Chair for Public Health and
Health Service Research
Applying the
International Classification of
Functioning, Disability and Health
(ICF)
in Hand Therapy
Alexandra Rauch, PT, MPH
Chair for Public Health and Health Service Research
Ludwig-Maximilians-University, Munich, Germany
25.05.2013
Applying the ICF in hand therapy
• About the ICF
• Development of ICF Core Sets
• The ICF Core Sets for hand conditions –
where are we now?
• The ICF Core Sets for hand conditions –
what is next
About the ICF
Hand conditions
Injuries - Diseases
•
•
•
•
•
•
•
•
•
•
•
Wounds
Fractures
Tendon injuries
Ruptures, strains and sprains of
ligaments
Nerv injuries
Amputations
Burns
Allergies
Carpal tunnel syndromes
Complex regional pain syndrome
Rhizarthrosis
What do these diagnosis
tell us about the lived
experience of a person
living with a hand
condition?
3
About the ICF
Health Condition
(disease, trauma)
Body Functions
Body Structures
Activities
Participation
Functioning
- Disability
Environmental
Factors
Personal Factors
4
About the ICF
Flexor tendon injury
ICD 10:
S 66.1
Health
Condition
14 weeks
ago
(disease,
trauma)
• Skin damage (scar)
Body Functions
• Reduced sensitivity
•Body
Decrased Structures
muscle power
• Reduced joint movement
• Pain
• Difficulties to grab and
hold big or heavy objects
• Difficulties with moving
smallActivities
objects with fingers
• Difficulties to lift objects
• Difficulties with washing
hair and body
• Difficulties with cooking
and cleaning the house
Environmental
No assistive
devices
Support fromFactors
daughter
Physiotherapy 2/week
Not able to work as goldsmith
Difficulties
with riding a bicycle
Participation
Not able to play piano
Personal
Factors
52
years old women,
living alone
Daughter and little grandchild
Goldsmith, owner of jewelry store
5
Flexor tendon injury
ICD 10:
S 66.1
Health
Condition
14 weeks
ago
(disease,
trauma)
• Skin damage (scar)
• Reduced sensitivity
• Decrased muscle power
• Reduced joint movement
• Pain
• Difficulties to grab and
hold big or heavy objects
• Difficulties with moving
small objects with fingers
• Difficulties to lift objects
• Difficulties with washing
hair and body
• Difficulties with cooking
and cleaning the house
Environmental
No assistive
devices
Support fromFactors
daughter
Physiotherapy 2/week
Not able to work as goldsmith
Difficulties with riding a bicycle
Not able to play piano
Personal
Factors
52
years old women,
living alone
Daughter and little grandchild
Goldsmith, owner of jewelry store
6
About the ICF
Health Condition
(disease, trauma)
Body Functions
Body Structures
Functioning
Activities
Environmental
Factors
Participation
Disability
Personal Factors
7
About the ICF
Family of International Classifications (FIC)
Diseases
Functioning/Disability
Joint
use
8
About the ICF
ICD
Health condition
ICF
Body functions
Body structures
Activities
Environmental factors
Participation
Personal factors
About the ICF
The classification
Structure
ICF
Functioning and Disability
Body functions and
Structures
Contextual factors
Activities and
Participation
Environmental
factors
b1 – b8
s1 – b8
d1 – d9
e1 – e5
b110 b899
s110 s899
d110 d999
e110 e599
b1100 b7809
s1100 s8309
d1550 d9309
e1100 e5959
b11420 b51059
s11000 s76009
Personal
factors
Describing Functioning and Disability
11
About the ICF
The classification
Body structures
Body function
Activities and
Participation
Environmental
factors
Structure
Chapter 1 MENTAL functions
Chapter 2 SENSORY functions and PAIN
Chapter 3 VOICE and SPEECH functions
Chapter 4 Functions of the CARDIOVASCULAR,
HAEMATOLOGICAL, IMMUNOLOGICAL
and RESPIRATORY system
Chapter 5 Functions of the DIGESTIVE, METABOLIC
and ENDOCRINE system
Chapter 6 GENITOURINARY and REPRODUCTIVE
functions
Chapter 7 NEUROMUSCULOSKELETAL and
MOVEMENT-RELATED functions
Chapter 8 Functions of the SKIN and RELATED
STRUCTURES
About the ICF
The classification
Body structures
Body function
Activities and
Participation
Environmental
factors
Structure
Chapter 1 MENTAL functions
Chapter 2 SENSORY functions and PAIN
