1. Chair for Public Health and Health Service Research Applying the International Classification of Functioning, Disability and Health (ICF) in Hand Therapy Alexandra Rauch, PT, MPH Chair for Public Health and Health Service Research Ludwig-Maximilians-University, Munich, Germany 25.05.2013

2. Applying the ICF in hand therapy About the ICF Development of ICF Core Sets The ICF Core Sets for hand conditions – where are we now? The ICF Core Sets for hand conditions – what is next

3. 33 Hand conditions Wounds Fractures Tendon injuries Ruptures, strains and sprains of ligaments Nerv injuries Amputations Burns Allergies Carpal tunnel syndromes Complex regional pain syndrome Rhizarthrosis Injuries - Diseases About the ICF What do these diagnosis tell us about the lived experience of a person living with a hand condition?

4. 44 Activities Body Functions Body Structures Participation About the ICF Health Condition (disease, trauma) Environmental Factors Personal Factors Functioning - Disability

5. 55 Not able to work as goldsmith Difficulties with riding a bicycle Not able to play piano Difficulties to grab and hold big or heavy objects Difficulties with moving small objects with fingers Difficulties to lift objects Difficulties with washing hair and body Difficulties with cooking and cleaning the house Skin damage (scar) Reduced sensitivity Decrased muscle power Reduced joint movement Pain Activities Body Functions Body Structures Participation About the ICF Health Condition (disease, trauma) Environmental Factors Personal Factors Flexor tendon injury ICD 10: S 66.1 14 weeks ago 52 years old women, living alone Daughter and little grandchild Goldsmith, owner of jewelry store No assistive devices Support from daughter Physiotherapy 2/week

6. 66 Skin damage (scar) Reduced sensitivity Decrased muscle power Reduced joint movement Pain Not able to work as goldsmith Difficulties with riding a bicycle Not able to play piano Difficulties to grab and hold big or heavy objects Difficulties with moving small objects with fingers Difficulties to lift objects Difficulties with washing hair and body Difficulties with cooking and cleaning the house Health Condition (disease, trauma) Environmental Factors Personal Factors Flexor tendon injury ICD 10: S 66.1 14 weeks ago 52 years old women, living alone Daughter and little grandchild Goldsmith, owner of jewelry store No assistive devices Support from daughter Physiotherapy 2/week

7. 77 Activities Body Functions Body Structures Participation About the ICF Health Condition (disease, trauma) Environmental Factors Personal Factors Functioning Disability Can we standardize the information reagarding health and functioning???

8. 88 Joint use Family of International Classifications (FIC) DiseasesFunctioning/Disability About the ICF

9. ICF ICD Health condition Environmental factors Personal factors Body functions Body structures Activities Participation About the ICF

11. 11 Describing Functioning and Disability b11420 - b51059 s11000 - s76009 b1100 - b7809 s1100 - s8309 d1550 - d9309 e1100 - e5959 b110 - b899 s110 - s899 d110 - d999 e110 - e599 b1 – b8s1 – b8d1 – d9e1 – e5 ICF Contextual factors Body functions and Structures Activities and Participation Environmental factors Personal factors Functioning and Disability About the ICF The classification Structure

12. Chapter 1 MENTAL functions Chapter 2 SENSORY functions and PAIN Chapter 3 VOICE and SPEECH functions Chapter 4 Functions of the CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL and RESPIRATORY system Chapter 5 Functions of the DIGESTIVE, METABOLIC and ENDOCRINE system Chapter 6 GENITOURINARY and REPRODUCTIVE functions Chapter 7 NEUROMUSCULOSKELETAL and MOVEMENT-RELATED functions Chapter 8 Functions of the SKIN and RELATED STRUCTURES Body structures Body function Activities and Participation Environmental factors The classification Structure About the ICF

