A Multimodal Prevention Program for Stress Reduction.

BACKGROUND: Stress-reducing preventive measures and the elements of which they are made up have been inadequately studied to date. In this trial, we studied the stress experienced over the twelve months from the beginning of the intervention by subjects who underwent a two-week-long multimodal prevention program for stress reduction with a psycho-educative component, with a refresher at six months, compared to that experienced by subjects in two control groups (CG-B: prevention program without psychoeducation, CG-C: no intervention). METHODS: Adults with an elevated stress exposure who were at risk of stressinduced health impairment were the subjects of a prospective, three-armed, randomized controlled trial. The subjects who participated in the two preventive programs (IG [intervention group], CG-B) traveled to a health resort. They were blinded with respect to their group assignment and the content of their intervention. The primary outcomes were subjectively experienced stress (Perceived Stress Questionnaire, PSQ) and chronic stress experience (Screening scale of the Trier Inventory for Chronic Stress, TICS-SSCS), assessed one, three, six, and twelve months after the start of the intervention. The groups were compared with univariate and multivariate analyses. Trial registry number: DRKS00011290. RESULTS: Among 120 candidates who expressed interest in participation and were randomly allotted to one of the three groups, 87 persons (67.8% female) with a mean age of 50.5 years (SD 8.8 years) were included in the study. Subjects in the IG with psychoeducation had a lower degree of perceived stress at twelve months than those in either one of the control groups, with controlling for baseline values, as measured by both of the instruments used: PSQ (ANCOVA: F[2, 77] = 11.77; p < 0.001, strong effect: ηp² = 0.234) and TICS-SSCS (ANCOVA: F[2, 78] = 3.93; p = 0.024, moderate effect: ηp² = 0.091). CONCLUSION: This exploratory trial reveals a lessening of subjectively experienced stress after participation in a two-part prevention program for stress reduction with a specific psychoeducative component.

[Quality of Life and Return to Work Following Rehabilitation - Results of the icfPROreha Study]. / Lebensqualität und Arbeitsfähigkeit nach unfallchirurgischer Rehabilitation ­ Ergebnisse der icfPROreha-Studie.

BACKGROUND: Not only the severity of an injury, but also bio-psycho-social factors affect health-related quality of life and participation in social life after severe musculoskeletal injuries. METHODS: Multicentre prospective longitudinal study with follow-up up to 78 weeks after discharge from inpatient trauma rehabilitation. Data were collected using a comprehensive assessment tool. Quality of life was assessed using the EQ-5D-5L, return to work by patients' self-reports and routine data of health insurances. Analyses of the association between quality of life and return to work, change over time in quality of life compared to the general German population and multivariate analyses to predict quality of life were conducted. RESULT: Of 612 study participants (444 men (72.5%); M=48.5 years; SD 12.0), 502 (82.0%) returned to work 78 weeks after discharge from inpatient rehabilitation. Quality of life improved during rehabilitation treatment from 50.18 to 64.50 (mean of visual analogue scale of EQ-5D-5L) and slightly to 69.38 78 weeks after discharge from inpatient trauma rehabilitation. EQ-5D index was below the values of the general population. In total, 18 factors were selected to predict quality of life 78 weeks after discharge from inpatient trauma rehabilitation. Among others, pain at rest and suspected anxiety disorder at admission had a very strong effect on quality of life. Contextual factors such as therapies after acute care and self-efficacy also had an effect on quality of life 78 weeks after discharge from inpatient rehabilitation. CONCLUSION: Bio-psycho-social factors affect long-term quality of life of patients with musculoskeletal injuries. Already at the time of discharge from acute treatment and even more at the beginning of inpatient rehabilitation, decisions can be made in order to achieve the best possible quality of life for those affected.

ICF-based prediction of return to work after trauma rehabilitation: Results of the icfPROreha study in patients with severe musculoskeletal injuries.

