Vol.:(0123456789)1 3
Journal of Occupational Rehabilitation (2019) 29:241–273 https://doi.org/10.1007/s10926-018-9788-4
REVIEW
International Classification of Functioning, Disability and Health in Vocational Rehabilitation: A Scoping Review of the State of the Field
A. H. Momsen1,2,7 · C. M. Stapelfeldt1,2 · R. Rosbjerg1,2 · R. Escorpizo3,4 · M. Labriola1,2 · M. Bjerrum5,6
Published online: 5 June 2018 © The Author(s) 2018
AbstractPurpose The purposes of this study were to provide an outline of the existing literature on operationalization of the Inter-national Classification of Functioning, Disability and Health (ICF) within vocational rehabilitation (VR) and to explore the ICF utility within VR. Methods The process was undertaken in five stages according to a framework of scoping review. Screening and extraction of data were done by two independent reviewers, and data was summarized according to content analysis. Results Fifty papers (25 qualitative and 25 quantitative) were included. The operationalization of the ICF was described in four different ways: In total 18 (36%) papers described use of the ICF for structuring information, 8 (15%) for linking information to ICF, 12 (24%) for analysis of results, and 12 (24%) for development of a model. In total 15 (29%) papers described VR interventions involving stakeholders, whereas 32 (62%) were reviews. Forty of the papers described all the ICF components. Conclusions The review revealed use of the ICF within the field VR in 50 papers, and in various settings. The ICF framework was most often operationalized for structuring or linking information of functioning. A majority of papers were reviews and involved researchers only, whereas different stakeholders and VR professionals were involved in the interventions. In 40 papers all the ICF components were described, and the ICF was considered a useful tool to inform the VR professionals´ assessment of functioning. However, more research within VR is needed to standardize and ease the use of the ICF.
Keywords Occupational health services · Rehabilitation · Return to work · Outcome assessment
Background
Work disability is often associated with personal suffering and loss of income, diminished productivity and increased medical and societal costs and can be addressed through
vocational rehabilitation (VR) [1]. The essence of VR is promotion of workers’ health in order to enter or return to work (RTW), prevent work disability, and sustain work ability [1–4]. VR professionals have been challenged by different perceptions of health, and researchers argue for a definition of health as a dynamic process of adaptation and self-management [5]. The Organisation for Economic Co-operation and Development (OECD) states that several countries have made efforts to move away from assessing a
Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s1092 6-018-9788-4) contains supplementary material, which is available to authorized users.
* A. H. Momsen [email protected]
1 Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
2 DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, 8000 Aarhus, Denmark
3 Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
4 Swiss Paraplegic Research, Nottwil, Switzerland
5 Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Department of Medicine and Technology, University of Aalborg, 9000 Aalborg, Denmark
6 Section of Nursing Science, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
7 DEFACTUM, Aarhus University Hospital, MarselisborgCentret, P.P. Oerums Gade 11, 8000 Aarhus, Denmark
242 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
person’s illness, but instead examining the person’s remain-ing work capacity [6]. The International Classification of Functioning, Disability and Health (ICF) (See Fig. 1) was approved by the World Health Assembly in 2001 [7], and the ICF framework covers a spectrum of body, personal, and societal aspects of human functioning. Thereby, the ICF captures a comprehensive view of disability relevant to VR, and the integration of “functioning” in VR rather than the traditional biomedical approach, which is in line with the efforts stated by OECD [2]. In VR a comprehensive under-standing of the aspects influencing patients’ functioning is important. Thus, the usefulness of the ICF may be demon-strated in VR [8]. The ICF framework has been proposed to offer opportunities to optimize VR for patients by providing a universal conceptual reference to improve communication between different users, such as health care professionals, researchers, and policy-makers.
There are several definitions of VR, e.g. medical, psycho-logical, social and occupational activities aiming to reestab-lish sick or injured peoples work capacity and prerequisites for returning or entering the labour market, i.e. to a job or availability for a job, 2009 [9]. In 2011, a broader ICF-based definition of VR was introduced: “A multi-professional evidence-based approach that is provided in different set-tings, services, and activities to working age individuals with health-related impairments, limitations, or restrictions with work functioning, and whose primary aim is to optimize work participation” [2].
A review showed diversity in the ICF contents of the measures used in the literature, and proposed that the ICF and VR interface should be further examined [10]. Know-ing more about how and to what extent the ICF framework is applied and has been utilized is suggested important in order to optimize VR interventions for patients [11] and the inter-professional approach in VR processes [8].
The purposes of this review were to provide an outline of the existing literature and to explore the ICF utility within VR. The primary aim was to examine and map the opera-tionalization of the ICF within VR. The second aim was to examine the different VR professionals´ use of the ICF.
Ideally a multi-professional, multimodal approach should be used in VR [12].
Within the WHO a number of ICF core sets have been developed in order to make the ICF more applicable for clinical practice. A third aim was to examine to what extent the components of the ICF framework, the VR core set, and other ICF core sets are used within VR. Core sets are lists of essential ICF-categories in specific health conditions and contexts to describe functioning, e.g. a comprehensive and a brief VR core set were developed and validated for interdis-ciplinary assessment, documentation, and communication in VR [13, 14].
A preliminary search in PROSPERO and PubMed showed no review on the topic, and to our knowledge there are no existing systematic reviews or scoping review on how the ICF is applied within VR.
Methods
The scoping review was conducted according the method-ology conduced in five steps: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting results [15–17].
Identifying the Research Question
(1) How is the ICF operationalized in empirical papers within VR?
(2) Who are involved and how does the ICF inform the professionals´ assessment of functioning in VR?
(3) Which of the ICF components and core sets are consid-ered when functioning is evaluated in VR?
Identifying Relevant Studies
A three-step search strategy was conducted [16]. Firstly, initial keywords were identified and secondly all identified keywords and index terms were used to build a comprehen-sive and specific search strategy for each included database: PubMed, Embase, Scopus, CINAHL, PsycINFO, Swemed+, and PEDro. Thirdly, the search strategies were refined: VR and RTW (MeSH term) in PubMed and other terms, e.g. sick leave, work disability were used as keywords [10], and ICIDH was used as ICF was not a MeSH term until 2012 [18, 19]. The search was performed in collaboration with a research librarian at Aarhus University Library. The search was restricted to papers in English, German, Danish, Swed-ish, and Norwegian (Online Appendix A).
Fig. 1 The internation classification of functioning, disability and health (ICF) framework
243Journal of Occupational Rehabilitation (2019) 29:241–273
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Study Selection
Inclusion criteria: ICF or International Classification of Functioning, Disability and Health mentioned in the title or abstract, ICF used in the field of VR research, peer reviewed original papers and reviews, date of publication from January 2001 to May 2016, abstract available, and study populations of working age adults. There were no limitations regarding including reviews and thereby poten-tial overlap of individual papers included in the reviews. There were no context limitations regarding geography or culture, and papers were eligible from any healthcare setting or research setting (e.g. rehabilitation clinic, in-patient or out-patient clinic, hospital, physicians, primary health care, occupational health services, insurance office, and research departments).
Exclusion criteria: papers only mentioning ICF in the abstract, background or discussion, or only mentioning ICIDH or ICIDH-2, overviews, editorials, comments, theo-retical papers, text and opinion papers, theses/dissertations, books, and papers on ICF-Children and Youth.
The process of study selection was reported using the PRISMA [20], and eligible studies were screened indepen-dently by two reviewers (AM and MB) followed by consen-sus discussions. The selection was performed in two groups for qualitative papers (AM and RR) and quantitative papers (AM and CMS), respectively.
Extraction of Data
Study characteristics were extracted from the included stud-ies using a pilot-tested non-software template. The papers were divided in qualitative and quantitative papers according to qualifications of the review team. Two authors extracted study characteristics independently for qualitative papers (AM and RR) and quantitative papers (AM and CMS), respectively. In case of disagreement, the final decision about characteristics was resolved through discussion. The papers were divided in qualitative and quantitative papers according to the data collection method described.
Study characteristics according to The Joanna Briggs Institute Reviewers’ Manual included: first author, publica-tion year, country, setting, study type (intervention yes/no), population, aims, methods, and outcomes [16]. Intervention was defined as “a treatment, whether for preventative or ther-apeutic reasons, an assessment or diagnostic tool or some other type of service or condition to which a patient might be exposed” [21]. Data from the included studies was coded by two authors (AM and RR; AM and CMS, respectively) using the three research questions.
Regarding the first research question; data was extracted according to the use of the ICF framework as described in the individual papers. Four different ways of operationalization
of the ICF were the most typical descriptions used in a sub-set of the papers included: (a) structuring, (b) linking, (c) analysing, or (d) developing instruments or models, respec-tively. All the included papers´ description were categorised in these. Structuring was considered present, when data or outcomes were categorized, or themes or information from interviews was coded according to the ICF framework. How-ever, in case structuring was followed by other use, data was extracted according to the latter. Linking was considered present, when health information (e.g. from questionnaires or interviews) was coded to specific ICF categories, based on linking rules, e.g. linking items in a questionnaire to catego-ries in a core set [9, 22]. Analysing was considered present if the paper explicitly described that data were analysed, most commonly after data or information had been structured fol-lowing the ICF framework. Developing instruments or mod-els based on the ICF framework was the last reported usage.
Regarding the second research question the description of VR professionals (e.g. health professionals) involved were extracted, and a descriptive summary of their use of the ICF in order to inform the assessment of functioning was presented. Regarding the third question; the use of the ICF components (body function, body structures, activity and participation, environmental factors) and the ICF core set(s) was extracted based on the information provided in individual papers.
Collating, Summarizing, and Reporting Results
A descriptive summary of the charted data was done inde-pendently by two authors on all the included papers. The coded data relevant to inform the three review questions were charted from each paper included and categorized according to content analysis [23–25]. Both deductive and inductive analyses were used, as the results were based on the description in the papers, e.g., of the pre-defined ICF components and core sets. The descriptive summary of the main results is presented in tables.
Results
In total 1343 papers were retrieved from seven databases, of which 702 duplicates were removed; thus, 641 papers were assessed for eligibility (Fig. 2). Sixty-four papers from these were read in full text of which 14 papers were excluded, mainly because the ICF was only mentioned in the introduc-tion or discussion and lack of information on VR. Thus, 50 papers (25 qualitative and 25 quantitative) were included. No additional papers were included.
A descriptive summary of the included study character-istics is shown in Table 1. The ICF referral in papers within VR was found among Western countries, except one paper
244 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
from Taiwan. Thus, nine papers were from Switzerland [10, 26–33] four were from the USA [34–37], three from Italy [38–40], two from Germany [41, 42], one from Canada [43], UK [44], Portugal [45], Turkey [46], Slovenia [47], Spain [48], Israel [49], and Taiwan [50]. Five papers were authored by an international [38, 51–54], three were from settings in Sweden [55–57], and three from Norway [58–60].
Although 32 of the papers were reviews, primarily from research settings (e.g. rehabilitation social medicine or phys-iotherapy departments) in Switzerland and the Netherlands; other VR settings in which the ICF was used were wide-spread, i.e. hospitals, rehabilitation centres, primary health care centres, and sickness certificate registration offices.
A minority of papers reported interventions within VR; only seven of the qualitative papers [34, 36, 38, 55, 61–63], and eight among the quantitative papers [37, 40–42, 46, 57, 60, 64]. Eleven papers were from health care and research settings in the Netherlands [61–71].
How is the ICF Operationalized in Empirical Papers within VR?
In total 18 papers (36%) used the ICF as a framework for structuring of information: twelve of the qualitative papers [26, 27, 30, 44, 61, 62, 66, 68–70, 72–74], and six of the quantitative papers [29, 37, 42, 57, 64, 74]; e.g. relating information in sickness certificates to the ICF framework [57] (Table 2). As an example, one paper reported that the ICF was used for verifying data on claimants´ disabilities
by comparing the information provided by the ICF and the bio-psycho model to see the extent of match [61].
In total eight papers (15%) used the ICF as a framework for linking between ICF categories and e.g. items in ques-tionnaires: three qualitative papers [31, 38, 52], and five quantitative papers [32, 33, 39, 71, 75]; e.g. of Italian leg-islative procedures to the ICF [39], of factors coded on the second- level ICF classifications [71], of items to the core set and following the linking rules [32, 33, 75]. As an example, one paper aimed at merging an ICF core set for a specific health-related condition (spinal cord injury) to the catego-ries of the VR core set [75]. Another paper identified the concepts within the functional problems which were coded, and linked to ICF categories, or to the categories of the VR core set [38].
The analysis was performed according to the ICF frame-work in 12 papers (24%): five qualitative papers [34, 36, 43, 55, 63], e.g. listing of the respondents´ answers followed by frequency analysis according to the relevant ICF domains [55] and seven quantitative papers [28, 40, 46, 49, 50, 56, 58]; e.g. rating and analysing problems regarding work [28], and extraction of phrases from a patients´ electronic record that could potentially be interpreted as an ICF category [46]. One of the quantitative papers analysed levels of function and how it correlated with vocational status [49].
The ICF was used as a framework for the development of an instrument or a new model for various aspects within VR in 12 papers (24%) : five qualitative papers [35, 48, 54, 65, 67]; e.g. a model relating the levels of activity to the ICF [48], and a model explaining work disability by health-related problems at work [53]. A paper concluded that the ICF may contribute by informing our thinking of RTW and work maintenance by conceptualizing phase-based RTW outcomes [54]. Seven quantitative papers reported use of the ICF for development [41, 45, 47, 53, 59, 60, 76]; e.g. relating with other questionnaires used in VR [41], and use of the ICF core sets for developing a questionnaire for description of workplace accommodation [60].
Who are Involved and How Does the ICF Inform the Professionals´ Assessment of Functioning in VR?
Four papers described involvement of patients and research-ers [34, 55] or patients and health professionals [38, 61]. Two papers described involvement of professionals, employ-ers, and employees as informants [68], medical profession-als as evaluators of work disability and researchers [26], respectively. A majority (32) of papers were reviews involv-ing solely the authors (researchers): twenty of the qualita-tive papers, and eleven of the quantitative papers, respec-tively. Two papers involved a research team, interviewers and project staff [37], researchers and an adjudicator [56], respectively. Seven papers involved researcher and numerous
Records iden�fied through database searching (n = 1343) PubMed 283 Embase 317 Scopus 283 CINAHL 243 PsychInfo 192 PEDdro 17 SweMed 8
Scre
enin
g In
clud
ed
Elig
ibili
ty
Iden
�fica
�on
Addi�onal records iden�fied through other sources
(n = 0)
Records a�er duplicates removed (n = 641 )
Records screened (n = 641 )
Records excluded (n = 577) ICF not mentioned in title/abstract (n=573) Books, thesis (n=4)
Full-text ar�cles assessed for eligibility
(n = 64)
Full-text ar�cles excluded, with reasons
(n=14)
ICF only men�oned in discussion (n = 7)
Not Voca�onal rehabilita�on (n = 3) Not English, German,
Danish, Swedish or Norwegian (n = 4) Studies included in
qualita�ve synthesis (n = 50)
Fig. 2 Flow diagram
245Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
Sum
mar
y of
bas
ic c
hara
cter
istic
s of t
he in
clud
ed p
aper
s, ai
ms,
met
hods
, and
out
com
es
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Qua
litat
ive
pape
rs A
bbot
t [55
]20
11Sw
eden
Orth
opae
dic
Clin
ic,
Kar
olin
ska
Uni
ver-
sity
Hos
pita
l
Yes.
