Instrumento para identificar barreras ambientales percibidas por personas mayores en el contexto cubano / An Instrument for Identifying Environmental Barriers Perceived by Elderly People in the Cuban Context

Introducción: El envejecimiento de la población cubana trae aparejado un aumento de la discapacidad. En este sentido la Clasificación Internacional del Funcionamiento, de la Discapacidad y la Salud recomienda el diseño de instrumentos de medición que identifiquen los factores ambientales que afectan la funcionalidad. Objetivo: Describir las propiedades psicométricas de un instrumento de medición diseñado para identificar barreras ambientales percibidas por las personas mayores en el contexto cubano en cuanto a la validez de apariencia, de contenido y constructo. Métodos: Se realizó un estudio de desarrollo tecnológico. Se consultó a un grupo de expertos para la validación de apariencia y contenido, y se calculó el coeficiente de validez de contenido insesgado y corregido. Para la validez de constructo se calculó el análisis factorial de los componentes principales. Resultados: El coeficiente de validez de contenido insesgado y el corregido mostraron cifras superiores a 0,80, considerado como bueno. El análisis factorial arrojó siete factores que explican las dimensiones exploradas en la definición que se pretende medir. Conclusiones: El instrumento diseñado mostró un alto acuerdo entre los expertos en cuanto a la validez de apariencia y contenido. Los indicadores evidenciaron que el instrumento tiene una estructura multidimensional que se corresponde con el constructo que se pretende medir(AU)

Introduction: The aging of the Cuban population brings about an increase in disability. In this sense, the International Classification of Functioning, Disability and Health recommends the design of measurement instruments to identify environmental factors affecting functionality. Objective: To describe, in terms of face, content and construct validity, the psychometric properties of a measurement instrument designed to identify environmental barriers perceived by elderly people in the Cuban context. Methods: A technological development study was carried out. A group of experts was consulted for the face and content validation, while the unbiased and corrected content validity coefficient was calculated. For construct validity, principal component factor analysis was calculated. Results: The unbiased and corrected content validity coefficient showed figures above 0.80, considered as good. Factor analysis yielded seven factors that explain the dimensions explored in the definition intended to be measured. Conclusions: The designed instrument showed high agreement among the experts in terms of face and content validity. The indicators showed that the instrument has a multidimensional structure that corresponds to the construct that it is intended to measure(AU)

Content validity of the Brief and Comprehensive ICF Core Sets for common disabling conditions in a developing country.

The International Classification of Functioning, Disability and Health (ICF) features associated tools, the Brief and Comprehensive ICF Core Sets. These are designed to be universally applicable, but have limited evidence of content validity (i.e. comprehensiveness and relevance) in low income, non-Western countries. In this cross-sectional study, we aimed to assess the content validity of the ICF Core Sets in Nepal. We interviewed 161 participants with stroke, spinal cord injury (SCI), chronic obstructive pulmonary disease (COPD), and musculoskeletal conditions and asked them to identify activities they had difficulty performing due to their health condition. We mapped 544 participant responses to the ICF and assessed if these ICF categories were represented in the respective ICF core sets. The Comprehensive Core Sets for stroke, COPD, SCI, and musculoskeletal conditions contained more items identified by participants than the respective Brief Core Sets (e.g., 89% vs. 26% in stroke). Among ICF categories that represented at least 5% of participants' responses, the Brief Core Sets covered 40%-71% of participants' responses whereas the Comprehensive Core Sets covered 67%-100% of responses. This is the first study to evaluate the content validity of the ICF Brief and Comprehensive core sets in Nepali individuals with stroke, SCI, MSK conditions, and COPD. The Comprehensive Core Sets for stroke, COPD, and SCI have adequate content validity for use in clinical practice and research in Nepal; the Brief Core Sets may not adequately meet local and individual needs unless supplemented with additional ICF categories.

Psychometric properties of the International Classification of Functioning, Disability and Health Rehabilitation Set: a Rasch analysis.

The International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set was proposed by the WHO ICF Research branch as a minimum standard for assessing and reporting functioning in a wide range of clinical settings. This study investigates the psychometric properties of ICF Rehabilitation Set using Rasch analysis. It was a multicenter, cross-sectional study involving 515 inpatients in the subacute or chronic phase of recovery from various health conditions selected by quota sampling (stratified by neurological, cardiopulmonary, musculoskeletal and other conditions). Registered physicians or nurses used the developed operational items of the ICF Rehabilitation Set to rate patients' functioning. A Rasch model was performed in assessing the psychometric properties of the ICF Rehabilitation Set. Good reliability was observed in the activity and participation components, but the body functions component needs additional items to distinguish among people with moderate or severe problems. After recalibration, the body functions, activities and participation components showed fit to the Rasch model. However, deletions mandated by the Rasch model decreased the functioning information reflected by the ICF Rehabilitation Set.

