Transcript ICF Core Set LBP Tehran 1387

Comprehensive ICF Core Set
for Low Back Pain
The Ninth Special Seminar on Spine
Tehran – December 2008
Mohammad Kamali, PhD, PT
Associate Professor,
School of Rehabilitation Sciences
Rehabilitation Research Center
Iran University of Medical Sciences
www.mkamali.com
[email protected]
P.O. Box 17445-183
From ICD to ICF in short
• 1893 : Classification of causes of death
• 1946 : ICD / Classification of diseases
• 1980 : ICIDH / Classification of disabilities as
consequences of disease
• 2001 : ICF / Classification of human functioning
ICIDH - 1980
Three levels of experience of disability:
(Disease or disorder)
impairment
disabilities
handicaps
International Classification of Functioning, Disability and
Health (ICF. WHO, 2001)
Health condition
(disorder, disease)
Body Functions and
Structures
Participation
(Restrictions)
Activities
(Limitations)
(Impairments)
Environmental
Personal
Factors
Factors
Body functions
& structures
Activity & Participation
Activity is the execution of a task or action by an
individual. It represents the individual perspective of
functioning.
Activity is the execution of a task or action by an
individual. It represents the individual perspective of
functioning.
Participation is involvement in a life situation. It
represents the societal perspective of functioning.
Impaired
body functions
& structures
Limitation in activity
Restriction in participation
Disability
Health Condition
(disease, disorder)
Impairment of body
Limitation
Restriction
function & structure
in activities
in participation
Personal
Environmental
Factors
Factors
Contextual factors
Disability
Functioning
Disability is a function of the interaction between the person and
the environment
Aims of ICF
• to provide a scientific basis for consequences of health
conditions
• to establish a common language to improve communications
• to permit comparison of data across:
– countries
– health care disciplines
– services
– time
• to provide a systematic coding scheme for health information
systems
•
WHO, Geneva, 2002
ICF application
• Statistical tool
– (surveys, management of information systems)
• Research tool
– (outcomes, quality of life, environmental factors)
• Clinical tool
– (assessment of needs, rehabilitation, outcomes)
• Social policy
– (planning social security, compensation, policy designs/implementation)
• Educational tool
– (curriculum designs, raise awareness)
The biopsychosocial model of functioning and disability
Health condition
(disease, disorder)
Body function
and body structure
Activity
Environmental
factors
Participation
Personal
factors
Contextual factors
ICF provides an international common
language for describing functioning, disability
and health
ICF
b1 - b8
s1 - s8
Activities and
Participation
d1 - d9
Environmental
Factors
e1 - e5
b110
s110
d110
e110
- b899
- s899
- b999
- e599
b1100-b7809
s1100-s8309
b11420-b54509
s11000-s76009
d1550-d9309
4 Components
Chapters/1st Level
2nd Level
e1100-e5959
bandwidth or breadth of health dimensions
3rd and 4th Level
level of precision
Body Functions and
Body Structures
ICF Categories
Health condition
(disease, trauma)
493 Body functions
and 310 structures
384 Activities & Participations
253 Environmental
factors
Personal
factors
Contextual factors
- Body functions
493
- Body structures
310
- Activity and participation
393
- Environmental factors
258
1454
• The ICF covers comprehensively the spectrum
of problems encountered in patients with
musculoskeletal conditions by clinical experts
throughout the world.
• In daily clinical practice, additional information
needs to be added to some ICF categories to
improve the precision of the description of a
specific patient.
"A clinician cannot easily take the main
volume of the ICF and consistently apply it
to his or her patients. In daily practice,
clinicians will only need a fraction of the
categories found in the ICF"
Üstün B et.al. Common yet specific tools to measure
clinical outcomes: ICF Comprehensive Sets and ICF
Core Sets. J Rehab Med 2004; (44 suppl):7-8.
Acceptance relies on
truly practical and useful tools!
