Application of the ICF in Physical Medicine and Rehabilitation

1
Application of the ICFin Physical Medicine and
Rehabilitation

• Alarcos Cieza PhD, MPH, Gerold Stucki, MD, MSc
• ICF Research Branch, WHO CC FIC Germany
• Department of Physical Medicine and
  Rehabilitation
• University of Munich
• Professor Cassia Buchalla
• WHO Collaborating Center for FIC for Portuguese
  Speaking Countries, Sau Paulo, Brazil

2
Rehabilitation

• Rehabilitation is dedicated to optimizing
  patients functioning and health and to prevent or
  minimize disability
• Concepts, models, classifications and
  measurements of functioning, disability and
  health are thus at the core of rehabilitation
  clinical practice, research, and teaching

Stucki G et.al. Disabil Rehabil 2002
24(17)932ff Walsh N, Arch Phys Med Rehabil
851395ff
3
Overview

• Concepts, models and classifications of
  functioning and disability
• The WHO model of functioning and disability
• International Classification of Functioning,
  Disability and Health (ICF)
• Use of the ICF in rehabilitation
• Clinical practice
• Research
• Teaching

4
Enabling-disabling Process
Disability
5
Enabling-disabling Process
6
Enabling-disabling Process
Enabling-disabling as basis of rehabilitation
7
Disability
8
Disability is a function of the interaction
between the person and the environment
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Institute of Medicine (IOM, 1997)
WHO Model of Functioning and Disability (WHO,
2001)
10
Institute of Medicine IOM 1997
Transactional factors
Disabling-process
Functional Limitation (inability to type)
Pathology (e.g. Arthritis)
Impairment (limited ROM in joint)
No disabling Condition
Enabling-process
11
The biopsychosocial model of functioning and
disability of the World Health Organization
Health condition(disease, trauma)
Functioning
Environmental factors
Personal factors
Contextual factors
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• Activity is the execution of a task or action by
  an individual. It represents the individual
  perspective of functioning.

14

• Activity is the execution of a task or action by
  an individual. It represents the individual
  perspective of functioning.

Participation is involvement in a life situation.
It represents the societal perspective of
functioning.
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The biopsychosocial model of functioning and
disability
Health condition(disease, trauma)
Body functionand body structure
Activity
Participation
Environmental factors
Personal factors
Contextual factors
17
Disability
18
Disability
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Functioning
20
Functioning
21
Foundations of the model of functioning and
disability

• Human Functioning - not merely disability
  
• Universal Model - not a minority
  model
• Integrative Model - not merely medical
  or social
• Interactive Model - not linear
  progressive
• Parity - not
  etiological causality
• Context - inclusive - not person alone
• Cultural applicability - not western
  concepts
• Life span coverage - not adult driven

22
ICF provides an international common language for
describing functioning, disability and health
23
World Health Assembly

• Use the ICF in Member States in
• research
• surveillance
• reporting
• surveys
• clinical settings
• Joint use with ICD

24
The biopsychosocial model of functioning and
disability
Health condition(disease, trauma)
Body functionand body structure
Activity
Participation
Environmental factors
Personal factors
Contextual factors
25
Health condition(disease, trauma)
493 Body functionsand body structure
Activities Participations
Environmental factors
Personal factors
Contextual factors
26
Health condition(disease, trauma)
493 Body functionsand 310 structures
Activities Participations
Environmental factors
Personal factors
Contextual factors
27
Health condition(disease, trauma)
493 Body functionsand 310 structures
384 Activities Participations
Environmental factors
Personal factors
Contextual factors
28
Health condition(disease, trauma)
493 Body functionsand 310 structures
384 Activities Participations
253 Environmental factors
Personal factors
Contextual factors
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Health condition(disease, trauma)
493 Body functionsand 310 structures
384 Activities Participations
253 Environmental factors
Personal factors
Contextual factors
30
ICF Categories
Health condition(disease, trauma)
493 Body functionsand 310 structures
384 Activities Participations
253 Environmental factors
Personal factors
Contextual factors
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Acceptance of the ICF ?

