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Exploring the relationships between International Classification of Functioning, Disability and Health (ICF) constructs of Impairment, Activity Limitation and Participation Restriction in people with osteoarthritis prior to joint replacement
Beth Pollard, Marie Johnston, Paul Dieppe
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-97
Abstract: A geographical cohort of 413 patients with osteoarthritis about to undergo hip and knee joint replacement completed the Aberdeen measures of Impairment, Activity Limitation and Participation Restriction (Ab-IAP). Confirmatory factor analysis was used to test the three factor (I, A, P) measurement model. Structural equation modelling was used to explore the I, A and P pathways in the ICF model.There was support from confirmatory factor analysis for the three factor I, A, P measurement model. The structural equation model had good fit [S-B Chi-square = 439.45, df = 149, CFI robust = 0.91, RMSEA robust = 0.07] and indicated significant pathways between I and A (standardised coefficient = 0.76 p < 0.0001) and between A and P (standardised coefficient = 0.75 p < 0.0001). However, the path between I and P was not significant (standardised coefficient = 0.01).The significant pathways suggest that treatments and interventions aimed at reducing impairment, such as joint replacement, may only affect P indirectly, through A, however, longitudinal data would be needed to establish this.Osteoarthritis (OA) in the lower limbs (hips and knees) is one of the commonest cause of physical disability in older people [1]. Many treatments are available, some of which target an impairment, such as pain, or restrictions of joint movement, and some on activities limitations, such as reduced walking ability or difficulties with stair climbing (e.g.[2-5]). However, an important issue, for people with OA is to improve their participation in society which has been restricted by the impairments and activities limitations [6-8]. It is therefore important to know the relationships between impairments, activities limitations and restricted participation in this patient group.The leading model of disability is the International Classification of Functioning, Disability and Health (ICF) [9]. The ICF proposes three main constructs, impairment (I), activity limitation (A) and participation restriction
Participation and quality of life in children with Duchenne muscular dystrophy using the International Classification of Functioning, Disability, and Health
Roxanna M Bendixen, Claudia Senesac, Donovan J Lott, Krista Vandenborne
Health and Quality of Life Outcomes , 2012, DOI: 10.1186/1477-7525-10-43
Abstract: Fifty boys with DMD and 25 unaffected age-matched boys completed two self-report measures: the Children’s Assessment of Participation and Enjoyment and the Pediatric Quality of Life InventoryTM 4.0. We investigated differences between the two groups with regard to participation in life activities and perceived quality of life (QoL). Additionally, we compared participation in activities and QoL in both cohorts of younger and older boys.Participation in physical activities was significantly lower in boys with DMD than unaffected boys. Perceived QoL was markedly diminished in children with DMD relative to unaffected controls, except in the emotional domain. The amount of time boys engage in an activity, as well as participation in social activities, declined for our older boys with DMD but no changes were observed for our older unaffected boys. For both groups, QoL remained constant over time.The ICF-CY provides a conceptual framework and specific terminology that facilitates investigation of the consequences of impairment in children and youth. Our study is one of the first to explore participation in a cohort of boys with DMD. It was not surprising that activities of choice for boys with DMD were less physical in nature than unaffected boys their age, but the consequences of less social engagement as the boys with DMD age is of great concern. Results from our study underscore the need to further evaluate activities that children elect to participate in, with special emphasis on facilitators and barriers to participation and how participation changes throughout the course of a disease.Duchenne muscular dystrophy (DMD), the most common form of muscular dystrophy, is a genetically-linked disease of male children which affects one in 3,300 boys [1]. The muscle damage and weakness which occurs with this disease leads to a progressive decline in the boy’s ability to perform everyday tasks, such as climbing stairs and walking short distances [2-4]. Disruption to the lives o
An ontology-based exploration of the concepts and relationships in the activities and participation component of the international classification of functioning, disability and health
Vincenzo Della Mea, Andrea Simoncello
Journal of Biomedical Semantics , 2012, DOI: 10.1186/2041-1480-3-1
