Delphi-based assessment of fall-related risk factors in acute rehabilitation settings according to the International Classification of Functioning, Disability and Health.

OBJECTIVE: To apply the International Classification of Functioning, Disability and Health (ICF) model to fall prevention by developing an ICF core set for fall risks in acute rehabilitation settings. DESIGN: Fall risk factors were identified based on a systematic review of the literature and linked to ICF categories. A consensus process was conducted using a Delphi-based evaluation technique. SETTING: University-based hospital. PARTICIPANTS: Multidisciplinary participants (N=20) from different institutions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A 5-point Likert-type scale was used to weigh the importance of each risk category. The level of agreement for each consensus was assessed based on Spearman rho and semi-interquartile range indices. Categories with a mean score ≥4 in the third round of evaluation were included in this ICF core set. RESULTS: The core set comprised 34 fall risk categories that were distributed as follows: 18 categories on body functions, 2 on body structures, 8 on activities and participation, 4 on environmental factors, and 2 categories on personal factors. CONCLUSIONS: An ICF core set for falls in acute rehabilitation settings was developed in this study. Further validation is required.

Implementing disability evaluation and welfare services based on the framework of the International Classification of Functioning, Disability and Health: experiences in Taiwan.

BACKGROUND: Before 2007, the disability evaluation was based on the medical model in Taiwan. According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person's eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. The purposes of this study were to: 1) design the evaluation tools for disability eligibility system based on the ICF/ICF-Children and Youth; 2) compare the differences of grades of disability between the old and new evaluation systems; 3) analyse the outcome of the new disability evaluation system. METHODS: To develop evaluation tools and procedure for disability determination, we formed an implementation taskforce, including 199 professional experts, and conducted a small-scale field trial to examine the feasibility of evaluation tools in Phase I. To refine the evaluation tools and process and to compare the difference of the grades of disability between new and old systems, 7,329 persons with disabilities were randomly recruited in a national population-based study in Phase II. To implement the new system smoothly and understand the impact of the new system, the collaboration mechanism was established and data of 168,052 persons who applied for the disability benefits was extracted from the information system and analysed in Phase III. RESULTS: The measures of the 43 categories for body function/structure components, the Functioning Scale of Disability Evaluation System for activities/participation components, and the needs assessment have been developed and used in the field after several revisions. In Phase II, there was 49.7% agreement of disability grades between the old and new systems. In Phase III, 110,667 persons with a disability received their welfare services through the new system. Among them, 77% received basic social welfare support, 89% financial support, 24% allowance for assistive technology, 7% caregiver support, 8% nursing care and rehabilitation services at home, and 47% were issued parking permits for persons with disability. CONCLUSION: This study demonstrated that disability evaluation system based on the ICF could provide a common language between disability assessment, needs assessment and welfare services. However, the proposed assessment protocol and tools require additional testing and validation.

Evolution of system for disability assessment based on the International Classification of Functioning, Disability, and Health: A Taiwanese study.

BACKGROUND/PURPOSE: The criteria for disability were mainly based on the medical model, and the candidates for disability benefits were identified by physicians mainly depending on their degree of bodily impairment, but without sufficient evaluation of their activity, participation, and environment in Taiwan. According to the People with Disabilities Rights Protection Act, the assessment of a person's eligibility for disability benefits was required to be based on the International Classification of Functioning, Disability, and Health (ICF) framework since July 11, 2012. This study investigated a proposed system to assess patients' eligibility for disability in Taiwan, based on the ICF. METHODS: We have initiated a national decision-making process involving members of Taiwan's ICF Team. We facilitated 16 group discussions on the ICF coding system, in which 199 professionals participated. In each group, one member led the group discussion until a consensus was reached. RESULTS: We have developed a process to determine the eligibility of people with disabilities. This study set up the standards, tools, and practice manuals for each category. We have also developed a core set for disability assessment. CONCLUSION: We implemented a new system to assess patients' eligibility for disability. The proposed assessment protocol and tools require further validation.

Individual-level responsiveness of the original and short-form postural assessment scale for stroke patients.

