PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (1134957)

Clipboard (0)
None

Related Articles

1.  ICF Based Comprehensive Evaluation for Post-Acute Spinal Cord Injury 
Annals of Rehabilitation Medicine  2012;36(6):804-814.
Objective
To evaluate the feasibility of the ICF for initial comprehensive evaluation of early post-acute spinal cord injury.
Method
A comprehensive evaluation of 62 early post-acute spinal cord injury (SCI) patients was conducted by rehabilitation team members, such as physicians, physical therapists, occupational therapists, nutritionists, medical social-workers, and nurses. They recorded each of their evaluation according to the ICF first level classification. The contents of the comprehensive evaluation were linked to the ICF second level categories, retrospectively. The linked codes were analyzed descriptively and were also compared with the brief ICF core set for early post-acute SCI.
Results
In the evaluation of early post-acute SCI patients based on the ICF first level categories, 19 items from the body functions domain, such as muscle power functions (b730) and urination functions (b620), 15 items from the body structures domain, including spinal cord and related structures (s120), 11 items from the activities and participation domain, such as transferring oneself (d420) and walking (d450), and 9 items from the environmental factors domain, e.g., health professionals (e355), were linked to the ICF second level categories. In total, 82.4% of all contents were linked to the brief ICF core set. Prognosis insight, a personal factor not linkable to an ICF code, was mentioned in 29.0% of all patients.
Conclusion
First level ICF categories can provide a structural base for a comprehensive evaluation in early post-acute spinal cord injury. However, frequently linked items, including the brief core set, as well as personal factors should be considered via a checklist in order to prevent the omission of significant contents.
doi:10.5535/arm.2012.36.6.804
PMCID: PMC3546183  PMID: 23342313
Spinal cord injury; ICF; Post-acute rehabilitation; Comprehensive evaluation; Framework
2.  Patients' functioning as predictor of nursing workload in acute hospital units providing rehabilitation care: a multi-centre cohort study 
Background
Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite of the patients' individual health status, particularly with respect to functioning status, individual need for nursing care, and severity of symptoms. The International Classification of Functioning, Disability and Health (ICF) and the derived subsets, the so-called ICF Core Sets, are a standardized approach to describe patients' functioning status. The objectives of this study were to (1) examine the association between patients' functioning, as encoded by categories of the Acute ICF Core Sets, and nursing workload in patients in the acute care situation, (2) compare the variance in nursing workload explained by the ICF Core Set categories and with the Barthel Index, and (3) validate the Acute ICF Core Sets by their ability to predict nursing workload.
Methods
Patients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression.
Results
In patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%).
Conclusions
A substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial.
doi:10.1186/1472-6963-10-295
PMCID: PMC2988780  PMID: 21034438
3.  Retaining the patient perspective in the International Classification of Functioning, Disability and Health Core Set for low back pain 
Objective
To examine the relationship between health problems as rated by the health professionals in the Norwegian form of the Core Set for low back pain and the patients’ self-reported health problems in Oswestry Disability Index (ODI) and World Health Organization Disability Assessment Schedule II (WHODAS II).
Methods
This was part of an international multicenter study where a convenience sample of 118 Norwegian patients with low back pain (LBP) participated. The ICF Core Set for LBP was filled in by the health professionals. The patients reported their health problems in the WHODAS II and ODI. The items in WHODAS II and ODI were linked to the ICF. The problems reported in WHODAS II and ODI were compared to the problems scored by the health professionals in the linked ICF categories in the Comprehensive ICF Core Set for LBP.
Results
All items in ODI could be linked the ICF. Four items in WHODAS II could not be linked to the ICF and additionally two items could not be linked to specific ICF categories. All ICF categories linked to the ODI were included in the Comprehensive Core Set for LBP, whereas six items in WHODAS II could not be linked, and additionally 11 of the items were not represented in the Core Set. With the exception of sexual function, above three quarter of the patients’ reported problems within body functions was captured by the health professionals. Within several of the activities and participation categories the health professionals scores in the ICF reflected the patients’ reported problems well. Surprisingly some of the problems in activities of daily living were poorly reflected.
Conclusion
The Comprehensive ICF Core Set for LBP covers most of the items in ODI and WHODAS II in areas where patients report significant problems, with some exceptions. The subjective dimension related to the impact of the health condition as well as the feeling of being a burden to their family appeared to be important to these patients and not covered in the ICF. Problems with sexual functions and relationship were poorly reflected in the health professionals’ scores in the Comprehensive ICF Core Set for LBP. In clinical practice it is a challenge to assess the individual patients’ broad spectrum of problems precisely.
PMCID: PMC2770393  PMID: 19920981
low back pain; WHODAS II; ICF; musculoskeletal disorders
4.  Comparing the content of participation instruments using the International Classification of Functioning, Disability and Health 
Background
The concept of participation is recognized as an important rehabilitation outcome and instruments have been developed to measure participation using the International Classification of Functioning, Disability and Health (ICF). To date, few studies have examined the content of these instruments to determine how participation has been operationalized. The purpose of this study was to compare the content of participation instruments using the ICF classification.
Methods
A systematic literature search was conducted to identify instruments that assess participation according to the ICF. Instruments were considered to assess participation and were included if the domains contain content from a minimum of three ICF chapters ranging from Chapter 3 Communication to Chapter 9 Community, social and civic life in the activities and participation component. The instrument content was examined by first identifying the meaningful concepts in each question and then linking these concepts to ICF categories. The content analysis included reporting the 1) ICF chapters (domains) covered in the activities and participation component, 2) relevance of the meaningful concepts to the activities and participation component and 3) context in which the activities and participation component categories are evaluated.
Results
Eight instruments were included: Impact on Participation and Autonomy, Keele Assessment of Participation, Participation Survey/Mobility, Participation Measure-Post Acute Care, Participation Objective Participation Subjective, Participation Scale (P-Scale), Rating of Perceived Participation and World Health Organization Disability Assessment Schedule II (WHODAS II). 1351 meaningful concepts were identified in the eight instruments. There are differences among the instruments regarding how participation is operationalized. All the instruments cover six to eight of the nine chapters in the activities and participation component. The P-Scale and WHODAS II have questions which do not contain any meaningful concepts related to the activities and participation component. Differences were also observed in how other ICF components (body functions, environmental factors) and health are operationalized in the instruments.