Qua
litat
ive
inte
rvie
w a
nd
self
repo
rt sc
ales
Lum
bar f
usio
n pa
tient
s, N
= 20
To d
escr
ibe
with
in
the
cont
ext o
f IC
F, p
atie
nts’
ex
perie
nces
of
post-
lum
bar f
usio
n re
gard
ing
low
bac
k pr
oble
ms,
reco
very
an
d ex
pect
atio
ns o
f re
habi
litat
ion.
To
cont
rast
with
the
cont
ent o
f out
com
e m
easu
res a
nd th
e IC
F lo
w b
ack
pain
co
re se
ts
Mix
ed m
etho
d:
Qua
litat
ive
cont
ent
anal
ysis
of s
emi-
struc
ture
d in
ter-
view
s 3–6
mon
ths
afte
r sur
gery
and
co
mpa
ring
ICF
with
que
stion
naire
s. IC
F lin
king
rule
s w
ere
used
to c
ode
mea
ning
uni
ts
Expe
rienc
es w
ith re
ha-
bilit
atio
n po
st-lu
m-
bar f
usio
n. E
xpec
ta-
tion
with
out
com
e of
re
habi
litat
ion
ICF
cate
gorie
s of a
ll co
mpo
nent
s
Aia
chin
i [38
]20
15Te
am (I
taly
, USA
, Sw
itzer
land
)Sp
inal
uni
t at R
eha-
bilit
atio
n ho
spita
l, Pa
via
Yes.
Focu
s gro
up
inte
rvie
ws
Patie
nts w
ith sp
inal
co
rd in
jury
(SC
I),
N =
24
To v
alid
ate
the
com
preh
ensi
ve IC
F C
ore
Set f
or V
R
from
the
pers
pec-
tive
of S
CI p
atie
nts
To e
xplo
re th
e as
pect
s of f
unct
ion-
ing
and
heal
th
impo
rtant
to
patie
nts w
ith S
CI
rega
rdin
g RT
W,
and
to e
xam
ine
to w
hat e
xten
t th
ese
aspe
cts a
re
repr
esen
ted
by th
e cu
rren
t ver
sion
of
VR
cor
e se
t
Focu
s gro
up in
ter-
view
s7
focu
s gro
ups w
ere
digi
tally
reco
rded
an
d tra
nscr
ibed
ve
rbat
im. T
he
mea
ning
con
dens
a-tio
n pr
oced
ure
was
us
ed fo
r the
dat
a an
alys
isLi
nkin
g ru
les w
ere
used
to c
ode
mea
n-in
g un
itsA
ddin
g th
e sp
ecifi
c IC
F C
ore
Set f
or
SCI i
n lo
ng-te
rm
cont
ext f
or n
ot
cove
red
conc
epts
Con
cept
s ide
ntifi
ed in
th
e fo
cus g
roup
s and
th
eir l
inki
ng to
ICF
com
preh
ensi
ve c
ore
set f
or V
R o
r not
246 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Ann
er [2
6]20
12Sw
itzer
land
Aca
dem
y of
Sw
iss
Insu
ranc
e M
edi-
cine
, Uni
vers
ity
Hos
pita
l Bas
el
No.
Qua
litat
ive
liter
atur
e stu
dySi
ck-li
sted
and
pers
ons u
nabl
e to
w
ork
(dis
abili
ty
eval
uatio
n in
med
i-ca
l rep
orts
)
To d
iscu
ss p
oten
tial
bene
fits o
f the
ICF
to st
ruct
ure
and
phra
se d
isab
ility
ev
alua
tion
in th
e fie
ld o
f soc
ial i
nsur
-an
ceTo
des
crib
e co
re
feat
ures
of d
is-
abili
ty e
valu
atio
n of
the
ICF
acro
ss
coun
tries
, and
to
addr
ess h
ow a
nd to
w
hat e
xten
t the
ICF
may
be
appl
ied
in
disa
bilit
y ev
alu-
atio
n
Qua
litat
ive
met
hod:
a
Euro
pean
com
-pa
rison
. Dis
cuss
ion
of IC
F (in
4 st
udie
s an
d in
gen
eral
)Re
porti
ng a
bout
wor
k di
sabi
lity
in so
cial
in
sura
nce
Cor
e fe
atur
es fo
r as
sess
ing
wor
k di
s-ab
ility
for m
edic
al
expe
rts
Bak
ker [
65]
2006
Net
herla
nds
Dis
abili
ty in
sura
nce,
C
entre
of H
ealth
-ca
re R
esea
rch,
U
nive
rsity
Med
ical
C
entre
Gro
ning
en
No.
Lite
ratu
re st
udy,
co
nsul
tatio
ns
amon
gst e
xper
ts
Dis
able
d se
lf-em
ploy
ed p
erso
nsFo
ur e
xper
ts
To tr
ace
risk
fac-
tors
for d
isab
ility
am
ongs
t the
self-
empl
oyed
To c
ontri
bute
to m
ore
evid
ence
-bas
ed
unde
rwrit
ing
cri-
teria
for d
isab
ility
in
sura
nce
Lite
ratu
re st
udy
and
cons
ulta
-tio
n am
ongs
t fou
r ex
perts
/rese
arch
ers
Ris
k fa
ctor
s and
med
i-ca
l cha
ract
erist
ics i
n lo
ng-te
rm d
isab
ility
in
the
empl
oyed
an
d se
lf-em
ploy
ed
popu
latio
ns
Cul
ler [
34]
2011
USA
Reha
bilit
atio
n In
sti-
tute
of C
hica
goYe
s. Q
ualit
ativ
e in
terv
iew
sSt
roke
surv
ivor
s, em
ploy
ers,
voca
-tio
nal s
peci
alist
s N
= 10
, 7, 2
1
To id
entif
y fa
ctor
s th
at fa
cilit
ate
or a
ct
as a
bar
rier t
o RT
W
for s
troke
surv
ivor
s
Qua
litat
ive
met
hods
: In
terv
iew
s with
str
oke
surv
ivor
s ab
out t
heir
RTW
ex
perie
nce
post
strok
eSu
rvey
with
voc
a-tio
nal s
peci
alist
s ab
out b
arrie
rs a
nd
faci
litat
ors o
f RTW
ba
sed
on th
eir c
lini-
cal p
ract
ice.
Inte
r-vi
ews w
ith e
mpl
oy-
ers e
xper
ienc
ed in
in
terv
iew
ing
Bar
riers
and
faci
lita-
tors
to R
TW fo
r str
oke
surv
ivor
s fro
m
thre
e pe
rspe
ctiv
es
wer
e ill
ustra
ted
Iden
tified
com
pone
nts
wer
e m
appe
d ba
sed
on th
e IC
F
247Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Dal
eman
s [66
]20
08N
ethe
rland
sH
ealth
car
e, Z
uyd
Uni
vers
ity, H
eerle
nN
o. S
yste
mat
ic
revi
ewSt
roke
surv
ivor
sTo
des
crib
e w
hat
is k
now
n in
the
liter
atur
e ab
out
parti
cipa
tion
in
wor
king
-age
per
-so
ns w
ith a
phas
ia
afte
r stro
ke
Syste
mat
ic li
tera
ture
se
arch
ing
for t
he
perio
d 19
60–2
005
on p
artic
ipat
ion:
th
e pe
rform
ance
of
peo
ple
in a
ctua
l ac
tiviti
es in
soci
al
life
dom
ains
th
roug
h in
tera
ctio
n w
ith o
ther
s in
the
cont
ext i
n w
hich
th
ey li
ve
Four
soci
al li
fe
dom
ains
(1) d
omes
tic li
fe(2
) int
erpe
rson
al li
fe(3
) edu
catio
n an
d em
ploy
men
t(4
) com
mun
ity, c
ivic
, an
d so
cial
life
, in
clud
ing
relig
ion,
po
litic
s, re
crea
tion,
an
d le
isur
e
Dan
iel [
44]
2009
UK
Stro
ke re
habi
litat
ion;
D
ivis
ion
of H
ealth
an
d So
cial
Car
e Re
sear
ch
No.
Sys
tem
atic
re
view
of q
uant
i-ta
tive
and
qual
i-ta
tive
studi
es
Stro
ke su
rviv
ors
To id
entif
y th
e so
cial
co
nseq
uenc
es o
f str
oke
in w
orki
ng-
aged
adu
lts, w
hich
m
ight
impl
y so
cial
nee
ds to
be
addr
esse
d by
hea
lth
and
soci
al c
are
serv
ices
. Inf
orm
th
e de
velo
pmen
t an
d ev
alua
tion
of
serv
ices
for t
his
grou
p
Revi
ew o
f qua
ntita
-tiv
e an
d qu
alita
tive
studi
es id
entif
ying
so
cial
con
sequ
ence
s fo
r wor
king
-age
d ad
ults
with
stro
ke
usin
g m
ultip
le
sear
ch st
rate
gies
Prev
alen
ce o
f wor
k af
ter s
troke
Soci
al c
onse
quen
ces o
f str
oke
for w
orki
ng-
aged
adu
lts
De
Boe
r [61
]20
09N
ethe
rland
sSo
cial
insu
ranc
e,
Dut
ch A
ssoc
iatio
n of
Insu
ranc
e M
edi-
cine
Yes.
Des
crip
tive
Surv
ey a
nd a
qu
estio
nnai
re
Soci
al In
sura
nce
Phys
icia
ns (S
IPs)
, N
= 98
To in
vesti
gate
to
wha
t ext
ent S
IPs
are
fam
iliar
with
th
e pr
otoc
ols,
and
to w
hat e
xten
t th
ey a
dher
e to
th
e pr
inci
ples
of
the
expe
rt- a
nd
prac
tice-
base
d pr
o-to
cols
dev
elop
ed to
co
nduc
t int
ervi
ews
with
cla
iman
ts fo
r lo
ng-te
rm in
capa
c-ity
for w
ork
Mix
ed m
etho
ds:
Surv
ey a
mon
g ex
perie
nced
SIP
sQ
ualit
ativ
e stu
dy:
com
paris
on o
f the
th
ree
prot
ocol
s w
ith e
ach
othe
r and
w
ith IC
F to
pics
. D
evel
opm
ent o
f a
ques
tionn
aire
to
elic
it th
e ad
her-
ence
SIP
s hav
e to
th
e pr
otoc
ols,
thei
r un
derly
ing
prin
ci-
ples
and
topi
cs
App
licat
ion
of
prot
ocol
(s)
Trai
ning
in a
nd a
ctua
l us
e. C
onstr
uctio
n of
ow
n pr
otoc
ol.
Ans
wer
s to
ques
tions
no
ted
in %
, in
tota
l an
d pe
r pro
toco
l
248 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Des
iron
[67]
2013
Bel
gium
Dep
artm
ent o
f O
ccup
atio
nal,
Envi
ronm
enta
l and
In
sura
nce
Med
i-ci
ne, L
euve
n
No.
Qua
litat
ive
liter
atur
e stu
dyPe
rson
s with
bre
ast
canc
erTo
iden
tify
a th
eore
ti-ca
l fra
mew
ork
for
occu
patio
nal t
hera
-pi
st (O
T) in
terv
en-
tion
by q
uesti
onin
g ho
w O
T m
odel
s can
be
use
d in
OT
inte
r-ve
ntio
ns in
RTW
of
bre
ast c
ance
r pa
tient
s
Lite
ratu
re se
arch
ing:
Re
sear
ch sp
ecifi
c cr
iteria
der
ived
fro
m O
T lit
erat
ure
conc
eptu
al O
T-m
odel
, mul
tidis
ci-
plin
ary,
refe
rrin
g to
the
ICF.
Con
tent
an
alys
is. C
heck
ing
for b
reas
t can
cer
spec
ific
issu
es
OT
mod
els t
o fa
cilit
ate
RTW
in b
reas
t ca
ncer
, mat
ches
be
twee
n lit
erat
ure
and
care
-mod
els
rega
rdin
g RT
W in
br
east
canc
er
Esc
orpi
zo [7
5]20
13Te
am (U
SA, G
erm
any,
Sw
itzer
land
)D
epar
tmen
t of
Phys
ical
The
rapy
, Lo
uisi
ana
Stat
e U
ni-v
ersi
ty H
ealth
Sc
ienc
es C
ente
r
No.
Pre
sent
atio
n pa
per
Aim
ed a
t per
sons
to
eval
uate
dis
abili
tyTo
pre
sent
the
ICF
as a
stan
dard
in
disa
bilit
y ev
alua
-tio
n an
d to
dis
cuss
th
e us
eful
ness
and
ch
alle
nges
of t
he
ICF
whe
n ap
plie
d in
dis
abili
ty e
valu
-at
ion
incl
udin
g th
e IC
F co
re se
t for
V
R.
Illus
tratio
n of
ope
ra-
tiona
lizin
g th
e IC
F in
a h
ypot
hetic
al
case
of a
con
struc
-tio
n w
orke
r who
ha
s chr
onic
low
ba
ck p
ain.
Ass
ess-
men
t of s
ampl
e IC
F ca
tego
ries
and
thei
r int
egra
-tio
n in
dev
elop
ing
goal
s and
pla
nnin
g in
terv
entio
n
Sam
ple
of IC
F ca
t-eg
orie
s
Esc
orpi
zo [5
2]20
09Te
am (S
witz
erla
nd,
Ger
man
y, C
anad
a,
Net
herla
nds)
ICF
Rese
arch
Bra
nch
of th
e W
HO
C
olla
bora
ting
Cen
ter
No.