ICF Core Set
List of ICF categories with the
typical spectrum of problems in
functioning and environmental
factors in patients with a specific
condition
ICF Core Sets Main Goals
• Make the ICF feasible for:
• Clinical practice
• Research: clinical and epidemiological studies,
Health reporting and monitoring of functioning and
health
• Link the ICF to the ICD and to existing health
status measures
Main Goals

What to measure
and not

How to measure






History, clinical exam and observations
Clinical tests and batteries
Standardized self-reported patient questionnaires
Measures of independence, occupation or "handicap"
Measures of resource utilization
ICF Core Measures - clinical measures of functioning
Value of ICF Core Sets
• Guide for clinical assessment
– Minimum Functioning catalogue: What to assess
– What are the patients’ problems
(we do not have a score, we have a list of problems)
• Compararability of clinical data
– Patients
– Institutions, where the measures for evaluation will be different
– Countries
• Basis to improve communication
– Among professionals
– Between settings
ICF core set
• Resulting in a list of ICF categories to be
recorded for a comprehensive,
multidisciplinary assessment of functioning and
health in patients with a specific condition
• Development is based on evidence
(preliminary studies) and consensus process
(Delphi exercise, international consensus
conferences)
b1
b130
b134
b152
b180
b1801
•
•
•
•
•
s299
s710
s720
s730
s73001
s73011
•
•
•
•
•
•
•
•
d170
d230
d360
d410
d415
d430
•
•
•
•
•
e110
e115
e120
e125
e135
e150
•
•
•
1454
ICF Core Set
Development of disease specific core sets
Empiric data
collection
(checklist)
Delphi procedures
Systematic
reviews
International consensus
conferences
Core sets
Intermediate data
analysis
Evaluation in
clinical practice
ICF Core Sets
• Comprehensive ICF Core Set
 to guide multidisciplinary assessments
in patients with that condition
• Brief ICF Core Set
 to be used in clinical studies
Development of core sets
• Musculoskeletal
• Neurology and mental
problems
• Internal medicine
•
Rheumatoid arthritis
•
Osteoarthritis
•
Osteoporosis
•
Back Pain
•
Stroke
•
Depression
•
Chronic pain
•
Obesity
•
Coronary heart disease
•
COPD/Asthma
•
Diabetes
•
Breast cancer
LBP - Body Functions
• b126 Temperament and personality functions
• b130 Energy and drive functions
• b134 Sleep functions
• b152 Emotional functions
• b180 Experience of self and time functions
Comprehensive
ICF Core Set
• b260 Proprioceptive function
• b280 Sensation of pain
• b455 Exercise tolerance functions
• b620 Urination functions
Brief ICF Core Set
LBP - Body Functions
• b640 Sexual functions
• b710 Mobility of joint functions
• b715 Stability of joint functions
• b720 Mobility of bone functions
• b730 Muscle power functions
• b735 Muscle tone functions
• b740 Muscle endurance functions
• b750 Motor reflex functions
• b770 Gait pattern functions
• b780 Sensations related to muscles and movement functions
LBP - Body Structures
• s120 Spinal cord and related structures
• s740 Structure of pelvic region
• s750 Structure of lower extremity
• s760 Structure of trunk
• s770 Additional musculoskeletal structures related to
movement
LBP - Activity & Participation
•
d240 Handling stress and other psychological demands
•
d410 Changing basic body position
•
d415 Maintaining a body position
•
d420 Transferring oneself
•
d430 Lifting and carrying objects
•
d445 Hand and arm use
•
d450 Walking
•
d455 Moving around
•
d460 Moving around in different locations
•
d465 Moving around using equipment
•
d470 Using transportation
•
d475 Driving
•
d510 Washing oneself
•
d530 Toileting
LBP - Activity & Participation
•
d540 Dressing
•
d570 Looking after one’s health
•
d620 Acquisition of goods and services
•
d630 Preparing meals
•
d640 Doing housework
•
d650 Caring for household objects
•
d660 Assisting others
•
d710 Basic interpersonal interactions
•
d760 Family relationships
•
d770 Intimate relationships
•
d845 Acquiring, keeping and terminating a job
•
d850 Remunerative employment
•
d859 Work and employment, other specified and unspecified
•
d910 Community life
•
d920 Recreation and leisure
LBP - Environmental Factors
•
e110
•
e120 Products and technology for personal indoor and outdoor mobility and transportation
•
e135 Products and technology for employment
•
e150 Design, construction and building products and technology of buildings for public use
•