BACKGROUND: The group-level responsiveness of the Postural Assessment Scale for Stroke Patients (PASS) is similar to that of the short-form PASS (SFPASS). This result is counterintuitive because the PASS has more items (12) and response levels (4) than does the SFPASS (5 items and 3 response levels). OBJECTIVE: The purpose of this study was to compare individual-level responsiveness between both measures to determine whether the SFPASS can detect change with as much sensitivity as the PASS. STUDY DESIGN AND SETTING: Two hundred fifty-one patients were assessed using the PASS at 14 and 30 days after stroke onset in a medical center. METHODS: The SFPASS scores were calculated from the patients' responses on the PASS. Individual-level responsiveness was calculated on the basis of the value of minimal detectable change (MDC). If a patient's change score was greater than the MDC of the PASS or SFPASS, his or her improvement was considered significant. The difference in the number of patients scoring greater than the MDC and the units of MDC (the MDC ratio) improved by the patients on both measures was examined. RESULTS: Fifty-three percent of the patients scored greater than the MDC of the PASS, whereas 43.0% of the patients scored greater than the MDC of the SFPASS. The difference was significant. The mean (±SD) MDC ratio of the PASS (1.8±1.7) was significantly higher than that of the SFPASS (1.2±1.3). LIMITATIONS: The scores of the SFPASS were retrieved from those of the PASS, which limits the generalization of our findings. CONCLUSIONS: The PASS has better individual-level responsiveness than does the SFPASS. To comprehensively report effects of clinical trials, future studies using the PASS should report the individual-level effect (eg, number of patients scoring greater than the MDC).

The impact of stroke: insights from patients in Taiwan.

Clinical stroke trials have been increasing interest in patient-centred assessments such as functional status and health-related quality of life. There is a consensus that these measurement factors must be relevant to, and obtained from, the patients of interest. The main purpose of this study was to evaluate the patients' reactions and concerns that individuals experience after having had a stroke. A focus group and individual interviews were conducted to identify and describe the patients' reactions to living with the results of a stroke. One hundred twelve patients participated in the study. Fifteen factors were identified as problems for the 112 participants. For the level of impact and importance, the highest percentages of responses rated by the participants in each factor were all towards the physical aspects of functioning such as hand/arm function and mobility. These findings provide important information on the impact of stroke that could be useful for occupational therapists in treatment planning and outcome measurement. Further research is recommended to understand the impact of a stroke on an individual's adjustment at home and in the community.

A Rasch analysis of the Frenchay Activities Index in patients with spinal cord injury.

STUDY DESIGN: A prospective interview study. OBJECTIVE: To determine whether items of the Frenchay Activities Index (FAI) measure Instrumental Activities of Daily Living (IADL), as a unidimensional construct, in patients with spinal cord injury (SCI). To examine whether the response categories of the FAI are useful in discerning the various ability levels of IADL. SUMMARY OF BACKGROUND DATA: No known IADL scale has been designed for SCI patients. The FAI, to our knowledge, has never been validated in patients with SCI. METHODS: A total of 233 persons with SCI participated in this study. The FAI was administered to the patients by interview at locations convenient for the participants. A Rasch analysis was used to examine the unidimensionality and appropriateness of the response categories of the FAI. RESULTS: All but 2 items ("going outside" and "reading books") of the FAI fitted the model's expectations. The results of Rasch analysis indicated that the response categories for the remaining 13 items of the FAI should be collapsed to create more suitable response categories (4 items, into dichotomies, and the remaining 9 items, into trichotomies). Thus, a revised 13-item FAI was formed by deleting the 2 misfitting items and collapsing the response categories of the items. CONCLUSIONS: This study demonstrated that the revised 13-item FAI assesses a single, unidimensional IADL for SCI patients living in the community. The revised FAI shows potential for assessment of IADL in SCI patients.

A validity study of the WHOQOL-BREF assessment in persons with traumatic spinal cord injury.

OBJECTIVE: To examine the distribution of the scores, internal consistency, structure, and discriminant validity of the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) assessment in persons with traumatic spinal cord injury (SCI). DESIGN: Validation study using multitrait analysis and known-groups methods. SETTING: Community and hospital. PARTICIPANTS: Persons with SCI (N=111) and non-SCI respondents (N=169). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The WHOQOL-BREF assessment. RESULTS: The frequency distribution of the 4 domains of the WHOQOL-BREF assessment was nearly symmetric and showed no floor or ceiling effects. All domains showed good internal consistency (Cronbach alpha range, .74-.78), with the exception of the social relationships domain (alpha=.54). The 4-domain structure of the WHOQOL-BREF assessment was confirmed using multitrait analysis. The discriminant validity of the WHOQOL-BREF assessment in persons with SCI was satisfactory. CONCLUSIONS: The WHOQOL-BREF assessment is suitable for measuring QOL as perceived by a person with SCI.