Lite
ratu
re re
view
Aim
ed a
t res
earc
hers
to
sele
ct a
n ap
pro-
pria
te q
uesti
onna
ire
for a
spec
ific
study
qu
estio
n
To d
escr
ibe
the
con-
tent
of s
elf-
repo
rt qu
estio
nnai
res
that
ass
ess w
orke
r pr
oduc
tivity
and
th
at a
re b
eing
use
d or
cou
ld p
oten
tially
be
use
d in
arth
ritis
an
d ot
her m
uscu
lo-
skel
etal
con
ditio
ns
usin
g th
e IC
F as
re
fere
nce
Lite
ratu
re se
arch
, co
nten
t exa
min
a-tio
n an
d us
e of
IC
F ca
tego
ries
as a
refe
renc
e fo
r co
mpa
rison
of
ques
tionn
aire
s
Mea
ning
ful c
once
pts
wer
e id
entifi
ed
and
linke
d to
the
corr
espo
ndin
g IC
F ca
tego
ry
249Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Fin
ger [
29]
2014
Switz
erla
ndSw
iss P
arap
legi
c Re
sear
ch, N
ottw
ilN
o.C
ase
study
(tea
ch-
ing
case
)
42-y
ear-o
ld te
ache
r, w
ho w
as o
n si
ck
leav
e fo
r 10
wee
ks
due
to n
on-s
peci
fic
low
bac
k pa
in N
= 1
To il
lustr
ate
an
appl
icat
ion
of
ICF-
base
d to
ols i
n a
mul
tidis
cipl
inar
y RT
W p
rogr
am
for p
atie
nts w
ith
non-
spec
ific
low
ba
ck p
ain
from
the
pers
pect
ive
of th
e ph
ysio
ther
apist
To g
uide
the
reha
-bi
litat
ion
proc
ess
and
faci
litat
e te
am-b
ased
and
ph
ysio
ther
apist
go
al se
tting
and
do
cum
enta
tion
Ass
essm
ent
of e
mpl
oyed
di
scip
line-
spec
ific
clin
ical
tests
and
m
easu
res t
ak-
ing
into
acc
ount
th
e as
sign
ed IC
F ca
tego
ries f
rom
the
chec
klist
. The
team
al
loca
ted
the
ICF
cate
gorie
s inc
lude
d in
the
Reha
bilit
a-tio
n M
anag
emen
t-Sh
eet t
o th
e m
ost
appr
opria
te lo
ng-
term
or s
hort-
term
go
als
The
team
and
pat
ient
ag
reed
on
the
inte
r-ve
ntio
ns th
at w
ould
ta
rget
the
spec
ific
goal
s and
resp
onsi
-bi
litie
s
Cat
egor
ies i
nclu
ded
in th
e IC
F-ba
sed
tool
(Reh
abili
tatio
n M
anag
emen
t-She
et)
and
clin
ical
tests
and
m
easu
res
Gla
ssel
[31]
2012
Switz
erla
ndSw
iss P
arap
legi
c Re
sear
ch N
ottw
ilN
o.C
ase
study
Patie
nts w
ith sp
inal
co
rd in
jury
. Aim
ed
at V
R p
rofe
ssio
nals
To il
lustr
ate
the
sys-
tem
atic
app
licat
ion
of IC
F-ba
sed
docu
-m
enta
tion
tool
s by
usin
g IC
F B
rief
Cor
e Se
ts in
VR
sh
own
with
a c
ase
exam
ple
of a
clie
nt
with
trau
mat
ic
spin
al c
ord
inju
ry
(SC
I)
Dev
elop
men
t of I
CF-
base
d do
cum
enta
-tio
n to
ols t
akin
g in
to a
ccou
nt th
e IC
F SC
I Cor
e Se
ts
to fa
cilit
ate
the
docu
men
tatio
n an
d pl
anni
ng o
f reh
a-bi
litat
ion
serv
ices
The
tool
s inc
lude
th
e IC
F A
sses
s-m
ent S
heet
, IC
F C
ateg
oric
al P
rofil
e,
ICF
Inte
rven
tion
Tabl
e an
d th
e IC
F Ev
alua
tion
Dis
play
Pres
enta
tion
of IC
F-ba
sed
docu
men
tatio
n to
ols:
ICF
Inte
rven
-tio
n Ta
ble
and
the
ICF
Eval
uatio
n D
ispl
ay o
f a c
lient
w
ith S
CI i
n a
VR
pr
ogra
m
250 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Gla
ssel
[30]
2011
Switz
erla
ndSw
iss P
arap
legi
c Re
sear
ch N
ottw
ilN
o.M
ixed
-met
hods
m
ultic
ente
r stu
dy, f
ocus
gr
oup
desi
gn
Prof
essi
onal
s in
VR
, N
= 26
To e
xplo
re th
e liv
ed
expe
rienc
es o
f pe
rson
s in
VR
with
re
gard
to fu
nctio
n-in
g an
d co
ntex
tual
fa
ctor
s
Focu
s gro
up in
ter-
view
s7
focu
s gro
ups
yiel
ding
rele
vant
co
ncep
ts b
y6
open
-end
ed q
ues-
tions
Link
ing
to th
e IC
F ca
tego
ries b
ased
on
est
ablis
hed
linki
ng ru
les:
Tr
ansc
riptio
n—C
once
pt—
ICF
cat-
egor
y—Q
ualit
ativ
e an
alys
is—
Link
ing
Iden
tified
con
cept
sre
late
d to
the
ICF
com
pone
nts
Cla
ssifi
catio
n of
con
-ce
pts w
ith IC
F as
a
refe
renc
e
Hoe
fsm
it [6
8]20
14N
ethe
rland
sD
epar
tmen
t of S
ocia
l M
edic
ine,
Maa
s-tri
cht U
nive
rsity
No.
Qua
litat
ive
study
Empl
oyee
s, em
ploy
-er
s, oc
cupa
tiona
l ph
ysic
ians
, N =
14,
15, 4
To id
entif
y w
hich
an
d ho
w e
nviro
n-m
enta
l and
per
sona
l fa
ctor
s sup
port
early
RTW
, and
ex
amin
e w
heth
er
the
ICF
can
be u
sed
to d
escr
ibe
thes
e fa
ctor
s
Inte
rvie
ws w
ith
empl
oyee
s, em
ploy
-er
s and
OPs
from
m
ultip
le o
rgan
isa-
tions
with
var
ying
or
gani
satio
nal
size
s and
type
s of
indu
stry
such
as
hea
lthca
re a
nd
educ
atio
n. Q
ualit
a-tiv
e da
ta a
naly
sis
parti
ally
bas
ed o
n th
e Q
ualit
ativ
e A
naly
sis G
uide
of
Leuv
en
Fact
ors t
hat s
uppo
rt em
ploy
ees’
ear
ly
RTW
and
fact
ors
that
can
or c
anno
t be
des
crib
ed a
nd
clas
sifie
d us
ing
ICF
codi
ng
Hom
a [3
5]20
07U
SAD
epar
tmen
t of R
eha-
bilit
atio
n an
d C
oun-
selin
g, U
nive
rsity
of
Wis
cons
in-S
tout
No.
Ove
rvie
w,
desc
riptiv
eA
imed
at p
rofe
s-si
onal
s in
VR
and
re
sear
cher
s
To p
rovi
de a
n ov
ervi
ew o
f the
IC
F, h
ighl
ight
its
appl
icab
ility
in jo
b pl
acem
ent,
and
desc
ribe
futu
re
poss
ibili
ties f
or
rese
arch
and
out
-co
me
mea
sure
men
t in
VR
Use
of t
he IC
F fr
amew
ork
in jo
b pl
acem
ent a
s a te
m-
plat
e to
org
aniz
e cl
ient
info
rmat
ion,
hi
ghlig
ht st
reng
ths
and
limita
tions
, and
pr
ovid
e gu
idan
ce
for i
nter
vent
ions
in
the
plac
emen
t pr
oces
s
Des
crip
tion
of IC
F us
ed in
job
plac
e-m
ent
251Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Koo
lhaa
s [62
]20
13N
ethe
rland
sD
epar
tmen
t of H
ealth
Sc
ienc
es, C
omm
u-ni
ty a
nd O
ccup
a-tio
nal M
edic
ine,
Uni
vers
ity M
edic
al
Cen
ter G
roni
ngen
Yes.
Surv
ey o
f per
spec
-tiv
es
Wor
kers
, > 45
yea
rs,
N =
3008
To u
nder
stan
d th
e nu
mbe
r and
type
of
exp
erie
nced
ag
eing
pro
blem
s an
d ob
stac
les t
o pe
rform
wor
k ta
sks,
rete
ntio
n fa
ctor
s to
mai
ntai
n w
ork
and
supp
ort
need
s to
cont
inue
w
orki
ng li
fe in
the
next
yea
rs a
mon
g w
orke
rs w
ith a
nd
with
out a
chr
onic
he
alth
con
ditio
n
Surv
ey a
mon
g w
ork-
ers i
n 9
com
pani
es.
Cla
ssifi
catio
n us
ing
ICF
Occ
upat
ion
was
di
vide
d in
to fo
ur
grou
ps: e
xecu
tive,
se
cret
aria
l, po
licy
and
man
agem
ent
Chr
onic
hea
lth c
ondi
-tio
n w
as d
efine
d as
the
subj
ectiv
e ex
perie
nce
of lo
ng-
term
irre
vers
ible
di
seas
e > 3
mon
ths
Prob
lem
s and
obs
tacl
es
rega
rdin
g w
ork;
age
, ge
nder
, edu
catio
n,
occu
patio
n, se
ctor
an
d w
heth
er th
e w
orke
r exp
erie
nced
a
chro
nic
heal
th
cond
ition
Min
is [6
9]20
09N
ethe
rland
sD
epar
tmen
t of
Occ
upat
ion
and
Hea
lth, p
reve
ntio
n an
d re
inte
grat
ion
HA
N U
nive
rsity
of
App
lied
Scie
nces
No.
Sys
tem
atic
re
view
Patie
nts w
ith n
euro
-m
uscu
lar d
isea
ses
(NM
D)
To id
entif
y he
alth
an
d co
ntex
tual
fa
ctor
s ass
ocia
ted
with
em
ploy
men
t in
patie
nts w
ith N
MD
an
d to
per
form
a
best
evid
ence
sy
nthe
sis
Lite
ratu
re se
arch
, ex
tract
ion
offa
ctor
s rel
ated
to
empl
oym
ent s
tatu
sRe
sults
of t
he fa
ctor
ex
tract
ion
rela
ted
to e
mpl
oym
ent
wer
e in
clud
ed
in th
e sc
hem
e of
H
eerk
ens´
ext
ende
d IC
F m
odel
Dis
ease
rela
ted
fact
ors,
func
tions
(phy
si-
cal,
mus
cle
pow
er),
pers
onal
fact
ors (
age,
ge
nder
and
edu
ca-
tion)
, wor
k re
late
d pe
rson
al fa
ctor
s (ty
pe o
f occ
upat
ion,
ex
pres
sed
inte
rest
in
empl
oym
ent)
Sev
illa
[48]
2013
Spai
nEl
ectri
cal a
nd E
lec-
troni
c En
gine
erin
g D
epar
tmen
t, U
ni-
vers
idad
Pub
lica
de
Nav
arra
No.
Lite
ratu
re re
view
Pers
ons w
ith d
isab
ili-
ties a
nd in
tend
ed
user
s (em
ploy
ees,
empl
oyer
s, or
VR
st
aff)
To p
ropo
se a
hie
r-ar
chic
al m
odel
of
acco
mm
odat
ion
asse
ssm
ent b
ased
on
leve
l of s
peci
fic-
ity o
f job
act
ivity
Lite
ratu
re re
view
: A
ppro
ach
to th
e hi
erar
chic
al m
odel
w
as te
sted
agai
nst
seve
ral c
ase
study
sc
enar
ios t
o ch
eck
its fe
asib
ility
and
co
mpl
eten
ess
App
licat
ions
of t
he
mod
el to
eac
h of
the
case
s´ c
ore
activ
i-tie
s of o
ccup
atio
ns,
such
as:
coo
k, o
ffice
as
sist
ant,
gard
ener
, se
win
g m
achi
ne
oper
ator
, or r
eal
esta
te b
roke
r
252 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Ste
rgio
u-K
ita [4
3]20
13C
anad
aTo
ront
o Re
ha-
bilit
atio
n In
stitu
te,
Uni
vers
ity H
ealth
N
etw
ork
No.
Sys
tem
atic
re
view
to o
utlin
e gu
idel
ines
Indi
vidu
als w
ith b
urn
inju
ries (
BI)
To g
athe
r evi
denc
e to
de
velo
p a
guid
e-lin
e fo
r voc
atio
nal
eval
uatio
n fo
llow
-in
g bu
rn in
jurie
s (B
I)To
iden
tify
the
key
proc
esse
s ev
alua
tors
shou
ld
follo
w a
nd th
e ke
y fa
ctor
s the
y sh
ould
co
nsid
er w
hen
com
plet
ing
such
ev
alua
tions
Lite
ratu
re re
view
; Se
arch
ing
in d
ata-
base
s and
web
site
sQ
ualit
y as
sess
men
t: U
sing
the
ICF
mod
el a
nd V
R c
ore
sets
and
dire
cted
co
nten
t ana
lysi
s, ke
y pr
oces
ses a
nd
fact
ors w
ere
ana-
lyse
d an
d sy
nthe
-si
zed
Key
fact
ors a
nd
proc
esse
s rel
evan
t to
a vo
catio
nal e
valu
-at
ion
in re
latio
n to
in
divi
dual
’s b
ody
func
tions
, act
ivity
lim
itatio
ns a
nd p
ar-
ticip
atio
n re
stric
tions
an
d pe
rson
al a
nd
envi
ronm
enta
l sup
-po
rts to
succ
essf
ul
RTW
Tre
nam
an [7
3]20
15C
anad
a/Sw
itzer
land
Dep
artm
ent o
f Occ
u-pa
tiona
l Sci
ence
an
d O
ccup
atio
nal
Ther
apy,
Uni
vers
ity
of B
ritis
h C
olum
bia
No.
Sys
tem
atic
re
view
Indi
vidu
als w
ith
spin
al c
ord
inju
ryTo
revi
ew fa
ctor
s tha
t ar
e co
nsist
ently
and
in
depe
nden
tly a
sso-
ciat
ed w
ith e
mpl
oy-
men
t out
com
es in
in
divi
dual
s with
sp
inal
cor
d in
jury
To u
nder
stan
d th
e m
agni
tude
of t
heir
influ
ence
Lite
ratu
re se
arch
id
entifi
ed st
ud-
ies p
ublis
hed
1952
–201
4. D
ata
wer
e ca
tego
rized
ba
sed
on th
e IC
F w
ith e
ach
dom
ain
sub-
cate
goriz
ed b
y m
odifi
abili
ty
Mod
ifiab
le a
nd n
on-
mod
ifiab
le fa
ctor
s in
the
cont
ext o
f em
ploy
men
t fol
low
-in
g SC
I
van
Vel
zen
[63]
2011
Net
herla
nds
Aca
dem
ic M
edic
al
Cen
ter,
Uni
vers
ity
of A
mste
rdam
Yes.
Sem
i-stru
c-tu
red
inte
rvie
ws
Pers
ons w
ith
acqu
ired
brai
n in
jury
, N =
12
To d
escr
ibe
the
fact
ors e
xper
i-en
ced
by a
dults
w
ith m
oder
ate-
to-
seve
re a
cqui
red
brai
n in
jury
as
eith
er li
miti
ng o
r fa
cilit
atin
g du
ring
the
RTW
pro
cess
in
ord
er to
giv
e an
ad
vice
abo
ut th
e V
R p
roce
ss
Sem
i-stru
ctur
ed
inte
rvie
ws w
ith 1
2 ad
ults
who
wer
e w
orki
ng b
efor
e ac
quiri
ng tr
aum
atic
or
non
-trau
mat
ic
brai
n in
jury
(2
–3 y
ears
ear
lier)
Asp
ects
that
wer
e ex
perie
nced
as b
eing
im
porta
nt d
urin
g th
e pr
oces
s of R
TW a
fter
AB
I
253Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Voo
ijs [7
0]20
15N
ethe
rland
sA
mste
rdam
No.
Sys
tem
atic
re
view
Peop
le o
f wor
king
ag
e w
ith a
chr
onic
di
seas
e
To se
arch
syste
m-
atic
ally
for d
isea
se-
gene
ric fa
ctor
s as
soci
ated
with
ei
ther
wor
k re
ten-
tion
or R
TW in
pe
ople
of w
orki
ng
age
with
a c
hron
ic
dise
ase
Lite
ratu
re se
arch
in
data
base
s, on
syno
-ny
ms o
f the
term
s:
chro
nic
dise
ase,
w
ork
rete
ntio
n an
d RT
W
Fact
ors a
ssoc
iate
d w
ith
wor
k pa
rtici
patio
n fo
r par
ticip
ants
with
a
chro
nic
dise
ase
(15–
67 y
ears
)
Was
iak
[54]
2007
USA
, NZ,
Net
herla
nds
Libe
rty M
utua
l Re
sear
ch In
stitu
te
for S
afet
y, C
ente
r fo
r Dis
abili
ty
Rese
arch
, Hop
kin-
ton,
MA
No.
