persons with a specific health condition along the continuum of care (ranging from the acute hospital to rehabilitation facilities and community) and across sectors (health, education, labour and social affairs)

• Brief ICF Core Set



…What to measure

and not

…How to measure

Keep in mind:

ICF Core Sets define…



Value of ICF Core Sets

• Guide for clinical assessment

– Minimum functioning catalogue:What to assess?

– What are the patient’s problems?

• Basis for improving communication

– Among professionals

– Between settings



ΨΨΨΨ diagnosisΨ Interventions

Ψdocumentation

__________

__________

__________

Physician‘ diagnosis Physician Interventions

Physician documentation

____________

____________

____________

Nurses‘ diagnosisNursing Interventions

Nursing documentation

___________

___________

___________

OT diagnosis OT Interventions

OTdocumentation

____________

____________

____________

PT diagnosisPT Interventions

PTdocumentation

____________

____________

____________

Patient


Actual situation ….


ΨΨΨΨ diagnosisΨ Interventions

Ψdocumentation

__________

__________

__________

Physician‘ diagnosis Physician Interventions

Physician documentation

____________

____________

____________

Nurses‘ diagnosisNursing Interventions

Nursing documentation

___________

___________

___________

OT diagnosis OT Interventions

OTdocumentation

____________

____________

____________

PT diagnosisPT Interventions

PTdocumentation

____________

____________

____________

Patient


Aim and vision….

ICF____________

____________

____________

ICD-10


Theory �� Practice

5. Using the ICF in rehabilitation management

Assessment

Assignment

Intervention

Evaluation Rehab-Cycle


At the core of rehabilitation care provision are the evolving problems and needs of individuals in relation to functioning.


To achieve or maintain optimal function a multidisciplinary approach is required. Hence, rehabilitation integrates medical approaches labor, educational, social, architectural etc. approaches through cooperation and professionals across sectors.


Use case ICF based rehabilitation management in an in-patient rehabilitation program for adolescents with Spina Bifida and Cerebral Palsy



Assessment of a patient‘s functioning status within the ICF Categorical Profile: A case example

62


A person with Spina Bifida

• 17 year old adolescent

• Living with his family

• Visiting regular school

• Hobbies: Impassioned panpipe-player, reading, listen to music, computer


6.2. Using the ICF in rehabilitation management

1991: Congenital lumbal meningomyelocele with Arnold-Chiari-Maldeformation type 3, sub L3

1993 Hydrocephalus, Shunt Hydrocephalus, Shunt revision

2000 Luxation of both hip joints, surgery (Stefan was able to stand and walk a little bit before the surgery, Pressure ulcer

2002 Tethered cord syndrome, Lumbal untethering

2004 Tethered cord syndrome, Cervical untethering (laminektomy C2/C3 and C1)

2004 Scoliosis, Spondylodesis Th3 to S1 (lead to stiffened spine)

2005 Scoliosis, Dorsal spondylodesis C2 to C5 (lead to stiffened spine)

2006 Traumatic SCI ASIA C, C6 (Epiduralhämatom, Skibob accident), surgery

Stefan‘s medical history


Assessment of a patient‘s functioning status within the ICF Categorical Profile: A case example

Health insurance agreed to pay for Stefan‘s participation in a three week in-patient rehabilitation program. This program aims to increase the independence of adolescents with congenital or traumatic spinal cord injuries.

64


„I don‘t like speed“

„My mother is doing

everything – and then she

says ‚Do it on your own‘ -

but at the same breath she is

doing it.“

„ I always have to rush about –…on the other hand, one could also say: ‚My family is too fast“


Assessment Global Goal: Service-Program-Goal: Cycle goal 1: Cycle goal 2:


Goal value

Body functions, body structures, activities and pa rticipation

problem 0 1 2 3 4

b152 Emotional functions b280 Sensation of pain b440 Respiration functions b525 Defecation functions b620 Urination functions b710 Mobility of joint functions b730 Muscle power functions b735 Muscle tone functions b810 Protective functions of the skin s120 Structure of the spinal cord and related struc tures s430 Structure of the respiratory system s610 Structure of the urinary system s810 Structure of areas of skin d230 Carrying out daily routine d240 Handling stress and other psychological demand s d410 Changing basic body positions d420 Transferring oneself d440 Fine hand use d445 Hand and arm use d455 Moving around d465 Moving around using equipment d470 Using transportation d520 Caring for body parts d530 Toileting d550 Eating d570 Looking after one’s health d710 Basic interpersonal interactions d720 Complex interpersonal interactions d920 Recreation and leisure

