The development of the International Classification of Functioning, Disability and Health Core Sets for deafblindness: A study protocol.

BACKGROUND: Individuals with deafblindness experience a combination of hearing and vision impairments. The World Health Organization has developed a global framework referred to as the International Classification of Functioning, Disability and Health (ICF) to describe health and functioning. From the full ICF classification, a selection of categories, referred to as ICF Core Sets, provide users with a tool to describe functioning and disability in specific health conditions. There has been no ICF Core Set created for deafblindness. Given that core sets are instrumental in improving clinical practice, research, and service delivery, the aim of this study is to develop an ICF Core Set for deafblindness. METHODS: As part of the preparatory phase in the ICF Core Set development, there are four studies that will be conducted. This includes the [1] systematic literature review that examines the researcher's perspective, [2] qualitative study focusing on the individuals with deafblindness experience, [3] experts survey that looks at health professional's perspective, and [4] empirical study that examines the clinical perspective. The studies will be conducted using the principles outlined by the ICF Research Branch for the development of ICF Core Sets. The systematic literature review protocol was submitted for registration on PROSPERO CRD42021247952. DISCUSSION: An ICF Core Set created for deafblindness will benefit individuals living with deafblindness who are often excluded from social participation, policies, and services. An ICF Core Set for deafblindness will have a significant impact on healthcare professionals, policymakers, researchers, service providers and individuals with deafblindness by facilitating communication among all stakeholder to support the functioning of those with deafblindness.

A comparative performance analysis of the International Classification of Functioning, Disability and Health and the Item-Perspective Classification framework for classifying the content of patient reported outcome measures.

BACKGROUND: Standardized coding of the content presented in patient reported outcome measures can be achieved using classification frameworks, and the resulting data can be used for ascertaining content validity or comparative analyses. The International Classification of Functioning (ICF) is a framework with a detailed conceptual structure that has been successfully utilized for such purposes through established coding procedures. The Item Perspective Classification (IPC) framework is a newly developed relational coding system that classifies the respondent perspective and conceptual domains addressed in items. The purpose of this study was to compare and describe the performance of these two frameworks when used alone, and in conjunction, for the generation of data pertaining to the content of patient reported outcome measures. METHODS: Six health-related quality of life questionnaires with a total of 159 items were classified by two raters using the Item Perspective Classification framework in conjunction with the International Classification of Functioning. Framework performance indicators included: classification capacity (percent of items amenable to successful classification), coding efficiency (number of codes required to classify items), and content overlap detection (percent of items sharing identical classification codes with at least one other item). Inter-rater reliability of item coding was determined using Krippendorff's alpha. RESULTS: Classification capacity of the IPC framework was 97%, coding efficiency 26, and content overlap detection was 95%; whereas respective values for the ICF were 68%, 114, and 58%. When used in conjunction values were 63%, 129, and 30%. Krippendorff's alpha exceeded 0.97 for all 3 classification indices. CONCLUSION: Inter-rater agreement on classification data was excellent. The IPC framework provided a unique classification of the respondent's judgment during item response and classified more items using fewer categories, indicated greater content overlap across items and was able to describe the relationship between multiple concepts presented within the context of a single item. The ICF provided a unique classification of item content relating to aspects of disability and generated more detailed and precise descriptions. A combined approach provided a rich description (detailed codes) with each framework providing complementary information. The benefits of this approach in instrument development and content validation require further investigation.

Describing Functioning in People Living With Spinal Cord Injury Across 22 Countries: A Graphical Modeling Approach.

