TY - JOUR A1 - Müller, Martin A1 - Grill, E. A1 - Quittan, M. A1 - Strobl, R. A1 - Kostanjsek, N. A1 - Stucki, G. ED - Medical Journals Limited, T1 - ICF Core Set for patients in geriatric post-acute rehabilitation facilities JF - Journal of Rehabilitation Medicine N2 - Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and clinical measurement of functioning in older patients in early post-acute rehabilitation facilities. Design: Prospective multi-centre cohort study. Patients: Older patients receiving rehabilitation interventions in early post-acute rehabilitation facilities. Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables. Results: A total of 209 patients were included in the study, mean age 80.4 years, 67.0% female. Selection yielded a total of 29 categories for the functioning part and 9 categories for the contextual part of the ICF. Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the clinical assessment and monitoring of functioning in older patients undergoing early post-acute rehabilitation. KW - Aged 80 and over KW - Classification KW - Clinical KW - Health status measurements KW - ICF KW - Outcome assessment KW - regression analysis KW - Rehabilitation Y1 - 2018 ER - TY - JOUR A1 - Stucki, G. A1 - Prodinger, Birgit A1 - Bickenbach, J. T1 - Four steps to follow when documenting functioning with the International Classification of Functioning, Disability and Health JF - European Journal of physical and rehabilitation medicine N2 - In this methodological note on applying the ICF in rehabilitation, we introduce suitable tools that allow us to document comprehensively and systematically the lived experience of health to guide clinical practice, the management of services, evidence-informed policy and scientific inquiry. The objective of this methodological note is to present the currently available tools with respect to four questions: 1) what ICF domains to document; 2) what perspective to take; 3) what data collection tools to apply; and 4) which approach to use for reporting. The application of these tools is illustrated using the Swiss Spinal Cord Injury (SwiSCI) Cohort Study. Existing ICF Sets provide a practical approach for identifying the domains to document. One can document from the perspective of biological health, lived health, and appraised health. For identifying suitable data collection tools, either existing tools can be linked to the ICF or available ICF-based data collection tools can be used. For reporting, an interval scale metric is suggested. The four step approach presented provides users with a logical sequence to follow when planning the documentation of functioning using the ICF as a health information reference system in practice and research. KW - ICF KW - Rehabilitation KW - Cohort study KW - Health Y1 - 2017 UR - https://doi.org/10.23736/S1973-9087.17.04569-5 VL - 53 IS - 1 SP - 144 EP - 149 ER - TY - JOUR A1 - Prodinger, Birgit A1 - O'Connor, R.J. A1 - Stucki, G. A1 - Tennant, A. T1 - Establishing score equivalence of the Functional Independence Measure (FIM™) motor scale and the Barthel Index, utilising the International Classification of Functioning, Disability and Health (ICF) and Rasch Measurement Theory JF - Journal of Rehabilitation Medicine N2 - Introduction: Two widely used outcome measures to assess functioning in neurological rehabilitation are the Functional Independence Measure (FIM™) and the Barthel Index. The current study aims to establish the equivalence of the total score of the FIM™ motor scale and the Barthel Index through the application of the International Classification of Functioning, Disability and Health, and Rasch measurement theory. Methods: Secondary analysis of a large sample of patients with stroke, spinal cord injury, and multiple sclerosis, undergoing rehabilitation was conducted. All patients were assessed at the same time on both the FIM™ and the Barthel Index. The International Classification of Functioning, Disability and Health Linking Rules were used to establish conceptual coherency between the 2 scales, and the Rasch measurement model to establish an exchange of the total scores. Results: Using the FIM™ motor scale, items from both scales linked to the International Classification of Functioning, Disability and Health d4 Mobility or d5 Self-care chapters. Their co-calibration satisfied the assumptions of the Rasch model for each of 3 diagnostic groups. A ceiling effect was observed for the Barthel Index when contrasted against the FIM™ motor scale. Conclusion: Having a Rasch interval metric to transform scores between the FIM™ motor scale and Barthel Index is valuable for monitoring functioning, meta-analysis, quality audits and hospital benchmarking. KW - International Classification of Functioning KW - Disability and health KW - ICF KW - Outcome measures KW - Patient outcome assessment Y1 - 2017 