Identification of relevant ICF categories for indication, intervention planning and evaluation of health resort programs: a Delphi exercise

Frequency of forest walking is not associated with prevalence of hypertension based on cross-sectional studies of a general Japanese population: a reconfirmation by the J-MICC Daiko Study

Forest walking or Shinrin-yoku is a health promotion activity in Japan. Although some studies have reported the acute effects of walking a few hours in forested areas in reducing blood pressure level compared to other environments, studies investigating whether successive walking has long-term effects in lowering blood pressure levels or lowering prevalence of hypertension are rare. This study aimed to reconfirm the presence or absence of an association between the frequency of forest walking and prevalence of hypertension in a Japanese population. This J-MICC Daiko Study was conducted targeting residents in Nagoya City. A total of 5,109 participants (1,452 men and 3,657 women; age, mean ± standard deviation: 52.5 ± 10.3 years) were included in the analysis. Age-adjusted blood pressure level by frequency of forest walking was not significant. After adjusting for age and lifestyle, the adjusted odds ratios (aORs) of the most frequent group (n=88, 1.7%; once a week or more group) relative to the less than once a month group (n=4,558, 89.2%) for prevalence of hypertension were not also significant [0.80 (95% CI: 0.40–1.62) for men and 1.48 (95% CI: 0.73–3.00) for women]. This study reconfirmed that either lowering blood pressure level or lowering the prevalence of hypertension is not associated with frequency of forest walking, similar to the results of our previous J-MICC Shizuoka Study. Given that these two studies were cross-sectional studies, cohort studies investigating the causal relationship are required to evaluate the effect of frequent forest walking on the prevention of hypertension.

[Identification of ICF categories representative of functioning problems in adult cancer patients at hospital discharge: National expert consensus]

INTRODUCTION

The International Classification of Functioning, Disability and Health (ICF) provides a standardised language and conceptual framework for health and health-related conditions, aiming to unify communication between different disciplines.

OBJECTIVE

To describe the process of selecting (through national expert consensus) ICF categories representative of functioning problems in cancer patients at hospital discharge.

METHOD

We conducted a descriptive qualitative and quantitative study that used the expert consensus method to design a clinical instrument. The study included 21 experts, consisting of 2 patients and 19 health professionals from different disciplines. A total of 208 ICF categories obtained in a previous stage through a systematic review and linking process were evaluated in 3 rounds. Participants evaluated each code and classified it as: highly relevant, relevant, slightly relevant, and not relevant at all. Only those codes assessed as «highly relevant» by more than 50% of the experts were included (cut off). In addition, another 143 ICF categories were evaluated in the second round.

RESULTS

In all, 24 ICF categories were obtained: 10 corresponded to the body function component, 11 to activities and participation, and 3 to environmental factors.

CONCLUSIONS

Consensus using the common language of the ICF resulted in the selection of 24 representative categories of the main health problems related to functioning at hospital discharge in adults treated for cancer.

Specifying clinical assessment schedules for the European framework of rehabilitation service types: the perspective of the physical and rehabilitation medicine Section and Board of the European Union of Medical Specialists

INTRODUCTION

In light of global mandates and in recognition of the value of data collection and reporting based on the International Classification of Functioning, Disability and Health (ICF), the UEMS PRM Section and Board established an action plan to implement the ICF in Physical and Rehabilitation Medicine, rehabilitation and health care at large. This includes, among other steps, the development of a framework of rehabilitation service types for Europe (European Framework) and corresponding clinical assessment schedules (CLASs) for each service type. A CLAS encompasses the recommendation for what aspects of functioning to document, for whom and when, and the data collection tools to use. The objective of this paper is to report on the development of the CLASs for the European Framework developed in Stockholm in 2018, with focus on what to document.

