Zhang, Tong, PhDa,*; Liu, Lixu, PhDa; Xie, Rong, MDb; Peng, Ying, PhDc; Wang, Huifang, MDd; Chen, Zhuoming, PhDe; Wu, Shizheng, MDf; Ni, Chaomin, MDg; Zheng, Jiejiao, MDh; Li, Xueping, PhDi; Liu, Heyu, MDj; Xu, Guangxu, MDi; Fan, Jianzhong, PhDk; Zhu, Yuhong, PhDl; Zhang, Fang, MDm; Du, Yanhui, MDn; Wang, Xin, PhDo; Wang, Yulong, MDp; Xiao, Weimin, MDq; Liu, Ming, PhDr; Mou, Xiang, PhDs; Zhao, Jun, PhDa; Song, Luping, PhDa; Li, Bingjie, PhDa
Section Editor(s): Ling., Hua
doi: 10.1097/MD.0000000000012802
Research Article: Observational Study
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.
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.