Chapter 3 VOICE and SPEECH functions
Chapter 4 Functions of the CARDIOVASCULAR,
HAEMATOLOGICAL, IMMUNOLOGICAL
and RESPIRATORY systems
Chapter 5 Functions of the DIGESTIVE, METABOLIC
and ENDOCRINE SYSTEMS
Chapter 6 GENITOURINARY and REPRODUCTIVE
functions
Chapter 7 NEUROMUSCULOSKELETAL and
MOVEMENT-RELATED functions
Chapter 8 Functions of the SKIN and RELATED
STRUCTURES
About the ICF
The classification
Structure
Chapter 7 NEUROMUSCULOSKELETAL and
MOVEMENT-RELATED functions
Body structures
Body function
Activities and
Participation
Environmental
factors
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
b755 Involuntary movement reaction functions
b760 Control of voluntary movement functions
b765 Involuntary movement functions
b770 Gait pattern functions
b780 Sensations related to muscles and movement
functions
About the ICF
The classification
Structure
Chapter 7 NEUROMUSCULOSKELETAL AND
MOVEMENT-RELATED functions
Body structures
Body function
b735 Muscle tone functions
Activities and
Participation
Functions related to the tension present in the resting muscles and the
resistance offered when trying to move the muscles passively.
Environmental
factors
Inclusions: functions associated with the tension of isolated muscles and
muscle groups, muscles of one limb, one side of the body and the lower half
of the body, muscles of all limbs, muscles of the trunk, and all muscles of the
body; impairments such as hypotonia, hypertonia and muscle spasticity
Exclusions: muscle power functions (b730); muscle endurance functions
(b740)
About the ICF
The classification
Structure
Chapter 7 NEUROMUSCULOSKELETAL and
MOVEMENT-RELATED functions
310
Body structures
493
Body function
384
Activities and
Participation
253
Environmental
factors
b735 Muscle tone functions
b7350 Tone of isolated muscles and muscle groups
b7351 Tone of muscles of one limb
b7352 Tone of muscles of one side of body
b7353 Tone of muscles of lower half of body
b7354 Tone of muscles of all limbs
b7355 Tone of muscles of trunk
b7356 Tone of all muscles of the body
About the ICF
The classification
Structure
specify
s730 Structure of the upper extremity
310 power
Body
structures
b730 Muscle
functions
493
Body function
d440 Fine hand functions
384
Activities and
Participation
d850 Remunerative employment
Environmental
factors
e135 Products and
technology for personal
253
use in daily life
About the ICF
The classification
ICF Qualifier
specify
evaluate
0 NO problem (none, absent, negligible,...)
(0-4%)
1 MILD problem (slight, low,...)
(5-24%)
2 MODERATE problem (medium, fair...) (25-49%)
310
Body structures
493
Body function
384
Activities and
Participation
3 SEVERE problem (high, extreme,...)
(50-95%)
253
Environmental
factors
4 COMPLETE problem (total,...)
(96-100%)
b730.3 = Severe problems in muscle power
functions
Flexor tendon injury
ICD 10:
S 66.1
Health
Condition
14 weeks
ago
(disease,
trauma)
• b820.1 Repair functions of
• the
Skinskin
damage (scar)
•• Reduced
b265.3 Touch
funtions
sensitivity
•• Decrased
b730.3 Muscle
power
muscle
power
functions
• Reduced joint movement
•• Pain
b710.3 Mobility of joint
functions
• b280.2 Sensation of pain
•• Difficulties
to grab and
d4401.3 Grasping
hold
big or heavy
objects
• d4402.3
Manipulating
•• Difficulties
with moving
d4300.2 Lifting
small
objects
with fingers
• d5100.2
Washing
body
••Difficulties
to
lift
objects
d630.1 Preparing
• Difficulties with
meals
and body
•washing
d6402.2hair
Cleaning
living
• Difficulties
with
cooking
area
and cleaning the house
• d850.4 Remunerative
Not able to work as
employment
goldsmith
• d4750.4 Driving human
Difficulties with riding a
powered transportation
bicycle
• d9202.4 Arts and culture
Not able to play piano
• e1151.4 Assistive products and
Personal Factors
Nopersonal
assistiveuse
devices
technology for
in daily living 52 years old women, living alone
Daughter and little grandchild
Support
daughter
• e310+3 Support
fromfrom
family
Goldsmith, owner of jewelry store
Physiotherapy
• e5800+1 Health