• Endorsed in May 2001 by the World Health Assembly
• Member of the WHO family of international
  classifications
• This is different from the ICIDH which was never
  endorsed
• Many countries are now actively implementing the
  ICF in different sectors

32
Acceptance of the ICF in Medicine ?

• Developed in a worldwide consensus process
• It addresses criticism of prior frameworks and
  integrates important developments
• The ICF now integrates the medical and social
  perspective of disability
• It uses a universal model of disability
• Acceptance by people with disabilities?

33
Acceptance and Applicability of the ICF for
Rehabilitation Medicine?

• The bio-psycho-social and etiologically neutral
  framework is consistent with the rehabilitation
  perspective
• Primary focus on functioning rather than the
  condition
• Consideration of personal and environmental
  factors and interactions with functioning
• The concept of the enabling/disabling process

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Functioning and Health in the Rehabilitation
Perspective
Health condition(disease, trauma)
Body functionand body structure

Functioning Intervention Target and Outcome
Activity
Participation
Environmental factors
Personal factors
Contextual factors
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• "A clinician cannot easily take the main volume
  of the ICF and consistently apply it to his or
  her patients. In daily practice, clinicians will
  only need a fraction of the categories found in
  the ICF"
• Üstün B et.al. Common yet specific tools to
  measure clinical outcomes ICF Comprehensive Sets
  and ICF Core Sets. J Rehab Med 2004 (44
  suppl)7-8.

37
Acceptance relies on truly practical and useful
tools!
38
ICF Core SetsICF Research Branch WHO
Collaborating Center for the Family of
International Classifications (DIMDI) Germany at
the University of MunichWHOCAS
Classification, Assessment Surveys
Partner-Organisations - ISPRM and many others
39
ICF Core Set
List of ICF categories with the typical spectrum
of problems in functioning and environmental
factors in patients with a specific condition
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Health Conditions

• Chronic widespread pain
• Low back pain
• Osteoarthritis
• Osteoporosis
• Rheumatoid arthritis
• Chonic ischemic heart disease
• Diabetes
• Obesity
• Obstructive pulmonary diseases
• Depression
• Breast cancer
• Stroke

42
ICF Core Sets

• Comprehensive ICF Core Set
• to guide multidisciplinary assessments in
  patients with that condition
• Brief ICF Core Set
• to be used in clinical studies

43
OA - Body Functions

• b280 Sensation of pain
• b710 Mobility of joint functions
• b730 Muscle power functions
• b770 Gait pattern functions
• b715 Stability of joint functions
• b740 Muscle endurance functions
• b780 Sensations related to muscles and
  movement functions
• b760 Control of voluntary movement functions
• b134 Sleep functions
• b735 Muscle tone functions

44
OA - Body Structures

• s750 Structure of lower extremity
• s730 Structure of upper extremity
• s770 Additional musculoskeletal
  structures related to movement
• s740 Structure of pelvic region
• s720 Structure of shoulder region

45
OA - Activity Participation

• d450 Walking
• d540 Dressing
• d445 Hand and arm use
• d510 Washing oneself
• d470 Using transportation
• d530 Toileting
• d430 Lifting and carrying objects
• d640 Doing housework
• d910 Community Life
• d440 Fine hand use
• d410 Changing basic body position

46
OA - Environmental Factors

• e115 Products and technology for personal use in
  daily living
• e310 Immediate family
• e580 Health services, systems and policies
• e150 Design, construction and building products
  and technology of buildings for public use
• e355 Health professionals
• e540 Transportation services, systems and
  policies
• e120 Products and technology for personal indoor
  and outdoor mobility and transportation
• e135 Products and technology for employment
• e155 Design, construction and building products
  and technology of buildings for private use
• e340 Personal care providers and personal
  assistants

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ICF CORE SETS FOR CHRONIC CONDITIONS

• Volume 36, Supplement 44 / August 2004

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Main Goals

• Make the ICF feasible for clinical practice
  and research
• Link the ICF to the ICD

49
Main Goals

• What to measure
• and not
• How to measure
• History, clinical exam and observations
• Clinical tests and batteries
• Standardized self-reported patient questionnaires
• Measures of independence, occupation or
  "handicap"
• Measures of resource utilization
• ICF Core Measures - clinical measures of
  functioning