UR - https://doi.org/10.2340/16501977-2225 VL - 49 IS - 5 SP - 416 EP - 422 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Scheel-Sailer, A. A1 - Escorpizo, R. A1 - Stucki, G. T1 - UEMS-PRM ICF workshop moderators and rapporteurs. (2017) European initiative for the application of the International Classification of Functioning, Disability and Health: Development of Clinical Assessment Schedules for specified rehabilitation services JF - European Journal of physical and rehabilitation medicine N2 - Clinical assessment schedule (CLAS) is a core part of the ICF-based implementation of functioning reporting across health conditions and along the continuum of care. The Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists (UEMS PRM) workshop held in January 2016 aimed to develop and specify a CLAS within the context of rehabilitation services. UEMS PRM Workshop in Nottwil, Switzerland, January 2016.PRM physicians representatives from 12 European countries, as well as Israel and Japan, mostly delegates of UEMS PRM Section and Board, and experts with other rehabilitation professional backgrounds.Participants were divided into 6 working groups and asked to specify what functioning aspects would be essential to document using the available ICF sets for the identified rehabilitation services contained in the newly developed service classification (ICSO-R): acute, post-acute and long-term rehabilitation services. The 7 ICF Generic and 23 Rehabilitation Set categories were confirmed as well as specific health condition categories for acute rehabilitation services (mobile team), for postacute rehabilitation services (general outpatient rehabilitation, musculoskeletal and neurological rehabilitation, as well as specialized SCI rehabilitation), and for long-term rehabilitation services (day clinic and rehabilitation provided in the community). While general principles of the CLAS were defined, the need to align the CLAS for a specific service, as well as across services along the continuum of care was highlighted. All groups deliberated on this topic; however, no conclusive statement was presented yet.The groups recognized a need for a systematic effort to identify data collection tools currently used.CLASs will serve in the future to ensure that functioning information is systematically and consistently collected across services, and thus respond also to various global reports and initiatives which stress the need for improving data collection on people's functioning. KW - Outcome assessment KW - Health care KW - Rehabilitation KW - Health information systems Y1 - 2017 UR - https://doi.org/10.23736/S1973-9087.16.04438-5 VL - 53 IS - 2 SP - 319 EP - 332 ER - TY - JOUR A1 - Fekete, C. A1 - Post, M. A1 - Bickenbach, J. A1 - Middleton, J. A1 - Prodinger, Birgit A1 - Selb, M. A1 - Stucki, G. T1 - A structured approach to capture the lived experience of spinal cord injury: Data model and questionnaire of the International Spinal Cord Injury Community Survey (InSCI) JF - American Journal of physical and rehabilitation medicine N2 - The International Spinal Cord Injury (InSCI) community survey has been developed to collect internationally comparable data on the lived experience of persons with spinal cord injury (SCI) in all 6 WHO regions. The InSCI survey provides a crucial first step to generate evidence on functioning, health maintenance, and subjective well-being in persons with SCI globally. A major challenge in setting up the InSCI community survey was to develop a data model and questionnaire that comprehensively captures what matters to people and, at the same time, is feasible and parsimonious in terms of participant’s burden. This paper outlines the components of the InSCI data model and presents the question selection to operationalize the data model along the 4 guiding principles of efficiency, feasibility, comparability, and truth and discrimination. The data model consists of 6 components operationalized with 125 questions including functioning (n = 28 body functions and structures; n = 42 activities and participation), contextual factors (n = 26 environmental; n = 19 personal factors), lesion characteristics (n = 2), and appraisal of health and well-being (n = 8). The InSCI questionnaire presents an efficient and feasible solution with satisfying comparability to other populations; however, its validity and reliability still needs to be confirmed. KW - International Spinal Cord Injury KW - Comparability of spinal cord injury Y1 - 2017 UR - https://doi.org/10.1097/PHM.0000000000000622 VL - 96 IS - 2 SP - S5 EP - S16 ER - TY - JOUR A1 - Dorjbal, D. A1 - Cieza, A. A1 - Gmünder, H.