Comprehensive ICF Core Set for Low Back Pain
The Ninth Special Seminar on SpineTehran – December 2008
Mohammad Kamali, PhD, PTAssociate Professor,School of Rehabilitation SciencesRehabilitation Research CenterIran University of Medical Sciences
[email protected]. Box 17445-183
From ICD to ICF in short
• 1893 : Classification of causes of death
• 1946 : ICD / Classification of diseases
• 1980 : ICIDH / Classification of disabilities as
consequences of disease
• 2001 : ICF / Classification of human functioning
ICIDH - 1980
Three levels of experience of disability:
(Disease or disorder)
impairment disabilities handicaps
International Classification of Functioning, Disability and International Classification of Functioning, Disability and
Health (ICF. WHO, 2001)Health (ICF. WHO, 2001)
Health condition (disorder, disease)
Body Functions and Structures
(Impairments)
Activities(Limitations)
Participation(Restrictions)
Personal
Factors
Environmental
Factors
& ParticipationActivityBody functions& structures
Activity is the execution of a task or action by an individual. It represents the individual perspective of functioning.
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.
Impairedbody functions& structures
Limitation in activityRestriction in participation
Health Condition
EnvironmentalFactors
PersonalFactors
(disease, disorder)
Contextual factors
LimitationLimitation
in activitiesin activities
Impairment of Impairment of body body
function & structurefunction & structure
RestrictionRestriction
in participationin participation
Disability
Disability
Functioning
Disability is a function of the interaction between the person and the environment
Aims of ICF Aims of ICF
• to provide to provide a a scientific basisscientific basis for consequences of health for consequences of health
conditionsconditions
• to establish ato establish a common languagecommon language to improve communications to improve communications
• to permit to permit comparison of datacomparison of data across:across:
– countries countries – health care disciplines health care disciplines – services services – timetime
• to provide ato provide a systematic coding schemesystematic coding scheme for health information for health information
systemssystems
• WHO, Geneva, 2002
ICF application• Statistical tool
– (surveys, management of information systems)
• Research tool
– (outcomes, quality of life, environmental factors)
• Clinical tool
– (assessment of needs, rehabilitation, outcomes)
• Social policy
– (planning social security, compensation, policy designs/implementation)
• Educational tool
– (curriculum designs, raise awareness)
ICF provides an international common language for describing functioning, disability and health
Health condition(disease, disorder)
Environmental factors
Personal factors
Contextual factors
The biopsychosocial model of functioning and disability
ActivityBody functionand body structure
Participation
ICFICF
4 Components4 Components
Chapters/1st LevelChapters/1st Level
Body Functions and Body Functions and Body StructuresBody Structures
Body Functions and Body Functions and Body StructuresBody Structures
Activities and Activities and ParticipationParticipation
Activities and Activities and ParticipationParticipation
Environmental Environmental FactorsFactors
Environmental Environmental FactorsFactors
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2nd Level2nd Level
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- b- b889999
bb111010
- b- b889999
ss111010
- s- s889999
ss111010
- s- s889999
dd111010
- b- b999999
dd111010
- b- b999999
ee111010
- e- e559999
ee111010
- e- e559999
bb11101000-b-b77808099
bb111414220-b0-b5545450099
bb11101000-b-b77808099
bb111414220-b0-b5545450099
ss11101000-s-s88303099
ss1110100000-s-s7760600099
ss11101000-s-s88303099
ss1110100000-s-s7760600099
dd11555500-d9-d9303099dd11555500-d9-d9303099 ee11101000-e-e55959599ee11101000-e-e55959599
3rd and 4th Level3rd and 4th Level
lev
el o
f pre
cis
ion
bandwidth or breadth of health dimensions
Health condition(disease, trauma)
253 Environmental factors
Personal factors
Contextual factors
384 Activities & ParticipationsParticipations493 Body functionsand 310 structures
ICF Categories
- Body functions 493
- Body structures 310
- Activity and participation 393
- Environmental factors 258
1454
• The ICF covers comprehensively the spectrum of problems encountered in patients with musculoskeletal conditions by clinical experts throughout the world.