services 2/week
19
Flexor tendon injury
ICD 10: S 66.1
14 weeks ago
0
1
2
3
4
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
b820.1 Repair functions of the skin
b265.3 Touch funtions
b730.3 Muscle power functions
b710.3 Mobility of joint functions
b280.2 Sensation of pain
d4401.3 Grasping
d4402.3 Manipulating
d4300.2 Lifting
d5100.2 Washing body
d630.1 Preparing meals
d6402.2 Cleaning living area
d850.4 Remunerative employment
d4750.4 Driving human powered transportation
d9202.4 Arts and culture
e1151.4 Assistive products and technology for
personal use in daily living
• e310+3 Support from family
• e5800+1 Health services
20
About the ICF
The classification
Number of ICF categories
310
Body structures
493
Body function
384
Activities and
Participation
253
Environmental
factors
Very comprehensive
Very comprehensive
ICF Qualifier
Facilitates profiles
Reliability?
About the ICF
The classification
"To be useful, practical ICF based
tools need to be tailored to the need
of the users without forgoing the
information needed for health
statistics and health reporting“
310
Body structures
493
Body function
384
Activities and
Participation
253
Environmental
factors
Dr. Bedirhan Üstün
WHO Classification Office Director
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.
Development of ICF Core Sets
310
Body structures
493
Body function
384
Activities and
Participation
253
Environmental
factors
s110
s120
s130
s430
s510
s710
…
b110
b114
b117
b130
b152
b144
b730
...
d110
d240
d410
d415
d520
d630
d920
…
e110
e115
e120
e125
e130
e150
…
s110
s430
s710
b110
b130
b152
b730
d240
d410
d415
d920
e110
e120
e130
Comprehensive
ICF Core Set
Brief
ICF Core Set
Development of ICF Core Sets
Preliminary studies
Decision
Validation
Empirical study
(Patient data)
Qualitative study
International
ConsensusConference
(Patient interviews)
Testing &
Validation
Expert Survey
(Multiprofessional)
Systematic Review
ICF Core Sets
(Comprehensive
and Brief)
(Scientific literature)
TIME
Development of ICF Core Sets
Musculosckeletal
conditions
Neurological
conditions
Cardiopulmonary
conditions
Others
Musculoskeletal
condition in acute care
Neurological
conditions in acute
care
Cardiopulmonary
conditions in acute
care
Diabetes mellitus
Musculoskeletal
condition in early postacute care
Neurological
conditions in early
post-acute care
Cardiopulmonary
conditions in early
post-acute care
Obesity
Low back pain
Stroke
Chronic ischaemic
heart disease
Inflammatory bowel
diseases
Chronic widespread
pain
Multiple sclerosis
Obstructive
pulmonary diseases
Vertigo
Osteoarthritis
Spinal cord injury
Hearing loss
Rheumatoid arthritis
Traumatic brain injury
Cerebral palsy
Mental disorders
Sleep disorders
Ankylosing spondylitis
Osteoporosis
Depression
Hand conditions
Bipolar disorders
Amputation
Geriatric patients
Vocational
rehabilitation
The ICF Core Sets for hand conditions – where
are we now?
• Developed from
2008 to 2010
• Applicable in hand
injuries and hand
diseases
• 117 categories in the
Comprehensive ICF
Core Set
• 23 categories in the
Brief ICF Core Set
The ICF Core Sets for hand conditions – where
are we now?
Preliminary studies
Empirical study
(Patient data n=210)
Qualitative study
Decision
International
ConsensusConference
(Patient interviews n=59)
Expert Survey
(Multiprofessional n=162
Systematic Review
ICF Core Sets
(Comprehensive
and Brief)
Validation
Implementation
Validation of the
ICF Core Sets
for
Hand Conditions
in Germany
(Scientific literature)
2008/2009
05/2009
2010
2012-2015
Brief ICF Core Set for Hand conditions
Body structures
Activity and Participation
s120 Structure of the spinal cord and related
structures
d230 Carry out daily routine
s720 Structure of shoulder region
d440 Fine hand functions
s730 Structure of the upper extremity
d445 Hand and arm use
Body functions
d5 Self-care
b152 Emotional functions
d6 Domestic life
b265 Touch function
d7 Interpersonal interactions and
relationships
b270 Sensory functions related to
temperature and other stimuli
