Towards a new ICIDH. International Classification of Impairments, Disabilities and Handicaps

Evaluation of the Effect of Non-Surgical Periodontal Treatment on Oral Health-Related Quality of Life in Patients with Periodontitis at Different Stages

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On the road to DSM-V and ICD-11

Development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has been ongoing since 1994, though official release will not occur for another 4 years. Potential revisions are being derived from multiple sources, including building on perceived limitations of DSM-IV; broad-based literature reviews; secondary and primary data analyses; and discussions between global members of the mental health community. The current focus on aligning DSM with the International Classification of Diseases-11 (ICD-11) speaks to the importance of creating a unified text that embraces cross-cutting issues of diagnostics, such as developmental, age-related, and cultural phenomena. International discourse is vital to this process and has been fostered by a National Institutes of Health-sponsored conference series on diagnosis-specific topics. From this series, the DSM-V Task Force developed the following set of revision principals to guide the efforts of the DSM-V Work Groups: grounding recommendations in empirical evidence; maintaining continuity with previous editions of DSM; removing a priori limitations on the amount of changes DSM-V may incur; and maintaining DSM's status as a living document. With work group formation complete, members are currently carrying out the research and revision recommendations proposed during the conference series. Ongoing activities include adding specialized advisors to each work group; completing literature reviews and planning data analyses; and forming study groups to discuss integration of cross-cutting issues (e.g., developmental lifespan factors; formation of diagnostic spectra). The road to DSM-V and ICD-11 has been challenging, but members continue to work diligently in their goal of constructing the most harmonious, scientifically sound, and clinically relevant DSM to date.

Client satisfaction of hand therapy intervention: An evaluation of the effectiveness of therapy for clients recovered from complex regional pain syndrome

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that may develop following trauma to an extremity. Clients treated for CRPS at St Joseph's Health Care London - Hand and Upper Limb Centre, London, Ontario, were asked to evaluate their level of satisfaction with the treatment they had received by comparing their pain, functional status and emotional status before and after receiving therapy. The results indicated a high level of satisfaction among clients, attributable to the unique nature of the therapy program in use at this facility, where the occupational therapist works in close collaboration with the surgeon and pain specialists, and the therapy regimen is designed for each client individually according to his or her needs. The unique contribution of the present study to the body of clinical literature on CRPS is that it introduces a focus on client functionality and on client satisfaction with therapy received.

Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper

Background

Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments.

Aim of the study

To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis.

Methods

We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members).

Results

The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood.

Discussion

In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance.

Conclusion

We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation, but not lateral flexion, are secondary outcomes and only instrumental to previously reported primary outcomes. We advocate a multidimensional, comprehensive evaluation of scoliosis patients, to gather all necessary data for a complete therapeutic approach, that goes beyond x-rays to reach the person and the family.

Physical activity for people with a disability: a conceptual model

The promotion of a physically active lifestyle has become an important issue in health policy in first-world countries. A physically active lifestyle is accompanied by several fitness and health benefits. Individuals with a disability can particularly benefit from an active lifestyle: not only does it reduce the risk for secondary health problems, but all levels of functioning can be influenced positively. The objective of this article is to propose a conceptual model that describes the relationships between physical activity behaviour, its determinants and functioning of people with a disability. The literature was systematically searched for articles considering physical activity and disability, and models relating both topics were looked for in particular. No models were found relating physical activity behaviour, its determinants and functioning in people with a disability. Consequently, a new model, the Physical Activity for people with a Disability (PAD) model, was constructed based on existing models of disability and models of determinants of physical activity behaviour. The starting point was the new WHO Model of Functioning and Disability, part of the International Classification of Functioning, Disability and Health (ICF), which describes the multidimensional aspects of functioning and disability. Physical activity behaviour and its determinants were integrated into the ICF model. The factors determining physical activity were based mainly on those used in the Attitude, Social influence and self-Efficacy (ASE) model. The proposed model can be used as a theoretical framework for future interventions and research on physical activity promotion in the population of people with a disability. The model currently forms the theoretical basis for a large physical activity promotion trial in ten Dutch rehabilitation centres.

