A185 icf, rehabilitation, health system, health policy and outcome measurement

1. ICF Clinical Data Collection
Tool: What to Report
Stucki G, Gutenbrunner C, Giustini A,
on behalf of the international effort under an activity
in the ISPRM-WHO’s Collaboration Plan, spearheaded by the
Chinese Association of Rehabilitation Medicine (CARM),
the Italian Society of Physical Medicine and Rehabilitation (SIMFER),
and the UEMS-PRM Section, and coordinated by the
ICF Research Branch at Swiss Paraplegic Research

2. • WHO´s paradigm shift and the ICF
– A unique opportunity to strengthen
Rehabilitation and PRM
• ICF  the reference system for describing,
understanding and influencing health
– Thanks to tools that have been developed, the
ICF is now ready for implementation
• System-wide implementation of the ICF
– A call for action to all national societies!

3. WHO’s Mandate
Normative, aspirational
“…health is a state of complete
physical, mental and social well-being
and not merely the absence of disease
or infirmity…”
Preamble to the Constitution of the World Health Organization April 1948.
The Definition has not been amended since 1948

4. WHO’s Paradigm Shift
• Traditional focus
–compression of morbidity
• “absence of disease or infirmity”
• New focus
–optimal functioning
• “complete physical, mental and
social well-being”

5. With the new ICF-lens we can now study
how to describe, understand and influence
1. the lived experience of health and its determinants
2. the social translation of biological health into lived health
3. The response by the society to functioning needs

6. Declaration of Alma-Ata
Expresses the need for urgent action
by all governments, all health and
development workers, and the world
community to protect and promote
the health of all the people of the world
by year 2000.
By ‘…address[ing] the main health
problems in the community, providing
promotive, preventive, curative and
rehabilitative services accordingly…’
http://www.who.int/publications/almaata_declaration_en.pdf
Rethinking the Health Strategies
in light of the ICF

7. Rethinking the Health Strategies
in light of ICF
Strategy Health Goal Indicator Classification
Preventive Disease prevention Morbidity ICD
Promotive Opt. biological health ICF-Capacity ICF
Curative Disease control Mortality ICD
ICF Capacity ICF
Rehabilitative Optimal functioning ICF Capacity & Performance ICF
Supportive Optimal lived health ICF Performance ICF
Palliative Well-being Quality of Life ?
Stucki G. The Olle Höök Lectureship 2015: WHO’s Paradigm Shift and the Implementation of the ICF in Rehabilitation. J
Rehab Med 2016; 48:486-493.

8. 21th Century - the Rehabilitative Strategy
The goal  Optimal functioning
Health Strategies
 a historical perspective

9. 2001
World Health
Assembly endorses
the International
Classification of
Functioning,
Disability and Health
(ICF)
2011
World Report
on Disability
(WRD)
2013
International
Perspectives on
Spinal Cord Injury
(IPSCI)
2014
Global Disability
Action Plan
2014–2021: Better
health for all people
with disability
(GDAP)
2015
Learning Health
System for Spinal
Cord Injury
and
International SCI
Survey (INSCI)
2006, Convention on the Rights of Persons with Disabilities (CRPD)
WHO Taking Action

10. PRM
The Medicine of Functioning

11. Functioning Properties
A first step to introduce ICD users
to functioning  as an essential
component of health
Functioning Properties
can inform the diagnosis
and trigger a more
comprehensive
assessment of functioning
 assessment
__________
__________
__________
Physician‘s
diagnosis
PT assessment
__________
__________
__________
Additional
Tests

12. Rehabilitation has the aim of
supporting peoples’
independent living and their
autonomy and takes a holistic
approach to facilitate this.”
(White Book – UEMS-PRM)
Section of Physical and Rehabilitation Medicine Union Européenne des Médecins Spécialistes (UEMS); European
Board of Physical and Rehabilitation Medicine; Académie Européenne de Médecine de Réadaptation; European
Society for Physical and Rehabilitation Medicine. White book on physical and rehabilitation medicine in Europe.
Eura Medicophys. 2006; 42(4): 292-332.

