Disability Degree Assessment: A Comprehensive Approach According to Royal Decree 888/2022. / Evaluación del grado de discapacidad: un enfoque integral según el Real Decreto 888/2022.

BACKGORUND AND OBJECTIVE: Royal Decree 888/2022 establishes that the evaluation of disability situations is carried out by multiprofessional teams responsible for assessing and recognizing the degree of disability. The participation of professionals in the healthcare and social fields can be valuable in providing reports from which the necessary data for the proper assessment of disability can be obtained, with the ultimate goal of providing comprehensive assistance to people with disabilities. MATERIALS AND METHODS: An analysis and summary of Royal Decree 888/2022, which has recently come into effect, is performed, focusing on the most relevant aspects for professionals in the healthcare and social fields. RESULTS: The recognition and classification of the degree of disability are the responsibility of the autonomous communities, and the assessments are issued by multiprofessional teams. To do this, four components are evaluated using the criteria outlined in the annexes of the Royal Decree itself. Each criterion generates a score that is combined to obtain a single score, the Final Disability Degree of the Person. CONCLUSIONS: The pathology that causes the disability must have been previously diagnosed by the Healthcare System and considered permanent. Its evaluation is based on the evidence of objective clinical findings that are documented and supported by clinical reports. For this reason, it is important to maintain an accurate medical history, document reviews, and provide all relevant evidence.

Self-reported functioning among patients with ultra-rare nemaline myopathy or a related disorder in Finland: a pilot study.

BACKGROUND: Nemaline myopathy (NM) and related disorders (NMr) form a heterogenous group of ultra-rare (1:50,000 live births or less) congenital muscle disorders. To elucidate the self-reported physical, psychological, and social functioning in the daily lives of adult persons with congenital muscle disorders, we designed a survey using items primarily from the Patient Reported Outcomes Measurement Information System, PROMIS®, and conducted a pilot study in patients with NM and NMr in Finland. The items were linked to International Classification of Functioning, Disability and Health (ICF) categories. RESULTS: In total, 20 (62.5%) out of 32 invited persons resident in Finland participated in the study; 12 had NM and 8 NMr, 15 were women and 5 men aged 19-75 years. Sixteen (80%) were ambulatory and 4 (20%) NM patients used wheelchairs. The results from the PROMIS measuring system and ICF categories both indicated that non-ambulatory patients of this study faced more challenges in all areas of functioning than ambulatory ones, but the differences were smaller in the domains measuring psychological and social functioning than in physical functioning. In addition, the COVID-19 pandemic adversely affected the functioning of non-ambulatory patients more than that of ambulatory patients. The interindividual differences were, however, noticeable. CONCLUSIONS: To our knowledge, this pilot study is the first comprehensive survey-based study of the physical, psychological, and social functioning of adult persons with nemaline myopathy or related disorders. The results indicate vulnerability of non-ambulatory patients being at higher risk to a decrease in general functioning during global or national exceptional periods. The responses also gave directions for modifying and improving the survey for future studies.

Artificial Intelligence in Evaluation of Permanent Impairment: New Operational Frontiers.

Artificial intelligence (AI) and machine learning (ML) span multiple disciplines, including the medico-legal sciences, also with reference to the concept of disease and disability. In this context, the International Classification of Diseases, Injuries, and Causes of Death (ICD) is a standard for the classification of diseases and related problems developed by the World Health Organization (WHO), and it represents a valid tool for statistical and epidemiological studies. Indeed, the International Classification of Functioning, Disability, and Health (ICF) is outlined as a classification that aims to describe the state of health of people in relation to their existential spheres (social, family, work). This paper lays the foundations for proposing an operating model for the use of AI in the assessment of impairments with the aim of making the information system as homogeneous as possible, starting from the main coding systems of the reference pathologies and functional damages. Providing a scientific basis for the understanding and study of health, as well as establishing a common language for the assessment of disability in its various meanings through AI systems, will allow for the improvement and standardization of communication between the various expert users.

Environmental determinants for participation among stroke survivors in Africa, a scoping review.

