Chair for Public Health and Health Service Research
Applying the International Classification of
Functioning, Disability and Health (ICF)
in Hand Therapy
Alexandra Rauch, PT, MPHChair for Public Health and Health Service Research
Ludwig-Maximilians-University, Munich, Germany25.05.2013
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
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?
44
ActivitiesBody Functions Body Structures
Participation
About the ICF
Health Condition(disease, trauma)
Environmental Factors
Personal Factors
Functioning - Disability
55
Not able to work as goldsmithDifficulties with riding a bicycleNot 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
ActivitiesBody Functions Body Structures
Participation
About the ICF
Health Condition(disease, trauma)
Environmental Factors
Personal Factors
Flexor tendon injuryICD 10: S 66.114 weeks ago
52 years old women, living aloneDaughter and little grandchildGoldsmith, owner of jewelry store
No assistive devicesSupport from daughterPhysiotherapy 2/week
66
• Skin damage (scar)• Reduced sensitivity• Decrased muscle power • Reduced joint movement• Pain
Not able to work as goldsmithDifficulties with riding a bicycleNot 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 injuryICD 10: S 66.114 weeks ago
52 years old women, living aloneDaughter and little grandchildGoldsmith, owner of jewelry store
No assistive devicesSupport from daughterPhysiotherapy 2/week
77
ActivitiesBody Functions Body Structures
Participation
About the ICF
Health Condition(disease, trauma)
Environmental Factors
Personal Factors
Functioning DisabilityCan we standardize the
information reagarding health
and functioning???Can we standardize the
information reagarding health
and functioning???
88
Joint
use
Family of International Classifications (FIC)
Diseases Functioning/Disability
About the ICF
ICF
ICDHealth condition
Environmental factors Personal factors
Body functionsBody structures
Activities Participation
About the ICF
11Describing Functioning and Disability
b11420 -b51059
s11000 -s76009
b1100 -b7809
s1100 -s8309
d1550 -d9309
e1100 -e5959
b110 -b899
s110 -s899
d110 -d999
e110 -e599
b1 – b8 s1 – b8 d1 – d9 e1 – e5
ICF
Contextual factors
Body functions and Structures
Activities and Participation
Environmental factors
Personal factors
Functioning and Disability
About the ICF
The classification Structure
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
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
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
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
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 groupsb7351 Tone of muscles of one limbb7352 Tone of muscles of one side of bodyb7353 Tone of muscles of lower half of bodyb7354 Tone of muscles of all limbsb7355 Tone of muscles of trunkb7356 Tone of all muscles of the body
About the ICF
The classification Structure
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
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%)
0 NO problem (none, absent, negligible,...) (0-4%)
b730.3 = Severe problems in muscle power functions
The classification ICF Qualifier
specify
About the ICF
evaluate
1919
Not able to work as goldsmithDifficulties with riding a bicycleNot 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 injuryICD 10: S 66.114 weeks ago
52 years old women, living aloneDaughter and little grandchildGoldsmith, owner of jewelry store
No assistive devicesSupport from daughterPhysiotherapy 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
2020
Flexor tendon injuryICD 10: S 66.114 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
0 1 2 3 4
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 Very comprehensive
Facilitates profiles Reliability?
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 ÜstünWHO 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.
s110s120s130s430s510s710
… b110b114b117b130b152b144b730
...d110d240d410d415d520d630d920
…e110e115e120e125e130e150
…
s110s430s710b110b130b152b730d240d410d415d920e110e120e130
Body structures
Body function
Activities and Participation
Environmental factors
310
493
384
253
Development of ICF Core Sets
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 studies Decision Validation
• 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?
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
forHand Conditions
in Germany
2008/2009 05/2009 2010 2012-2015
Preliminary studies Decision Validation Implementation
The ICF Core Sets for hand conditions – where are we now?
2828
Brief ICF Core Set for Hand conditions
Body structuress120 Structure of the spinal cord and related structures
s720 Structure of shoulder region
s730 Structure of the upper extremity
Activity and Participationd230 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 functionsb152 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 factorse1 Products and technology
e3 Support and relationships
e5 Services, systems and policies
2929
Comprehensive ICF Core Set for Hand conditions
Body structuress120 Structure of the spinal cord and related structuress410 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
3030
Comprehensive ICF Core Set for Hand conditions
Body functionsb134 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 painb415 Blood vessel functions
3131
Comprehensive ICF Core Set for Hand conditions
Body functionsb710 Mobility of joint functions b7100 Mobility of a single joint
b7101 Mobility of several joints
b715 Stability of joint functionsb720 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 functionsb765 Involuntary movement functions
b780 Sensations related to muscles and movement functions
3232
Comprehensive ICF Core Set for Hand conditions
Body functionsb810 Protective functions of the skinb820 Repair functions of the skin
b830 Other functions of the skin
b840 Sensations related to the skin
b860 Functions of nails
3333
Comprehensive ICF Core Set for Hand conditions
Activity and Participationd170 Writing
d230 Carry out daily routined360 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
3434
Comprehensive ICF Core Set for Hand conditions
Activity and Participationd445 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
3535
Comprehensive ICF Core Set for Hand conditions
Activity and Participationd5 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
3636
Comprehensive ICF Core Set for Hand conditions
Activity and Participationd7 Interpersonelle Interaktionen und Beziehungend810 – d839 Education
d840-d859 Work and employmentd920 Recreation and leisure
3737
Comprehensive ICF Core Set for Hand conditions
Environmental factorse1 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
3838
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
3939
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
4040
Comprehensive ICF Core Set for Hand conditions
Environmental factorse5 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
The ICF Core Sets for hand conditions – where are we now?