Conclusion
Linking the meaningful concepts in the participation instruments to the ICF classification provided an objective and comprehensive method for analyzing the content. The content analysis revealed differences in how the concept of participation is operationalized and these differences should be considered when selecting an instrument.
doi:10.1186/1477-7525-7-93
PMCID: PMC2785762  PMID: 19909555
5.  Validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis from the patient perspective using focus groups 
Functioning is recognized as an important study outcome in rheumatoid arthritis (RA). The Comprehensive ICF Core Set for RA is an application of the International Classification of Functioning, Disability and Health (ICF) of the World Health Organisation with the purpose of representing the typical spectrum of functioning of patients with RA. To strengthen the patient perspective, persons with RA were explicitly involved in the validation of the Comprehensive ICF Core Set for RA using qualitative methodology. The objective of the study was twofold: to come forward with a proposal for the most appropriate methodology to validate Comprehensive ICF Core Sets from the patient perspective; and to add evidence to the validation of the Comprehensive ICF Core Set for RA from the perspective of patients. The specific aims were to explore the aspects of functioning and health important to patients with RA using two different focus group approaches (open approach and ICF-based approach) and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for RA. The sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. After qualitative data analysis, the resulting concepts were linked to ICF categories according to established linking rules. Forty-nine patients participated in ten focus groups (five in each approach). Of the 76 ICF categories contained in the Comprehensive ICF Core Set for RA, 65 were reported by the patients based on the open approach and 71 based on the ICF-based approach. Sixty-six additional categories (open approach, 41; ICF-based approach, 57) that are not covered in the Comprehensive ICF Core Set for RA were raised. The existing version of the Comprehensive ICF Core Set for RA could be confirmed almost entirely by the two different focus group approaches applied. Focus groups are a highly useful qualitative method to validate the Comprehensive ICF Core Set for RA from the patient perspective. The ICF-based approach seems to be the most appropriate technique.
doi:10.1186/ar1956
PMCID: PMC1779412  PMID: 16684371
6.  The ICF as a common language for rehabilitation goal-setting: comparing client and professional priorities 
Background
Joint rehabilitation goals are an important component for effective teamwork in the rehabilitation field. The activities and participation domain of the ICF provides a common language for professionals when setting these goals. Involving clients in the formulation of rehabilitation goals is gaining momentum as part of a person-centred approach to rehabilitation. However, this is particularly difficult when clients have an acquired communication disability. The expressive communication difficulties negatively affect the consensus building process. As a result, obtaining information regarding rehabilitation goals from professionals and their clients warrants further investigation for this particular population.
Methods
This comparative study investigated clients and their assigned rehabilitation professionals' perception of the importance of ICF activities and participation domains for inclusion in their rehabilitation program. Twelve clients in an acute rehabilitation centre and twenty of their corresponding rehabilitation professionals participated in an activity using the Talking Mats™ visual framework for goal setting. Each participant rated the importance of the nine activities and participation domains of the ICF for inclusion in their current rehabilitation program.
Results
The ICF domains which consistently appear as very important across these groups are mobility, self-care and communication. Domains which consistently appear in the lower third of the rankings include spare time, learning and thinking and domestic life. Results indicate however that no statistical significant differences exist in terms of the individual domains across each of the participant groups. Within group differences however indicated that amongst the speech-language therapists and physiotherapists there was a statistical significant difference between spare time activities and communication and mobility.
Conclusions
Findings indicate that consensus is possible amongst professionals and clients even within an acute-rehabilitation setting. In addition, the Talking Mats™ visual framework appears to be a valid protocol for including clients with acquired communication disabilities in the process of obtaining consensus during goal-setting.
doi:10.1186/1477-7525-9-87
PMCID: PMC3204224  PMID: 21978385
7.  Identification of candidate categories of the International Classification of Functioning Disability and Health (ICF) for a Generic ICF Core Set based on regression modelling 
Background
The International Classification of Functioning, Disability and Health (ICF) is the framework developed by WHO to describe functioning and disability at both the individual and population levels.
While condition-specific ICF Core Sets are useful, a Generic ICF Core Set is needed to describe and compare problems in functioning across health conditions.
Methods
The aims of the multi-centre, cross-sectional study presented here were: a) to propose a method to select ICF categories when a large amount of ICF-based data have to be handled, and b) to identify candidate ICF categories for a Generic ICF Core Set by examining their explanatory power in relation to item one of the SF-36.
The data were collected from 1039 patients using the ICF checklist, the SF-36 and a Comorbidity Questionnaire.
ICF categories to be entered in an initial regression model were selected following systematic steps in accordance with the ICF structure. Based on an initial regression model, additional models were designed by systematically substituting the ICF categories included in it with ICF categories with which they were highly correlated.
Results
Fourteen different regression models were performed. The variance the performed models account for ranged from 22.27% to 24.0%. The ICF category that explained the highest amount of variance in all the models was sensation of pain. In total, thirteen candidate ICF categories for a Generic ICF Core Set were proposed.
Conclusion
The selection strategy based on the ICF structure and the examination of the best possible alternative models does not provide a final answer about which ICF categories must be considered, but leads to a selection of suitable candidates which needs further consideration and comparison with the results of other selection strategies in developing a Generic ICF Core Set.
doi:10.1186/1471-2288-6-36
PMCID: PMC1569864  PMID: 16872536
8.  Aspects of functioning and environmental factors in medical work capacity evaluations of persons with chronic widespread pain and low back pain can be represented by a combination of applicable ICF Core Sets 
BMC Public Health  2012;12:1088.
Background
Medical work capacity evaluations play a key role in social security schemes because they usually form the basis for eligibility decisions regarding disability benefits. However, the evaluations are often poorly standardized and lack transparency as decisions on work capacity are based on a claimant’s disease rather than on his or her functional capacity. A comprehensive and consistent illustration of a claimant’s lived experience in relation to functioning, applying the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets (ICF-CS), potentially enhances transparency and standardization of work capacity evaluations. In our study we wanted to establish whether and how the relevant content of work capacity evaluations can be captured by ICF-CS, using disability claimants with chronic widespread pain (CWP) and low back pain (LBP) as examples.