Environmental factors facilitator barrier 4+ 3+ 2+ 1+ 0 1 2 3 4

e110 Products or substances for personal consumptio n e115 Products and technology for personal use in da ily living e120 Products and technology for personal…mobility e150 Design, construction…of buildings for public u se e310 Immediate family e340 Personal care providers e355 Health professionals e460 Social attitudes e580 Health services, systems and policies


Assessment of functioning

Test: Muscle power functions

Observation: Caring for body parts

Examination: Transferring oneself


Assessment Global Goal: Serv.-Progr.-Goal: Increase independence in daily r outine 2 Cycle goal 1: Mobility 2 Cycle goal 2: Self-Care 2


Goal value

Body functions, body structures, activities and par ticipation

problem 0 1 2 3 4

b152 Emotional functions SPG 1 b280 Sensation of pain CG1 1 b440 Respiration functions b525 Defecation functions b620 Urination functions b710 Mobility of joint functions CG1 0 b730 Muscle power functions CG1 2 b735 Muscle tone functions CG1 1 b810 Protective functions of the skin s120 Structure of the spinal cord and related struc tures s430 Structure of the respiratory system s610 Structure of the urinary system s810 Structure of areas of skin d230 Carrying out daily routine SPG 2 d240 Handling stress and other psychological demand s d410 Changing basic body positions CG1 2 d420 Transferring oneself CG1 2 d440 Fine hand use CG1 1 d445 Hand and arm use d455 Moving around d465 Moving around using equipment CG1 1 d470 Using transportation CG1 2 d520 Caring for body parts CG2 1 d530 Toileting CG2 2 d550 Eating d570 Looking after one’s health CG2 1 d710 Basic interpersonal interactions d720 Complex interpersonal interactions d920 Recreation and leisure

Environmental factors facilitator barrier

4+ 3+ 2+ 1+ 0 1 2 3 4 e110 Products or substances for personal consumptio n e115 Products and techn. for personal use in daily living CG2 +4 e120 Products and techn. for personal…mobility CG1 +4 e150 Design, construction…of buildings for public u se e310 Immediate family e340 Personal care providers 9 e355 Health professionals e460 Social attitudes e580 Health services, systems and policies

ICF Categorical Profile

Result


Assessment

Assignment

Intervention



ICF Assessment Sheet

ICF Intervention Table

ICF Evaluation Display



Intervention targets MD Nurs

PT OT Psy

SW

Oth Intervention First value

Goal value

Final value

B

ody

func

tion

/-

stru

ctur

e

Act

ivity

/ P

artic

ipat

ion

Env

ironm

en-

tal f

acto

rs

Per

sona

l fa

ctor

s

b280 Sensation of pain

b710 Mobility of joint functions

b7300 Power of isolated muscles

b7305 Power of muscles of the trunk

b7353 Tone of muscles of lower half

b755 Involuntary movement reactions

d410 Changing basic body positions

d4153 Maintaining a body position

d420 Transferring oneself

d475 Driving

d510 Washing oneself

d520 Caring for body parts

d540 Dressing

d850 Remunerative employment

e115 Products and techn. for use in daily

e120 Products and techn. for mobility

e155 Design, construction of buildings

pf Coping with disease

pf Acceptance of emotions

pf Self competencies

Manual therapy

Active and passive movement of joints

Muscle power training with equipment

Muscle power training without equipment

Medication, Hippotherapy, Water therapy

Movement reaction training

Training of activites of daily living

Muscle power training, movement reaction tr.


Driving training


d570 Looking after one‘s health

Training of activites of daily living, Counselling


Education, Counselling,

Vocational training

Choice and adaptation of assistive devices

Choice and adaptation of wheelchair

Clarification of living situation (private build.)

Other psych. therapy, Psych. counselling



XX

X

X

X

X XX

X

X X

X

XXX

XX

XXX

X XX X X X

X

XX XX XX

XX

X

2

01223

322

412

324

+3+24

+--

0

01011

111

201

013

+4+42

+00


1… provides an overview of the assignment of interventions to intervention targets and to the different health professionals.