Dev
elop
men
t stu
dyW
orke
rsTo
ope
ratio
naliz
e th
e co
ncep
tual
-iz
atio
n of
RTW
, w
hich
arg
ues f
or a
n ex
pand
ed aw
are-
ness
that
enc
om-
pass
es 4
pha
ses:
off
wor
k, w
ork
rein
tegr
atio
n, w
ork
mai
nten
ance
and
ad
vanc
emen
t
Revi
ew o
f exi
sting
in
strum
ents
for
thei
r use
as m
eas-
ures
of R
TW
Whe
re g
aps i
n in
strum
enta
tion
wer
e fo
und,
a w
ider
se
arch
was
don
e fo
r ins
trum
ents
that
co
uld
be a
dapt
ed
for u
se in
RTW
re
sear
ch
Use
of m
easu
rem
ent
tool
s tha
t do
not
capt
ure
a co
mpl
ete
pict
ure
of w
orke
rs’
RTW
exp
erie
nces
You
ng [3
6]20
10U
SALi
berty
Mut
ual
Rese
arch
Insti
tute
fo
r Saf
ety,
Cen
ter
for D
isab
ility
Re
sear
ch, H
opki
n-to
n, M
A, U
SA
Yes.
Qua
ntita
tive
and
qual
itativ
e co
mpo
nent
s
Occ
upat
iona
lly
inju
red
wor
kers
af
ter V
R, N
= 15
0
To d
eter
min
e po
st-RT
W d
isab
ility
an
d fu
nctio
ning
am
ongs
t occ
upa-
tiona
lly in
jure
d w
orke
rsTo
test
the
exte
nt to
w
hich
dem
ogra
phic
an
d ot
her v
aria
bles
re
late
to e
mpl
oy-
men
t mai
nten
ance
, an
d to
doc
umen
t w
hat w
orke
rs
belie
ve d
eter
min
ed
thei
r wor
k co
ntin
u-at
ion
Sem
i-stru
ctur
ed
in-d
epth
inte
rvie
ws
abou
t par
tici-
pant
s´ p
ost-V
R
RTW
exp
erie
nces
re
gard
ing
impo
rtant
fa
ctor
s det
erm
inin
g th
eir c
ontin
uatio
n of
wor
k
Fact
ors e
xper
ienc
ed
rega
rdin
g RT
W.
Func
tiona
l res
tric-
tions
, act
ivity
-bas
ed-,
or c
onte
xtua
l-Fa
ctor
s diff
eren
tiatin
g th
ose
empl
oyed
from
th
ose
not
254 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Qua
ntita
tive
pape
rs A
ndel
ic [5
8]20
12N
orw
ayH
ospi
tal o
utpa
tient
cl
inic
, Osl
oN
o.C
ross
-sec
tiona
l stu
dy
Patie
nts w
ith n
eck
pain
refe
rred
to th
e ne
ck a
nd b
ack
N =
249
To d
escr
ibe
com
-m
only
repo
rted
self-
dete
rmin
ed
func
tiona
l pro
blem
s in
pat
ient
s with
ne
ck p
ain
E.g.
pro
blem
s with
w
ork
parti
cipa
tion
To e
valu
ate
thei
r fit
to th
e co
mpo
nent
s of
the
ICF
Self-
repo
rted
func
-tio
nal p
robl
ems o
n th
e Pa
tient
-Spe
cific
Fu
nctio
nal S
cale
. Th
e IC
F w
as u
sed
as a
tool
for a
naly
-si
s. M
eani
ngfu
l co
ncep
ts w
ithin
the
func
tiona
l pro
blem
s w
ere
iden
tified
, co
ded,
and
link
ed
to se
cond
-leve
l ca
tego
ries w
ithin
th
e co
mpo
nent
s of
bod
y fu
nctio
ns,
activ
ities
and
pa
rtici
patio
n. T
he
ICF
cate
gorie
s w
ere
pres
ente
d by
pe
rcen
tage
of t
he
tota
l num
ber o
f fu
nctio
nal p
robl
ems
linke
d to
the
ICF
Func
tiona
l pro
blem
s fit
with
the
ICF
mod
el;
13 m
eani
ngfu
l IC
F do
mai
ns w
ere
iden
ti-fie
d: 4
dom
ains
in
body
func
tion
(= 12
un
derly
ing
cate
go-
ries)
. 13
dom
ains
in
activ
ity a
nd p
artic
i-pa
tion
(= 31
und
erly
-in
g ca
tego
ries)
Cho
w [3
7]20
14U
SAEi
ght s
tate
sYe
s. Lo
ngitu
dina
l, 4
year
8-s
tate
m
ultis
ite d
emon
-str
atio
n pr
ojec
t, qu
asi-e
xper
i-m
enta
l des
ign
Psyc
hiat
ric d
isab
ility
ou
t-pat
ient
s: S
ever
e an
d pe
rsist
ent m
en-
tal i
llnes
s, N
= 16
54Re
ferr
ed b
y pr
ovid
er,
self,
fam
ily, w
ord
of m
outh
, new
spa-
per a
ds
To e
valu
ate
the
impa
ct o
f an
evid
ence
-bas
ed
appr
oach
to
deliv
erin
g em
ploy
-m
ent s
ervi
ces t
o in
divi
dual
s with
ps
ychi
atric
dis
abili
-tie
s bet
wee
n 19
96
and
2000
To c
ompa
re th
ose
with
/with
out
repo
rted
wor
k ac
com
mod
atio
ns
Inte
rvie
w p
roto
cols
, str
uctu
red
asse
ss-
men
ts, w
eekl
y re
cord
ing,
and
de
taile
d de
scrip
tion
of a
ccom
mod
a-tio
ns-s
umm
ariz
edEff
ects
ass
esse
d w
ith
mod
els i
nfor
med
by
ICF
and
othe
r. G
ener
aliz
ed li
near
m
odel
(num
ber o
f ho
urs o
f ove
rtim
e w
ork
afte
r job
ac
com
mod
atio
n)
and
surv
ival
ana
ly-
sis (
time
until
job
shift
/acc
omm
oda-
tion)
How
job
acco
mm
oda-
tions
that
are
mod
er-
ated
by
clin
ical
and
co
ntex
tual
fact
ors a
re
rela
ted
to(1
) ave
rage
-mon
thly
ho
urs w
orke
d in
co
mpe
titiv
e em
ploy
-m
ent a
cros
s mul
tiple
sp
ells
of e
mpl
oy-
men
t?(2
) the
dur
atio
n of
jo
b te
nure
acr
oss
mul
tiple
spel
ls o
f em
ploy
men
t
255Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Con
clav
e [3
9]20
09Ita
lyN
atio
nwid
e, o
rder
ed
by It
alia
n M
inis
-try
of L
abou
r and
So
cial
Pol
icie
s
No.
Expe
rimen
tal
appl
icat
ion
of
the
ICF
base
d m
etho
d an
d de
velo
pmen
t
Aim
ed fo
r eva
luat
ion
of P
erso
ns w
ith d
is-
abili
ty (P
wD
)
To d
evel
op a
nat
ion-
wid
e IC
F-ba
sed
wor
ker c
heck
list
To p
rese
nt th
e pr
o-ce
ss a
nd th
e re
sults
of
ICF
and
Labo
ur
Polic
ies P
roje
ct
with
a sp
ecia
l foc
us
on th
e de
velo
pmen
t of
the
chec
klist
Dev
elop
men
t of
the
dedi
cate
d IC
F-ba
sed
wor
ker
chec
klist
on
the
basi
s of t
he m
inist
e-ria
l sch
edul
e fo
r the
ev
alua
tion
of P
wD
an
d th
e W
HO
’s IC
F ch
eckl
ist, (
a lis
t of
128
ICF
cate
gorie
s em
ploy
ed d
urin
g IC
F’s fi
eld
trial
)St
anda
rdis
ed li
nkin
g ru
les w
ere
follo
wed
to
iden
tify
conc
epts
co
ntai
ned
in th
e m
inist
eria
l sch
edul
e
Tool
sTw
o m
ain
tool
s hav
e be
en p
rodu
ced
by
the
ICF
and
labo
ur
polic
ies p
roje
ct: t
he
wor
ker c
heck
list a
nd
the
prot
ocol
de
Bee
r [71
]20
14N
ethe
rland
sD
epar
tmen
t Occ
upa-
tion
& H
ealth
, H
AN
Uni
vers
ity o
f A
pplie
d Sc
ienc
esN
ijmeg
en, T
he N
eth-
erla
nds
No.
Syste
mat
ic re
view
Pers
ons w
ith d
ys-
lexi
a or
(spe
cific
) le
arni
ng/re
adin
g di
sord
er
To d
eter
min
e hi
nder
-in
g an
d fa
cilit
atin
g fa
ctor
s ass
ocia
ted
with
par
ticip
atio
n in
wor
k of
indi
vidu
-al
s with
dev
elop
-m
enta
l dys
lexi
a (D
D),
clas
sifie
d ac
cord
ing
to th
e di
men
sion
s of t
he
ICF
To e
xplo
re a
nd fu
lly
unde
rsta
nd fa
ctor
s as
soci
ated
with
w
ork
parti
cipa
tion
of a
dults
with
DD
Syste
mat
ic li
tera
ture
se
arch
of q
uant
ita-
tive
or q
ualit
ativ
e m
etho
dolo
gy, p
ub-
lishe
d af
ter 1
995.
IC
F-ex
pand
ed w
ith
two
subd
ivis
ions
: on
e th
at m
ade
the
envi
ronm
enta
l fa
ctor
s mor
e w
ork-
rela
ted
and
one
of
pers
onal
fact
ors.
For d
ata
extra
ctio
n:
qual
itativ
e m
eta
sum
mar
y w
as u
sed
and
the
man
ifest
freq
uenc
y eff
ect
size
(MFE
S) fo
r ea
ch c
ateg
ory
Effec
t siz
e of
fact
ors
betw
een
dysl
exia
or
lear
ning
/read
ing
diso
rder
/dis
abili
ty
and
wor
kTh
e m
anife
st fr
e-qu
ency
effe
ct si
ze is
pr
esen
ted:
cal
cula
ted
by d
ivid
ing
the
num
ber o
f all
studi
es
(that
met
the
qual
ity
crite
rion)
and
in
whi
ch a
fact
or w
as
foun
d by
the
tota
l nu
mbe
r of s
tudi
es
256 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Esc
orpi
zo [7
5]20
11Sw
itzer
land
Swis
s Par
aple
gic
Rese
arch
, Not
will
No.
Dev
elop
men
t stu
dy
Pers
ons w
ith sp
inal
co
rd in
jury
(SC
I)To
dev
elop
a se
t of
ICF-
base
d SC
I Pa
rtici
patio
n an
d SC
I Env
ironm
ent
Dom
ain
Set a
nd
mea
sure
men
t in
strum
ents
that
in
tend
to m
easu
re
thos
e do
mai
ns,
base
d on
the
ICF
Cor
e Se
ts fo
r SC
I
Mer
ging
of t
he IC
F C
ore
Set f
or S
CI
and
cate
gorie
s fro
m
the
ICF
Cor
e Se
t fo
r VR
ICF
cate
gorie
s bas
ed
on th
e ex
istin
g IC
F co
re se
ts fo
r SC
I and
V
R
Esc
orpi
zo [3
3]20
11Sw
itzer
land
Dep
artm
ent o
f H
ealth
Sci
ence
s an
d H
ealth
Pol
icy,
N
otw
ill
No.
Dev
elop
men
t stu
d-ie
s, in
tern
atio
nal
cons
ensu
s co
nfer
ence
VR
pro
fess
iona
ls a
nd
rese
arch
ers
Pres
enta
tion
of fi
ve
artic
les i
n an
effo
rt to
adv
ance
our
un
ders
tand
ing
and
mea
sure
men
t of V
R
and
RTW
pro
cess
Diff
eren
t per
spec
tives
on
ICF/
VR
Dist
ribut
ion
of IC
F ca
tego
ries a
cros
s IC
F co
mpo
nent
s an
d ac
ross
stud
ies.
3 co
re se
ts (2
SC
I + 1
VR
) and
6 in
stru-
men
ts th
at m
easu
re
envi
ronm
ent a
nd
parti
cipa
tion
Esc
orpi
zo [3
2]20
11Sw
itzer
land
Inte
rnat
iona
l sur
vey
No.
Inte
rnet
-bas
ed su
r-ve
y w
ith e
xper
tpa
rtici
pant
s fro
m si
x W
HO
Re
gion
s
VR
pro
fess
iona
ls,
(exp
erts
from
6 W
HO
Reg
ions
), N
= 15
1
Surv
ey th
e ex
perts
in
the
VR
fiel
d w
ith re
gard
to w
hat
fact
ors a
re c
onsi
d-er
ed im
porta
nt to
pa
tient
s par
ticip
at-
ing
in V
R u
sing
the
ICF
as th
e la
ngua
ge
to su
mm
ariz
e th
e re
sults
Surv
ey w
ith V
R
expe
rts. Q
uesti
on
was
rela
ted
to a
co
mpo
nent
of t
he
ICF,
resp
onse
s lin
ked
to IC
F
List
of IC
F ca
tego
ries
that
wer
e co
nsid
ered
to
be
impo
rtant
in th
e V
R p
roce
ss
257Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Fer
rario
[40]
2014
Italy
Occ
upat
iona
l Med
i-ci
ne D
epar
tmen
t, Tu
rin U
nive
rsity
Yes.
Cro
ss- s
ectio
nal
study
Out
patie
nts u
nder
-go
ne h
eart
trans
-pl
anta
tion,
live
r -,
and
kidn
ey- a
nd
surv
ived
at l
east
12 m
onth
s, N
= 15
0
To p
rovi
de e
valu
-at
ion
of p
ossi
ble
RTW
and
of fi
tnes
s fo
r spe
cific
and
ad
equa
te ta
sks o
f su
rviv
ing
trans
plan
t re
cipi
ents
and
to
com
pare
the
resu
lts
with
the
asse
ss-
men
t of t
heir
actu
al
empl
oym
ent s
tatu
s
ICF
ques
tionn
aire
; 10
que
stion
s wer
e fu
rther
app
lied
to
thos
e w
ho w
ere
empl
oyed
at t
he
time
of th
e stu
dy.
Que
stion
s reg
ard-
ing
the
follo
win
g:
time
to R
TW a
fter
surg
ery,
jobs
per
-fo
rmed
afte
r RTW
, pa
rt-tim
e or
fixe
d-sh
ift jo
b as
sign
a-tio
n, d
ifficu
lties
in
per
form
ing
the
prev
ious
or t
he n
ew
job,
pos
sibl
e pe
ri-od
s of u
nem
ploy
-m
ent,
satis
fact
ion
with
the
job
gain
ed
afte
r tra
nspl
anta
-tio
n, th
e re
latio
ns
with
the
empl
oyer
an
d th
e oc
cupa
-tio
nal p
hysi
cian
, the
su
ppor
t rec
eive
d
Com
paris
on o
f wor
k-in
g ab
ility
eva
luat
ion
and
empl
oym
ent s
ta-
tus.
Inte
rnal
com
pari-
son
amon
g di
ffere
nt
orga
n re
cipi
ents
61%
of p
atie
nts w
ere
in p
aid
empl
oym
ent,
4% o
f stu
dent
s and
ho
usew
ives
. 24%
un
empl
oyed
rela
ted
or n
ot to
hea
lth
cond
ition
s, 11
% w
ere
retir
ed
Fin
ger [
28]
2011
Switz
erla
ndV
R c
entre
s; 4
in
Switz
erla
nd 1
in
Ger
man
y
No.
