Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago A Delphi Exercise to Help Determine a Core Set of ICF Items for Psoriatic Arthritis Dr William Taylor GRAPPA, June 2005

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Body Function & Structure Body Function & Structure ActivitiesParticipation Environmental Factors Personal Factors Health Condition (disorder/disease) Health Condition (disorder/disease) Contextual Factors

b1 b130 b134 b152 b180 b1801 s299 s710 s720 s730 s73001 s73011 d170 d230 d360 d410 d415 d430 e110 e115 e120 e125 e135 e ICF Core Set ICF

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Consensus conferences 2005/062006/07 Preliminary Studies Patients’ data Multicentre study Expert opinion Delphi exercise Study outcomes Literature reviews Phase I ICF Core Sets -- Development Process Patient opinion Focus groups

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Consensus conferences 2005/062006/07 Preliminary Studies Patients’ data Multicentre study Expert opinion Delphi exercise Study outcomes Literature reviews Phase I ICF Core Sets -- Development Process Patient opinion Focus groups

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Delphi exercise (PsA) 37 respondents (rheum, derm, rehab, OT, PT, nurse) to -based survey First round: free-text nomination of life areas important to people with PsA These were mapped onto specific ICF categories Second round: rate the relevance of ICF item on a 9-point scale (1=no relevance) Third round: repeat rating for items where there was disagreement or uncertainty (median rating 4 to 6)

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Body Function & Structure ActivitiesParticipation Environmental Factors Personal Factors Health Condition (disorder/disease) Contextual Factors

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Activity & Participation 83 items suggested by the first round responses 41 of these were agreed to be relevant (median score 7 to 9) in the second round In the third round a further 2 were agreed to be relevant and 39 were rated as neutral (of these, 29 items scored 6); total of 72 items

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago 1.Carrying out daily routine19. Washing whole body38. Sexual relationships55. Handling stress 2. Managing one's own activity level 20. Caring for body parts33. Recreation and leisure56. Using writing machines 3. Changing basic body position 21. Caring for skin39. Moving around57. Squatting 4. Lying down22. Caring for fingernails 40. Using public motorized transportation 58. Kneeling 5. Sitting23. Caring for toenails41. Family relationships59. Maintaining a body position 6. Bending24. Toileting42. Informal social relationships60. Maintaining a lying position 7. Lifting and carrying objects25. Dressing43. Parent-child relationships61. Crawling 8. Lifting26. Taking off footwear44. Maintaining a standing position 62. Moving objects with lower extremities 9. Carrying in the hands27. Maintaining one's health45. Transferring oneself63. Basic interpersonal interactions 10. Fine hand use28. Preparing meals46. Climbing 64. Complex interpersonal interactions 11. Picking up29. Doing housework47. Running65. School education 12. Grasping30. Walking 48. Moving around in different locations 66. Vocational training 13. Manipulating 31. Remunerative employment 49. Moving around using equipment67. Higher education 14. Hand and arm use 32. Personal economic resources 50. Managing diet and fitness 68. Apprenticeship (work preparation) 15. Reaching34. Eating51. Acquisition of goods and services69. Non-remunerative employment 16. Driving35. Drinking52. Shopping70. Community life 17. Using transportation36. Writing53. Cleaning living area71. Sports 18. Washing oneself37. Intimate relationships 54. Handling stress and other psychological demands 72. Socializing

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Participation (?) items 1. Driving15. Acquisition of goods and services 2. Using transportation16. Shopping 3. Maintaining one's health17. Cleaning living area 4. Preparing meals18. Basic interpersonal interactions 5. Doing housework19. Complex interpersonal interactions 6. Remunerative employment21. School education 7. Personal economic resources22. Vocational training 8. Intimate relationships23. Higher education 9. Sexual relationships24. Apprenticeship (work preparation) 10. Recreation and leisure25. Non-remunerative employment 11. Using public motorized transportation26. Community life 12. Family relationships27. Sports 13. Informal social relationships28. Socializing 14. Parent-child relationships

Rehabilitation Teaching & Research Unit, Wellington School of Medicine & Health Sciences, University of Otago Conclusion Excessive number of items for a core-set (e.g. there are 32 items from Activity & Participation in the RA core-set) Now need patients’ perspective Further refinement through consensus conference More manageable number of ‘participation’ items that could be used to develop a measurement questionnaire