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Health Conditions

• Work in progress
• Psoriasis GRAPPA, Will Taylor, Wellington NZL
• Psoriatic arthritis "
• Ankylosing sponylitis ASAS, D van der Heide,
  Maastricht
• SLE Tba, Martin Aringer, Vienna
• Scleroderma EUSTAR, Martin Aringer, Vienna
• Grant proposal
• Spinal Cord Injury ISCoS
• Vision
• In discussion
• Hearing
• HIV
• Malaria
• Tuberculosis

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ICF Core Sets

• Acute hospital and early post-acute
  rehabilitation facilities
• Musculoskeletal, neurological, cardiopulmonary
• Geriatric (only post-acute)
• Disability Rehabilitation Special Issue 2005

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Generic Core SetsDevelopment

• Commonalities
• Explanation of an external standard
• E.g. FIM
• SF-36 Global

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Commonalities Chronic ConditionsAt least in 10
out of 12 conditions

• Body functions
• energy and drive functions (b126)
• sleep (b134)
• emotional functions (b152)
• Sensation of pain (b280)
• muscle power
• Activities and Participation
• walking (d455)
• doing housework (d640)
• remunerative employment (d850)

54
Commonalities Chronic ConditionsIn all 12
conditions

• Environmental factors e.g.
• Immediate family (e310)
• Attitudes of health professionals (e450)
• Health services, systems and policies (e580)

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Value of ICF Core Sets

• Guide for clinical assessment
• Minimum Functioning catalogue What to assess
• What are the patients problems(we do not have a
  score, we have a list of problems)
• Compararability of clinical data
• Patients
• Institutions, where the measures for evaluation
  will be different
• Countries
• Basis to improve communication
• Among professionals
• Between settings

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Problem-solving approach
57
Rehab-Cycle
Assessment
Assignment
Evaluation
Intervention
58
Rehab-Cycle
Assessment
ICF Model ICF ICF Core Sets
Assignment
Evaluation
Intervention
59
ICF assessment based on the ICF Sheet / Model
Steiner et al. Use of the ICF Model as a
Clinical Problem-Solving Tool in Physical
Therapy and Rehabilitation Medicine. Physical
Therapy 2002 82(11) 1098-1107
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ICF Sheet
Diagnose ICD-10 Goals of Rehabilitation
___M51.1 Lumbar and other_____________ short-ter
m _______________________________________________
______________ __intervertebral disc
disorders _____
__________________________________________________
___________ __ with radiculopathy
________________ long-term _____________________
_________________________________________
____________________________________
_________________________
back pain
What are the patients' problems from his/her
perspective?
I can not walk for long periods gt 5 minutes
I am in sick leave
Patient perspective
Determine the target problems
weakness in both legs
I can not carry my chlid
I can not sit for long periods
I can not sleep through
driving
Body-Structures/Functions Activities/Participati
on
herniated vertebral disk
walking for more than 5 minutes
What are the patients' problems from the
rehabilitation team perspective?
nerve root compression
standing for more than 15 minutes
limited ROM spinal column
carrying objects (3 kilos) in the arms
Rehabilitation team perspective
muscular atrophy
sitting for more than 5 minutes
Personal factors ________ _______________
______________________________________
______________________________________
Environmental factors___________________
______________________________________
______________________________________
Posture
His wife is PT ,
muscle weakness of lowerextremities and trunk
muscles
pain-related coping strategies -
muscle tension
lives in a 3rd floor flat without lift-
lives in a 3rd floor flat without lift
pain killers but not time contingent -
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ICF Sheet
Diagnose ICD-10 Goals of Rehabilitation
___M51.1 Lumbar and other_____________ short-ter
m _______________________________________________
______________ __intervertebral disc
disorders _____
__________________________________________________
___________ __ with radiculopathy
________________ long-term _____________________
_________________________________________
____________________________________
_________________________
Reduce pain, muscle endurance and walking and
sitting for longer periods of time
return to work and improvement of coping
strategies
back pain
I can not walk for long periods gt 5 minutes
I am in sick leave
Patient perspective
weakness in both legs
I can not carry my chlid
I can not sit for long periods
What is related to (determine) the targert
problems?
driving
I can not sleep through
Body-Structures/Functions Activities/Participati
on
herniated vertebral disk
walking for more than 5 minutes
nerve root compression
standing for more than 15 minutes
limited ROM spinal column
carrying objects (3 kilos) in the arms
Rehabilitation team perspective
muscular atrophy
sitting for more than 5 minutes
Personal factors ________ _______________
______________________________________
______________________________________
Environmental factors___________________
______________________________________
______________________________________
Posture
His wife is PT ,
muscle weakness of lowerextremities and trunk
muscles
pain-related coping strategies -
muscle tension
lives in a 3rd floor flat without lift-
lives in a 3rd floor flat without lift
pain killers but not time contingent -
62
ICF Sheet
Diagnose ICD-10 Goals of Rehabilitation
___M51.1 Lumbar and other_____________ short-ter
m _______________________________________________
______________ __intervertebral disc
disorders _____
__________________________________________________
___________ __ with radiculopathy
________________ long-term _____________________
_________________________________________
____________________________________
_________________________
Reduce pain, muscle endurance and walking and
sitting for longer periods of time
return to work and improvement of coping
strategies
back pain
I can not walk for long periods gt 5 minutes
I am in sick leave
Patient perspective
weakness in both legs
I can not carry my chlid
I can not sit for long periods
driving
I can not sleep through
Determine the treatment goals
Body-Structures/Functions Activities/Participati
on
herniated vertebral disk
walking for more than 5 minutes
nerve root compression
standing for more than 15 minutes
limited ROM spinal column
carrying objects (3 kilos) in the arms
Rehabilitation team perspective
muscular atrophy
sitting for more than 5 minutes
Personal factors ________ _______________
______________________________________
______________________________________
Environmental factors___________________
______________________________________
______________________________________
Posture
His wife is PT ,
muscle weakness of lowerextremities and trunk
muscles
pain-related coping strategies -
muscle tension
lives in a 3rd floor flat without lift-
lives in a 3rd floor flat without lift
pain killers but not time contingent -
63
Rehab-Cycle
Assessment
Assignment
Evaluation
Intervention
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Assignment