Purpose: In this review, we aimed to determine the environmental factors that are influencing the participation of stroke survivors in Africa. Methods: Four electronic databases were systematically searched from inception to August 2021, and identified articles were screened by the two authors of this review based on predetermined criteria. No date restrictions were imposed, and we included any type of paper, including gray literature. We followed the scoping review framework by Arksey and O'Malley, which was later revised by Levac et al. The whole finding is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR). Results: A total of 584 articles were generated by the systematic search, and one article was added manually. After eliminating the duplicates, the titles and abstracts of 498 articles were screened. From the screening, 51 articles were selected for full article review, of which 13 met the criteria to be included. In total, 13 articles were reviewed and analyzed based on the international classification of functioning, disability, and health (ICF) framework of the environmental determinants. Products and technology; natural environment and human-made changes to environment; and services, systems, and policies were found to be barriers for stroke survivors to participate in their community. Conversely, stroke survivors are getting good support from their immediate family and health professionals. Conclusion: This scoping review sought to identify the environmental barriers and the facilitators that are determining the participation of stroke survivors in Africa. The results of this study can serve as a valuable resource for policymakers, urban planners, health professionals, and other stakeholders involved in disability and rehabilitation. Nonetheless, additional research is necessary to validate the identified facilitators and barriers.

ACTIVLIM-Hemo: A new self-reported, unidimensional and linear measure of activity limitations in persons with haemophilia.

INTRODUCTION: To assess activity limitations in people with haemophilia (PwH), the self-reported Haemophilia Activity List (HAL) is widely employed, despite several methodological limitations impacting the interpretation of categorical scores. Modern psychometric approaches avoid these limitations by using a probabilistic model, such as the Rasch model. The ACTIVLIM is a Rasch-built measurement of activity limitations previously validated in several clinical conditions like neuromuscular disorders. AIMS: This study sought to develop the ACTIVLIM-Hemo, meaning an ACTIVLIM scale version specifically adapted to assess daily activity limitations in adult PwH. METHODS: Daily activities were assessed as "impossible," "difficult" or "easy" by 114 PwH (median age of 44 years) with 63 of them reassessed after 12 days. The Rasch Rating Scale model was used to identify activities delineating a unidimensional and linear scale unbiased by demographic and clinical status. Concurrent validity was determined through correlation with the HAL sub-scores and sum score. RESULTS: The ACTIVLIM-Hemo included 22 pertinent activities, with difficulties independent of demographic and clinical conditions, allowing a reliable measure of activity limitations (PSI = .92) expressed on a linear and unidimensional scale in PwH (7%-100 % range, ceiling effect of 1/114) with excellent test-retest reliability (ICC = .978). Spearman rank correlations between ACTIVLIM-Hemo and HAL sub-scores ranged between .623 and .869. CONCLUSIONS: The ACTIVLIM-Hemo is an easy-to-administer, valid and reliable alternative to HAL in assessing activity limitations in PwH. Its invariant scale can be used across conditions and time to compare the functional status of PwH over a wide measurement range.

What Predicts Falls, and what are the Circumstances and Consequences of Falls in Community-Dwelling Older Adults Who Need Walking Aids or Home Help Service.

The objective was to analyze predictive variables for falls in older community-dwelling adults who needed walking aids or home help service, to describe the circumstances and consequences of falls and fall injuries, and to describe the activities preceding falls, n = 175, mean age 83 years. Falls were self-reported monthly in a fall calendar and were followed up by a telephone interview. A logistic regression analysis was performed to investigate predictive baseline variables for falls. Injuries were reported in 82 of the 185 fall events. Previous falls and a high level of education had a significant association with falls odds ratios 1.9 (95% CI 1.3-2.7), and 2.7 (95% CI 1.4-5.3). Activities preceding the falls were classified according to the International Classification of Functioning (ICF). Falls and fall injuries were most common while moving around within the home and rising from sitting to standing.

Social Environmental Factors Related to Resuming Driving after Brain Injury: A Multicenter Retrospective Cohort Study.

Many patients resume driving after brain injury regardless of their ability to drive safely. Predictors for resuming driving in terms of actual resumption status and environmental factors are unclear. We evaluated the reasons for resuming driving after brain injury and examined whether social environmental factors are useful predictors of resuming driving. This retrospective cohort study was based on a multicenter questionnaire survey at least 18 months after discharge of brain injury patients with rehabilitation. A total of 206 brain injury patients (cerebrovascular disease and traumatic brain injury) were included in the study, which was conducted according to the International Classification of Functioning (ICF) items using log-binominal regression analysis, evaluating social environmental factors as associated factors of resuming driving after brain injury. Social environmental factors, inadequate public transport (risk ratio (RR), 1.38), and no alternative driver (RR, 1.53) were included as significant independent associated factors. We found that models using ICF categories were effective for investigating factors associated with resuming driving in patients after brain injury and significant association between resuming driving and social environmental factors. Therefore, social environmental factors should be considered when predicting driving resumption in patients after brain injury, which may lead to better counseling and environmental adjustment.