Keep in mind:

The ICF Intervention Table…


2… illustrates the required resources


Assessment

Assignment

Intervention



ICF Assessment Sheet

ICF Intervention Table

ICF Evaluation Display




Evaluation of the changes in the functioning status (in intervention targets) following the rehabilitative interventions

Assessment Evaluation Global Goal:

Serv.-Progr.-Goal: Increased independence in daily routine 2 - Cycle goal 1: Mobility 2 � Cycle goal 2: Self-Care 2 -


Goal value

ICF Qualifier Goal achie-

vement

problem

problem 0 1 2 3 4 0 1 2 3 4

b152 Emotional functions SPG 1 � b280 Sensation of pain CG1 1 � b710 Mobility of joint functions CG1 0 - b730 Muscle power functions CG1 2 - b735 Muscle tone functions CG1 1 - d230 Carrying out daily routine SPG 2 � d410 Changing basic body positions CG1 2 � d420 Transferring oneself CG1 2 � d440 Fine hand use CG1 1 - d465 Moving around using equipment CG1 1 � d470 Using transportation CG1 2 - d520 Caring for body parts CG2 1 � d530 Toileting CG2 2 - d570 Looking after one’s health CG2 1 �

facilitator barrier

facilitator barrier 4+ 3+ 2+ 1+ 0 1 2 3 4 4+ 3+ 2+ 1+ 0 1 2 3 4

e115 Assistive products… for personal use in daily living CG2 +4 � e120 Assistive products---for personal…mobility … CG1 +4 �


1… depicts the changes in a patient’s functioning status and goal achievement

Keep in mind:

The ICF Evaluation Display…


2… provides information for further rehabilitation planning


Activity and Participation

Assessment Evaluation

0% 100% 0%0%

0%0% 100% 0%

0% 25% 50% 25%

0%0% 100% 0%

0%0% 50% 50%

0%0% 67% 33%

100% 0%0%0%

0% 60% 20% 20%

0% 25% 50% 25%

0% 100% 0%0%

0% 50% 50% 0%

0% 25% 50% 25%

0% 33% 33% 33%

0%0% 80% 20%

0%0% 67% 33%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Die tägliche Routine durchführen d230 (9)

Mit Stress u. a. psych. Anforderungen umgehen d240 (5)

Eine elementare Körperposition wechseln d410 (6)

Sich verlagern d420 (4)

Feinmotorischer Handgebrauch d440 (2)

Hand- und Armgebrauch d445 (2)

Sich auf andere Weise fortbewegen d455 (4)

Sich unter Verwendung von Geräten fortbewegen d465 (5)

Transportmittel benutzen d470 (1)

Seine Körperteile pflegen d520 (6)

Die Toilette benutzen d530 (6)

Essen d550 (3)

Auf seine Gesundheit achten d570 (4)

Elementare interpersonelle Aktivitäten d710 (3)

Erholung und Freizeit d920 (3) 33% 67% 0%0%

0% 33% 67% 0%

25% 25% 50% 0%

0% 33% 67% 0%

17% 17% 33% 33%

17% 17% 33% 33%

100% 0%0%0%

20% 40% 40% 0%

25% 0% 25% 50%

100% 0%0%0%

50% 0% 50% 0%

25% 25% 50% 0%

33% 33% 17% 17%

0% 20% 60% 20%

11% 33% 44% 11%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

d230 Carrying out daily routine

d240 Handling stress and o. psychol.

d410 Changing basic body positions

d420 Transferring oneself

d440 Fine hand use

d445 Hand and arm use

d455 Moving around

d465 Moving around using equipment

d470 Using transportation

d520 Caring for body parts

d530 Toileting

d550 Eating

d570 Looking after one‘s health

d710 Basic interpersonal interactions

d920 Recreation and leisure


Evaluation

0=no 1=mild 2=moderate 3=severe 4=complete Problem Problem Problem Problem Problem(0-4%) (5-24%) (25-49%) (50-95%) (96-100%)


Practicability of the ICF Categorical Profile

The use of the ICF Categorical Profile• facilitated a clear depiction of a patient‘s functioning status and allowed the documentation of rehabilitation goals and intervention targets

• contributed rehabilitation management by increasing communication and common goal-setting

• increased time consumption for documentation



Practicability of the ICF Categorical Profile

Challenges:• ICF categories were experienced too less comprehensive and specific

• Definition of ICF categories were experienced sometimes too less precise and sometimes overlapping

• Rating within ICF Qualifiers was experienced too less objective

• ICF Qualifiers are too less sensitive for illustrating changes in the functioning states

• Ambivalent EF cannot be coded.



