[Bavarian online database for corona screening tests-development and use of a digital solution in the pandemic]. / Bayerisches Meldeportal für Corona-Reihenuntersuchungen ­ Entwicklung und Einsatz einer digitalen Lösung in der Pandemie.

During the SARS-CoV­2 pandemic, various data had to be collected to support political decisions for pandemic preparedness and response. Nevertheless, using analogue tools like paper and pencil as well as sending files with media discontinuity that have to be merged later are not useful and can hardly provide usable data in real time. With the selected system architecture, the Bavarian Online Database for Corona Screening Tests (BayCoRei) is a central, Bavaria-wide, consistent digital solution that is agile and easy to use. BayCoRei uses established technical components and interfaces. Apart from this, the support of the individual stakeholders (e.g., health authorities, service providers, and district governments) plays a decisive role in the success of the solution. The present article describes BayCoRei and two other online databases as examples that comprise the technology and architecture that have proven to be (rapidly) deployable and points out the gap between intention and reality regarding pandemic management.

Occurrence of Mental Illness and Mental Health Risks among the Self-Employed: A Systematic Review.

We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.

Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective "real world" data analysis of fibromyalgia patients.

OBJECTIVE: To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). METHODS: In this cross-sectional, observational study, "real world" data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. RESULTS: The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (- 0.22), pain-related interference with everyday life (- 0.19), general activity (0.13), general health perception (0.11), punishing response from others (- 0.11), work status (- 0.10), vitality (- 0.11) and cognitive difficulties (- 0.12). Pain intensity or frequency was not an independent correlate. CONCLUSIONS: More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

Hospitalization cost at childbirth: Health parameters and colonization with antimicrobial resistant bacteria and methicillin susceptible Staphylococcus aureus.

OBJECTIVE: Antimicrobial resistant bacteria (AMR) are of public health and economic relevance. However, there is a lack of data regarding AMR colonization in pregnant women and in newborns. Furthermore, there are few studies analyzing hospital's net income (revenues and costs). STUDY DESIGN: The cross-sectional study took place in two Bavarian clinics. Available data regarding women and newborns were collected using a standardized questionnaire, personal IDs and medical records in addition to AMR/MSSA screening. Economic data consisted of estimated hospitalization costs, calculated using a billing system called G-DRG (German-Diagnosis Related Groups) as well as real hospitalization costs (e.g. staff, medical and non-medical infrastructure costs). RESULTS: Data from 635 pregnant women and 566 newborns were included. While AMR colonization has shown no significant association with clinical complications, or net hospital income; primipara status and medical condition during pregnancy did. AMR colonization did not have a significant influence on the health status of pregnant women or of the newborns. Net hospital income for pregnant women was mostly negative in 2014. In 2014 and 2015 the majority of the cases had a net income between ±€ 1000. Newborns with clinical complications differed significantly in Apgar score at 1min, weight, body length and AMR colonization of the pregnant woman and/or the newborn (p<=0.05). CONCLUSION: Results indicate that colonization does not lead to increased costs during hospitalization considering real hospitalization costs as well as G-DRG estimated costs. Both DRG groups had similar MSSA and AMR prevalence and health status. In future studies, a Centralized Cost Accounting as billing method and an improved possibility of AMR coding in G-DRG catalog would be desirable.

[Optimization of Community Health Care: First Experiences of the Office for Medical Care in Districts and Municipalities of Bavaria]. / Optimierung der kommunalen Gesundheitsversorgung: Erste Erfahrungen des Kommunalbüros für ärztliche Versorgung des Landes Bayern.

Background: Demographic changes pose serious challenges for the healthcare system. One important goal is to sustain the local healthcare provision in the future - especially in rural areas. In this context, more attention must be given to the statutory health service by communal as well as state authorities. Most of the municipalities have to tackle this problem for the first time and, due to lack of support, are faced with serious impediments. The aim of this paper is to describe the sphere of action of the Office for Medical Care in Districts and Municipalities (OMCDM) as well as its core outcome. Methods: The Bavarian Ministry of Health and Care (StMGP) established the OMCDM at the Bavarian Health and Food Safety Authority to support communal authorities. On behalf of the StMGP, this office analyses the existing set-ups of local health services and advises local authorities on improvement. For 2012-2015, the OMCDM database was analyzed for frequency and main reasons of contact with health services. Results: The action of the OMCDM is driven by a comprehensive assessment, specialist counseling, and networking to develop action potential for the individual local health authorities. Over the past four years, there has been an increasing demand for support. Until 2015-11-30, 233 cases of counseling and 155 intensive counseling cases were recorded. The topics most frequently mentioned in these consultations were primary care by General Practitioners (68%) and specialist care (29%). Other important issues were the search for successors (33%), the establishment of new practices (23%) and opening of branch practices (18%). Conclusion: On behalf of Bavarian government, the OMCDM offers easy access to objective and neutral counseling about statutory health services for Bavarian municipalities. This offer has been used frequently by districts and municipalities. Primary care by general practitioners on the local level was the most common reason to contact the OMCDM. The establishment of the Office for Medical Care in Districts and Municipality is a comprehensive support for local authorities and can be regarded as a pattern for other states in Germany.