Is there evidence of the International Classification of Functioning, Disability and Health in undergraduate nursing students' patient assessments?

This paper reports on a secondary analysis of undergraduate nursing students' patient assessments while on clinical placement in a rehabilitation setting in search of evidence of the International Classification of Functioning, Disability and Health (ICF). It describes the evolution of the original World Health Organization's International Classification of Impairment, Disability and Handicap into the ICF. Data was analysed using the ICF categories of function, activity, participation, environmental factors and personal factors. Some evidence of ICF was revealed. Nurses are encouraged to further explore the relevance of ICF for nursing.

Impairments and activity limitations in subjects with chronic upper-limb complex regional pain syndrome type I

OBJECTIVE

To determine the degree of impairments and activity limitations and their interrelationship in complex regional pain syndrome type I (CRPS type I).

DESIGN

Cross-sectional study interrelating impairments and objectively measured activity limitations.

SETTING

Ambulatory and home environment.

PARTICIPANTS

Thirty nonacute upper-limb CRPS type I subjects.

INTERVENTIONS

Not applicable. Main outcome measures Sensory, motor, and autonomic impairments, as well as activity-limitation outcome measures. The latter were objectively measured with a novel upper-limb activity monitor (based on ambulatory accelerometry).

RESULTS

All subjects were impaired to some degree but with a large variability with respect to magnitude. Regarding activity limitations, the involved upper limb was clearly less active (lower intensity and percentage of activity) than the noninvolved side. Impaired active range of motion (adjusted R(2) range, 18%-39%) and grip strength (adjusted R(2) range, 12%-45%) were the most important factors explaining variance in activity limitations.

CONCLUSIONS

All subjects were still impaired nearly 3 years after the causative event. The involved upper limb was also clearly less active than the noninvolved side, especially when the subjects were sitting and when the dominant side was involved. The more impairments a subject had, especially motor impairments, the more activity limitations were present.

A new instrument for outcome assessment in rehabilitation medicine: spinal cord injury ability realization measurement index

OBJECTIVES

To introduce a new measure of disability weighted for the neurologic deficit in patients with spinal cord lesions and to examine the effect on the instrument of being in rehabilitation.

DESIGN

Development of instrument and preliminary comparative before-after study.

SETTING

Spinal department in a rehabilitation hospital in Israel.

PARTICIPANTS

Seventy-nine patients with spinal cord lesions.

INTERVENTIONS

Patients were repeatedly assessed during rehabilitation with the American Spinal Injury Association Impairment Scale (AIS) to measure neurologic motor impairment and with the Spinal Cord Independence Measure (SCIM-II) to measure disability. Scores of the 2 assessments were combined to create the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI).

MAIN OUTCOME MEASURES

A preliminary formula for the calculation of SCI-ARMI using the individual patients' SCIM-II and AIS motor scores and changes in SCI-ARMI values through rehabilitation.

RESULTS

The highest observed SCIM-II scores at patients' AIS level correlated highly with the AIS motor scores (r=.96, P<.01). A regression performed for this linear relationship resulted in a preliminary SCI-ARMI formula. The calculated SCI-ARMI values improved during rehabilitation irrespective of patient age, gender, lesion level, or lesion severity (P<.001).

CONCLUSIONS

The preliminary version of the SCI-ARMI can be used to assess quantitatively changes in functional ability, isolating them from the effect of neurologic changes.

Quality of life in hereditary neuromuscular diseases

OBJECTIVE

The aim of the study is to evaluate different aspects in the quality of life (QoL) in a group of patients affected by hereditary neuromuscular disease.

MATERIAL AND METHODS

Forty-five consecutive outpatients (mean age 49.46 +/- 17.07 years, range 19-80 years) with hereditary neuromuscular disease underwent the Brooke scale and functional independent measure to assess the functional status, the Sickness Impact Profile (SIP) and Psychological General Well-Being Index (PGWBI), as a measure of the QoL.

