2. ICF International Classification of Functioning, Disability and Health Sini Puustinen, PT, MSc (Health Science) 2

3. THE Customer 3 Interview -62 years, female, has worked as secretary for 32 years -Work includes sitting (7/8 hours/day) and use of computer and phone, paperwork, occationally meetings (sitting), leisure time includes gardening and meeting friends -Asthma (diagnosed 26 years ago), arthritis in left knee joint (Gradus I, diagnosed 4 years ago), occational head ache and low back pain (no sick leaves) -Has met a doctor (physician) 4 weeks ago, diagnosed M54.5 Low back pain, no sciatica symptoms, sick leave for 2 weeks because sitting is painful (VAS 6/10) (ICD http://apps.who.int/classifications/icd10/browse/2015/en#/M50-M54) http://apps.who.int/classifications/icd10/browse/2015/en#/M50-M54 -Low back pain started 9 weeks ago, VAS in the morning 1/10, during the day 4/10, after 30 minutes sitting 6/10, lying on the back helps > VAS 3/10. Gardening includes back flexion, kneeling, and lifting boxes and tools, after 10 minutes of gardening VAS 5/10. No peripheric symptoms to lower extremeties.

4. FOCUS: Functioning, Disability and Health -Focus on customer’s own expectations and wishes -PERCEIVED DISABILITY > resources and challenges 4

5. MTV 2011 Turun Sanomat 2014 EXPECTATIONS AND WISHES for PHYSIOTHERAPY 1.To be able to work and sit without low back pain 2. To be able to do gardening in leisure time without pain in the low back area

6. HOW TO APPROACH? HOLISTIC APPROACH OF FUNCTIONING, DISABILITY, AND HEALTH -Personal Factors -Environmental Factors -Body functions and Structures -Activities -Participation

7. HOW TO APPROACH?

8. What is ICF? -The International Classification of Functioning, Disability and Health (ICF) -A framework for organizing and documenting information on functioning and disability (WHO 2001) -It conceptualises functioning as a “dynamic interaction between a person’s health condition, environmental factors and personal factors” WHO 2013

9. What is ICF? -It integrates the major models of disability - the medical model and the social model - as a “bio-psycho-social synthesis” -ICF provides a standard language and conceptual basis for the definition and measurement of disability (and it provides classifications and codes) WHO 2013

10. What is ICF -PRACTICAL MANUAL: http://www.who.int/classifications/drafticf practicalmanual2.pdf?ua=1 http://www.who.int/classifications/drafticf practicalmanual2.pdf?ua=1

11. What is ICF? -Functioning and disability are understood as umbrella terms denoting the positive and negative aspects of functioning from a biological, individual and social perspective. -The ICF therefore provides a multi- perspective, bio-psycho-social approach which is reflected in the multidimensional model WHO 2013

12. What is ICF? -In classifying functioning and disability, there is not an explicit or implicit distinction between different health conditions -Disability is not differentiated by aetiology. -ICF clarifies that we cannot, for instance, infer participation in everyday life from medical diagnosis alone. -In this sense ICF is aetiology-neutral: if a person cannot walk or go to work it may be related to any one of a number of different health conditions. -By shifting the focus from health condition to functioning, the ICF places all health conditions on an equal footing, allowing them to be compared, in terms of their related functioning, via a common framework. WHO 2013

13. What is ICF -The ICF provides a scientific, operational basis for describing, understanding and studying health and health-related states, outcomes and determinants. -The health and health-related states associated with any health condition can be described using ICF. WHO 2013

14. What is ICF? -ICF organises information in two parts: -Part 1 deals with functioning and disability while Part 2 covers contextual factors Each part has two components: Functioning and Disability: -Body Functions and Body Structures -Activities and Participation Contextual Factors: -Environmental Factors -Personal Factors WHO 2013

