Linking the Spinal Function Sort and Functional Capacity Evaluation Tests to the International Classification of Functioning, Disability and Health Core Set of Vocational Rehabilitation.

Purpose The International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for Vocational Rehabilitation (CSVR) is a shortlist of functioning domains developed for use with people of working age that experience limitation in their work-related functional capacity. Functional capacity can be measured by, for example, Spinal Function Sort pictorial questionnaire and Functional Capacity Evaluation tests such as the: Complete Minnesota Dexterity Test, grip strength test, pushing, pulling, progressive iso-inertial lifting and carrying. However, these tests have not yet been linked to the CSVR. The objective of this study was to evaluate the extent to which the Spinal Function Sort and Functional Capacity Evaluation tests could be mapped to the ICF categories of the CSVR. Methods Two raters independently performed the linking of the Spinal Function Sort and the Functional Capacity Evaluation related tests to the CSVR according to established ICF linking rules. If an item could not accurately be linked to a CSVR category, the item was linked to the most fitting ICF category. Disagreements were resolved in a consensus meeting. Interrater agreement between raters was expressed in percentage agreement. Results The Spinal Function Sort and Functional Capacity Evaluation tests described a total of 39 unique ICF categories, out of which only six (15%) came from the CSVR. Interrater agreement ranged between 17 and 91%. Conclusions The study found six categories including vestibular functions, muscle power functions, writing, lifting and carrying objects, fine hand use and hand and arm use within the CSVR using the Spinal Function Sort and The Complete Minnesota Dexterity Test. With the rest of the items, the CSVR was considered too broad.

International Classification of Functioning, Disability and Health in Vocational Rehabilitation: A Scoping Review of the State of the Field.

Purpose The purposes of this study were to provide an outline of the existing literature on operationalization of the International Classification of Functioning, Disability and Health (ICF) within vocational rehabilitation (VR) and to explore the ICF utility within VR. Methods The process was undertaken in five stages according to a framework of scoping review. Screening and extraction of data were done by two independent reviewers, and data was summarized according to content analysis. Results Fifty papers (25 qualitative and 25 quantitative) were included. The operationalization of the ICF was described in four different ways: In total 18 (36%) papers described use of the ICF for structuring information, 8 (15%) for linking information to ICF, 12 (24%) for analysis of results, and 12 (24%) for development of a model. In total 15 (29%) papers described VR interventions involving stakeholders, whereas 32 (62%) were reviews. Forty of the papers described all the ICF components. Conclusions The review revealed use of the ICF within the field VR in 50 papers, and in various settings. The ICF framework was most often operationalized for structuring or linking information of functioning. A majority of papers were reviews and involved researchers only, whereas different stakeholders and VR professionals were involved in the interventions. In 40 papers all the ICF components were described, and the ICF was considered a useful tool to inform the VR professionals´ assessment of functioning. However, more research within VR is needed to standardize and ease the use of the ICF.

A descriptive study on the functioning profile of patients with spinal cord injury in a rehabilitation center in Russia.

STUDY DESIGN: This is a cross-sectional study. OBJECTIVES: (1) To use the International Classification of Functioning, Disability and Health (ICF) profile to assess the functioning of patients with spinal cord injury (SCI) admitted to a rehabilitation center; (2) To determine the role of the ICF in the operation of a rehabilitation center in Russia. SETTING: This study was conducted in the Federal center for disability rehabilitation in Novokuznetsk, Russia. METHODS: Eighty-one patients with SCI (59 men and 22 women; 31 with cervical, 41 with thoracic and 9 with lumbar level of injury) were included in the study. We determined the odds ratios of more pronounced impairments in ICF categories according to the duration of SCI and degree of neurological deficit. RESULTS: Mean age of patients was 34.9±11.1 years, men/women ratio was 2.7:1 and the median of time from injury was 2.5 (1.5-6) years. On the basis of American Spinal Injury Association Impairment Scale (AIS), most patients had AIS A (N=31, 38.3%). Patients with tetraplegia and AIS A or AIS B were at risk for more significant impairments in b620 'urination functions' and b640 'sexual functions'. Patients with paraplegia and AIS A or AIS B were at risk for more significant impairments in b735 'muscle tone functions'. CONCLUSION: Using the ICF, we were able to describe the range and extent of functioning problems experienced by patients with SCI who were admitted in our rehabilitation center. Moreover, the use of the ICF improved the interaction between specialists.

