Khan and Pallant [51] (N = 101)
Holper et al. [52] (N = 205)
Svestkova et al. [53] (N = 100)
All cases (N = 406)
Body functions
b770 Gait pattern
98.0 %
89.8 %
54.0 %
83.0 %
b730 Muscle power
95.0 %
94.6 %
44.0 %
82.3 %
b620 Urination functions
93.1 %
81.5 %
70.0 %
81.5 %
b130 Energy and drive
97.0 %
71.2 %
52.0 %
72.9 %
b134 Sleep
83.2 %
68.3 %
60.0 %
70.0 %
b210 Seeing
46.5 %
75.1 %
65.0 %
65.5 %
b735 Muscle tone
93.1 %
63.4 %
41.0 %
65.3 %
b140 Attention
65.3 %
63.9 %
42.0 %
58.9 %
b280 Sensation of pain
75.2 %
55.1 %
–
54.2 %
b235 Vestibular
70.3 %
38.0 %
65.0 %
52.7 %
b152 Emotional functions
96.0 %
33.2 %
47.0 %
52.2 %
b640 Sexual functions
56.4 %
40.5 %
58.0 %
48.8 %
b710 Mobility of joint
–
82.9 %
–
48.5 %
b780 Sensation related to muscles
–
81.5 %
–
41.1 %
b525 Defecation
88.1 %
–
49.0 %
39.4 %
b144 Memory
61.4 %
–
41.0 %
37.9 %
Body structures
s110 Brain
99.0 %
99.5 %
97.0 %
98.8 %
s120 Spinal cord
–
93.2 %
97.0 %
70.9 %
s750 Lower extremity
96.0 %
75.1 %
–
67.0 %
s610 Urinary system
92.1 %
80.0 %
–
63.3 %
s760 Trunk
84.2 %
47.3 %
–
44.8 %
s730 Upper extremity
43.6 %
59.0 %
–
40.6 %
S2 Eye, ear and related structures
–
73.2 %
–
36.9 %
Khan and Pallant [51] (N = 101) | Holper et al. [52] (N = 205) | Svestkova et al. [53] (N = 100) | All cases (N = 406) | |
|---|---|---|---|---|
d450 Walking | 100.0 % | 90.7 % | 63.0 % | 86.2 % |
d640 Doing housework | 93.1 % | 90.7 % | 61.0 % | 84.0 % |
d620 Acquisition of goods and services | 91.1 % | 88.3 % | 60.0 % | 82.0 % |
d920 Recreation and leisure | 96.0 % | 90.2 % | 50.0 % | 81.8 % |
d850 Remunerative employment | 89.1 % | 74.6 % | 63.0 % | 75.4 % |
d455 Moving around | 98.0 % | 88.3 % | – | 74.4 % |
d470 Using transportation | 99.0 % | 69.3 % | 56.0 % | 73.4 % |
d650 Caring for household objects | 83.2 % | 69.8 % | 58.0 % | 70.2 % |
d910 Community life | 78.2 % | 91.2 % | – | 65.5 % |
d475 Driving | 98.0 % | 67.3 % | – | 63.8 % |
d230 Carrying out daily routine | 79.2 % | 82.9 % | – | 61.6 % |
d465 Moving around using equipment | 97.0 % | 69.8 % | – | 59.4 % |
d870 Economic self-sufficiency | 83.2 % | 57.6 % | 38.0 % | 59.1 % |
d460 Moving around in different locations | – | 80.0 % | 66.0 % | 56.7 % |
d440 Fine hand use | 50.5 % | 67.3 % | 38.0 % | 55.9 % |
d660 Assisting others | 86.1 % | 63.4 % | – | 53.4 % |
d770 Intimate relationships | 60.4 % | 54.6 % | 42.0 % | 53.0 % |
d430 Lifting and carrying objects | 52.5 % | 59.0 % | 38.0 % | 52.2 % |
d630 Preparation of meals | 88.1 % | 55.1 % | – | 49.8 % |
d445 Hand and arm use | 36.6 % | 70.7 % | – | 44.8 % |
d220 Undertaking multiple tasks | 87.1 % | 41.0 % | – | 42.4 % |
d177 Making decisions | 58.4 % | 50.7 % | – | 40.1 % |
d510 Washing oneself | 40.6 % | 36.1 % | 37.0 % | 37.4 % |
d166 Reading | – | 69.8 % | – | 35.2 % |
d760 Family relationships | 72.3 % | – | – | 33.0 % |
Khan and Pallant [51] (N = 101) | Holper et al. [52] (N = 205) | Svestkova et al. [53] (N = 100) | All cases (N = 406) | |
|---|---|---|---|---|
e310 Immediate family | 44.6 % | 100.0 % | 81.0 % | 81.5 % |
e110 Substances for personal consumption (food, medicines) | 100.0 % | 61.5 % | 95.0 % | 79.3 % |
e120 Technologies for personal indoor and outdoor mobility and transportation | 90.1 % | 61.0 % | 41.0 % | 63.3 % |
e320 Friends | – | 96.6 % | 50.0 % | 61.1 % |
e225 Climate | 98.0 % | 69.3 % | – | 59.4 % |
e315 Extended family | 41.6 % | 97.1 % | – | 59.4 % |
e410 Attitudes of family members | – | 100.0 % | – | 58.1 % |
e580 Health SSP | 78.2 % | 64.9 % | – | 52.2 % |
e415 Attitudes of extended family | – | 99.0 % | – | 50.0 % |
e420 Attitudes of friends | – | 97.1 % | – | 49.0 % |
e150 Design, construction and building products and technology of buildings for public use | 69.3 % | 38.0 % | 50.0 % | 48.8 % |