Abstract: In the relationship analysis, we used four predicates among those available in SUMO for processes (Patient, Instrument, Agent, and subProcess). While at the top level subsumption was used in most cases (90%), at the lower levels the percentage of other relationships rose to 41%. Chapters were heterogeneous in the relationships used and some of the leaves of the tree seemed to represent properties or parts of the parent concept rather than subclasses. Mapping of ICF to SUMO proved partially feasible, with the activity concepts being mapped mostly (but not totally) under the IntentionalProcess concept in SUMO. On the other hand, the participation concept has not been mapped to any upper level concept.Our analysis of the relationships within ICF revealed issues related to confusion between classes and their properties, incorrect classifications, and overemphasis on subsumption, confirming what already observed by other researchers. However, it also suggested some properties for Activities that could be included in a more formal model: number of agents involved, the instrument used to carry out the activity, the object of the activity, complexity of the task, and an enumeration of relevant subtasks.Terminologies and classifications are particularly crucial in the medical field, as they are widely diffused to represent knowledge in the clinical practice. Perhaps the most known terminologies and classifications are the International Classification of Diseases (ICD) [1] and the Systematized Nomenclature of Medicine (SNOMED) [2].Ontologies are means for specifying the intended meaning of a vocabulary in a logical manner [3]. Depending on generality, we can distinguish between upper (or top-level) and domain ontologies. The former describe very general concepts like space, time, matter, object, event, action, etc., which are independent of a particular problem or domain. The latter describe the vocabulary related to a generic domain or a generic task or activity, by speciali
Validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis from the patient perspective using focus groups
Michaela Coenen, Alarcos Cieza, Tanja A Stamm, Edda Amann, Barbara Kollerits, Gerold Stucki
Arthritis Research & Therapy , 2006, DOI: 10.1186/ar1956
Abstract: Functioning is recognized as an important study outcome in rheumatoid arthritis (RA). The number of clinical studies addressing functioning as a study endpoint in patients with RA has steadily increased during the past decade [1]. These investigations have predominantly been guided by the medical perspective, from which the measurement of functioning and health is required to evaluate the patient-relevant outcomes of an intervention and from which functioning and health are seen primarily as a consequence of the disease [2]. Many of these investigations include patient-oriented instruments, for example, patient and proxy self-reports on health status, quality of life, and health preferences. In rheumatology, the Health Assessment Questionnaire Disability Index (HAQ [3]) and the Arthritis Impact Measurement Scales (AIMS2 [4]), which can be considered a generic instrument specific for RA, are widely used.These instruments have also been developed according to the medical perspective and in line with the current concept in outcomes and quality-of-life research of condition-specific measures [5], that is, they are based on the assumption that different conditions are associated with salient patient problems in functioning. The individual influence of the environment and personal factors is, however, rarely taken into account [6,7]. In addition, widely used RA-specific health-status measures, like the Health Assessment Questionnaire Disability Index, mainly address activities far more than participation [8]. However, patients' experiences of functioning are determined by their interaction with the environment and their own personal characteristics and not only by the health condition [9-12]. RA is also very much associated with the inability to continue working, ultimately leading to the experience of restriction in participation [13-16]. Thus, a very comprehensive approach is required when addressing RA.The bio-psycho-social model of Functioning, Disability and Health o
The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) can measure the impairment, activity limitations and participation restriction constructs from the International Classification of Functioning, Disability and Health (ICF)
Diane Dixon, Marie Johnston, Margaret McQueen, Charles Court-Brown
BMC Musculoskeletal Disorders , 2008, DOI: 10.1186/1471-2474-9-114
Abstract: Twenty-four judges used the method of Discriminant Content Validation to allocate the 38 items of the DASH to the theoretical definition of one or more ICF outcome. One-sample t-tests classified each item as measuring, impairment, activity limitations, participation restrictions, or a combination thereof.The DASH contains items able to measure each of the three ICF outcomes with discriminant validity. The DASH contains five pure impairment items, 19 pure activity limitations items and three participation restriction items. In addition, seven items measured both activity limitations and participation restrictions.The DASH can measure the three health outcomes identified by the ICF. Consequently the DASH could be used to examine the impact of trauma and subsequent interventions on each health outcome in the absence of measurement confound.Fracture of the wrist is a common injury and is especially prevalent in older post-menopausal women. Wrist fracture is associated with variable outcome, for example, approximately 50% of cases fail to recover