Methods
Mixed methods study, involving a qualitative and quantitative content analysis of medical reports. The ICF was used for data coding. The coded categories were ranked according to the percentage of reports in which they were addressed. Relevance thresholds at 25% and 50% were applied. To determine the extent to which the categories above the thresholds are represented by applicable ICF-CS or combinations thereof, measures of the ICF-CS’ degree of coverage (i.e. content validity) and efficiency (i.e. practicability) were defined.
Results
Focusing on the 25% threshold and combining the Brief ICF-CS for CWP, LBP and depression for CWP reports, the coverage ratio reached 49% and the efficiency ratio 70%. Combining the Brief ICF-CS for LBP, CWP and obesity for LBP reports led to a coverage of 47% and an efficiency of 78%.
Conclusions
The relevant content of work capacity evaluations involving CWP and LBP can be represented by a combination of applicable ICF-CS. A suitable standard for documenting such evaluations could consist of the Brief ICF-CS for CWP, LBP, and depression or obesity, augmented by additional ICF categories relevant for this particular context. In addition, the unique individual experiences of claimants have to be considered in order to assess work capacity comprehensively.
doi:10.1186/1471-2458-12-1088
PMCID: PMC3560212  PMID: 23249190
International Classification of Functioning; Disability and Health (ICF); Work capacity evaluation; Chronic widespread pain; Low back pain; Standardization
9.  A cross-sectional look at patient concerns in the first six weeks following primary total knee arthroplasty 
Background
To date, no researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA). An understanding of patient concerns at a time when physical therapists are involved in the treatment of these patients will aid clinicians in providing patient-centered care. Linking of items to the International Classification of Functioning, Disability and Health (ICF) allows for comparison and sharing of data amongst researchers, as the ICF is the accepted framework for evaluating disability in rehabilitation. The objective of this study was to identify patient concerns in the first six weeks following primary TKA and link these concerns to components of the ICF and map them to commonly used outcome measures.
Methods
Individual interviews were conducted to identify patient concerns during their recovery following primary TKA. Concerns identified by patients were analysed for content and linked to the components of the ICF using the operational definitions of the ICF components. These concerns were mapped to the WOMAC, KOOS and Oxford Knee Scale.
Results
Thirty patients (18 female) with an average age (SD) of 68.4 (11.1) years completed the study. Patients identified 32 concerns. Twenty-two percent (n = 7) of the concerns linked to Body Function and Structure, 47% (n = 15) to Activity, 13% (n = 4) to Participation, and 13% (n = 4) to the Environmental Factors component of the ICF. Six percent (n = 2) of the concerns did not link to the ICF. Of the 32 concerns identified by patients 14 mapped to the KOOS, 11 to the WOMAC and 4 to the Oxford Knee Scale.
Conclusion
Patient concerns linked to four different components of the ICF indicating that patients are involved in or are thinking of multiple aspects of life even in this early phase of recovery. The KOOS was found to be the most appropriate for use based on the patients' perspective. However, less than half of the concerns identified by patients were covered by the KOOS, WOMAC or Oxford Knee Scale indicating that other existing measures that evaluate the concepts identified as important to patients should be considered when evaluating outcomes during this acute phase of recovery following primary TKA.
doi:10.1186/1477-7525-5-48
PMCID: PMC1950700  PMID: 17678532
10.  Development of ICF Core Sets to standardize assessment of functioning and impairment in ADHD: the path ahead 
European Child & Adolescent Psychiatry  2013;23(12):1139-1148.
In the study of health and quality of life in attention deficit/hyperactivity disorder (ADHD), it is of paramount importance to include assessment of functioning. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive, universally accepted framework for the description of functioning in relation to health conditions. In this paper, the authors outline the process to develop ICF Core Sets for ADHD. ICF Core Sets are subgroups of ICF categories selected to capture the aspects of functioning that are most likely to be affected in specific disorders. The ICF categories that will be included in the ICF Core Sets for ADHD will be determined at an ICF Core Set Consensus Conference, wherein evidence from four preliminary studies (a systematic review, an expert survey, a patient and caregiver qualitative study, and a clinical cross-sectional study) will be integrated. Comprehensive and Brief ICF Core Sets for ADHD will be developed with the goal of providing useful standards for research and clinical practice, and to generate a common language for the description of functioning in ADHD in different areas of life and across the lifespan.
doi:10.1007/s00787-013-0496-5
PMCID: PMC4246121  PMID: 24337412
Neurodevelopmental disorders; Assessment; Children and youth; Psychiatry; Mental health; Health care
11.  Enhanced clarity and holism: the outcome of implementing the ICF with an acute stroke multidisciplinary team in England 
Disability and Rehabilitation  2013;35(22):1921-1925.
Purpose:
Although it is recommended that the ICF (International Classification of Functioning, Disability and Health) should be implemented to aid communication within multidisciplinary stroke services, there is no empirical evidence to demonstrate the outcomes of such implementation. Working with one stroke service, this project aimed to address this gap and sought to evaluate the outcomes of implementing an ICF-based clinical tool into practice.
Method:
Using an action research framework with mixed methods, data were collected from individual interviews, a focus group, questionnaires, email communications, minutes from relevant meetings and field notes. Thematic analysis was undertaken, using immersion and crystallisation, to define overall themes. Descriptive statistics were used to analyse quantitative data. Data from both sources were combined to create key findings.
Results:
Three findings were determined from the data analysis. The ICF (1) fosters communication within and beyond the multidisciplinary stroke team; (2) promotes holistic thinking; and (3) helps to clarify team roles.
Conclusions:
The ICF enhanced clarity of communication and team roles within the acute stroke multidisciplinary team as well as with other clinicians, patients and their relatives. In addition, the ICF challenged stroke clinicians to think holistically, thereby appropriately extending their domain of concern beyond their traditional remit.