e325 Acquaintances, peers and colleagues | – | 82.0 % | – | 46.3 % |
e355 Health professionals | – | 69.8 % | 30.0 % | 42.6 % |
e465 Social norms | – | 46.3 % | 64.0 % | 39.2 % |
e540 Transportation SSP | 67.3 % | 30.2 % | – | 37.7 % |
e450 Attitudes of health professionals | – | 73.7 % | – | 37.2 % |
What emerges from these data is that there are more differences than similarities in the profiles of functioning collected by the three studies. These differences are likely to reflect the heterogeneous clinical manifestations of MS, with varying degrees of impairments in movement-related functions (e.g. muscle power was reported as impaired in 95 % of patients in the 2007 study by Khan and Pallant [51] and in 44 % of patients in the 2010 study by Svestkova and colleagues [53]) as well as in mental functions (e.g. emotional functions were impaired in 95 % in the 2007 study by Khan and Pallant [51] and in 33.2 % in the 2010 study by Holper and colleagues [52]). In turn, this had an impact on the way in which patients were able to carry out daily life activities, as well as on the way in which assistive devices, or the support from relevant others, were needed. However, it is also correct to suppose that some of these differences are due to the way in which disease severity and disability were assessed in the three groups of MS patients, in terms of available instruments and domains taken into consideration in the settings in which the patients’ data were collected. The issue of the differences related to assessment instruments and MS features was addressed in Sect. 10.2.1 of this chapter. By using a common framework to address functioning and disability, the ICF-based data add information on the consequences of these differences. The definition of functioning and disability shows the advantages for using the ICF in vocational rehabilitation practice with MS patients. ICF-based data, in fact, enable VR professionals to classify and collect data on problems at the personal or environmental level beyond those that are likely to be stipulated by the presence of MS symptoms or that are relevant to the disease’s management. In fact, MS-related symptoms and problems in performing tasks and activities are difficult to capture with a limited set of assessment tools, which makes it critical to define VR goals. An ICF-based procedure of describing functioning and disability, on the contrary, enables VR professionals to collect information on a wide set of impairments and limitations, with a good balance between synthesis and comprehensiveness. Therefore, it can be used to create a profile of functioning that is strictly connected to the job tasks an individual is expected to perform. Moreover, it enables collection of data on environmental facilitators and barriers, including those connected to job-related activities. Thus, the ICF-based procedure achieves comprehensive and tailored planning for a person in the workplace.
The results of this synopsis on ICF-based data in MS show that there are wide differences across studies, reflecting differences in the clinical manifestation of MS and the variety of movement-related and mental functions impairments.
10.3.2 ICF-Based Description of Disability in Persons with Stroke
The ICF Core Set for stroke has been available since 2004 and is composed of 130 ICF categories, mostly from activities and participation (51 categories) and body functions (41 categories) [54]. A brief Core Set, composed of 18 categories, is also available. To our knowledge, ICF-derived data on samples of stroke patients have been reported in three studies [55–57].
