icf core sets concept, utility and challenges

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


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


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



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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


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


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


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



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





b455 Exercise tolerance functions

b640 Sexual functions




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


d920 Recreation and leisure



specifically across people with various health conditions

Extended ICF Disability Set ICF Code Title






b620 Urination functions





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


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


d920 Recreation and leisure



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

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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


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].

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• 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

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Linking concepts to ICF categories

21

Frequency analysis of the ICF categories


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


Clinical Perspective: Empirical Multicentre Study

List of

candidate ICF

categories

based on the

clinician‘s

perspective

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Experts from all 6 WHO world regions and multidisciplinary

1) Experts complete an online survey of 6 questions

2) Linking concepts to 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»

http://www.paranet.ch/sw13412.asp


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

[email protected]


http://www.icf-research-branch.org/





Documentation Form


www.icf-core-sets.org

www.icf-core-sets.org


http://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

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

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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






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




b260 Proprioceptive functions

b265 Touch functions

b270 Sensory functions related to temperature and other..


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


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


b6200 Urination

b6201 Frequency of urination

b6202 Urinary continence

b630 Sensations associated with urinary functions


b670 Sensations associated with genital and reproductive functions


b715 Stability of joint 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:


Cycle goal 1:

Cycle goal 2:

Cycle goal 3:


problem 0 1 2 3 4

Goal Relation

Goal value

b152 Emotional function








s120 Spinal cord and related structures

s430 Structure of the respiratory system

s610 Structure of the urinary system

d410 Changing basic body positions



d450 Walking


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 …


e340 Personal care providers and personal assistants


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


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:


Cycle goal 1:

Cycle goal 2:

Cycle goal 3:


problem 0 1 2 3 4

Goal Relation

Goal value

b152 Emotional function








s120 Spinal cord and related structures

s430 Structure of the respiratory system

s610 Structure of the urinary system




d450 Walking


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 …


e340 Personal care providers and personal assistants


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







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



b7300 Power of isolated muscles

b7305 Power of muscles of the trunk

b7353 Tone of muscles of lower half

b755 Involuntary movement reactions


d4153 Maintaining a body position


d475 Driving


d520 Caring for body parts

d540 Dressing


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.


Driving training


d570 Looking after one‘s health

Training of activites of daily living, Counselling


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



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

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X

X

2

0

1

2

2

3

3

2

2

4

1

2

3

2

4

+3

+2

4

+

-

-

0

0

1

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1

1

1

1

1

2

0

1

0

1

3

+4

+4

2

+

0

0

Assessment

Assignment

Intervention







Evaluation of the changes in the functioning status (in intervention targets) following the rehabilitative interventions


VIRK

Vocational

Rehabilitation Fund

www.virk.is

http://www.virk.is/

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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.

http://www.who.int/classifications/en/FamilyDocument2007.pdf

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…

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ANY QUESTIONS ?

Melissa Selb

[email protected]

58

Thank you for your attention…

icf core sets concept, utility and challenges

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