16. How ICF can be used? Examples of possible uses of an ICF-based patient profile include: -Snapshot profile of a single individual to detect areas of needs, problems and strengths, -Dynamic profile of the functional status of an individual or group to track changes, such as those due to natural history, interventions, or environmental modifications, -Functional profile of a cohort grouped by some criteria (e.g. diagnosis, age, or gender), or -Planning treatment or management WHO 2013

17. GOAL SETTING CUSTOMERS EXPECTATIONS AND WISHES

18. THE Customer WHAT WOULD YOU EXAMINATE? Interview -62 years, female, has worked as secretary for 32 years -Work includes sitting (7/8 hours/day) and use of computer and phone, paperwork, occationally meetings (sitting), leisure time includes meeting friends and gardening -Asthma (diagnosed 26 years ago), arthritis in left knee joint (Gradus I, diagnosed 4 years ago), occational head ache and low back pain (no sick leaves) -Has met a doctor (physician) 4 weeks ago, diagnosed M54.5 Low back pain, no sciatica symptoms, sick leave for 2 weeks because sitting is painful (VAS 6/10) -(Low back pain started 9 weeks ago, VAS in the morning 1/10, during the day 4/10, after 30 minutes sitting 6/10, lying on the back helps > VAS 3/10. Gardening includes back flexion, kneeling, and lifting boxes and tools, after 10 minutes of gardening VAS 5/10. No peripheric symptoms to lower extremeties. -Expectations and wishes for Physiotherapy: 1. To be able to work and sit without low back pain, 2. To be able to do gardening in leisure time without pain in the low back area Iltasanomat 2015

19. What is ICF? -Core sets: http://www.icf-core-sets.org/ -Low Back Pain Comprehensive: http://www.icf-core-sets.org/en/page4.php

21. CLASSIFICATION OF LOW BACK PAIN (O’Sullivan 2005, Luomajoki 2008) Spesific LBP (5-10%) Specific medical finding Fracture Tumours Anomalies Nerve root affection Spinalcanal Stenosis Non-mechanical (30%) ”Central Pain” Yellow flags Psychosocial factors - Fear avoidance - Catastrofication Mechanical Movement impairment (30%) Direction specific Hypomobility and pain (instant pain in certain direction, e.g. pain in lumbar flexion > intrest in structures Movement control impairment (30%) Direction specific or Multidirectional (e.g. after prolonged sitting or standing, gets worse during work day > intrest in function Non-specific LBP (90%)

22. PERSONAL FACTORS -Gender, race, ethnicity, age, social and educational background, profession, lifestyles and habits (exercise, smoking, alcohol consumption), illnesses, medication, past and current experiences, and life events, character styles, behaviour patterns, and psychological assets are all personal factors that may potentially affect functioning -They represent influences on functioning particular to the individual which are not represented elsewhere in ICF -An example of this is when an individual cannot get a job due to lack of qualifications, rather than any difficulty in functioning or problem in the environment WHO 2013, 64

23. ENVIRONMENTAL FACTORS -Products or substances for personal consumption (food, drink and drugs) -Products and technology for personal indoor and outdoor mobility and transportation -Products and technology for employment -Design, construction and building products and technology of buildings for public use / for private use -Climate -Vibration -Immediate family, Acquintances, peers, colleaques, neighbours and community members -People in position of authority -Health professionals, Other professionals -Individual attitudes of immediate family members -Individual attitudes of health professionals / health related professionals -Societal attitudes -Social norms, practices idelogies -Transportation services, systems and policies, Legal services, systems and policies, Social security services, systems and policies -General social support services, systems and policies -Health services, systems and policies -Education and training services, systems and policies, Labour and employment services, systems and policies

24. PARTICIPATION -Basic interpersonal interactions, Family relationships, Intimate relationships -Remunerative employment, Work and employment, -Community life -Recreation and leisure