pre-operative function [1] and 20% of patients report moderate to severe pain at 6 month post-fracture [2]. A recent series of Cochrane reviews of the effectiveness of commonly applied interventions for wrist fracture have highlighted the continued unsatisfactory outcome for many patients [3]. Further, there is an association between wrist fracture and long-term disability and increased risk of dependency [4]. Any measure of outcome from wrist fracture needs to be able to index the impact of fracture, not only on the impairment itself but also on the level of associated disability.The WHO identifies three health outcomes in its International Classification of Functioning Disability and Health (ICF) taxonomy of the consequences of disease, namely, impairments (I), activity limitations (A) and restrictions in social participation (P) [5] (see Table 1 for definitions). In accordance with the ICF, a complete assessment of outcome fo
Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health
Martin Mueller, Edith Schuster, Ralf Strobl, Eva Grill
Health and Quality of Life Outcomes , 2012, DOI: 10.1186/1477-7525-10-75
Abstract: We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF).From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect “dizziness” most participants reported problems within “Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported “Immediate family (e310)” as a relevant modifying environmental factor.From the patients’ perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals’ daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo.
Disability in people affected by leprosy: the role of impairment, activity, social participation, stigma and discrimination
Wim H. van Brakel,Benyamin Sihombing,Hernani Djarir,Kerstin Beise
Global Health Action , 2012, DOI: 10.3402/gha.v5i0.18394
Abstract: Background: Leprosy-related disability is a challenge to public health, and social and rehabilitation services in endemic countries. Disability is more than a mere physical dysfunction, and includes activity limitations, stigma, discrimination, and social participation restrictions. We assessed the extent of disability and its determinants among persons with leprosy-related disabilities after release from multi drug treatment. Methods: We conducted a survey on disability among persons affected by leprosy in Indonesia, using a Rapid Disability Appraisal toolkit based on the International Classification of Functioning, Disability and Health. The toolkit included the Screening of Activity Limitation and Safety Awareness (SALSA) scale, Participation Scale, Jacoby Stigma Scale (anticipated stigma), Explanatory Model Interview Catalogue (EMIC) stigma scale and Discrimination assessment. Community members were interviewed using a community version of the stigma scale. Multivariate linear regression was done to identify factors associated with social participation. Results: Overall 1,358 persons with leprosy-related disability (PLD) and 931 community members were included. Seventy-seven percent of PLD had physical impairments. Impairment status deteriorated significantly after release from treatment (from 59% to 77%). Around 60% of people reported activity limitations and participation restrictions and 36% anticipated stigma. As for participation restrictions and stigma, shame, problems related to marriage and difficulties in employment were the most frequently reported problems. Major determinants of participation were severity of impairment and level of education, activity and stigma. Reported severity of community stigma correlated with severity of participation restrictions in the same districts. Discussion: The majority of respondents reported problems in all components of disability. The reported physical impairment after release from treatment justifies ongoing monitoring to facilitate early prevention. Stigma was a major determinant of social participation, and therefore disability. Stigma reduction activities and socio-economic rehabilitation are urgently needed in addition to strategies to reduce the development of further physical impairment after release from treatment.
New international classification of functioning, disability and health  [PDF]
Stucki Gerold,Maksimovi? Milo?,Davidovi? Dragana,Jorga Jagoda
Srpski Arhiv za Celokupno Lekarstvo , 2007, DOI: 10.2298/sarh0706371s
Abstract: The WHO International Classification of Functioning, Disability and Health (ICF) provides a coherent view of health from a biological, individual and social perspective. This view may be defined both as multi- and interdisciplinary management of one’s functioning and health. This new classification is currently being assessed in multiple centers in 32 countries, on 12 health conditions. The Institute of Hygiene and Medical Ecology, School of Medicine, University of Belgrade, is one of them, serving as the centre where the classification is being tested in obese population. The objective of this paper is to provide information needed for further development and practical application of this classification in various health conditions. The new language of ICF is an exciting landmark event for preventive medicine and rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multiprofessional communication and improve communication between patients and health professionals. .