Background: Physical aspects such as the type and severity of an injury are not the only factors contributing to whether or not a person can return to work (RTW) after a serious injury. A more comprehensive, biopsychosocial approach is needed to understand the complexity of RTW fully. The study aims to identify predictors of RTW 78 weeks after discharge from initial inpatient trauma rehabilitation in patients with severe musculoskeletal injuries using a biopsychosocial perspective. Methods: This is a prospective multicenter longitudinal study with a follow-up of up to 78 weeks after discharge from trauma rehabilitation. Data on potential predictors were collected at admission to rehabilitation using a comprehensive assessment tool. The status of RTW (yes vs. no) was assessed 78 weeks after discharge from rehabilitation. The data were randomly divided into a training and a validation data set in a ratio of 9:1. On the training data, we performed bivariate and multiple logistic regression analyses on the association of RTW and potential predictors. The final logit model was selected via stepwise variable selection based on the Akaike information criterion. The final model was validated for the training and the validation data. Results: Data from 761 patients (n = 561 male, 73.7%; mean age: 47.5 years, SD 12.3), primarily suffering from severe injuries to large joints and complex fractures of the large tubular bones, could be considered for analyses. At 78 weeks after discharge, 618 patients (81.2%) had returned to work. Eleven predictors remained in the final logit model: general health, current state of health, sensation of pain, limitations and restrictions in activities and participation (disability), professional sector, ongoing legal disputes, financial concerns (assets), personality traits, life satisfaction preaccident, attitude to life, and demand for pension claim. A predicted probability for RTW based on the multiple logistic regression model of 76.3% was revealed as the optimal cut-off score based on the ROC curve. Conclusion: A holistic biopsychosocial approach is needed to address RTW and strengthen person-centered treatment and rehabilitation. Patients at risk for no RTW in the long term can already be identified at the onset of rehabilitation.

Evaluating the Effectiveness of a One-Week Multimodal Prevention Program for Slowing down and Stress Reduction Performed in a German Health Resort: Results of a Randomized Controlled Trial.

BACKGROUND: Effective concepts are required to overcome the negative impact of daily stressful overwhelming. We investigated the effectiveness of a 1-week multimodal program for stress reduction. METHODS: We performed a randomized controlled trial including adults with above-average stress level. The intervention consisted of health coaching, relaxation, physical activity, and balneotherapeutic elements. Individuals were randomized either to the intervention group (IG) or to one of the two control groups B and C. The main outcome was change in stress (Perceived Stress Questionnaire [PSQ], Screening Scale of Chronic Stress of the Trier Inventory for Chronic Stress [TICS-SSCS]) at 6 months post intervention; further outcomes were well-being (World Health Organization 5-Item Well-Being Index [WHO-5]) and health status (EuroQol visual analog scale [EQ-5D VAS]). Data were collected pre/post intervention as well as after 1, 3, and 6 months. RESULTS: Data of 96 individuals (mean age 48.0 years, 74% female) were available for analyses. The IG improved overtime with -13.45 points for the PSQ and -6.44 points for the TICS-SSCS after 6 months. At 6-month follow-up the IG did not significantly differ from group B (PSQ: p = 0.2332; TICS-SSCS: p = 0.0805) or group C (PSQ: p = 0.0950; TICS-SSCS: p = 0.0607) when controlling for baseline (ANCOVA). Compared to group C, ANCOVA revealed significant differences in WHO-5 (p = 0.0292) and EQ-5D VAS (p = 0.0177) post intervention. At the 3- and 6-month follow-up and compared to group B, no substantial differences could be found for WHO-5 and EQ-5D VAS. CONCLUSION: The results indicate that even a short-term multimodal program for stress reduction appears to set a positive trend towards less perceived and chronic stress.

Psychological Stress among Students in Health-Related Fields during the COVID-19 Pandemic: Results of a Cross-Sectional Study at Selected Munich Universities.

The COVID-19 pandemic has been a challenging period of upheaval for higher education students. This study aims to assess the factors associated with psychological stress during the COVID-19 pandemic among a sample of students in health-related fields at Munich universities in Germany. Students (n = 623) from KSH Munich and LMU Munich completed an online cross-sectional survey. Information on demographics and academic and everyday difficulties due to the COVID-19 pandemic as well as data on physical and mental health were collected. Multivariable logistic regression analyses were performed to identify factors associated with the outcome. The prevalence for higher psychological stress was 44% among the study population. Factors associated with higher psychological stress were: lower overall life satisfaction (p < 0.0001), worsened health situation (p < 0.0001), lack of social support (p = 0.0301) and social interaction (p = 0.0115), worries about financial difficulties due to loss of income (p = 0.0134), stressful thoughts about a second wave (p < 0.0001), feeling unable to positively influence the situation (p = 0.0262) and study-related effects, such as perceived study burden (p = 0.0003) and likely delay in studies (p = 0.0178)). The COVID-19 pandemic is having a significant negative impact on the mental health of students in health-related fields. Proactive efforts to support the mental health and well-being of students are needed.