RESULTS AND CONCLUSIONS

All patients had a poor QoL assessment with SIP. The higher disability level was not related to a worse QoL perception with the exception of the physical area. Females and patients above 49 years showed the worst QoL profile. The discomfort linked to the emotional and affective sphere, assessed with PGWBI, appeared low in the study sample. Therefore psychosocial aspects and economical and environmental factors may influence the QoL.

Stuttering and the International Classification of Functioning, Disability, and Health: an update

The World Health Organization (WHO) recently presented a multidimensional classification scheme for describing health status and the experience of disablement. This new framework, the International Classification of Functioning, Disability, and Health (ICF; WHO, 2001), is a revision of WHO's prior framework for describing the consequences of disorders, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH; WHO, 1980). In previous papers, Yaruss had shown how the original ICIDH could be adapted to describe the consequences of stuttering at several levels that are relevant to the communication and life experiences of the person who stutters. The current manuscript presents an update of the Yaruss (1998) model that accounts for the new structure of the ICF. A comparison of the WHO's ICIDH and ICF frameworks is presented, followed by an analysis of how the ICF can be adapted to describe the speaker's experience of the stuttering disorder. Emphasis is placed on the fact that stuttering involves more than just observable behaviors. Specifically, the speaker's experience of stuttering can involve negative affective, behavioral, and cognitive reactions (both from the speaker and the environment), as well as significant limitations in the speaker's ability to participate in daily activities and a negative impact on the speaker's overall quality of life.

LEARNING OUTCOMES

As a result of reading this manuscript, participants, willgain an understanding of the updates to the World Health Organization's original International Classification of Impairments, Disabilities, and Handicaps that are seen in the International Classification of Functioning, Disability, and Health understand how the ICF can be applied to the study of stuttering recognize that health conditions such as stuttering are affected by both internal and external factors, and can involve more than just observable behaviors that are seen on the surface.

Adaptation to disability in chronic obstructive pulmonary disease: neglected relationships to older adults' perceptions of independence

PURPOSE

This study extends understanding of the relationship between disability and independence in older adults with COPD.

METHODS

An interviewer-administered questionnaire was used to examine disability, adaptation, perceptions of independence, and self-efficacy in a sample of 50 community-dwelling older adults. Odds ratios were used to investigate relationships between variables.

RESULTS

Participants used a wide range of behavioural strategies to adapt to their disability including: limiting activities, optimizing performance (e.g. taking rests), compensating for lost function (e.g. using equipment), and obtaining help from others. The relative use of these adaptations varied across five domains of activity: personal care, in-home mobility, household activities, community mobility, and valued activities. Most participants felt very or extremely independent in all domains. In personal care, those who reported greater disability (O.R. = 0.26), more frequent attempts to optimize performance (O.R. = 0.57), or greater reliance on help from others (O.R. = 0.79) were significantly (p < 0.05) less likely to feel very or extremely independent.

CONCLUSIONS

The relationship between disability and perceptions of independence depends on the nature of the activity and is influenced by factors that are amenable to study and intervention. In particular, the vast array of behavioural strategies available to older adults with COPD enables them to feel highly independent despite disability.

Reliability of the Catz-Itzkovich Spinal Cord Independence Measure assessment by interview and comparison with observation

OBJECTIVE

To examine the reliability of assessment with the Catz-Itzkovich Spinal Cord Independence Measure II (SCIM II) by interview and compare the findings with assessment by observation.

DESIGN

In a cohort, comparative study, 28 inpatients with spinal cord lesions were assessed by two nurses using the Catz-Itzkovich SCIM II (interview) and by a multidisciplinary team (observation).

RESULTS

Total agreement between interviewers ranged from 50% to 80% (Kappa coefficients 0.40-0.60). Pearson's coefficients of the correlation between scores obtained for the various SCIM subscales by interview or observation were 0.765-0.940 (P < 0.0001). The differences in mean scores obtained between the interview and observation methods were small and not statistically significant for most of the subscales.