The association between chronological age, age at injury and employment: Is there a mediating effect of secondary health conditions?

STUDY DESIGN: Cross-sectional observational study with data from the 2012 community-based survey of the Swiss Spinal Cord Injury Cohort Study. OBJECTIVES: To examine the relationships between chronological age, age at injury, secondary health conditions (SHCs) and paid employment. SETTING: Community setting in Switzerland. METHODS: A total of 1159 individuals of working age (16-63 years for women and 64 years for men) with traumatic or non-traumatic spinal cord injury (SCI) were included in the study. Direct and indirect (via SHCs) effects of chronological age and age at injury on paid employment were tested using a decomposition method for logistic regression models. RESULTS: Both chronological age groups (age 35-49 and 50-63/64 years) and the group with age at injury beyond 40 years showed negative direct effects on employment status. A partial indirect effect (mediation) via chronic pain was found in the group with the highest chronological age (>50 years). Furthermore, pressure ulcer, pain and urinary tract infection were negatively related with employment in both models, that is, chronological age and employment and age at injury and employment. CONCLUSION: Being older and having a higher age at injury directly affects whether an individual is employed. Pain is mediating the relation between chronological age and employment. Furthermore, pressure ulcer, chronic pain and urinary tract infection directly reduce the likelihood to be employed and, therefore, represent important intervention targets in efforts to maintain or engage in employment of individuals with SCI.

A guide on how to develop an International Classification of Functioning, Disability and Health Core Set.

International Classification of Functioning, Disability and Health (ICF) Core Sets are purpose-tailored shortlists of ICF categories from the whole ICF classification for describing functioning and disability. Although the 34 ICF Core Sets developed up to now already cover many health conditions, there may still be a need to develop additional ICF Core Sets that tackle other health conditions and address other purposes. This paper provides a detailed description of the standard process for developing ICF Core Sets that will serve as a guide for future ICF Core Set development projects. ICF Core Sets are developed by means of a three-phase, multi-method scientific process. The process involves four preparatory studies - an empirical multicentre study, a systematic literature review, a qualitative study and an expert survey. The results of the preparatory studies serve as the starting point for a structured decision-making and consensus process at an international conference, during which participating experts decide on the ICF categories to be included in the Comprehensive and Brief ICF Core Sets. The first version of the ICF Core Set may necessitate modifications for specific applications and implementation in specific settings.

Interventions for improving employment outcomes among individuals with spinal cord injury: a systematic review.

STUDY DESIGN: Systematic literature review. OBJECTIVE: The primary aim of this study was to evaluate interventions aimed at improving employment outcomes for individuals with spinal cord injuries (SCI). METHODS: An electronic search of Medline/PubMed, EMBASE, Cochrane database, CINAHL, PsycINFO, Social Science Abstracts and Social Work Abstract databases was performed on 31 December 2013. To be included in the review, studies needed to investigate interventions among individuals with SCI where employment was an outcome. Exclusion criteria include (i) reviews, (ii) studies not published in English and (iii) non-peer reviewed publications. RESULTS: Fourteen studies met the inclusion criteria, two were randomized controlled trials. The strongest evidence finds that supported employment can improve employment outcomes among individuals with SCI. The use of service dogs has also been shown to improve employment outcomes. The remaining 12 studies are observational and predominantly focus on vocational rehabilitation programs. CONCLUSION: There is a dearth of high-quality intervention research that targets employment outcomes in individuals with SCI. Consequently, conclusions are mostly based on evidence from observational studies. Vocational rehabilitation programs are the primary focus of this evidence, but conclusions may be confounded, as individuals may be self-selecting for these programs. Additional randomized trials on employment interventions are needed to overcome these limitations. Studies should aim to identify which components of these programs have the greatest influence on employment outcomes.