Uncovering Indicators of the International Classification of Functioning, Disability, and Health from the 39-Item Parkinson's Disease Questionnaire  [PDF]
Maria H. Nilsson,Albert Westergren,Gunilla Carlsson,Peter Hagell
Parkinson's Disease , 2010, DOI: 10.4061/2010/984673
Abstract: The 39-item Parkinson's disease questionnaire (PDQ-39) is the most widely used patient-reported rating scale in Parkinson's disease (PD). However, recent studies have questioned its validity and it is unclear what scores represent. This study explored the possibility of regrouping PDQ-39 items into scales representing the International Classification of Functioning, Disability, and Health (ICF) components of Body Functions and Structures (BF), Activities and Participation (AP), and Environmental (E) factors. An iterative process using Rasch analysis produced five new items sets, two each for the BF and AP components and one representing E. Four of these were found to represent clinically meaningful variables: Emotional Impairment (BF), Gross Motor Disability (AP), Fine Motor Disability (AP), and Socioattitudinal Environment (E) with acceptable reliability (0.73–0.96) and fit to the Rasch model (total item-trait chi-square, 8.28–33.2; ). These new ICF-based scales offer a means to reanalyze PDQ-39 data from an ICF perspective and to study its health components using a widely available health status questionnaire for people with PD. 1. Introduction The International Classification of Functioning, Disability, and Health (ICF) provides a conceptualisation and classification of different components of health including biological, individual, and social perspectives [1]. The ICF contains two parts. The first part defines functioning and disability, which in turn consists of two components, Body Functions and Structures, and Activities and Participation. Body functions include physiological and psychological functions, and body structures refer to the anatomical integrity of the body. Activities are the execution of tasks or actions, whereas participation refers to the involvement in life situations. The second part conceptualizes contextual factors, which include environmental and personal factors. The environmental component is the facilitating or hindering impact of the physical, social, and attitudinal environment. Similarly, personal factors are recognized as having a facilitating or hindering impact but they are not further specified because of their vast social and cultural variation [1]. In addition to its use for clinical, educational, and research purposes, the ICF can be used to understand the content of different health outcome measures [2]. Linking such scales to the ICF can be valuable to allow clinical studies to relate to the ICF and for gaining a conceptual understanding of scale contents [3, 4], thereby serving as a base for their further
Parents’ actions, challenges, and needs while enabling participation of children with a physical disability: a scoping review
Barbara Pi?kur, Anna JHM Beurskens, Marian J Jongmans, Marjolijn Ketelaar, Meghan Norton, Christina A Frings, Helena Hemmingsson, Rob JEM Smeets
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-177
Abstract: Scoping review with extensive literature search (September 2011) and a thematic analysis to synthesize findings.Fourteen relevant articles revealed two major themes: ‘parents enable and support performance of meaningful activities’ and ‘parents enable, change and use the environment’. Each theme holds a number of actions (e.g. choosing the right type of meaningful activities for facilitating social contacts) and challenges (e.g. negative attitudes of other people). Less information is available about the needs of parents.This study indicates that parents apply a broad range of strategies to support participation of their children. They experience many challenges, especially as a result of constraints in the social and physical environments. However, this review also shows that little is known about needs of parents in facilitating participation. As Family-centered service (FCS) philosophy is all about the needs of the child and the family, it is essential to further investigate the needs of the parents and to understand if and to what extent they wish to be supported in enabling their child’s participation in daily life.The concept of participation is important in the field of childhood disability [1]. Participation has been defined by the International Classification of Functioning, Disability and Health (ICF) as “a person’s involvement in life situations” [2]. For children, involvement includes participation in everyday activities, such as recreational, leisure, school, and household activities [3]. Participation is an important outcome for the health of adults and children [4-7]. Furthermore, children’s participation at home, at school, and in the community relates to well-being, quality of life, and development [5,8-10]. Several authors use the term social participation for participation, emphasizing the importance of engagement in social situations [11-13]. Through participation in different social contexts, children gather knowledge and skills needed to intera
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