• Health Professionals
• Program or service
• Inpatient or outpatient rehab, home rehab
• Type of specific service
• Single vs group
• First intervention, refresher
• Specific interventions

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Rehab-Cycle
Assessment
Assignment
Evaluation
Intervention
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Assessement (Rehadiagnostik ICF)
Diagnose ICD-10 Goals of Rehabilitation
___M51.1 Lumbar and other_____________ short-ter
m _______________________________________________
______________ __intervertebral disc
disorders _____
__________________________________________________
___________ __ with radiculopathy
________________ long-term _____________________
_________________________________________
____________________________________
_________________________
muscle indurence and walking for longer periods
of time
return to work and improvement of coping
strategies
back pain
I can not walk for long periods gt 5 minutes
I am in sick leave
Patient perspective
weakness in both legs
I can not carry my chlid
I can not sit for long periods
driving
I can not sleep through
Body-Structures/Functions Activities/Participati
on
herniated vertebral disk
walking for more than 5 minutes
nerve root compression
standing for more than 15 minutes
limited ROM spinal column
carrying objects (3 kilos) in the arms
Rehabilitation team perspective
muscular atrophy
sitting for more than 5 minutes
Personal factors ________ _______________
______________________________________
______________________________________
Environmental factors___________________
______________________________________
______________________________________
Posture
His wife is PT ,
muscle weakness of lowerextremities and trunk
muscles
pain-related coping strategies -
muscle tension
lives in a 3rd floor flat without lift-
lives in a 3rd floor flat without lift
pain killers but not time contingent -
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Rehab-Cycle
Assessment
Assignment
Evaluation
Intervention
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Assessement (Rehadiagnostik ICF)
Rehadiagnose ICD-10 Goals of
Rehabilitation ___M51.1 Lumbar and
other_____________ short-term ___________________
__________________________________________
__intervertebral disc disorders _____
____________________________________________
_________________ __ with radiculopathy
________________ long-term _____________________
_________________________________________
____________________________________
_________________________
muscle indurence and walking for longer periods
of time
return to work and improvement of coping
strategies
back pain
I can not walk for long pereriods gt 5 minutes
I am in sick leave
Patient perspective
weakness in both legs
I can not carry my chlid
I can not sit for long periods
driving
I can not sleep through
Body-Structures/Functions Activities/Participati
on
herniated vertebral disk
walking for more than 5 minutes
nerve root compresion
standing for more than 15 minutes
limited ROM spinal column
carring objects (3 klios) in the arms
Rehabilitation team perspective
muscular atrophy
Personal factors ________ _______________
______________________________________
______________________________________
Environmental factors___________________
______________________________________
______________________________________
His wife is PT ,
muscle weakness of lowerextremities and trunk
muscles
pain-related coping strategies -
muscle tension
lives in a 3rd floor flat without lift-
lives in a 3rd floor flat without lift
pain killers but not time contingent -
69
ICF assessment based onthe ICF Model andthe ICF
Core Sets
70
ICF Sheet Osteoarthritis
Rehadiagnose ICD-10 Goals of
Rehabilitation _____________________________
__________ short-term ___________________________
__________________________________
_______________________________________
_________________________________________
____________________ _______________________
________________ long-term ____________________
__________________________________________
___________________________________
__________________________
Patient perspective
Body-Structures/Functions Activities/Participati
on
d450 Walking d540 Dressing d445 Hand and arm use
S750 Structure of lower extremity s730 Structure
of upper extremity s770 Additional
musculoskeletal structures related to movement
b280 Sensation of pain b710 Mobility of joint
functions b730 Muscle power functions
Personal factors ________ _______________
______________________________________
______________________________________
Environmental factors E115 Products and
technology for personal use in daily living E310
Immediate family E580 Health services, systems
and policies E150 Design, construction and
building products and technology of
buildings for public use
Rehabilitation team perspective
b760 Control of voluntary movement functions
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ICF Clinical Practice - RehabCycle