Laying the foundation for a primary care core set of the International Classification of Functioning, Disability and Health (ICF) for community-dwelling older adults: A qualitative study.

OBJECTIVE: To explore relevant areas of functioning from the perspective of community-dwelling adults aged 75 years and over, in order to develop a Core Set of the International Classification of Functioning, Disability and Health (ICF) for community-dwelling older adults for use in primary care. DESIGN: Qualitative study using semi-structured interviews and focus groups. PARTICIPANTS: A total of 27 community-dwelling older adults participated in the interviews and 24 of them in the focus groups. METHODS: Following the proposed methodology of the ICF Research Branch, this is 1 of 4 preparatory studies in the Core Set development process. Within the transcripts, concepts of functioning were identified, based on Mayring's qualitative content analysis using deductive category assignment with the ICF being the category system. RESULTS: Overall 6,667 concepts were identified. Most were linked to the Activities and Participation component. The most frequently identified categories were "recreation and leisure" and "family relationships". CONCLUSION: Categories from all ICF chapters were identified, demonstrating the complexity and multidimensionality of the ageing process, with a special emphasis on the component Activities and Participation. This qualitative study provides a list of relevant categories from the perspective of community--dwelling elderly people, which will be used to develop a Core Set for older primary care patients.

A team approach to applying the International Classification of Functioning, Disability and Health Rehabilitation set in clinical evaluation.

OBJECTIVE: To develop a team approach to applying the International Classification of Functioning, Disability and Health Rehabilitation Set (ICF-RS) in clinical evaluation. DESIGN: A Delphi study. SUBJECTS: Experts from rehabilitation institutions in China including physicians, nurses, physiotherapists and occupational therapists. METHODS: A 2-round Delphi survey and expert panel discussion were used to generate the team approach. Firstly, the candidate types of professionals for team rating were chosen through expert panel discussion. A carefully selected group of participants was then asked to score the suitability of physicians, nurses, or other candidate therapists for each category's rat-ing, applying the International Classification of Functioning, Disability and Health Rehabilitation Set in clinical evaluation. After initial assignment of cate-gory to types of professionals, a second round Delphi survey was conducted to quantify the professionals' agreement with the category assignments and generate a final team evaluation approach. RESULTS: Thirty of the category assignments achiev-ed consensus. The final team evaluation approach assigned 6 categories to physicians to evaluate, 7 categories to nurses, 9 categories to physiotherapists, and 8 to occupational therapists. CONCLUSION: Such a team evaluation approach could facilitate implementation of the ICF-RS in clinical settings and provide a more convenient assessment tool for professionals.

Creating a common metric based on existing activities of daily living tools to enable standardized reporting of functioning outcomes achieved during rehabilitation.

OBJECTIVE: Many different assessment tools are used to assess functioning in rehabilitation; this limits the comparability and aggregation of respective data. The aim of this study was to outline the development of an International Classification of Functioning, Disability and Health (ICF)-based interval-scaled common metric for 2 assessment tools assessing activities of daily living: the Functional Independence Measure (FIMTM) and the Extended Barthel Index (EBI), used in Swiss national rehabilitation quality reports. METHODS: The conceptual equivalence of the 2 tools was assessed through their linking to the ICF. The Rasch measurement model was then applied to create a common metric including FIMTM and EBI. SUBJECTS: Secondary analysis of a sample of 265 neurological patients from 5 Swiss clinics. RESULTS: ICF linking found conceptual coherency of the tools. An interval-scaled common metric, including FIMTM and EBI, could be established, given fit to the Rasch model in the related analyses. CONCLUSION: The ICF-based and interval-scaled common metric enables comparison of patients and clinics functioning outcomes when different activities of daily living tools are used. The common metric can be included in a Standardized Assessment and Reporting System for functioning information in order to enable data aggregation and comparability.

International Classification of Functioning in professional rehabilitation: instruments for assessing work disability.