Validation of the International Classification of Functioning Disability and Health framework using multidimensional item response modeling.

PURPOSE: To examine the construct validity of the International Classification of Functioning Disability and Health (ICF) framework using multidimensional item response modelling and data collected in different regions from patients with five chronic health conditions. We assume that the ICF components should represent statistically called dimensions that are distinct although related. METHOD: Retrospective validation study using the ICF Core Sets from a convenience sample of patients in an international multicentre, cross-sectional database obtained in different rehabilitation centres. Health professionals working in 89 rehabilitation centres in 32 countries collected data from 3227 rehabilitation patients using the respective ICF Core Sets. Patients included had one of the following health conditions: low back pain (LBP), rheumatoid arthritis (RA), osteoarthritis (OA), obesity (OB) or post-stroke. Data from questions regarding a patient's functioning based on body structures and functions, activities, participation along the ICF Core Sets were analysed with multidimensional item response modelling. RESULTS: The multidimensional models fit the data better than a model with few or no specifications regarding an underlying framework. For example, a model separating four dimensions 'body structures', 'body functions', 'activities' and 'participation' fits the data better than a model differentiating between 'body functions and structures' and 'activities and participation'. The ICF framework with its components represents underlying statistically called dimensions. CONCLUSION: The results of this study support the construct validity of the functioning part of the ICF. The distinct dimensions may facilitate the alignment of ICF components with other measures used clinically and in research. Based on our results it is justifiable to construct instruments integrating ICF categories within components.

The comparative effectiveness of a multimodal program versus exercise alone for the secondary prevention of chronic low back pain and disability.

OBJECTIVE: The objective of this study was to examine whether a multimodal, secondary prevention program (MP) is superior to a general physical exercise program (EP) in influencing the process leading to chronic low back pain (LBP) in nurses with a history of back pain. DESIGN: The study was conducted as a randomized controlled parallel-group trial. SETTING: The interventions were performed in a single center at the Department of Physical and Rehabilitation Medicine at the University of Munich in Germany. PARTICIPANTS: A total of 235 nurses from 14 nearby hospitals and nursing homes who experienced at least one episode of back pain during the previous 2 years were invited into the study. Of these, 183 nurses were enrolled and 169 (83 in the MP and 86 in the EP) qualified for the intent-to-treat analysis. INTERVENTIONS: The EP consisted of 11 group sessions, each lasting 1 hour. After introductory sessions, subsequent sessions included general physical strengthening and stretching exercises as well as instructions for a home-training program. The MP consisted of 17 group sessions of 1.75 hours and one individual session of 45 minutes. In addition to the full EP, the MP included 5 psychological units, 7 segmental stabilization exercises units, and 8 ergonomic and workplace-specific units. MAIN OUTCOME MEASUREMENTS: The primary study end-point variable was pain interference, and the secondary study end-point variables were pain intensity and functioning as measured with the West Haven-Yale Multidimensional Pain Inventory and the Short Form-36, respectively. These study end-point variables were defined a priori. RESULTS: There was no statistically significant difference between the 2 groups. Small-to-moderate effects were observed in both intervention programs across all study end-point variables. For pain interference, the effect size at 12 months after intervention was 0.58 in the MP and 0.47 in the EP. CONCLUSIONS: A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.

Reliability of a test measuring transversus abdominis muscle recruitment with a pressure biofeedback unit.