-P- A1 - Scheel-Sailer, A. A1 - Stucki, G. A1 - Üstün, T.B. A1 - Prodinger, Birgit T1 - Strengthening quality of care through standardized reporting based on the World Health Organization's reference classifications JF - International Journal of Quality in Health N2 - Quality issue Responding to person's health and related needs requires the availability of health information that reflects relevant aspects of a health condition and how this health condition impacts on a person's daily life. Initial assessment Health information is routinely collected at different time points by diverse professionals, in different settings for various purposes with varying methods. Consequently, health information is not always comparable, posing a challenge to the regular monitoring of quality. Choice of solution The World Health Organization's (WHO) International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI; under development) are complementary and serve as meaningful reference classifications for comparing data on persons’ health and related interventions across health systems. Implementation We developed a systematic approach of translating routinely collected information into a standardized report based on the three WHO reference classifications and the Rehab-Cycle®. Subsequently, we have demonstrated its application using five random case records of individuals attending a rehabilitation program. Evaluation All identified concepts were able to be linked to WHO's reference classifications. The ICF served as a tool to standardize information on rehabilitation goals and their achievement. The ICHI served as the basis for reporting the interventions that were documented in the case records, including the intervention targets that were derived from the ICF codes. Lessons learned Our experience shows that, it is possible to translate routinely collected information into standardized reports by linking existing narrative records with WHO's reference classifications. KW - International Classification of Diseases KW - International Classification of Functioning KW - Disability and health KW - Quality improvement KW - Rehabilitation Y1 - 2016 UR - https://doi.org/10.1093/intqhc/mzw078 VL - 28 IS - 5 SP - 626 EP - 633 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Tennant, A. A1 - Stucki, G. A1 - Cieza, A. A1 - Üstün, T.B. T1 - Harmonizing routinely collected health information for strengthening quality management in health systems: requirements and practice JF - Journal of Health Services Research & Policy N2 - Objective Our aim was to specify the requirements of an architecture to serve as the foundation for standardized reporting of health information and to provide an exemplary application of this architecture. Methods The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) served as the conceptual framework. Methods to establish content comparability were the ICF Linking Rules. The Rasch measurement model, as a special case of additive conjoint measurement, which satisfies the required criteria for fundamental measurement, allowed for the development of a common metric foundation for measurement unit conversion. Secondary analysis of data from the North Yorkshire Survey was used to illustrate these methods. Patients completed three instruments and the items were linked to the ICF. The Rasch measurement model was applied, first to each scale, and then to items across scales which were linked to a common domain. Results Based on the linking of items to the ICF, the majority of items were grouped into two domains, Mobility and Self-care. Analysis of the individual scales and of items linked to a common domain across scales satisfied the requirements of the Rasch measurement model. The measurement unit conversion between items from the three instruments linked to the Mobility and Self-care domains, respectively, was demonstrated. Conclusions The realization of an ICF-based architecture for information on patients’ functioning enables harmonization of health information while allowing clinicians and researchers to continue using their existing instruments. This architecture will facilitate access to comprehensive and consistently reported health information to serve as the foundation for informed decision-making. KW - Decision making KW - Health classification KW - Health status measurement KW - Information standards KW - Quality management Y1 - 2016 UR - https://doi.org/10.1177/1355819616636411 VL - 21 IS - 4 SP - 223 EP - 228 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Stamm, T. A1 - Petersson, D. A1 - Stucki, G. A1 - Tennant, A. T1 - Toward a standardized reporting of outcomes in hand osteoarthritis: Developing a common metric of outcome measures commonly used to assess functioning. JF - Arthritis Care & Research N2 - Objective Functioning is an important outcome in hand osteoarthritis (OA). The heterogeneity of patient‐reported outcome measures (PROMs) available challenges the direct comparability of information collected by these instruments. This study aimed to examine whether it is