OBJECTIVE To review the main instruments of functional assessment and health status cited in the literature to evaluate Brazilian workers and verify the compatibility of their items with the core set for professional rehabilitation. METHODS A review of the literature was conducted in the main databases in search of articles that used assessment instruments in populations of workers between 2007 and 2017. Subsequently, the contents of the identified instruments were retrieved, and two evaluators analyzed their items to verify the compatibility with the categories of the core set of the International Classification of Functioning for professional rehabilitation. Cohen's kappa coefficient was used to evaluate the agreement between the evaluators. RESULTS Five specific and eight generic instruments were selected to evaluate the functioning of workers. The analysis of the items of the total instruments allowed the definition of 58 categories (64.5%) of the core set with minimal overlap: 13 (76.5%) of the body functions component, 29 (72.5%) of the activities and participation component and 16 (49%) environmental factors. CONCLUSIONS The association of several instruments requires time and makes it difficult to use the classification. The development of instruments with direct association with its categories is essential to operationalize it.

Performance of brief ICF-sleep disorders and obesity core set in obstructive sleep apnea patients.

BACKGROUND: Clinical questionnaires are mainly applied as screening tools for identification of the Obstructive sleep apnea (OSA) patients. Little attention has been paid to assess the body functions and health status of the patients. International Classification of Functioning, Disability and Health (ICF) was designed for better understanding and describing functioning and disability of patients. This study adopted the Brief ICF-Sleep Disorders and Obesity Core Set to evaluate the impairment of functioning and health status of OSA patients. METHODS: Five hundred ninety-two participants were enrolled in this cross-sectional study. Data were collected using Brief ICF-Sleep Disorders and Obesity Core Set Polysomnography was performed and basic characteristics of the patients were recorded. RESULTS: The scores for the component Body Functions and Code b130, b134, b140, b440, b530, s330, d160, d240, d450 of the two core sets were significantly different among the patients divided by apnea-hypopnea index (AHI) or oxygen saturation (SaO2) nadir, but the frequency of code s330, d160, d240, d450 was low. The Body Functions component of the both sets were closely related to neck circumference (NC), body mass index (BMI), apnea-hypopnea index (AHI) of the OSA patients. Body Functions of the Brief ICF-Sleep Disorders performed better with a threshold of 4 with sensitivity, specificity and area under the receiver operating characteristic curve (AUC) as 0.62, 0.74, 0.68(AHI ≥ 5), 0.69, 0.63, 0.66 (AHI ≥ 15), 0.75, 0.56, 0.66 (AHI ≥ 30), 0.56, 0.70, 0.63 (SaO2 nadir≤90%), 0.67, 0.66, 0.66 (SaO2 nadir<85%), 0.71, 0.59, 0.65 (SaO2 nadir<80%), separately. CONCLUSION: The Body Functions component of both two sets could be an evaluation tool of impairment of body functions for OSA patients. The Brief ICF-Sleep Disorders Body Functions component performed better with a threshold of 4 and might provide a new insight for physicians to assess OSA patients.

The influence and added value of a Standardized Assessment and Reporting System for functioning outcomes upon national rehabilitation quality reports.

OBJECTIVE: To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric. DESIGN: Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets. SETTING: Swiss national public rehabilitation outcome quality reports on the clinic level. PARTICIPANTS: A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18 047 patients. INTERVENTIONS: Neurological or musculoskeletal rehabilitation. MAIN OUTCOME MEASURES: Functional Independence Measure™ or Extended Barthel Index. RESULTS: Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric's content with ICF Core Sets suggests to include 'energy and drive functions' or 'maintaining a basic body position' to enhance the content of functioning as an indicator. CONCLUSIONS: A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS' ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation.

Developing an ICF Core Set for adults with cerebral palsy: A Global expert survey of relevant functions and contextual factors.

OBJECTIVE: To identify areas of functioning in adults with cerebral palsy that are considered relevant by experts, in order to develop an International Classification of Functioning, Disability and Health (ICF) Core Set for adults with cerebral palsy. PARTICIPANTS: Experts from various professional backgrounds worldwide who had experience working with adults with cerebral palsy for ≥2 years and were able to complete the survey in the English language. METHODS: A cross-sectional study using an international internet-based survey. The experts were asked to address relevant areas of functioning in adults with cerebral palsy. These areas of functioning were then linked to the ICF and the frequencies analysed. RESULTS: A total of 126 experts from 32 countries completed the survey. From the responses, 217 unique second-level ICF categories were identified. The three most frequently mentioned categories were "design, construction and building products and technology of buildings for public use (e150, 77%) and private use" (e155, 67%), followed by "sensation of pain" (b280, 62%). CONCLUSION: The broad diversity of ICF categories reported by the experts emphasize the known heterogeneity of cerebral palsy and the variety of func-tioning in adulthood. They also reported on many environmental factors, illustrating the importance of person-environment interactions. These findings provide information about relevant issues for use in developing an ICF Core Set for adults with cerebral palsy.