BACKGROUND: There are indications that segmental stabilising exercises (SSEs) are effective in the treatment of low back pain. The evaluation of successful training in SSE performance in patients requires a reliable outcome measure. The PRONE test gives an indication of the activity of the transversus abdominis muscle. Performed in prone lying using a pressure biofeedback unit, it has been used as an aid to training and to assess the subject's ability to perform SSEs correctly. OBJECTIVES: To evaluate inter-observer and test-retest reliability of the PRONE test. DESIGN: Repeated measures by three observers on 2 days. SETTING: Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian University, Munich, Germany. PARTICIPANTS: Forty nurses (39 females and one male), aged between 24 and 62 years, with at least one episode of low back pain. MAIN OUTCOME MEASURES: During the test, movement of the abdominal wall was monitored by measuring a change in pressure during muscle contraction termed 'abdominal hollowing'. Defined observation and palpation criteria were verified by the observers to ensure correct execution of the test. METHODS: Participants were tested on two separate days. On the first day, Observer A performed two similar test sets, each with four exercises. On the second test day, Observers B and C conducted one test set each. RESULTS: This study found an intra-class correlation coefficient (ICC) of 0.47 [95% confidence interval (CI) 0.20 to 0.67] for inter-observer reliability, and an ICC of 0.81 (95% CI 0.67 to 0.90) for test-retest reliability. Kappa values and the limits of agreement were also calculated with similar results. CONCLUSIONS: For this subject group, the PRONE test had relatively low inter-observer reliability but, as may be expected, higher test-retest reliability. It is suggested that by providing visual feedback, the PRONE test may enhance patients' insight into their deep abdominal muscle recruitment and thereby increase their motivation to exercise.

Factors explaining improvement of isoinertial lifting-capacity.

INTRODUCTION: A clearer understanding of the factors involved in improving lifting-capacity may assist professional health workers to enhance patient's functioning and minimize chronic back pain. However, few studies have examined this association. This study is part of a trial comparing two secondary back pain prevention programs. It aims to identify anthropometric, physical, psychic and demographic baseline variables (baseline model), and over time change variables (comprehensive model), which explain the alteration of lumbar isoinertial lifting-capacity, from baseline to post-treatment. METHODS: The association between these variables' baseline- or change values, and the change of lifting-capacity (PILE-test) over time, were analyzed with multiple regression analyses. Potential variables for the regression analyses were identified within a standardized stepwise selection process. RESULTS: In the baseline model, 35.2% of the variance in lifting-capacity was mainly explained by a low baseline score of lumbar lifting-capacity, high body weight and gender. In the comprehensive model, 41.9% could be mainly explained by the same baseline variables, an increase of perceived exertion during the PILE-tests and decrease of fear-avoidance caused by work. CONCLUSIONS: The results suggest that treatments to improve lifting-capacity in individuals with mild low back pain should particularly address the reduction of fear-avoidance beliefs. Although strong conclusions cannot be drawn from this study due to methodological limitations, they may be helpful to assign patients to appropriate and most beneficial treatment programs, as well as to develop specific programs. Fear-reduction may be an important target for early interventions in regard to functional capacity.

Change factors explaining reductions of "interference" in a multidisciplinary and an exercise prevention program for low back pain.

OBJECTIVES: To identify relevant changes in process variables that are associated with outcome following an exercise and a multidisciplinary secondary prevention program for low back pain. METHODS: Data from a randomized controlled clinical trial to examine the effectiveness of an exercise and a multidisciplinary prevention program were analyzed using multiple regression analyses. The specific goal was to examine the amount of variance in changes in "interference" postintervention that could be explained by prechanges to postchanges in physical and psychologic parameters, and to determine if there are interactions between physical/psychologic parameters and the program type. RESULTS: One hundred sixty-two (89%) participants were included in the regression analyses. Reductions of interference at postmeasurement were explained best by reductions of pain intensity and catastrophizing in the multidisciplinary and the exercise prevention program. No significant interaction between the changes in process variables and the program type was found. The final model could explain 68.7% of variance. CONCLUSIONS: Owing to methodologic limitations, strong conclusions cannot be drawn from this study. The findings suggest that treatment success in exercise and multidisciplinary interventions might be influenced by the same change factors, namely changes in pain and psychologic factors. The results raise the question of whether the mechanism through which exercise works, is improve in physical variables, or rather a change in psychologic attributes, in that people correct their irrational cognitions by making experiences that differ from their expectations. If these findings can be confirmed in longitudinal studies with more measurement points, they would have implications for treatment refinement.

Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke.

