TY - JOUR A1 - Maritz, R. A1 - Tennant, A. A1 - Fellinghauer, C. A1 - Stucki, G. A1 - Prodinger, Birgit T1 - The Functional Independence Measure 18-item version can be reported as a unidimensional interval-scaled metric: Internal construct validity revisited JF - Journal of Rehabilitation Medicine N2 - Abstract Objective: Since the 1990s the Functional Independence Measure (FIM™) was believed to measure 2 different constructs, represented by its motor and cognitive subscales. The practice of reporting FIM™ total scores, together with recent developments in the understanding of the influence of locally dependent items on fit to the Rasch model, raises the question of whether the FIM™ 18-item version can be reported as a unidimensional interval-scaled metric. Design: Rasch analysis of the FIM™ using testlet approaches to accommodate local response dependency. Patients: A calibration sample containing 946 cases of data from 11,103 patients undergoing neurological or musculoskeletal rehabilitation in Switzerland in 2016. Results: Baseline analysis and the traditional testlet approach showed no fit with the Rasch model. When items were grouped into 2 testlets, fit to the Rasch model was achieved, indicating unidimensionality across all 18 items. A transformation table to convert FIM™ raw ordinal scores to the corresponding Rasch interval scaled values was created. Conclusion: This study provides evidence that FIM™ total scores represent a unidimensional set of items, supporting their use in clinical practice and outcome reporting when applying the respective transformation table. This provides a basis for standardized reporting of functioning. Lay Abstract The aim of this study was to look in detail at the FIM™, an assessment tool often used for patients undergoing rehabilitation. Some users report the FIM™ as 2 scores: one related to motor tasks, the other to cognitive tasks; others recommend reporting it as a single score including both motor and cognitive tasks. This study explored whether it is statistically meaningful to sum all the points into a single FIM™ total score. The results support the current practice of summing the points into a single total score for patients undergoing musculo-skeletal and neurological rehabilitation. The results also allowed an interval scale to be derived from the FIM™, enabling a broad range of calculations to be made using the FIM™ score, such as calculating the change in FIM™ outcomes from the time a patient is admitted to a rehabilitation clinic until their discharge. KW - Functional Independence Measure Y1 - 2019 UR - https://doi.org/10.2340/16501977-2525 VL - 51 IS - 3 SP - 193 EP - 200 ER - TY - JOUR A1 - Dorjbal, D. A1 - Prodinger, Birgit A1 - Zanini, C. A1 - Avirmed, B. A1 - Stucki, G. A1 - Rubinelli, S. T1 - Living with spinal cord injury in Mongolia: A qualitative study on perceived environmental barriers JF - Journal of Spinal Cord Medicine N2 - Context: Environmental factors play a key role in the lives of individuals with a spinal cord injury (SCI). This study identifies environmental barriers and their impacts on daily lives as perceived by individuals living with SCI in Mongolia. Design: A qualitative study with semi-structured interviews was conducted. A topic guide for the interviews was structured around the components of the International Classification of Functioning, Disability, and Health. Setting: Urban and rural areas of Mongolia. Participants: A purposive sample of 16 persons with traumatic SCI. Interventions: Not applicable. Outcome Measures: Not applicable. Results: Seven categories of environmental barriers were mentioned, such as poor access to the physical environment, absence of wheelchair-friendly transportation, negative societal attitudes, inadequate health and rehabilitation services, lack of access to assistive devices and medicines, limited financial resources for healthcare, and inaccurate categorization of disabilities in laws. These barriers were claimed to have an impact on physical and psychological health, limit activities, and restrict participation in almost all areas of life. Conclusion: This study contributes to the identification of targets for interventions aimed at improving the lived experience of persons with SCI in a low-resource context. The findings reveal that while the Mongolian government already has laws and policies in place to improve access to the physical environment, transportation, assistive devices and employment, much more has to be done in terms of enforcement. Specialized SCI care and rehabilitation services are highly demanded in Mongolia. KW - Lived experience KW - Developing country KW - International Classification of Functioning, Disability, and Health KW - Semi-structured interviews KW - Person-centeredness KW - Rehabilitation services Y1 - 2020 UR - https://doi.org/10.1080/10790268.2019.1565707 VL - 43 IS - 4 SP - 518 EP - 531 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Stucki, G. A1 - Coenen, M. A1 - Tennant, A. T1 - The measurement of functioning using the International Classification of Functioning, Disability and Health: comparing qualifier ratings with existing health status instruments JF - Disability and Rehabilitation N2 - Background: The International Classification of