[Multidisciplinary approach to the rehabilitation of patients with osteoporosis]. / Mul'tidistsiplinarnyi podkhod k reabilitatsii patsientov s osteoporozom.

The article outlines the modern concept of rehabilitation of patients with osteoporosis (OP), the cornerstone of which is the use of a multidisciplinary approach. This approach involves not only the participation of specialists of various specializations and levels in the process of rehabilitation treatment, but the formation of a new functional unit - a multidisciplinary team, whose members actively interact with each other from the first days to the completion of the rehabilitation course at every stage of the course; they together make a rehabilitation diagnosis based on the International Classification of Functioning, Disability and Health (ICF); they formulate rehabilitation goals, evaluate rehabilitation potential, discuss and develop a rehabilitation program and evaluate its effectiveness by using modern scales, tests and questionnaires to assess the change in the condition of the patient"s life at all levels and the quality of life in general. Taking into account the principle of multidisciplinarity, approaches to preparation of rehabilitation programs for patients with OP are described using various methods: those of therapeutic gymnastics, mechanotherapy, physiotherapy, balneotherapy, occupational therapy, psychotherapy, drug treatment and orthosis. Particular attention in the process of rehabilitation of patients with OP is given to physical therapy and orthosis, which are aimed at reducing pain, improving coordination, posture, as well as reducing the risk of falls and fractures. The literature review presented in the article allows us to conclude that the use of a multidisciplinary approach in the rehabilitation of patients with OP makes it possible to significantly improve the quality of life of patients even with severe forms of the disease.

The requirements for social participation of people with disabilities in the community in Honduras: A qualitative study / 国際保健医療

Background and Objectives  In Honduras, only a few rehabilitation centers have provided social participation services consistent with the International Classification of Functioning (ICF). The goal of this study were to describe how people with disabilities (PWD) felt a need to participate in society, and to clarify what aspects of social participation were of interest to PWD.Methods  A survey was conducted in a rehabilitation facility operated by the Intibucá department in Honduras. A semi-structured interview was conducted people with physical disabilities who attended the facility to analyze their needs and state of social participation.Results  In total, 22 PWDs participated in this study. Data analysis showed that the needs of PWD were classified into six categories: Improving the Social Environment, Improving Physical Function and Activities of daily living Ability, Reacquiring Work and Productive Activities, Acquiring Home Activities, Spending Time with Family, and Resuming Leisure Activities. Six participants were employed, and those who were unemployed were also limited in their community participation other than work.Conclusion  This study revealed that PWD in the Intibucá Department missed opportunities to participate in the community. PWD stated that improved physical functioning was essential for achieving social participation. Rehabilitation professionals need to develop shared decision-making based on an understanding of the social context of PWD, and both rehabilitation professionals and local community supporters working with PWD should partner with other professionals to support the social participation of PWD.

Rehabilitation in Low-Resource Areas.

Earlier rehabilitation interventions, like community-based rehabilitation (CBR), could not make a remarkable impact because they ran parallel to the health system, but the newer model establishes health-related rehabilitation as an integral part of the health care system at all levels and thus should be implemented as such. Collaborating with other players relevant to the CBR matrix, such as social and vocational services, can be imparted for the empowerment of a disabled group at the village level through the CBR center. A multipurpose rehabilitation worker, through skill transfer or task shifting, can start rehabilitation at the primary health center.

Influence of visual impairment and hearing impairment on functional dependence status among people in Taiwan-An evaluation using the WHODAS 2.0 score.