Assessment of health-related quality of life of clients in vocational rehabilitation: association with depressive symptoms and type of services.

BACKGROUND: Health-related quality of life (HRQOL) has been frequently used as an outcome measure in disability-related studies, yet little is known about HRQOL in vocational rehabilitation (VR). AIM: To evaluate HRQOL in VR clients and identify factors associated with their HRQOL DESIGN, SETTING AND POPULATION: Cross-sectional study of 149 clients from 5 VR centers in Switzerland and Germany METHODS: HRQOL was measured by 8 dimensions of the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and compared with sex-matched German population norms. Multiple regression analyses were conducted to identify whether VR-related variables (VR duration and type, sick leave duration) and depressive symptoms were associated with HRQOL dimensions independent of sociodemographics (age, sex, education) and clinical characteristics (type of disorders, number of comorbidities) RESULTS: HRQOL in VR clients was significantly lower in all dimensions measured by the SF-36 compared to the general population. Returning to the former workplace and being oriented to a new job were associated with less functional limitation due to physical problems, less pain and better mental health. Being oriented to a new job was also associated with better vitality. Presence of depressive symptoms was negatively related with all dimensions of HRQOL. Overall, the regression models explained 10%-25% variance of the physical HRQOL domain and 18%-27% variance of the mental HRQOL domain. CONCLUSION: Multiple dimensions of HRQOL were significantly decreased in VR clients. Depressive symptoms were prevalent and contributed significantly to poorer HRQOL, thus should be considered in the VR process. Further research is needed to ascertain the effect of different VR types to HRQOL and to elaborate the role of depressive symptoms in HRQOL over time. CLINICAL REHABILITATION IMPACT: Rehabilitation professionals should be informed of the level of HRQOL in VR clients in order to tailor effective interventions to improve HRQOL by not only focusing on functional ability but also the psychological well-being.

Content validity of the work rehabilitation questionnaire-self-report version WORQ-SELF in a subgroup of spinal cord injury patients.

STUDY DESIGN: Mixed methods study design. OBJECTIVES: The Work Rehabilitation Questionnaire-Self-Report Version (WORQ-SELF) is an assessment tool based on the International Classification of Functioning, Disability and Health (ICF) developed to evaluate functioning in different patient populations in vocational rehabilitation (VR) settings. The objective of this study is to establish the content validity of WORQ-SELF in a subgroup of spinal cord injury (SCI) patients in the early post-acute context. SETTING: Swiss Paraplegic Research and Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Contents of WORQ-SELF were compared with semi-guided interviews with SCI patients in Switzerland, the Comprehensive ICF Core Set for SCI early post-acute, and outcome instruments used in VR and SCI. A frequency analysis was performed. RESULTS: WORQ-SELF represented 46 different ICF categories and of these 37 categories were confirmed by the patient interviews. The Comprehensive ICF Core Set for SCI confirmed 25 categories. Four instruments used in VR and SCI setting were identified. Contents of those instruments confirmed 14 categories of WORQ-SELF. Overall, 26 categories of the WORQ-SELF were confirmed by at least 2 of the 3 sources, 13 categories by 1 source and 7 were not confirmed by any of the sources. CONCLUSION: The WORQ-SELF proved to have content validity for utility in patients with SCI within the context of VR. WORQ-SELF can be used to assess the functioning and disability of patients in the return to work process.

Need for a comprehensive epidemiologic study of spinal cord injury in Poland: findings from a systematic review.