Towards an ICF Core Set for functioning assessment in severe mental disorders: Commonalities in bipolar disorder, depression and schizophrenia.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) offers an internationally accepted standard for describing and assessing functioning and disability in any health condition. A specific list of ICF categories, an ICF Core Set (CS), has been developed for bipolar disorder, depression and schizophrenia. The aim of this study was to determine commonalities in the ICF-CSs for these three disorders, and to identify relevant categories for the development of tentative ICF-CSs for severe mental disorders in general. METHODS: The ICF categories of all three mental health conditions were examined and compared. RESULTS: Comparison of the Comprehensive ICF-CSs for the three mental health conditions revealed a set of 34 common categories (i.e., 10 from the Body functions component, 14 from the Activities and participation component, and 10 Environmental factors ). These categories formed the proposed Comprehensive ICF-CS for severe mental disorders. A total of 11 categories were common to the Brief ICF-CSs of the three mental health conditions, and these formed the Brief ICF-CS for severe mental disorders (i.e., 3 from the Body functions component, 6 from the Activities and participation component, and 2 Environmental factors ). All the categories included refer to key aspects of functioning for severe mental disorders. CONCLUSIONS: The proposed ICF-CSs for severe mental disorders may be applicable across a number of psychotic and affective disorders and they should prove useful for mental health services whose care remit covers a range of conditions.

Validation of the International Classification of Functioning, Disability and Health Core Set for obstructive pulmonary diseases in the perspective of adults with asthma.

Purpose: To validate the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases from the perspective of adults with asthma.Methods: This was a qualitative, cross-sectional study. Individual interviews with questions related to the disease and its impact on the patient's life were performed. The meaning condensation procedure was used for analysis.Results: Thirty-five participants (26 females, 41 ± 13 years old) were interviewed. A total of 405 concepts were identified, and 348 were associated to the components Body Functions (n = 168), Body Structures (n = 22), Activities and Participation (n = 33), Environmental Factors (n = 125). These concepts were linked to 61 categories: second level (n = 25), third level (n = 33), fourth level (n = 3), which confirmed 41% and 77% of those included in the Comprehensive and Brief Core Sets, respectively. Twenty-four additional categories were identified, and 57 concepts could not be linked to the classification.Conclusions: The International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases were supported by the perspective of adults with asthma. The Brief version seemed the best reference for rehabilitation, reflecting the typical disabilities and impairments of these patients. Unconfirmed and added categories have been reported, and their analysis may assist future document updates.Implications for rehabilitationThe use of the International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases is relevant to guide patient assessment, treatment and monitoring.The concepts related to the Body functions and Environmental factors were the most relevant according to the perspective of adults with asthma.The Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases were supported by adults with asthma.

An alternative perspective on assistive technology: The person-environment-tool (PET) model.

The medical and social models of disability categorize people as ablebodied or disabled. In contrast, the biopsychosocial model, which forms the basis for the International Classification of Functioning, Disability and Health (ICF), suggests a universalistic perspective on human functioning, encompassing all human beings. In this article, we argue that the artificial separation of function-enhancing technology into assistive technology (AT) and mainstream technology (MST) might be one of the barriers to a universalistic view of human functioning. Thus, an alternative view of AT is needed. The aim of this article was to construct a conceptual model to demonstrate how all human activities and participation depend on factors related to the person, environment, and tools, emphasizing a universalistic perspective on human functioning. In the person-environment-tool (PET) model, a person's activity and participation are described as a function of factors related to the person, environment, and tool, drawing on various ICF components. Importantly, the PET model makes no distinction between people of different ability levels, between environmental modifications intended for people of different ability levels, or between different function-enhancing technologies (AT and MST). The PET model supports a universalistic view of technology use, environmental adapMcNeill tations, and variations in human functioning.