BACKGROUND: Visual impairment (VI) and hearing impairment (HI) are the two most common types of sensory disability encountered clinically. However, VI and HI result in different limitations in daily life. We assessed the level of functioning in patients with VI or HI based on the International Classification of Functioning, Disability, and Health. METHODS: This nationwide, cross-sectional study included 312 people with VI and 540 people with HI. Each participant's degree of functioning and disability was evaluated using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The standardized WHODAS 2.0 scores ranged from 0 (least difficulty) to 100 (most difficulty). RESULTS: Patients with VI and those with HI had a mean (±standard error) 32-item WHODAS 2.0 score of 42.4 ± 2.9 and 27.1 ± 1.6, respectively. The degree of restriction was positively related to the level of VI. Specifically, the patients with VI and a WHODAS 2.0 score of 33.7-35.3 or higher were likely to experience barriers to accessing mobility products, communication products, and education products. Furthermore, patients with a score of 42.9 or higher might experience barriers to accessing ingestion products and living products. CONCLUSION: WHODAS 2.0 scores are strongly correlated with the severity of VI. Mild VI should be targeted for treatment and referral as early as possible. Compared with the patients with HI, the patients with VI more frequently experience barriers to accessing environmental factors.

Patient reported outcome measures (PROMs) for goalsetting and outcome measurement in primary care physiotherapy, an explorative field study.

OBJECTIVES: Routine use of patient reported outcome measures (PROMs) may provide an effective way of monitoring patient valued outcomes. In this study we explored (1) the current use of PROMs; (2) to what extent the goals correspond with the selected PROMs; (3) the health outcomes based on PROMs. DESIGN: Observational clinical cohort study. SETTING: Dutch primary care physiotherapy practices (n=43). PARTICIPANTS: Patients (n=299) with neck pain or low back pain. MAIN OUTCOME MEASURES: The number of PROMs used per patient were calculated. The International Classification of Functioning, Disability and Health was used to map the patients' goals and the percentages of PROMS selected that match the domains of the goals were calculated. Health outcomes were assessed using two approaches for estimating the minimal clinically important difference (MCID). RESULTS: Repeated measurements with the Visual Analogue Scale, the Patient Specific Complaints questionnaire, the Quebec Back Pain Disability Scale, or the Neck Disability Index were completed by more than 60% of the patients. The PROMs used matched in 46% of the cases with goals for pain improvement, and in 43% with goals set at activity/participation level. The mean differences between baseline and follow up scores for all PROMs were statistically significant. Improvements of patients based on MCID varied from 57% to 90%. CONCLUSIONS: PROMs were used in the majority of the patients, showed improved health outcomes and fitted moderately with goals. The results of this study can be used for future research assessing the routine use of outcome measurements with PROMs.

The International Classification of Functioning (ICF) to evaluate deep brain stimulation neuromodulation in childhood dystonia-hyperkinesia informs future clinical & research priorities in a multidisciplinary model of care.

The multidisciplinary team (MDT) approach illustrates how motor classification systems, assessments and outcome measures currently available have been applied to a national cohort of children and young people with dystonia and other hyperkinetic movement disorders (HMD) particularly with a focus on dyskinetic cerebral palsy (CP). The paper is divided in 3 sections. Firstly, we describe the service model adopted by the Complex Motor Disorders Service (CMDS) at Evelina London Children's Hospital and King's College Hospital (ELCH-KCH) for deep brain stimulation. We describe lessons learnt from available dystonia studies and discuss/propose ways to measure DBS and other dystonia-related intervention outcomes. We aim to report on current available functional outcome measures as well as some impairment-based assessments that can encourage and generate discussion among movement disorders specialists of different backgrounds regarding choice of the most important areas to be measured after DBS and other interventions for dystonia management. Finally, some recommendations for multi-centre collaboration in regards to functional clinical outcomes and research methodologies for dystonia-related interventions are proposed.

An overview of vestibular rehabilitation.

Data related to the efficacy of vestibular rehabilitation and its evolution as an intervention are provided. Concepts and various treatment strategies are described, with explanations of why people with uncompensated peripheral and central vestibular disorders might improve with rehabilitation. Various tests and measures are described that are commonly used to examine patients and determine their level of ability to participate in their environment. Factors that affect recovery, both positively and negatively, are described in order to better prognosticate recovery. A case utilizing many of the principles discussed is included to provide insight into how to utilize vestibular rehabilitation with a person with an uncompensated peripheral vestibular loss.

Three different points of view in stroke rehabilitation: patient, caregiver, and physiotherapist.