OBJECTIVE: To provide prevalence estimates for problems in functioning of community-dwelling persons with spinal cord injury (SCI) and to examine associations between various areas of functioning with the purpose of supporting countries in identifying targets for interventions. DESIGN: Cross-sectional survey. SETTING: Community, 22 countries including all World Health Organization regions. PARTICIPANTS: Persons (N=12,591) with traumatic or nontraumatic SCI aged 18 years or older. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We estimated the prevalence of problems in 53 areas of functioning from the Brief International Classification of Functioning, Disability and Health (ICF) core set for SCI, long-term context, or ICF rehabilitation set covering 4 domains: impairments in body functions, impairments in mental functions, independence in performing activities, and restrictions in participation. Associations between areas of functioning were identified and visualized using conditional independence graphs. RESULTS: Participants had a median age of 52 years, 73% were male, and 63% had paraplegia. Feeling tired, bowel dysfunction, sexual functions, spasticity, pain, carrying out daily routine, doing housework, getting up off the floor from lying on the back, pushing open a heavy door, and standing unsupported had the highest prevalence of problems (>70%). Clustering of associations within the 4 functioning domains was found, with the highest numbers of associations within impairments in mental functions. For the whole International Spinal Cord Injury sample, areas with the highest numbers of associations were circulatory problems, transferring bed-wheelchair, and toileting, while for the World Health Organization European and Western Pacific regions, these were dressing upper body, transferring bed-wheelchair, handling stress, feeling downhearted and depressed, and feeling happy. CONCLUSIONS: In each domain of functioning, high prevalence of problems and high connectivity of areas of functioning were identified. The understanding of problems and the identification of potential targets for intervention can inform decision makers at all levels of the health system aiming to improve the situation of people living with SCI.

Aplicabilidade do instrumento "Screening of Activity Limitation and Safety Awareness" em idosos com hanseníase / Aplicabilidad del instrumento "Screening of Activity Limitation and Safety Awareness" en personas de edad avanzada con lepra / Applicability of the instrument "Screening of Activity Limitation and Safety Awareness" in elderly with leprosy

RESUMO Objetivo Analisar a aplicabilidade da Screening of Activity Limitation and Safety Awareness (SALSA) para a avaliação da capacidade funcional de idosos com hanseníase. Método Pesquisa descritiva, transversal, desenvolvida com 77 idosos com hanseníase acompanhados no Centro de Referência em Dermatologia, em Fortaleza, Ceará, de junho a agosto de 2015, por meio da aplicação da SALSA e de outras duas escalas já validadas para uso em idosos. Para a análise, utilizou-se estatística descritiva e inferencial. Resultados Houve convergência entre as escalas (p=0,0000) na avaliação da capacidade funcional. As variáveis idade e sexo apresentaram maior número de associações com as atividades avaliadas, ao passo que, nas variáveis clínicas relacionadas à hanseníase, apenas o grau de incapacidade física apresentou relação com mais de duas atividades. Conclusão A SALSA contribuiu para a avaliação eficaz da capacidade funcional na população estudada, sendo mais influenciada pela idade do que pela hanseníase. Implicações para a prática: Assim, recomenda-se a sua aplicação nas consultas iniciais como instrumento de rastreio da capacidade funcional de idosos com hanseníase.

RESUMEN Objetivo Analizar la aplicabilidad del Screening of Activity Limitation and Safety Awareness (SALSA) para evaluación de la capacidad funcional de personas mayores con lepra. Método Investigación descriptiva, transversal, desarrollada con 77 personas mayores con enfermedad de Hansen acompañadas por el Centro de Referencia en Dermatología, en Fortaleza, Ceará, desde junio hasta agosto de 2015, mediante la aplicación de la SALSA y otras dos escalas ya validadas para uso en personas de edad avanzada. Para el análisis, se utilizó estadística descriptiva e inferencial. Resultados Hubo convergencia entre las escalas (p=0,0000) en la evaluación de la capacidad funcional. Los variables edad y sexo mostraron mayor número de asociaciones con las actividades evaluadas, mientras que en las variables clínicas relacionadas con la lepra, apenas el grado de incapacidad física presentó relación con más de dos actividades. Conclusiones La SALSA ha contribuido a la efectiva evaluación de la capacidad funcional en la población estudiada, siendo influenciada más por edad que por la enfermedad de Hansen. Implicaciones para la práctica: Su aplicación se recomienda en las consultas iniciales como una herramienta para la detección de la capacidad funcional de personas mayores con lepra.