d430 Lifting and carrying objects
d840-d859 Remunerative employment
b280 Sensation of pain
b710 Mobility of joint functions
Environmental factors
b715 Stability of joint functions
e1 Products and technology
b730 Muscle power functions
e3 Support and relationships
b760 Control of voluntary movement
functions
e5 Services, systems and policies
b810 Protective functions of the skin
28
Comprehensive ICF Core Set for Hand conditions
Body structures
s120 Structure of the spinal cord and related structures
s410 Structure of cardiovascular system
s710 Structure of head and neck region
s720 Structure of shoulder region
s730 Structure of the upper extremity
s7300 Structure of upper arm
s7301 Structure of forearm
s7302 Structure of hand
s770 Additional musculoskeletal structures related to movement
s810 Structure of areas of skin
s830 Structure of nails
29
Comprehensive ICF Core Set for Hand conditions
Body functions
b134 Sleep functions
b152 Emotional functions
b1801 Body image
b260 Proprioceptive functions
b265 Touch functions
b270 Sensory functions related to temperature and other stimuli
b2700 Sensitivity to temperature
b2701 Sensitivity to vibration
b2702 Sensitivity to pressure
b2703 Sensitivity to a noxious stimulus
b280 Sensation of pain
b415 Blood vessel functions
30
Comprehensive ICF Core Set for Hand conditions
Body functions
b710 Mobility of joint functions
b7100 Mobility of a single joint
b7101 Mobility of several joints
b715 Stability of joint functions
b720 Mobility of bone functions
b730 Muscle power functions
b7300 Power of isolated muscles and muscle groups
b7301 Power of muscles of one limb
b735 Muscle tone functions
b740 Muscle endurance functions
b760 Control of voluntary movement functions
b765 Involuntary movement functions
b780 Sensations related to muscles and movement functions
31
Comprehensive ICF Core Set for Hand conditions
Body functions
b810 Protective functions of the skin
b820 Repair functions of the skin
b830 Other functions of the skin
b840 Sensations related to the skin
b860 Functions of nails
32
Comprehensive ICF Core Set for Hand conditions
Activity and Participation
d170 Writing
d230 Carry out daily routine
d360 Using communcation devices and techniques
d410 Changing basic body positions
d420 Transferring oneself
d430 Lifting and carrying objects
d440 Fine hand functions
d4400 Picking up
d4401 Grasping
d4402 Manipulating
d4403 Releasing
d4408 Fine hand use, other specified
33
Comprehensive ICF Core Set for Hand conditions
Activity and Participation
d445 Hand and arm use
d4450 Pulling
d4451 Pushing
d4452 Reaching
d4453 Turning or twisting the hands or arms
d4454 Throwing
d4455 Catching
d4458 Hand and arm use, other specified
d455 Moving around
d465 Moving around using equipment
d470 Using transportation
d475 Driving
34
Comprehensive ICF Core Set for Hand conditions
Activity and Participation
d5 Self-care
d510 Washing oneself
d520 Caring for body parts
d530 Toileting
d540 Dressing
d550 Eating
d560 Drinking
d570 Looking after one´s health
d6 Domestic life
d620 Acquisition of goods and services
d630 Preparing meals
d640 Doing housework
d650 Caring for household objects
d660 Assisting others
35
Comprehensive ICF Core Set for Hand conditions
Activity and Participation
d7 Interpersonelle Interaktionen und Beziehungen
d810 – d839 Education
d840-d859 Work and employment
d920 Recreation and leisure
36
Comprehensive ICF Core Set for Hand conditions
Environmental factors
e1 Products and technology
e110 Products or substances for personal consumption
e115 Products and technology for personal use in daily living
e120 Products and technology for personal indoor and outdoor mobility and
transportation
e125 Products and technology for communication
e130 Products and technology for education
e135 Products and technology for employment
e140 Products and technology for culture, recreation and sport
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
e165 Assets
37
Comprehensive ICF Core Set for Hand conditions
Environmental factors
e225 Climate