Factors influencing study engagement during the COVID-19 pandemic: A cross-sectional study among health and social professions students.

BACKGROUND: The aim of this study is to explore factors influencing the study engagement of health and social professions students during the COVID-19 pandemic. While antecedents of study engagement have been studied previously, the factors influencing engagement under pandemic conditions have not yet been investigated. Furthermore, there is a particular need for research among students in health and social professions programs, as these students are particularly affected by the pandemic. As theoretical basis, the study draws on the demands-resources-theory. It is hypothesized that pandemic-related study and personal resources drive engagement during the pandemic, and that pandemic-related demands negatively influence engagement. METHOD: The study uses a cross-sectional survey to explore the hypothesized effects. The sample consists of 559 university students of health and social professions in Germany. The study was carried out in July 2020, towards the end of the first digital semester and after the first peak in COVID-19 cases. Data are analyzed using linear multiple regression analysis. RESULTS: The findings show that the demands-resources-theory is suitable to explain study engagement even under pandemic conditions. Suitable digital learning formats and social support are identified as important study resources for study engagement during major life events, while emotional resilience, active self-care and academic self-efficacy are identified as important personal resources. CONCLUSIONS: Under pandemic conditions academic institutions should focus on providing beneficial teaching formats and innovative ways to support students lacking social networks. Besides, they should consider developing means to help students structuring daily life as well as establishing initiatives to strengthen students' self-efficacy beliefs.

[PFLEGEprevent - A Randomized Controlled Intervention Study on the Effectiveness of a Prevention Program on Caregiver Workload]. / PFLEGEprevent ­ Präventiv der Arbeitsbelastung von Pflegekräften begegnen. Ergebnisse einer randomisiert kontrollierten Interventionsstudie zur Wirksamkeit einer Präventionsmaßnahme für Pflegekräfte.

BACKGROUND: Care staff in Germany is being increasingly affected by physical and mental stress, which is reflected in high number of sick days and early retirement rates. A prevention program that addresses the specific needs of caregivers - strengthening their resources in dealing with workloads and daily challenges- was developed in the project PFLEGEprevent. The prevention program was implemented in an RCT and its effects on stress, work ability and quality of life were evaluated. METHOD: The randomized controlled intervention study was conducted with 6 survey periods over 9 months. Targeted data were collected using validated tools: Perceived Stress Questionnaire (PSQ), Perceived Stress Scale (PSS), Work Ability Index (WAI), Recovery-Load Questionnaire for work (EBF-Work 27), Short Form-Health Survey (SF-12) and WHO-Five Well-Being Index (WHO-5). Descriptive analyses and the t-test for independent samples to compare changes in primary and secondary outcomes between study groups were conducted. RESULTS: A total of 125 (92% female, average age 46.7 years) caregivers participated in the study. There were significant group differences in changes of the target size to the follow-up measures up to 9 months. Especially stress was reduced in the long term in the intervention group. Overall well-being in this group improved significantly from baseline to follow-up. CONCLUSION: The evaluation of the prevention program showed a positive effect in the measured outcome of perceived stress. In other outcomes, significant group differences could be shown after 1 and 3 months.

[Work Ability and Health Promotion Offers needed by Healthcare Personnel in Germany: Results of an Expert Survey]. / Arbeitsfähigkeit von Pflegekräften in Deutschland ­ welchen Präventionsbedarf hat das Pflegepersonal: Ergebnisse einer Expertenbefragung.