ABSTRACT Objective To analyze the applicability of Screening of Activity Limitation and Safety Awareness (SALSA) for the evaluation of the functional capacity of the elderly with leprosy. Method Descriptive and transversal research, developed with 77 elderly people with Hansen's disease accompanied at the Reference Center in Dermatology, in Fortaleza, Ceará, from June to August 2015, through the application of SALSA and two other scales already validated for use in elderly. For the analysis, descriptive and inferential statistics were used. Results There was convergence between the scales (p=0.0000) on the evaluation of functional capacity. The variables age and gender showed a larger number of associations with the activities evaluated, whereas, in the clinical variables related to leprosy, just the grade of disability presented a relationship with more than two activities. Conclusion and Implications for practice The SALSA has contributed to the effective evaluation of functional capacity in the population studied, being more influenced by age than by leprosy. SALSA's application is recommended in the initial consultations as a tool for screening of the functional capacity of older people with leprosy.

Participation of children with disabilities in school: A realist systematic review of psychosocial and environmental factors.

BACKGROUND: In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4-12 year old children with disabilities to inform the development of participation-fostering interventions. METHODS: A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported. RESULTS AND IMPLICATIONS: We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children's participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.

Classificação Internacional de Funcionalidade, Incapacidade e Saúde: uma análise de conteúdo / International Classification of Functioning, Disability and Health: a content analysis / Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud: un análisis de contenido

Objetivo: Produzir uma análise de conteúdo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Métodos: Trata-se de uma análise de conteúdo para descrever e interpretar os conteúdos da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, a partir de uma perspectiva qualitativa e com aporte teórico de Georges Canguilhem em "O Normal e o Patológico". Resultados: Emergiram as seguintes categorias: Organismo biológico e a relação de normalidade/patologia; Incapacidade e funcionalidade influenciadas pelo ambiente. Conclusão: A normatividade contida na Classificação Internacional de Funcionalidade, Incapacidade e Saúde, por princípio, não atende a diversidade da população, apesar disso, apresenta uma tentativa de articulação dos modelos médico e social, o que pode ampliar a perspectiva dos enfermeiros acerca da relação do ambiente e do corpo na patologia e na normalidade, para além das métricas

Objective: The study's purpose has been to produce a content analysis of the International Classification of Functioning, Disability and Health, aiming to describe and interpret it. Methods: It is a research with a qualitative approach and showing a theoretical basis of Georges Canguilhem in "The Normal and the Pathological". Results: Based on the findings, the following categories appeared: Biological organism and the normality/pathology relationship; Disability and functioning influenced by the environment. Conclusion: It is concluded that the normatively contained in International Classification of Functioning, disability and Health, by principle, does not meet the population diversity. Nonetheless, it shows an articulate attempt towards medical and social models, which can extend the nurses' perspective beyond metrics, with regards to the relation of environment and body under pathological and normal condition

Objetivo: Producir un análisis de contenido de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud. Método: Se trata de una análisis de contenido para describir e interpretar los contenidos de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud, desde una perspectiva cualitativa y una base teórica de Georges Canguilhem en "Lo normal y lo patológico." Resultados: Surgieron las siguientes categorías: organismo biológico y la relación de la normalidad/ patología; discapacidad y funcionalidad influenciadas por el ambiente. Conclusión: Se llegó a la conclusión de que la normatividad contenida en la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud, en principio, no comprende la diversidad de la población, aunque presenta un intento de articular los modelos médicos y sociales, lo que puede ampliar la perspectiva de los enfermeros sobre la relación del ambien te y del cuerpo en la patología, y en la normalidad, además de las métricas

Conceptual Underpinnings of the Quality of Life in Neurological Disorders (Neuro-QoL): Comparisons of Core Sets for Stroke, Multiple Sclerosis, Spinal Cord Injury, and Traumatic Brain Injury.