METHODS

Involving UEMS PRM delegates across European regions, a multistage Delphi process comprised the development of an initial proposal of the CLASs (i.e. default and optional ICF Sets to document), two feedback (pre- and post-Stockholm) rounds via e-mail, and a deliberation by the UEMS PRM during its March 2019 meeting in Budapest. In both Delphi rounds, participants were asked whether the initially proposed default and optional ICF Sets represent what is currently documented at an exemplary service provider in the country or in consideration of their own expertise. The European Framework was revised between the two Delphi rounds, requiring a revision of the CLAS proposal accordingly. Participants were additionally asked whether they support the suggested ICF Sets as the specification of the CLAS. Level of support (strong = ≥80%, moderate = between 80-60%, weak =≤59%) was calculated as the percentage of countries supporting the suggested CLAS over the number of responding countries. The results of the post-Stockholm round were presented for discussion, revision and approval at the Budapest meeting.

RESULTS

Pre-Stockholm Delphi round: due to low response rate only a summary of comments made by the responding countries was provided as reference information for the post-Stockholm round. Post-Stockholm Delphi round: results indicated moderate to strong support for the proposed CLASs. Deliberation Budapest Meeting - Motions for specific revisions to the CLASs based on the results of the Post-Stockholm round were predominately accepted. With additional minor revisions, the UEMS PRM General Assembly approved a version of the CLASs for the European Framework.

CONCLUSIONS

To kick-off the implementation of these CLASs, UEMS PRM plans demonstration projects in at least one rehabilitation facility in each delegate country that exemplifies the rehabilitation service types of the European Framework which exist in the respective country. The demonstration projects are intended to orient service providers and clinicians to the CLASs and illustrate how the CLASs can be implemented.

A tool for enhancing strategic health planning: a modeled use of the International Classification of Functioning, Disability and Health

This article describes use of the International Classification of Functioning, Disability and Health (ICF) as a tool for strategic planning. The ICF is the international classification system for factors that influence health, including Body Structures, Body Functions, Activities and Participation and Environmental Factors. An overview of strategic planning and the ICF are provided. Selected ICF concepts and nomenclature are used to demonstrate its utility in helping develop a classic planning framework, objectives, measures and actions. Some issues and resolutions for applying the ICF are described. Applying the ICF for strategic health planning is an innovative approach that fosters the inclusion of social ecological health determinants and broad populations. If employed from the onset of planning, the ICF can help public health organizations systematically conceptualize, organize and communicate a strategic health plan.

Code Sets for Everyday Life Situations of Children Aged 0–6: Sleeping, Mealtimes and Play — A Study Based on the International Classification of Functioning, Disability and Health for Children and Youth

Introduction:

The complexity of the Child and Youth version of the International Classification of Functioning, Disability and Health, the ICF-CY, is a challenge for occupational therapists and other professionals in clinical work. Code sets including only essential categories help to make it more user-friendly. Thus far, code sets have been developed to reflect functioning for children in different developmental periods. However, there are no code sets that support screening of participation in everyday life situations and can be used across diagnoses. This exploratory study is the first attempt to develop code sets for preschoolers' (age 0–6 years) everyday life situations.

Method:

Using sequential Delphi processes with expert panels consisting of 35 professionals in five interdisciplinary early intervention teams and six parents of children, the study identified content in three code sets: Sleeping, Mealtimes and Play.

Results:

A limited number of relevant categories were identified for three code sets: Sleeping (12), Mealtimes (21) and Play (30). Findings suggested a professional focus on Environmental factors compared with a parental focus on Body functions.

Conclusion:

It is important to consider the opinions of all involved when developing code sets to provide a common framework for screening of children's everyday functioning.

A before and after comparison of the effects of forest walking on the sleep of a community-based sample of people with sleep complaints

BACKGROUND

Sleep disturbance is a major health issue in Japan. This before-after study aimed to evaluate the immediate effects of forest walking in a community-based population with sleep complaints.

METHODS

Participants were 71 healthy volunteers (43 men and 28 women). Two-hour forest-walking sessions were conducted on 8 different weekend days from September through December 2005. Sleep conditions were compared between the nights before and after walking in a forest by self-administered questionnaire and actigraphy data.