Implications for Rehabilitation
The ICF is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the outcomes of using it in clinical practice have yet to be fully explored.
This study found that the ICF enhanced clarity of communication and team roles within an acute stroke multidisciplinary team and to others beyond the team, including clinicians, patients and their relatives.
Using the ICF also challenged clinicians to think holistically about patient needs following a stroke.
doi:10.3109/09638288.2013.766272
PMCID: PMC3812702  PMID: 23530624
Health; ICF; implementation; stroke
12.  Content Validity of the Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases: An International Delphi Survey  
Introduction:
The “Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases (COPD)“ is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with COPD. The objective of this study was to validate this ICF Core Set from the perspective of physicians.
Materials and Methodology:
Physicians experienced in COPD treatment were asked about the patients’ problems treated by physicians in patients with COPD in a three-round electronic mail survey using the Delphi technique. Responses were linked to the ICF.
Results:
Seventy-six physicians in 44 countries gave a total of 1330 responses that were linked to 148 different ICF categories. Nine ICF categories were not represented in the Comprehensive ICF Core Set for COPD although at least 75% of the participants have rated them as important. Nineteen concepts were linked to the not yet developed ICF component personal factors and seventeen concepts were not covered by the ICF.
Conclusion:
The high percentage of ICF categories represented in the ICF Core Set for COPD indicates satisfactory content validity from the perspective of the physicians. However, some issues were raised that were not covered and need to be investigated further.
doi:10.2174/1874306401307010033
PMCID: PMC3636487  PMID: 23730367
Chronic obstructive pulmonary disease; asthma; rehabilitation; international classification of functioning; disability and health; ICF core set.
13.  Validation of the International Classification of Functioning, Disability and Health Core Set for chronic widespread pain from the perspective of fibromyalgia patients 
Introduction
Functioning is recognized as an important study outcome in chronic widespread pain (CWP). The Comprehensive ICF Core Set for CWP is an application of the International Classification of Functioning, Disability and Health (ICF) with the purpose of representing the typical spectrum of functioning of patients with CWP. The objective of the study was to add evidence to the validation of the Comprehensive ICF Core Set for CWP from the patient perspective. The specific aims were to explore the aspects of functioning and health important to patients with fibromyalgia, and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for CWP.
Methods
The sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for qualitative data analysis. After qualitative data analysis, the identified concepts were linked to ICF categories.
Results
Thirty-three patients participated in six focus groups. Fifty-four ICF categories out of 67 categories of the Comprehensive ICF Core Set for CWP were reported by the patients. Forty-eight additional categories that are not covered in the Comprehensive ICF Core Set for CWP were raised.
Conclusions
Most ICF categories of the existing version of the Comprehensive ICF Core Set for CWP could be confirmed from the patient perspective. However, several categories not included in the Core Set emerged and should be considered for inclusion.
doi:10.1186/ar2696
PMCID: PMC2714113  PMID: 19442275
14.  Functioning and health in patients with cancer on home-parenteral nutrition: a qualitative study 
Background
Malnutrition is a common problem in patients with cancer. One possible strategy to prevent malnutrition and further deterioration is to administer home-parenteral nutrition (HPN). While the effect on survival is still not clear, HPN presumably improves functioning and quality of life. Thus, patients' experiences concerning functioning and quality of life need to be considered when deciding on the provision of HPN. Currently used quality of life measures hardly reflect patients' perspectives and experiences. The objective of our study was to investigate the perspectives of patients with cancer on their experience of functioning and health in relation to HPN in order to get an item pool to develop a comprehensive measure to assess the impact of HPN in this population.
Methods
We conducted a series of qualitative semi-structured interviews. The interviews were analysed to identify categories of the International Classification of Functioning, Disability and Health (ICF) addressed by patients' statements. Patients were consecutively included in the study until an additional patient did not yield any new information.
Results
We extracted 94 different ICF-categories from 16 interviews representing patient-relevant aspects of functioning and health (32 categories from the ICF component 'Body Functions', 10 from 'Body Structures', 32 from 'Activities & Participation', 18 from 'Environmental Factors'). About 8% of the concepts derived from the interviews could not be linked to specific ICF categories because they were either too general, disease-specific or pertained to 'Personal Factors'. Patients referred to 22 different aspects of functioning improving due to HPN; mainly activities of daily living, mobility, sleep and emotional functions.
Conclusions
The ICF proved to be a satisfactory framework to standardize the response of patients with cancer on HPN. For most aspects reported by the patients, a matching concept and ICF category could be found. The development of categories of the component 'Personal Factors' should be promoted to close the existing gap when analyzing interviews using the ICF. The identification and standardization of concepts derived from individual interviews was the first step towards creating new measures based on patients' preferences and experiences which both catch the most relevant aspects of functioning and are sensitive enough to monitor change associated to an intervention such as HPN in a vulnerable population with cancer.
doi:10.1186/1477-7525-8-41
PMCID: PMC2862019  PMID: 20398396
15.  The functional barometer –a self-report questionnaire in accordance with the international classification of functioning, disability and health for pain related problems; validity and patient-observer comparisons 
Background
The International Classification of Functioning, Disability and Health, (ICF) provides a unified, international standardized framework for describing and classifying health and health-related functioning and disability. Based on an ICF core sets the Functional Barometer, (FB), was developed for assessments of perceived pain-related problems with functions, activity and quality-of-life by patients suffering from long-term pain. The aim was to evaluate the construct validity, and to compare the assessments of a patient’s problems from the perspectives of the patient and of the examining professional when using the validated FB and corresponding ICF-classification form, respectively.
Methods
Patients with long-term pain for more than 3 months that visited one of four pain clinics during specified time periods of data collections were eligible. The self-report Balanced Inventory for Spinal disorders was used for validation of the FB. Correspondingly to the validated FB an ICF-classification form for professional’s assessment was developed. The data sets for these inter-scale and the patient-professional comparisons were collected adjacent to the clinical examination. By the statistical method used for evaluation of the pairs of ordinal data presence of systematic disagreement was identified and measured separately from additional individual variations.