Cro
ss-s
ectio
nal
mul
ticen
ter s
tudy
Pers
ons w
ith v
ario
us
heal
th p
rob-
lem
s > 18
yea
rsN
= 15
2
To d
escr
ibe
pers
ons
unde
rgoi
ng V
RTo
iden
tify
the
mos
t co
mm
on p
robl
ems
arou
nd w
ork
and
in
VR
usi
ng th
e IC
F
Cas
e Re
cord
For
m
base
d on
an
exte
nded
ver
sion
of
the
ICF
Che
cklis
t co
ntai
ning
292
and
SE
S
Cat
egor
ies f
rom
all
four
ICF
com
pone
nts
258 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Fin
ger [
27]
2014
Switz
erla
ndV
R c
entre
sN
o.D
evel
opm
ent a
nd
valid
atio
n stu
dy
Psyc
holo
gist.
Tes
t-sa
mpl
e of
pat
ient
s 18
–65
year
s, pa
r-tic
ipat
ing
in V
RN
= 74
To d
evel
op a
n in
ter-
view
er a
dmin
is-
tere
d IC
F-ba
sed
ques
tionn
aire
(W
OR
Q) t
o as
sess
fu
nctio
ning
in V
RTo
repo
rt pr
elim
i-na
ry p
sych
omet
ric
evid
ence
Mix
ed m
etho
ds
incl
udin
g so
phis
-tic
ated
stat
istic
al
appr
oach
and
qu
alita
tive
cont
ent
asse
ssm
ent.
cat.
from
ICF
VR-
Cor
e Se
ts, e
xplo
rativ
e R
asch
-ana
lysi
s an
d V
R li
tera
ture
re
view
.Q
uesti
ons w
ere
wor
ded
to a
sses
s id
entifi
ed IC
F ca
tego
ries.
WO
RQ
w
as tr
ansl
ated
from
En
glis
h to
Ger
man
. Ex
amin
atio
n of
ps
ycho
met
rics f
or
the
Ger
man
ver
sion
of
WO
RQ
Item
s of W
OR
Q,
the
ICF
cate
gory
m
easu
red
Kui
jer [
64]
2006
Net
herla
nds
Cen
tre fo
r Reh
abili
-ta
tion,
Uni
vers
ity
Med
ical
Cen
tre
Gro
ning
en
Yes.
Cro
ss. s
ectio
nal
study
Patie
nts w
ith
chro
nic
low
bac
k pa
in re
ferr
ed fo
r m
ultid
isci
plin
ary
treat
men
tN
= 92
To e
xplo
re w
hich
va
riabl
es a
re re
late
d to
wor
k st
atus
ac
cord
ing
to IC
F
Que
stion
naire
s (h
ealth
, lim
itatio
n),
test
of p
hysi
cal
perfo
rman
ceLo
gisti
c re
gres
sion
an
alys
is w
as p
er-
form
ed to
exp
lain
wor
k st
atus
(out
-co
me)
from
the
incl
uded
var
iabl
es
offu
nctio
ning
Wor
k st
atus
, var
iabl
es
of fu
nctio
ning
259Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Ley
shon
[76]
2008
Can
ada
Uni
vers
ity o
f Wes
t-er
n O
ntar
ioN
o.Li
tera
ture
revi
ewIn
jure
d w
orke
rs
(mus
culo
skel
-et
al d
isor
ders
mos
t co
mm
on)
To in
trodu
ce a
n IC
F-ba
sed
new
pra
ctic
e m
odel
of o
ccup
a-tio
nal r
ehab
ilita
tion
ergo
nom
ics
Trad
ition
al m
odel
: M
icro
/mac
ro-e
rgon
omic
s ha
ve b
een
defin
ed
as “
the
study
and
pr
oces
s of d
esig
n-in
g an
d/or
mod
ify-
ing
tool
s, m
ater
ials
, eq
uipm
ent,
wor
k sp
aces
, tas
ks, j
obs,
prod
ucts
, sys
tem
s, an
den
viro
nmen
ts to
m
atch
the
abili
ties,
limita
tions
, and
so
cial
nee
ds o
f hu
man
bei
ngs i
n th
e w
orkp
lace
”
Mod
el, i
n or
der t
o be
tter d
escr
ibe
inte
rven
tions
, as
inte
rven
tions
car
ried
out i
n th
e w
orkp
lace
ap
pear
to b
e “v
ery
hete
roge
neou
s and
ill
-defi
ned”
Lin
den
[41]
2010
Ger
man
yIn
patie
nts,
depa
rt-m
ent o
f beh
avio
ural
and
psyc
hoso
mat
ic
med
icin
e, T
elto
v
Yes.
Cro
ss-s
ectio
nal,
exam
inat
ion
and
inte
rvie
w
Patie
nts a
dmitt
ed to
th
e D
epar
tmen
t of
Beh
avio
ral M
edi-
cine
, N =
213
To e
xam
ine
the
rela
-tio
nshi
p be
twee
n m
easu
res o
f cap
ac-
ity*,
mot
ivat
ion
and
perfo
rman
ce*i
nabi
lity
to p
erfo
rm
activ
ities
(i.e
. dys
-fu
nctio
ns)
Spec
ial c
linic
al
inte
rvie
w a
nd
ques
tionn
aire
s ob
serv
er ra
ting
for
Men
tal D
isor
ders
(M
ini-I
CF-
APP
), w
ork
perfo
rman
ce
Endi
cott
Wor
k Pr
oduc
tivity
Sca
le
(EW
PS),
and
volit
iona
l and
mot
i-va
tiona
l pro
blem
s
Ass
essm
ent o
f cap
aci-
ties (
wor
k-re
late
d at
titud
es, v
oliti
on a
nd
mot
ivat
ion)
260 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Mar
tins [
45]
2015
Portu
gal
Coi
mbr
a H
ealth
Sc
hool
, Phy
siot
her-
apy
Dep
artm
ent
No.
Expl
orat
ive,
cro
ss-
sect
iona
l stu
dy
Wor
king
-age
per
sons
w
ith d
isab
ilitie
s liv
-in
g in
com
mun
ity
dwel
ling
setti
ngs.
Seve
re li
mita
tions
in
mob
ility
due
to
a ch
roni
c di
seas
e or
inju
ry, u
sing
a
whe
elch
air f
or >
1 ye
ar, N
= 14
9
To e
xplo
re k
ey
indi
cato
rs o
f soc
ial
parti
cipa
tion
(life
ha
bits
) of p
erso
ns
with
dis
abili
ties,
parti
cula
rly re
late
d to
wor
k
Que
stion
naire
s:
Atti
tude
s Tow
ards
D
isab
led
Pers
ons
Que
stion
naire
, se
lf-effi
cacy
and
the
LIFE
-H(7
7 ite
ms a
cros
s 12
prim
ary
dom
ains
, in
clud
ing
nutri
tion,
fit
ness
, per
sona
l ca
re, c
omm
uni-
catio
n, h
ousi
ng,
mob
ility
, res
pons
i-bi
lity,
inte
rper
sona
l re
latio
ns, c
om-
mun
ity, e
duca
tion,
em
ploy
men
t, an
d re
crea
tion)
Det
erm
inan
ts fo
r so
cial
par
ticip
atio
n,
empl
oym
ent (
self-
effica
cy, Q
oL)
Nils
ing
[56]
2012
Swed
enH
ospi
tal p
hysi
cian
s an
d G
Ps, O
sterg
ot-
land
Cou
nty
No.
Com
para
tive
study
All
new
sick
leav
e ce
rtific
ates
dur
ing
2-w
eek
perio
d in
20
07 a
nd 4
-wee
k pe
riod
in 2
009,
N
= 47
5501
To c
ompa
re q
ualit
y of
sick
ness
cer
tifi-
cate
s bet
wee
n 20
07
and
2009
. (D
if-fe
renc
es b
etw
een
ICF-
code
s in
2007
an
d 20
09)
Pear
son’
s chi
2 an
d t-t
est w
as p
er-
form
ed to
test
diffe
renc
es b
etw
een
varia
bles
Qua
lity
in si
ckne
ss
certi
ficat
es, d
escr
ip-
tion
of fu
nctio
ning
an
d pr
escr
iptio
ns o
f ea
rly re
habi
litat
ion
Pty
ushk
in [4
7]20
11Sl
oven
iaO
rgan
isat
ions
gr
ante
d to
ass
ess
pers
ons w
ith d
isab
ili-
ties a
nd to
ope
rate
th
eir V
R
No.
Revi
ew, s
urve
yPs
ycho
logi
sts, s
ocia
l w
orke
rs a
nd o
ccu-
patio
nal t
hera
pists
To re
view
use
of t
he
ICF
in V
R a
nd d
is-
abili
ty a
sses
smen
t
Revi
ew o
f the
Sl
oven
ian
law
, su
rvey
, gro
up a
nd
indi
vidu
al in
ter-
view
s. N
ine
of 1
3 or
gani
satio
ns w
ere
surv
eyed
tota
lly o
r pa
rtial
ly
Mai
n ad
vant
ages
/di
s-ad
vant
ages
and
qu
aliti
es/d
efici
en-
cies
; whe
ther
the
ICF
help
s to
esta
blis
h a
com
mon
lang
uage
Rei
chel
[42]
2010
Ger
man
yIn
patie
nt re
habi
lita-
tion
cent
re, B
adB
rück
enau
Yes.
Cha
rt re
view
Patie
nts w
ith g
astro
-in
testi
nal d
isea
ses,
N =
355
To li
nk IC
F to
oth
er
spec
ific
instr
umen
ts
and
com
pare
with
ot
her p
redi
ctor
s of
reha
bilit
atio
n ou
tcom
es
Scre
enin
g fil
es;
Cro
hn’s
Dis
ease
A
ctiv
ity In
dex
vari-
able
s wer
e lin
ked
with
ICF
cate
gorie
s us
ing
linki
ng ru
les
Varia
bles
link
ed w
ith
clin
ical
impr
ove-
men
t (de
crea
se in
H
arve
y-B
rads
haw
In
dex
of ≥
2 U
) and
V
R su
cces
s
261Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 1
(con
tinue
d)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Sal
tych
ev [4
6]20
13Tu
rkey
Turk
ish
Uni
vers
ity
Hos
pita
lYe
s. Re
trosp
ectiv
e co
hort
study
Patie
nts w
ith c
hron
ic
mus
culo
skel
etal
di
sord
ers,
unde
rgo-
ing
VR-
eval
uatio
n,
N =
32
To id
entif
y th
e m
ost
freq
uent
func
tiona
l lim
itatio
ns a
ccor
d-in
g to
ICF
Each
phr
ase
from
the
patie
nts’
ele
ctro
nic
reco
rd th
at c
ould
po
tent
ially
be
inte
r-pr
eted
as a
n IC
F co
de w
as e
xtra
cted
ICF
code
s cat
egor
ized
141
diffe
rent
wer
e id
entifi
ed w
ith a
pr
ecis
enes
s of t
hree
or
mor
e di
gits
Stu
ress
on [5
7]20
15Sw
eden
Swed
ish
Soci
al In
sur-
ance
Age
ncy
146
diffe
rent
GPs
, at
29 c
entre
s
Yes.
Qua
lity
asse
ss-
men
t, ba
sed
on
an in
terv
entio
n
Patie
nts a
tpr
imar
y he
alth
car
e ce
ntre
s, si
ck-
ness
cer
tifica
tes,
N =
323
To e
valu
ate
the
qual
ity o
f sic
knes
s ce
rtific
ates
issu
ed
in p
rimar
y he
alth
ca
re a
nd e
xam
ine
if th
e pa
tient
s’ o
r ph
ysic
ians
’ gen
der
influ
ence
s
Eval
uatio
n w
as
perfo
rmed
in
acco
rdan
ce w
ith th
e sa
me
crite
ria a
s in
the
natio
nal ‘
Sick
Le
ave
Bill
ion’
Suffi
cien
t inf
orm
atio
n co
ncer
ning
the
diag
-no
sis,
leve
l of s
ick
leav
e an
d tim
e pe
riod
for t
he si
ck le
ave
Var
ekam
p [5
3]20
13N
ethe
rland
s/G
erm
any
Cur
rent
Hea
lth in
G
erm
any
No.
Des
crip
tive
study
, re
giste
rs
Popu
latio
n 18
–65
year
, N =
35,5
74To
exp
lore
pro
blem
s or
solu
tions
for
wor
kers
with
a
chro
nic
dise
ase;
fro
m q
uant
itativ
e an
d qu
alita
tive
rese
arch
Tele
phon
e su
rvey
s co
nduc
ted
from
Ju
ly 2
008
to Ju
ly
2010
am
ong
adul
ts
Chr
onic
dis
ease
, pa
rtici
patio
n (w
ork
disa
bilit
y)
Wan
g [5
0]20
13Ta
iwan
Uni
vers
ity C
olle
ge o
f So
cial
Sci
ence
No.
Surv
ey, s
econ
dary
an
alys
es
Labo
ur fo
rce
with
di
sabi
lity
livin
g at
ho
me,
N =
2,90
9
To e
xplo
re IC
F fa
ctor
s ass
ocia
tion
with
em
ploy
men
t in
disa
bled
Surv
ey: L
ife si
tua-
tion
for d
isab
led;
se
cond
ary
data
an
alys
is, r
egre
ssio
n m
odel
Empl
oym
ent,
type
of
disa
bilit
y an
d IC
F ca
tego
ry
Zei
lig [4
9]20
12Is
rael
Post-
polio
out
patie
nt
clin
ic. T
el-
Has
hom
er
No.
Dat
a ex
tract
ion
from
reco
rds
Patie
nts w
ith lo
ng-
stan
ding
pol
iom
ye-
litis
(LSP
), N
= 12
3
To d
eter
min
e th
e eff
ects
of a
num
ber
of so
cial
and
fu
nctio
nal v
ari-
able
s as b
arrie
rs o
r fa
cilit
ator
s to
wor
k pa
rtici
patio
n in
pe
rson
s with
LSP
Revi
ew o
f the
m
edic
al re
cord
s. Em
ploy
men
t de
fined
as >
= 20
h
of re
gula
r rem
u-ne
rativ
e ac
tivity
Empl
oym
ent;
assi
stan
t de
vice
s for
mob
ility
, de
pend
ent f
or b
asic
A
DL
asso
ciat
ed w
ith
low
er e
mpl
oym
ent.
Driv
ing
posi
tive
asso
ciat
ions
Øste
rås [
60]
2007
Nor
way
Ulle
nsak
er m
unic
i-pa
lity
Yes.
Surv
eySe
ven
birth
coh
orts
, N
= 16
20To
pro
vide
mea
sure
-m
ent o
f pop
ulat
ion
func
tiona
l lev
els,
asse
ssm
ent o
f re
liabi
lity
of a
Nor
-w
egia
n sc
ale
base
d on
ICF
Post
al q
uesti
onna
ire
in 2
004
Instr
umen
t bas
ed o
n IC
F-fu
nctio
nal a
bil-
ity; d
eriv
ed fr
om th
e ac
tiviti
es/p
artic
ipa-
tion
com
pone
nt
262 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
VR professionals [32, 39, 40, 42, 46, 47, 59], e.g. psycholo-gists, social workers, technologists, occupational therapists, occupational physicians, education counsellor, rehabilitation counsellor. Two papers involved health professionals and patients [28], and solely health professionals [27], respec-tively. A paper described all professionals involved in reha-bilitation research (experienced physiotherapists, certified physiotherapist/movement scientist, research assistant) [64], another paper involved independent insurance specialists, who were trained to assess the quality of information in sick-ness certificates [57].
