ICF Core Set LBP Tehran 1387

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Comprehensive ICF Core Set for Low Back Pain

• The Ninth Special Seminar on Spine
• Tehran December 2008

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Mohammad Kamali, PhD, PTAssociate
Professor,School of Rehabilitation
SciencesRehabilitation Research CenterIran
University of Medical Sciences

• www.mkamali.com
• Kamali_at_mkamali.com
• P.O. Box 17445-183

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From ICD to ICF in short

• 1893 Classification of causes of death
• 1946 ICD / Classification of diseases
• 1980 ICIDH / Classification of disabilities as
  consequences of disease
• 2001 ICF / Classification of human functioning

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ICIDH - 1980

• Three levels of experience of disability
• (Disease or disorder)
• impairment disabilities
  handicaps

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International Classification of Functioning,
Disability and Health (ICF. WHO, 2001)
Health condition (disorder, disease)
Body Functions and Structures (Impairments)
Participation(Restrictions)
Activities(Limitations)
Personal Factors
Environmental Factors
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• Activity is the execution of a task or action by
  an individual. It represents the individual
  perspective of functioning.

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• Activity is the execution of a task or action by
  an individual. It represents the individual
  perspective of functioning.

Participation is involvement in a life situation.
It represents the societal perspective of
functioning.
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Disability
Health Condition


(disease, disorder)
Limitation in activities
Impairment of body function structure
Restriction in participation
Personal
Environmental
Factors
Factors
Contextual factors
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Disability
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Functioning
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Disability is a function of the interaction
between the person and the environment
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Aims of ICF

• to provide a scientific basis for consequences of
  health conditions
• to establish a common language to improve
  communications
• to permit comparison of data across
• countries
• health care disciplines
• services
• time
• to provide a systematic coding scheme for health
  information systems
• WHO, Geneva, 2002

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ICF application

• Statistical tool
• (surveys, management of information systems)
• Research tool
• (outcomes, quality of life, environmental
  factors)
• Clinical tool
• (assessment of needs, rehabilitation, outcomes)
• Social policy
• (planning social security, compensation, policy
  designs/implementation)
• Educational tool
• (curriculum designs, raise awareness)

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ICF provides an international common language for
describing functioning, disability and health
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ICF Categories
Health condition(disease, trauma)
493 Body functionsand 310 structures
384 Activities Participations
253 Environmental factors
Personal factors
Contextual factors
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• The ICF covers comprehensively the spectrum of
  problems encountered in patients with
  musculoskeletal conditions by clinical experts
  throughout the world.
• In daily clinical practice, additional
  information needs to be added to some ICF
  categories to improve the precision of the
  description of a specific patient.

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• "A clinician cannot easily take the main volume
  of the ICF and consistently apply it to his or
  her patients. In daily practice, clinicians will
  only need a fraction of the categories found in
  the ICF"
• Üstün B et.al. Common yet specific tools to
  measure clinical outcomes ICF Comprehensive Sets
  and ICF Core Sets. J Rehab Med 2004 (44
  suppl)7-8.

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Acceptance relies on truly practical and useful
tools!
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ICF Core Set
List of ICF categories with the typical spectrum
of problems in functioning and environmental
factors in patients with a specific condition
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ICF Core Sets Main Goals

• Make the ICF feasible for
• Clinical practice
• Research clinical and epidemiological
  studies,Health reporting and monitoring of
  functioning and health
• Link the ICF to the ICD and to existing health
  status measures

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Main Goals

• What to measure
• and not
• How to measure
• History, clinical exam and observations
• Clinical tests and batteries
• Standardized self-reported patient questionnaires
• Measures of independence, occupation or
  "handicap"
• Measures of resource utilization
• ICF Core Measures - clinical measures of
  functioning

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Value of ICF Core Sets

• Guide for clinical assessment
• Minimum Functioning catalogue What to assess
• What are the patients problems(we do not have a
  score, we have a list of problems)
• Compararability of clinical data
• Patients
• Institutions, where the measures for evaluation
  will be different
• Countries
• Basis to improve communication
• Among professionals
• Between settings

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ICF core set

• Resulting in a list of ICF categories to be
  recorded for a comprehensive, multidisciplinary
  assessment of functioning and health in patients
  with a specific condition
• Development is based on evidence (preliminary
  studies) and consensus process (Delphi exercise,
  international consensus conferences)

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ICF Core Sets

• Comprehensive ICF Core Set
• to guide multidisciplinary assessments in
  patients with that condition
• Brief ICF Core Set
• to be used in clinical studies

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Development of core sets

• Rheumatoid arthritis
• Osteoarthritis
• Osteoporosis
• Back Pain
• Stroke
• Depression
• Chronic pain
• Obesity
• Coronary heart disease
• COPD/Asthma
• Diabetes
• Breast cancer

• Musculoskeletal
• Neurology and mental problems
• Internal medicine

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LBP - Body Functions

• b126 Temperament and personality functions
• b130 Energy and drive functions
• b134 Sleep functions
• b152 Emotional functions
• b180 Experience of self and time functions
• b260 Proprioceptive function
• b280 Sensation of pain
• b455 Exercise tolerance functions
• b620 Urination functions

Brief ICF Core Set
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LBP - Body Functions

• b640 Sexual functions
• b710 Mobility of joint functions
• b715 Stability of joint functions
• b720 Mobility of bone functions
• b730 Muscle power functions
• b735 Muscle tone functions
• b740 Muscle endurance functions
• b750 Motor reflex functions
• b770 Gait pattern functions
• b780 Sensations related to muscles and movement
  functions

