Disability assessment in an Italian cohort of patients with obesity using an International Classification of Functioning, Disability and Health (ICF)-derived questionnaire.

BACKGROUND: Obesity is a clinical condition that contributes to the development of related disability in different areas (physical, psychological and social). Multidisciplinary treatment calls for specific instruments able to evaluate all related functional problems. We have developed a tool (an ICF-based assessment instrument, the ICF-OB schedule) to evaluate obesity-related disability, composed of an inventory of 71-items from the WHO International Classification of Functioning, Disability and Health (ICF). AIM: The aim of the present study was to validate this new tool for the definition of obesity-related disability. We also sought to examine the relationship between obesity disability, an index of multimorbidity (Cumulative Illness Rating Scale [CIRS]) and a well-validated score of perceived obesity-related disability (Italian Obesity Society Test for Obesity-Related Disability [TSD-OC]). DESIGN: Process validation of the ICF-OB schedule. SETTING: Baseline conditions of out- and in-patients. POPULATION: A large cohort of obese patients recruited from 9 multidisciplinary centers belonging to the Italian Obesity Society (SIO) network, which provide specialized obesity care. METHODS: A total of 353 patients (F: 70%, age: 50.2±12.7yrs, BMI: 41.4±8.3kg/m2) were enrolled between January 2017 and June 2018. The ICF-OB was used to define patients' functioning and disability profiles in order to set and appraise rehabilitation goals. RESULTS: We described the distribution of body functions (BF), body structures (BS) and activities and participations (A&P) categories and the agreement rates were significant for the majority of these. The ICF-OB was more often significantly associated, and with stronger coefficients, with patients' comorbidities as described by the CIRS rather than with Body Mass Index (BMI). The TSD-OC also presented a strong association with A&P indexes. CONCLUSIONS: The complexity of clinical condition, that generates disability in obesity might be well identified with the use of this new instrument that appear significant related to the perceived disability for each patients and also with their multimorbidity. CLINICAL REHABILITATION IMPACT: The ICF-OB shows great promise as a tool for goal setting in the rehabilitation of obese patients.

Patients with obesity-related comorbidities have higher disability compared with those without obesity-related comorbidities: results from a cross-sectional study.

The aim of the present study was to describe disability in adult obese patients with obesity-related comorbidities, and to compare it with that of patients without obesity-related comorbidities. Two groups of obese patients were administered a set of 166 International Classification of Functioning, Disability and Health (ICF) categories; on the basis of this set, count-based indexes were developed for each ICF component and difference between patients with and without comorbidities were assessed with independent-sample t-test and Cohen's d as a measure of effect size. ICF categories in which at least 20% of patients reported a problem were considered relevant for describing functioning of obese patients; for each of them, the risk of having obesity-related comorbidities was calculated using odds ratio and 95% confidence interval. A total of 106 inpatients were enrolled in the study: 68 ICF categories reached the 20% threshold, and 31 of them were relevant only among patients with comorbidities. The presence of obesity-related comorbidities was associated with an increased risk of bodily impairments and limitations in performing daily activities. Compared with patients without obesity-related comorbidities, those with comorbidities showed higher disability. Comorbidities contribute to obesity-related disability, and our results support the importance of early rehabilitation interventions to reduce disability.

An ICF-Based Model for Implementing and Standardizing Multidisciplinary Obesity Rehabilitation Programs within the Healthcare System.

INTRODUCTION/OBJECTIVE: In this study, we aimed to design an ICF-based individual rehabilitation project for obese patients with comorbidities (IRPOb) integrated into the Rehab-CYCLE to standardize rehabilitative programs. This might facilitate the different health professionals involved in the continuum of care of obese patients to standardize rehabilitation interventions. METHODS: After training on the ICF and based on the relevant studies, ICF categories were identified in a formal consensus process by our multidisciplinary team. Thereafter, we defined an individual rehabilitation project based on a structured multi-disciplinary approach to obesity. RESULTS: the proposed IRPOb model identified the specific intervention areas (nutritional, physiotherapy, psychology, nursing), the short-term goals, the intervention modalities, the professionals involved and the assessment of the outcomes. Information was shared with the patient who signed informed consent. CONCLUSIONS: The model proposed provides the following advantages: (1) standardizes rehabilitative procedures; (2) facilitates the flow of congruent and updated information from the hospital to outpatient facilities, relatives, and care givers; (3) addresses organizational issues; (4) might serve as a benchmark for professionals who have limited specific expertise in rehabilitation of comorbid obese patients.

Obesity is a marker of reduction in QoL and disability.

The purpose of this paper is to verify the association between outcome measures of health-related quality of life (HRQoL) and disability, BMI, gender, and age. Adult obese patients were clustered using HRQoL (IWQoL-Lite) and disability (WHO-DAS II) scores into three groups: mild, moderate, and high. One-way ANOVA with Bonferroni post hoc test was used to evaluate differences in age and BMI between subjects from different clusters, contingency coefficient to test the relationship between cluster groups and gender. In total, 117 patients were enrolled: subjects with higher disability and HRQoL decrement were older and had higher BMI. Women were more likely to present moderate disability and reduction in HRQoL, while men more likely presented mild disability and HRQoL reduction. Our data further confirm the connection between disability and HRQoL, high BMI and older age. These data obtained with outcomes measures might better address rehabilitation programs.

Quality of life, disability, and body mass index are related in obese patients.