STUDY DESIGN: Systematic literature review OBJECTIVE: To review and assess the quality of available epidemiologic data of spinal cord injury (SCI) in Poland in the context of general International Classification of Functioning (ICF) domains and to answer the question whether there is a need for a comprehensive epidemiologic study of SCI in Poland. METHODS: Databases Medline, Embase and Polish Medical Bibliography were searched using keywords 'spinal cord injury', 'paraplegia', 'tetraplegia' and 'Poland'. INCLUSION CRITERIA: studies on humans, original papers, publication in 1979 or later. Case reports and studies with unclear inclusion criteria or performed on a population other than Polish were excluded. Full texts were reviewed for data on incidence, prevalence, etiology, mortality, natural history and outcome of comprehensive treatment. Quality of studies was assessed according to the modified Downs and Black criteria. The ICF model was applied to group the studies according to the ICF components. RESULTS: Out of 536 identified papers, 224 articles were extracted and reviewed. Mean quality score was 11.04 points based on a 28-grade scale. Body functions and structures were assessed in 81.6%, activities in 22.4%, participation in 14.8%, environmental factors in 15.2% and personal factors in 47% of the studies reviewed. CONCLUSION: Current epidemiologic data on SCI in Poland are insufficient and biased toward biomedical aspects. There is a need to develop a long-term research strategy for SCI in Poland in the form of a comprehensive cohort study.

Towards an ICF- and IMMPACT-based pain vocational rehabilitation core set in the Netherlands.

BACKGROUND: For clinical use and research of pain within the context of vocational rehabilitation, a specific core set of measurements is needed. The recommendations of the International Classification of Functioning, Disability and Health (ICF) brief Core Set for Vocational Rehabilitation (VR) and those of Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) cover two broad areas. These two sources can be integrated when made applicable to vocational rehabilitation and pain. Objective To develop a core set of diagnostic and evaluative measures specifically for vocational rehabilitation of patients with subacute and chronic musculoskeletal pain, while using the brief ICF core set for VR as the reference framework in VR, and the IMMPACT recommendations in the outcome measurements around pain. METHODS: Three main steps were taken. The first step was to remove irrelevant and duplicate domains of the brief ICF Core Set for Vocational Rehabilitation and the IMMPACT recommendations around pain. The second step was to match the remaining domains with existing instruments or measures. Instruments were proposed based on availability and its proven use in Dutch practice and based on proof of sufficient clinimetric properties. In step 3, the preliminary VR-Pain core set was presented to 3 expert panels: proposed users, Dutch pain rehabilitation experts, and international VR experts. RESULTS: Experts agreed with the majority of the proposed domains and instruments. The final VR-Pain Core Set consists of 18 domains measured with 12 instruments. All instruments possessed basic clinimetric properties. CONCLUSION: An agreed-upon VR-Pain Core Set with content that covers relevant domains for pain and VR and validated instruments measuring these domains has been developed. The VR-Pain Core Set may be used for regular clinical purposes and research in the field of vocational rehabilitation and pain, but adaptations should be considered for use outside the Netherlands.

To work or not to work: labour market participation of people with spinal cord injury living in Switzerland.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: To establish labour market participation figures of persons with spinal cord injury (SCI) living in Switzerland and to investigate determinants and consequences of having paid work. SETTING: Community. METHODS: A survey among members of the Swiss Paraplegic Association was performed in 2008. Inclusion criteria were: SCI of traumatic or non-traumatic origin, minimum age of 18 years, and living in the community for at least 1 year. A total of 559 persons with SCI returned the questionnaire (response rate 27%), of which 495 (24%) fulfilled the eligibility criteria. Bivariate and logistic regression analyses were performed based on theoretical considerations and relevant determinants found in the literature. RESULTS: Of the respondents of working age, 63.8% were involved in gainful employment. No significant difference between persons with para- and tetraplegia was observed. Logistic regression showed that employment was associated with age, time since onset of SCI, having worked at 2 years after initial rehabilitation, having received vocational counselling, having less pain, more years of education and more perceived importance of work. Working persons achieved a significantly higher total income. The most important reasons to work were not financial, but rather of social nature. Barriers to work were primarily health-related. CONCLUSIONS: We found a relatively high employment rate among the studied persons with SCI living in Switzerland. However, because of the low response, it is difficult to generalise this finding.