OBJECTIVE: To determine the extent to which the content of the Quality of Life in Neurological Disorders (Neuro-QoL) covers the International Classification of Functioning, Disability and Health (ICF) Core Sets for multiple sclerosis (MS), stroke, spinal cord injury (SCI), and traumatic brain injury (TBI) using summary linkage indicators. DESIGN: Content analysis by linking content of the Neuro-QoL to corresponding ICF codes of each Core Set for MS, stroke, SCI, and TBI. SETTING: Three academic centers. PARTICIPANTS: None. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Four summary linkage indicators proposed by MacDermid et al were estimated to compare the content coverage between Neuro-QoL and the ICF codes of Core Sets for MS, stroke, MS, and TBI. RESULTS: Neuro-QoL represented 20% to 30% Core Set codes for different conditions in which more codes in Core Sets for MS (29%), stroke (28%), and TBI (28%) were covered than those for SCI in the long-term (20%) and early postacute (19%) contexts. Neuro-QoL represented nearly half of the unique Activity and Participation codes (43%-49%) and less than one third of the unique Body Function codes (12%-32%). It represented fewer Environmental Factors codes (2%-6%) and no Body Structures codes. Absolute linkage indicators found that at least 60% of Neuro-QoL items were linked to Core Set codes (63%-95%), but many items covered the same codes as revealed by unique linkage indicators (7%-13%), suggesting high concept redundancy among items. CONCLUSIONS: The Neuro-QoL links more closely to ICF Core Sets for stroke, MS, and TBI than to those for SCI, and primarily covers activity and participation ICF domains. Other instruments are needed to address concepts not measured by the Neuro-QoL when a comprehensive health assessment is needed.

Ethnic and Gender Differences in Preferred Activities among Maori and non-Maori of Advanced age in New Zealand.

This study explored active aging for older Maori and non-Maori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Maori aged 80 to 90 and non-Maori aged 85 were recruited. Of the 937 participants enrolled, 649 answered an open question about their three most important activities. Responses were coded under the World Health Organization's International Classification of Functioning, Disability and Health (ICF), Activities and Participation domains. Data were analyzed by ethnicity and gender for first in importance, and all important activities. Activity preferences for Maori featured gardening, reading, walking, cleaning the home, organized religious activities, sports, extended family relationships, and watching television. Gendered differences were evident with walking and fitness being of primary importance for Maori men, and gardening for Maori women. Somewhat similar, activity preferences for non-Maori featured gardening, reading, and sports. Again, gendered differences showed for non-Maori, with sports being of first importance to men, and reading to women. Factor analysis was used to examine the latent structural fit with the ICF and whether it differed for Maori and non-Maori. For Maori, leisure and household activities, spiritual activities and interpersonal interactions, and communicating with others and doing domestic activities were revealed as underlying structure; compared to self-care, sleep and singing, leisure and work, and domestic activities and learning for non-Maori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.

[Use of the ICF in medical rehabilitation in Germany: claims and reality]. / Nutzung der ICF in der medizinischen Rehabilitation in Deutschland: Anspruch und Wirklichkeit.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) is being used in the medical rehabilitation practice in different ways. The World Health Organization (WHO) and many other stakeholders have formulated claims and expectations for its use. OBJECTIVES: A comparative presentation of the claims of various stakeholders for the use of the ICF with examples in current practice. MATERIALS AND METHODS: Database searches (PubMed, REHADAT, and Google Scholar) were conducted for studies concerning claims and the current use of the ICF in practice. RESULTS: There are different requirements regarding the use of the ICF. While lawmakers and social insurance agencies remain very cautious and vague, other stakeholders (research institutions, organizations, stakeholders, service providers) formulate higher expectations and call for greater use of the ICF. In practice, the ICF is used in the form of a bio-psycho-social model, a common language and many different adaptations. CONCLUSIONS: The different requirements for the use of ICF demonstrate the motivations and interests of the stakeholders. Signals must now be sent both by politics and by social insurance agencies that go far beyond non-binding declarations. Furthermore it is necessary to systematize and evaluate the many use adaptations that are primarily being used by service providers. Research is needed on the concrete use of ICF-based instruments and its intended and unintended effects.

Functioning in patients with schizophrenia: a systematic review of the literature using the International Classification of Functioning, Disability and Health (ICF) as a reference.

PURPOSE: To identify and quantify the main concepts included in published studies focusing on individuals with schizophrenia using the International Classification of Functioning, Disability and Health (ICF). METHODS: Searches (limited to those published from 2008 to 2012) were performed in MEDLINE, PsycINFO and CINAHL. Included studies described participants with schizophrenia, were original articles and included only subjects who were at least 18 years of age at study entry. All concepts underlying the measures and the text of the articles were extracted, and they were linked to ICF categories using standardized rules. RESULTS: From the 3584 abstracts retrieved, 348 were randomly selected, and of these, 206 studies met the inclusion criteria. A total of 17,141 concepts were extracted, 84.8% of which could be linked to 491 ICF categories: 222 (45.21%) of the categories referred to Body Functions, 29 (5.91%) to Body Structures, 186 (37.88%) to Activities and Participation and 54 (11%) to Environmental Factors. Seventy second-level categories were reported in at least 5% of all studies: 30 of these categories referred to Body Functions, 2 to Body Structures, 34 to Activities and Participation and 4 to Environmental Factors. CONCLUSION: The study has allowed us to identify and quantify the main concepts included in studies focusing on people with schizophrenia using the ICF. The majority of the concepts refer to Body Functions and Activities and Participation, rather than to Body Structures and Environmental Factors.