AIM: The burden on nursing staff in Germany is continuously increasing. Specific health promotion programs can help to reduce this burden. To develop such programs, the concrete needs of nurses for instructions and training have to be determined. The aim of the project "PFLEGEprevent" (funded by the Bayerisches Staatsministerium für Gesundheit und Pflege) is to develop a prevention program that focuses on the special needs of the nursing staff. The project is structured in four subprojects: (1) identification of needs, workloads and occupational challenges of caregivers and the scientific evidence (national expert survey and systematic literature review), (2) development of a specific prevention program, (3) implementation and evaluation of the prevention program (Intervention study; DRKS00012870), (4) development of a manual to instruct the implementation of the prevention program (transferability). METHOD: In subproject (1) the current subjective work ability of the nursing staff in Germany and their need for preventive offers were revealed by a national expert survey. The survey was directed to nurses in outpatient, semi-inpatient and inpatient care facilities and clinics. In addition to personal information and questions on current work and organization, the subjective work ability of the nurses (based on the Work Ability Index, WAI) and the need for preventive offers were queried. RESULTS: A total of 1381 questionnaires were analysed. The majority of surveyed healthcare staff was female (81%). On average they were 40.1 years old (SD=12.0) and had worked in the care sector for 16.3 years (SD=10.9). The mean of the WAI score was 37.2 (SD=7.1) points, which indicates a good work ability. However, there were differences in work ability between types of institution and number of years in job. The care staff needed instructions mainly on the topics of stress, communication and teamwork. Active training was required for relaxation, back muscle training and strengthening. 75% of respondents said they would participate in a 5-day prevention program.

Reliability, usability and applicability of the ICD-11 beta draft focusing on hand injuries and diseases: results from German field testing.

OBJECTIVE: To test the interrater reliability when using the codes of the 11th revision of the International Classification of Diseases (ICD)-11 beta draft as well as ICD-10 and to explore the usability of the ICD-11 beta draft and the applicability of ICD-11's Supplementary section for functioning assessment in hand injuries and diseases. DESIGN: We conducted a validation study of the ICD-11 beta draft complemented by a single-centre study to collect clinical routine data on functioning. SETTING: German hand surgery clinics. PARTICIPANTS: Twenty-three physicians coded real-life cases containing diagnostic information on hand injuries and diseases. Additionally, clinical information of 100 patients was coded by 6 physicians and a nurse using ICD-11's Supplementary section for functioning assessment. MAIN OUTCOME MEASURES: Physicians coded 210 cases using the ICD-11 beta draft and ICD-10. Krippendorff's alpha was calculated. Clinical routine data was coded using 38 functioning categories. RESULTS: Interrater reliability (Krippendorff's alpha) of 0.67 for ICD-11 coding and 0.71 for ICD-10 coding was obtained, indicating substantial agreement. However, physicians reported a high proportion of problems with ICD-11 coding and slightly fewer problems with ICD-10 coding. The collected data on functioning could be mapped to ICD-11's Supplementary section for functioning assessment. For some data, however, only unspecific codes were available. CONCLUSIONS: Interrater reliability of ICD-10 and ICD-11 was satisfactory. Training material for ICD-11 is needed to further improve reliability and usability. Future users of ICD-11 should be encouraged to use the Supplementary section for functioning assessment to shed light on the problems patients experience in everyday life.

[Validation of the ICD-11 beta draft in hand surgery]. / Validierung der ICD-11 Betaversion im Bereich Handchirurgie.