Functioning, Disability and Health is the international standard for describing and monitoring functioning. While the categories, the units of the classification, were not designed with measurement in mind, the hierarchical structure of the classification lends itself to the possibility of summating categories into some higher order domain. Focusing on the chapters of d4 Mobility, d5 Self-Care and d6 Domestic Life, this study seeks to ascertain if qualifiers rating of categories (0-No problem to 4-Complete problem) within those chapters can be summated, and whether such derived measurement is consistent with estimates obtained from well-known instruments which purport to measure the same constructs. Methods: The current study applies secondary analysis to data previously collected in the context of validating Core Sets for stroke, rheumatoid arthritis, and osteoarthritis. Data included qualifier-based ratings of the categories in the Core Sets, and the physical functioning sub-scale of the Short-Form 36, and the World Health Organization Disability Assessment Schedule 2.0. To examine qualifier-comparator scale item agreement Kappa statistics were used. To identify whether appropriate gradients of the comparator scales were observed across qualifier levels, an Independent Sample Median Test of the ordinal scores was deployed. To investigate the internal validity of the summated ICF categories, the Rasch model was applied. Results: Data from 2,927 subjects from Europe, Australasia, Middle East and South America were available for analysis; 36.3% had experienced a stroke, 35.8% osteoarthritis, and 27.9% had rheumatoid arthritis. The items from the Short-Form 36 could not match directly the qualifier categories as the former had only 3 response options. The Kappa between World Health Organization Disability Assessment Schedule 2.0 items and categories was low. For all qualifiers, a significant (<0.001) overall gradient was observed across the comparator scales. Only in few of the World Health Organization Disability Assessment Schedule 2.0 items could no discrete level be detected. The aggregation of the qualifiers at the Chapter and higher order levels mostly revealed fit to the Rasch model. Almost all ICF qualifiers showed ordered thresholds suggesting that the current structure and response options of the qualifiers worked as intended. Conclusions: The findings of this study provide supporting evidence for the use of the professionally rated categories and associated qualifiers to measure functioning. Implication for Rehabilitation - This study provides evidence that functioning data can be collected directly with the International Classification of Functioning, Disability and Health (ICF) by using the ICF categories as items and the ICF qualifiers as rating scale. - The findings of this study show the aggregated ratings of ICF categories from the chapters d4 Mobility, d5 Self-care, and d6 Domestic life capture a broader spectrum of the construct than the corresponding summated items from the SF36-Physical Function sub-scale and the corresponding items of the World Health Organization Disability Assessment Schedule 2.0. - This study illustrates the potential of building quantitative measurement by aggregating ICF categories and their qualifier ratings into meaningful domains. KW - ICF KW - health status KW - Rasch model KW - outcome measure KW - WHODAS 2.0 KW - SF-36 Y1 - 2019 UR - https://doi.org/10.1080/09638288.2017.1381186 VL - 41 IS - 5 SP - 541 EP - 548 ER - TY - JOUR A1 - Ehrmann, C. A1 - Prodinger, Birgit A1 - Stucki, G. A1 - Cai, W. A1 - Zhang, X. A1 - Liu, S. A1 - Liu, S. A1 - Li, J. A1 - Reinhardt, J. D. T1 - ICF Generic Set as new standard for the system wide assessment of functioning in China: a multicentre prospective study on metric properties and responsiveness applying item response theory JF - BMJ Open N2 - Objectives: To examine metric properties and responsiveness of the International Classification of Functioning, Disability and Health (ICF) Generic Set when used in routine clinical practice to assess functioning. Design: Prospective multicentre study. Setting: 50 hospitals from 20 provinces of Mainland China. Participants: 4510 adult inpatients admitted to the departments of Pulmonology, Cardiology, Neurology, Orthopaedics, Cerebral Surgery or Rehabilitation Medicine. Main outcome measures: The ICF Generic Set (ICF Generic 6 Set) applied with an 11-point numeric rating scale (0-no problem to 10-complete problem) was fit to the Partial Credit Model (PCM) to create an interval score of functioning. Results: PCM assumptions were found to be fulfilled after accounting for Differential Item Functioning. With an average improvement by 7.86 points of the metric ICF Generic 6 score (95% CI 7.53 to 8.19), the ICF Generic 6 Set proved sensitive to change (Cohen’s f2=0.41). Ceiling and floor effects on detecting change in functioning were cancelled or reduced by using the metric score. Conclusion: The ICF Generic 6 Set can be used for the assessment of functioning in routine clinical practice and an interval score can be derived which is sensitive to change. KW - International Classification of Functioning, Disability and Health (ICF) Y1 - 2018 UR - https://doi.org/10.1136/bmjopen-2018-021696 