International classification of functioning in professional rehabilitation: instruments for assessing work disability / Classificação internacional de funcionalidade na reabilitação profissional: instrumentos de avaliação da incapacidade laboral

ABSTRACT OBJECTIVE To review the main instruments of functional assessment and health status cited in the literature to evaluate Brazilian workers and verify the compatibility of their items with the core set for professional rehabilitation. METHODS A review of the literature was conducted in the main databases in search of articles that used assessment instruments in populations of workers between 2007 and 2017. Subsequently, the contents of the identified instruments were retrieved, and two evaluators analyzed their items to verify the compatibility with the categories of the core set of the International Classification of Functioning for professional rehabilitation. Cohen's kappa coefficient was used to evaluate the agreement between the evaluators. RESULTS Five specific and eight generic instruments were selected to evaluate the functioning of workers. The analysis of the items of the total instruments allowed the definition of 58 categories (64.5%) of the core set with minimal overlap: 13 (76.5%) of the body functions component, 29 (72.5%) of the activities and participation component and 16 (49%) environmental factors. CONCLUSIONS The association of several instruments requires time and makes it difficult to use the classification. The development of instruments with direct association with its categories is essential to operationalize it.

RESUMO OBJETIVO Revisar os principais instrumentos de avaliação funcional e situação de saúde citados na literatura para avaliar trabalhadores brasileiros e verificar a compatibilidade de seus itens com o core set para reabilitação profissional. MÉTODOS Foi realizada uma revisão da literatura nas principais bases de dados em busca de artigos que utilizaram instrumentos de avaliação em populações de trabalhadores entre 2007 e 2017. Posteriormente foram recuperados os conteúdos dos instrumentos identificados e dois avaliadores analisaram seus itens para verificar a compatibilidade com as categorias do core set da Classificação Internacional de Funcionalidade para reabilitação profissional. O coeficiente kappa de Cohen foi utilizado para avaliar a concordância entre os avaliadores. RESULTADOS Foram selecionados cinco instrumentos específicos e oito genéricos que avaliaram a funcionalidade de trabalhadores. A análise dos itens do total de instrumentos permitiu o preenchimento de 58 categorias (64,5%) do core set com o mínimo de sobreposição: 13 (76,5%) do componente funções corporais, 29 (72,5%) do componente de atividades e participação e 16 (49%) de fatores ambientais. CONCLUSÕES A associação de vários instrumentos requer tempo e dificulta o uso da classificação. A elaboração de instrumentos com associação direta às suas categorias se faz essencial para operacionalizá-la.

Concept Changes and Standardizing Tools in Community-Based Rehabilitation.

Community-based rehabilitation (CBR) has changed considerably over 4 decades, resulting in a rights-based approach, holding local authorities accountable for service delivery. For medical rehabilitation in low-resource countries, there is concern about how this service gap will be covered. The CBR community continues to strengthen the evidence base for CBR implementation, acknowledging its extensiveness and variety on the ground. The creation of standardizing tools favors this process because it provides the building blocks to scale up, setting standards for implementation research. Finally, an International Classification of Functioning, Disability, and Health-based assessment and intervention model for CBR is proposed.

Content comparison of the Spinal Cord Injury Model System Database to the ICF Generic Sets and Core Sets for spinal cord injury.

STUDY DESIGN: Mapping of the National Spinal Cord Injury Model System (SCIMS) Database (NSCID) to the International Classification of Functioning, Disability and Health (ICF). OBJECTIVES: To link the content of the latest two versions of the NSCID to the ICF; more specifically (1) to compare the content of the current NSCID 2016-2021 version to its predecessor (NSCID 2011-2016) using the ICF as a neutral reference framework, and (2) to compare the content contained in the NSCID 2016-2021 version with relevant ICF Sets. SETTING: The forms of the NSCID 2016-2021 and 2011-2016 versions were linked to the ICF and contrasted. Comparability of the current version of the NSCID with the ICF Core Set for Spinal Cord Injury (SCI) in the post-acute and long-term context and the two generic ICF sets- ICF Generic-7 and ICF Generic-30 was then examined. METHODS: ICF Linking Rules and descriptive statistics. RESULTS: The current NSCID 2016-2021 version covers functioning as classified in the ICF with 8 ICF categories more comprehensively than its predecessor does. More than 50% of ICF categories contained in the two ICF Generic Sets were covered. The coverage of the brief ICF Core Sets for SCI by the NSCID 2016-2021 was more than 50%, but the coverage of the comprehensive core sets was low. Results showed the best coverage in the ICF component Activities and Participation. CONCLUSIONS: This study emphasizes how the ICF and its Sets can serve as a reference framework to foster comparability of existing data sets from both clinical practice and research.

Common content between quality of life questionnaires for children with cystic fibrosis and the International Classification of Functionality, Disability and Health.