possible to achieve metric equivalence of PROMs commonly used to measure functioning in people with hand OA. Methods A secondary analysis of data from 253 persons who participated in the Vienna Hand Osteoarthritis Cohort Study was conducted applying the Rasch measurement model. Participants completed the Health Assessment Questionnaire, the Australian/Canadian Index for Hand Osteoarthritis, the Functional Index for Hand Osteoarthritis (FIHOA), and the Cochin Scale. The assumptions of stochastic ordering, local independence, unidimensionality, and invariance were tested for each scale independently before the scales were co‐calibrated onto a common metric. Results Except for the FIHOA, all measures indicated issues of local dependency in the initial analyses. After accommodating those with testlets, all scales satisfied the assumptions of the Rasch model (χ2 > 0.05). Marginal misfit in 2 items was found in the FIHOA, but this did not disturb person estimates. As the 4 scales form a common metric that satisfies the assumptions of the Rasch model, the scores can be equated. Conclusion The scores of the 4 hand function measures can be transformed to a common 0–100 metric, such that scores can be interchanged. A user‐friendly transformation table enables clinicians and researchers to have access to the common metric by simply adding up the total score for each instrument and identifying the corresponding transformed score on the common metric. KW - Osteoarthritis KW - Outcome measures KW - Cohort study Y1 - 2016 UR - https://doi.org/10.1002/acr.22816 VL - 68 IS - 8 SP - 1115 EP - 1127 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Cieza, A. A1 - Oberhauser, C. A1 - Bickenbach, J. A1 - Üstün, T.B. A1 - Chatterji, S. A1 - Stucki, G. T1 - Toward the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set: A Minimal Generic Set of Domains for Rehabilitation as a Health Strategy JF - Archives of Physical Medicine and Rehabilitation KW - Rehabilitation KW - Disability and health KW - ICF Rehabilitation Set Y1 - 2016 UR - https://doi.org/10.1016/j.apmr.2015.12.030 VL - 97 IS - 6 SP - 875 EP - 884 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Reinhard, J.D. A1 - Selb, M. A1 - Stucki, G. A1 - Yan, T. A1 - Zhang, C. A1 - Li, J. T1 - Towards system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in routine practice: Developing simple, intuitive descriptions of ICF categories in the ICF Generic and Rehabilitation Set JF - Journal of Rehabilitation Medicine N2 - Objective: A national, multi-phase, consensus process to develop simple, intuitive descriptions of International Classification of Functioning, Disability and Health (ICF) categories contained in the ICF Generic and Rehabilitation Sets, with the aim of enhancing the utility of the ICF in routine clinical practice, is presented in this study. Methods: A multi-stage, national, consensus process was conducted. The consensus process involved 3 expert groups and consisted of a preparatory phase, a consensus conference with consecutive working groups and 3 voting rounds (votes A, B and C), followed by an implementation phase. In the consensus conference, participants first voted on whether they agreed that an initially developed proposal for simple, intuitive descriptions of an ICF category was in fact simple and intuitive. Results: The consensus conference was held in August 2014 in mainland China. Twenty-one people with a background in physical medicine and rehabilitation participated in the consensus process. Four ICF categories achieved consensus in vote A, 16 in vote B, and 8 in vote C. Discussion: This process can be seen as part of a larger effort towards the system-wide implementation of the ICF in routine clinical and rehabilitation practice to allow for the regular and comprehensive evaluation of health outcomes most relevant for the monitoring of quality of care. KW - Disability and health KW - Health information systems KW - International classification of functioning KW - Practicing standards Y1 - 2016 UR - https://doi.org/10.2340/16501977-2066 VL - 48 IS - 6 SP - 508 EP - 514 ER - TY - JOUR A1 - Li, J. A1 - Prodinger, Birgit A1 - Reinhard, J. D. A1 - Stucki, G. T1 - Toward the system-wide implementation of the International Classification of Functioning, Disability and Health in routine clinical practice: Lessons from a pilot study in China JF - Journal of Rehabilitation Medicine N2 - In 2011 the Chinese leadership in rehabilitation, in collaboration with the International Classification of Functioning, Disability and Health (ICF) Research Branch, embarked on an effort towards the system-wide implementation of the ICF in the healthcare system in China. We report here on the lessons learned from the pilot phase of testing the ICF Generic Set, a parsimonious set of 7 ICF categories, which have been shown to best describe