BACKGROUND: The practice of hand surgery is characterised by the surgical and conservative treatment of patients with a broad range of single and multiple hand injuries, many of them complex, as well as hand diseases. Thus far, the coding of especially complex hand injuries using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (German Modification) (ICD-10-GM) has often been a challenge for the persons responsible for coding. To ensure an exact, unambiguous and reliable coding of patient cases, the mapping of these cases in the 11th revision of the ICD is an inevitable requirement. The aim of this study was to examine the representation of hand injuries and diseases in the ICD-11 beta draft. METHODS: We performed a case-oriented validation study. Based on real-life patient cases, we developed two types of case scenarios (short diagnostic statements: "lines", and more comprehensive case descriptions: "cases"), which were coded using the ICD-11 beta draft. To gain insight into participants' experiences with the coding process, additional telephone interviews were carried out. RESULTS: Twenty-three hand surgeons from nine participating institutions coded a total of 315 case scenarios using the ICD-11 beta draft - 210 lines and 105 cases. An inter-rater reliability (Krippendorff's alpha) of 0.67 for both lines and cases indicated substantial agreement between the coding physicians. Study participants reported difficulties with coding in approximately one third of case scenarios (lines: 27 % and cases: 35 %). Nine physicians additionally took part in telephone interviews. Problems with coding using the ICD-11 beta draft as well as specific suggestions for changes were collected, verified by a working group and complemented by further proposals. CONCLUSION: The results of this study entailed important adaptations of the ICD-11 in the field of hand surgery and will in future enable an unambiguous and specific coding of hand injuries and diseases, especially multiple injuries. The obtained inter-rater reliability for the ICD-11 beta draft is satisfactory. Specific problems as well as proposals for changes supported the finalisation of the ICD-11.

Using the refined ICF Linking Rules to compare the content of existing instruments and assessments: a systematic review and exemplary analysis of instruments measuring participation.

BACKGROUND: Existing instruments measuring participation may vary with respect to various aspects. This study aimed to examine the comparability of existing instruments measuring participation based on the International Classification of Functioning, Disability and Health (ICF) by considering aspects of content, the perspective adopted and the categorization of response options. METHODS: A systematic literature review was conducted to identify instruments that have been commonly used to measure participation. Concepts of identified instruments were then linked to the ICF following the refined ICF Linking Rules. Aspects of content, perspective adopted and categorization of response options were documented. RESULTS: Out of 315 instruments identified in the full-text screening, 41 instruments were included. Concepts of six instruments were linked entirely to the ICF component Activities and Participation; of 10 instruments still 80% of their concepts. A descriptive perspective was adopted in most items across instruments (75%), mostly in combination with an intensity rating. An appraisal perspective was found in 18% and questions from a need or dependency perspective were least frequent (7%). CONCLUSION: Accounting for aspects of content, perspective and categorization of responses in the linking of instruments to the ICF provides detailed information for the comparison of instruments and guidance on narrowing down the choices of suitable instruments from a content point of view. Implications for Rehabilitation For clinicians and researchers who need to identify a specific instrument for a given purpose, the findings of this review can serve as a screening tool for instruments measuring participation in terms of the following: • Their content covered based on the ICF. • The perspective adopted in the instrument (e.g., descriptive, need/dependency or appraisal). • The categorization of their response options (e.g., intensity or frequency).

[The International Classification of Functioning, Disability and Health (ICF) : The implementation of the ICF Core Sets for Hand Conditions in clinical routine as an example of application]. / Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) : Implementierung in der klinischen Routine am Beispiel der ICF Core Sets der Hand.

The International Classification of Functioning, Disability and Health (ICF) provides a standardized language of almost 1500 ICF categories for coding information about functioning and contextual factors. Short lists (ICF Core Sets) are helpful tools to support the implementation of the ICF in clinical routine. In this paper we report on the implementation of ICF Core Sets in clinical routine using the "ICF Core Sets for Hand Conditions" and the "Lighthouse Project Hand" as an example. Based on the ICF categories of the "Brief ICF Core Set for Hand Conditions", the ICF-based assessment tool (ICF HandA) was developed aiming to guide the assessment and treatment of patients with injuries and diseases located at the hand. The ICF HandA facilitates the standardized assessment of functioning - taking into consideration of a holistic view of the patients - along the continuum of care ranging from acute care to rehabilitation and return to work. Reference points for the assessment of the ICF HandA are determined in treatment guidelines for selected injuries and diseases of the hand along with recommendations for acute treatment and care, procedures and interventions of subsequent treatment and rehabilitation. The assessment of the ICF HandA according to the defined reference points can be done using electronic clinical assessment tools and allows for an automatic generation of a timely medical report of a patient's functioning. In the future, the ICF HandA can be used to inform the coding of functioning in ICD-11.

Exploring the Relation Between Impairment Rating by AMA Guide and Activity and Participation Based on ICF in the Patients with Hand Injuries.

