ICF Clinical Data Collection Tool: What to Report

Stucki G, Gutenbrunner C, Giustini A,on behalf of the international effort under an activity

in the ISPRM-WHO’s Collaboration Plan, spearheaded by the Chinese Association of Rehabilitation Medicine (CARM),

the Italian Society of Physical Medicine and Rehabilitation (SIMFER), and the UEMS-PRM Section, and coordinated by the ICF Research Branch at Swiss Paraplegic Research

• WHO´s paradigm shift and the ICF– A unique opportunity to strengthen

Rehabilitation and PRM

• ICF the reference system for describing, understanding and influencing health– Thanks to tools that have been developed, the

ICF is now ready for implementation

• System-wide implementation of the ICF– A call for action to all national societies!

WHO’s Mandate

Normative, aspirational

“…health is a state of complete physical, mental and social well-being and not merely the absence of disease

or infirmity…”Preamble to the Constitution of the World Health Organization April 1948.

The Definition has not been amended since 1948

WHO’s Paradigm Shift

• Traditional focus–compression of morbidity

• “absence of disease or infirmity”

• New focus–optimal functioning

• “complete physical, mental and social well-being”

With the new ICF-lens we can now studyhow to describe, understand and influence

1. the lived experience of health and its determinants2. the social translation of biological health into lived health3. The response by the society to functioning needs

Declaration of Alma-Ata Expresses the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by year 2000.By ‘…address[ing] the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly…’

http://www.who.int/publications/almaata_declaration_en.pdf

Rethinking the Health Strategies in light of the ICF

Rethinking the Health Strategiesin light of ICF

Strategy Health Goal Indicator Classification

Preventive Disease prevention Morbidity ICDPromotive Opt. biological health ICF-Capacity ICFCurative Disease control Mortality ICD

ICF Capacity ICFRehabilitative Optimal functioning ICF Capacity & Performance ICFSupportive Optimal lived health ICF Performance ICFPalliative Well-being Quality of Life ?

Stucki G. The Olle Höök Lectureship 2015: WHO’s Paradigm Shift and the Implementation of the ICF in Rehabilitation. J Rehab Med 2016; 48:486-493.

21th Century - the Rehabilitative Strategy

The goal Optimal functioning

Health Strategies a historical perspective

2001World Health

Assembly endorses the International Classification of

Functioning, Disability and Health

(ICF)

2011World Reporton Disability

(WRD)

2013International

Perspectives onSpinal Cord Injury

(IPSCI)

2014Global Disability

Action Plan2014–2021: Better

health for all people with disability

(GDAP)

2015Learning Health

System for Spinal Cord Injury

and International SCI

Survey (INSCI)

2006, Convention on the Rights of Persons with Disabilities (CRPD)

WHO Taking Action

PRMThe Medicine of Functioning

Functioning Properties

A first step to introduce ICD users to functioning as an essential component of health

Functioning Properties can inform the diagnosis and trigger a more comprehensive assessment of functioning

assessment__________

____________________

Physician‘s diagnosis

PT assessment__________

____________________

Additional Tests

Rehabilitation has the aim of supporting peoples’

independent living and their autonomy and takes a holistic

approach to facilitate this.” (White Book – UEMS-PRM)

Section of Physical and Rehabilitation Medicine Union Européenne des Médecins Spécialistes (UEMS); European Board of Physical and Rehabilitation Medicine; Académie Européenne de Médecine de Réadaptation; European Society for Physical and Rehabilitation Medicine. White book on physical and rehabilitation medicine in Europe. Eura Medicophys. 2006; 42(4): 292-332.

Objective 2To strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation

Objective 3To strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services2

World Health Organization. WHO Global Disability Action Plan 2014-2021: Better health for all people with disability. Sixty-seventh World Health Assembly 4 April 2014: World Health Organization; 2014Available from: http://www.who.int/disabilities/actionplan/en/

WHO-ISPRM Collaboration Planfor 2015-2017

World Health Organization (WHO) & International Society of Physical and Rehabilitation Medicine (ISPRM). WHO-ISPM Collaboration Plan 2015-2017. Unpublished document. 2015.