functioning across the general population and people with various health conditions, for use in routine clinical practice in China. The paper discusses whether classification and measurement are compatible, what number of ICF categories should be included in data collection in routine practice, and the usefulness of a functioning profile and functioning score in clinical practice and health research planning. In addition, the paper reflects on the use of ICF qualifiers in a rating scale and the particularities of certain ICF categories contained in the ICF Generic Set when used as items in the context of Chinese rehabilitation and healthcare. Finally, the steps required to enhance the utility of system-wide implementation of the ICF in rehabilitation and healthcare services are set out. KW - Functional status KW - ICF KW - Psychomatrics KW - Rasch analysis KW - Sensitivity to change Y1 - 2016 UR - https://doi.org/10.2340/16501977-2067 VL - 48 IS - 6 SP - 502 EP - 507 ER - TY - JOUR A1 - Reinhardt, J. D. A1 - Zhang, X. A1 - Prodinger, Birgit A1 - Ehrmann-Bostan, C. A1 - Selb, M. A1 - Stucki, G. A1 - Li, J. T1 - Toward the system-wide implementation of the International Classification of Functioning, Disability and Health in routine clinical practice: Empirical findigns of a pilot study from Mainland China JF - Journal of Rehabilitation Medicine N2 - Objective: The aims of this study were to evaluate the feasibility of using the International Classification of Functioning, Disability and Health (ICF) Generic Set in routine clinical practice, and of creating a functioning score based on it, and, subsequently, to examine its sensitivity to change. Methods: In this prospective cohort study, data from 761 adult inpatients from 21 Chinese hospitals were analysed. Each patient was assessed at admission and discharge. Feasibility was evaluated by analysing mean assessment time. The Rasch model was used to create a metric of functioning. Sensitivity to change was analysed with mixed-effects regression and by calculating standardized effect size based on Cohen's f2. Results: Mean duration of assessment was 5.3 min, with a significant decrease between admission and discharge. After removal of the item remunerative employment, the remaining ICF Generic Set categories fitted the Rasch model well. With a mean improvement in functioning of 12.1 (95% confidence interval (95% CI): 11.5–12.6), this metric proved sensitive to change, both in terms of statistical significance (p < 0.001) and standardized effect size (Cohen's f2 = 2.35). Discussion: The ICF Generic Set is feasible for use in routine clinical practice and is promising to serve as the basis for the development of a functioning score that is sensitive to change. KW - Functional status KW - ICF KW - Psychomatrics KW - Rasch analysis Y1 - 2016 UR - https://doi.org/10.2340/16501977-2102 VL - 48 IS - 6 SP - 515 EP - 521 ER - TY - JOUR A1 - Maritz, R. A1 - Ehrmann, C. A1 - Prodinger, Birgit A1 - Tennant, A. A1 - Stucki, G. T1 - The influence and added value of a Standardized Assessment and Reporting System for functioning outcomes upon national rehabilitation quality reports JF - International Journal for Quality in Health Care N2 - Objective To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric. Design Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets. Setting Swiss national public rehabilitation outcome quality reports on the clinic level. Participants A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18 047 patients. Interventions Neurological or musculoskeletal rehabilitation. Main outcome measures Functional Independence Measure™ or Extended Barthel Index. Results Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric’s content with ICF Core Sets suggests to include ‘energy and drive functions’ or ‘maintaining a basic body position’ to enhance the content of functioning as an indicator. Conclusions A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS’ ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation. KW - quality of health care KW - public reporting of healthcare data KW - outcome assessment (health care) KW - rehabilitation KW - international classification of functioning, disability and health KW - psychometrics Y1 - 2020 UR - https://doi.org/10.1093/intqhc/mzaa058 VL - 32 IS - 6 SP - 379 EP - 387 PB - Oxford University Press CY - Oxford ER - TY - JOUR A1 - Mukaino, M. A1 - Prodinger, Birgit A1 - Yamada, S. A1 - Senju, Y. A1 - Izumi, S. I. A1 - Sonoda, S. A1 - Selb, M. A1 - Saitoh, E. A1 - Stucki, G. T1 - Supporting the clinical use of the ICF in Japan - development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 set, its operationalization through a rating reference guide, and interrater reliability study JF - BMC Health Services Research N2 - Background The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) in 