• ICF Sheet / Model
• Reference for the documentation of functioning
  based on history, exam and analysis
• Multi-disciplinary communication and goal setting
  
• ICF Core Sets
• Guide for multi-disciplinary assessment
• Basis for institutional, professional, national
  or international guidelines how to measure
  specific categories
• Guide for the assignment of interventions and
  intervention management

72
ICF in Research

• Analysing the Literature and planing
  investigations using the ICF Model
• Linking Outcome measures to the ICF

73
Analysing the literature and planing
investigations using the ICF Model

• Cieza A, Stucki G. Understanding functioning,
  disability and health in rheumatoid arthritis
  the basis for rehabilitation care. Curr Opin
  Rheumatol 2005, 17(2)183-189

74
Analysing the Literature using the ICF Model -
Steps

• Aim To examine the recent literature on
  Rheumatoid Arthritis (RA) in relation to
  functioning and disability
• Method Depiction of the variables studied in the
  ICF Model

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ICF Sheet
Evers et al., Behaviour Research and Therapy
2003 41 1295-1310Pain coping and social
support as predictors of long-term functional
disability and pain in early RA
Pain (Six items scale measuring severity
andfrequency of pain, swollen joints
andduration of morning stiffness)
What are the dependent variables?
Dependent Variables
Functional Disability grip strength mobility and
Self-care (IRGL)
Body-Structures/Functions Activities/Participati
on
What are the independent variables?
Independent Variables
Umweltbedingte persönliche Kontextfaktoren
Pain coping (Pain Coping Inventory)
Social Support
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Dependent variables
Independent variables
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Conclusions

• The ICF is a useful framework for understanding
  the interactions among variables studied in the
  different models.
• Studies focus on Activity
• Hardly any models exploring participation
• Comprehensive models are rare
• Most studies take just one perspective, often
  according to the professional perspective of the
  main investigator
• Therefore, the true relevance of identified
  determinants in relation to not covered variables
  remains unclear

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Conclusions

• The ICF model can be useful when planning studies
  focusing on the study of functioning and
  disability
• A theoretical model rather than merely practical
  considerations should be the basis for future
  investigations and should comprehensively
  integrate potentially relevant variables.