e3 Support and relationships
e310 Immediate family
e315 Extended family
e320 Friends
e325 Acquaintances, peers, colleagues, neighbours and community members
e330 People in positions of authority
e335 People in subordinate positions
e340 Personal care providers and personal assistants
e345 Strangers
e355 Health professionals
e360 Other professionals
38
Comprehensive ICF Core Set for Hand conditions
Environmental factors
e410 Individual attitudes of immediate family members
e420 Individual attitudes of friends
e425 Individual attitudes of acquaintances, peers, colleagues, neighbours and
community members
e430 Individual attitudes of people in positions of authority
e440 Individual attitudes of personal care providers and personal assistants
e445 Individual attitudes of strangers
e450 Individual attitudes of health professionals
e455 Individual attitudes of other professionals
e460 Societal attitudes
e465 Social norms, practices and ideologies
39
Comprehensive ICF Core Set for Hand conditions
Environmental factors
e5 Services, systems and policies
e525 Housing services, systems and policies
e530 Utilities services, systems and policies
e535 Communication services, systems and policies
e540 Transportation services, systems and policies
e550 Legal services, systems and policies
e555 Associations and organizational 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 Labour and employment services, systems and policies
40
The ICF Core Sets for hand conditions – where
are we now?
How to implement the ICF
Core Sets for hand condition
in clinical practice?
The ICF Core Sets for hand conditions – where
are we now?
ICF Core Sets - Manual for
Clinical Practice
Eds: J. Bickenbach, A. Cieza,
A. Rauch, G. Stucki
Hogrefe 2012
The ICF Core Sets for hand conditions – where
are we now?
The ICF Core Sets for hand condition
Implementation
The ICF Core Sets for hand conditions – where
are we now?
The ICF Core Sets for hand condition
Implementation
1. Select ICF categories from the ICF Core Set for hand
conditions
What to measure?
1. Select appropriate measures to assess functioning
How to measure?
1. Coordinate assessment
Who to measure?
2. Report on functioning
What to report?
The ICF Core Sets for hand conditions – where
are we now?
The ICF Core Sets for hand condition
Implementation
1. Select ICF categories from the ICF Core Set for hand
conditions
What to measure?
The ICF Core Sets for hand conditions – where
are we now?
1. Select ICF categories from the ICF Core Set for hand conditions
Use categories from the Brief ICF Core Set...
... and select additional ICF categories from the
Comprehensive ICF Core Set if necessary
The ICF Core Sets for hand conditions – where
are we now?
1. Select ICF categories from the ICF Core Set for hand conditions
Brief ICF Core Set
Comprehensive ICF Core Set
d230 Carry out daily routine
d360 Using communcation
devices and techniques
d430 Lifting and carrying objects
d440 Fine hand functions
d4400 Picking up
d4402
Manipulating
d445 Hand and arm use
d5 Self-care
d510 Washing
oneself
d540 Dressing
d6 Domestic life
d7 Interpersonal interactions and
relationships
The ICF Core Sets for hand conditions – where
are we now?
The ICF Core Sets for hand condition
Implementation
2. Select appropriate measures to assess functioning
How to measure?
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
 Patient-reported questionnaire (DASH)
 Questioning of the patient (patient history)
 Clinical examination
Observation of the patient
Standardized tests
 Technical examination (X-Ray, CT, ENG, etc.)
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
Systematic literature
review
National expert
survey
Survey DGUV
Consensus conference
ICF categories
Assessment (PRQ/PH/CE/TI)
3 Body structures
14
9 Body functions
25
8 Activities and Participation
25
3 Environmental factors
15
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
Body structures
ICF category
s120 Structure of the spinal cord and
related structures
Source
Specification
PRQ
PH
CE
TI