13. Objective 2
To strengthen and extend rehabilitation,
habilitation, assistive technology,
assistance and support services, and
community-based rehabilitation
Objective 3
To strengthen collection of relevant and
internationally comparable data on
disability and support research on
disability and related services2
World Health Organization. WHO Global Disability Action Plan 2014-2021: Better health for all people with
disability. Sixty-seventh World Health Assembly 4 April 2014: World Health Organization; 2014
Available from: http://www.who.int/disabilities/actionplan/en/

14. WHO-ISPRM Collaboration Plan
for 2015-2017
World Health Organization (WHO) & International Society of Physical and Rehabilitation Medicine (ISPRM). WHO-
ISPM Collaboration Plan 2015-2017. Unpublished document. 2015.

15. ICF the reference system
for describing, understanding and influencing functioning
15

16. Functioning Diagnosis
1. What to document, for Whom and When
– Clinical Assessment Schedule
2. How to assess
– ICF-based Data Collection Tools
3. How to report
– Raw Data
– Interval Scale Metric

17. Clinical Assessment Schedule
• Option 1 – “From the shelf”
– Select a Model Rehabilitation Service
• developed by the UEMS PRM Section and Board
• includes a Model Clinical Assessment Schedule

18. Clinical Assessment Schedule
• Option 2 – “Custom-made”
– Describe your Rehabilitation Service
• Characterize your Patient Population(s)
• Specify the Time Point(s) for assessment
• Select relevant Brief ICF Core Sets
– for each Time Point and Patient Population
– recommend including the ICF Generic Set (7 Categories)
– add ICF Categories from Comprehensive ICF Core Sets

19. 4 Steps for the Standardized Description of
Functioning based on the ICF
1. What ICF domains to document
• ICF Generic Set and ICF Rehabilitation Set
• ICF Core Sets for specific health conditions
2. What perspective to choose?
• Capacity or Performance
3. What data collection tools to apply
• Current health status instruments
• ICF-based data collection tools
4. What approach to use for reporting
• Transformation into a common metric
• Specific approach for a data collection tool

20. German Italian Spanish
ICF Core Sets
Chinese Japanese Korean
English
WHO
http://www.who.int/classifications/icf/en/
ICF Research Branch
http://www.icf-research-branch.org/
Endorsed by
ISPRM 2009

21. “The ICF serves as practical lens through which we can observe the lived
experience of health in a way that is meaningful and useful to
practitioners who aim to optimize functioning of individual patients,
policy-makers who aim to shape the health system in response to
persons’ functioning needs, and researchers who aim to explain and
influence functioning.”
Minimum standard for collecting
data on functioning
Stucki G. Olle Höök lectureship 2015: The World Health Organization's paradigm shift and implementation of the ICF in
rehabilitation. J Rehabil Med. 2016; 48: 486-493.
Cieza A, Oberhauser C, Bickenbach J, Chatterji S, Stucki G. Towards a minimal generic set of domains of functioning and
health. BMC Public Health. 2014;14(1):218.

22. ICF Rehabilitation Set
9 categories from Body Functions
b130 Energy and drive functions (G)
b134 Sleep functions
b152 Emotional functions (G)
b280 Sensation of pain (G)
b455 Exercise tolerance functions
b620 Urination functions
b640 Sexual functions
b710 Mobility of joint functions
b730 Muscle power functions
21 categories from Activities & Participation
d230 Carrying out daily routine (G)
d240 Handling stress and other psychological
demands
d410 Changing basic body position
d415 Maintaining a body position
d420 Transferring oneself
d450 Walking (G)
d455 Moving around (G)
d465 Moving around using equipment
d470 Using transportation
d510 Washing oneself
d520 Caring for body parts
d530 Toileting
d540 Dressing
d550 Eating
d570 Looking after one's health
d640 Doing housework
d660 Assisting others
d710 Basic interpersonal interactions
d770 Intimate relationships
d850 Remunerative employment (G)
d920 Recreation and leisure
Minimal Set of Environmental
Factors
Can be used to complement the
ICF Generic and Rehabilitation
Sets
Prodinger B, Cieza A, Oberhauser C, Bickenbach J, TB Üstün, Chatterji S, Stucki G: Toward the ICF Rehabilitation
Set: A minimal generic set of domains for rehabilitation as a health strategy. Archives of Physical Medicine and
Rehabilitation 2016; 97(6): 875-884.

