Analysis and implementation of a World Health Organization health report: methodological concepts and strategies.

A long-standing scientific discourse on the use of health research evidence to inform policy has come to produce multiple implementation theories, frameworks, models, and strategies. It is from this extensive body of research that the authors extract and present essential components of an implementation process in the health domain, gaining valuable guidance on how to successfully meet the challenges of implementation. Furthermore, this article describes how implementation content can be analyzed and reorganized, with a special focus on implementation at different policy, systems and services, and individual levels using existing frameworks and tools. In doing so, the authors aim to contribute to the establishment and testing of an implementation framework for reports such as the World Health Organization World Report on Disability, the World Health Organization International Perspectives on Spinal Cord Injury, and other health policy reports or technical health guidelines.

Linking health and health-related information to the ICF: a systematic review of the literature from 2001 to 2008.

INTRODUCTION: In 1976, the World Health Organization (WHO) estimated worldwide disability prevalence at 10%; recent evidence suggests the prevalence is even higher. Given the extent of disability around the world, it is essential for researchers and policy makers to have a uniform language for describing and discussing disability. The International Classification of Functioning, Disability and Health (ICF) is WHO's attempt to provide that standard language. Linking rules were published in 2002 and 2005 suggesting a method for standardising the process of connecting outcome measures to the ICF classification. The objective of this study is to study the extent to which the linking rules have been used by researchers to link health and health-related information to the ICF and collect the feedback about the current practices, applications and areas to improve the linking method. METHOD: Using a systematic review of health-based literature between 2001 and February 2008, we (1) determined research areas where the linking method is applied, (2) examined the characteristics of studies that linked information to the ICF and (3) described current practices and issues related to the process of linking health and health-related information to the ICF both quantitatively and qualitatively. RESULTS: The systematic review yielded 109 articles from 58 journals that linked health information to the ICF and 58 of the articles employed published linking rules. The majority of articles were descriptive in nature, used linking for connecting content of health instruments to the ICF and linked English health content. Quality controls such as reliability checks, multiple raters and iterative linking processes were found frequently among users of the linking rules. Qualitative analysis created themes about: preparing units of information, who links to the ICF, reliability, matching or translating concepts from text to ICF categories, information unable or difficult to capture, quantitative reporting standards and overall linking process. DISCUSSION: This review also shows that the linking process is a useful way to apply the ICF classification in research. With over 100 articles published in 58 peer-reviewed journals across 50 focus areas, linking health and health-related information to the ICF has been shown to be a useful tool for describing, comparing and contrasting information from outcome measures used to collect quantitative data, qualitative research results and clinical patient reports across diagnoses, settings, languages and countries.

The World Report on Disability ­ implications, perspectives and opportunities for physical and rehabilitation medicine (PRM).

On June 9th 2011 the WHO World Report on Disability(WRD), called for by the World Health Assembly (WHA),was launched at the United Nations headquarters in NewYork. The WRD displays what has come to be known as the integrative model of functioning and disability as expressed in the International Classification of Functioning, Disability and Health (ICF). The present paper summarizes the representation of the role of rehabilitation in the WRD. It in particular highlights implications, perspectives and opportunities for Physical and Rehabilitation Medicine (PRM) and the International Society of Physical and Rehabilitation Medicine(ISPRM). The WRD acknowledges the genuine role of PRM and its contribution to enhancing a person's functioning and participation in life. Challenges lie in the delivery of rehabilitation services in underserved parts of the world,ranging from the provision of timely, cost efficient and effective treatment, and the involvement of people with disability,family and care givers in the decision making process.In the present paper it is concluded that these challenges and the implementation of the WRD's recommendations call upon multiple actors including ISPRM and for national rehabilitation strategies that can coordinate scarce resources effectively, especially in times of crisis such as disaster relief efforts.

Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation.

PURPOSE: To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001. METHOD: The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application. RESULTS: A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009. CONCLUSIONS: The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.

Functioning and disability in traumatic brain injury.