e155 Design, construction and building products and technology of buildings for private
use
•
e225 Climate
•
e255 Vibration
•
e310 Immediate family
•
e325 Acquaintances, peers, colleagues, neighbors and community members
•
e330 People in positions of authority
•
e360 Other professionals
•
e410 Individual attitudes of immediate family members
Products or substances for personal consumption
LBP - Environmental Factors
•
e425 Individual attitudes of acquaintances, peers, colleagues, neighbors and community
members
•
e450 Individual attitudes of health professionals
•
e455 Individual attitudes of other professionals
•
e460 Societal attitudes
•
e465 Social norms, practices and ideologies
•
e540 Transportation services, systems and policies
•
e550 Legal services, systems and policies
•
e570 Social security services, systems and policies
•
e575 General social support services, systems and policies
•
e580 Health services, systems and policies
•
e585 Education and training services, systems and policies
•
e590 Labor and employment services, systems and policies
Body Functions - RA
b280
b710
b730
b4555
b780
b2800
b2801
b7102
b7800
b134
b130
b640
b715
b152
b180
b1801
b740
b510
b770
b430
Pain
Mobility of joint functions
Muscle power functions
Exercise tolerance function
Sensations related to muscles and movement functions
Generalized pain
Pain in body part
Mobility of joints generalized
Sensation of muscle stiffness
Sleep functions
Energy and drive functions
Sexual functions
Stability of joint functions
Emotional functions
Experience of self and time functions
Body image
Muscle endurance function
Ingestion functions
Gait pattern functions
Haematological system functions
Body Structures - RA
s750
Structure of lower extremity
s730
Structure of upper extremity
s710
Structure of head and neck region
s720
Structure of shoulder region
s75001 Hip joint
s75011
Knee joint
s7502
Structure of ankle and foot
s73001
Elbow joint
s73011
Wrist joint
s7302
Structure of hand
s73021
Joints of hand and fingers
s73022
Muscles of hand
s760
Structure of trunk
s7600
Structure of vertebral column
s76000
Cervical vertebral column
s770
Additional musculoskeletal structures related to movement
s299
Eye, ear and related structures, unspecified
s810
Structure of areas of skin
Activities & Participation – RA
d450
d850
d440
d410
d445
d230
d430
d470
d620
d920
d640
d540
d630
d475
d530
d550
d859
d170
d510
d770
Walking
Remunerative employment
Fine hand use
Changing basic body position
Hand and arm use
Carrying out daily routine
Lifting and carrying objects
Using transportation
Acquisition of goods and services
Recreation and leisure
Doing housework
Dressing
Preparing meals
Driving
Toileting
Eating
Work and employment, other specified and unspecified
Writing
Washing oneself
Intimate relationships
Environmental Factors - RA
e310
e580
e355
e115
e570
e155
e110
e450
e150
e135
e425
e410
e420
e540
e340
e360
e320
e120
e460
e125
e225
Immediate family
Health services, systems and policies
Health professionals
Products and technology for personal use in daily living
Social security services, systems and policies
Design, construction and building products and technology of buildings for private use
Products or substances for personal
consumption
Individual attitudes of health professionals
Design, construction and building products and technology of buildings for public use
Products and technology for employment
Individual attitudes of aquaintances, peers, colleagues, neighbors and community members
Individual attitudes of immediate family members
Individual attitudes of friends
Transportation services, systems and policies
Personal care providers and personal assistants
Other professionals
Friends
Products and technology for personal indoor and outdoor mobility and transportation
Societal attitudes
Products and technology for communication
Climate
FURTHER DEVELOPMENT OF CORE SETS
• Core sets for patients with neurological,
musculoskeletal, and cardiopulmonary
conditions in the acute setting
•
Core sets for other chronic conditions,
as psoriasis, ankylosing spondylitis, …
•
Core sets for special situations, e g
home setting, job rehabilitation
‫طبقه بندی بین المللی عملکرد‪،‬ناتوانی و سالمت‬
‫• مترجمین‬
‫– دکتر محمد کمالی‬
‫– دکتر منوچهر ارجمند حسابی‬
‫• انتشارات مراکز آمار ایران‬
‫• ‪1384‬‬
Rehabilitation
is the multi- and interdisciplinary
patient-oriented management of
functioning and health of people
with a condition
Rehabilitation
=
Management of
functioning and health