VL - 8 IS - 12 SP - e021696 ER - TY - JOUR A1 - Hopfe, M. A1 - Prodinger, Birgit A1 - Bickenbach, J. E. A1 - Stucki, G. T1 - Optimizing health systems response to patient’s needs: An argument for the importance of functioning information JF - Disability and Rehabilitation N2 - Background: Current health systems are increasingly challenged to meet the needs of a growing number of patients living with chronic and often multiple health conditions. The primary outcome of care, it is argued, is not merely curing disease but also optimizing functioning over a person’s life span. According to the World Health Organization, functioning can serve as foundation for a comprehensive picture of health and augment the biomedical perspective with a broader and more comprehensive picture of health as it plays out in people’s lives. The crucial importance of information about patient’s functioning for a well-performing health system, however, has yet to be sufficiently appreciated. Methods: This paper argues that functioning information is fundamental in all components of health systems and enhances the capacity of health systems to optimize patients’ health and health-related needs. Results and conclusion: Beyond making sense of biomedical disease patterns, health systems can profit from using functioning information to improve interprofessional collaboration and achieve cross-cutting disease treatment outcomes. - Implications for rehabilitation - Functioning is a key health outcome for rehabilitation within health systems. - Information on restoring, maintaining, and optimizing human functioning can strengthen health system response to patients’ health and rehabilitative needs. - Functioning information guides health systems to achieve cross-cutting health outcomes that respond to the needs of the growing number of individuals living with chronic and multiple health conditions. - Accounting for individuals functioning helps to overcome fragmentation of care and to improve interprofessional collaboration across settings KW - Health systems KW - health service delivery KW - rehabilitation services KW - functioning information KW - patient’s needs KW - fragmentation of care Y1 - 2018 UR - https://doi.org/10.1080/09638288.2017.1334234 VL - 40 IS - 19 SP - 2325 EP - 2330 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Tennant, A. A1 - Stucki, G. T1 - Standardized reporting of functioning information on ICF-based common metrics JF - European Journal of Physical and Rehabilitation Medicine N2 - BACKGROUND: In clinical practice and research a variety of clinical data collection tools are used to collect information on people’s functioning for clinical practice and research and national health information systems. Reporting on ICF-based common metrics enables standardized documentation of functioning information in national health information systems. The objective of this methodological note on applying the ICF in rehabilitation is to demonstrate how to report functioning information collected with a data collection tool on ICF-based common metrics. We first specify the requirements for the standardized reporting of functioning information. Secondly, we introduce the methods needed for transforming functioning data to ICF-based common metrics. Finally, we provide an example. METHODS: The requirements for standardized reporting are as follows: 1) having a common conceptual framework to enable content comparability between any health information; and 2) a measurement framework so that scores between two or more clinical data collection tools can be directly compared. The methods needed to achieve these requirements are the ICF Linking Rules and the Rasch measurement model. Using data collected incorporating the 36-item Short Form Health Survey (SF-36), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Stroke Impact Scale 3.0 (SIS 3.0), the application of the standardized reporting based on common metrics is demonstrated. RESULTS: A subset of items from the three tools linked to common chapters of the ICF (d4 Mobility, d5 Self-care and d6 Domestic life), were entered as “super items” into the Rasch model. Good fit was achieved with no residual local dependency and a unidimensional metric. A transformation table allows for comparison between scales, and between a scale and the reporting common metric. CONCLUSIONS: Being able to report functioning information collected with commonly used clinical data collection tools with ICF-based common metrics enables clinicians and researchers to continue using their tools while still being able to compare and aggregate the information within and across tools. KW - International Classification of Functioning, Disability and Health KW - Rehabilitation KW - Delivery of health care Y1 - 2018 UR - https://doi.org/10.23736/S1973-9087.17.04784-0 VL - 54 IS - 1 SP - 110 EP - 117 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Cieza, A. A1 - Williams, D.A. A1 - Mease, P. A1 - Boonen, A. A1 - Kerschan-Schindl, K. A1 - Fialka-Moser, V. A1 - Smolen, J. A1 - Stucki, G. A1 - Machold, K. A1 - Stamm, T. T1 - Measuring health in patients with fibromyalgia: Content comparison of questionnaires based on the International Classification of Functioning, Disability and Health (ICF) JF - Arthritis