Clinician-Reported Outcome Measures: Experiences from Multicenter Follow-Up and an Overview of Commonly Used Measures in Vocational Rehabilitation and Disability Evaluation


Structure and function

Activity and participation

Environmental factors

Personal factors

Functional Capacity Evaluations (FCE)

Six-minute walk test

Quick Exposure Check (QEC)
 
Aerobic capacity test

The PILE test

Assessment of Work Characteristics (AWC)
 
Grip strength

Timed walking
  
Shoulder, arm, and hand test

Timed stair climbing
  
Signal of Functional Impairment (SOFI)

Timed chair stand
   
Patient-Specific Functional Scale (PSFS)
  





21.5 Using the ICF in Clinical Follow-Up: Examples from a National Rehabilitation Program


In Sweden, a national rehabilitation program was introduced in 2009 to develop primary health-care-based vocational rehabilitation to improve work ability in patients on sick leave or at risk for long-term sick leave. This was a national initiative from the government and fully tax funded [36]. The program was aimed at patients with MSD and/or mild to moderate mental illness, which were the two patient groups dominating the sickness compensation programs in Sweden. The program included multimodal rehabilitation for patients with MSD and cognitive behavioral therapy for patients with mental illness. It had its full focus on vocational-oriented interventions in primary health care.

In southern Sweden, comprehensive preparations were conducted before the rehabilitation program started, in order to enable follow-up on results, quality assurance, bench marking, and research. The aim was also to ensure that different patient-related aspects were covered in relation to the ICF. For this purpose, a new observational methodology was used as CROM. It was also important that outcomes were easy to assess and to report. The follow-up included both CROMs and PROMs.

Functioning was assessed by a health-care professional (occupational therapist, nurse, psychologist, physical therapist or physician). Functional limitations were graded on five levels, from no limitation (1) to total limitation (5). The health-care professionals were also supposed to state whether functional limitations were confirmed by objective measures and to make a prognosis of the function.

For patients with MSD, three function categories were chosen: b280 Sensation of pain, b710 Mobility in joint functions, and b455 Exercise tolerance functions. These categories were chosen from the Comprehensive ICF Core Set for Chronic Widespread Pain [37]. For patients with mental illness, function categories were chosen from the Comprehensive ICF Core Set for Depression, b134 Sleep functions and b164 Higher-level cognitive functions [38]. In addition, d240 Handling stress and other psychological demands was included since patients with mental disorders often had stress-related problems.

The follow-up for patients with MSD and mental illness included PROMs covering function, activity, and participation. Also, the EuroQOL five dimensions questionnaire (EQ-5D) was used to evaluate changes in health-related quality of life and to be used in health economic evaluations. This instrument covers several function and activity categories [39]. The patients were asked to rate how they perceived their own work ability.


21.5.1 Research Report from Follow-Up on Functioning Assessment in Pain Rehabilitation


In the scientific report on multimodal rehabilitation in the national rehabilitation program, 406 patients were included [40]. Several outcomes were reported. The CROMs on function, evaluated by health professionals, were reported at the start and after rehabilitation. In the analysis, the patients were divided in three groups, based on sick leave and/or disability pension records the year prior to the rehabilitation program, no sick leave, part-time sick leave, and full-time sick leave. Within all three groups, all functions (pain, mobility in joint functions, and exercise tolerance functions) improved between start and after rehabilitation.

At the start, there were significant differences in b280 Sensation of pain between the group with no sick leave and/or disability pension in the year prior to rehabilitation and the group with full-time sick leave before rehabilitation. After rehabilitation, there were differences in pain between the group with no sick leave and part-time sick leave and also between the group with no sick leave and full-time sick leave. In the group with no sick leave before rehabilitation, a larger part of the patients improved concerning b280 Sensation of pain and b710 Mobility in joint functions.

In b455 Exercise tolerance functions, there were no differences between the groups in improvement, even though there were differences both at rehabilitation start and after rehabilitation between the groups.

When evaluating b710 Mobility in joint functions, there were differences in how this function improved, but differences were also seen at rehabilitation start and after rehabilitation.

The function categories that were chosen in the follow-up of the Swedish national rehabilitation program were easy to evaluate, and they provided a broad description of the patient’s functioning. Since they were chosen from the Comprehensive ICF Core Set for Chronic Widespread Pain, they were seen as relevant and valid.


21.5.2 Research Report from Follow-Up on Functioning Assessments in Rehabilitation of Mental Illness


In a report on the results of the national rehabilitation program on patients with mental illness, the ICF function categories were evaluated at baseline and after completed rehabilitation [41]. These functions were reported as CROMs. Patients with no sick leave at rehabilitation start were compared with patients with sick leave. b134 Sleep functions were reported as improved, within both groups, but there were no differences in improvement between patients with and without sick leave. The levels of b164 Higher-level cognitive functions were also reported as significantly improved within both groups, and here a difference was seen when the groups were compared. The group with no sick leave at baseline improved more. When looking at d240 Handling stress and other psychological demands, improvement was seen within both groups, but there were no differences between the groups. Among patients with mental disorders, the selection of three different function categories from the Comprehensive ICF Core Set for Depression was easy to evaluate.


21.6 Conclusions and Recommendations


In summary, it is important to ensure that different components of ICF are covered already in the planning process on follow-up of interventions.

Regardless the type of evaluation measures used (CROMs and/or PROMs), it is necessary to map how these measures correspond to the ICF. This is especially important in vocational rehabilitation and work disability evaluation, since environmental and also personal factors may play such an important role.

In the Swedish national rehabilitation program, we gained valuable experience from evaluating different function categories, based on the Comprehensive ICF Core Sets. We have experienced these categories as feasible and convenient. We have also, as described in Sect. 21.5.1, experienced that they are sensitive to changes and differences in clinical practice in primary care. Still, there is a need for further evaluating reliability aspects as well as the value as long-term prognostic factors.

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Sep 25, 2016 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Clinician-Reported Outcome Measures: Experiences from Multicenter Follow-Up and an Overview of Commonly Used Measures in Vocational Rehabilitation and Disability Evaluation

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