BACKGROUND: The similarities or differences of the three some (physiotherapists, patients, and caregivers) thought about the process of stroke rehabilitation can play a key role in the success of rehabilitation. OBJECTIVE: The aim of this qualitative study was to investigate the perspectives of the three some, with regard to the two themes of the study: (1) What are the problems faced by the patients after stroke?; and (2) What does recovery after stroke mean to you? METHODS: The qualitative questions and possible answers were prepared by four physiotherapists. The answers were matched to International Classification of Functioning (ICF) components. Seventy patients who were having treatment as in-patient rehabilitation centers, their caregivers, and physiotherapists were invited to the study. After the questions were asked and the possible response choices were presented, subjects were asked to prioritize these response choices. RESULTS: One hundred and fifty-nine subjects, including 53 patients, 53 caregivers, and 53 physiotherapists, were included to the study. When the theme 1 were examined, we found that the patients' first priority was functional abilities (ICF: body function and structure) such as using the hands and feet while the caregivers and physiotherapists prioritized self-care problems (ICF: activity and participation). The most common response to the theme 2 was "being in same health condition before the disease" (ICF: activity and participation) among the patients and caregivers and "being able to move arm and leg on the affected side" (body function and structure) among the physiotherapists. CONCLUSION: As a conclusion, problems faced by the patients, caregivers, and physiotherapists were perceived under the same ICF domain and that caregivers' and physiotherapists' priorities were the same.

Construcción de una herramienta para certificar la discapacidad en Colombia / Constructing a tool for certifying handicap / disability in Colombia

Objetivo Describir el proceso de construcción de una herramienta para la certificación de la condición de discapacidad en Colombia Método Se realiz- un estudio descriptivo, que por medio de una estrategia multimétodo busc- identificar desde diferentes perspectivas y con una metodolog’a participativa las necesidades, antecedentes, referentes, categorías, y procedimientos propicios para identificar y certificar la condición de discapacidad en un ciudadano colombiano. Resultados Una herramienta con la que el Sistema de Salud Colombiano y los profesionales del área de la salud pueden certificar la condición de discapacidad. Conclusiones La construcción de una herramienta que a través de la evaluación y certificación de la condición de discapacidad busca identificar a las personas con discapacidad como titulares de los derechos establecidos en la Ley, facilitando su acceso en condiciones de equidad, es una clara evidencia del compromiso del Estado Colombiano, de avanzar hacia una sociedad incluyente.

Objective Describing how a tool was created/constructed for certifying Colombian people's disability status. Method This was a descriptive study involving a five-phase, multi-method design. It sought to identify needs, background, categories and procedures from differingview points, using participatory methodology, for identifying and certifying disabled people in Colombia. Results The study led to an international classification of functioning, disability and health (ICF)-based certification tool which can be used by a multi-professional team in healthcare institution settings to guarantee access to benefits approved by Colombian disability law. Conclusions Certification (even when voluntary) can be the key to enjoying all the benefits designed for Colombian people suffering disability; such people are not the subjects of mercy and compassion anymore. Certification seeks to identify people suffering disabilities as holders of rights under Colombian law, as clear evidence of Colombian state commitment to ensuring an inclusive society.

Clasificación internacional del funcionamiento, la discapacidad y certificación de discapacidad en Colombia / International classification of functioning, disability and disability certification in Colombia

Lograr la certificación de la discapacidad en Colombia ha sido un reto que las personas con discapacidad se han impuesto y que el país ha asumido, en el marco de la legislación vigente y de los acuerdos internacionales a los que ha adherido Colombia. Para el efecto, se ha adoptado el modelo de clasificación internacional del funcionamiento, la discapacidad y la salud (CIF), en razón a que este instrumento, validado internacionalmente en diversos estudios, permite incorporar un estándar internacional de evaluación del estado funcional de los individuos. En este ensayo, inicialmente se define el concepto "discapacidad" y se ubica en el contexto histórico que lo precede, hasta llegar a la actual estructura de dominios y categorías de la CIF, instrumento que proporciona un marco común y generalizado, de forma tal que se permita proporcionar una adecuada asignación de servicios y beneficios generales, específicos, y a la vez se evalúa el diferencial existente entre el funcionamiento real y el potencial de las personas con discapacidad.

Certifying disability in Colombia has been demanded by disabled people; the country has assumed such challenge within the frame work of current legislation and international agreements signed by Colombia. A model of international classification of functioning (ICF), disability and healthwas thus adopted as it has been validated internationally in several studies; it incorporates international standards thereby allowing reliable evaluation of individuals' functional status. This essayinitially defines the concept of disabilityand locates it within a historical context leading to current ICF domain structure and categories. Such instrument provides a common, wide-ranging framework for providing suitable allocation of services and general and specific benefits, while assessing the differential between disabled people's current performance and their potential.