Results
The validation process resulted in a revised FB(2.0) that meets the requirements of good construct and content validity. The professionals’ ICF-classifications of the patients’ problems disagreed with the patients’ assessments on the FB(2.0); the percentage agreements ranged from 18% to 51%. The main reason was that the practitioners systematically underestimated the patients’ levels of problems but the different professionals contributed also to a large individual variability (noise) in assessment.
Conclusions
This study presents an ICF-based validated self-report questionnaire, The FB, to be used for identifying and describing pain-related problems with current functioning, activities and quality-of-life as perceived by patients suffering from long-term pain. The strong evidences of underestimation of the patients’ problems and the variability in the professionals’ ICF-classifications demonstrated the importance of describing the patient’s problems both from the patient’s and the professional’s perspective beneficial for the patient’s rehabilitation.
doi:10.1186/1472-6963-14-187
PMCID: PMC4002556  PMID: 24758709
Disagreement measures; ICF; Ordinal data; Pain; Patient-professional disagreement; Questionnaire; Rehabilitation; Validity
16.  Using a profile of a modified Brief ICF Core Set for chronic widespread musculoskeletal pain with qualifiers for baseline assessment in interdisciplinary pain rehabilitation 
Aim
To describe the use of a “workable” visual profile of function and disability, based on a modified Brief International Classification of Functioning, Disability and Health (ICF) Core Set for chronic widespread pain, for initial assessments in a clinical setting of interdisciplinary pain rehabilitation teams.
Method
The Brief ICF Core Set was slightly adapted to meet the needs of an interdisciplinary rehabilitation medicine team working in a university outpatient clinic and admitting patients referred from primary care. The Core Set categories were made measurable by means of eg, assessment instruments and clinical investigations. The resulting profile was given a workable shape to facilitate rapid understanding of the initial assessment outcome.
Results
Individual patients showed different profiles of problems and resources, which facilitated individual rehabilitation planning. At the level of the study group, the profiles for the Core Set component Body Functions showed that most patients had severe impairment in the sensation of pain and exercise tolerance categories of function, but most had resources in the motivation and memory categories of function. Likewise, for the component Activities, most patients had limitations in lifting and carrying objects and remunerative employment, but most had resources in intimate relationships and family relationships. At first, the use of the modified Brief ICF Core Set in the team conference was rather time consuming, but after a couple of months of experience, the team assessment took approximately 30 minutes to complete per patient.
Conclusion
The profile of the modified Brief ICF Core Set for chronic widespread pain served as a common platform, facilitating cooperation between the rehabilitation team members and providing a uniform language, which helped in structuring the clinical work. The profile also provided an easily accessible, overall view of the patient’s problems and resources, which helped in understanding the functioning situation of the patient.
doi:10.2147/JMDH.S46501
PMCID: PMC3770625  PMID: 24039435
ICF; interdisciplinary teamwork; chronic widespread pain; assessment
17.  Relationship between interRAI HC and the ICF: opportunity for operationalizing the ICF 
Background
The International Classification of Functioning, Disability and Health (ICF) is embraced as a framework to conceptualize human functioning and disability. Health professionals choose measures to represent the domains of the framework. The ICF coding classification is an administrative system but multiple studies have linked diverse clinical assessments to ICF codes. InterRAI-HC (home care) is an assessment designed to assist planning of care for patients receiving home care. Examining the relationship between the ICF and the interRAI HC is of particular interest because the interRAI assessments are widely used in clinical practice and research, are computerized, and uploaded to databases that serve multiple purposes including public reporting of quality in Canada and internationally. The objective of this study was to examine the relationship between the interRAI HC (home care) assessment and the ICF. Specifically, the goal was to determine the proportion of interRAI HC items that can be linked to each of the major domains of the ICF (Body Function, Body Structure, Activities and Participation, and the Environmental Factors), the chapters and the specific ICF codes.
Methods
Three coders who were familiar with both the home care assessment and the ICF independently assigned ICF codes to inter-RAI HC items. Subsequently, a series of teleconference meetings were held to reach consensus on the primary code and much later consensus was used to finalize codes for additional items added to the interRAI HC.
Results
Following exclusion of administrative and diagnostic sections, 175 interRAI items were examined for potential assignment of codes. Of these 52 were assigned codes related to body function, 43 to activities and participation, 34 to environment, 1 to body structure, 17 to not coded, and 26 to not defined. Considering all 3-digit ICF codes, interRAI items addressed 43.2% of Body Function and 50.6% of Activities and Participation codes.
Conclusion
The conceptual overlap in content, offers an excellent opportunity to operationalize the ICF domains and the codes particularly in the areas of Body Function and Activities and Participation. Use of measures such as the interRAI assessments with common elements across settings facilitates standardized reporting for organizations, regions and nations.
doi:10.1186/1472-6963-9-47
PMCID: PMC2666676  PMID: 19292897
18.  Are they relevant? A critical evaluation of the international classification of functioning, disability, and health core sets for osteoarthritis from the perspective of patients with knee osteoarthritis in Singapore 
Annals of the Rheumatic Diseases  2006;65(8):1067-1073.
Objectives
To determine the extent to which health items identified from the perspective of patients with knee osteoarthritis can be linked with the International Classification of Functioning, Disability and Health (ICF); and to evaluate critically the content validity of ICF comprehensive and brief core sets for osteoarthritis.
Methods
Items identified from a focus group study were linked independently by two researchers based on the 10 a priori linking rules. Both percentage agreement and κ statistics were calculated to measure interobserver agreement. Any disagreements were resolved by reaching a consensus among the researchers. The categories linked with all items were compared with the comprehensive core set, while the categories linked with those items reported as important by over 30% of subjects within each of three local ethnic groups (Chinese, Malay, and Indian) were compared with the brief core set. Both comparisons were made only at the second level of the ICF.
Results
In all, 74 items were linked with 44 different ICF categories through 105 linkages with generally good interobserver agreement. The 69 items were linked with the ICF at the third or fourth levels. Both commonalities and disparities were found through comparison between the categories linked with these items and both core sets.