s720 Structure of shoulder region
s730 Structure of the upper extremity
X-Ray, CT, ENG, etc.
---




Circumferential
measure, Volumetry /
X-Ray, CT, etc.
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
s730 Structure of the upper extremity – Bones
Technical investigation
(e.g. X-Ray)
s730 Structure of the upper extremity - Swallowing
Circumferential
measure
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
Body functions
ICF category
Source
Specification
PRQ
PH
CE
TI
b152 Emotional functions




PHQ-9, GAD-7, IES-R /
Questioning
b265 Touch function




Ten-Test, Object identification (Moberg Test)
b270 Sensory functions related to
temperature and other stimuli




2-Point-Discrimination, Pinprick, Cold-WarmDiscrimination
b280 Sensation of pain








Numeric Rating Scale








Stability-Tests




Observation, Purdue
Pegboard Test
b710 Mobility of joint functions
b715 Stability of joint functions
b730 Muscle power functions
b760 Control of voluntary
movement functions
Goniometer, Finger-nailTable-Distance, FingertipPalmar-Distance
Dynamometer, Pinch gauge
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
b265 Touch functions
Object identification
(Moberg Test)
b280 Sensation of pain
NRS Scale
b730 Muscle power functions
Dynamometer
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
Activities and participation
ICF category
Source
Specification
PRQ
PH
CE
TI








Questioning
d440 Fine hand functions




DASH items 2, 3 / Pick
up Test (Moberg Test)
d445 Hand and arm use




Observation, Selected
tests from EFC
d5 Self-care









DASH items 13, 14, 15
d7 Interpersonal interactions and
relationships



d840-d859 Remunerative
employment




DASH Work module /
Work profile, EFC
d230 Carry out daily routine
d430 Lifting and carrying objects
d6 Domestic life
Observation, Selected
tests from EFC
DASH items 4, 7, 8, 9
Questioning
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
d440 Fine hand functions
Pick up test (Moberg
Test)
d445 Hand and arm use
Evaluation functional
capacity
Mild difficulty
Moderate
difficulty
Severe
difficulty
Unable
13
Wash or blow dry your hair
1
2
3
4
5
14
Wash your back
1
2
3
4
5
15
Put on a pullover sweater
1
2
3
4
5
DASH Item
DASH items
Please rate your ability to do the following activities
in the last week by circling the number below the
appropriate response.
No difficultiy
d5 Self-care
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
Environmental factors
ICF category
e1 Products and technology
e3 Support and relationships
e5 Services, systems and policies
Source
Specification
PRQ
PH
CE
TI