ICF the reference systemfor describing, understanding and influencing functioning

15

Functioning Diagnosis

1. What to document, for Whom and When– Clinical Assessment Schedule

2. How to assess– ICF-based Data Collection Tools

3. How to report– Raw Data– Interval Scale Metric

Clinical Assessment Schedule• Option 1 – “From the shelf”

– Select a Model Rehabilitation Service• developed by the UEMS PRM Section and Board• includes a Model Clinical Assessment Schedule

Clinical Assessment Schedule• Option 2 – “Custom-made”

– Describe your Rehabilitation Service• Characterize your Patient Population(s)• Specify the Time Point(s) for assessment• Select relevant Brief ICF Core Sets

– for each Time Point and Patient Population– recommend including the ICF Generic Set (7 Categories)– add ICF Categories from Comprehensive ICF Core Sets

4 Steps for the Standardized Description of Functioning based on the ICF

1. What ICF domains to document• ICF Generic Set and ICF Rehabilitation Set• ICF Core Sets for specific health conditions

2. What perspective to choose?• Capacity or Performance

3. What data collection tools to apply• Current health status instruments• ICF-based data collection tools

4. What approach to use for reporting• Transformation into a common metric • Specific approach for a data collection tool

German Italian Spanish

ICF Core Sets

Chinese Japanese Korean

EnglishWHOhttp://www.who.int/classifications/icf/en/ICF Research Branchhttp://www.icf-research-branch.org/

Endorsed by ISPRM 2009

“The ICF serves as practical lens through which we can observe the lived experience of health in a way that is meaningful and useful to

practitioners who aim to optimize functioning of individual patients, policy-makers who aim to shape the health system in response to

persons’ functioning needs, and researchers who aim to explain and influence functioning.”

Minimum standard for collecting data on functioning

Stucki G. Olle Höök lectureship 2015: The World Health Organization's paradigm shift and implementation of the ICF in rehabilitation. J Rehabil Med. 2016; 48: 486-493.Cieza A, Oberhauser C, Bickenbach J, Chatterji S, Stucki G. Towards a minimal generic set of domains of functioning and health. BMC Public Health. 2014;14(1):218.

ICF Rehabilitation Set 9 categories from Body Functionsb130 Energy and drive functions (G)

b134 Sleep functions

b152 Emotional functions (G)

b280 Sensation of pain (G)

b455 Exercise tolerance functions

b620 Urination functions

b640 Sexual functions

b710 Mobility of joint functions

b730 Muscle power functions

21 categories from Activities & Participationd230 Carrying out daily routine (G)

d240 Handling stress and other psychological demands

d410 Changing basic body position

d415 Maintaining a body position

d420 Transferring oneself

d450 Walking (G)

d455 Moving around (G)

d465 Moving around using equipment

d470 Using transportation

d510 Washing oneself

d520 Caring for body parts

d530 Toileting

d540 Dressing

d550 Eating

d570 Looking after one's health

d640 Doing housework

d660 Assisting others

d710 Basic interpersonal interactions

d770 Intimate relationships

d850 Remunerative employment (G)

d920 Recreation and leisure

Minimal Set of Environmental Factors

Can be used to complement the ICF Generic and Rehabilitation

Sets

Prodinger B, Cieza A, Oberhauser C, Bickenbach J, TB Üstün, Chatterji S, Stucki G: Toward the ICF Rehabilitation Set: A minimal generic set of domains for rehabilitation as a health strategy. Archives of Physical Medicine and Rehabilitation 2016; 97(6): 875-884.