CONCLUSIONS

The results support the reliability of the Catz-Itzkovich SCIM assessment by interview and show it to be comparable with assessment by observation. The SCIM II interview may serve as an accurate measure of daily function in patients with spinal cord injury. However, with the sample of the study being relatively small, a larger scale examination is needed to generalize the results.

Assessment of functional limitations caused by Mycobacterium ulcerans infection: towards a Buruli ulcer functional limitation score

The purpose of this study of treated Buruli ulcer patients in Ghana was to identify and assess late sequelae of treated Buruli ulcer using a goniometer, and to develop a scoring system for functional limitations. Of 78 patients, 58% (n = 45) had a reduction in the range of motion of one or more joints: 30% (n = 23) had one or more functional limitations of the leg and 21% (n = 16) of the arm; 49% (n = 38) had a functional limitation. Of all patients with affected knees, the predicted average extent of limitation was 63%. In patients with affected ankles, limitation was 78% on average; in those with elbow involvement, this was 76% on average, and in wrists involved, 65%. All of the hands involved were markedly restricted. We propose a simplified and functional scoring system that should be tested for validation in a second patient sample, and, if properly validated and adjusted, can be used in future intervention trials.

Systematic review of randomized controlled trials of nonpharmacological interventions for fibromyalgia

OBJECTIVE

Little is known of the effectiveness of nonpharmacological interventions for fibromyalgia syndrome (FMS). The authors therefore carried out a systematic review from 1980 to May 2000 of randomized controlled trials (RCTs) of nonpharmacological interventions for FMS.

METHOD

A search of computerized databases was supplemented by hand searching of bibliographies of key publications. The methodological quality of studies included in the review was evaluated independently by two researchers according to a set of formal criteria. Discrepancies in scoring were resolved through discussion.

RESULTS

The review yielded 25 RCTs, and the main categories of interventions tested in the studies were exercise therapy, educational intervention, relaxation therapy, cognitive-behavioral therapy, acupuncture, and forms of hydrotherapy. Methodological quality of studies was fairly low (mean score = 49.5/100). Most studies had small samples (median for individual treatment groups after randomization = 20), and the mean power of the studies to detect a medium effect ( > or = 0.5) was 0.36. Sixteen studies had blinded outcome assessment, but patients were blinded in only 6 studies. The median longest follow-up was 16 weeks. Statistically significant between-group differences on at least one outcome variable were reported in 17 of the 24 studies.

CONCLUSIONS

The varying combinations of interventions studied in the RCTs and the wide range of outcome measures used make it hard to form conclusions across studies. Strong evidence did not emerge in respect to any single intervention, though preliminary support of moderate strength existed for aerobic exercise. There is a need for larger, more methodologically rigorous RCTs in this area.

Rasch analysis of the Catz-Itzkovich spinal cord independence measure

BACKGROUND

The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions (SCL). Its original and second versions (SCIM and SCIM II) were found to be reliable and more sensitive than the Functional Independence Measure (FIM) to functional changes in SCL patients.

OBJECTIVE

To further validate the SCIM II, examining its components on a larger population.

DESIGN

Retrospective cohort study.

SETTING

Two rehabilitation centers in Israel.

SUBJECTS

Two hundred and two inpatients with SCL.

INTERVENTIONS

Routine SCIM assessments by staff nurses. Rasch and accompanying analyses.

MAIN OUTCOME MEASURES

Unidimensionality of subscales (areas of function); goodness of fit of the tasks to the Rasch model; relationship of total-patient and single-task performance-ability; usability of task categories and the order of threshold locations between them; subscale discrimination of ability and difficulty and hierarchical nature; discrimination of task-categories ability, ie, distribution of thresholds along ability levels; and differential task behavior by age, gender and examination subgroups.