Questioning
Questioning
Questioning
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
2. Select appropriate measures to assess functioning
e1 Products and technology
Questioning
e3 Support and relationships
Questioning
PRQ= Patient reported questionnaire, PH=Patient history; CE=Clinical examination, TI=Technical investigation
The ICF Core Sets for hand conditions – where
are we now?
The ICF Core Sets for hand condition
3. Coordinate assessment
Who to measure?
Implementation
The ICF Core Sets for hand conditions – where
are we now?
3. Coordinate assessment
Create intervention table:
ICF category
Assessment
Responsibility
s730 Structure of the upper extremity
X-Ray
MD
b152 Emotional functions
Questioning, PRQ
MD, Psychologist
b270 Sensory functions related to
temperature and other stimuli
2-Point-Discrimination, Pin-prick,
Cold-WarmDiscrimination
MD
b710 Mobility of joint functions
Goniometer, Pinch
Gauge
PT/OT
d440 Fine hand functions
Pick up test
PT/OT
e3 Support and relationships
Questioning
MD
The ICF Core Sets for hand conditions – where
are we now?
The ICF Core Sets for hand condition
4. Report on functioning
What to report?
Implementation
The ICF Core Sets for hand conditions – where
are we now?
4. Report on functioning
The ICF Core Sets for hand conditions – where
are we now?
www.icf-casestudies.org
The ICF Core Sets for hand conditions – where
are we now?
http://www.icf-core-sets.org/index.php
The ICF Core Sets for hand conditions – what is
next?
The ICF Core Sets for hand conditions – what is
next?
Development of functioning scores
0
problem
10
20
Functioning
No
30
40
50
60
70
80
90
Disability
100
Complete
problem
Cieza A et al. The International Classification of Functioning, Disability, and Health could be used to measure
functioning. J Clin Epidemiol 2009; 62: 899-911
Grill E et al. Scales could be developed based on simple clinical ratings of ICF Core Set categories. J Clin Epidemiol
2009; 62: 891-898
The ICF Core Sets for hand conditions – what is
next?
Which ICF Categories should be included in a functioning score?
b110 Consciousness functions
b210 Seeing functions
b310 Vice functions
b410 Heart functions
b510 Ingestion functions
b610 Urinary excretory functions
b710 Mobility of joint functions
b810 Protective functions of the skin
…
Body
functions
s110 Structure of brain
s210 Structure of eye socket
s310 Structure of nose
s410 Structure of cardiovascular system
s510 Structure of salivary glands
s610 Structure of urinary system
s710 Structure of head and neck region
s810 Structure of areas of skin
…
Body
structures
d110 Watching
d210 Undertaking simple tasks
d310 Communicating with –receiving – spoken messages
d410 Changing basic body positions
d510 Washing oneself
d610 Acquiring a place to live
d710 Basic interpersonal interactions
d810 Informal education
…
Activity & Participation
 Method
The ICF Core Sets for hand conditions – what is
next?
Method: Identify ICF categories that explain functioning!
Example: What explains functioning in persons with spinal cord injury
Example: d525 Defecation functions
= good fitting
The ICF Core Sets for hand conditions – what is
next?
Method: Identify ICF categories that explain functioning!
Example: What explains functioning in persons with spinal cord injury
Example: d550 Eating
= poor fitting
The ICF Core Sets for hand conditions – what is
next?
Functioning score
0
10
20
30
40
50
60
Disability
70
80
90
100
Cieza A et al. The International Classification of Functioning, Disability, and Health could be used to measure
functioning. J Clin Epidemiol 2009; 62: 899-911
The ICF Core Sets for hand conditions – what is
next?
„Translate“ assessment results
0
0
10
1
20
30
40
2
50
60
70
3
80
90
100
4
The ICF Core Sets for hand conditions – what is
next?
0
NO problem (none, absent, negligible,...)
1 (5-24%)
MILD problem (slight, low,...)
2 (25-49%)