Simple, Intuitive Description

Selb M, Gimigliano F, Prodinger B, Stucki G, Pestelli G, Iocco M, Boldrini B. Toward an International Classification of Functioning, Disability and Health clinical data collection tool: The Italian experience of developing simple, intuitive descriptions of the Rehabilitation Set categories. Manuscript submitted for publication. ICF Research Branch, Chinese Association of Rehabilitation Medicine, Nanjing Medical University, First Affiliated Hospital of Nanjing of Nanjing Medical University. Assessing functioning in routine clinical practice. Manual on applying the ICF Generic Set in practical assessments. Manual in development; 2016.

Simple, intuitive descriptions can be used together with a Numeric Rating Scale (NRS)

in routine clinical practice

Assessing Functioning in Routine Clinical Practice

ICF-based reporting of data collected with various instruments

on a common metricMobility items

No problem Complete problem

No problem Complete problem

Self-Care items

“Having functioning information available in a systematic way will ensure that this information is available to all

stakeholders in the health system, who can, in turn, use it to inform their decision-making at the clinical as well as

management level, and ultimately contribute to optimizing the quality of care.”

National Rehabilitation Quality Management (NRQM)

Systems

Prodinger B, Reinhardt J, Selb M, Stucki G, Yan T, Zhang X, Li J. Toward the system-wide implementation of the ICF in routine practice: Developing simple, intuitive descriptions of ICF categories in the ICF Generic and Rehabilitation Set. J Rehabil Med. 2016; 48(6): 508-514.

System-wide Implementation of the ICF

Call to all National societiesto join the efforts of ISPRM and WHO

1. Section of Physical and Rehabilitation Medicine Union Européenne des Médecins Spécialistes (UEMS); European Board of Physical and Rehabilitation Medicine; Académie Européenne de Médecine de Réadaptation; European Society for Physical and Rehabilitation Medicine. White book on physical and rehabilitation medicine in Europe. Eura Medicophys. 2006; 42(4): 292-332.

2. World Health Organization. WHO Global Disability Action Plan 2014-2021: Better health for all people with disability. Sixty-seventh World Health Assembly 4 April 2014: World Health Organization; 2014; Available from: http://www.who.int/disabilities/actionplan/en/

3. World Health Organization (WHO) & International Society of Physical and Rehabilitation Medicine (ISPRM). WHO-ISPM Collaboration Plan 2015-2017. Unpublished document. 2015.

4. Stucki G. Olle Höök lectureship 2015: The World Health Organization's paradigm shift and implementation of the ICF in rehabilitation. J Rehabil Med. 2016; 48: 486-493.

5. Cieza A, Oberhauser C, Bickenbach J, Chatterji S, Stucki G. Towards a minimal generic set of domains of functioning and health. BMC Public Health. 2014;14(1):218.

6. Prodinger B, Cieza A, Oberhauser C, Bickenbach J, TB Üstün, Chatterji S, Stucki G: Toward the ICF Rehabilitation Set: A minimal generic set of domains for rehabilitation as a health strategy. Archives of Physical Medicine and Rehabilitation 2016; 97(6): 875-884.

7. Prodinger B, Reinhardt J, Selb M, Stucki G, Yan T, Zhang X, Li J. Toward the system-wide implementation of the ICF in routine practice: Developing simple, intuitive descriptions of ICF categories in the ICF Generic and Rehabilitation Set. J Rehabil Med. 2016; 48(6): 508-514.

8. Selb M, Gimigliano F, Prodinger B, Stucki G, Pestelli G, Iocco M, Boldrini B. Toward an International Classification of Functioning, Disability and Health clinical data collection tool: The Italian experience of developing simple, intuitive descriptions of the Rehabilitation Set categories. Manuscript submitted for publication.

9. ICF Research Branch, Chinese Association of Rehabilitation Medicine, Nanjing Medical University, First Affiliated Hospital of Nanjing of Nanjing Medical University. Assessing functioning in routine clinical practice. Manual on applying the ICF Generic Set in practical assessments. Manual in development; 2016.