RESULTS

Two hours of forest walking improved sleep characteristics; impacting actual sleep time, immobile minutes, self-rated depth of sleep, and sleep quality. Mean actual sleep time estimated by actigraphy on the night after forest walking was 419.8 ± 128.7 (S.D.) minutes whereas that the night before was 365.9 ± 89.4 minutes (n = 42). Forest walking in the afternoon improved actual sleep time and immobile minutes compared with forest walking in the forenoon. Mean actual sleep times did not increase after forenoon walks (n = 26) (the night before and after forenoon walks, 380.0 ± 99.6 and 385.6 ± 101.7 minutes, respectively), whereas afternoon walks (n = 16) increased mean actual sleep times from 342.9 ± 66.2 to 475.4 ± 150.5 minutes. The trend of mean immobile minutes was similar to the abovementioned trend of mean actual sleep times.

CONCLUSIONS

Forest walking improved nocturnal sleep conditions for individuals with sleep complaints, possibly as a result of exercise and emotional improvement. Furthermore, extension of sleep duration was greater after an afternoon walk compared to a forenoon walk. Further study of a forest-walking program in a randomized controlled trial is warranted to clarify its effect on people with insomnia.

Linking health and health-related information to the ICF: a systematic review of the literature from 2001 to 2008

INTRODUCTION

In 1976, the World Health Organization (WHO) estimated worldwide disability prevalence at 10%; recent evidence suggests the prevalence is even higher. Given the extent of disability around the world, it is essential for researchers and policy makers to have a uniform language for describing and discussing disability. The International Classification of Functioning, Disability and Health (ICF) is WHO's attempt to provide that standard language. Linking rules were published in 2002 and 2005 suggesting a method for standardising the process of connecting outcome measures to the ICF classification. The objective of this study is to study the extent to which the linking rules have been used by researchers to link health and health-related information to the ICF and collect the feedback about the current practices, applications and areas to improve the linking method.

METHOD

Using a systematic review of health-based literature between 2001 and February 2008, we (1) determined research areas where the linking method is applied, (2) examined the characteristics of studies that linked information to the ICF and (3) described current practices and issues related to the process of linking health and health-related information to the ICF both quantitatively and qualitatively.

RESULTS

The systematic review yielded 109 articles from 58 journals that linked health information to the ICF and 58 of the articles employed published linking rules. The majority of articles were descriptive in nature, used linking for connecting content of health instruments to the ICF and linked English health content. Quality controls such as reliability checks, multiple raters and iterative linking processes were found frequently among users of the linking rules. Qualitative analysis created themes about: preparing units of information, who links to the ICF, reliability, matching or translating concepts from text to ICF categories, information unable or difficult to capture, quantitative reporting standards and overall linking process.

DISCUSSION

This review also shows that the linking process is a useful way to apply the ICF classification in research. With over 100 articles published in 58 peer-reviewed journals across 50 focus areas, linking health and health-related information to the ICF has been shown to be a useful tool for describing, comparing and contrasting information from outcome measures used to collect quantitative data, qualitative research results and clinical patient reports across diagnoses, settings, languages and countries.

No association between the frequency of forest walking and blood pressure levels or the prevalence of hypertension in a cross-sectional study of a Japanese population

OBJECTIVE

To study the non-temporary effects of successive walks in forested areas (shinrin-yoku) on hypertension prevalence and blood pressure levels.

METHODS

Data for the analysis were derived from the baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study in the Shizuoka area. Eligible participants were individuals aged 35-69 years who attended a health check-up center during 2006 and 2007. Of the 5,040 individuals who participated in the J-MICC study, Shizuoka, 4,666 were included in this analysis [3,174 men and 1,492 women; age (mean ± standard deviation) 52.1 ± 8.7 years]. The frequency of forest walking was estimated by a self-administrated questionnaire. Hypertension was defined as a systolic blood pressure ≥ 140 mmHg, a diastolic blood pressure ≥ 90 mmHg or, based on information provided in the questionnaire, the use of medication for hypertension.

RESULTS

After adjusting for age, body mass index (BMI), smoking status, alcohol consumption, and habitual exercise, the odds ratios of hypertension associated with forest walking once a week or more frequently, relative to less than once a month were 0.98 in men [95% confidence interval (CI) 0.68-1.42] and 1.48 (95% CI 0.80-2.71) in women. There was no significant trend between adjusted blood pressure levels and the frequency of forest walking.

CONCLUSION

The results of our cross-sectional study in a Japanese population show no association between either blood pressure levels or the prevalence of hypertension and the frequency of forest walking.

Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation

PURPOSE

To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001.

METHOD

The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application.

RESULTS

A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009.

CONCLUSIONS

The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.

Two thirds of forest walkers with Japanese cedar pollinosis visit forests even during the pollen season

BACKGROUND

The most common type of pollinosis in Japan is Japanese cedar pollinosis (JCP). While forest walking is a common form of recreation for Japanese people, it has been unclear whether forest walkers with JCP still choose to visit forested areas during the pollen season or whether they avoid those areas, and as such, the aim of this study was to investigate this question.

METHODS

The study participants were all healthy men and women volunteers aged 20 years or over who visited the Tokyo University Forest in Chiba during 4 different days. The survey was conducted using self-administered questionnaires.

RESULTS

The number of available responses was 498. Of these, 112 participants who experienced JCP were included in the analysis. Seventy-three participants (65.2%) responded that they visit forests even during the pollen season. The association between forest walking choices during the pollen season and self-rated levels of pollinosis symptoms was not statistically significant (Cramer's V = 0.13, p = 0.47). As many as 60% of the participants who reported serious symptom levels responded that they visit forested areas even during the pollen season.

CONCLUSIONS

These results revealed that two thirds of forest walkers who had experienced JCP visited forests even during the pollen season. This indicates the further need for public service announcements informing people with JCP that the risk of pollen exposure and subsequent JCP reaction is increased by visiting forested areas during the pollen season.

Identification of relevant concepts of functioning in daily life in people with systemic lupus erythematosus: A patient Delphi exercise

OBJECTIVE

To identify the most important and relevant concepts of daily functioning from the perspective of patients with systemic lupus erythematosus (SLE).

METHODS

We conducted a consensus-building, 3-round, electronic mail survey with SLE patients using the Delphi technique. The Delphi technique is a structured communication process with 4 key characteristics: anonymity, iteration with controlled feedback, statistical group response, and informed input. The concepts contained in the answers of the patients were extracted and linked to the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Of the total 225 participants, 194 (86.2%) completed the questionnaires from all 3 Delphi rounds. In total, after the third Delphi round, 307 concepts were identified. Ninety concepts (55 in the domain body functions and structures, 16 in activities and participation, and 19 in environmental factors) were considered relevant by at least 50% of the participants in the third round and linked to the ICF. Twelve concepts were considered important by at least 75% of the participants.

CONCLUSION

The high number of concepts resulting from this large-scale patient Delphi approach underlines the great variety of SLE patients' problems in daily functioning. The results of this patient Delphi project supplement the findings of our focus-group study in establishing a comprehensive overview of the patient perspective in SLE.

Has time come for a re-assessment of spa therapy? The NAIADE survey in Italy

Goal of this study was to investigate whether appropriately applied spa therapy in several indications could be associated with a subsequent fall in the need for costly health services and missed working days due to sick-leave. The Naiade project was a multicenter observational, longitudinal, questionnaire-based study comparing an "entry" inquiry addressed to patients before an entry thermal cycle, and a "return" inquiry after 1 year. Routine statistical methods were used for comparisons. The study was carried out in 297 of the 340 certified Italian spa centers. Inquiries were managed by the spa doctor(s), with the collaboration of family doctors, and when necessary, hospitals, other health services, labour offices and employers. After exclusion of regular customers and of patients with acute disease phases or severe health conditions, 39,943 patients divided into eight diseases subgroups (rheumatic, respiratory, dermatologic, gynaecologic, otorhynologic, urinary, vascular and gastroenteric) underwent entry inquiry and appropriate spa treatment. Patients who returned for treatment after 1 year ("index year") were 23,680 (59.2%) and received return inquiry. Outcomes considered were: frequency and duration of hospitalisation periods; missed working days; regular use of disease-specific drugs; and resort to "non-spa" rehabilitation therapies. The data collected at return inquiry were compared with those of entry inquiry. All the considered outcomes appeared to be significantly reduced in the index year in seven of the eight disease subgroups in comparison with the previous year. In conclusion, disease-appropriate spa treatments were followed by a reduction in the need of subsequent health interventions in most disease subgroups. The health promoting value of spa treatments should therefore undergo more rigorous assessment with randomised controlled studies.