2001 and has been in the process of implementing it in clinics since then. Current international efforts to implement ICF in rehabilitation clinics include the implementation of ICF Core Sets and the development of simple, intuitive descriptions for the ICF Generic-30 Set (also called Rehabilitation Set). The present study was designed to operationalize these ICF tools for clinical practice in Japan. This work included 1) the development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, 2) the development of a rating reference guide for Activity and Participation categories, and 3) the examination of the interrater reliability of rating Activity and Participation categories. Methods The Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set was developed following the process employed to develop the Chinese and Italian versions. For further operationalization of this ICF Set in practice, a rating reference guide was developed. The development of the rating reference guide involved the following steps: 1) a trial of rating patients by several raters, 2) cognitive interviewing of the raters to analyse the thinking process involved in rating, 3) drafting of the rating reference guide, and 4) review by ICF specialists to confirm consistency with the original ICF concepts. After the rating reference guide was developed, interrater reliability of the rating with the reference guide was determined. Interrater reliability was examined using weighted kappa statistics with linear weight. Results Through the pre-defined process, the Japanese version of the simple, intuitive descriptions for 30 categories of the ICF Generic-30 Set and the rating reference guides for 21 Activity and Participation categories were successfully developed. The weighted kappa statistics ranged from 0.61 to 0.85, showing substantial to excellent agreement of the ratings between raters. Conclusions The present study demonstrates that ICF categories can be translated into clinical practice. Collaboration between clinicians and researchers would further enhance the implementation of the ICF in Japan. KW - ICF KW - ICF rehabilitation set KW - Simple, intuitive descriptions KW - Interrater reliability Y1 - 2020 UR - https://doi.org/10.1186/s12913-020-4911-6 VL - 20 IS - 1 SP - 66 ER - TY - JOUR A1 - Maritz, R. A1 - Tennant, A. A1 - Fellinghauer, C. A1 - Stucki, G. A1 - Prodinger, Birgit T1 - The Extended Barthel Index (EBI) can Be Reported as a Unidimensional Interval-Scaled Metric – A Psychometric Study JF - Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin N2 - Background: The Extended Barthel Index (EBI), consisting of the original Barthel Index plus 6 cognitive items, provides a tool to monitor patients’ outcomes in rehabilitation. Whether the EBI provides a unidimensional metric, thus can be reported as a valid sum-score, remains to be examined. Objective: To examine whether the EBI can be reported as unidimensional interval-scaled metric for neurological and musculoskeletal rehabilitation. Methods: Rasch analysis of a calibration sample of 800 cases from neurological or musculoskeletal rehabilitation in 2016 in Switzerland. Results: In the baseline analysis no fit to the Rasch Model was achieved. When accommodating local dependencies with a testlet approach satisfactory fit to the Rasch Model was achieved, and an interval scale transformation table was created. Conclusion: The results support the reporting of adapted EBI total scores for both rehabilitation groups by applying the interval scaled transformation table presented in this study. N2 - Hintergrund: Der Erweiterte Barthel Index (EBI), der den Barthel Index um 6 kognitive Items ergänzt, ist ein Assessmentinstrument für die Rehabilitation. Ob der EBI eine eindimensionale Metrik liefert und somit als valider Gesamtscore berichtet werden kann, ist unklar. Ziel: Untersuchung ob der EBI für die neurologische und muskuloskelettale Rehabilitation als eindimensionale intervallskalierte Metrik berichtet werden kann. Methode: Rasch-Analyse einer Stichprobe von 800 neurologischen und muskuloskelettalen Rehapatienten aus der Schweiz. Ergebnisse: In der Basisanalyse wurde keine Übereinstimmung mit den Annahmen des Rasch-Modells erreicht. Nachdem lokale Item-Abhängigkeiten mit 2 Testlets angepasst wurden, wurde die Übereinstimmung erreicht und eine intervallskalierte Transformationstabelle erstellt. Konklusion: Die Ergebnisse unterstützen die Verwendung eines angepassten EBI Gesamtscores für beide Rehabilitationsgruppen unter Anwendung der intervallskalierten Transformationstabelle. KW - activities of daily living KW - assessment instruments KW - outcome assessment KW - rehabilitation KW - Rasch model KW - quality management Y1 - 2019 UR - https://doi.org/10.1055/a-0820-4642 VL - 29 IS - 04 SP - 224 EP - 232 ER - 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 -