13. Chapter 1 MENTAL functions Chapter 2 SENSORY functions and PAIN Chapter 3 VOICE and SPEECH functions Chapter 4 Functions of the CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL and RESPIRATORY systems Chapter 5 Functions of the DIGESTIVE,METABOLIC and ENDOCRINE SYSTEMS Chapter 6 GENITOURINARY and REPRODUCTIVE functions Chapter 7 NEUROMUSCULOSKELETAL and MOVEMENT-RELATED functions Chapter 8 Functions of the SKIN and RELATED STRUCTURES Body structures Body function Activities and Participation Environmental factors About the ICF The classification Structure

14. Chapter 7 NEUROMUSCULOSKELETAL and MOVEMENT-RELATED functions Body structures Body function Activities and Participation Environmental factors 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 b755 Involuntary movement reaction functions b760 Control of voluntary movement functions b765 Involuntary movement functions b770 Gait pattern functions b780 Sensations related to muscles and movement functions About the ICF The classification Structure

15. Chapter 7 NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED functions Body structures Body function Activities and Participation Environmental factors b735 Muscle tone functions Functions related to the tension present in the resting muscles and the resistance offered when trying to move the muscles passively. Inclusions: functions associated with the tension of isolated muscles and muscle groups, muscles of one limb, one side of the body and the lower half of the body, muscles of all limbs, muscles of the trunk, and all muscles of the body; impairments such as hypotonia, hypertonia and muscle spasticity Exclusions: muscle power functions (b730); muscle endurance functions (b740) About the ICF The classification Structure

16. Chapter 7 NEUROMUSCULOSKELETAL and MOVEMENT-RELATED functions Body structures Body function Activities and Participation Environmental factors 310 493 384 253 b735 Muscle tone functions b7350 Tone of isolated muscles and muscle groups b7351 Tone of muscles of one limb b7352 Tone of muscles of one side of body b7353 Tone of muscles of lower half of body b7354 Tone of muscles of all limbs b7355 Tone of muscles of trunk b7356 Tone of all muscles of the body About the ICF The classification Structure

17. e135 Products and technology for personal use in daily life d850 Remunerative employment d440 Fine hand functions b730 Muscle power functions s730 Structure of the upper extremity Body structures Body function Activities and Participation Environmental factors 310 493 384 253 specify About the ICF The classification Structure

18. Body structures Body function Activities and Participation Environmental factors 310 493 384 253 1 MILD problem (slight, low,...) (5-24%) 3 SEVERE problem (high, extreme,...) (50-95%) 2 MODERATE problem (medium, fair...) (25-49%) 4 COMPLETE problem (total,...) (96-100%) 0NO problem (none, absent, negligible,...) (0-4%) b730.3 = Severe problems in muscle power functions The classification ICF Qualifier specify About the ICF evaluate

19. 19 Not able to work as goldsmith Difficulties with riding a bicycle Not able to play piano Difficulties to grab and hold big or heavy objects Difficulties with moving small objects with fingers Difficulties to lift objects Difficulties with washing hair and body Difficulties with cooking and cleaning the house Skin damage (scar) Reduced sensitivity Decrased muscle power Reduced joint movement Pain Health Condition (disease, trauma) Personal Factors Flexor tendon injury ICD 10: S 66.1 14 weeks ago 52 years old women, living alone Daughter and little grandchild Goldsmith, owner of jewelry store No assistive devices Support from daughter Physiotherapy 2/week b820.1 Repair functions of the skin b265.3 Touch funtions b730.3 Muscle power functions b710.3 Mobility of joint functions b280.2 Sensation of pain d4401.3 Grasping d4402.3 Manipulating d4300.2 Lifting d5100.2 Washing body d630.1 Preparing meals d6402.2 Cleaning living area d850.4 Remunerative employment d4750.4 Driving human powered transportation d9202.4 Arts and culture e1151.4 Assistive products and technology for personal use in daily living e310+3 Support from family e5800+1 Health services

20. 20 Flexor tendon injury ICD 10: S 66.1 14 weeks ago b820.1 Repair functions of the skin b265.3 Touch funtions b730.3 Muscle power functions b710.3 Mobility of joint functions b280.2 Sensation of pain d4401.3 Grasping d4402.3 Manipulating d4300.2 Lifting d5100.2 Washing body d630.1 Preparing meals d6402.2 Cleaning living area d850.4 Remunerative employment d4750.4 Driving human powered transportation d9202.4 Arts and culture e1151.4 Assistive products and technology for personal use in daily living e310+3 Support from family e5800+1 Health services 01234

21. Number of ICF categories ICF Qualifier Body structures Body function Activities and Participation Environmental factors 310 493 384 253 About the ICF The classification Very comprehensive Facilitates profiles Reliability?

