Comprehensive ICF Core Set for Low Back Pain

The Ninth Special Seminar on SpineTehran – December 2008

Mohammad Kamali, PhD, PTAssociate Professor,School of Rehabilitation SciencesRehabilitation Research CenterIran University of Medical Sciences

www.mkamali.comKamali@mkamali.comP.O. Box 17445-183

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 - 1980

Three levels of experience of disability:

(Disease or disorder)

impairment disabilities handicaps

International Classification of Functioning, Disability and International Classification of Functioning, Disability and

Health (ICF. WHO, 2001)Health (ICF. WHO, 2001)

Health condition (disorder, disease)

Body Functions and Structures(Impairments)

Activities(Limitations)

Participation(Restrictions)

PersonalFactors

EnvironmentalFactors

& ParticipationActivityBody functions& structures

Activity is the execution of a task or action by an individual. It represents the individual perspective of functioning.

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.

Impairedbody functions& structures

Limitation in activityRestriction in participation

Health Condition

EnvironmentalFactors

PersonalFactors

(disease, disorder)

Contextual factors

LimitationLimitationin activitiesin activities

Impairment of Impairment of body body function & structurefunction & structure

RestrictionRestriction in participationin participation

Disability

Disability

Functioning

Disability is a function of the interaction between the person and the environment

Aims of ICF Aims of ICF • to provide to provide a a scientific basisscientific basis for consequences of health for consequences of health

conditionsconditions

• to establish ato establish a common languagecommon language to improve communications to improve communications

• to permit to permit comparison of datacomparison of data across:across:– countries countries – health care disciplines health care disciplines – services services – timetime

• to provide ato provide a systematic coding schemesystematic coding scheme for health information for health information systemssystems

• 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

Health condition(disease, disorder)

Environmental factors

Personal factors

Contextual factors

The biopsychosocial model of functioning and disability

ActivityBody functionand body structure Participation

ICFICF

4 Components4 Components

Chapters/1st LevelChapters/1st Level

Body Functions and Body Functions and Body StructuresBody Structures

Activities and Activities and ParticipationParticipation

Environmental Environmental FactorsFactors

bb11 - b - b88 ss11 - s - s88 dd11 - d - d99 ee11 - e - e55

2nd Level2nd Levelbb111010

- b- b889999

ss111010

- s- s889999

dd111010

- b- b999999

ee111010

- e- e559999

bb11101000-b-b77808099

bb111414220-b0-b5545450099

ss11101000-s-s88303099

ss1110100000-s-s7760600099

dd11555500-d9-d9303099 ee11101000-e-e55959599

3rd and 4th Level3rd and 4th Level

level of precision

bandwidth or breadth of health dimensions

Health condition(disease, trauma)

253 Environmental factors

Personal factors

Contextual factors

384 Activities & ParticipationsParticipations493 Body functionsand 310 structures

ICF Categories

- Body functions 493

- Body structures 310

- Activity and participation 393

- Environmental factors 258

1454

• 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 GoalsICF 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)

b1b130b134b152b180b1801• • • • • s299s710s720 s730s73001s73011• • • • • • • • d170d230d360d410 d415d430• • • • • e110e115e120e125e135e150• • •

1454

ICF Core Set

Development of disease specific core sets

Systematic reviews

Empiric data collection (checklist)

Delphi -procedures

Core sets

Evaluation in clinical practice

Intermediate data analysis

International consensus conferences

• 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

ComprehensiveICF 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

• e110 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 - RAb280 Painb710 Mobility of joint functionsb730 Muscle power functionsb4555 Exercise tolerance functionb780 Sensations related to muscles and movement functionsb2800 Generalized pain b2801 Pain in body part b7102 Mobility of joints generalized b7800 Sensation of muscle stiffnessb134 Sleep functionsb130 Energy and drive functionsb640 Sexual functionsb715 Stability of joint functionsb152 Emotional functionsb180 Experience of self and time functionsb1801 Body imageb740 Muscle endurance functionb510 Ingestion functionsb770 Gait pattern functionsb430 Haematological system functions

25 out of 485

Body Structures - RA

s750 Structure of lower extremitys730 Structure of upper extremitys710 Structure of head and neck regions720 Structure of shoulder regions75001 Hip joints75011 Knee joint s7502 Structure of ankle and foots73001 Elbow joints73011 Wrist joint s7302 Structure of hands73021 Joints of hand and fingers s73022 Muscles of hand s760 Structure of trunks7600 Structure of vertebral columns76000 Cervical vertebral column s770 Additional musculoskeletal structures related to movements299 Eye, ear and related structures, unspecifieds810 Structure of areas of skin

18 out of 302

Activities & Participation – RAd450 Walkingd850 Remunerative employmentd440 Fine hand used410 Changing basic body positiond445 Hand and arm used230 Carrying out daily routined430 Lifting and carrying objects d470 Using transportationd620 Acquisition of goods and services d920 Recreation and leisured640 Doing houseworkd540 Dressingd630 Preparing mealsd475 Drivingd530 Toiletingd550 Eatingd859 Work and employment, other specified and unspecifiedd170 Writingd510 Washing oneselfd770 Intimate relationships

31 out of 384

Environmental Factors - RA

e310 Immediate familye580 Health services, systems and policiese355 Health professionalse115 Products and technology for personal use in daily livinge570 Social security services, systems and policiese155 Design, construction and building products and technology of buildings for private usee110 Products or substances for personal consumptione450 Individual attitudes of health professionalse150 Design, construction and building products and technology of buildings for public usee135 Products and technology for employmente425 Individual attitudes of aquaintances, peers, colleagues, neighbors and community memberse410 Individual attitudes of immediate family memberse420 Individual attitudes of friendse540 Transportation services, systems and policiese340 Personal care providers and personal assistantse360 Other professionalse320 Friendse120 Products and technology for personal indoor and outdoor mobility and transportation e460 Societal attitudese125 Products and technology for communicatione225 Climate

21 out of 253

FURTHER DEVELOPMENT OF FURTHER DEVELOPMENT OF CORE SCORE SETSETS

• 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

المللی بین بندی طبقهسالمت و عملکرد،ناتوانی

مترجم=ین•دکتر محمد کمالی–دکتر منوچهر ارجمند –

حسابی

انتشارا=ت مرا=کز آمار •ایران

•1384

Rehabilitationis the multi- and interdisciplinary patient-oriented management offunctioning and health of people with a condition

Rehabilitation=Management of functioning and health