Conclusions
All items could be successfully linked with the ICF. The comprehensive core set showed good content validity, while the brief core set needs to be supported by more empirical evidence in various sociocultural contexts. This study specifically complemented the development and refinement of both core sets from the perspective of patients with knee osteoarthritis.
doi:10.1136/ard.2005.043067
PMCID: PMC1798241  PMID: 16396981
osteoarthritis; knee; ICF
19.  ICF based comparison of disease specific instruments measuring physical functional ability in ankylosing spondylitis 
Annals of the Rheumatic Diseases  2005;64(11):1576-1581.
Objectives: To link validated and widely used instruments measuring physical functional ability in ankylosing spondylitis to the International Classification of Functioning, Disability, and Health (ICF) and to compare their contents, based on the results of the linking process.
Methods: The Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), the Health Assessment Questionnaire modified for the spondylarthropathies (HAQ-S), and the Revised Leeds Disability Questionnaire (RLDQ) were linked to the ICF separately by two trained health professionals according to 10 linkage rules.
Results: All concepts contained in the items of the selected instruments could be successfully linked to the ICF except for "illness" included in the HAQ-S. Altogether 55 different ICF categories were linked. Seven belonged to "body functions", 43 to "activities and participation", and five to "environmental factors". The component "body structure" was not contained in any of the four instruments. Only two ICF categories were common to all selected questionnaires, but there was a high level of concordance on the concepts represented in them. However, especially in terms of "activities and participation", the emphasised aspects differed.
Conclusions: The ICF provides an excellent common framework for the comparison of disease specific instruments for ankylosing spondylitis. For a future revision of the ICF, a specification of major limitations in patients with ankylosing spondylitis is suggested.
doi:10.1136/ard.2004.027185
PMCID: PMC1755279  PMID: 15843457
20.  Development of the first disability index for inflammatory bowel disease based on the international classification of functioning, disability and health 
Gut  2011;61(2):241-247.
Objective
The impact of inflammatory bowel disease (IBD) on disability remains poorly understood. The World Health Organization's integrative model of human functioning and disability in the International Classification of Functioning, Disability and Health (ICF) makes disability assessment possible. The ICF is a hierarchical coding system with four levels of details that includes over 1400 categories. The aim of this study was to develop the first disability index for IBD by selecting most relevant ICF categories that are affected by IBD.
Methods
Relevant ICF categories were identified through four preparatory studies (systematic literature review, qualitative study, expert survey and cross-sectional study), which were presented at a consensus conference. Based on the identified ICF categories, a questionnaire to be filled in by clinicians, called the ‘IBD disability index’, was developed.
Results
The four preparatory studies identified 138 second-level categories: 75 for systematic literature review (153 studies), 38 for qualitative studies (six focus groups; 27 patients), 108 for expert survey (125 experts; 37 countries; seven occupations) and 98 for cross-sectional study (192 patients; three centres). The consensus conference (20 experts; 17 countries) led to the selection of 19 ICF core set categories that were used to develop the IBD disability index: seven on body functions, two on body structures, five on activities and participation and five on environmental factors.
Conclusions
The IBD disability index is now available. It will be used in studies to evaluate the long-term effect of IBD on patient functional status and will serve as a new endpoint in disease-modification trials.
doi:10.1136/gutjnl-2011-300049
PMCID: PMC3245899  PMID: 21646246
Antibacterial peptide; azathioprine; bacterial translocation; Crohn's colitis; Crohn's disease; disability; gut immunology; IBD basic research; IBD clinical; IBD models; ICF; immunology; inflammatory bowel disease; infliximab; lamina proprial lymphocytes; mucosal immunology; 6-mercaptopurine; thiopurine methyltransferase; ulcerative colitis
21.  Employing the International Classification of Functioning, Disability and Health to enhance services for children and youth with chronic physical health conditions and disabilities 
Paediatrics & Child Health  2008;13(3):173-178.
PURPOSE
In 2001, the World Health Organization published the International Classification of Functioning, Disability and Health (ICF). The ICF is just beginning to be used in a variety of clinical and research settings in Canada and worldwide. The purpose of the present article is to describe the initial use of the ICF at an Ontario children’s rehabilitation centre, and to consider further uses both within and outside the centre for enhancing services for children and youth with chronic physical health conditions and disabilities, as well as for their families.
METHOD
A description is provided on how the ICF has been used at the centre to guide clinical thinking and practice, and to justify and steer research directions. Plans underway to use the ICF to collect and record functional data at the centre are also described. Finally, recommendations for the use of the ICF to enhance communication among child health professionals across service settings are provided.
CONCLUSIONS
Used in conjunction with the International Classification of Diseases – Tenth Revision, the ICF’s conceptual framework and classification system shows great promise for enhancing the quality of services for children with chronic conditions and their families. This information may assist paediatric specialists, other child health professionals, researchers and administrators to use the ICF in similar settings. It may also stimulate exploration of the use of the ICF for general paediatricians and other service providers in the larger community.
PMCID: PMC2529418  PMID: 19252693
Canada; Children; Chronic illness; Disability; ICF; Paediatrics; Rehabilitation; Youth
22.  Linking self-determined functional problems of patients with neck pain to the International Classification of Functioning, Disability, and Health (ICF) 
Objective
To describe commonly reported self-determined functional problems in patients with neck pain and to evaluate their fit to the components of the International Classification of Functioning, Disability, and Health (ICF).
Methods
Overall, 249 patients were included in this cross-sectional study that comprised patients with neck pain referred to the outpatient clinic at Oslo University Hospital (2007–2009). Patients were asked to report their three most significant functional problems on the Patient-Specific Functional Scale, a self-determined measure of function. The ICF was used as a tool for analysis. Meaningful concepts within the functional problems were identified, coded, and linked to second-level categories within the components of “body functions,” and “activities and participation.” Two researchers performed coding and linking independently. The ICF categories were presented by percentage of the total number of functional problems linked to the ICF.