How the ICF Inform Assessment of Functioning
Regarding to what extent the ICF informed professionals´ assessment of functioning; several papers reported discus-sions on the ICF´s applicability for VR, service delivery, and RTW support. As examples were papers reporting on potential benefits of the ICF: to structure and phrase dis-ability evaluation in the field of social insurance [26], on tracking risk factors for disability amongst the self-employed [65], highlight its applicability in job placement [35], and to identify the most common problems around work and in VR.
One paper concluded that a questionnaire based on the ICF proved to be a “useful framework that can be used for research but also by occupational physicians in their usual practice after specific training” [29]. A paper reported on an expert survey on use of the ICF as the language to sum-marize the results in VR [32]. Another paper concluded, that although the procedure using the ICF was “complex, time-consuming, and requires specific training of the staff involved in its use”; the occupational physicians were pro-vided with a standardized procedure to evaluate working ability and suggest re-employment for transplant recipients [40].
A paper described how VR professionals used the ICF to guide assessment in the job placement process and used the appropriate ICF domains and categories as a template to determine what specific information needed to be obtained, and how to organize it in a systematic way. Thus, an inter-view format informed by the ICF structure enabled the pro-fessionals to highlight the needs for assessment information [35].
Criticism of the ICF
One paper involving several health and non-health profes-sionals concluded, that disadvantages of the ICF are the “complicated terminology, perceived subjectivity of the assessor in coding” and that ‘it is too bulky’ [47]. Another paper described factors that support employees’ early RTW and reported that some factors cannot be described and clas-sified using the existing coding system of the ICF [68].Ta
ble
1 (c
ontin
ued)
Aut
hor
Year
Cou
ntry
Setti
ngIn
terv
entio
n (y
es/
no) S
tudy
type
Popu
latio
nA
ims
Met
hods
Out
com
es (p
rimar
y/se
cond
ary)
Aas
[59]
2007
Nor
way
Com
mun
ity-b
ased
O
T se
rvic
esN
o. C
ross
-se
ctio
nal p
osta
l su
rvey
Clie
nts i
n co
mm
u-ni
ty h
ealth
car
e,
N =
168
To d
escr
ibe
soci
o-de
mog
raph
ic fa
ctor
s an
d th
e oc
curr
ence
of
dise
ases
and
di
sabi
litie
s am
ong
a re
pres
enta
tive
sam
ple
of c
lient
s w
ho w
ere
usin
g co
mm
unity
OT
serv
ices
Com
mun
ity o
ccup
a-tio
nal t
hera
pyC
oded
dia
gnos
es
-acc
ordi
ng to
the
Inte
rnat
iona
l Cla
s-si
ficat
ion
of P
rimar
y C
are
(IC
PC-2
)
Aas
[74]
2011
Nor
way
Coc
hran
e B
ack
Gro
upN
o. S
yste
mat
ic
revi
ewA
dult
wor
kers
with
ne
ck p
ain
To d
eter
min
e th
e eff
ectiv
enes
s of
wor
kpla
ce in
terv
en-
tions
com
pare
d to
no
trea
tmen
t, us
ual
care
or o
ther
wor
k-pl
ace
inte
rven
tions
fo
r adu
lt w
orke
rs
with
nec
k pa
in
Lite
ratu
re se
arch
, w
orke
rs a
t wor
k or
abs
ent f
rom
w
ork.
Wor
kers
with
ac
ute,
sub-
acut
e or
ch
roni
c ne
ck p
ain
Two
mai
n ou
tcom
esPa
in re
lief a
nd re
duce
d si
ckne
ss a
bsen
ce/
RTW
. Pai
n se
verit
y or
pai
n pr
eval
ence
263Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 2
Sum
mar
y of
the
incl
uded
pap
ers´
ope
ratio
naliz
atio
n of
ICF,
per
sons
invo
lved
in V
R, a
nd IC
F co
mpo
nent
s use
d
Aut
hor
Ope
ratio
naliz
atio
n of
ICF
(i.e.
as a
fram
ewor
k fo
r: str
uctu
ring,
link
ing,
ana
lysi
s or d
evel
opm
ent)
Who
are
invo
lved
(sta
keho
lder
s, pa
tient
s)IC
F co
mpo
nent
s use
d
Qua
litat
ive
struc
turin
g A
nner
[26]
Fram
ewor
k to
stru
ctur
e an
d ph
rase
dis
abili
ty e
valu
atio
n by
use
of I
CF.
Med
ical
Eva
luat
ion
of w
ork
disa
bilit
y.
The
ICF
fram
ewor
k di
sting
uish
es th
e do
mai
ns a
nd
thei
r int
erac
tion
but d
oes n
ot fo
rese
e a
restr
icte
d ca
usal
rela
tion
Rese
arch
ers,
med
ical
eva
luat
ors o
f wor
k di
sabi
lity
All
com
pone
nts e
xcep
t per
sona
l fac
tors
Dal
eman
s [66
]Fr
amew
ork
for c
ateg
oriz
ing.
Sea
rch
term
s wer
e de
rived
fro
m IC
F. A
spec
ts o
f dom
estic
life
, int
erpe
rson
al
inte
ract
ions
and
rela
tions
hips
, edu
catio
n an
d em
ploy
-m
ent,
and
com
mun
ity, c
ivic
, and
soci
al li
fe w
ere
incl
uded
Rese
arch
ers
Parti
cipa
tion
only
In d
omes
tic li
fe, i
nter
-per
sona
l life
, edu
catio
n, c
omm
u-ni
ty, c
ivic
, and
soci
al li
fe
Dan
iel [
44]
Fram
ewor
k fo
r cat
egor
izin
g. D
efini
ng so
cial
con
se-
quen
ces a
ccor
ding
as t
hose
per
tain
ing
to th
e IC
F do
mai
n of
“pa
rtici
patio
n”. S
ocia
l con
sequ
ence
s gr
oupe
d in
to 5
dom
ains
refle
ctin
g th
e to
pics
inve
sti-
gate
d: R
TW, f
amily
rela
tions
hips
, sex
ual,
finan
ces,
and
soci
al a
ctiv
ities
. Dev
elop
ing
a st
anda
rdiz
ed
instr
umen
t, w
hich
take
s int
o ac
coun
t spe
cific
nee
ds
of w
orki
ng-a
ged
peop
le. T
his s
cale
shou
ld b
e in
line
w
ith th
e IC
F
Rese
arch
ers
Parti
cipa
tion
only
In w
ork
only
De
Boe
r [61
]Fr
amew
ork
and
verifi
catio
n ac
cord
ing
to IC
F ca
tego
-rie
s. Th
e to
pics
that
add
ress
a c
laim
ant’s
dis
abili
ty
wer
e co
mpa
red
to IC
F an
d a
bio-
psyc
ho-s
ocia
l ap
proa
ch to
see
the
exte
nt o
f mat
ch
Rese
arch
er a
nd so
cial
insu
ranc
e ph
ysic
ians
All
com
pone
nts
Esc
orpi
zo [7
5]Fr
amew
ork.
Des
crip
tion
and
use
of IC
F ca
tego
ries.
Use
of I
CF
as a
lang
uage
of d
isab
ility
, a c
omm
on
refe
renc
e fr
amew
ork
to p
rovi
de d
isab
ility
crit
eria
in
dete
rmin
ing
func
tiona
l and
wor
k ca
paci
ty, a
nd to
hel
p fa
cilit
ate
a co
mm
on g
roun
d of
und
erst
andi
ng
Rese
arch
ers
All
com
pone
nts
ICF
gene
ric se
t, co
re se
ts fo
r VR
and
Dis
abili
ty E
valu
a-tio
n in
Soc
ial S
ecur
ity
Fin
ger [
29]
Fram
ewor
k of
stru
ctur
ing.
App
licat
ion
and
com
pari-
son
of IC
F-ba
sed
tool
s the
Reh
abili
tatio
n M
anag
e-m
ent S
heet
, the
Wor
k Re
habi
litat
ion
Que
stion
naire
(W
OR
Q, t
he g
ener
ic a
nd b
rief c
ore
set o
f low
bac
k pa
in).
ICF
struc
ture
s use
d to
faci
litat
e co
mm
unic
atio
n be
twee
n st
akeh
olde
rs, t
o he
lp st
ruct
ure
reha
bilit
atio
n pl
ans a
nd fo
r set
ting
goal
s, an
d cl
arify
ing
team
role
s
Rese
arch
er a
nd st
akeh
olde
rs: r
ehab
ilita
tion
phys
icia
n,
a ph
ysio
ther
apist
, a p
sych
olog
ist a
nd a
voc
atio
nal
coun
sello
r
All
com
pone
nts
Exce
pt p
erso
nal f
acto
rsC
ore
set o
f low
bac
k pa
in (L
BP)
Gla
ssel
[31]
Fram
ewor
k fo
r a sy
stem
atic
app
licat
ion
of IC
F-ba
sed
docu
men
tatio
n to
ols b
y us
ing
ICF
Cor
e Se
ts in
VR
. U
se o
f the
ICF
Cor
e Se
ts in
VR
allo
ws a
com
preh
en-
sive
ass
essm
ent
Rese
arch
er a
nd V
R te
am O
T, p
hysi
cal t
hera
pist,
nu
rses
, voc
atio
nal
Cou
nsel
lor,
soci
al w
orke
r, ph
ysic
ian,
and
psy
chol
ogist
All
com
pone
nts
Cor
e se
t for
VR
Hoe
fsm
it [6
8]Fr
amew
ork
for d
escr
iptio
n of
env
ironm
enta
l and
per
-so
nal f
acto
rs re
gard
ing
supp
ort o
f em
ploy
ees´
RTW
. Pr
ofes
sion
als´
use
of t
he IC
F
Rese
arch
er a
nd p
erso
ns in
terv
iew
ed: 1
4 em
ploy
ees,
15 e
mpl
oyer
s and
4 O
Ps fr
om m
ultip
le o
rgan
isat
ions
(h
ealth
care
and
edu
catio
n)
All
com
pone
nts.
Exce
pt p
erso
nal f
acto
rs
264 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 2
(con
tinue
d)
Aut
hor
Ope
ratio
naliz
atio
n of
ICF
(i.e.
as a
fram
ewor
k fo
r: str
uctu
ring,
link
ing,
ana
lysi
s or d
evel
opm
ent)
Who
are
invo
lved
(sta
keho
lder
s, pa
tient
s)IC
F co
mpo
nent
s use
d
Koo
lhaa
s [62
]Fr
amew
ork
for c
ateg
oriz
atio
n. IC
F us
ed fo
r cla
ssifi
ca-
tion
and
com
parin
g th
e w
orke
rs’ p
ersp
ectiv
esRe
sear
cher
All
com
pone
nts
Min
is [6
9]Fr
amew
ork,
ICF
used
as a
stru
ctur
e fo
r fac
tor e
xtra
c-tio
n in
dica
tive
for a
ssoc
iatio
n w
ith e
mpl
oym
ent s
tatu
s fro
m st
udie
s. Fa
ctor
s rel
ated
to h
ealth
stat
e, w
ork
and
othe
r env
ironm
enta
l and
per
sona
l fac
tors
is n
eede
d to
im
prov
e ca
re a
nd se
rvic
es b
y al
lied
heal
th p
rofe
ssio
n-al
s and
org
anis
atio
ns in
volv
ed in
the
(re-
) int
egra
tion
proc
ess
Rese
arch
erA
ll co
mpo
nent
s
Tre
nam
an [7
3]Fr
amew
ork
for c
ateg
oriz
atio
n. F
acto
rs c
ateg
oriz
ed
base
d on
the
ICF
with
eac
h do
mai
n su
b-ca
tego
rized
by
mod
ifiab
ility
Rese
arch
ers
All
com
pone
nts
Voo
ijs [7
0]Fr
amew
ork
for c
ateg
oriz
atio
n. F
acto
rs a
ssoc
iate
d w
ith w
ork
parti
cipa
tion
wer
e ca
tego
rized
acc
ordi
ng
to IC
F. V
ario
us d
isea
se-g
ener
ic fa
ctor
s are
ass
oci-
ated
with
wor
k pa
rtici
patio
n, o
f whi
ch m
ost o
f the
re
porte
d fa
ctor
s are
inde
pend
ent o
f dia
gnos
is
Rese
arch
ers
All
com
pone
nts
Qua
litat
ive
linki
ng A
iach
ini [
38]
Fram
ewor
k fo
r lin
king
. Val
idat
ion
of c
ore
set f
or V
R.
Con
cept
s wer
e lin
ked
to IC
F ca
tego
ries a
ccor
ding
to
esta
blis
hed
linki
ng ru
les.
70%
of 9
0 ca
tego
ries i
n V
R
core
set w
ere
foun
d
Spin
al c
ord
inju
ry p
atie
nts,
two
heal
th p
rofe
ssio
nals
lin
ked
the
conc
epts
to IC
FA
ll co
mpo
nent
s. C
ompr
ehen
sive
cor
e se
t for
VR
Esc
orpi
zo [5
2]Fr
amew
ork
for l
inki
ng, I
CF
used
as a
refe
renc
e to
de
scrib
e an
d co
mpa
re th
e co
nten
tsof
thes
e qu
estio
nnai
res:
Hea
lth a
nd W
ork
Q.,
Wor
k Ro
le F
unct
ioni
ng Q
.R
heum
atoi
d A
rthrit
is-W
ork
Inst
abili
ty S
cale
, Hea
lth
and
Labo
ur Q
Rese
arch
ers
All
com
pone
nts
Hea
lth a
nd W
ork
Q. t
he o
nly
incl
udin
g en
viro
nmen
tal
and
pers
onal
fact
ors
Gla
ssel
[30]
Fram
ewor
k fo
r lin
king
. Ref
eren
ce to
ICF
cate
gorie
s ac
cord
ing
to e
stab
lishe
d lin
king
rule
sRe
sear
cher
All
com
pone
nts
Qua
litat
ive
anal
ysin
g A
bbot
t [55
]Fr
amew
ork
for a
naly
sing
inte
rvie
ws.
Bas
ed o
n IC
F a
qual
itativ
e co
nten
t ana
lysi
s of s
emi-s
truct
ured
in
terv
iew
s pos
t-sur
gery
was
per
form
ed. I
CF
was
ap
plie
d to
iden
tify
and
code
mea
ning
ful u
nits
, whi
ch
wer
e co
mpa
red
with
the
ICF
rela
ted
cont
ent o
f the
O
swes
try D
isab
ility
Inde
x, S
F-36
, EQ
5D a
nd th
e IC
F LB
P co
re se
ts
Patie
nts,
rese
arch
ers
All
com
pone
nts
Cor
e se
t for
low
bac
k pa
in
265Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 2
(con
tinue
d)
Aut
hor
Ope
ratio
naliz
atio
n of
ICF
(i.e.
as a
fram
ewor
k fo
r: str
uctu
ring,
link
ing,
ana
lysi
s or d
evel
opm
ent)
Who
are
invo
lved
(sta
keho
lder
s, pa
tient
s)IC
F co
mpo
nent
s use
d
Cul
ler [
34]
Fram
ewor
k fo
r ana
lysi
ng in
terv
iew
s. C
ompo
nent
s ide
n-tifi
ed in
3 p
ersp
ectiv
es (p
atie
nts,
voca
tiona
l exp
erts
an
d em
ploy
ers)
wer
e ill
ustra
ted
and
map
ped
onto
the
ICF
codi
ng
10 st
roke
surv
ivor
s, 21
voc
atio
nal s
peci
alist
s, 7
empl
oyer
s (ex
perie
nced
in in
terv
iew
ing
pers
ons
with
dis
abili
ties a
nd w
ith a
utho
rity
to m
ake
hirin
g de
cisi
ons)
All
com
pone
nts.