The aim of this paper is to analyze the relation between components of disability with distinguished score of impairment, activity and participation questionnaire based on clinical data of persons with hand injuries. Impairment was evaluated by use of AMA guide 6th edition and disability by DASH questionnaire on Convenience sample of patients (N = 117), with chronic hand injuries. Linking and allocating items of the DASH were done based on the ICF Core Set for Hand Conditions and the opinions of a group of experts from different related fields. Data was analyses by using Kappa index, Chi square test and a set of Pearson, Part and Partial correlations coefficient. Most of the DASH items were allocated to the activity; one to four of the items could not be classified and 0 to 22 were classified as having overlap. Participation and activity scores correlated positively with each other (r > 0.80). Impairment had high correlation with activity and participation scores (>73). With controlling the effect of each or both construct, this relation between them with impairment diminished but still significant between activity and impairment. There is a huge overlap in definition of activity and participation. The most effecting item in relation of disability and impairment is activity restriction. Participation had no relation with impairment.

Health resort medicine in non-musculoskeletal disorders: is there evidence of its effectiveness?

Health resort medicine (HRM; in German: Kurortmedizin) is a field of medicine with long-lasting tradition in several European countries. A number of systematic reviews have shown the effectiveness of HRM in musculoskeletal conditions. Reviews focusing on the effectiveness of HRM in non-musculoskeletal disorders are rare. This systematic review aims to provide an overview about all types of health resort treatments applied in non-musculoskeletal conditions, to summarize evidence for its effectiveness and to assess the quality of published studies. MEDLINE, Web of Knowledge and Embase were searched for articles published between January 2002 and December 2013. We used a broad search strategy in order to find studies investigating the effects of HRM in non-musculoskeletal disorders. Two authors independently extracted data and assessed quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP-QAT). Forty-one studies (19 of them with control group) from eight countries examining the efficacy of various forms of spa treatment for 12 disease groups were included. The studies are markedly heterogeneous regarding study design, population and treatment. HRM treatment is associated with clinical improvement in diseases of the skin, respiratory, circulatory, digestive and nervous system among others. However, small samples, the lack of control groups and an insufficient follow-up often limit the generated evidence. The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of HRM. The challenge for the future will be to carry out thoroughly designed studies in larger patient populations to corroborate the impact of HRM treatment on non-musculoskeletal disorders.

Do patient-reported outcome measures capture functioning aspects and environmental factors important to individuals with injuries or disorders of the hand?

STUDY DESIGN: Qualitative study. INTRODUCTION: Clinical outcome evaluation needs to consider the patient perspective for an in-depth understanding of functioning and disability. PURPOSE OF THE STUDY: To explore whether patient-reported outcome measures (PROMs) used in the field of hand injuries or hand disorders, capture functioning aspects and environmental factors important to the patients. METHODS: We performed a qualitative study and a systematic literature review. The focus group sessions were recorded, transcribed verbatim, and the identified concepts were linked to the ICF. We searched in MEDLINE for reviews, related to injuries or disorders of the hand, reporting on PROMs. We linked the items of the identified PROMs to the ICF and compared the qualitative data with the content of the PROMs. RESULTS: Statements from 45 individuals who participated in eight focus groups were linked to 97 categories of the ICF. From 15 reviews included, eight PROMs were selected. The selected PROMs capture 34 of the categories retrieved from the qualitative data. CONCLUSIONS: PROMs used in the context of hand injuries or hand disorders capture only in parts the functioning aspects important to the patients.

Validation of the brief International Classification of Functioning, Disability, and Health (ICF) core set for hand conditions.

STUDY DESIGN: Cross-sectional multi-centre study. INTRODUCTION: The ICF Core Sets for Hand Conditions (HC) have been developed to describe functioning of patients with HC. PURPOSE OF THE STUDY: To study the content validity of the Brief ICF Core Set for HC. METHODS: Patients with HC were interviewed using the Comprehensive ICF Core Set for HC. ICF categories that best explained variation in patients' general health were identified using multiple regression methods. RESULTS: Overall, 12 of the 23 ICF categories of the Brief ICF Core Set could be validated. Our analyzes further revealed that the categories "b134 Sleep functions", "s830 Structure of nails", "e225 Climate" as well as categories referring to "e4 Attitudes" also deserve consideration when assessing functioning in patients with HC. CONCLUSIONS: Clinicians are encouraged to complement the Brief ICF Core Set for HC by adding sleep functions, structure of nails, climate and attitudes, especially when following patients over time. LEVEL OF EVIDENCE: Level 3.