22. Body structures Body function Activities and Participation Environmental factors 310 493 384 253 About the ICF The classification "To be useful, practical ICF based tools need to be tailored to the need of the users without forgoing the information needed for health statistics and health reporting“ Dr. Bedirhan Üstün WHO Classification Office Director 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.

23. s110 s120 s130 s430 s510 s710 … b110 b114 b117 b130 b152 b144 b730... d110 d240 d410 d415 d520 d630 d920 … e110 e115 e120 e125 e130 e150 … s110 s430 s710 b110 b130 b152 b730 d240 d410 d415 d920 e110 e120 e130 Body structures Body function Activities and Participation Environmental factors 310 493 384 253 Comprehensive ICF Core Set Brief ICF Core Set Development of ICF Core Sets

24. Empirical study (Patient data) Qualitative study (Patient interviews) Systematic Review (Scientific literature) Expert Survey (Multiprofessional) International Consensus- Conference ICF Core Sets (Comprehensive and Brief) TIME Testing & Validation Development of ICF Core Sets Preliminary studiesDecisionValidation

25. Development of ICF Core Sets

26. Developed from 2008 to 2010 Applicable in hand injuries and hand diseases 117 categories in the Comprehensive ICF Core Set 23 categories in the Brief ICF Core Set The ICF Core Sets for hand conditions – where are we now?

27. Empirical study (Patient data n=210) Qualitative study (Patient interviews n=59) Systematic Review (Scientific literature) Expert Survey (Multiprofessional n=162 International Consensus- Conference ICF Core Sets (Comprehensive and Brief) Validation of the ICF Core Sets for Hand Conditions in Germany 2008/2009 05/2009 20102012-2015 Preliminary studiesDecisionValidationImplementation The ICF Core Sets for hand conditions – where are we now?

28. 28 Brief ICF Core Set for Hand conditions Body structures s120 Structure of the spinal cord and related structures s720 Structure of shoulder region s730 Structure of the upper extremity Activity and Participation d230 Carry out daily routine d430 Lifting and carrying objects d440 Fine hand functions d445 Hand and arm use d5 Self-care d6 Domestic life d7 Interpersonal interactions and relationships d840-d859 Remunerative employment Body functions b152 Emotional functions b265 Touch function b270 Sensory functions related to temperature and other stimuli b280 Sensation of pain b710 Mobility of joint functions b715 Stability of joint functions b730 Muscle power functions b760 Control of voluntary movement functions b810 Protective functions of the skin Environmental factors e1 Products and technology e3 Support and relationships e5 Services, systems and policies

29. 29 Comprehensive ICF Core Set for Hand conditions Body structures s120 Structure of the spinal cord and related structures s410 Structure of cardiovascular system s710 Structure of head and neck region s720 Structure of shoulder region s730 Structure of the upper extremity s7300 Structure of upper arm s7301 Structure of forearm s7302 Structure of hand s770 Additional musculoskeletal structures related to movement s810 Structure of areas of skin s830 Structure of nails

30. 30 Comprehensive ICF Core Set for Hand conditions Body functions b134 Sleep functions b152 Emotional functions b1801 Body image b260 Proprioceptive functions b265 Touch functions b270 Sensory functions related to temperature and other stimuli b2700 Sensitivity to temperature b2701 Sensitivity to vibration b2702 Sensitivity to pressure b2703 Sensitivity to a noxious stimulus b280 Sensation of pain b415 Blood vessel functions

