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.

[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.

Examination of the Applicability of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to Patients with Hand Injuries and Diseases Using Rasch Analysis.

BACKGROUND: The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire is the most commonly applied patient-reported outcome measure used to assess disability and functioning in clinical research and practice for patients with injuries and diseases of the upper extremities. The objective of this study was to assess whether the DASH is a valid and reliable questionnaire to measure disability and functioning in patients with hand injuries and diseases using Rasch analysis. METHODS: We performed a psychometric study using data derived from two multicentre studies carried out to develop the International Classification of Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. We analysed the data of 417 patients recruited in a clinical setting and suffering from hand injuries (e.g. finger fracture, flexor tendon injury) or diseases (e.g. carpal tunnel syndrome, rhizarthrosis). We examined whether the DASH fulfilled the assumptions for its use as a measure by applying a partial credit model and testing for differential item functioning for sex and age. RESULTS: Bifactor analysis revealed problems with the underlying latent trait of functioning and disability. Rasch analysis raised further issues, including disordered thresholds for eight items and misfit in nine items. One item showed Differential Item Functioning for sex. CONCLUSION: The study reveals that some DASH items do not fit the underlying trait that the DASH aims to measure. Further studies using Rasch analysis are needed to compare our findings with results of studies involving other target groups (e.g. patients with injuries of the upper arm and shoulder).

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.