Development of the International Classification of Functioning, Disability and Health core sets for hand conditions--results of the World Health Organization International Consensus process.

PURPOSE: A formal decision-making and consensus process was applied to develop the first version of the International Classification on Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. METHOD: To convene an international panel to develop the ICF Core Sets for Hand Conditions (HC), preparatory studies were conducted, which included an expert survey, a systematic literature review, a qualitative study and an empirical data collection process involving persons with hand conditions. A consensus conference was convened in Switzerland in May 2009 that was attended by 23 healthcare professionals, who treat hand conditions, representing 22 countries. RESULTS: The preparatory studies identified a set of 743 ICF categories at the second, third or fourth hierarchical level. Altogether, 117 chapter-, second-, or third-level categories were included in the comprehensive ICF Core Set for HC. The brief ICF Core Set for HC included a total of 23 chapter- and second-level categories. CONCLUSIONS: A formal consensus process integrating evidence and expert opinion based on the ICF led to the formal adoption of the ICF Core Sets for Hand Conditions. The next phase of this ICF project is to conduct a formal validation process to establish its applicability in clinical settings.

What is our knowledge of functioning and disability in hand conditions based on?

OBJECTIVES: To analyze the content of published studies on hand conditions using the International Classification of Functioning, Disability and Health (ICF) as a reference, and to highlight the most common aspects of functioning as well as those that deserve more consideration in research on hand conditions. DATA SOURCES: The MEDLINE, Embase, PsycINFO, CINAHL, and PEDro databases were searched for English language studies on hand conditions published between 1998 and 2008. STUDY SELECTION: The identified studies were reviewed by 2 persons independently. Studies reporting firsthand data of patients with diseases/injuries of the hand and with a minimum sample size of 10 patients were included. Reviews, overviews, meta-analyses, and psychometric studies were excluded. DATA EXTRACTION: Peer review strategy was conducted in the data extraction process. Data from a random sample of 15% of the included studies was extracted by 2 reviewers independently. DATA SYNTHESIS: The search identified 18,861 citations. A random sample of 2782 (15%) abstracts was reviewed, leading to the inclusion of 471 publications. Preliminary included publications were reviewed in full-text, resulting in the final inclusion of 188 studies. The information obtained from the included studies was linked to 127 different second-level ICF categories. Second-level categories most frequently addressed in the studies were: health services, systems, and policies; sensation of pain and structure of upper extremity; mobility of joint functions; and muscle power functions. CONCLUSIONS: The ICF provides a valuable reference to systematically analyze the content of published studies on hand conditions. Research activity needs to widen its focus on mental functions, further mobility functioning, self-care, and domestic life aspects, as well as environmental factors to encompass the impact of hand conditions on an individual's health. This would increase our knowledge on patients' needs and would help to ensure patient-oriented care.

Patient goals in post-acute geriatric rehabilitation--goal attainment is an indicator for improved functioning.

OBJECTIVE: To identify goals of older patients in geriatric rehabilitation and to measure their improvement in overall functioning. DESIGN: A prospective multi-centre cohort study. METHODS: A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning from patients' and health professionals' perspectives. Patients' goals were linked to the International Classification of Functioning, Disability and Health (ICF). Using a residualized change score, we identified patients who improved more than statistically expected. RESULTS: A total of 209 patients gave 476 statements. Of these, 346 (72.7%) statements were linked to 58 different ICF categories. More than 90% of the ICF categories were part of the comprehensive geriatric ICF Core Set. "Walking", "getting rid of pain", "autonomy" and "returning home" were the most frequently reported goals. Multivariable analysis identified shorter length of inpatient stay and goal attainment to be significant predictors for an improvement in overall functioning from the patients' perspective. CONCLUSION: The ICF can be used to identify and structure patients' goals in geriatric rehabilitation. The association between goal attainment and improved overall functioning underlines the necessity of considering the patients' perspective in the rehabilitation process.