icf core sets concept, utility and challenges
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Melissa Selb MSc
ICF Research Branch Coordinator 1
ICF Core Sets –
Concept, utility and challenges
• describe the reason for developing ICF Core Sets concept
• explain what ICF Core Sets are
• show the different types of ICF Core Sets
• describe the general process for developing ICF Core Sets
• show different uses of ICF Core Sets
• outline some challenges of using ICF Core Sets
• present an outlook to the future
This talk will…
diagnosis Interventions
documentation
__________ __________
__________
Physician‘ diagnosis Physician Interventions
Physician documentation
____________
____________
____________
Nurses‘ diagnosis Nursing Interventions
Nursing documentation
___________
___________
___________
OT diagnosis OT Interventions
OT documentation
____________
____________
____________
PT diagnosis PT Interventions
PT documentation
____________
____________
____________
Patient
Reason for Developing ICF Core Sets
Actual situation ….
diagnosis Interventions
documentation
__________ __________
__________
Physician‘ diagnosis Physician Interventions
Physician documentation
____________
____________
____________
Nurses‘ diagnosis Nursing Interventions
Nursing documentation
___________
___________
___________
OT diagnosis OT Interventions
OT documentation
____________
____________
____________
PT diagnosis PT Interventions
PT documentation
____________
____________
____________
Patient
Reason for Developing ICF Core Sets
Aim and vision….
ICF
__________
__________
__________
ICD-10
Health Condition
(disease, trauma)
Environmental
Factors
Personal
Factors
Activities Body Functions
Body Structures Participation
Introduction to the ICF
493
310
384
253
Over 1400 ICF categories
Reason for Developing ICF Core Sets
Development of ICF Core Sets
ICF Research Branch in cooperation with the WHO-FIC Collaborating Centre in Germany (at DIMDI)
Swiss Paraplegic Research Ludwig-Maximilians-University
WHO Classifications, Terminology and Standards Team
Partner-Organizations
Reason for Developing ICF Core Sets
Development of ICF Core Sets
7
What are ICF Core Sets?
s110
s120
s130
s430
s510
s710
… b110
b114
b117
b130
b152
b144
b730
...
d110
d240
d410
d415
d520
d630
d920
…
e110
e115
e120
e125
e130
e150
…
s110
s430
s710
b110
b130
b152
b730
d240
d410
d415
d920
e110
e120
e130
Health condition-, setting- and situation-specific, Minimal Generic Set
Comprehensive ICF Core Sets
Brief ICF Core Sets
Over 1400 categories
Health sector
• Settings in which a comprehensive multidisciplinary description and assessment of functioning is necessary (e.g. rehabilitation)
Comprehensive ICF Core Set for a specific health condition or setting or situation
Brief ICF Core Set for a specific health condition or setting or situation
• Settings in which a brief description and assessment of functioning is sufficient (e.g. primary care)
• clinical & epidemiological studies / research
• reporting of disability and other variables of functioning; population studies
What are ICF Core Sets?
b152 Emotional functions
b265 Touch function
b270 Sensory functions related to temperature
and other stimuli
b280 Sensation of pain
b710 Mobility of joint functions
b715 Stability of joint functions
b730 Muscle power functions
b760 Control of voluntary movement functions
b810 Protective functions of the skin
b740 Muscle endurance functions
b780 Sensations related to muscles and movement functions
b820 Repair functions of the skin
b860 Function of nails
Comprehensive ICF Core Set
Hand conditions (Excerpt) – Body Functions
Brief ICF Core Set
What are ICF Core Sets?
d230 Carrying out daily routine
d430 Lifting and carrying objects
d440 Fine hand use
d445 Hand and arm use
d5 Self-care
d6 Domestic life
d7 Interpersonal interactions and relationships
d840 - d859 Work and employment
d170 Writing
d360 Using communication devices and techniques
d4400 Picking up
d4401 Grasping
d4403 Releasing
d4408 Fine hand use, other specified
What are ICF Core Sets?