23. Simple, Intuitive Description
Selb M, Gimigliano F, Prodinger B, Stucki G, Pestelli G, Iocco M, Boldrini B. Toward an International Classification of
Functioning, Disability and Health clinical data collection tool: The Italian experience of developing simple, intuitive
descriptions of the Rehabilitation Set categories. Manuscript submitted for publication.
ICF Research Branch, Chinese Association of Rehabilitation Medicine, Nanjing Medical University, First Affiliated Hospital
of Nanjing of Nanjing Medical University. Assessing functioning in routine clinical practice. Manual on applying the ICF
Generic Set in practical assessments. Manual in development; 2016.

24. Simple, intuitive descriptions can be used
together with a Numeric Rating Scale (NRS)
in routine clinical practice
Assessing Functioning in
Routine Clinical Practice

25. ICF-based reporting of data
collected with various instruments
on a common metric
Mobility items
No problem Complete problem
No problem Complete problem
Self-Care items

26. “Having functioning information available in a systematic
way will ensure that this information is available to all
stakeholders in the health system, who can, in turn, use it
to inform their decision-making at the clinical as well as
management level, and ultimately contribute to optimizing
the quality of care.”
National Rehabilitation
Quality Management (NRQM)
Systems
Prodinger B, Reinhardt J, Selb M, Stucki G, Yan T, Zhang X, Li J. Toward the system-wide implementation of the
ICF in routine practice: Developing simple, intuitive descriptions of ICF categories in the ICF Generic and
Rehabilitation Set. J Rehabil Med. 2016; 48(6): 508-514.

27. System-wide Implementation of the ICF
Call to all National societies
to join the efforts of ISPRM and WHO

28. 1. Section of Physical and Rehabilitation Medicine Union Européenne des Médecins Spécialistes (UEMS); European Board of
Physical and Rehabilitation Medicine; Académie Européenne de Médecine de Réadaptation; European Society for Physical
and Rehabilitation Medicine. White book on physical and rehabilitation medicine in Europe. Eura Medicophys. 2006; 42(4):
292-332.
2. World Health Organization. WHO Global Disability Action Plan 2014-2021: Better health for all people with disability. Sixty-
seventh World Health Assembly 4 April 2014: World Health Organization; 2014; Available from:
http://www.who.int/disabilities/actionplan/en/
3. World Health Organization (WHO) & International Society of Physical and Rehabilitation Medicine (ISPRM). WHO-ISPM
Collaboration Plan 2015-2017. Unpublished document. 2015.
4. Stucki G. Olle Höök lectureship 2015: The World Health Organization's paradigm shift and implementation of the ICF in
rehabilitation. J Rehabil Med. 2016; 48: 486-493.
5. Cieza A, Oberhauser C, Bickenbach J, Chatterji S, Stucki G. Towards a minimal generic set of domains of functioning and
health. BMC Public Health. 2014;14(1):218.
6. Prodinger B, Cieza A, Oberhauser C, Bickenbach J, TB Üstün, Chatterji S, Stucki G: Toward the ICF Rehabilitation Set: A
minimal generic set of domains for rehabilitation as a health strategy. Archives of Physical Medicine and Rehabilitation 2016;
97(6): 875-884.
7. Prodinger B, Reinhardt J, Selb M, Stucki G, Yan T, Zhang X, Li J. Toward the system-wide implementation of the ICF in routine
practice: Developing simple, intuitive descriptions of ICF categories in the ICF Generic and Rehabilitation Set. J Rehabil Med.
2016; 48(6): 508-514.
8. Selb M, Gimigliano F, Prodinger B, Stucki G, Pestelli G, Iocco M, Boldrini B. Toward an International Classification of
Functioning, Disability and Health clinical data collection tool: The Italian experience of developing simple, intuitive
descriptions of the Rehabilitation Set categories. Manuscript submitted for publication.
9. ICF Research Branch, Chinese Association of Rehabilitation Medicine, Nanjing Medical University, First Affiliated Hospital of
Nanjing of Nanjing Medical University. Assessing functioning in routine clinical practice. Manual on applying the ICF Generic
Set in practical assessments. Manual in development; 2016.