6. Ausblick

• Das ICF Modell und Klassifikation (ICF-CY) bieten eine umfassende und dynamische Perspektive für die Rehabilitation von Kindern und Jugendlichen

• Weiterentwicklungen in Forschung und Praxis sind aber unabdingbar:

– Noch keine diagnosespezifischen Core Sets für Kinder und Jugendliche -> Differentielle Core Sets für unterschiedliche Entwicklungsstufen

– Klinische ICF Tools sind am Anfang ihrer Entwicklung und weisen noch einige Schwächen auf

76


6. Ausblick

• Kaum systematische Evaluationsstudien bzgl. clinical effectiveness

• Mittelfristig muss eine Erhöhung des Dokumentationsaufwands durch ICF vermieden werden, z.B.

– die Entwicklung ICF-basierter Outcome Instrumente

– durch integrierte, elektronische ICF-basierte Dokumentationssysteme

– Algorhythmen zur Umrechnung klinischer Testergebnisse in ICF Qualifier

• Klärung des Verhältnisses zur ICD: – Symptome und Functioning?

– Risk factors und Umweltfaktoren?

77


Danke für Ihre Aufmerksamkeit!

78


Training Material der ICF Research Branch

79

ICFresearch branch

The use of the ICF Core Sets in clinical practice and research

Training VideoICF Research Branch of WHO CC FIC (DIMDI)

Swiss Paraplegic ResearchLudwig-Maximilians-University

Ressourcen

http://p.ideaday.de/104.2/icf/http://www.icf-research-branch.org/aboutus/services.htm


Backup – ICF Linking

80


Targets for ICF linking:

• standardized patient-orientedoutcomes

• clinical assessments, also thoserequiring an specialized apparatus

• interventions targets

• qualitative data

3.2. Linking health and health related information to the ICF


Linking steps for qualitative data

Identification of linking units

Linking of linking unit to the ICF

Preparation of the information

Divide the text where a change in meaning is discerned


The text contained between two divisions usually have a common unifying theme


Data from a qualitative interview:

“Sometimes I s-s-stutter and can’t find the right word to use, but only when I am around strangers for the first time. Because of this I have a hard time making friends, since they make fun of me, or else try to keep their distance. But recently things have been looking up for me because my parents have gotten me a dog as a new friend and they say that as soon as I have my birthday and I turn 11 I can take the dog for long walks. Right now, though, I feel sad most of the day.”



Linking steps for qualitative data

Identification of linking units

Linking of linking unit to the ICF

Preparation of the information

Divide the text where a change in meaning is discerned


What is this text about?(in the peron’s own words)


Division of text when a change in meaning is discerned

Linking unit ICF Code

Sometimes I s-s-stutter and can’t find the right word to use, but only when I am around strangers for the first time.

-Sometimes I s-s-stutter-can’t find the right word to use-only when I am around strangers for the first time

Because of this I have a hard time making friends, since they make fun of me, or else try to keep their distance.

But recently things have been looking up for me because my parents have gotten me a dog as a new friend and they say that as soon as I have my birthday and I turn 11 I can take the dog for long walks.

Right now, though, I feel sad most of the day



If yes…• Which component?

• Which chapter within the selected component is the most appropriated?

• Which category within the selected chapter is the most precise?

Health condition(disease, trauma)

Environmentalfactors

Personalfactors

Activity ParticipationParticipationBody function

and Body structure

Is the linking unit an element of …?



Division of text when a change in meaning is discerned

Linking unit ICF Code

Sometimes I s-s-stutter and can’t find the right word to use, but only when I am around strangers for the first time.

-Sometimes I s-s-stutter-can’t find the right word to use-only when I am around strangers for the first time

-b3300 Fluency of speech-b16710 Expression of spoken

language

-d730 relating with strangers

Because of this I have a hard time making friends, since they make fun of me, or else try to keep their distance.

But recently things have been looking up for me because my parents have gotten me a dog as a new friend and they say that as soon as I have my birthday and I turn 11 I can take the dog for long walks.