Hand conditions (Excerpt) – Activities and Participation
Brief ICF Core Set
Comprehensive ICF Core Set
Acute inflammatory arthritis Ankylosing spondylitis Low back pain Obstructive pulmonary diseases Osteoarthritis Osteoporosis Rheumatoid arthritis Chronic widespread pain Breast cancer Head and neck cancer Depression Bipolar disorders Chronic ischemic heart disease Diabetes Obesity Stroke Hand conditions
Available ICF Core Sets
Types of ICF Core Sets: Condition-specific
Multiple sclerosis Traumatic brain injury Spinal cord injury in post-acute
and long-term care Sleep disorders Inflammatory bowel diseases Hearing Loss Vertigo Children/youth with Cerebral
Palsy Current developments • Autism spectrum
• Attention Deficit Hyperactivity Disorder (ADHD)
• Schizophrenia
• Lower limb amputees
Types of ICF Core Sets: Other
Cardiopulmonary conditions in acute settings
Cardiopulmonary conditions in post-acute settings
Musculoskeletal conditions in acute settings
Musculoskeletal conditions in post-acute settings
Neurological conditions in acute settings
Neurological conditions in post-acute settings
Geriatric care
Vocational rehabilitation
ICF Generic Set ICF Code Title
b130 Energy and drive functions
b134 Sleep functions
b280 Sensation of pain
d230 Carrying out daily routine
d450 Walking
d455 Moving around
d850 Remunerative employment
Specifies ICF categories relevant to discriminate levels of functioning across
the general population and people with various health conditions
ICF Generic Set & ICF Disability Set ICF Code Title
b130 Energy and drive functions
b134 Sleep functions
b152 Emotional functions
b280 Sensation of pain
b455 Exercise tolerance functions
b640 Sexual functions
b710 Mobility of joint functions
b730 Muscle power functions
d230 Carrying out daily routine
d240 Handling stress and other psychological demands
d450 Walking
d455 Moving around
d470 Using transportation
d510 Washing oneself
d540 Dressing
d570 Looking after one’s health
d640 Doing housework
d660 Assisting others
d710 Basic interpersonal interactions
d770 Intimate relationships
d850 Remunerative employment
d920 Recreation and leisure
Specifies ICF categories relevant to discriminate levels of functioning across
the general population and people with various health conditions
specifically across people with various health conditions
Extended ICF Disability Set ICF Code Title
b130 Energy and drive functions
b134 Sleep functions
b152 Emotional functions
b280 Sensation of pain
b455 Exercise tolerance functions
b620 Urination functions
b640 Sexual functions
b710 Mobility of joint functions
b730 Muscle power functions
d230 Carrying out daily routine
d240 Handling stress and other psychological demands
d410 Changing basic body position
d415 Maintaining a body position
d420 Transferring oneself
d450 Walking
d455 Moving around
d465 Moving around using equipment
d470 Using transportation
d510 Washing oneself
d520 Caring for body parts
d530 Toileting
d540 Dressing
d550 Eating
d570 Looking after one’s health
d640 Doing housework
d660 Assisting others
d710 Basic interpersonal interactions
d770 Intimate relationships
d850 Remunerative employment
d920 Recreation and leisure
Specifies ICF categories relevant to discriminate levels of functioning across
the general population and people with various health conditions
specifically across people with various health conditions
along the continuum of care
Environmental Factors – can be added to Disability Set (N=10)
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
e310 Immediate family
e320 Friends
e450 Individual attitudes of health professionals
e580 Health services, systems and policies
Types of ICF Core Sets: EF for Disability Set
Where to find existing ICF Core Sets
17
Clinical Perspective
Researcher’s Perspective
Patient’s Perspective
Expert’s
Perspective
International ICF
consensus
conference
1st version of the
ICF Core Set
Phase I Phase II Preparatory Phase
Year 1 Year 2
Testing and
Validation of the
1st version of the
ICF Core Sets
Development of ICF Core Sets
Selb M, Escorpizo R, Kostanjsek N, Stucki G, Ustün B, Cieza A. A guide on how to develop an international classification of functioning, disability and health core set. Eur J Phys Rehabil Med. 2014 Apr 1. [Epub ahead of print].
19
• Focus groups recommended
• Interviews option for those who cannot participate in focus groups due the severity of their health condition
• Participants are persons with the health condition and/or caregivers
Patient Perspective: Qualitative Study
Focus groups Individual interviews
20
Patient Perspective: Qualitative Study
Linking concepts to ICF categories
21
Frequency analysis of the ICF categories
Patient Perspective: Qualitative Study
List of candidate ICF
categories based on the
patient‘s perspective
22
1) Concepts resulting from systematic literature review
2) Linking concepts to ICF categories
3) Frequency analysis of the ICF categories
Research Perspective: Systematic Literature Review
List of
candidate ICF
categories
based on the
researcher‘s
perspective
23
Different from other preliminary studies 1) Data collected using extended
ICF Checklist based on WHO’s ICF checklist and other documents like patient records – already has ICF categories
2) Frequency analysis of the ICF categories
Clinical Perspective: Empirical Multicentre Study
List of
candidate ICF
categories
based on the
clinician‘s
perspective
24
Experts from all 6 WHO world regions and multidisciplinary
1) Experts complete an online survey of 6 questions
2) Linking concepts to ICF categories
3) Frequency analysis of the ICF categories
Expert Perspective: Web-based Expert Survey
List of
candidate ICF
categories
based on the
health
professional‘s
perspective
25
Consensus Conference
Candidate ICF
categories from all
4 preparatory
studies
26
…What to measure
and not …How to measure
Keep in mind:
ICF Core Sets define…
ICF Core Sets
Now the “how to describe” using the ICF is here…
Bickenbach J, Cieza A, Rauch A, Stucki G, ed. ICF Core Sets:
Manual for Clinical Practice: Hogrefe, Göttingen; 2012
ICF Core Set Manual – The «how»
Revisión cientifica
Dra. Mercè Avellanet Viladomat SERMEF Chair Scientific Committee
Dra. Roser Garreta Figuera SERMEF President
Dra. Patricia Nilda Soliz Sanchez OPS / OMS (PAHO / WHO)
SOCIEDAD ESPAÑOLA DE
REHABILITACIÓN Y MEDICINA FÍSICA
www.icf-research-branch.org
melissa.selb@paraplegie.ch
www.icf-core-sets.org
www.icf-core-sets.org
Assessment
Assignment
Intervention
Evaluation Rehab-Cycle
ICF Categorical Profile
ICF Assessment Sheet
ICF Intervention Table
ICF Evaluation Display
ICF Core Sets: Use in rehabilitation management
Assessment
Assignment
Intervention
Evaluation Rehab-Cycle
ICF Categorical Profile
ICF Assessment Sheet
ICF Intervention Table
ICF Evaluation Display
ICF Core Sets: Use in rehabilitation management
e355 Health professionals
ID number: Long term goal: Date of birth: October 13th 1981
Program goal: Diagnosis: ICD10: G82.4 Spastic paraplegia, SCI AIS A, Th8
Pa
tie
nts
Pe
rsp
ec
tive
Body-Structures/Functions Activities & Participation
He
alt
h P
rofe
ss
ion
al P
ers
pec
tiv
e
Environmental factors Personal factors
I have pain in my back
My bowel and bladder do not work anymore
To balance my body is really difficult
My bodyweight loss bothers me
I am not able to sense my body anymore
I have spasticity in my legs
My blood pressure decreases very often
The compression hosery helps a little bit
I cannot work as a mover anymore
It is important for me to meet my friends
I have to sleep on my back, that bothers me
The support of my parents and friends is a very big help for me
The flat is not wheel chair accessible
My willpower is extremely strong
b152 Emotional functions b260 Proprioceptive functions b265 Touch functions b270 Sensory functions b280 Sensation of pain b4202 Maintenance of blood pressure b445 Respiratory muscle functions b525 Defecation functions b530 Weight maintenance functions b620 Urination functions b7300 Power of isolated muscles… b7303 Power of muscles on lower half… b7305 Power of muscles of the trunk b7353 Tone of muscles of lower half… b755 Involuntary movement reaction functions
d410 Changing basic body position d4153 Maintaining a sitting position d420 Transferring oneself d450 Walking d465 Moving around using equipment d475 Driving d510 Washing oneself d520 Caring for body parts d5301 Regulating defecation d540 Dressing d570 Looking after one‘s health d580 Remunerative employment d920 Recreation and leisure
e115 Assistive products for personal use
e310 Immediate family, e320 Friends e155 Design, construction of buildings
I am not able to walk anymore
To transfer myself is quiet difficult
I am not able to take a shower by myself
To dress the lower extremity is impossible, the T-Shirt, I slowly get under control
I am able to catheterize myself, but I need support to purge the bowel
To move the wheelchair uphill and overcoming barriers is a problem
26 year old men
Assessment
Assignment
Intervention
Evaluation Rehab-Cycle
ICF Categorical Profile
ICF Assessment Sheet
ICF Intervention Table
ICF Evaluation Display
Using the ICF in rehabilitation management
Assessment
Global Goal:
Service-Programme-Goal:
Cycle goal 1:
Cycle goal 2:
Cycle goal 3:
ICF categories ICF Qualifier
problem
0 1 2 3 4
Goal Relation
Goal value
b126 Temperament and personality functions
b130 Energy and drive functions
b134 Sleep functions
b152 Emotional functions
b260 Proprioceptive functions
b265 Touch functions
b270 Sensory functions related to temperature and other..
b280 Sensation of pain
b28010 Pain in head and neck
b28013 Pain in back
b28014 Pain in upper limb
b28015 Pain in lower limb
b28016 Pain in joints
b310 Voice functions
b410 Heart functions
b415 Blood vessel functions
b4200 Increased blood pressure
b4201 Decreased blood pressure
b4202 Maintenance of blood pressure
b430 Haematological system functions
b440 Respiration functions
b445 Respiratory muscle functions
b450 Additional respiratory functions
b455 Exercise tolerance functions
b510 Ingestion functions
b515 Digestive functions
b525 Defecation functions
b5250 Elemination of faeces
b5251 Faecal consistency
b5252 Frequency of defecation
b5253 Faecal continence
b5254 Flatulence
b530 Weight maintenance functions
b550 Thermoregulation functions
b610 Urinary excretory functions
b620 Urination functions
b6200 Urination
b6201 Frequency of urination
b6202 Urinary continence
b630 Sensations associated with urinary functions
b640 Sexual functions
b670 Sensations associated with genital and reproductive functions
b710 Mobility of joint functions
b715 Stability of joint functions
b730 Muscle power functions
b7300 Power of isolated muscles and muscle groups
b7302 Power of muscles of one side of the body
b7303 Power of muscles on lower half of the body
b7304 Power of muscles of all limb
b7305 Power of muscles of the trunk
b735 Muscle tone functions
b7353 Tone of muscles of lower half of the body
b7354 Tone of muscles of all limbs
ICF categories from the Brief ICF Core Set (bold letters) have to be rated and documented
In addition: ICF categories from the Comprehensive ICF Core Set (thin letters) should be rated in a multidisciplinary rehabilitation team.
Responsibilities for the assessment of specific ICF categories can be distributed among the team members
Global Goal:
Service-Programme-Goal:
Cycle goal 1:
Cycle goal 2:
Cycle goal 3:
ICF categories ICF Qualifier
problem 0 1 2 3 4
Goal Relation
Goal value
b152 Emotional function
b280 Sensation of pain
b440 Respiration functions
b525 Defecation functions
b620 Urination functions
b730 Muscle power functions
b735 Muscle tone functions
b810 Protective functions of the skin
s120 Spinal cord and related structures
s430 Structure of the respiratory system
s610 Structure of the urinary system
d410 Changing basic body positions
d420 Transferring oneself
d445 Hand and arm use
d450 Walking
d510 Washing oneself
d530 Toileting
d540 Dressing
d550 Eating
d560 Drinking
facilitator barrier 4+ 3+ 2+ 1+ 0 1 2 3 4
e115 Products and technology… for personal use in daily living
e120 Products and technology…for personal…mobility …
e310 Immediate family
e340 Personal care providers and personal assistants
e355 Health professionals
Result:
PT: José is suffering from moderate pain (VAS Scale: 4) in his back, apparently related to movement in his trunk.
moderate pain (VAS Scale: 4) in his back
b280 Sensation of pain
Moderate = ICF Qualifier 2
VAS 4/10 = 40% of the problem = ICF Qualifier 2
1. Perform a clinical test, examination, observation or interview
2. → Rate the result within
the ICF Qualifiers
3. → Enter the results in
the ICF Categorical Profile
Global Goal:
Service-Programme-Goal:
Cycle goal 1:
Cycle goal 2:
Cycle goal 3:
ICF categories ICF Qualifier
problem 0 1 2 3 4
Goal Relation
Goal value
b152 Emotional function
b280 Sensation of pain
b440 Respiration functions
b525 Defecation functions
b620 Urination functions
b730 Muscle power functions
b735 Muscle tone functions
b810 Protective functions of the skin
s120 Spinal cord and related structures
s430 Structure of the respiratory system
s610 Structure of the urinary system
d410 Changing basic body positions
d420 Transferring oneself
d445 Hand and arm use
d450 Walking
d510 Washing oneself
d530 Toileting
d540 Dressing
d550 Eating
d560 Drinking
facilitator barrier 4+ 3+ 2+ 1+ 0 1 2 3 4
e115 Products and technology… for personal use in daily living
e120 Products and technology…for personal…mobility …
e310 Immediate family
e340 Personal care providers and personal assistants
e355 Health professionals
Community integration
Independence in daily living
Mobility
Self-Care
Vocational reintegration
CG1
CG1
CG1
CG1
CG1
1 3
1 0 0
0
1
1
1
4+
Assessment
Assignment
Intervention
Evaluation Rehab-Cycle
ICF Categorical Profile
ICF Assessment Sheet
ICF Intervention Table
ICF Evaluation Display
Using the ICF in rehabilitation management
Intervention targets MD Nurs
PT OT Psy
SW
Oth Intervention First value
Goal value
Final value
Bo
dy
fu
nc
tio
n /
-
str
uc
ture
Ac
tiv
ity
/ P
arti
cip
ati
on
En
vir
on
me
n-
tal
fac
tors
Pe
rs
on
al
fac
tors
b280 Sensation of pain
b710 Mobility of joint functions
b7300 Power of isolated muscles
b7305 Power of muscles of the trunk
b7353 Tone of muscles of lower half
b755 Involuntary movement reactions
d410 Changing basic body positions
d4153 Maintaining a body position
d420 Transferring oneself
d475 Driving
d510 Washing oneself
d520 Caring for body parts
d540 Dressing
d850 Remunerative employment
e115 Products and techn. for use in daily
e120 Products and techn. for mobility
e155 Design, construction of buildings
pf Coping with disease
pf Acceptance of emotions
pf Self competencies
Manual therapy
Active and passive movement of joints
Muscle power training with equipment
Muscle power training without equipment
Medication, Hippotherapy, Water therapy
Movement reaction training
Training of activites of daily living
Muscle power training, movement reaction tr.
Training of activites of daily living
Driving training
Training of activites of daily living
d570 Looking after one‘s health
Training of activites of daily living, Counselling
Training of activites of daily living
Education, Counselling,
Vocational training
Choice and adaptation of assistive devices
Choice and adaptation of wheelchair
Clarification of living situation (private build.)
Other psych. therapy, Psych. counselling
Other psych. therapy, Psych. counselling
Other psych. therapy, Psych. counselling
X X
X
X
X
X X
X
X
X X
X
X X
X
X X
X
X
X
X X
X X X X
X
X
X X
X X X
X
X
X
2
0
1
2
2
3
3
2
2
4
1
2
3
2
4
+3
+2
4
+
-
-
0
0
1
0
1
1
1
1
1
2
0
1
0
1
3
+4
+4
2
+
0
0
Assessment
Assignment
Intervention
Evaluation Rehab-Cycle
ICF Categorical Profile
ICF Assessment Sheet
ICF Intervention Table
ICF Evaluation Display
Using the ICF in rehabilitation management
Evaluation of the changes in the functioning status (in intervention targets) following the rehabilitative interventions
Using the ICF in rehabilitation management
46
ICF Core Set for SCI in Finland
47
ICF Core Set for SCI in Finland
Makes the ICF practical for daily use
Guide for clinical assessment
– Minimum catalogue of functioning indicates what to assess
– comprehensively identifies the person’s problems
Basis for improving communication
– Among professionals
– Between settings
Value of ICF Core Sets
• Missing categories in an ICF Core Set
• Applicability to different settings and cultures
• Does not cover all health conditions
• ICF Core Set has to be chosen carefully
• Time consumption for documentation for large ICF Core Sets
Challenges in using ICF Core Sets
Outlook to the Future: Joint Use of ICD-ICF-ICHI
Madden R, Sykes, C, Ustun B. World Health Organization Family of International Classifications: definiton, scope and purpose. http://www.who.int/classifications/en/FamilyDocument2007.pdf
WHO-FIC Standardized information about
diseases, functioning and interventions
Complete the understanding of health and health information systems
Sound and comparable documentation and to
Support (clinical) decision-making.
Outlook to the Future: ICD-ICF Joint Use
Outlook to the Future: ICD-ICF Joint Use
Brief ICF Core Set including Generic Set
Combination of Brief ICF Core Sets including Generic Set
Disability Set
Possible Utility of ICD-ICF Joint Use
Clinical Practice – Documentation & Reporting, Teamwork, Patient communication
Disability Evaluation
Case-mix / Reimbursement
New area of research
Much more…
Outlook to the Future: ICD-ICF Joint Use
57
ANY QUESTIONS ?
Melissa Selb
melissa.selb@paraplegie.ch
58
Thank you for your attention…
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