Impa
irmen
ts o
f bod
y, a
ctiv
ity li
mita
-tio
ns to
par
ticip
atio
n. R
estri
ctio
ns b
y en
viro
nmen
tal
and
pers
onal
fact
ors
Ste
rgio
u-K
ita [4
3]Fr
amew
ork
for d
ata
anal
ysis
. Util
ized
as g
uidi
ng
fram
ewor
ks d
urin
g da
ta a
naly
sis.
ICF
focu
sed
mor
e sp
ecifi
cally
on
iden
tifyi
ng k
ey d
omai
ns o
r fac
tors
and
fa
iled
to c
aptu
re th
e pr
oces
ses r
elev
ant t
o a
rigor
ous
eval
uatio
n
Rese
arch
erA
ll co
mpo
nent
s
Van
Vel
zen
[63]
Fram
ewor
k fo
r the
inte
rvie
w a
nd th
e an
alys
isRe
sear
cher
sA
ll co
mpo
nent
s Y
oung
[36]
Fram
ewor
k fo
r ana
lysi
ng in
terv
iew
s. Re
sults
wer
e in
terp
rete
d us
ing
the
heal
th a
nd h
ealth
-rel
ated
do
mai
ns fr
om th
e IC
F. In
terv
iew
s wer
e co
nduc
ted
to
inqu
ire a
bout
par
ticip
ant’s
pos
t-VR
RTW
exp
eri-
ence
s. C
odin
g of
the
qual
itativ
e da
ta a
nd a
naly
sis w
as
cond
ucte
d in
tand
em
Rese
arch
ers a
nd p
ost V
R p
artic
ipan
tsA
ll co
mpo
nent
s
Qua
litat
ive
deve
lopm
ent
Bak
ker [
65]
Fram
ewor
k fo
r dev
elop
ing
a ris
k as
sess
men
t mod
el,
with
a st
rong
focu
s on
pers
onal
and
env
ironm
enta
l fa
ctor
s, as
it w
ill a
ffect
cla
im b
ehav
iour
. The
mod
el
will
brin
g th
e cu
rren
t med
ical
mod
el a
t the
und
er-
writ
ing
stag
e m
ore
in li
ne w
ith th
e so
cial
mod
el a
t cl
aim
stag
e
Rese
arch
ers
All
com
pone
nts
Focu
s on
envi
ronm
enta
l and
per
sona
l fac
tors
in a
dditi
on
to m
edic
al d
ata
Des
iron
[67]
Fram
ewor
k us
ed to
iden
tify
elem
ents
in O
T m
odel
s. Re
sear
ch sp
ecifi
c cr
iteria
der
ived
from
OT
liter
atur
e (c
once
ptua
l OT
mul
tidis
cipl
inar
y m
odel
refe
rrin
g to
th
e IC
F)
Rese
arch
erA
ll co
mpo
nent
s. Id
entifi
ed e
lem
ents
: fun
ctio
nal,
med
i-ca
l, RT
W
Hom
a [3
5]Fr
amew
ork
for d
evel
opm
ent o
f int
ervi
ew fo
rmat
in
form
ed b
y th
e IC
F str
uctu
re. U
sed
in jo
b pl
acem
ent
as a
tem
plat
e to
org
aniz
e cl
ient
info
rmat
ion,
hig
hlig
ht
stren
gths
and
lim
itatio
ns, a
nd p
rovi
de g
uida
nce
for
inte
rven
tions
Rese
arch
erA
ll co
mpo
nent
sEx
cept
per
sona
l fac
tors
Sev
illa
[48]
Fram
ewor
k fo
r dev
elop
men
t of a
mod
el o
f whi
ch th
e le
vels
of a
ctiv
ity c
an b
e cr
oss-
wal
ked
to th
e IC
FRe
sear
cher
All
com
pone
nts
The
new
mod
el in
clud
e m
ore
than
ICF
Was
iak
[54]
Fram
ewor
k fo
r dev
elop
men
tal c
once
ptua
lizat
ion
of
RTW
. Usi
ng th
e IC
F to
info
rm o
ur th
inki
ng a
nd
codi
ng st
ruct
ure,
con
cept
ualiz
ing
phas
e-ba
sed
RTW
ou
tcom
es a
nd c
ateg
oriz
atio
n in
‘tas
ks a
nd a
ctio
ns’,
‘con
text
ual’
or ‘p
roce
ss d
riven
’. A
war
enes
s of R
TW
enco
mpa
ssin
g fo
ur p
hase
s: o
ff w
ork,
wor
k re
inte
gra-
tion,
wor
k m
aint
enan
ce a
nd a
dvan
cem
ent
Rese
arch
ers
All
com
pone
nts
266 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 2
(con
tinue
d)
Aut
hor
Ope
ratio
naliz
atio
n of
ICF
(i.e.
as a
fram
ewor
k fo
r: str
uctu
ring,
link
ing,
ana
lysi
s or d
evel
opm
ent)
Who
are
invo
lved
(sta
keho
lder
s, pa
tient
s)IC
F co
mpo
nent
s use
d
Qua
ntita
tive
struc
turin
g C
how
[37]
Fram
ewor
k fo
r cat
egor
izat
ion
and
desc
riptio
n on
how
lim
itatio
ns in
func
tioni
ng a
nd th
e en
viro
nmen
t are
re
late
d to
em
ploy
men
t out
com
es
Rese
arch
team
; tra
ined
inte
rvie
wer
s; p
roje
ct st
aff
mem
bers
All
com
pone
nts
Pers
onal
cha
ract
erist
ics
Fin
ger [
27]
Fram
ewor
k fo
r stru
ctur
ing.
ICF
core
set b
asis
for
deve
lopi
ng a
n in
strum
ent.
Parti
cipa
nts c
omm
ente
d on
th
e us
abili
ty
Prof
essi
onal
s, 25
pat
ient
s, vo
catio
nal c
ouns
ello
rs, a
nd
a w
ork
rein
tegr
atio
n sp
ecia
list
All
com
pone
nts
Exce
pt p
erso
nal f
acto
rsC
ore
set
Kui
jer [
64]
Fram
ewor
k fo
r cla
ssifi
catio
n. V
aria
bles
cla
ssifi
ed
acco
rdin
g to
the
ICF
Rese
arch
ass
istan
t; 2
phys
ioth
erap
ists (
PT);
PT/m
ove-
men
t sci
entis
t, tra
ined
, cer
tified
and
exp
erie
nced
All
com
pone
nts
Part
1, fu
nctio
ning
and
dis
abili
tyPa
rt 2,
con
text
ual f
acto
rs R
eich
el [4
2]Fr
amew
ork
for c
ateg
oriz
atio
n. L
inki
ng e
ach
mea
ning
-fu
l con
cept
and
obj
ectiv
e w
ith th
e m
ost p
reci
se IC
F ca
tego
ry
Phys
icia
ns sp
ecia
lized
in g
astro
ente
rolo
gica
l reh
abili
-ta
tion
Bod
y fu
nctio
ns/b
ody
struc
ture
s onl
y
Stu
ress
on [5
7]Fr
amew
ork
for c
ateg
oriz
atio
n an
d ve
rifyi
ng th
e in
form
atio
n of
sick
ness
cer
tifica
tes.
The
asse
ssm
ent
of S
wed
ish
Soci
al In
sura
nce
Age
ncy
(SSI
A) h
as to
ve
rify
that
the
info
rmat
ion
clar
ifies
a lo
gica
l lin
k be
twee
n di
agno
ses,
impa
irmen
t of b
ody
func
tion
and
activ
ity li
mita
tion
(the
‘DFA
cha
in’)
. The
voc
abul
ary
and
defin
ition
s in
the
DFA
cha
in a
re in
acc
orda
nce
with
the
ICF
Inde
pend
ent i
nsur
ance
spec
ialis
t fro
m th
e SS
IA, e
du-
cate
d an
d tra
ined
to a
sses
s the
qua
lity
Impa
irmen
t of b
ody
func
tion,
lim
itatio
n of
act
ivity
onl
y
Aas
[74]
Fram
ewor
k fo
r cat
egor
izat
ion.
ICF
term
inol
ogy
was
us
ed to
cla
ssify
the
inte
rven
tion
com
pone
nts.
ICF
coul
d ha
ve c
ontri
bute
d to
a c
once
ptua
l fra
me
of re
fer-
ence
bas
ed o
n co
mm
on te
rmin
olog
y
Rese
arch
ers
All
com
pone
nts
Qua
ntita
tive
linki
ng C
oncl
ave
[39]
Fram
ewor
k fo
r stru
ctur
ing
follo
wed
by
linki
ng It
alia
n le
gisl
ativ
e pr
oced
ures
to th
e IC
F do
mai
ns a
nd c
ateg
o-rie
s, an
d ad
ding
stan
dard
ICF
chec
klist
cat
egor
ies.
The
ICF-
base
d w
orke
r che
cklis
t is c
ompo
sed
of 1
83
ICF
cate
gorie
s
Prof
essi
onal
s in
job
plac
emen
t of p
erso
ns w
ith d
is-
abili
ties.
Parti
cipa
nts:
895
in B
asic
ICF
train
ing,
552
in
Adv
ance
d
All
com
pone
nts
de
Bee
r [71
]Fr
amew
ork
for l
inki
ng, c
odin
g. T
he fa
ctor
s fro
m a
ll stu
dies
cod
ed o
n th
e tw
o-le
vel c
lass
ifica
tions
of I
CF.
Fr
eque
ncy
and
cons
isten
cy in
hin
derin
g or
faci
litat
ing
mad
e vi
sibl
e by
use
of I
CF
cate
gorie
s
Rese
arch
team
All
com
pone
nts
Wor
k-re
late
d ac
tiviti
es, p
artic
ipat
ion,
env
ironm
enta
l and
pe
rson
al fa
ctor
s
Esc
orpi
zo [7
5]Fr
amew
ork
for s
truct
urin
g fo
llow
ed b
y lin
king
. Ite
ms
of m
easu
rem
ent i
nstru
men
ts w
ere
linke
d to
the
ICF
core
sets
, app
lyin
g th
e lin
king
rule
s
Rese
arch
er, t
wo
code
rsA
ll co
mpo
nent
s exc
ept b
ody
fact
ors
Act
iviti
es, p
artic
ipat
ion
and
envi
ronm
ent c
ompo
nent
s. C
ompr
ehen
sive
ICF
Cor
e Se
t for
SC
I, V
R
267Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 2
(con
tinue
d)
Aut
hor
Ope
ratio
naliz
atio
n of
ICF
(i.e.
as a
fram
ewor
k fo
r: str
uctu
ring,
link
ing,
ana
lysi
s or d
evel
opm
ent)
Who
are
invo
lved
(sta
keho
lder
s, pa
tient
s)IC
F co
mpo
nent
s use
d
Esc
orpi
zo [3
3]Fr
amew
ork
for s
truct
urin
g fo
llow
ed b
y lin
king
. Lin
king
be
twee
n 3
core
sets
of 6
que
stion
naire
s ass
essi
ng
envi
ronm
ent a
nd p
artic
ipat
ion
by tw
o in
depe
nden
t re
sear
cher
s. M
ergi
ng IC
F ca
tego
ries
Inte
rnat
iona
l tea
m o
f res
earc
hers
All
com
pone
nts
Exce
pt p
erso
nal f
acto
rs
Esc
orpi
zo [3
2]Fr
amew
ork
for l
inki
ng. I
CF
appl
ying
pub
lishe
d lin
king
ru
les;
resp
onse
s wer
e lis
ted
and
freq
uenc
y an
alys
is
was
per
form
ed
Resp
onde
rs (1
51),
expe
rts fr
om 4
7 co
untri
es, r
ando
m
sam
ple
of p
rofe
ssio
ns, W
HO
regi
ons,
coun
tries
All
com
pone
nts
Qua
ntita
tive
anal
ysin
g A
ndel
ic [5
8]Fr
amew
ork,
tool
for a
naly
sis.
Link
ing
of se
lf-re
porte
d pr
oble
ms r
elat
ed to
nec
k pa
in to
dom
ains
of t
he IC
FRe
sear
ch te
amA
ll co
mpo
nent
s exc
ept e
nviro
nmen
tal f
acto
rs. D
omai
ns
load
ing
on th
e ac
tiviti
es a
nd p
artic
ipat
ion
Nils
ing
[56]
Fram
ewor
k fo
r ana
lysi
s. Fr
ee te
xt o
n fu
nctio
ning
was
an
alys
ed d
educ
tivel
y us
ing
the
ICF
fram
ewor
k an
d pl
aced
into
cat
egor
ies
Rese
arch
ers a
nd a
n ad
judi
cato
r. C
onse
nsus
mee
ting
betw
een
the
rese
arch
ers a
nd a
djud
icat
orB
ody
and
activ
ity o
nly
(Sen
satio
ns o
f pai
n or
em
otio
nal f
unct
ions
. Wal
king
or
hand
ling
stres
s) W
ang
[50]
Fram
ewor
k fo
r ana
lysi
s. D
epen
dent
and
inde
pend
ent
varia
bles
bas
ed o
n IC
F, a
nd th
eir o
pera
tiona
l defi
ni-
tion
wer
e us
ed fo
r cod
ing;
e.g
. 0 =
not e
mpl
oyed
/no,
1 =
empl
oyed
/yes
Rese
arch
erA
ll co
mpo
nent
s
Fer
rario
[40]
Fram
ewor
k fo
r ana
lysi
s. IC
F qu
estio
nnai
re; u
sed
the
ICF
to e
valu
ate
wor
king
abi
lity
of tr
ansp
lant
reci
pi-
ents
to p
rovi
de th
e oc
cupa
tiona
l phy
sici
ans a
stan
d-ar
dize
d pr
oced
ure
to su
gges
t the
bes
t pos
sibi
lity
of
re-e
mpl
oym
ent i
n cl
ose
co-o
pera
tion
with
the
patie
nt
Occ
upat
iona
l phy
sici
an o
f the
Occ
upat
iona
l Med
icin
e D
epar
tmen
t, re
sear
cher
All
com
pone
nts
Fin
ger [
28]
Fram
ewor
k fo
r ana
lysi
s. Id
entifi
catio
n of
the
mos
t com
-m
on p
robl
ems a
roun
d w
ork
and
in V
R. E
xam
ine
the
freq
uenc
y an
d ra
te p
robl
ems b
ased
on
the
exte
nded
IC
F ch
eckl
ist (t
he IC
F C
heck
list v
ersi
on 2
.1a)
Hea
lth p
rofe
ssio
nals
All
com
pone
nts
Exce
pt p
erso
nal f
acto
rs
Sal
tych
ev [4
6]Fr
amew
ork
for c
odin
g fo
llow
ed b
y an
alys
is o
f com
-pa
rison
. Des
crip
tions
of f
unct
iona
l lim
itatio
ns w
ere
conv
erte
d to
ICF
code
s, an
d th
e m
ost f
requ
ent w
ere
com
pare
d w
ith th
e IC
F C
heck
list a
nd V
R c
ore
sets
Mul
ti-pr
ofes
sion
al te
am. (
Spec
ialis
t in
phys
ical
and
re
hab.
med
icin
e, re
hab.
pla
nner
, psy
chol
ogist
and
the
patie
nts)
All
com
pone
nts
Exce
pt p
erso
nal f
acto
rsC
ore
set f
or V
R
Zei
lig [4
9]Fr
amew
ork
for a
naly
sis.