Results
Of 628 reported functional problems, 13 meaningful ICF domains were identified: four domains belonging to the body functions component (b) and nine domains belonging to activities and participation components (d). Within the 88 second-level ICF classification categories of body functions, the most frequently reported items were sleep function (b134; 27%) and mobility of joint functions (b710; 26%). Within the 538 second-level categories of activities and participation, remunerative employment was reported as the most frequent item (d850; 15%), closely followed by doing housework (d640; 14%), and recreation and leisure activities (d920; 13%). Only two meaningful concepts, described as “be active” and “to function after activities,” were not assigned to a specific ICF category.
Conclusion
The majority of the specific functional problems presented by patients in this study showed a good fit with the ICF model. The substantial number of links to the activities and participation categories, such as mobility, domestic life, employment, and social and civic life, suggests that a comprehensive approach, as well as the involvement of a multidisciplinary team, should be present in the rehabilitation of neck pain-related disability.
doi:10.2147/PPA.S36165
PMCID: PMC3484528  PMID: 23118531
neck pain disability; self-determined functional problems; PSFS; ICF
23.  Reliability of the ICF Core Set for rheumatoid arthritis 
Annals of the Rheumatic Diseases  2007;66(8):1078-1084.
Background
The comprehensive ICF Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the International Classification of Functioning, Disability and Health (ICF), representing relevant aspects in the functioning of RA patients.
Objectives
To study the reliability of the ICF Core Set for RA in rheumatological practice, and to explore the metric of the qualifiers' scale.
Methods
25 RA patients from an outpatient department of rheumatology were interviewed using the ICF Core Set for RA (76% females, mean (SD) age 57.5 (12.5) years, disease duration 15.9 (14.6) years). Interviews were performed independently by both a physiotherapist and an occupational therapist on the same day and again after one week by one of them. The severity of the patients' problems was quantified on a qualifier scale ranging from 0 (no problem) to 4 (complete problem). Analyses of intra‐rater and inter‐rater agreement, kappa statistics, and Rasch analyses were applied.
Results
Mean intra‐rater (inter‐rater) complete agreement for all categories was seen in 59% (47%) of observations, ranging from 29% (0%) to 96% (80%) for individual categories. Weighted kappa statistics with value ⩾0.4 showed reliability in 86% of categories within raters, and in 43% of categories between raters. Improved inter‐rater and intra‐rater reliability was observed with a reduced number of qualifiers for the categories.
Conclusions
Inter‐rater and intra‐rater reliability of the ICF Core Set of RA was low to moderate. The metric of the qualifiers' scale may be improved by reducing the number of qualifiers to three for all components.
doi:10.1136/ard.2006.058693
PMCID: PMC1954720  PMID: 17223659
International Classification of Functioning, Disability and Health (ICF); reliability; ICF Core Set; rheumatoid arthritis; health status measure
24.  Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD) 
Executive Summary
In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions.
After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses.
The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html.
Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework
Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis
Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model
Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature
For more information on the qualitative review, please contact Mita Giacomini at: http://fhs.mcmaster.ca/ceb/faculty_member_giacomini.htm.
For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx.
The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: http://theta.utoronto.ca/static/contact.
Objective
The objective of this analysis was to conduct an evidence-based assessment of home telehealth technologies for patients with chronic obstructive pulmonary disease (COPD) in order to inform recommendations regarding the access and provision of these services in Ontario. This analysis was one of several analyses undertaken to evaluate interventions for COPD. The perspective of this assessment was that of the Ontario Ministry of Health and Long-Term Care, a provincial payer of medically necessary health care services.
Clinical Need: Condition and Target Population
Canada is facing an increase in chronic respiratory diseases due in part to its aging demographic. The projected increase in COPD will put a strain on health care payers and providers. There is therefore an increasing demand for telehealth services that improve access to health care services while maintaining or improving quality and equality of care. Many telehealth technologies however are in the early stages of development or diffusion and thus require study to define their application and potential harms or benefits. The Medical Advisory Secretariat (MAS) therefore sought to evaluate telehealth technologies for COPD.
Technology
Telemedicine (or telehealth) refers to using advanced information and communication technologies and electronic medical devices to support the delivery of clinical care, professional education, and health-related administrative services.
Generally there are 4 broad functions of home telehealth interventions for COPD:
to monitor vital signs or biological health data (e.g., oxygen saturation),
to monitor symptoms, medication, or other non-biologic endpoints (e.g., exercise adherence),
to provide information (education) and/or other support services (such as reminders to exercise or positive reinforcement), and
to establish a communication link between patient and provider.
These functions often require distinct technologies, although some devices can perform a number of these diverse functions. For the purposes of this review, MAS focused on home telemonitoring and telephone only support technologies.
Telemonitoring (or remote monitoring) refers to the use of medical devices to remotely collect a patient’s vital signs and/or other biologic health data and the transmission of those data to a monitoring station for interpretation by a health care provider.
Telephone only support refers to disease/disorder management support provided by a health care provider to a patient who is at home via telephone or videoconferencing technology in the absence of transmission of patient biologic data.
Research Questions
What is the effectiveness, cost-effectiveness, and safety of home telemonitoring compared with usual care for patients with COPD?
What is the effectiveness, cost-effectiveness, and safety of telephone only support programs compared with usual care for patients with COPD?
Research Methods
Literature Search
Search Strategy
A literature search was performed on November 3, 2010 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 2000 until November 3, 2010. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist, and then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low, or very low according to GRADE methodology.
Inclusion Criteria – Question #1
frequent transmission of a patient’s physiological data collected at home and without a health care professional physically present to health care professionals for routine monitoring through the use of a communication technology;
monitoring combined with a coordinated management and feedback system based on transmitted data;
telemonitoring as a key component of the intervention (subjective determination);
usual care as provided by the usual care provider for the control group;
randomized controlled trials (RCTs), controlled clinical trials (CCTs), systematic reviews, and/or meta-analyses;
published between January 1, 2000 and November 3, 2010.
Inclusion Criteria – Question #2
scheduled or frequent contact between patient and a health care professional via telephone or videoconferencing technology in the absence of transmission of patient physiological data;
monitoring combined with a coordinated management and feedback system based on transmitted data;
telephone support as a key component of the intervention (subjective determination);
usual care as provided by the usual care provider for the control group;
RCTs, CCTs, systematic reviews, and/or meta-analyses;
published between January 1, 2000 and November 3, 2010.
