Use of the ICF to describe functioning and disability in obese patients

The impact of living with morbid obesity on psychological need frustration: A study with bariatric patients

Guided by self-determination theory, the purpose of this study was to gain an understanding of the previous experiences of living with morbid obesity of 10 postbariatric patients enrolled in a physical activity programme. Qualitative data were collected through interviews and diarized observations. A thematic analysis revealed that participants suffered from health and mobility troubles in their daily life and experienced stigmatization and discrimination in most areas of their social functioning. Participants described how these experiences resulted in the thwarting of their basic psychological needs for autonomy, competence and relatedness. In turn, psychological need frustration contributed to negative consequences such as body image concerns, low self-esteem, anxiety and depression; controlled regulation of their eating behaviour and extrinsic goals; rigid behaviours such as avoiding social situations; and compensatory and self-defeating behaviours such as giving up diet and physical activity regimens and binge eating (i.e., oppositional defiance). This study highlights how living with morbid obesity can impair optimal functioning and well-being via experiences of psychological need frustration.

Patients with obesity-related comorbidities have higher disability compared with those without obesity-related comorbidities: results from a cross-sectional study

The aim of the present study was to describe disability in adult obese patients with obesity-related comorbidities, and to compare it with that of patients without obesity-related comorbidities. Two groups of obese patients were administered a set of 166 International Classification of Functioning, Disability and Health (ICF) categories; on the basis of this set, count-based indexes were developed for each ICF component and difference between patients with and without comorbidities were assessed with independent-sample t-test and Cohen's d as a measure of effect size. ICF categories in which at least 20% of patients reported a problem were considered relevant for describing functioning of obese patients; for each of them, the risk of having obesity-related comorbidities was calculated using odds ratio and 95% confidence interval. A total of 106 inpatients were enrolled in the study: 68 ICF categories reached the 20% threshold, and 31 of them were relevant only among patients with comorbidities. The presence of obesity-related comorbidities was associated with an increased risk of bodily impairments and limitations in performing daily activities. Compared with patients without obesity-related comorbidities, those with comorbidities showed higher disability. Comorbidities contribute to obesity-related disability, and our results support the importance of early rehabilitation interventions to reduce disability.

An ICF-Based Model for Implementing and Standardizing Multidisciplinary Obesity Rehabilitation Programs within the Healthcare System

Introduction/Objective: In this study, we aimed to design an ICF-based individual rehabilitation project for obese patients with comorbidities (IRPOb) integrated into the Rehab-CYCLE to standardize rehabilitative programs. This might facilitate the different health professionals involved in the continuum of care of obese patients to standardize rehabilitation interventions. Methods: After training on the ICF and based on the relevant studies, ICF categories were identified in a formal consensus process by our multidisciplinary team. Thereafter, we defined an individual rehabilitation project based on a structured multi-disciplinary approach to obesity. Results: the proposed IRPOb model identified the specific intervention areas (nutritional, physiotherapy, psychology, nursing), the short-term goals, the intervention modalities, the professionals involved and the assessment of the outcomes. Information was shared with the patient who signed informed consent. Conclusions: The model proposed provides the following advantages: (1) standardizes rehabilitative procedures; (2) facilitates the flow of congruent and updated information from the hospital to outpatient facilities, relatives, and care givers; (3) addresses organizational issues; (4) might serve as a benchmark for professionals who have limited specific expertise in rehabilitation of comorbid obese patients.

Development of the MG-DIS: an ICF-based disability assessment instrument for myasthenia gravis

PURPOSE

To develop a preliminary version of a disease-specific, patient-reported disability assessment instrument for myasthenia gravis (MG) based on the International Classification of Functioning, Disability and Health (ICF): the MG-DIS.

METHODS

Five consecutive steps were taken: literature review and selection of outcome measures; linking of measures' concepts to ICF categories and selection of those reported by 30% of the instruments; comparison of linking results with a previous selection of MG-relevant ICF categories; patient interview; development of questions based on retained ICF categories.

RESULTS

Thirty-one papers containing 21 different outcome measures were found: 13 ICF categories were linked to them. Fifty-five items were retained after the comparison with the list of MG-specific categories, and were used for patient interview. Thirteen interviews were conducted before saturation of data was reached and the final list was composed of 42 categories: based upon them, 44 questions were developed.

CONCLUSIONS

The preliminary version of the MG-DIS contains more information than each single MG-specific tool, in particular, for the component of environmental factors. Further research is needed to test its psychometric properties.

IMPLICATIONS FOR REHABILITATION

It is important that patient-reported outcome is incorporated in MG patient's assessment. MG features can be evaluated with ICF-based methods. An MG-specific patient-reported disability assessment instrument can be used to monitor changes of functioning in patients on MG-specific treatments, and can be used in clinical trials as outcome measure.

Prevalence and correlates of disability in a late middle-aged population of women

OBJECTIVE

This study estimates the prevalence of disability among late middle-aged women and identifies important correlates of disability among this population.