• In daily clinical practice, additional information needs to be added to some ICF categories to improve the precision of the description of a specific patient.
"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.
Acceptance relies on truly practical and useful tools!
List of ICF categories with the typical spectrum of problems in functioning and environmental factors in patients with a specific condition
ICF Core Set
ICF Core Sets Main GoalsICF Core Sets Main Goals
• Make the ICF feasible for:
• Clinical practice
• Research: clinical and epidemiological studies,
Health reporting and monitoring of functioning and
health
• Link the ICF to the ICD and to existing health
status measures
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
Main Goals
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
ICF core set
• Resulting in a list of ICF categories to be recorded for a comprehensive, multidisciplinary assessment of functioning and health in patients with a specific condition
• Development is based on evidence (preliminary studies) and consensus process (Delphi exercise, international consensus conferences)
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1454
ICF Core Set
Development of disease specific core sets
Systematic reviews
Empiric data collection (checklist)
Delphi -procedures
Core sets
Evaluation in clinical practice
Intermediate data analysis
International consensus conferences
• Comprehensive ICF Core Set to guide multidisciplinary assessments
in patients with that condition
• Brief ICF Core Set to be used in clinical studies
ICF Core Sets
Development of core sets
• Musculoskeletal
• Neurology and mental problems
• Internal medicine
• Rheumatoid arthritis
• Osteoarthritis
• Osteoporosis
• Back Pain
• Stroke
• Depression
• Chronic pain
• Obesity
• Coronary heart disease
• COPD/Asthma
• Diabetes
• Breast cancer
LBP - Body Functions• b126 Temperament and personality functions
• b130 Energy and drive functions
• b134 Sleep functions
• b152 Emotional functions
• b180 Experience of self and time functions
• b260 Proprioceptive function
• b280 Sensation of pain
• b455 Exercise tolerance functions
• b620 Urination functions Brief ICF Core Set
ComprehensiveICF Core Set
LBP - Body Functions• b640 Sexual functions
• b710 Mobility of joint functions
• b715 Stability of joint functions
• b720 Mobility of bone functions
• b730 Muscle power functions
• b735 Muscle tone functions
• b740 Muscle endurance functions
• b750 Motor reflex functions
• b770 Gait pattern functions
• b780 Sensations related to muscles and movement functions
• s120 Spinal cord and related structures
• s740 Structure of pelvic region
• s750 Structure of lower extremity
• s760 Structure of trunk
• s770 Additional musculoskeletal structures related to movement
LBP - Body Structures
• d240 Handling stress and other psychological demands
• d410 Changing basic body position
• d415 Maintaining a body position
• d420 Transferring oneself
• d430 Lifting and carrying objects
• d445 Hand and arm use
• d450 Walking
• d455 Moving around
• d460 Moving around in different locations
• d465 Moving around using equipment
• d470 Using transportation
• d475 Driving
• d510 Washing oneself
• d530 Toileting
LBP - Activity & Participation
• d540 Dressing
• d570 Looking after one’s health
• d620 Acquisition of goods and services
• d630 Preparing meals
• d640 Doing housework
• d650 Caring for household objects
• d660 Assisting others
• d710 Basic interpersonal interactions
• d760 Family relationships
• d770 Intimate relationships
• d845 Acquiring, keeping and terminating a job
• d850 Remunerative employment
• d859 Work and employment, other specified and unspecified
• d910 Community life
• d920 Recreation and leisure
LBP - Activity & Participation
• e110 Products or substances for personal consumption
• e120 Products and technology for personal indoor and outdoor mobility and transportation
• e135 Products and technology for employment
• e150 Design, construction and building products and technology of buildings for public use
• e155 Design, construction and building products and technology of buildings for private use
• e225 Climate
• e255 Vibration
• e310 Immediate family
• e325 Acquaintances, peers, colleagues, neighbors and community members