31. 31 Comprehensive ICF Core Set for Hand conditions Body functions b710 Mobility of joint functions b7100 Mobility of a single joint b7101 Mobility of several joints b715 Stability of joint functions b720 Mobility of bone functions b730 Muscle power functions b7300 Power of isolated muscles and muscle groups b7301 Power of muscles of one limb b735 Muscle tone functions b740 Muscle endurance functions b760 Control of voluntary movement functions b765 Involuntary movement functions b780 Sensations related to muscles and movement functions

32. 32 Comprehensive ICF Core Set for Hand conditions Body functions b810 Protective functions of the skin b820 Repair functions of the skin b830 Other functions of the skin b840 Sensations related to the skin b860 Functions of nails

33. 33 Comprehensive ICF Core Set for Hand conditions Activity and Participation d170 Writing d230 Carry out daily routine d360 Using communcation devices and techniques d410 Changing basic body positions d420 Transferring oneself d430 Lifting and carrying objects d440 Fine hand functions d4400 Picking up d4401 Grasping d4402 Manipulating d4403 Releasing d4408 Fine hand use, other specified

34. 34 Comprehensive ICF Core Set for Hand conditions Activity and Participation d445 Hand and arm use d4450 Pulling d4451 Pushing d4452 Reaching d4453 Turning or twisting the hands or arms d4454 Throwing d4455 Catching d4458 Hand and arm use, other specified d455 Moving around d465 Moving around using equipment d470 Using transportation d475 Driving

35. 35 Comprehensive ICF Core Set for Hand conditions Activity and Participation d5 Self-care d510 Washing oneself d520 Caring for body parts d530 Toileting d540 Dressing d550 Eating d560 Drinking d570 Looking after one´s health d6 Domestic life d620 Acquisition of goods and services d630 Preparing meals d640 Doing housework d650 Caring for household objects d660 Assisting others

36. 36 Comprehensive ICF Core Set for Hand conditions Activity and Participation d7 Interpersonelle Interaktionen und Beziehungen d810 – d839 Education d840-d859 Work and employment d920 Recreation and leisure

37. 37 Comprehensive ICF Core Set for Hand conditions Environmental factors e1 Products and technology e110 Products or substances for personal consumption e115 Products and technology for personal use in daily living e120 Products and technology for personal indoor and outdoor mobility and transportation e125 Products and technology for communication e130 Products and technology for education e135 Products and technology for employment e140 Products and technology for culture, recreation and sport 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 e165 Assets

38. 38 Comprehensive ICF Core Set for Hand conditions Environmental factors e225 Climate e3 Support and relationships e310 Immediate family e315 Extended family e320 Friends e325 Acquaintances, peers, colleagues, neighbours and community members e330 People in positions of authority e335 People in subordinate positions e340 Personal care providers and personal assistants e345 Strangers e355 Health professionals e360 Other professionals

39. 39 Comprehensive ICF Core Set for Hand conditions Environmental factors e410 Individual attitudes of immediate family members e420 Individual attitudes of friends e425 Individual attitudes of acquaintances, peers, colleagues, neighbours and community members e430 Individual attitudes of people in positions of authority e440 Individual attitudes of personal care providers and personal assistants e445 Individual attitudes of strangers e450 Individual attitudes of health professionals e455 Individual attitudes of other professionals e460 Societal attitudes e465 Social norms, practices and ideologies

40. 40 Comprehensive ICF Core Set for Hand conditions Environmental factors e5 Services, systems and policies e525 Housing services, systems and policies e530 Utilities services, systems and policies e535 Communication services, systems and policies e540 Transportation services, systems and policies e550 Legal services, systems and policies e555 Associations and organizational 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 Labour and employment services, systems and policies

41. The ICF Core Sets for hand conditions – where are we now? How to implement the ICF Core Sets for hand condition in clinical practice?

42. ICF Core Sets - Manual for Clinical Practice Eds: J. Bickenbach, A. Cieza, A. Rauch, G. Stucki Hogrefe 2012 The ICF Core Sets for hand conditions – where are we now?