Exclusion Criteria
published in a language other than English;
intervention group (and not control) receiving some form of home visits by a medical professional, typically a nurse (i.e., telenursing) beyond initial technology set-up and education, to collect physiological data, or to somehow manage or treat the patient;
not recording patient or health system outcomes (e.g., technical reports testing accuracy, reliability or other development-related outcomes of a device, acceptability/feasibility studies, etc.);
not using an independent control group that received usual care (e.g., studies employing historical or periodic controls).
Outcomes of Interest
hospitalizations (primary outcome)
mortality
emergency department visits
length of stay
quality of life
other […]
Subgroup Analyses (a priori)
length of intervention (primary)
severity of COPD (primary)
Quality of Evidence
The quality of evidence assigned to individual studies was determined using a modified CONSORT Statement Checklist for Randomized Controlled Trials. (1) The CONSORT Statement was adapted to include 3 additional quality measures: the adequacy of control group description, significant differential loss to follow-up between groups, and greater than or equal to 30% study attrition. Individual study quality was defined based on total scores according to the CONSORT Statement checklist: very low (0 to < 40%), low (≥ 40 to < 60%), moderate (≥ 60 to < 80%), and high (≥ 80 to 100%).
The quality of the body of evidence was assessed as high, moderate, low, or very low according to the GRADE Working Group criteria. The following definitions of quality were used in grading the quality of the evidence:
Summary of Findings
Six publications, representing 5 independent trials, met the eligibility criteria for Research Question #1. Three trials were RCTs reported across 4 publications, whereby patients were randomized to home telemonitoring or usual care, and 2 trials were CCTs, whereby patients or health care centers were nonrandomly assigned to intervention or usual care.
A total of 310 participants were studied across the 5 included trials. The mean age of study participants in the included trials ranged from 61.2 to 74.5 years for the intervention group and 61.1 to 74.5 years for the usual care group. The percentage of men ranged from 40% to 64% in the intervention group and 46% to 72% in the control group.
All 5 trials were performed in a moderate to severe COPD patient population. Three trials initiated the intervention following discharge from hospital. One trial initiated the intervention following a pulmonary rehabilitation program. The final trial initiated the intervention during management of patients at an outpatient clinic.
Four of the 5 trials included oxygen saturation (i.e., pulse oximetry) as one of the biological patient parameters being monitored. Additional parameters monitored included forced expiratory volume in one second, peak expiratory flow, and temperature.
There was considerable clinical heterogeneity between trials in study design, methods, and intervention/control. In relation to the telemonitoring intervention, 3 of the 5 included studies used an electronic health hub that performed multiple functions beyond the monitoring of biological parameters. One study used only a pulse oximeter device alone with modem capabilities. Finally, in 1 study, patients measured and then forwarded biological data to a nurse during a televideo consultation. Usual care varied considerably between studies.
Only one trial met the eligibility criteria for Research Question #2. The included trial was an RCT that randomized 60 patients to nurse telephone follow-up or usual care (no telephone follow-up). Participants were recruited from the medical department of an acute-care hospital in Hong Kong and began receiving follow-up after discharge from the hospital with a diagnosis of COPD (no severity restriction). The intervention itself consisted of only two 10-to 20-minute telephone calls, once between days 3 to 7 and once between days 14 to 20, involving a structured, individualized educational and supportive programme led by a nurse that focused on 3 components: assessment, management options, and evaluation.
Regarding Research Question #1:
Low to very low quality evidence (according to GRADE) finds non-significant effects or conflicting effects (of significant or non-significant benefit) for all outcomes examined when comparing home telemonitoring to usual care.
There is a trend towards significant increase in time free of hospitalization and use of other health care services with home telemonitoring, but these findings need to be confirmed further in randomized trials of high quality.
There is severe clinical heterogeneity between studies that limits summary conclusions.
The economic impact of home telemonitoring is uncertain and requires further study.
Home telemonitoring is largely dependent on local information technologies, infrastructure, and personnel, and thus the generalizability of external findings may be low. Jurisdictions wishing to replicate home telemonitoring interventions should likely test those interventions within their jurisdictional framework before adoption, or should focus on home-grown interventions that are subjected to appropriate evaluation and proven effective.
Regarding Research Question #2:
Low quality evidence finds significant benefit in favour of telephone-only support for self-efficacy and emergency department visits when compared to usual care, but non-significant results for hospitalizations and hospital length of stay.
There are very serious issues with the generalizability of the evidence and thus additional research is required.
PMCID: PMC3384362  PMID: 23074421
25.  Understanding human functioning using graphical models 
Background
Functioning and disability are universal human experiences. However, our current understanding of functioning from a comprehensive perspective is limited. The development of the International Classification of Functioning, Disability and Health (ICF) on the one hand and recent developments in graphical modeling on the other hand might be combined and open the door to a more comprehensive understanding of human functioning. The objective of our paper therefore is to explore how graphical models can be used in the study of ICF data for a range of applications.
Methods
We show the applicability of graphical models on ICF data for different tasks: Visualization of the dependence structure of the data set, dimension reduction and comparison of subpopulations. Moreover, we further developed and applied recent findings in causal inference using graphical models to estimate bounds on intervention effects in an observational study with many variables and without knowing the underlying causal structure.
Results
In each field, graphical models could be applied giving results of high face-validity. In particular, graphical models could be used for visualization of functioning in patients with spinal cord injury. The resulting graph consisted of several connected components which can be used for dimension reduction. Moreover, we found that the differences in the dependence structures between subpopulations were relevant and could be systematically analyzed using graphical models. Finally, when estimating bounds on causal effects of ICF categories on general health perceptions among patients with chronic health conditions, we found that the five ICF categories that showed the strongest effect were plausible.
Conclusions
Graphical Models are a flexible tool and lend themselves for a wide range of applications. In particular, studies involving ICF data seem to be suited for analysis using graphical models.
doi:10.1186/1471-2288-10-14
PMCID: PMC2831907  PMID: 20149230

Results 1-25 (1134957)