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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.
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.