MODERATE problem (medium, fair...)
3 (50-95%)
SEVERE problem (high, extreme,...)
4 (96-100%)
COMPLETE problem (total,...)
10
0 (0-4%)
20
30
40
50
60
70
80
90
100
Cieza A et al. Items from patient-oriented instruments can be integrated into interval scales to operationalize
categories of the ICF . J Clin Epidemiol 2009; 62: 912-921
The ICF Core Sets for hand conditions – what is
next?
Which ICF Categories should be included in a disability score?
b110 Consciousness functions
b210 Seeing functions
b310 Vice functions
b410 Heart functions
b510 Ingestion functions
b610 Urinary excretory functions
b710 Mobility of joint functions
b810 Protective functions of the skin
…
Body
functions
s110 Structure of brain
s210 Structure of eye socket
s310 Structure of nose
s410 Structure of cardiovascular system
s510 Structure of salivary glands
s610 Structure of urinary system
s710 Structure of head and neck region
s810 Structure of areas of skin
…
Body
structures
d110 Watching
d210 Undertaking simple tasks
d310 Communicating with –receiving – spoken messages
d410 Changing basic body positions
d510 Washing oneself
d610 Acquiring a place to live
d710 Basic interpersonal interactions
d810 Informal education
…
Activity & Participation
 Purpose driven:
Ministry level
Service provision level
Professional level
Flexor tendon injury
ICD 10: S 66.1
14 weeks ago
0
1
2
3
4
•b265.3 Touch funtions
• b730.3 Muscle power functions
• b710.3 Mobility of joint functions
• b280.2 Sensation of pain
• d440.3 Fine hand function
• d4300.2 Hand and arm use
• d630.1 Preparing meals
• d850.4 Remunerative employment
• d4750.4 Driving human powered transportation
0
10
20
30
40
50
60
Functioning
70
80
90
100
79
The ICF Core Sets for hand conditions – what is
next?
Service provision level
Purpose:
b110 Consciousness functions
b210 Seeing functions
b310 Vice functions
b410 Heart functions
b510 Ingestion functions
b610 Urinary excretory functions
b710 Mobility of joint functions
b810 Protective functions of the skin
…
Body functions
s110 Structure of brain
s210 Structure of eye socket
s310 Structure of nose
s410 Structure of cardiovascular system
s510 Structure of salivary glands
s610 Structure of urinary system
s710 Structure of head and neck region
s810 Structure of areas of skin
…
Body structures
d110 Watching
d210 Undertaking simple tasks
d310 Communicating with –receiving – spoken messages
d410 Changing basic body positions
d510 Washing oneself
d610 Acquiring a place to live
d710 Basic interpersonal interactions
d810 Informal education
…
Activity & Participation
To monitor service provision
 Health condition specific
 Selection from health
condition specific ICF Core Sets
Flexor tendon injury
ICD 10: S 66.1
14 weeks ago
0
•
•
•
•
•
•
•
•
•
•
•
1
2
3
4
b820.1 Repair functions of the skin
b265.3 Touch funtions
b730.3 Muscle power functions
b710.3 Mobility of joint functions
b280.2 Sensation of pain
0
10
0
10
20
30
40
50
60
70
80
90
100
20
30
40
50
60
70
80
90
100
Body functions and structures
d4401.3 Grasping
d4402.3 Manipulating
d4300.2 Lifting
d5100.2 Washing body
d630.1 Preparing meals
d6402.2 Cleaning living area
• d850.4 Remunerative employment
• d4750.4 Driving human powered transportation
• d9202.4 Arts and culture
Activities and Participation
81
The ICF Core Sets for hand conditions – what is
next?
Professional level
Purpose:
Body
functions
Body
structures
Mobility
Body
functions
Body
structures
Body
functions
Activity & Participation
Body
structures
Employment
To measure functioning in
relation to intervention
goals
Activity & Participation
Self-care
 Health condition specific
Activity & Participation
Body
functions
Body
structures
Social life
Activity & Participation
Body
functions
Body
structures
Education
Activity & Participation
 From health condition
specific ICF Core Sets
Thank you very much for your attention!
alexandra.rauch@med.uni-muenchen.de