OBJECTIVE: The Stroke-Specific Quality of Life Scale (SS-QOL) is a recently developed measure to assess health-related quality of life in stroke patients. The objective of this study was to translate the American version of the SS-QOL and examine the validity of the German proxy version, in both ischemic and hemorrhagic stroke survivors. METHODS: The translation was conducted according to published guidelines. The validation was performed in consecutive adult stroke survivors. Data were obtained 1 year after discharge. To examine the dimensionality of the SS-QOL, factor analyses were conducted. The validity was examined by the associations of the subscales with the Functional Independence Measure and Short Form 36. RESULTS: The literal translation revealed no major changes between the American and the German versions of the SS-QOL. Three hundred seven stroke survivors were included in the study. Unlike the 1st validation study, most of the variance could be explained by 8 instead of 12 factors; therefore, the 8-factor solution was further examined. The validity of the SS-QOL total score and "observable" scales such as "activities" was shown. CONCLUSIONS: For the German proxy version of the SS-QOL, an 8-factor solution was found to be the most appropriate. The psychometric properties of these 8 subscales were good or excellent with respect to internal consistency. The validity of the total score was shown, but some subscales (energy, mood, and thinking) failed the hypothesized associations. Therefore, the SS-QOL needs to be further explored in other settings and populations.

Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. METHODS: MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. RESULTS: Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long-term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. CONCLUSION: For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions.

Measuring the outcome of health resort programs.

OBJECTIVE: To evaluate the metric properties and practicability of valid, internationally available outcome instruments in the special setting of health resort programs. METHODS: A cohort study in a convenience sample of patients with low back pain, upper back pain, conditions of the lower extremities, and conditions of the upper extremities was conducted. Their functioning and health were assessed before and after a health resort program by the disease-specific North American Spine Society (NASS) instruments Lumbar NASS and Cervical NASS; WOMAC Osteoarthritis Index; Disabilities of Arm, Shoulder and Hand Questionnaire; and the general instrument, Medical Outcome Study Short Form-36 (SF-36). RESULTS: Completeness on the scale level ranged between 1% and 10%. Criterion validity of condition-specific instruments was confirmed by stronger associations of the pain and function scales to the Physical Health component of the SF-36 (r = -0.59 to -0.79, p < 0.001 for all scales) than to the Mental Health component (r = -0.11, NS, to r = -0.42, p < 0.001). Reliability (Cronbach's alpha coefficient) was higher than 0.8 for all scales of condition-specific instruments and for 6 of 8 SF-36 scales. Floor and ceiling effects ranged between 0% and 7%. The condition-specific instruments demonstrated a good responsiveness with an effect size ranging between 0.28 and 0.55 and with a standardized response mean between 0.32 and 0.94. The responsiveness of most SF-36 scales was similar, but the Physical Function scale showed a lower responsiveness than the condition-specific scales. CONCLUSION: The evaluated instruments can be recommended for use in clinical trials that assess the outcome of health resort programs.

What predicts outcome in non-operative treatments of chronic low back pain? A systematic review.

Systematic reviews have shown that as non-operative treatments exercise, behavioural and multimodal treatment programs are effective for chronic low back pain. There is, however, a lack of knowledge concerning the association between changes in treatment process variables and changes in outcome for the three treatment forms. The objective of this systematic review was to evaluate which changes in treatment process variables predict outcome of exercise, behavioural and multimodal treatment of chronic low back pain. Medline, Embase and PsychInfo were systematically searched. A descriptive analysis was used to summarize the results regarding the outcomes pain, disability and return to work (RTW). 13 studies were identified. The results showed that functional coping mechanisms and pain reduction were associated with a decrease in disability and increase in RTW, and physical performance factors were not. Related to pain reduction decreases in disability, functional coping mechanisms as well as physical performance factors were associated. Strong conclusions cannot be drawn from this review, because of the heterogeneity and the limited number of studies. The results of this review raise the question if changes in behavioural variables and reductions of disability which facilitate an improvement in function, may be more important than physical performance factors for successful treatment of chronic low back pain. This is relevant for the refinement of future treatment programs.

ICF Core Sets development for the acute hospital and early post-acute rehabilitation facilities.

The goal of this paper is to report on the background and the methods used in the ICF Core Set development for patients in the acute hospital and early post-acute rehabilitation facilities. ICF Core Sets are sets of categories out of the International Classification of Functioning, Disability and Health (ICF) which can serve as minimal standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. The ICF Core Sets were developed in a formal decision-making and consensus process, integrating evidence gathered from preliminary studies and expert opinion. The Acute ICF Core Sets for patients with neurological, musculoskeletal and cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals working in the acute hospital on medical, surgical or other units not specialised in rehabilitation. The Post-acute ICF Core Sets for geriatric patients and patients with neurological, musculoskeletal or cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals involved in early post-acute rehabilitation. The Acute and Post-acute ICF Core Sets are first versions and need to be tested and validated in the patient and professional perspective and in different countries, regions, health care and provider settings.