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LBP - Body Structures

• s120 Spinal cord and related structures
• s740 Structure of pelvic region
• s750 Structure of lower extremity
• s760 Structure of trunk
• s770 Additional musculoskeletal structures
  related to movement

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LBP - Activity Participation

• d240 Handling stress and other psychological
  demands
• d410 Changing basic body position
• d415 Maintaining a body position
• d420 Transferring oneself
• d430 Lifting and carrying objects
• d445 Hand and arm use
• d450 Walking
• d455 Moving around
• d460 Moving around in different locations
• d465 Moving around using equipment
• d470 Using transportation
• d475 Driving
• d510 Washing oneself
• d530 Toileting

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LBP - Activity Participation

• d540 Dressing
• d570 Looking after ones health
• d620 Acquisition of goods and services
• d630 Preparing meals
• d640 Doing housework
• d650 Caring for household objects
• d660 Assisting others
• d710 Basic interpersonal interactions
• d760 Family relationships
• d770 Intimate relationships
• d845 Acquiring, keeping and terminating a job
• d850 Remunerative employment
• d859 Work and employment, other specified and
  unspecified
• d910 Community life
• d920 Recreation and leisure

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LBP - Environmental Factors

• e110 Products or substances for personal
  consumption
• e120 Products and technology for personal indoor
  and outdoor mobility and transportation
• e135 Products and technology for employment
• e150 Design, construction and building products
  and technology of buildings for public use
• e155 Design, construction and building products
  and technology of buildings for private use
• e225 Climate
• e255 Vibration
• e310 Immediate family
• e325 Acquaintances, peers, colleagues, neighbors
  and community members
• e330 People in positions of authority
• e360 Other professionals
• e410 Individual attitudes of immediate family
  members

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LBP - Environmental Factors

• e425 Individual attitudes of acquaintances,
  peers, colleagues, neighbors and community
  members
• e450 Individual attitudes of health professionals
• e455 Individual attitudes of other professionals
• e460 Societal attitudes
• e465 Social norms, practices and ideologies
• e540 Transportation services, systems and
  policies
• e550 Legal services, systems and policies
• e570 Social security services, systems and
  policies
• e575 General social support services, systems and
  policies
• e580 Health services, systems and policies
• e585 Education and training services, systems and
  policies
• e590 Labor and employment services, systems and
  policies

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Body Functions - RA

• b280 Pain
• b710 Mobility of joint functions
• b730 Muscle power functions
• b4555 Exercise tolerance function
• b780 Sensations related to muscles and movement
  functions
• b2800 Generalized pain
• b2801 Pain in body part
• b7102 Mobility of joints generalized
• b7800 Sensation of muscle stiffness
• b134 Sleep functions
• b130 Energy and drive functions
• b640 Sexual functions
• b715 Stability of joint functions
• b152 Emotional functions
• b180 Experience of self and time functions
• b1801 Body image
• b740 Muscle endurance function
• b510 Ingestion functions
• b770 Gait pattern functions

25 out of 485
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Body Structures - RA

• s750 Structure of lower extremity
• s730 Structure of upper extremity
• s710 Structure of head and neck region
• s720 Structure of shoulder region
• s75001 Hip joint
• s75011 Knee joint
• s7502 Structure of ankle and foot
• s73001 Elbow joint
• s73011 Wrist joint
• s7302 Structure of hand
• s73021 Joints of hand and fingers
• s73022 Muscles of hand
• s760 Structure of trunk
• s7600 Structure of vertebral column
• s76000 Cervical vertebral column
• s770 Additional musculoskeletal structures
  related to movement
• s299 Eye, ear and related structures,
  unspecified
• s810 Structure of areas of skin

18 out of 302
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Activities Participation RA

• d450 Walking
• d850 Remunerative employment
• d440 Fine hand use
• d410 Changing basic body position
• d445 Hand and arm use
• d230 Carrying out daily routine
• d430 Lifting and carrying objects
• d470 Using transportation
• d620 Acquisition of goods and services
• d920 Recreation and leisure
• d640 Doing housework
• d540 Dressing
• d630 Preparing meals
• d475 Driving
• d530 Toileting
• d550 Eating
• d859 Work and employment, other specified and
  unspecified
• d170 Writing
• d510 Washing oneself

31 out of 384
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Environmental Factors - RA
21 out of 253

• e310 Immediate family
• e580 Health services, systems and policies
• e355 Health professionals
• e115 Products and technology for personal use in
  daily living
• e570 Social security services, systems and
  policies
• e155 Design, construction and building products
  and technology of buildings for private use
• e110 Products or substances for personal
  consumption
• e450 Individual attitudes of health professionals
• e150 Design, construction and building products
  and technology of buildings for public use
• e135 Products and technology for employment
• e425 Individual attitudes of aquaintances, peers,
  colleagues, neighbors and community members
• e410 Individual attitudes of immediate family
  members
• e420 Individual attitudes of friends
• e540 Transportation services, systems and
  policies
• e340 Personal care providers and personal
  assistants
• e360 Other professionals
• e320 Friends
• e120 Products and technology for personal indoor
  and outdoor mobility and transportation
• e460 Societal attitudes

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FURTHER DEVELOPMENT OF CORE SETS

• Core sets for patients with neurological,
  musculoskeletal, and cardiopulmonary conditions
  in the acute setting
• Core sets for other chronic conditions, as
  psoriasis, ankylosing spondylitis,
• Core sets for special situations, e g home
  setting, job rehabilitation

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• 1384

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Rehabilitationis the multi- and
interdisciplinary patient-oriented management
offunctioning and health of people with a
condition
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RehabilitationManagement of functioning and
health