In 2010, Algurén and colleagues collected data on body functions and activities and participation of the ICF Comprehensive Core Set for stroke on a sample of 89 stroke patients and selected as relevant those categories rated as impaired or limited in at least 10 % of the cases; 28 categories from body functions and 41 from activities and participation were considered relevant 3 months after stroke [55]. No data were collected from the components body structures and environmental factors. Using the ICF checklist, in 2010 Goljar and colleagues [56] collected data on a sample of 197 patients attending inpatient rehabilitation services and reported as relevant those categories in which at least 20 % of persons reported some problems (in the case of environmental factors, the threshold was based on the sum of barriers and facilitators). A total of 61 ICF categories reached the threshold, mostly from body functions and activities and participation. In 2012 Quintas and colleagues [57] collected data on a sample of 111 patients using the Brief ICF Core Set for stroke, reporting prevalence of problems only in those 18 categories included in this Core Set. Comparisons of these three studies indicate differences that are mostly due to the sets of ICF categories that were used to collect data. The amount of ICF categories ranged from only 18 (i.e. those of the Brief Core Set for stroke) to 128 (i.e. the ICF checklist). In addition, the fact that the protocol used by Algurén and colleagues did not include body structures and environmental factors limits analysis of data for these two domains.
Based on our inclusion criterion of 33 % described earlier, 44 ICF categories are included in the analysis. The most common impairments in body functions and structures are shown in Table 10.4; there were 18 body functions and two body structures. The most common functional impairments were related to mobility functions, with very relevant differences in the prevalence of most of these impairments. Mental and sensory functions were also among the most frequently reported categories, again with noticeable differences between the samples. Table 10.5 shows the most common limitations in activities and participation; in total, 17 categories reached the inclusion threshold, with mobility-related and self-care activities being the most commonly reported. Also in this case, relevant differences between samples are observed. Table 10.6 shows the most common facilitators and barriers in environmental factors, where data have been aggregated without showing differences between facilitators and barriers. In total, seven environmental factors have been reported, mostly related to the domain of products and technologies.
Algurén et al. [55] (N = 89) | Goljar et al. [56] (N = 197) | Quintas et al. [57] (N = 111) | All cases (N = 397) | |
|---|---|---|---|---|
Body functions | ||||
b770 Gait pattern functions | 75.0 % | 87.8 % | nc | 83.8 % |
b760 Control of voluntary movement functions | 44.0 % | 99.5 % | nc | 82.2 % |
b420 Blood pressure functions | 76.0 % | 79.7 % | nc | 78.5 % |
b144 Memory functions | 61.0 % | 94.9 % | 62.7 % | 78.3 % |
b210 Seeing functions | 96.0 % | 67.5 % | nc | 76.4 % |
b455 Exercise tolerance functions | 94.0 % | 59.9 % | nc | 70.5 % |
b280 Sensation of pain | 35.0 % | 85.3 % | nc | 69.6 % |
b730 Muscle power functions | 61.0 % | 99.5 % | 52.7 % | 63.0 % |
b265 Touch function | – | 84.8 % | nc | 61.5 % |
b710 Mobility of joint functions | – | 88.3 % | nc | 60.8 % |
b260 Proprioceptive function | – | 68.5 % | nc | 56.5 % |
b735 Muscle tone functions | – | 77.7 % | nc | 53.5 % |
b750 Motor reflex functions | – | 54.8 % | nc | 40.9 % |
b152 Emotional functions | – | 54.3 % | nc | 37.4 % |
b620 Urination functions | – | 46.2 % | nc | 36.8 % |
b140 Attention functions | – | 41.6 % | 46.4 % | 36.1 % |
b410 Heart functions | 42.0 % | 33.0 % | nc | 35.8 % |
b130 Energy and drive functions | 65.0 % | – | nc | 34.2 % |
Body structures | ||||
s110 Structure of the brain | nc | 96.4 % | 100.0 % | 97.7 % |
s720 Structure of shoulder region | nc | 35.5 % | nc | 35.5 % |
Algurén et al. [55] (N = 89) | Goljar et al. [56] (N = 197) | Quintas et al. [57] (N = 111) | All cases (N = 397) | |
|---|---|---|---|---|
d460 Moving around in different locations | 67.0 % | 93.3 % | nc | 85.1 % |
d440 Fine hand use | 46.0 % | 99.0 % | nc | 82.5 % |
d450 Walking | 78.0 % | 92.4 % | 47.3 % | 76.6 % |
d410 Changing basic body position | 37.0 % | 86.3 % | nc | 71.0 % |
d520 Caring for body parts | 33.0 % | 85.7 % | nc | 69.3 % |
d175 Solving problems | – | 84.8 % | nc | 61.2 % |
d510 Washing oneself | – | 92.4 % | – | 60.7 % |
d540 Dressing | 33.0 % | 88.8 % | – | 59.1 % |
d415 Maintaining a body position | 36.0 % | 67.5 % | nc | 57.7 % |
d710 Basic interpersonal interactions | nc | 80.7 % | nc | 55.6 % |
d550 Eating | – | 90.6 % | – | 53.9 % |
d530 Toileting | – | 78.6 % | – | 48.4 % |
d920 Recreation and leisure | 39.0 % | 48.2 % | nc | 45.3 % |
d465 Moving around using equipment | 38.0 % | 48.2 % | nc | 45.0 % |
d330 Speaking | – | 62.4 % | – | 42.5 % |
d310 Communicating with – receiving – spoken messages | – | 56.4 % | – | 36.5 % |
d166 Reading | 34.0 % | 37.6 % | nc | 36.5 % |
Algurén et al. [55] (N = 89) | Goljar et al. [56] (N = 197) | Quintas et al. [57] (N = 111) | All cases (N = 397) | |
|---|---|---|---|---|
e110 Products or substances for personal consumption | nc | 100.0 % | nc | 100.0 % |
e120 Products and technology for personal indoor and outdoor mobility and transportation | nc | 85.3 % | nc | 85.3 % |