The Burn Model Systems outcome measures: a content analysis using the International Classification of Functioning, Disability, and Health.

BACKGROUND: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems (BMS) is a nationwide database that uses patient-reported outcome measures to collect data. Though the outcome measures demonstrate good psychometric properties, the question remains whether or not these measures collect data that encompass the entire experience of burn patients over time. METHODS: Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also determined. RESULTS: The body function component was most frequently addressed overall followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective. CONCLUSION: This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery. Implications for Rehabilitation A better understanding of the data collected through the Burn Model Systems (BMS) project may contribute to improve data collection tools and ultimately lead to clinical practice innovations and improvements. Clinicians interested in using BMS data for research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed. This study highlights the need for burn clinicians around the world to lend their expertise to the WHO for the development of a much needed burn injury International Classification of Functioning, Disability and Health Core Set.

[The bio-psycho-social model and the International Classification of Functioning, Disability and Health : Examples of using the model, its parts and the items]. / Das biopsychosoziale Modell und die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit : Beispiele für die Nutzung des Modells, der Teile und der Items.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) can be used in practice in a variety of ways. OBJECTIVES: The aim of this work is to illustrate some of the most important ways of using the ICF and some aspects of their theoretical concepts. MATERIALS AND METHODS: Database searches (PubMed, Rehadat, and Google Scholar) were conducted for studies concerning the use of the ICF in practice. RESULTS: For all aspects of the ICF, and many of the intended ways of using it, there are concrete developments and examples or indications for their implementation into practice in different contexts. In particular, the common language and the bio-psycho-social model is widely accepted and applied in practice. At the level of chapters, there are a few developments and examples of practical applications of the ICF. When using the ICF based on Items, however, diverse developments of different theoretical and methodological quality are available. CONCLUSION: The multitude of different adaptations of the ICF for practice illustrates the great effort to the implementation in practice. However, this also shows that no comprehensive solution to the satisfaction of concerned protagonists was found. Research is needed on the theoretical foundations of the ICF, capturing the current practice of using the ICF and in the creation of specific instructions for ways to use the ICF in practice.

Using the ICF's environmental factors framework to develop an item bank measuring built and natural environmental features affecting persons with disabilities.

OBJECTIVES: To develop a measure of natural environment and human-made change features (Chapter 2 of the international classification of functioning, disability, and health) and evaluate the influence of perceived barriers on health-related quality of life. METHODS: A sample of 570 adults with stroke, spinal cord injury, and traumatic brain injury residing in community settings reported their functioning in home, outdoor, and community settings (mean age = 47.0 years, SD = 16.1). They rated 18 items with a 5-point rating scale to describe the influence of barriers to moving around, seeing objects, hearing sounds, hearing conversations, feeling safe, and regulating temperature and indicated whether any difficulties were due to environmental features. We used Rasch analysis to identify misfitting items and evaluate differential item functioning (DIF) across impairment groups. We computed correlations between barriers and patient-reported outcomes measurement information system (PROMIS) social domain measures and community participation indicators (CPI) measures. RESULTS: The 18 items demonstrated person reliability of .70, discriminating nearly three levels of barriers. All items fit the Rasch model; impairment-related DIF was negligible. Ceiling effects were negligible, but 25 % of the respondents were at the floor, indicating that they did not experience barriers that they attributed to the built and natural environment. As anticipated, barriers correlated moderately with PROMIS and CPI variables, suggesting that although this new item bank measures a construct that is related to participation and health-related quality of life, it also captures something unique. Known-groups validity was supported by wheelchair users reporting a higher level of barriers than did ambulatory respondents. CONCLUSIONS: Preliminary evidence supports the reliability and validity of this new measure of barriers to the built and natural environment. This measure allows investigators and clinicians to measure perceptions of the natural environment and human-made changes, providing information that can guide interventions to reduce barriers. Moderate relationships between barriers and PROMIS and CPI variables provide support for the measurement and theory of environmental influences on social health and participation.