43. The ICF Core Sets for hand condition Implementation

44. 1.Select ICF categories from the ICF Core Set for hand conditions 1.Select appropriate measures to assess functioning 1.Coordinate assessment 2.Report on functioning The ICF Core Sets for hand conditions – where are we now? The ICF Core Sets for hand condition Implementation What to measure? How to measure? Who to measure? What to report?

45. 1.Select ICF categories from the ICF Core Set for hand conditions The ICF Core Sets for hand conditions – where are we now? The ICF Core Sets for hand condition Implementation What to measure?

46. Use categories from the Brief ICF Core Set...... and select additional ICF categories from the Comprehensive ICF Core Set if necessary The ICF Core Sets for hand conditions – where are we now? 1. Select ICF categories from the ICF Core Set for hand conditions

47. Brief ICF Core SetComprehensive ICF Core Set d230 Carry out daily routine d360 Using communcation devices and techniques d430 Lifting and carrying objects d440 Fine hand functionsd4400 Picking up d4402 Manipulating d445 Hand and arm use d5 Self-cared510 Washing oneself d540 Dressing d6 Domestic life d7 Interpersonal interactions and relationships The ICF Core Sets for hand conditions – where are we now? 1. Select ICF categories from the ICF Core Set for hand conditions

48. 2.Select appropriate measures to assess functioning The ICF Core Sets for hand conditions – where are we now? The ICF Core Sets for hand condition Implementation How to measure?

49. The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning  Patient-reported questionnaire (DASH)  Questioning of the patient (patient history)  Clinical examination  Observation of the patient  Standardized tests  Technical examination (X-Ray, CT, ENG, etc.) PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation

50. Systematic literature review Consensus conference ICF categoriesAssessment (PRQ/PH/CE/TI) 3 Body structures 14 9 Body functions 25 8 Activities and Participation 25 3 Environmental factors 15 National expert survey Survey DGUV The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning

51. ICF categorySourceSpecification PRQPHCETI s120 Structure of the spinal cord and related structures  X-Ray, CT, ENG, etc. s720 Structure of shoulder region --- s730 Structure of the upper extremity  Circumferential measure, Volumetry / X-Ray, CT, etc. PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning Body structures

52. s730 Structure of the upper extremity – Bones s730 Structure of the upper extremity - Swallowing PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation Technical investigation (e.g. X-Ray) Circumferential measure The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning

53. ICF categorySourceSpecification PRQPHCETI b152 Emotional functions  PHQ-9, GAD-7, IES-R / Questioning b265 Touch function  Ten-Test, Object identi- fication (Moberg Test) b270 Sensory functions related to temperature and other stimuli  2-Point-Discrimination, Pin- prick, Cold-Warm- Discrimination b280 Sensation of pain  Numeric Rating Scale b710 Mobility of joint functions  Goniometer, Finger-nail- Table-Distance, Fingertip- Palmar-Distance b715 Stability of joint functions  Stability-Tests b730 Muscle power functions  Dynamometer, Pinch gauge b760 Control of voluntary movement functions  Observation, Purdue Pegboard Test The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning Body functions

54. b265 Touch functions b280 Sensation of pain b730 Muscle power functions PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation Object identification (Moberg Test) NRS Scale Dynamometer The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning

55. ICF categorySourceSpecification PRQPHCETI d230 Carry out daily routine  Questioning d430 Lifting and carrying objects  Observation, Selected tests from EFC d440 Fine hand functions  DASH items 2, 3 / Pick up Test (Moberg Test) d445 Hand and arm use  Observation, Selected tests from EFC d5 Self-care  DASH items 13, 14, 15 d6 Domestic life  DASH items 4, 7, 8, 9 d7 Interpersonal interactions and relationships  Questioning d840-d859 Remunerative employment  DASH Work module / Work profile, EFC PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning Activities and participation

56. PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation d440 Fine hand functions d445 Hand and arm use d5 Self-care Pick up test (Moberg Test) DASH Item Please rate your ability to do the following activities in the last week by circling the number below the appropriate response. No difficultiy Mild difficulty Moderate di fficulty Severe difficulty Unable 13Wash or blow dry your hair12345 14Wash your back12345 15Put on a pullover sweater12345 DASH items The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning Evaluation functional capacity

57. ICF categorySourceSpecification PRQPHCETI e1 Products and technology  Questioning e3 Support and relationships  Questioning e5 Services, systems and policies  Questioning PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning Environmental factors

58. PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation e1 Products and technology e3 Support and relationships The ICF Core Sets for hand conditions – where are we now? 2. Select appropriate measures to assess functioning Questioning

59. 3.Coordinate assessment The ICF Core Sets for hand conditions – where are we now? The ICF Core Sets for hand condition Implementation Who to measure?

60. Create intervention table: The ICF Core Sets for hand conditions – where are we now? 3. Coordinate assessment ICF categoryAssessmentResponsibility s730 Structure of the upper extremityX-RayMD b152 Emotional functionsQuestioning, PRQMD, Psychologist b270 Sensory functions related to temperature and other stimuli 2-Point-Discrimina- tion, Pin-prick, Cold-Warm- Discrimination MD b710 Mobility of joint functionsGoniometer, Pinch Gauge PT/OT d440 Fine hand functionsPick up testPT/OT e3 Support and relationshipsQuestioningMD

61. 4. Report on functioning The ICF Core Sets for hand conditions – where are we now? The ICF Core Sets for hand condition Implementation What to report?

62. The ICF Core Sets for hand conditions – where are we now? 4. Report on functioning

63. www.icf-casestudies.org The ICF Core Sets for hand conditions – where are we now?

64. http://www.icf-core-sets.org/index.php The ICF Core Sets for hand conditions – where are we now?

70. The ICF Core Sets for hand conditions – what is next?

71. 90 80 0 10 20 30 40 50 60 70 100 No problem Complete problem Functioning Disability Development of functioning scores Cieza A et al. The International Classification of Functioning, Disability, and Health could be used to measure functioning. J Clin Epidemiol 2009; 62: 899-911 Grill E et al. Scales could be developed based on simple clinical ratings of ICF Core Set categories. J Clin Epidemiol 2009; 62: 891-898 The ICF Core Sets for hand conditions – what is next?

72. Which ICF Categories should be included in a functioning score? b110 Consciousness functions b210 Seeing functions b310 Vice functions b410 Heart functions b510 Ingestion functions b610 Urinary excretory functions b710 Mobility of joint functions b810 Protective functions of the skin … Body functions s110 Structure of brain s210 Structure of eye socket s310 Structure of nose s410 Structure of cardiovascular system s510 Structure of salivary glands s610 Structure of urinary system s710 Structure of head and neck region s810 Structure of areas of skin … Body structures d110 Watching d210 Undertaking simple tasks d310 Communicating with –receiving – spoken messages d410 Changing basic body positions d510 Washing oneself d610 Acquiring a place to live d710 Basic interpersonal interactions d810 Informal education … Activity & Participation  Method The ICF Core Sets for hand conditions – what is next?

73. Method: Identify ICF categories that explain functioning! Example: d525 Defecation functions Example: What explains functioning in persons with spinal cord injury = good fitting The ICF Core Sets for hand conditions – what is next?

74. Example: d550 Eating = poor fitting The ICF Core Sets for hand conditions – what is next? Method: Identify ICF categories that explain functioning! Example: What explains functioning in persons with spinal cord injury

75. Functioning score 0 10 20 30 40 50 60 70 80 90 100 Disability Cieza A et al. The International Classification of Functioning, Disability, and Health could be used to measure functioning. J Clin Epidemiol 2009; 62: 899-911 The ICF Core Sets for hand conditions – what is next?