How to implement the ICF Core Sets for hand condition in clinical practice?
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?
The ICF Core Sets for hand conditions – where are we now?
The ICF Core Sets for hand condition Implementation
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?
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?
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
Brief ICF Core Set Comprehensive ICF Core Set
d230 Carry out daily routine
d360 Using communcation devices and techniques
d430 Lifting and carrying objects
d440 Fine hand functions d4400 Picking up
d4402 Manipulating
d445 Hand and arm use
d5 Self-care d510 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
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?
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 patientStandardized tests
Technical examination (X-Ray, CT, ENG, etc.)
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
ICF categories Assessment (PRQ/PH/CE/TI)
3 Body structures 14
9 Body functions 25
8 Activities and Participation 25
3 Environmental factors 15
The ICF Core Sets for hand conditions – where are we now?2. Select appropriate measures to assess functioning
ICF category Source SpecificationPRQ PH CE TI
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
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
ICF category Source SpecificationPRQ PH CE TI
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
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
ICF category Source SpecificationPRQ PH CE TI
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
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 items
The ICF Core Sets for hand conditions – where are we now?2. Select appropriate measures to assess functioning
Evaluation functional capacity
ICF category Source SpecificationPRQ PH CE TI
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
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
Questioning
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?
Create intervention table:
The ICF Core Sets for hand conditions – where are we now?3. Coordinate assessment
ICF category Assessment Responsibility
s730 Structure of the upper extremity X-Ray MD
b152 Emotional functions Questioning, PRQ MD, Psychologist
b270 Sensory functions related to temperature and other stimuli
2-Point-Discrimina-tion, Pin-prick, Cold-Warm-Discrimination
MD
b710 Mobility of joint functions Goniometer, Pinch Gauge
PT/OT
d440 Fine hand functions Pick up test PT/OT
e3 Support and relationships Questioning MD
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?
90
80
01
02
03
04
05
06
07
01
00
No problem
Complete problem
Fu
nctio
nin
g D
isability
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?
Which ICF Categories should be included in a functioning score?
b110 Consciousness functionsb210 Seeing functionsb310 Vice functionsb410 Heart functionsb510 Ingestion functionsb610 Urinary excretory functionsb710 Mobility of joint functionsb810 Protective functions of the skin…
Body functions
s110 Structure of brains210 Structure of eye sockets310 Structure of noses410 Structure of cardiovascular systems510 Structure of salivary glandss610 Structure of urinary systems710 Structure of head and neck region s810 Structure of areas of skin…
Body structures
d110 Watchingd210 Undertaking simple tasksd310 Communicating with –receiving – spoken messagesd410 Changing basic body positionsd510 Washing oneselfd610 Acquiring a place to lived710 Basic interpersonal interactionsd810 Informal education…
Activity & Participation
Method
The ICF Core Sets for hand conditions – what is next?
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?
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
Functioning score
0 10 20 30 40 50 60 70 80 90 100
DisabilityDisability
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?
1
0
2
3
4
90
80
01
02
03
04
05
06
07
01
00
The ICF Core Sets for hand conditions – what is next?
„Translate“ assessment results
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
01
02
03
04
05
06
07
01
00
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?
Which ICF Categories should be included in a disability score?
Purpose driven:Ministry level Service provision level Professional level
b110 Consciousness functionsb210 Seeing functionsb310 Vice functionsb410 Heart functionsb510 Ingestion functionsb610 Urinary excretory functionsb710 Mobility of joint functionsb810 Protective functions of the skin…
s110 Structure of brains210 Structure of eye sockets310 Structure of noses410 Structure of cardiovascular systems510 Structure of salivary glandss610 Structure of urinary systems710 Structure of head and neck region s810 Structure of areas of skin…
d110 Watchingd210 Undertaking simple tasksd310 Communicating with –receiving – spoken messagesd410 Changing basic body positionsd510 Washing oneselfd610 Acquiring a place to lived710 Basic interpersonal interactionsd810 Informal education…
Body functions
Body structures
Activity & Participation
The ICF Core Sets for hand conditions – what is next?
7979
Flexor tendon injuryICD 10: S 66.114 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
0 1 2 3 4
0 10 20 30 40 50 60 70 80 90 100
FunctioningFunctioning
Purpose:
To monitor service provision
Health condition specific
Selection from health condition specific ICF Core Sets
Service provision level
b110 Consciousness functionsb210 Seeing functionsb310 Vice functionsb410 Heart functionsb510 Ingestion functionsb610 Urinary excretory functionsb710 Mobility of joint functionsb810 Protective functions of the skin…
Body functions
s110 Structure of brains210 Structure of eye sockets310 Structure of noses410 Structure of cardiovascular systems510 Structure of salivary glandss610 Structure of urinary systems710 Structure of head and neck region s810 Structure of areas of skin…
Body structures
d110 Watchingd210 Undertaking simple tasksd310 Communicating with –receiving – spoken messagesd410 Changing basic body positionsd510 Washing oneselfd610 Acquiring a place to lived710 Basic interpersonal interactionsd810 Informal education…
Activity & Participation
The ICF Core Sets for hand conditions – what is next?
8181
Flexor tendon injuryICD 10: S 66.114 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
0 1 2 3 4
0 10 20 30 40 50 60 70 80 90 100
Activities and ParticipationActivities and Participation
0 10 20 30 40 50 60 70 80 90 100Body functions and structuresBody functions and structures
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 lifeEducation
The ICF Core Sets for hand conditions – what is next?