• e330 People in positions of authority
• e360 Other professionals
• e410 Individual attitudes of immediate family members
LBP - Environmental Factors
• e425 Individual attitudes of acquaintances, peers, colleagues, neighbors and community members
• e450 Individual attitudes of health professionals
• e455 Individual attitudes of other professionals
• e460 Societal attitudes
• e465 Social norms, practices and ideologies
• e540 Transportation services, systems and policies
• e550 Legal services, systems and policies
• e570 Social security services, systems and policies
• e575 General social support services, systems and policies
• e580 Health services, systems and policies
• e585 Education and training services, systems and policies
• e590 Labor and employment services, systems and policies
LBP - Environmental Factors
Body Functions - RAb280 Pain
b710 Mobility of joint functionsb730 Muscle power functionsb4555 Exercise tolerance functionb780 Sensations related to muscles and movement functionsb2800 Generalized pain b2801 Pain in body part b7102 Mobility of joints generalized b7800 Sensation of muscle stiffnessb134 Sleep functionsb130 Energy and drive functionsb640 Sexual functionsb715 Stability of joint functionsb152 Emotional functionsb180 Experience of self and time functionsb1801 Body imageb740 Muscle endurance functionb510 Ingestion functionsb770 Gait pattern functionsb430 Haematological system functions
25 out of 485
Body Structures - RA
s750 Structure of lower extremity
s730 Structure of upper extremitys710 Structure of head and neck regions720 Structure of shoulder regions75001 Hip joints75011 Knee joint s7502 Structure of ankle and foots73001 Elbow joints73011 Wrist joint s7302 Structure of hands73021 Joints of hand and fingers s73022 Muscles of hand s760 Structure of trunks7600 Structure of vertebral columns76000 Cervical vertebral column s770 Additional musculoskeletal structures related to movements299 Eye, ear and related structures, unspecifieds810 Structure of areas of skin
18 out of 302
Activities & Participation – RA
d450 Walking
d850 Remunerative employmentd440 Fine hand used410 Changing basic body positiond445 Hand and arm used230 Carrying out daily routined430 Lifting and carrying objects d470 Using transportationd620 Acquisition of goods and services d920 Recreation and leisured640 Doing houseworkd540 Dressingd630 Preparing mealsd475 Drivingd530 Toiletingd550 Eatingd859 Work and employment, other specified and unspecifiedd170 Writingd510 Washing oneselfd770 Intimate relationships
31 out of 384
Environmental Factors - RA
e310 Immediate family
e580 Health services, systems and policiese355 Health professionalse115 Products and technology for personal use in daily livinge570 Social security services, systems and policiese155 Design, construction and building products and technology of buildings for private usee110 Products or substances for personal consumptione450 Individual attitudes of health professionalse150 Design, construction and building products and technology of buildings for public usee135 Products and technology for employmente425 Individual attitudes of aquaintances, peers, colleagues, neighbors and community memberse410 Individual attitudes of immediate family memberse420 Individual attitudes of friendse540 Transportation services, systems and policiese340 Personal care providers and personal assistantse360 Other professionalse320 Friendse120 Products and technology for personal indoor and outdoor mobility and transportation e460 Societal attitudese125 Products and technology for communicatione225 Climate
21 out of 253
FURTHER DEVELOPMENT OF FURTHER DEVELOPMENT OF CORE SCORE SETSETS
• Core sets for patients with neurological, musculoskeletal, and cardiopulmonary conditions in the acute setting
• Core sets for other chronic conditions, as psoriasis, ankylosing spondylitis, …
• Core sets for special situations, e g home setting, job rehabilitation
المللی بین بندی طبقهسالمت و عملکرد،ناتوانی
مترجمین•
دکتر محمد کمالی–دکتر منوچهر ارجمند –
حسابی
انتشارات مراکز آمار •ایران
•1384
Rehabilitationis the multi- and interdisciplinary patient-oriented management offunctioning and health of people with a condition
Rehabilitation=Management of functioning and health