ICF Core Set for patients with neurological conditions in the acute hospital.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with neurological conditions in the acute hospital. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Twenty-one experts selected a total of 85 second-level categories. The largest number of categories was selected from the ICF component Body Functions (41 categories or 48%). Five (6%) of the categories were selected from the component Body Structures, 18 (21%) from Activities and Participation and 21 (25%) from Environmental Factors. CONCLUSIONS: The Acute ICF Core Set for patients with neurological conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

ICF Core Set for patients with neurological conditions in early post-acute rehabilitation facilities.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for neurological patients in early post-acute rehabilitation facilities. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Seventeen experts selected a total of 116 second-level categories. The largest number of categories was selected from the ICF component Body Functions (54 categories or 47%). Eleven (9%) of the categories were selected from the component Body Structures, 34 (29%) were of the categories from the component Activities and Participation, and 17 (15%) from the component Environmental Factors. CONCLUSION: The Post-acute ICF Core Set for neurological patients is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

The factor subdimensions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) help to specify hip and knee osteoarthritis. a prospective evaluation and validation study.

OBJECTIVE: To determine whether it is possible to specify different score patterns for hip and knee osteoarthritis (OA), and to identify the degree of responsiveness and the validity of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) factors, which are alternative health dimensions obtained by factor analysis of the WOMAC items. METHODS: WOMAC scales and WOMAC factors were compared in a prospective setting examining patients with hip and knee OA before and after rehabilitative inpatient intervention (n = 317). In a partial sample (n = 103), the validity of the WOMAC factors was determined by a global rating of their activities. RESULTS: The WOMAC factor "ascending/descending" was significantly different for hip and knee OA in the health state before therapy (score in hip 5.09, in knee 6.59; p < 0.001); this was also true of the effect size after therapy (hip 0.39, knee 0.65; p = 0.012). The WOMAC scales did not differ for the 2 conditions. The WOMAC factor "ascending/descending" was the most responsive dimension in knee OA (effect size 0.65), but in hip OA the WOMAC pain scale was most responsive (effect size 0.55). Most of the WOMAC factors correlated moderately (r = 0.52-0.69) with the patient's self-rating on the validation questionnaire. CONCLUSION: The WOMAC factors are valid measures. Analyzing the WOMAC by the WOMAC factors facilitates and improves the differential relevance and accuracy of the WOMAC for specific conditions such as hip and knee OA.

Development of ICF Core Sets for patients with chronic conditions.

OBJECTIVE: The objective of the ICF Core Sets project is the development of internationally agreed Brief ICF Core Sets and Comprehensive ICF Core Sets. METHODS: The methods to develop both ICF Core Sets, the Comprehensive ICF Core Set and the Brief ICF Core Set, involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies and expert opinion. RESULTS: The results regarding the development of the ICF Core Sets for 12 health conditions (chronic widespread pain, low back pain, osteoarthritis, osteoporosis, rheumatoid arthritis, chronic ischemic heart disease, diabetes mellitus, obesity, obstructive pulmonary diseases, breast cancer, depression, and stroke) are presented in this supplement. CONCLUSION: Both, the Brief ICF Core Sets and the Comprehensive ICF Core Sets are preliminary and need to be tested in the coming years based on a standardized protocol in close cooperation with the ICF research branch of the WHO FIC CC (DIMDI) in Munich and the CAS team at WHO. The final goals are valid and globally agreed tools to be used in clinical practice, research and health statistics.

Identification of the most common patient problems in patients with chronic conditions using the ICF checklist.

OBJECTIVE: To identify the most common patient problems in patients with 12 different chronic conditions using the ICF checklist. METHODS: A multi-centre, cross-sectional study with convenient samples of patients who had received a clinical diagnosis of any of 12 different chronic conditions undergoing inpatient or outpatient rehabilitation. To describe the population, age, gender, and the SF-36 were recorded. Data for 917 patients from 33 rehabilitation centres were analysed. RESULTS: Most of the ICF-checklist categories were common to at least 1 condition. Pain was the sole category of 125 ICF-checklist categories that was common to all chronic conditions. Patients with low back pain, rheumatoid arthritis, and diabetes mellitus did not often experience the problems listed in the ICF-checklist. CONCLUSION: The main finding, that in most conditions categories from each component were common, underscores the need to address all components when assessing functioning and health in patients with chronic conditions.