Integrating the ICF with positive psychology: Factors predicting role participation for mothers with multiple sclerosis.

OBJECTIVE: Being a mother has become a realizable life role for women with disabilities and chronic illnesses, including multiple sclerosis (MS). Identifying psychosocial factors that facilitate participation in important life roles-including motherhood-is essential to help women have fuller lives despite the challenge of their illness. By integrating the International Classification of Functioning, Disability, and Health (ICF) and a positive psychology perspective, this study examined how environmental social factors and positive personal factors contribute to daily role participation and satisfaction with parental participation. METHOD: One hundred and 11 community-dwelling mothers with MS completed Ryff's Psychological Well-Being Scales, the Medical Outcome Study Social Support Survey, the Short Form-36, and the Parental Participation Scale. Hierarchical regression analyses examined associations between social support and positive personal factors (environmental mastery, self-acceptance, purpose in life) with daily role participation (physical and emotional) and satisfaction with parental participation. One-way ANOVAs tested synergistic combinations of social support and positive personal factors. RESULTS: Social support predicted daily role participation (fewer limitations) and greater satisfaction with parental participation. Positive personal factors contributed additional unique variance. Positive personal factors and social support synergistically predicted better function and greater satisfaction than either alone. CONCLUSION: Integrating components of the ICF and positive psychology provides a useful model for understanding how mothers with MS can thrive despite challenge or impairment. Both positive personal factors and environmental social factors were important contributors to positive role functioning. Incorporating these paradigms into treatment may help mothers with MS participate more fully in meaningful life roles.

Exploring use of the ICF in health education.

PURPOSE: Currently, little is known regarding use of the International Classification of Functioning, Disability and Health (ICF) in health education applications. Therefore, this review sought to examine the scope of work that has been conducted regarding the application of the ICF in health education. METHODS: A review of the current literature related to use of the ICF in health education programs was conducted. Twelve electronic databases were searched in accordance with a search protocol developed by a health sciences librarian. In total, 17,878 records were reviewed, and 18 articles met the criteria for inclusion in this review. RESULTS: Current evidence regarding use of the ICF in healthcare education revealed that program and participant properties can be essential facilitators or barriers to successful education programs. In addition, gaps in comprehensive outcome measurement were revealed as areas for future attention. Educational applications of the ICF are very much a work in progress as might be expected given the ICF's existence for only a little over a decade. CONCLUSIONS: To advance use of the ICF in education, it is important to incorporate the measurement of both knowledge acquisition and behavior change related to ICF-based programs. Ultimately, widespread implementation of the ICF represents not only a substantial opportunity but also poses a significant challenge.

[ICF assessment in the field of psychiatric rehabilitation--a rationale for a stand-alone rehabilitation assessment]. / ICF-Assessment in der psychiatrischen Rehabilitation--Begründung einer eigenständigen Rehabilitationsdiagnostik.

PURPOSE: Assessment in the field of rehabilitation tries to establish the impairment of the functional health on basis of an existent ICD disease. Regarding the same disease there can be very different states of functional health. Within the interdisciplinary rehabilitation field the ICF is supposed to be an appropriate format to function as a common assessment tool. METHODOLOGY: A rehabilitation center had gathered data (n=77) with an ICF core set for psychiatric rehabilitation that was analyzed with quantitative methods (secondary data analysis). The logic of data evaluation was as follows: are there autonomous types (factor analysis) of impairment concerning the ICF concepts and is there a systematically intervention allocation according to these types (comparison of means)? For this purpose the quantita-tive assessed ICF item selection was compared to the ICD-10 diagnosis schizophrenia, affective disorder or personality disorder as well as with the quantified interventions as listed from the annuity insurance. RESULTS: The core set shows discriminant construct validity concerning ICD-10 diagnoses. Factor analysis identified 3 types of impairment of functional health independent of ICD-10 diseases: cognitive, psychomotoric and emotional type. The allocation of therapeutic interventions happens not yet systematically according to the impairment type. CONCLUSIONS: An autonomous rehabilitation assessment beyond the ICD-10 diagnosis is scientifically verified. Furthermore research is necessary which interventions are indicated for the several ICF impairment types what should lead to an increased efficiency.