Right now, though, I feel sad most of the day



Linking Methodology

Uses and advantages



The health and health-related information for linking may be derived from:

• standardized patient-orientedoutcomes

• clinical assessments, also thoserequiring an specialized apparatus

• interventions targets

• qualitative data



SF-36

INSTRUCTIONS: This survey asks foryour views about your health. Thisinformation will help keep track of howyou feel and how well you are able todo your usual activities.

Answer every question by markingthe answer as indicated. If you arunsure about how to answer aquestion, please give the best answer you can.

b1b130b134b152b180b1801b280••••

s299s710s720 s730s73001s73011••••••••

d170d230d360d410 d415d430•••••

e110e115e120e125e135e150••

1424


When a single patient-oriented measure is linked …


… its content validity can be studied

– breadth of coverage– repetition of content area



The SF-36 addresses:

b130 3b1300 1b152 13b280 3

d 9d4102 1d4105 2d4300 1d4309 1d4500 1d4501 1d4509 1d4551 2

d540 1d589 1d640 1

d859 7

d9 4


The SF-36 also addresses:

gh 15nc 7pf 4ph 10d 9


MHQ

Joint mobilityMobility (general)Muscle power / StrengthPainStability of jointsEmotional functionEngergy & Drive functionsGait / AmbulationStiffnessMuscle enduranceSexual functionsSleep

DAQ


SF-36



SIP


AIMS


HAQ



b1b130b134b152b180b1801b280••••

s299s710s720 s730s73001s73011••••••••

d170d230d360d410 d415d430•••••

e110e115e120e125e135e150••

1424


When several patient-oriented measures are linked …


… their content can be compared and the most appropriate measure to address the person’s needs can be selected



MHQ


DAQ


SF-36



SIP


AIMS


HAQ



b1b130b134b152b180b1801b280••••

s299s710s720 s730s73001s73011••••••••

d170d230d360d410 d415d430•••••

e110e115e120e125e135e150••

1424


When several patient-oriented measures are linked …


… the basis for categories-specific item banks can be created



b130 Energy and drive

MFI-20I feel fit.

I feel very active.

I feel tired.

I am rested.

Physically, I feel only able to do a little.

Physically, I can take on a lot.

Physically, I feel I am in bad condition.

I tire easily.

Physically, I feel I am in excellent condition.

CES-DI did not feel like eating; my appetite was poor.

I felt that everything I did was an effort.

I could not get “going”.

RAQOLI have to go to bed earlier than I would like to.

It’s too much effort to go out and see people.

I have to keep stopping what I am doing, to rest.

I feel tired whatever I do.

SF-36Did you have a lot of energy?

Did you feel worn out?

Did you feel tired?



9080

010

2030

4050

6070

100

RAQoL 25: It’s too much effort to go out and see people.

CES-D 07: I felt that everything I did was an effort.

CES-D 20: I could not get “going”.

SF-36 9g: Did you feel worn out?

MFI 2: Physically, I feel only able to do a little.

SF-36 9e: Did you have a lot of energy?MFI 5: I feel tired.

MFI 3: I feel very active.

MFI 8: Physically, I can take on a lot.

MFI 1: I feel fit.

MFI 12: I am rested.MFI 16: I tire easily.

RAQoL 10: I have to keep stopping what I am doing, to rest.

SF 36 9i: Did you feel tired?

RAQoL 21: I feel tired whatever I do.

MFI 20: Physically, I feel I am in an excellent condition.

b130 Energy and drive


Cieza A, Hilfiker R, Boonen A, Chatterji S, Kostanjsek N, Ustün BT, Stucki G. Items from patient-oriented instrumentscan be integrated into interval scales to operationalize categories of the International Classification of Functioning,

Disability and Health. J Clin Epidemiol. 2009 Sep;62(9):912-21

Energy and drive sum score


The use of the linking methodology in qualitative data obtained from patients is useful for:

• identifying patients’ needs and for comparing these needs among different groups of patients

• evaluating the content validity of instruments

– Do the existing instruments address what is relevant to patients?

• evaluating interventions and studies

– Do the existing interventions and the studies being performed address what is relevant to patients?


Documents

Die Internationale Klassifikation der Funktionsfähigkeit ... · Jan D. Reinhardt, PhD; Berchtesgaden 1/14 2011 1 Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung