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 P.O. Box

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 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 (Impairments) Activities (Limitations) Participation (Restrictions) Personal Factors Environmental Factors

& ParticipationActivityBody functions & structures

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

Health Condition Environmental Factors Personal Factors (disease, disorder) Contextual factors Limitation in activities Impairment of body function & structure Restriction in participation 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 conditionsto provide a scientific basis for consequences of health conditions to establish a common language to improve communicationsto establish a common language to improve communications to permit comparison of data across:to permit comparison of data across: – countries – health care disciplines – services – time to provide a systematic coding scheme for health information systemsto 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)

ICF provides an international common language for describing functioning, disability and health

ICF 4 Components Chapters/1st Level Body Functions and Body Structures Activities and Participation Environmental Factors b1 - b8 s1 - s8 d1 - d9 e1 - e5 2nd Level b110 - b899 s110 - s899 d110 - b999 e110 - e599 b1100-b7809 b11420-b54509 s1100-s8309 s11000-s76009 d1550-d9309 e1100-e5959 3rd and 4th Level level of precision bandwidth or breadth of health dimensions

Health condition (disease, trauma) 253 Environmental factors Personal factors Contextual factors Participations 384 Activities & Participations 493 Body functions and 310 structures ICF Categories

- Body functions Body structures Activity and participation Environmental factors

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!

List of ICF categories with the typical spectrum of problems in functioning and environmental factors in patients with a specific condition ICF Core Set

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

 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 Main Goals

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 e ICF Core Set

Comprehensive ICF Core Set  to guide multidisciplinary assessments in patients with that condition Brief ICF Core Set  to be used in clinical studies ICF Core Sets

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 b260 Proprioceptive function b280 Sensation of pain b455 Exercise tolerance functions b620 Urination functions Brief ICF Core Set Comprehensive 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

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 - Body Structures

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 - Activity & Participation

e 110 Products or substances for personal consumption 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 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 LBP - Environmental Factors

Body Functions - RA b280Pain b710Mobility of joint functions b730Muscle power functions b4555Exercise tolerance function b780Sensations related to muscles and movement functions b2800Generalized pain b2801Pain in body part b7102Mobility of joints generalized b7800Sensation of muscle stiffness b134Sleep functions b130Energy and drive functions b640Sexual functions b715Stability of joint functions b152Emotional functions b180Experience of self and time functions b1801Body image b740Muscle endurance function b510Ingestion functions b770Gait pattern functions b430Haematological system functions 25 out of 485

Body Structures - RA s750Structure of lower extremity s730Structure of upper extremity s710Structure of head and neck region s720 Structure of shoulder region s75001 Hip joint s75011Knee joint s7502Structure of ankle and foot s73001Elbow joint s73011Wrist joint s7302Structure of hand s73021Joints of hand and fingers s73022Muscles of hand s760Structure of trunk s7600Structure of vertebral column s76000Cervical vertebral column s770Additional musculoskeletal structures related to movement s299Eye, ear and related structures, unspecified s810Structure of areas of skin 18 out of 302

Activities & Participation – RA d450Walking d850Remunerative employment d440Fine hand use d410 Changing basic body position d445Hand and arm use d230Carrying out daily routine d430Lifting and carrying objects d470Using transportation d620Acquisition of goods and services d920 Recreation and leisure d640Doing housework d540Dressing d630Preparing meals d475Driving d530Toileting d550Eating d859Work and employment, other specified and unspecified d170Writing d510Washing oneself d770Intimate relationships 31 out of 384

Environmental Factors - RA e310Immediate family e580Health services, systems and policies e355Health professionals e115Products and technology for personal use in daily living e570 Social security services, systems and policies e155 Design, construction and building products and technology of buildings for private use e110Products or substances for personal consumption e450Individual attitudes of health professionals e150Design, construction and building products and technology of buildings for public use e135Products and technology for employment e425Individual attitudes of aquaintances, peers, colleagues, neighbors and community members e410Individual attitudes of immediate family members e420Individual attitudes of friends e540 Transportation services, systems and policies e340Personal care providers and personal assistants e360Other professionals e320Friends e120Products and technology for personal indoor and outdoor mobility and transportation e460Societal attitudes e125Products and technology for communication e225Climate 21 out of 253

FURTHER DEVELOPMENT OF CORE S ETS 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 سلامت 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