1. Application of the ICF model in clinical and rehabilitation settings: Presentation of MHADIE results
Dr. José Luis Ayuso-Mateos
Professor of Psychiatry
Universidad Autónoma de Madrid , Spain
WP4 Leader

2. General Objetives
Use the functioning and disability model of the ICF to analyze health surveys in the general population and existing statistics about education.
Demonstrate how the ICF model is appropriate for describing disability patterns in the clinical population.
Demonstrate ICF validity and usefulness in compiling educational databases.
Formulate recommendations for the development of health and social policies in the UE.

3. How do we measure the impact of disease?

4. 2000
2000

5. EURO: Top Ten DALYs 2000 1. Ischaemic heart disease 10.5%
Cerebrovascular disease
6.8%
Unipolar depressive disorders
6.1%
Alzheimer and other dementias
3.0%
Alcohol use disorders
2.9%
Hearing loss, adult onset
2.6%
COPD
2.4%
Road traffic accidents
Osteoarthritis
10. Self-inflicted injuries
2.3%

6. Need for instruments that use the biopsychosocial model in the assesment of functioning and disability

7. ICF TOOLS
Full Version of ICF
ICF Checklist
WHO-DAS II
ICF Core Sets

8. ICF Checklist
Selection of the most relevant ICF categories (169 from 1494):
Alterations in:
body functions
body structures
Activities and participation
Environmental factors
Other information about environment
Used by:
clinical
patients / relatives
researchers

9. WHO-DAS II Assesses 6 domains: Understanding and communication
Getting around
Self-care
Interpersonal interactions and relationships
Daily activities
Participation

10. WP 4: Application of the ICF model in clinical and rehabilitation settings
Objectives
To demonstrate the applicability of ICF-linked measurement instruments, the ICF Checklist and the WHODAS II in a variety of clinical settings and by different professionals
To evaluate the quality of care in patient clinical settings by using functioning levels as outcome indicators in a range of clinical conditions
To evaluate disability profiles obtained from ICF-linked assessment instruments

11. WP4 Participants involved
Statistical centres
IMIM
ARS
WHO
Clinical and rehabilitation centres
UAM
Instituto Nazionale Neurologico
Ludwig-Maximilians Uni
Charles Uni.
Rehabilitation Institute Slovenia
Malarden University
AA A total of 74 researchers

12. ICF Reumathology Psychiatry Neurology Rehabilitacion Cardiology
Reumathoid Dis
Musculoskeletal Dis
Bipolar Dis.
Depressión
Reumathology
Psychiatry
Neurology
ICF
Rehabilitacion
Cardiology
Parkinson
M. Sclerosis
Migraine
Ischaemic
Coronary
disease
Stroke
Brain injury

13. ICF in clinical and rehabilitation settings N = 1200 patients
Rheumathoid Arthritis
Musculoeskeletal diseases
Multiple sclerosis
Traumatic Brain Injury
Stroke
Unipolar Depression
Bipolar Disorder
Migraine
Parkinson Disease
Musc conditions
Ischaemic Heart Disease

14. Design: multicentre, transversal and longitudinal study
METHOLOGY
Design: multicentre, transversal and longitudinal study
Dependent Variable:
Functioning and disability (defined by the ICF model)
Common Instruments for evaluation:
Sociodemografic characteristics
ICF-Checklist
WHODAS-II
SF-36
Disease-specific instruments for evaluation
Time points of assessment:
Baseline assessment
6 weeks
3 months

15. ICF Checklist and WHODAS II have good psychometric properties
Objective 1: To demonstrate the validity and applicability of ICF-linked measurement instruments, the ICF Checklist and the WHODAS II in a variety of clinical settings
ICF Checklist and WHODAS II have good psychometric properties
Structural validity indicates that they are closely related to the underlying conceptual model (ICF)
They have sensibility to change

16. RESULTS:Depression sample treated in Primary Care
Evolution of symptomatology after 6 weeks and 3 months:
Clinical remission: 53.8% at 6 weeks and 71.8% at 3 months

17. Overall and Individual Fitted Regression Lines For the Whole Sample (unipolar depression N=97)

18. Within Variance

19. Between Variance

20. Objective II : To evaluate the quality of care in patient clinical settings by using functioning levels as outcome indicators in a range of clinical conditions

21. DEPRESSION
NORMAL MOOD
MANIA
HYPOMANIA
MIXED EPISODE
More than 6 months

22. Euthymic patients Functioning was impaired in at least 35 ICF categories in more than 75% of participants

23. The gap between clinical recovery and functional recovery

24. Euthymic patients Environmental Factors
facilitators
barriers
attitudes of immediate family members and friends
social norms
practices and ideologies
health services, systems and policies
health professional
support of family members and friends

25. Objective III: To evaluate disability profiles obtained from ICF-linked assessment instruments

26. Difference in proportions of Capacity, Performance, Barriers and Facilitators code counts for two Stroke patients compared with the average Stroke group profile

27. Uses of disability profiles
Identifying gaps between Capacity and Performance
Performance
Capacity
= positive effect of environment

29. Uses of disability profiles
Identifying gaps between Capacity and Performance
Performance
Capacity
= negative effect of environment

31. Recommendation 1
Diagnoses alone are not sufficient in clinical settings to guide care and management. MHADIE researchers recommend that the ICF model and its related instruments be used as complementary tools for:
define person’s functioning
identifying patient’s needs
planning interventions, and evaluating clinical outcomes

32. Recommendation 2 Since MHADIE data have shown that the
ICF notions of the patient’s capacity and
performance play a crucial role in explaining
the impact of a health condition on the
person’s life, in a reliable and valid manner,
MHADIE researchers recommend that
ICF-based clinical instruments be developed
for routine clinical use in order to assess
both capacity and performance.

33. Recommendation 3
MHADIE research shows that environmental factors have an influence on patient’s
performance independent of their capacity, MHADIE researchers therefore recommend
that these factors be taken in account when assessing and planning clinical as
well as social interventions.
environmental factors should be taken into account when assessing and planning all interventions, both medical and social

34. Recommendation 4 MHADIE researchers recommend that the
impact of disability must be assessed, not
merely at the clinical level, but also at the level
of the person’s social and economic participation.
MHADIE project proves that information about interpersonal interactions, major life areas and community and social life, can be successfully collected and evaluated.

35. Recommendation 5
MHADIE researchers recommend that, in the clinical setting, the ICF model be used as a common language across levels of care and for different intervention purposes (prevention, treatment, rehabilitation, public health);
ICF is useful as a common language
across professions and for collecting information for multidisciplinary treatment.