OBJECTIVE: To identify the most common quality of life instruments for children with cystic fibrosis and link the content with the International Classification of Functioning, Disability and Health (ICF). METHODS: The study was conducted in 2 stages. The first stage involved a review of the literature to select quality of life questionnaires. In the second stage 2 independent reviewers identified questionnaire items and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient. RESULTS: Two questionnaires were selected: the Cystic Fibrosis Questionnaire and DISABKIDS®. A total of 130 concepts were identified from the 112 items. Forty-seven different ICF categories were linked (k>0.62 for all questionnaires), 21 (44.7%) were related to the "body function" domain, 20 (42.6%) to "activity and participation" and 6 (12.8%) to "environmental factors". Thirteen items (10%) could not be linked because they represent personal factors or are not covered by the ICF. CONCLUSION: Body functions were the category most linked to the ICF. Environmental factors were poorly described, and no items were related to body structures in any of the instruments.

Participation of children with disabilities in school: A realist systematic review of psychosocial and environmental factors.

BACKGROUND: In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4-12 year old children with disabilities to inform the development of participation-fostering interventions. METHODS: A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported. RESULTS AND IMPLICATIONS: We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children's participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.

The impact of age and gender on the ICF-based assessment of chronic low back pain.

PURPOSE: To evaluate the impact of age and gender on the international classification of functioning, disability and health (ICF)-based assessment for chronic low back pain. METHODS: Two hundred forty-four chronic low back pain patients (52% female) with a mean age of 49 years (SD =17.64) were interviewed with the comprehensive ICF core set for activities and participation, and environmental factors. After conducting explorative factor analysis, the impact of age and gender on the different factors was analyzed using analyzes of variances. RESULTS: Results revealed that older patients experienced more limitations within "self-care and mobility" and "walking" but less problems with "transportation" compared to younger patients. Older or middle-aged low back pain patients further perceived more facilitation through "architecture and products for communication", "health services", and "social services and products for mobility" than younger patients. Regarding gender differences, women reported more restriction in "housework" than men. An interaction effect between age and gender was found for "social activities and recreation" with young male patients reporting the highest impairment. CONCLUSIONS: The study demonstrated that the comprehensive ICF core set classification for chronic low back pain is influenced by age and gender. This impact is relevant for ICF-based assessments in clinical practice, and should be considered in intervention planning for rehabilitative programs. Implications for rehabilitation It is important to consider age and gender differences when classifying with the ICF. The intervention planning based on the ICF should focus on improvement of bodily functioning and mobility in older patients, facilitation of household activities in women, consideration of work-life balance and recreation (e.g., through mindfulness based stress reduction), and reduction of dissatisfaction with rehabilitation in younger patients. It is important to offer patients the opportunity to participate in intervention planning based on the ICF. For intervention planning professionals should bear in mind the resource-oriented approach of the ICF (e.g., facilitation through environmental factors), and a collaboration with other professionals.

Inter-rater reliability, standard error of measurement and minimal detectable change of the 12-item WHODAS 2.0 and four performance tests in institutionalized ambulatory older adults.

PURPOSE: Self-reported and performance-based instruments are both necessary for a comprehensive view of the functioning of institutionalized older adults. Our aim was to assess the reliability and measurement error of the 12-item World Health Organization Disability assessment Schedule and compare these indexes against performance-based tests. MATERIALS AND METHODS: One hundred participants from Nursing Homes and Day Care Centers were assessed twice (two days to one week apart) by two independent assessors. Reliability and measurement error indexes were calculated. RESULTS: Reliability of the World Health Organization Disability assessment Schedule total score, and of three performance tests was appropriate for individual comparisons (ICC ≥ 0.92). Reliability for the five times seat to stand test was appropriate for group comparisons only (ICC = 0.84). The high measurement error of the timed up and go test (SEM = 4.25; MDC = 11.78) and of the five times seat to stand test (SEM = 3.47; MDC = 9.62) and the number of participants unable to perform them (TUG: n = 11; FTSST: n = 41) suggest that these tests are less suitable to monitor individual changes. CONCLUSIONS: The 12-item World Health Organization Disability Assessment Schedule total score, the gait speed and hand grip tests could be used to monitor changes at both the individual and group level in a population with decreased functioning. Implications for Rehabilitation The 12-item World Health Organization Disability assessment Schedule, could be used to monitor changes in perceived functioning both at the individual and group level in institutionalized ambulatory older adults. The gait speed and hand grip tests could be used to monitor changes in performance both at the individual and group level in institutionalized ambulatory older adults' functioning. The utility of the time up and go and of the five times seat to stand test might be of limited value when aiming to monitor changes in institutionalized older adults' functioning.