Bar
riers
and
faci
litat
ors o
f w
orki
ng p
artic
ipat
ion
defin
ed a
ccor
ding
to th
e IC
F ca
tego
ries.
Leve
ls o
f fun
ctio
n w
ere
then
ana
lyse
d fo
r co
rrel
atio
n to
the
voca
tiona
l sta
tus
Rese
arch
erB
ody
func
tions
and
act
iviti
es o
nly.
Foc
us o
n m
obili
ty in
re
gard
to e
mpl
oym
ent s
tatu
s
Qua
ntita
tive
deve
lopm
ent
Ley
shon
[76]
Fram
ewor
k, b
asis
for a
new
mod
el. D
iscu
ssio
n of
op
portu
nitie
s to
use
this
mod
el in
rese
arch
ing
out-
com
es o
f erg
onom
ic in
terv
entio
ns. I
llustr
ate
how
the
ICF
fram
ewor
k co
uld
be a
pplie
d to
a w
orke
r with
a
low
bac
k di
sord
er
Rese
arch
erA
ll co
mpo
nent
s
268 Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Tabl
e 2
(con
tinue
d)
Aut
hor
Ope
ratio
naliz
atio
n of
ICF
(i.e.
as a
fram
ewor
k fo
r: str
uctu
ring,
link
ing,
ana
lysi
s or d
evel
opm
ent)
Who
are
invo
lved
(sta
keho
lder
s, pa
tient
s)IC
F co
mpo
nent
s use
d
Lin
den
[41]
Fram
ewor
k fo
r eva
luat
ion.
Use
of m
ini I
CF
to a
sses
s its
clin
ical
rele
vanc
e. C
orre
latio
ns m
ade
with
oth
er
instr
umen
ts. F
unct
ions
, cap
aciti
es a
nd p
artic
ipat
ion
are
not l
inea
r but
inte
ract
ive,
as k
now
n fro
m o
ccup
a-tio
nal p
sych
olog
y
Rese
arch
erA
ll co
mpo
nent
s
Mar
tins [
45]
Fram
ewor
k fo
r eva
luat
ion.
To
expl
ore
corr
elat
ions
be
twee
n so
cial
par
ticip
atio
n, e
mpl
oym
ent a
nd
pers
onal
fact
ors s
uch
as se
lf-effi
cacy
and
atti
tude
s to
war
ds d
isab
ility
Rese
arch
erA
ll co
mpo
nent
s exc
ept b
ody
func
tions
and
act
ivity
Pty
ushk
in [4
7]Fr
amew
ork
for d
evel
opm
ent o
f que
stion
naire
. Sub
ject
fo
r que
stion
naire
: VR
pro
fess
iona
ls´ o
pini
ons a
bout
IC
F. (H
ow w
ould
you
defi
ne th
e IC
F? W
hat i
s the
IC
F fo
r you
? an
d ‘I
n yo
ur o
pini
on, w
hat i
s the
pur
-po
se o
f the
ICF’
)In
tegr
atio
n of
the
ICF
into
the
Slov
enia
n V
R a
nd
Empl
oym
ent o
f Per
sons
with
Dis
abili
ties A
ct m
ade
the
use
of IC
F ob
ligat
ory
45 p
rofe
ssio
nals
invo
lved
in V
R (P
sych
olog
ists,
soci
al
wor
kers
, tec
hnol
ogist
s, O
Ts, p
hysi
cian
s, ed
ucat
ion
coun
sello
r, re
habi
litat
ion
coun
sello
r)
Bod
y fu
nctio
ns c
ompo
nent
onl
y
Var
ekam
p [5
3]Fr
amew
ork
for e
valu
atio
n. U
nder
stan
ding
and
con
sid-
erin
g he
alth
-rel
ated
pro
blem
s at w
ork
and
findi
ng
solu
tions
; IC
F us
ed a
s a m
odel
to e
xpla
in w
ork
disa
bilit
y. P
reva
lenc
e of
chr
onic
med
ical
con
ditio
ns
(non
-com
mun
icab
le d
isea
ses)
is st
rong
ly re
late
d to
ag
e
Rese
arch
erA
ll co
mpo
nent
sFo
cus o
n en
viro
nmen
tal a
nd o
rgan
isat
iona
l fac
tors
Øste
rås [
60]
Fram
ewor
k fo
r dev
elop
men
t. IC
F us
ed a
s bas
is fo
r de
velo
pmen
t of n
atio
nal q
uesti
onna
ire (N
orw
egia
n Fu
nctio
n A
sses
smen
t Sca
le)
Rese
arch
erA
ctiv
ities
/par
ticip
atio
n co
mpo
nent
s
Aas
[59]
Fram
ewor
k fo
r dev
elop
men
t. IC
F us
ed a
s bas
is fo
r qu
estio
nnai
re in
surv
ey o
f im
pairm
ent,
activ
ity li
mi-
tatio
ns, a
nd p
artic
ipat
ion
restr
ictio
ns (e
.g. p
artic
ipa-
tion
in o
rdin
ary
wor
king
life
)9
OTs
from
4 m
unic
ipal
are
as te
sted
the
ques
tionn
aire
on
18
clie
nts
Occ
upat
iona
l the
rapi
sts (O
T) a
nd c
lient
sB
ody,
act
ivity
and
par
ticip
atio
n co
mpo
nent
s
269Journal of Occupational Rehabilitation (2019) 29:241–273
1 3
Which of the ICF Components and Core Sets are Considered When Functioning is Evaluated in VR?
Except in 10 papers all the ICF components were described. Two papers commented on personal factors, despite the fact they are part of the ICF there are no categorizations [29, 35]. Only two papers described the component participation [44, 66]. One paper described all components but environmental factors [58]. Six papers evaluated the body functions compo-nent only [42, 47, 49, 56, 57, 59], and three papers reported on all components except body functions or participation components [45, 60, 75].
Seven papers used the ICF core set [27, 29, 30, 38, 46, 51, 55], among which four studies reported on the core set for VR [30, 38, 46, 72]. The VR core set was used for valida-tion of another ICF core set [38], development of ICF-based documentation tools [30], comparison of the most frequent ICF coding of functional limitations with the ICF Checklist and VR core sets [46].
Discussion
The ICF was primarily used in Western VR contexts. The ICF used as a framework was the most prevalent operation-alizing of ICF (18 papers), whereas linking, analysing and developing appeared in 8, 12 and 12 papers respectively. As 32 of the 50 included papers were reviews the predominant profession involved in ICF were researchers. Among the original papers no single profession stood out as particularly ICF users. In general the ICF enabled the various profes-sions involved in VR in a structured way to obtain relevant need assessments and communicate this across professions. The majority (40) of papers described all factors, which support the bio-psycho-social approach. However, it was not clear if the ICF was suitable as an instrument for goal setting and evaluation as merely single papers mentioned these properties. Moreover, the ICF was criticised for being time consuming. Unexpectedly four papers described the ICF components body and acidity only, despite participation and environmental factors seem inseparable from VR. The VR core set was not the primary tool when functioning was evaluated within VR.
Compared to the findings in another review where quali-tative papers only constituted a tenth [10], and despite some papers with a mixed study designs were defined as qualita-tive in this review, the number of qualitative and quantitative papers was more balanced in this review.
The ICF defines functioning as the interaction between an individual and that individual’s environmental and per-sonal factors; accordingly a paper illustrated the problems of functioning in a person with low back pain by use of the framework [75].
The ICF is seen as a useful tool for describing, compar-ing and contrasting information from outcome measures and clinical patient reports across diagnoses, settings, languages and countries [77]. A review showed that linking health and health-related information to the ICF is a useful way to apply the ICF in research [77].
Evaluation of functioning is relevant early in VR [8], and this review found several presentations of the applicability for VR and use of the ICF to examine and measure VR pro-cesses and outcomes. The findings show that the ICF was useful in providing a clear description of the consequences of diseases, and of the factors that can be described using the ICF coding, which may potentially support the VR pro-fessionals, e.g. factors that support employees’ early RTW [68]. The ICF can help VR professionals gain a more pre-cise understanding of the impact of disability on individu-als’ ability to perform life tasks or activities. Thus, the ICF might contribute to a more informative description in multi-professional assessments, because healthcare professionals have different perspectives on the health-care process [57]. However, a paper concluded that in primary care there seem to be a lack of knowledge about the ICF, and that increased cooperation between GPs and other health-care professions may require learning as well as a change of attitudes [57].
Furthermore, an ICF-based questionnaire regarding time to RTW, work difficulties, job satisfaction, and work rela-tions was reportedly useful for occupational physicians assessing patients after transplant procedures [40]. Thus, the ICF framework provided an effective evaluation of possible RTW and capabilities of these patients, who had undergone transplants and survived at least 12 months. However, the procedure of for assessment of self-reported work ability was reported as complex and required specific training of the staff involved [40].
The present review illustrates how the ICF may support development of questionnaires [59, 60], like e.g. the Work Rehabilitation Questionnaire (WORQ). The WORQ has proven to be a valuable instrument within VR [27], e.g. as to support the physiotherapist´s role within the rehabilitation team by enhancing transparency in goal setting and interven-tion planning across disciplines [29].
Although the ICF is a reasonable starting point in efforts to harmonize terminologies [33], the framework is also criti-cised for limitations. This scoping review reported on the ICF components only. However, each of the components (except for personal factors) is further divided into domains and underlying categories providing more detail of a com-ponent. The ICF coding system is intended to describe a per-son’s functioning at a specific time, in that person’s normal circumstances and environment. Qualifiers are built into the coding system to indicate the magnitude of the impairment, limitation or restriction for each category.
270 Journal of Occupational Rehabilitation (2019) 29:241–273
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A review on the use of ICF in outcome measures used within VR identified that a third of categories were related to body functions [10]. This review also identified some papers solely reporting on body functions, which is not rep-resenting a bio-psycho-social approach. It should be recog-nized that the ICF is limited with respect to comprehensive descriptions of work disability, e.g. the cause why a person is not able to work is an important part of disability evalu-ation. The ICF however, cannot describe causal relation-ship [26], and a solution may be to use the ICF combined with other instruments, which can reveal causal relations. It was pointed out that although the framework includes personal factors, they cannot be classified in the ICF [68]. This is a limitation of the framework, as e.g. motivation is important to consider when making prognosis of work abil-ity and RTW. Personal factors also include an individual’s lifestyle, habits, social background, education, life events, race/ethnicity, sexual orientation, and coping mechanisms [43]. Work participation relies on both personal and environ-mental factors, which in addition to the medical data, affect functioning and participation, e.g. a paper concluded these factors affect claim behaviour [65]. Factors that are likely to be emphasized in a VR setting are within the components: activities, participation and environmental factors [35]. A Cochrane review found a lack of interventions targeting the ICF-domains: attitudinal and social environment [74]. However, this review found only a few papers lacking the environmental factors.
Unexpectedly, the review revealed a limited use of the ICF VR core sets. These include environmental factors that may prove to be useful when disability evaluation and work capacity is being assessed. However, a validation study of the comprehensive VR core set concluded, that it was insuf-ficient from a sole physiotherapist perspective, there was a need for additional ICF categories. Although the VR core set was considered useful to clarify responsibilities and for communication in a multidisciplinary setting, it was too comprehensive for mono-disciplinary use of physiothera-pist [78]. The core sets in general were not recognized to provide an exhaustive list but rather the minimum number of categories to be assessed [8]. Therefore practice may sup-ply the VR core set with other instruments in order to fully assess functioning.
Strengths and Limitations
One strength was the inclusion of both qualitative and quan-titative papers from multiple settings and countries. Further-more, the scoping review format offers an overview of study findings in a field where the knowledge is still limited.
The reviewers experienced difficulties in study selection, despite the method by two reviewers and how to ensure eligibility criteria is a limitation. In a scoping review the extracted data is based on information provided in individ-ual papers without critical assessment, which is a limitation despite no scope of synthesizing evidence. Furthermore, the categories of operationalization may not be mutual exclusive.
The sixth and optional stage of involving relevant stake-holders was not included but may have contributed with other VR professionals´ views [15].
Implications for Practice within VR
This review confirm challenges with the use of the ICF: e.g. it cannot infer causality in disability [8] and not categorize personal factors. The content of VR varies widely among countries because of differing insurance policies and dis-ability attitudes; e.g. in Slovenia the ICF for work assess-ment was made obligatory but the lack of interface between the ICF and policies on VR was a challenge [47]. The ICF may be used to ensure comprehensiveness of evaluation in study populations with chronic diseases [46]. Furthermore, the framework may cover all relevant aspects of disability and may encourage the VR professionals to draw a holistic picture [26]. The ICF “corresponds closely to this ecological systems approach and could help rehabilitation practitioners more specifically and precisely identify those subsystems or environmental factors that have an impact on successful job placement” [35]. The ICF may be combined with existing measures and incorporated in daily practice [31].
Implications for Future Research in Work Disability and VR
Our findings revealed that the ICF has been applied in differ-ent settings and for different purposes, which has important implications for future research. In order to ensure compara-bility across studies and robust testing of hypotheses the use of the ICF needs to be clarified. Furthermore, how data are collected, assessed and classified based is lacking in the field of VR. Hence, research on the practical utility of the ICF across different assessment instruments is crucially needed to inform a feasible framework development in VR.
Although the ICF provides a framework to evaluate contextual factors, this review finds there is a gap between the knowledge of the impact of personal factors and actual assessment within VR and more research is needed.
271Journal of Occupational Rehabilitation (2019) 29:241–273
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Conclusions
The scoping review revealed use of the ICF within the field VR in 50 papers, and in various settings; e.g. hospitals, rehabilitation centres, primary health care centres, sickness certificate registration offices, and research departments. The operationalization of the ICF was described in four ways: for structuring information, linking of categories or content, analysis according to the ICF framework, or development of instruments or models based on the ICF.
A majority of papers were reviews and involved research-ers only, whereas different stakeholders and VR profession-als were involved in the interventions. The components of the ICF that depict functioning and disability were largely incorporated in the VR research. This observation points to the benefit of using a common set of ICF components to inform the selection of set of measurement instruments. Such a process would lead to a single set of standardized measures looking at similar outcomes and make compa-rability across studies possible However, more research is needed to develop and validate instruments measuring rel-evant domains including personal factors and to standardize and ease the VR professionals´ use of the ICF.
Acknowledgements We thank the research librarian Helene Sognstrup Aarhus University Library, for providing support in the search strate-gies for this review.
Compliance with Ethical Standards
Conflict of interest A.H. Momsen, C.M. Stapelfeldt, R. Rosbjerg, M. Labriola, R. Escorpizo, and M. Bjerrum declare that they have no con-flict of interest.
Research Involving Human and Animal Participants This article does not contain any studies with human participants performed by any of the authors.
Open Access This article is distributed under the terms of the Crea-tive Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribu-tion, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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