RESULTS

Four unidimensional subscales were identified, and an acceptable goodness of fit to the Rasch model was demonstrated in most of their tasks (infit mean square=0.8-1.2, outfit mean square=0.6-1.4). However, some tasks showed overfit (bathing lower body) and some showed misfit (wheelchair-car transfer). Additional analyses performed to check for reasons for less than acceptable fit revealed flaws in a minority of the outcome measures.

CONCLUSIONS

The findings of this analysis confirm the validity and reliability of the SCIM II. To a large extent we can infer that the SCIM II construct allows for the detection of any level of disability in any patient with SCL. A few item categories, however, should be rephrased or removed.

Is global outcome predictable in the rehabilitation of patients with musculoskeletal disorders? A pilot study

Definition of prognostic factors for outcome quality is of increasing interest in rehabilitation medicine. The main question of this pilot study in 552 patients was whether global outcome could be predicted by a team-based chief physician specialized in physical medicine and rehabilitation (PMR), and whether other predictive factors would exist (ICIDH-2 levels, pain, working incapacity). Little data is available about the possibility of global prediction of prognosis in the rehabilitation of patients with musculoskeletal disorders. All 552 patients met each member of the rehabilitation team and key data from each patient was discussed at the rehabilitation conference within the first 2 days. On entry to the study, a chief physician specialized in PMR assessed the patient's key data, which was structured according to ICIDH-2 (ICF) and assessed quantitatively on a scale from zero to ten. Second, the PMR physician rated the expected global prognosis on the basis of ICIDH-2 and other key data, and in respect to the defined rehabilitation goals (see Table 2). At the same time, the patient and an assistant doctor (AD) assessed pain scores (VAS 0-10) and the actual working incapacity (%). These assessments were completed within the first 3 days and were repeated before discharge. Assessment of outcome was rated by both, separately, according to the above-mentioned scale. Different regression models were calculated, searching for significant differences between the numerous variables. In the regression models, the best predictor for outcome was the PMR physician assessment. Complete and good correspondence between prediction and outcome was obtained in 71.4% (42.1% and 29.3%, respectively) in the descriptive model. Quantitatively assessed ICIDH-2 levels, pain at entrance and working incapacity at entrance were not predictive factors for global outcome. The global outcome was rated as very good/good in 79.0% of cases by patient and in 75.1% cases by the AD, as moderate in 13.9% of cases by the patient and 18.4% of cases by the AD, and as poor/worsening in 7.1% of cases by the patient and in 6.5% of cases by the AD. Rating of outcome by the patient and the AD gave complete and good correspondence in 87.6% and no correspondence in only 2.6% of cases. Pain could be reduced highly significantly (P<0.001). There was a highly significant degree of correlation between quality of outcome and pain relief (outcome 'very good' and 'good', P<0.001; 'moderate', P=0.003; 'poor/worsening', not significant). Partial or complete reduction of working incapacity could be reached in 30% of the patients. This had no statistical influence on global outcome; neither did persistent working incapacity. Prediction of global outcome by a team-based PMR assessment seems to be a useful semiquantitative method with high predictive value. The method, including the critical point of validation, is currently being extensively discussed. Prediction is an integral process based on the high information grade of a multiprofessional rehabilitation team, the ICIDH-2 structures, the definition of rehabilitation goals, the knowledge and experience in bio-psycho-social medicine and the application of common sense. Rating of global outcome by the patient/AD is an integrative process as well. Pain relief is an important and very strong factor, with a high degree of influence on global outcome in musculoskeletal rehabilitation, probably by improving quality of life. Working incapacity is no reason for refusing patients rehabilitation and both improvement of working capacity and persistence of working incapacity, has no statistical influence on global outcome. Finally, the extent of the four ICIDH-2 levels, especially negative contextual factors, were not predictive, that is, they had no significant influence on global outcome in this study. In conclusion, prediction of global outcome by a team-based chief physician specialized in PMR is of high predictive value, practicable and useful for rehabilitation processes, quality assurance, insurance companies and health policies. To our knowledge, this is the first published study on this topic.