PURPOSE: To describe functioning and disability in patients with traumatic brain injury (TBI) according to the model endorsed by the International Classification of Functioning Disability and Health (ICF). METHODS: Adult patients with acquired TBI were consecutively enrolled. The Functional Independence Measure (FIM), the WHO Disability Assessment Schedule II (WHO-DAS II) and the ICF checklist were administered in individual sessions. Descriptive analyses were performed to report on FIM and WHO-DAS II scores. ICF categories reported as a problem by more than 20% of patients were described in detail. RESULTS: One hundred patients (66 males, mean age 36.1) were enrolled. Mean WHO-DAS II score was 16.8, mean FIM was 116.5 and 87 ICF categories were selected: 27 Body Functions (mainly mental and movement-related) and Structures, 43 Activities and Participation (mainly connected with mobility) and 17 Environmental Factors. Negligible difference between capacity and performance qualifiers was observed. CONCLUSIONS: The ICF can be successfully implemented in clinical and rehabilitation of patients with TBI, because it enables to describe the variety of problems they encounter: ICF-derived data provide a holistic view of disability and enable the impact of service interventions on functioning and participation, and enable clinicians to tailor intervention according to patient's actual needs.

Functioning and disability in stroke.

PURPOSE: To describe functioning and disability in patients with stroke according to the model endorsed by the International Classification of Functioning Disability and Health (ICF) in a rehabilitation hospital. METHODS: Adult patients with stroke were consecutively enrolled. The Functional Independence Measure (FIM) and the WHO Disability Assessment Schedule II (WHO-DAS II) were administered in individual sessions. ICF checklist was applied on the basis of medical documentation and rehabilitation team meetings. Descriptive analyses were performed to report on FIM and WHO-DAS II scores. ICF categories reported as a problem by more than 20% of patients were described in detail. RESULTS: Patients (197 in total) were mainly men, aged about 60, with average FIM score of 75. Within ICF Body Functions component 32 categories were applied in at least 20% of the patients, 5 within Body Structures, 27 within Activities and Participation and 7 within Environmental Factors. CONCLUSIONS: ICF represents a new integrative tool to help professionals dealing with stroke. The checklist captures the various sequels of stroke in terms of impairments, activity limitations and participation restrictions. It shows the extensive need for rehabilitation, whereby it facilitates consideration of the patient' needs.

Functioning and disability in multiple sclerosis.

PURPOSE: To describe functioning and disability in patients with multiple sclerosis (MS) according to the model endorsed by the International Classification of Functioning Disability and Health (ICF). METHODS: Adult patients with MS were consecutively enrolled. The Expanded Disability Status Scale (EDSS), the WHO Disability Assessment Schedule II (WHO-DAS II) and the ICF checklist were administered in individual sessions. Descriptive analyses were performed to report on EDSS and WHO-DAS II scores. ICF categories reported as a problem by more than 20% of patients were described in detail. RESULTS: One hundred patients (70 females, mean age 41.7), 73 with relapsing-remitting MS were enrolled. Mean WHO-DAS II score was 10.6 and 58 ICF categories were selected: 23 Body Functions and Structures, 21 Activities and Participation and 14 Environmental Factors. CONCLUSIONS: The ICF can be successfully implemented in clinical and rehabilitation of patients with MS, because it enables to describe its multiple facets. Little differences between capacity and performance in ICF categories connected with activities of daily living, and presence of technical aids and other environmental factors are reported. On the contrary, in categories related to relationships, performance was worse than capacity thus revealing attitudinal barriers.

Integrating research into policy planning: MHADIE policy recommendations.

MHADIE project (Measuring Health and Disability in Europe: Supporting policy development) aimed at developing realistic, evidence-based and effective national policies for persons with disabilities. A preliminary step towards this goal was the demonstration on the feasibility of employing the ICF in clinical, educational and statistical fields, which corresponds to the recognised need to enhance the European Union's capacity of analysis of disability, as highlighted in its Disability Action Plan 2006-2007. The ultimate outcome of the project is the production of 13 policy recommendations, dealing with statistics clinical and educational areas, and four general policy recommendations focusing on: (a) the need of coordinating and integrating disability conceptualization at all policy levels and across sectors; (b) the need of conducting longitudinal cohort studies which include children aged 0-6; (c) the need of reviewing transportation policies in light of the requirements of persons with disabilities; (d) the need of reviewing all disability policies to emphasise and support the role of the family, which is a consistent and substantial environmental facilitator in the lives of persons with disabilities.