Value of using the international classification of functioning, disability, and health for stroke rehabilitation assessment: A multicenter clinical study

I can see NO value from this piece of research. It contains nothing that even suggests that use of it will direct survivors to correct protocols for rehab.  Assessment to me is you don't know jackshit about recovery for stroke but you needed to do some useless piece of research anyway. And look at all these MDs and PhDs behind this, being book trained doesn't mean you are smart or know what the hell you are doing. 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

Value of using the international classification of functioning, disability, and health for stroke rehabilitation assessment: A multicenter clinical study

Zhang, Tong, PhD^a,*; Liu, Lixu, PhD^a; Xie, Rong, MD^b; Peng, Ying, PhD^c; Wang, Huifang, MD^d; Chen, Zhuoming, PhD^e; Wu, Shizheng, MD^f; Ni, Chaomin, MD^g; Zheng, Jiejiao, MD^h; Li, Xueping, PhDⁱ; Liu, Heyu, MD^j; Xu, Guangxu, MDⁱ; Fan, Jianzhong, PhD^k; Zhu, Yuhong, PhD^l; Zhang, Fang, MD^m; Du, Yanhui, MDⁿ; Wang, Xin, PhD^o; Wang, Yulong, MD^p; Xiao, Weimin, MD^q; Liu, Ming, PhD^r; Mou, Xiang, PhD^s; Zhao, Jun, PhD^a; Song, Luping, PhD^a; Li, Bingjie, PhD^a

Section Editor(s): Ling., Hua

Medicine: October 2018 - Volume 97 - Issue 42 - p e12802

doi: 10.1097/MD.0000000000012802

Research Article: Observational Study

• Abstract
• Author Information
• Article Outline
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This study aimed to evaluate the efficiency of the International Classification of Functioning, Disability, and Health (ICF) in stroke rehabilitation assessment in China and to identify correlations between the ICF and several commonly used clinical assessment instruments for stroke.
In total, 52 hospitals and 5 premier rehabilitation and neurology research centers participated in this cross-sectional multicenter clinical study. A total of 2822 stroke patients admitted to a neurology or rehabilitation department of a participating medical center between July 2012 and June 2014 were included. The ICF checklist contains 4 parts with 128 two-level items: body functions, body structures, activities and participation, and environmental factors. We analyzed the results of ICF assessments and determined whether correlations existed between the various items of the ICF and several commonly used clinical assessment instruments.
In all but 3 instances, the scores for the ICF-b-body function, ICF-s-body structure-degree of impairment, ICF-s-body structure-impairment location, ICF-d-activity performance, ICF-d-ability performance, ICF-e-facilitator, and ICF-e-barrier correlated significantly (P < .05) with the scores for the commonly used clinical assessment instruments.
The ICF checklist is a new rehabilitation assessment instrument that is compatible with commonly used clinical assessment scales for stroke and can be used in combination with these scales.

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1 Introduction

The rehabilitation of patients with stroke is one of the most effective methods for reducing disability. Successful rehabilitation of stroke patients is particularly important because stroke is common globally (e.g., about 2 million people have stroke every year in China), and is one of the leading causes of disability-adjusted life years in both developed and developing countries.^[1,2] Typically during rehabilitation, the assessment of functional status is performed by a number of different observers with various points of view.^[3] It is important that the assessment of stroke recovery not only be limited to nervous system symptoms and functional outcome, but also encompass psychological, physiological, and social function. A “biopsychosocial” model of this type is being increasingly applied in clinical medicine and research, especially in the field of rehabilitation medicine. Disability according to the biopsychosocial approach is defined in terms of conflict between a patient's health status and needs of the patient's daily life.^[4] A broad-based recovery assessment of stroke patients should be performed to better formulate individualized stroke recovery treatment plans that can ease the level of disability and enhance quality of life. Various clinical and laboratory variables are also used to predict disability and functioning outcomes in stroke patients, including blood pressure measurements at admission, plasma total cholesterol levels, lower Charlson index scores, frequency of CD4 and CD28 cells as severity markers, and pretreatment with ACE inhibitors, calcium channel blockers, or antiplatelet drugs. Results of such variables may be used in conjunction with stroke scale scores to identify stroke subtypes.^[5,6]

The International Classification of Functioning, Disability and Health (ICF) is a global, general purpose instrument that is the framework used by the World Health Organization (WHO) to gauge health at the individual and group levels.^[7] It is especially noteworthy that the ICF can assess how health conditions can hamper or promote real-life situations in patients’ living environments. In the ICF model, functionality includes the interaction of body structure and function, activity, and participation.^[2] Both personal and environmental factors can act to facilitate or inhibit performance in daily activities and participation in the various aspects of daily life.^[2]

The ICF uses an alphanumeric coding system, which provides a framework to code a wide range of information about health, and uses a standardized common language permitting communication about health and health care across the world in various disciplines and sciences.^[8] Accordingly, the ICF is intended to be used to provide a unified and standard language and framework for the description of health and health-related states. Both a Comprehensive ICF Core Set and a Brief ICF Core Set are available.^[8,9]

Studies of the ICF have been carried out in some countries and the results have indicated that this classification system may be useful to assess disability and functional status.^[10,11] However, no studies of the ICF have been conducted using a large sample. Therefore, we planned to establish a large-sample, multicenter ICF database for stroke, and then evaluate the status of patients with regard to their function, structure, activities, participation, and environmental factors. Our goal for this study was to evaluate the efficiency of the ICF in stroke rehabilitation assessment and identify correlations between the ICF and several commonly used clinical assessment instruments for stroke. We hope that using the ICF will allow patients to be evaluated more globally and efficiently, which may help to strengthen the applicability of rehabilitation and improve outcomes and quality of life.

Much more at link.