25. PARTICIPATION: Percieved disability -The Roland-Morris Low Back Pain and Disability Questionnaire https://depts.washington.edu/anesth/education/for ms/pain/Roland-Morris-Questionaire.pdf https://depts.washington.edu/anesth/education/for ms/pain/Roland-Morris-Questionaire.pdf -Oswestry Low Back Pain Disability Questionnaire: http://www.rehab.msu.edu/_files/_docs/Oswestry_ Low_Back_Disability.pdf http://www.rehab.msu.edu/_files/_docs/Oswestry_ Low_Back_Disability.pdf -The Patient-Specific Functional Scale: https://www.tac.vic.gov.au/files-to- move/media/upload/patient-specific.pdf https://www.tac.vic.gov.au/files-to- move/media/upload/patient-specific.pdf -DEPS: Depression Scale

26. ACTIVITIES -Carrying out daily routines -Handling stress and other psychological demands -Changing body position, Maintaining a body position -Transferring oneself -Lifting and carrying objects, Hand and arm use -Walking -Moving around, Moving around in different locations, Moving around using equipment -Using transportation, Driving -Washing oneself, Toileting, Dressing -Lookin after one’s health -Acquisition of goods and services, Preparing meals -Doing housework, Caring for household objects -Assisting others

27. … AND STRUCTURES -Spinal cord and related structures -Structure of pelvic region -Structure of lower extremity -Structure of trunk -Additional musculoskeletal structures related to movement

28. BODY FUNCTIONS … -Temperament and personality functions, Energy and Drive Functions -Sleep Functions -Emotional Functions -Experience of self and Time Functions -Proprioceptive functions -Sensation of Pain -Exercise tolerance functions -Urination functions -Sexual functions -Mobility of joint functions -Stability of joint functions -Mobility of bone functions -Muscle power functions -Muscle tone functions -Muscle endurance functions -Motor reflex functions -Gait pattern functions -Sensations related to muscles and movement functions

29. Pain Assessment -VAS: visual analogue scale and NRS: numeric rating scale (Kalso & Vainio, 2002) -Numeral scales 0 -100 (NRS 101) (Jensen 1986) -Face score (for children) -Self-report pain drawing (Vainio, Estlander 2002) -Pain glossary (Kalso & Vainio, 2002) Magee 2014, 4-13

30. 30

31. 31 GOAL SETTING CUSTOMERS EXPECTATIONS AND WISHES

32. References -WHO 2013. How to Use the ICF. A Practical Manual for using the International Classification of Functioning, Disability and Health (ICF). http://www.who.int/classifications/drafticfpracticalmanual2.pdf 20.4.2015 http://www.who.int/classifications/drafticfpracticalmanual2.pdf -WHO. 2014. Core Sets. http://www.icf-core-sets.org/en/page1.php 20.4.2015http://www.icf-core-sets.org/en/page1.php -Magee. 2014. Orthopedic Physical Assessment. 6th Edition. Elsevier Saunders, -O’Sullivan. 2005. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairment as underlying mechanism. Manual Therapy, 11(104), 242-255 -Luomajoki, Kool, de Bruin, Airaksinen. 2008. Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. BMC Musculoskeletal Disorders 9:170. http://www.biomedcentral.com/1471-2474/9/170 20.4.2015.http://www.biomedcentral.com/1471-2474/9/170 Pictures -Iltasanomat. 2015. http://www.iltasanomat.fi/muoti-kauneus/art-1428723393122.html 21.4.2015http://www.iltasanomat.fi/muoti-kauneus/art-1428723393122.html -MTV. 2011. http://www.mtv.fi/uutiset/kotimaa/artikkeli/istutko-hyvin-enta-liikaa-katso- taalta-mille-istuminen-altistaa/1926018 21.4.2015http://www.mtv.fi/uutiset/kotimaa/artikkeli/istutko-hyvin-enta-liikaa-katso- taalta-mille-istuminen-altistaa/1926018 -Turun sanomat. 2014. http://www.ts.fi/teemat/terveys/610634/Puutarhanhoito+on+liikuntaa+ja+rauhoittumista 21.4.2015 http://www.ts.fi/teemat/terveys/610634/Puutarhanhoito+on+liikuntaa+ja+rauhoittumista