• Use the ICF model when planning investigations

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Additional Conclussions

• Studies that best contribute to our understanding
  of functioning use a
• Comprehensive model that integrates different
  variables of interest
• Cover at least the Brief ICF Core Set
• Longitudinal design that enables the
  investigation of determinants of components of
  functioning
• E.g. hierarchical regression analyses or path
  analysis to study the relationship

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These kind of studies are helpful because

• a better insight into the determinants of
  functioning could lead physicians and health
  professionals to target relevant and modifiable
  factors to regain and maintain functioning and to
  minimize or prevent disability.

81
ICF in Research

• Analysing the Literature using the ICF Model
• Linking Outcome measures to the ICF

82
Outcome measures

• Measures used to assess the results of health
  services
• Technical measures (e.g. laboratory, imaging and
  electro-physiologic examinations)
• Clinical measures (e.g. tests of physical and
  cognitive impairment and tests to assess
  activities like walking)
• Patient-oriented measures (e.g. patient and proxy
  self-reports on health status, quality of life,
  and health preferences)

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The Fundamental Ideas

• Since the ICF is the universal and standardized
  language to describe functioning and health, the
  concepts contained in outcome measures to assess
  functioning and health can be translated into the
  ICF language
• After having translated different outcome
  measures into the same language (ICF) content
  comparisons among the instruments can be performed

• The ICF as fundamental reference

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Special Report Jounal of Rehabilitation Medicine
(in press) ICF linking rules an update based on
lessons learned Alarcos Cieza, Szilvia Geyh ,
Somnath Chatterji, Nenad Kostanjsek, Bedirhan
Üstün and Gerold Stucki
87
Outcome measures

• Measures used to assess the results of health
  services
• Technical measures (e.g. laboratory, imaging and
  electro-physiologic examinations)
• Clinical measures (e.g. tests of physical and
  cognitive impairment and tests to assess
  activities like walking)
• Patient-oriented measures (e.g. patient and proxy
  self-reports on health status, quality of life,
  and health preferences)

88
Rule 2
Each item of a health-status measure should be
linked to the most precise ICF category
89
Rule 2
Each item of a health-status measure should be
linked to the most precise ICF category
West Haven Yale Multidimensional Pain Inventory
90
Rule 3
If a single item encompasses different concepts,
the information in each concept should be linked
91
Rule 9
If the information provided by the item/concept
is not sufficient for making a decision about
which ICF category the item/concept should be
linked to, this item/concept is assigned nd(not
definable)
92
Rule 10
If an item / a concept is not contained in the
ICF classification, then this item/concept is
assigned nc (not covered by ICF)
93
The Fundamental Ideas

• Since the ICF is the universal and standardized
  language to describe functioning and health, the
  concepts contained in measures to assess
  functioning and health (health status measures)
  can be translated into the ICF language
• After having translated different health status
  measures into the same language (ICF) content
  comparisons among the instruments can be performed

• The ICF as cardinal reference

94
Example

• Nottingham Health Profile (NHP)
• Short Form 36 (SF-36)
• Fibromyalgia Impact Questionnaire (FIQ)

95
Comparison at Different Levels
96
Content Comparison Component Level

• ICF Component NHP SF-36 FIQ
• Body Functions X X X
• Body Structures
• Activities and Participation X X X
• Environmental Factors X

97
Content Comparison Component Level

• ICF Component NHP SF-36 FIQ Brief ICF Core Set
• CWP
• Body Functions X X X X
• Body Structures
• Activities and Participation X X X X
• Environmental Factors X X

98
Content Comparison Chapter Level

• Body Functions
• NHP SF-36 FIQ Brief ICF Core Set CWP
• b1 MENTAL FUNCTIONS X X X X
• b2 SENSORY FUNCTIONS AND PAIN X X X X
• b4 FUNCTIONS OF THE CARDIOVASCULAR,
• HAEMATOLOGICAL, IMMUNOLOGICAL AND
• RESPIRATORY SYSTEMS X X
• b7 NEUROMUSCULOSKELETAL AND
• MOVEMENT-RELATED FUNCTIONS
  X X

Activity and Participation d1 LEARNING AND
APPLYING KNOWLEDGE X d2 GENERAL TASKS AND
DEMANDS X X d4 MOBILITY X X X X d5
SELF-CARE X X d6 DOMESTIC LIFE
X X X X d7 INTERPERSONAL INTERACTIONS AND
RELATIONS X X d8 MAJOR LIFE AREAS X X X X d9
COMMUNITY, SOCIAL AND CIVIC LIFE X X X X
99
Content Comparison