The aim of this study is to analyze the relationship between health-related quality of life (QoL), disability, and degree of obesity. Adult obese patients (BMI>30) were consecutively enrolled in this cross-sectional observational study. The WHO Disability Assessment Schedule (WHO-DAS II) and the short version of the impact of weight on QoL (IWQoL-Lite) were administered. Spearman's rank correlation analysis was performed. A P value of less than 0.01 was used to set the statistical significance. A total of 117 patients (mean age: 47.4 years, mean BMI: 43.7) were enrolled. Correlations between WHO-DAS II and IWQoL-Lite were between 0.21 and 0.78. BMI between 0.19 and 0.26 correlated with WHO-DAS II and BMI between 0.23 and 0.49 correlated with IWQoL-Lite. In conclusion, low/moderate correlations between BMI index, disability, and health-related QoL measures, and a low association between the two outcome measures are reported, supporting the idea that they underline different and not transposable dimensions.

Assessing disability in morbidly obese individuals: the Italian Society of Obesity test for obesity-related disabilities.

PURPOSE: To validate a new obesity-specific disability assessment test: the Obesity-related Disability test (Test SIO Disabilità Obesità Correlata, TSD-OC). METHODS: Adult obese individuals were assessed with the TSD-OC, 36-Item Short-Form Health Survey (SF-36), 6-min walking test (6MWT) and grip strength. The TSD-OC is composed of 36 items divided into seven sections (pain, stiffness, activities of daily living and indoor mobility, housework, outdoor activities, occupational activities and social life). Statistical correlations between the TSD-OC, functional assessment (6MWT and grip strength) and quality of life parameters (SF-36) were analysed. Internal consistency was assessed with Cronbach's α test. Test-retest reliability was evaluated in a subgroup of 30 individuals. A linking exercise between TSD-OC items and categories of the International Classification of Functioning, Disability and Health was performed. RESULTS: Test-retest showed excellent stability (r = 0.90) and excellent internal consistency was reported (Cronbach's α > 0.90). Significant low to moderate correlations between TSD-OC, SF-36 scores, 6MWT and grip strength were observed. A total of 26 ICF categories were linked, mostly related to the area of mobility. CONCLUSIONS: The TSD-OC is a reliable and valid instrument for measuring self-reported disability in obese subjects. It may represent an important tool for establishing rehabilitation needs in individuals with obesity-related disability, for planning appropriate rehabilitation programmes and for evaluating their effectiveness.

Obesity-related disability: key factors identified by the International Classification of Functioning, Disability and Health.

PURPOSE: To identify obese patients' disability features considering the level of body impairments, activity limitations and participation restrictions in relation to environmental factors' effect. METHOD: Adult obese inpatients (BMI > 35) were enrolled and were administered a set of 166 ICF categories. Count-based indexes were developed for each ICF component: correlations and regression on performance and capacity indexes were performed. RESULTS: Fifty-one patients (62.7% females, mean age 38.1) entered in the study. Description of ICF-based disability components is reported. Capacity is better correlated with body functions (r = 0.619, P < 0.01) and body structures (r = 0.375, P < 0.01) than performance; on the contrary, environmental barriers are correlated better with performance (r = 0.531, P < 0.01) than with capacity. Impairments in body functions and environmental barriers are the best predictors of limitations both in capacity and in performance. CONCLUSIONS: Through this multidisciplinary approach, supported by ICFs biopsychosocial model, we described functioning and disability in obese patients, highlighting the strong effect of body functions' impairments and the limited one of environmental factors. This approach can guide rehabilitation programmes, the promotion of positive health outcomes and the modification of patients' lifestyle, not only intended as an issue of barriers' elimination, but as the activation and maintenance of environmental facilitators.

Mapping an obesity clinical evaluation protocol to the International Classification of Functioning, Disability and Health.

PURPOSE: To evaluate a multidisciplinary clinical protocol for obesity treatment by mapping it against the International Classification of Functioning, Disability and Health (ICF) and to determine the areas, defined by the ICF, in which no standardized assessment tools are available. METHOD: Assessment instruments used by a multidisciplinary team were linked to ICF categories and compared with a list of ICF categories composed by the ICF checklist and the comprehensive ICF core-set for obesity. Other relevant ICF categories were added, and not relevant ones were deleted when appropriate. RESULTS: Five ICF categories were deleted and 11 were added, and 166 ICF categories were linked to assessment tools and to semi-structured interviews. The majority were linked to assessment tools, but within the domain of the environmental factors all ICF categories were mapped using semi-structured interviews. CONCLUSIONS: Our results show that an extended list of ICF categories is adequate to cover a wide spectrum of clinical and functional information, and it could be employed to describe, disability profiles of obese patients, to develop preventive measures and to identify what factors in the environment need to be changed to improve rehabilitation's outcomes.

Use of the ICF to describe functioning and disability in obese patients.

PURPOSE: To describe the functioning and disability in adult patients with severe obesity through an implementation of ICF-based tools in a clinical inpatient setting, and to highlight the most relevant domains of functioning. METHODS: Adult obese inpatients with BMI > or = 35 kg/m(2) were enrolled and underwent a clinical evaluation following a standardized diagnostic protocol. ICF categories were filled according to established coding rules, on the basis of an extended list composed by ICF Core Set for obesity, the ICF checklist and other categories linked to the diagnostic protocol. Categories reported as a problem by at least 20% of patients were considered relevant for describing functional profiles of obese patients. RESULTS: Fifty-one patients were enrolled and 43 ICF categories were selected: 11 body functions (26% out of the total selected categories), 3 body structures (7%), 15 activities and participation (35%) and 14 environmental factors (32%). Six ICF categories were not included in the Core-Set for obesity. CONCLUSIONS: Our study shows the applicability of an extended list of ICF categories to describe functioning and disability of obese patients, and provide a preliminary indication to expanding the ICF Core Set for obesity.