METHOD

Disability was assessed among 376 participants of the Michigan Study of Women's Health Across the Nation cohort at the 2011 follow-up using the World Health Organization Disability Assessment Schedule. Demographic and health measures were related to disability status using logistic regression models (none or mild vs. moderate, severe, or extreme disability).

RESULTS

Nearly 25% of women reported moderate to extreme global disability. African American race/ethnicity, economic strain, peripheral neuropathy, and depressive symptomatology were associated with global disability. Obesity, knee osteoarthritis, and hypertension were only associated with disability for the mobility domain (getting around).

DISCUSSION

The prevalence of disability is relatively high among this population of late middle-aged women. Efforts to prevent or forestall disability should be extended to include middle-aged populations as they may be most amenable to intervention.

Obesity is a marker of reduction in QoL and disability

The purpose of this paper is to verify the association between outcome measures of health-related quality of life (HRQoL) and disability, BMI, gender, and age. Adult obese patients were clustered using HRQoL (IWQoL-Lite) and disability (WHO-DAS II) scores into three groups: mild, moderate, and high. One-way ANOVA with Bonferroni post hoc test was used to evaluate differences in age and BMI between subjects from different clusters, contingency coefficient to test the relationship between cluster groups and gender. In total, 117 patients were enrolled: subjects with higher disability and HRQoL decrement were older and had higher BMI. Women were more likely to present moderate disability and reduction in HRQoL, while men more likely presented mild disability and HRQoL reduction. Our data further confirm the connection between disability and HRQoL, high BMI and older age. These data obtained with outcomes measures might better address rehabilitation programs.

Assessing disability in morbidly obese individuals: the Italian Society of Obesity test for obesity-related disabilities

PURPOSE

To validate a new obesity-specific disability assessment test: the Obesity-related Disability test (Test SIO Disabilità Obesità Correlata, TSD-OC).

METHODS

Adult obese individuals were assessed with the TSD-OC, 36-Item Short-Form Health Survey (SF-36), 6-min walking test (6MWT) and grip strength. The TSD-OC is composed of 36 items divided into seven sections (pain, stiffness, activities of daily living and indoor mobility, housework, outdoor activities, occupational activities and social life). Statistical correlations between the TSD-OC, functional assessment (6MWT and grip strength) and quality of life parameters (SF-36) were analysed. Internal consistency was assessed with Cronbach's α test. Test-retest reliability was evaluated in a subgroup of 30 individuals. A linking exercise between TSD-OC items and categories of the International Classification of Functioning, Disability and Health was performed.

RESULTS

Test-retest showed excellent stability (r = 0.90) and excellent internal consistency was reported (Cronbach's α > 0.90). Significant low to moderate correlations between TSD-OC, SF-36 scores, 6MWT and grip strength were observed. A total of 26 ICF categories were linked, mostly related to the area of mobility.

CONCLUSIONS

The TSD-OC is a reliable and valid instrument for measuring self-reported disability in obese subjects. It may represent an important tool for establishing rehabilitation needs in individuals with obesity-related disability, for planning appropriate rehabilitation programmes and for evaluating their effectiveness.

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.

ICF and ICF-CY for an innovative holistic approach to persons with chronic conditions

This introduction presents a brief review of projects carried out in Italy applying ICF model. ICF allows to capture and appropriately describe human functioning and disability in terms of body functions and body structures, life activities, participation in society, modulating contextual factors. ICF framework allows to have a complex profile of persons with different medical conditions. Several clinical studies have been performed using ICF and ICF-CY, in Italy from the publication of ICF in 2001 and ICF-CY in 2007. Most of them highlight the utility and feasibility of using ICF to describe the functional profiles of patients with different health conditions. The clinical applications of ICF clearly show that ICF-based functional profiles are useful in designing better interventions - directed not only to patients' health condition and symptoms but also to the most important activities of their daily living and environmental factors that may act as barriers or facilitators to the patients' recovery, well-being and participation in society.

Obesity-related disability: key factors identified by the International Classification of Functioning, Disability and Health

PURPOSE

To identify obese patients' disability features considering the level of body impairments, activity limitations and participation restrictions in relation to environmental factors' effect.

METHOD

Adult obese inpatients (BMI > 35) were enrolled and were administered a set of 166 ICF categories. Count-based indexes were developed for each ICF component: correlations and regression on performance and capacity indexes were performed.

RESULTS

Fifty-one patients (62.7% females, mean age 38.1) entered in the study. Description of ICF-based disability components is reported. Capacity is better correlated with body functions (r = 0.619, P < 0.01) and body structures (r = 0.375, P < 0.01) than performance; on the contrary, environmental barriers are correlated better with performance (r = 0.531, P < 0.01) than with capacity. Impairments in body functions and environmental barriers are the best predictors of limitations both in capacity and in performance.

CONCLUSIONS

Through this multidisciplinary approach, supported by ICFs biopsychosocial model, we described functioning and disability in obese patients, highlighting the strong effect of body functions' impairments and the limited one of environmental factors. This approach can guide rehabilitation programmes, the promotion of positive health outcomes and the modification of patients' lifestyle, not only intended as an issue of barriers' elimination, but as the activation and maintenance of environmental facilitators.