• Environmental Factors
• NHP SF-36 FIQ Brief ICF Core Set
• CWP
• e1 PRODUCTS AND TECHNOLOGY X X
• e3 SUPPORT AND RELATIONSHIPS X X
• e4 ATTITUDES X
• e5 SERVICES, SYSTEMS AND POLICIES X

100
Content Comparison at second and further levels
101
Body Functions

• ICF Category NHP SF-36 FIQ ICF Core Set
• CWP
• b130 Energy and drive functions X X X X
• b134 Sleep functions X X X
• b147 Psychomotor functions X
• b152 Emotional functions X X X X
• b280 Sensation of pain X X X X
• b450 Additional respiratory functions X
• b455 Exercise tolerance functions X
• b730 Muscle power functions X
• b760 Control of voluntary
• movement functions X
• b780 Sensations related to muscles
• and movement functions X

102
Activity and Participation

• ICF Category NHP SF-36 FIQ ICF Core Set
• CWP
• d175 Solving problems X
• d230 Carrying out daily routine X X
• d240 Handling stress and
• other psychological demands X
• d410 Changing basic body position X X
• d4153 Maintaining a sitting position X
• d430 Lifting and carrying objects X X
• d4452 Reaching X X
• d450 Walking X X X X
• D455 Moving around X X X
• d460 Moving around in different locations X
• d475 Driving X
• d5101 Washing whole body X
• d540 Dressing X X
• d620 Acquisition of goods and services X
• d630 Preparing meals X X

103
Activity and Participation

• ICF Category NHP SF-36 FIQ Brief ICF Core Set
• CWP
• d7 INTERPERSONAL INTERACTIONS X
• d760 Family relationships X
• d770 Intimate relationships X X
• d850 Remunerative employment X X X X
• d920 Recreation and leisure X X X X
• Environmental Factors
• ICF Category NHP SF-36 FIQ Brief ICF Core Set
• e1101 Drugs X X
• e310 Immediate family X
• e355 Health professionals X
• e399 Support and relationships X
• e410 Individual attitudes of
• immediate family members X
• e570 Social security services, systems

104
Body Functions

• ICF Category NHP SF-36 FIQ ICF Core Set
• CWP
• b134 Sleep functions X X X
• b1341 Onset of sleep X
• b1342 Maintenance of sleep X
• b1343 Quality of sleep X

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Obtained Information

• Concepts contained in the different health status
  measures
• Are the items covering different components,
  different chapters.
• Concepts contained in the different items
• The bandwidth or the breadth and the precision of
  health dimensions addressed
• Categories that are missing in the ICF
• Not covered by the ICF

107
Value of the Linking Process

• To improve our understanding of the structure of
  the existing instruments
• To study the content and clinical validity of
  instruments
• To facilitate the Selection of instruments
• Identification of most appropiate measures to
  efficiently cover the required categories of
  functioning in studies
• To identify short-forms in current measures
• To create ICF categories- (concepts-) based Item
  banking

108
ICF in Teaching

• The ICF Model as basis for the understanding of
  functioning and disability
• Disability is a process and not a state
• It is a new challenge every day!
• The ICF sheet
• Patient perspective
• Patient-oriented treatment and not exclusively
  disease-oriented
• Addresses the patients problems comprehensively
• Encourage multidisciplinarity
• The ICF Core Sets help young specialists when
  taking the patients history and when performing
  a physical examination

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Rehabilitation

• Rehabilitation is dedicated to optimizing
  patients functioning and health and to prevent or
  minimize disability
• Concepts, models, classifications and
  measurements of functioning, disability and
  health are thus at the core of rehabilitation
  clinical practice, research, and teaching

Stucki G et.al. Disabil Rehabil 2002
24(17)932ff Walsh N, Arch Phys Med Rehabil
851395ff
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Rehabilitationis the multi- and
interdisciplinary patient-oriented management
offunctioning and health of people with a
condition
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RehabilitationManagement of functioning and
health