Development of a Swedish Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for adult patients with attention-deficit hyperactivity disorder (ADHD).

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) in adults is a phenomenon that attracts a lot of attention in society today. Advances in research have made it clear that many conditions that make people seek medical and psychiatric care may have pervasive deficits in attention, motor control and impulsivity at their roots. Since ADHD in adults is a relatively new and very versatile concept, there is a great need for systemized classification of the ramifications of the deficit that extends into every aspect of these patients' lives. AIMS: To develop a Swedish Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for adult patients with ADHD. METHODS: A national expert survey was conducted using the Delphi technique and a formal consensus conference. Forty-two experts from different professions and organizations, including psychiatrists and physicians, psychologists, occupational therapists, a counsellor, a specialist nurse, representatives from a patient organization and representatives from the Swedish Social Insurance Agency, participated in the Delphi process and 28 participants from the expert group attended the consensus conference. RESULTS: At the formal consensus conference, 66 categories from the ICF were identified and included in the national Comprehensive Core Set for ADHD: 21 categories from the component body functions, 26 categories from the component activities and participation, and 19 categories from the component environmental factors. CONCLUSION: The Comprehensive Core Set for ADHD should be regarded as national and preliminary, and should be further tested and evaluated by experts in ADHD in clinical settings in Sweden.

The Gout Assessment Questionnaire 2.0: cross-cultural translation into Dutch, aspects of validity and linking to the International Classification of Functioning, Disability and Health.

OBJECTIVES: The Gout Assessment Questionnaire 2.0 (GAQ2.0) is a disease-specific patient-reported outcome measure for gout that distinguishes five different subscales and comprises overall 31 questions. The aims of this study were to translate the GAQ2.0 into Dutch and to test clinimetric properties. METHODS: Recommendations for translation and cross-cultural adaptation were followed and no cultural adaptations were needed. The resulting Dutch GAQ2.0 was administered to patients registered at the rheumatology outpatient clinic diagnosed with gout. Internal consistency was tested using Cronbach's α, reliability using intraclass correlation coefficient (ICC), content validity by linkage to the International Classification of Functioning, Disability and Health (ICF) and construct validity by correlating the subscales of the GAQ2.0 with the HAQ disability index (HAQ-DI) and 36-item Short Form Health Survey (SF-36). RESULTS: A total of 126 patients [106 (84%) male, mean age 66.6 years (s.d. 10.4), mean disease duration 11.2 years (s.d. 10.6)] completed a number of questionnaires, including the GAQ2.0, HAQ-DI and SF-36, and underwent a clinical examination. Internal consistency was sufficient (Cronbach's α = 0.83-0.94), except for the subscale gout medication side effects (Cronbach's α = 0.51). Test-retest reliability was good (ICCs 0.73-0.86) for all subscales, but moderate for the subscale unmet gout treatment need (ICC 0.56). Gout impact (GI) subscale scores showed only weak to moderate correlations with HAQ-DI and SF-36, but stronger emphasis on the emotional consequences of gout. Also, it correlated better with gout-specific outcomes such as the number of gout flares and pain. CONCLUSION: The Dutch GAQ2.0 shows sufficient evidence of validity to assess disease-specific functioning and health in patients with gout and seems to capture different aspects than those represented in the HAQ and SF-36.

Daily life dialogue assessment in psychiatric care-face validity and inter-rater reliability of a tool based on the International Classification of Functioning, Disability and Health.

This article describes the development of an assessment tool based on the International Classification of Functioning Disability and Health (ICF) adapted to a psychiatric nursing context where both the patient and the nurse assess the patient's ability to participate in various spheres of life. The aim was to test psychometric properties, focusing on face validity and inter-rater reliability. Three Swedish expert groups participated. Analysis of inter-rater reliability was conducted through simulated patient cases. The results of an unweighted kappa value of 0.38, a linear weighted kappa value of 0.65 and a quadratic weighted kappa value of 0.73 were considered as acceptable when using simulated patient cases.