76. 1 0 2 3 4 90 80 0 10 20 30 40 50 60 70 100 The ICF Core Sets for hand conditions – what is next? „Translate“ assessment results

77. Cieza A et al. Items from patient-oriented instruments can be integrated into interval scales to operationalize categories of the ICF. J Clin Epidemiol 2009; 62: 912-921 90 80 0 10 20 30 40 50 60 70 100 1 (5-24%)MILD problem (slight, low,...) 3 (50-95%)SEVERE problem (high, extreme,...) 2 (25-49%)MODERATE problem (medium, fair...) 4 (96-100%)COMPLETE problem (total,...) 0(0-4%)NO problem (none, absent, negligible,...) The ICF Core Sets for hand conditions – what is next?

78. Which ICF Categories should be included in a disability score?  Purpose driven: Ministry level Service provision level Professional level b110 Consciousness functions b210 Seeing functions b310 Vice functions b410 Heart functions b510 Ingestion functions b610 Urinary excretory functions b710 Mobility of joint functions b810 Protective functions of the skin … s110 Structure of brain s210 Structure of eye socket s310 Structure of nose s410 Structure of cardiovascular system s510 Structure of salivary glands s610 Structure of urinary system s710 Structure of head and neck region s810 Structure of areas of skin … d110 Watching d210 Undertaking simple tasks d310 Communicating with –receiving – spoken messages d410 Changing basic body positions d510 Washing oneself d610 Acquiring a place to live d710 Basic interpersonal interactions d810 Informal education … Body functions Body structures Activity & Participation The ICF Core Sets for hand conditions – what is next?

79. 79 Flexor tendon injury ICD 10: S 66.1 14 weeks ago b265.3 Touch funtions b730.3 Muscle power functions b710.3 Mobility of joint functions b280.2 Sensation of pain d440.3 Fine hand function d4300.2 Hand and arm use d630.1 Preparing meals d850.4 Remunerative employment d4750.4 Driving human powered transportation 01234 0 10 20 30 40 50 60 70 80 90 100 Functioning

80. Purpose: To monitor service provision  Health condition specific  Selection from health condition specific ICF Core Sets Service provision level b110 Consciousness functions b210 Seeing functions b310 Vice functions b410 Heart functions b510 Ingestion functions b610 Urinary excretory functions b710 Mobility of joint functions b810 Protective functions of the skin … Body functions s110 Structure of brain s210 Structure of eye socket s310 Structure of nose s410 Structure of cardiovascular system s510 Structure of salivary glands s610 Structure of urinary system s710 Structure of head and neck region s810 Structure of areas of skin … Body structures d110 Watching d210 Undertaking simple tasks d310 Communicating with –receiving – spoken messages d410 Changing basic body positions d510 Washing oneself d610 Acquiring a place to live d710 Basic interpersonal interactions d810 Informal education … Activity & Participation The ICF Core Sets for hand conditions – what is next?

81. 81 Flexor tendon injury ICD 10: S 66.1 14 weeks ago b820.1 Repair functions of the skin b265.3 Touch funtions b730.3 Muscle power functions b710.3 Mobility of joint functions b280.2 Sensation of pain d4401.3 Grasping d4402.3 Manipulating d4300.2 Lifting d5100.2 Washing body d630.1 Preparing meals d6402.2 Cleaning living area d850.4 Remunerative employment d4750.4 Driving human powered transportation d9202.4 Arts and culture 01234 0 10 20 30 40 50 60 70 80 90 100 Activities and Participation 0 10 20 30 40 50 60 70 80 90 100 Body functions and structures

82. Purpose: To measure functioning in relation to intervention goals  Health condition specific  From health condition specific ICF Core Sets Professional level Body functions Activity & Participation Body structures Body functions Activity & Participation Body structures Body functions Activity & Participation Body structures Body functions Activity & Participation Body structures Body functions Activity & Participation Body structures Self-care Mobility Employment Social life Education The ICF Core Sets for hand conditions – what is next?

84. Thank you very much for your attention! alexandra.rauch@med.uni-muenchen.de