Care & Research N2 - Objective To analyze the content of outcome measures commonly used to assess health in patients with fibromyalgia (FM) by linking the items of the instruments with the International Classification of Functioning, Disability and Health (ICF) in order to evaluate the adequacy of currently used measures. Methods Questionnaires used in FM were identified in a structured literature search. All concepts included in the items of the questionnaires were linked to ICF categories, according to previously published linking rules, by 2 independent health professionals. The percentages of linked ICF categories addressing the different ICF components were calculated. Results Generic and symptom‐specific instruments were included. From the 296 items contained in all 16 instruments, 447 concepts were extracted and then linked to 52 ICF categories of the component body functions, 1 category of the component body structure, 40 categories of the component activities and participation, and 9 categories of the component environmental factors. More than half of the concepts identified were linked to body function, fewer were linked to activities and participation, and only concepts of 4 instruments were linked to the ICF component environmental factors. Conclusion Many concepts were linked to the categories in the ICF component body functions. While linking to the broad category, purportedly similar instruments often covered widely varying areas of function at more fine‐grained levels of detail. Some categories, such as environmental factors, were barely covered by any of the instruments and might constitute an important aspect of health deserving better coverage and future development. KW - fibromyalgia Y1 - 2008 UR - https://doi.org/10.1002/art.23559 VL - 59 IS - 5 SP - 650 EP - 658 ER - TY - JOUR A1 - Hodel, J A1 - Ehrmann, C A1 - Stucki, G A1 - Bickenbach, JE A1 - Prodinger, Birgit A1 - SwiSCI Study Group, T1 - Examining the complexity of functioning in persons with spinal cord injury attending first rehabilitation in Switzerland using structural equation modelling JF - Spinal Cord N2 - Study design Cross-sectional. Objectives To examine the associations between activities, body structures and functions, and their relationship with aetiology, age and sex in persons with spinal cord injury (SCI) at discharge from first rehabilitation. Setting Swiss SCI Cohort Study (SwiSCI). Methods The study included 390 participants with newly acquired SCI and the International Classification of Functioning, Disability and Health (ICF) as conceptual frame of reference. Body structures were represented by injury level and severity; body functions by cardiovascular, pulmonary, skin, bowel and urinary functions and pain; mental functions by anxiety, depression, optimism and self-esteem; and activities by independence in performing activities of daily living (ADL). Using structural equation modelling (SEM), indirect effects of body structures and functions on independence in performing ADL through mental functions were tested for each mental function separately. For each structural model, fit was assessed using several indices and differences in aetiology, age and sex groups were explored. Results The structural model about optimism showed good fit in all indices; the models about anxiety, depression and self-esteem showed conflicting fit indices, respectively. Within all models, effects on independence in performing ADL were mainly direct. Pain showed significant (P < 0.05) indirect effects on independence in performing ADL within the depression, optimism and self-esteem models. The model about anxiety showed differences in aetiology groups. Conclusions Using an ICF-based modelling approach, this study presents an attempt towards a more comprehensive understanding of functioning in first rehabilitation of persons with SCI, which might be fundamental for rehabilitation planning. KW - functioning KW - structural equation modelling KW - rehabilitation KW - spinal cord injury Y1 - 2020 UR - https://doi.org/10.1038/s41393-020-0428-4 VL - 58 SP - 570 EP - 580 ER - TY - JOUR A1 - Senju, Y A1 - Mukaino, M A1 - Prodinger, Birgit A1 - Selb, M A1 - Okouchi, Y A1 - Mizutani, K A1 - Suzuki, M A1 - Yamada, S A1 - Izumi, SI A1 - Sonoda, S A1 - Otaka, Y A1 - Saitoh, E A1 - Stucki, G T1 - Development of a clinical tool for rating the body function categories of the ICF generic-30/rehabilitation set in Japanese rehabilitation practice and examination of its interrater reliability JF - BMC Medical Research Methodology N2 - Background: The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component "body functions" and 21 from the component "activities and participation". This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide. Methods: The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters' feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights. Results: The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher. Conclusions: In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice. KW - Clinical tool KW - International Classification of Functioning, Disability, and Health KW - Interrater reliability KW - Rehabilitation Y1 - 2021 UR - https://doi.org/10.1186/s12874-021-01302-0 VL - 21 IS - 1 SP - 121 ER -