e310 Immediate family | nc | 72.2 % | 95.4 % | 80.6 % |
e125 Products and technology for communication | nc | 58.4 % | nc | 58.4 % |
e115 Products and technology for personal use in daily living | nc | 50.3 % | nc | 50.3 % |
e355 Health professionals | nc | – | 83.6 % | 47.0 % |
e155 Design, construction and building products and technology of buildings for private use | nc | 44.7 % | nc | 44.7 % |
ICF-based data that were herein reported show differences that are mostly due to the different kind of data set used to collect functioning and disability information. In addition, differences related to clinical and sociodemographic data also exist: for example, individuals in the study of Algurén and colleagues [55] were approximately 12–14 years older and had a higher prevalence of cerebral infarction (81 %). These differences have a clear impact on the kind and degree of impairments and limitations patients experience, as well as on the need for medical treatment, personal assistance and need for assistive devices. It is, however, problematic to define a “typical” situation of a person surviving a stroke, as the features of the stroke itself, patient’s age and distance from the acute event play a fundamental role when rehabilitation programmes need to be planned. The issue of the differences related to assessment instruments and stroke features was addressed in Sect. 10.2.2 of this chapter. As noted earlier, ICF-based data highlight the consequences of these differences because they use a common framework to address functioning and disability. If the issues related to RTW are added to the complex situation of stroke outcomes, it is clear that VR professionals need to rely on a procedure for describing functioning and disability and of the tasks related to job activities. Such a procedure enables tailored goal planning, intervention procedures and criteria to evaluate goal achievements for each patient. Informed by the biopsychosocial model, ICF-based assessment procedures enable VR professionals to synthesise the various elements connected to the patient’s health state and the requirements at both person and environmental levels needed for returning to work. Of course, it is also possible that the general health status of stroke survivors prevents them from returning to work; in this instance, the ICF provides an adequate framework that is crucial when RTW is not achievable and appropriate measures of social protection are needed.
The results of this synopsis on ICF-based data in stroke are indicative of differences that are partly connected to the settings in which the studies were carried out, but also to clinical and demographic features of participants. It is in fact problematic to define a “typical” functional status of a stroke survivor: the clinical features of stroke itself, patients’ age and distance from event are fundamental issues to plan rehabilitative interventions.
10.3.3 ICF-Based Description of Disability in Persons with Traumatic Brain Injury
TBI may cause very different kinds of impairment, depending on the site of injury and presence of polytrauma. Therefore, defining a common set of ICF categories that should be used as a “minimum” set of functioning and disability information is challenging. The ICF Core Set for TBI was released in 2013 after some years of consultation and application of the ICF in clinical settings: the Comprehensive Core Set for TBI is composed of 139 categories, while the Brief Core Set is composed of 23 categories [58].
To our knowledge, ICF-derived data to describe functioning and disability in TBI patients have been reported in four studies [59–62]. Two studies used the WHO ICF checklist and two used the TBI Core Sets. In 2007 Koskinen and colleagues [59] evaluated medical records of a sample of 55 patients in a rehabilitation setting using the ICF checklist and judged the prevalence of impairments, limitations and environmental factors as relevant when these were reported in at least 30 % of patients by two different professionals. In total, 30 ICF categories – 12 body functions, one body structure, 11 activities and participation and six environmental factors – were judged as relevant to TBI patients in a post-acute setting. Aiachini and colleagues [60] reported the result of a cross-sectional study conducted in 24 Italian centres that collected data from 261 patients, of whom half were outpatients or day clinic patients. They used the ICF checklist to which other categories were added based on linking procedures with established assessment instruments. The resulting extended checklist was composed of 150 ICF categories, including 41 body functions, 16 body structures, 59 activities and participation and 34 environmental factors. They used a threshold of 5 % to report categories as relevant to TBI patients, and all the 150 categories reached the 5 % threshold. In 2010 Svestkova and colleagues [61] collected data on 100 outpatients with sequelae of TBI using the ICF checklist and selected categories as relevant if they occurred in at least 20 % of the cases. In total, 87 ICF categories were selected: 27 body functions and structures, 43 activities and participation and 17 environmental factors. Finally, Laxe and colleagues [62] collected data with the 150-item extended checklist used by Aiachini on a sample of 103 patients – mostly outpatients – and considered as relevant those reported by at least 10 %. In total, 130 categories were retained as relevant: 34 body functions, 7 body structures, 59 activities and participation and 30 environmental factors.
Data reported in these four papers show differences related to the prevalence of impairments, difficulties and environmental factors. These differences are likely to be due to the kind of impairments patients experienced – e.g. the not specified prevalence of polytrauma – as well as to the kinds of instruments that have been used to address the dimensions of functioning and disability and to the type of patients, as those in post-acute rehabilitation have different needs and difficulties compared to those of outpatients.
Based on our inclusion criterion of 33 % described earlier, 101 ICF categories are included in the analysis. Table 10.7 reports the most common impairments in body functions and structures; there were 22 body functions and three body structures. More than half of functional impairments are related to mental functions and five are related to mobility functions. Among body structures, in addition to the brain, lower and upper extremities were found to be impaired as a consequence of polytrauma. Table 10.8 reports the most common limitations and restrictions in activities and participation. In total, 54 categories were retained as relevant, and almost all ICF domains are widely represented in the list, with the most common difficulties related to the domains of mobility, interpersonal interactions and relationships. Table 10.9 reports the most commonly reported environmental factors: in total, 22 categories were reported as relevant, mostly related to support and relationships and to service, system and policy domains.
Koskinen et al. [59] (N = 55) | Aiachini et al. [60] (N = 261) | Svestkova et al. [61] (N = 100) | Laxe et al. [62] (N = 103) | All cases (N = 519) | |
|---|---|---|---|---|---|
Body functions | |||||
b152 Emotional functions | 96.4 % | 77.8 % | 67.0 % | 79.6 % | 78.0 % |
b164 Higher-level cognitive functions | 100.0 % | 77.7 % | 49.0 % | 90.3 % | 77.0 % |
b140 Attention functions | 96.4 % | 80.5 % | 59.0 % | 72.8 % | 76.5 % |
b144 Memory functions | 100.0 % | 78.9 % | 53.0 % | 80.6 % | 76.5 % |
b130 Energy and drive functions | 85.5 % | 70.0 % | 70.0 % | 84.5 % | 74.5 % |
b730 Muscle power functions | 47.3 % | 80.8 % | 47.0 % | 68.0 % | 68.2 % |
b710 Mobility of joint functions | – | 75.0 % | 38.0 % | 56.3 % | 56.2 % |
b117 Intellectual | – | 62.5 % | 38.0 % | 84.5 % | 55.5 % |
b126 Temperament and personality functions | – | 77.4 % | – | 83.5 % | 55.5 % |
b735 Muscle tone functions | – | 65.1 % | 38.0 % | 57.3 % | 51.4 % |
b156 Perceptual functions | 36.4 % | 52.1 % | 39.0 % | 61.2 % | 49.7 % |
b167 Mental functions of language | 76.4 % | 52.7 % | – | 50.5 % | 49.0 % |
b160 Thought functions | – | 62.1 % | – | 78.6 % | 46.8 % |
b760 Control of voluntary movement functions | – | 58.8 % | – | 51.5 % | 45.6 % |
b134 Sleep functions | 72.7 % | 44.0 % | 39.0 % | – | 42.7 % |
b330 Fluency and rhythm of speech functions | – | 61.9 % | – | 53.4 % | 41.7 % |
b114 Orientation functions | – | 53.7 % | 33.0 % | 38.8 % | 41.1 % |
b210 Seeing functions | 45.5 % | 41.3 % | 51.0 % | – | 41.0 % |
b320 Articulation functions | – | 50.1 % | – | 48.5 % | 40.8 % |
b310 Voice functions | – | 50.9 % | – | 45.6 % | 39.3 % |
b280 Sensation of pain
Related posts: State of Vocational Rehabilitation and Disability Evaluation in Chronic Musculoskeletal Pain Conditions
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 Applying the ICF in Disability Evaluation: A Report Based on Clinical Experience
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 Applying the Work Rehabilitation Questionnaire WORQ: A Case Illustrating Its Use in Evaluating Functioning of a Person After a Traumatic Brain Injury in an Interprofessional Vocational Rehabilitation Setting
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