Representing and organizing information to describe the lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health (ICF): a discussion paper.

PURPOSE: To discuss the representation and organization of information describing persons' lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health, using spinal cord injury as a case in point for disability. METHODS: The scientific literature was reviewed, discussion rounds conducted, and qualitative secondary analyses of data carried out using an iterative inductive-deductive approach. RESULTS: Conceptual considerations are explicated that distinguish the personal factors perspective from other components of the International Classification of Functioning, Disability and Health. A representation structure is developed that organizes health-related concepts describing the internal context of functioning. Concepts are organized as individual facts, subjective experiences, and recurrent patterns of experience and behavior specifying 7 areas and 211 concept groups. CONCLUSIONS: The article calls for further scientific debate on the perspective of personal factors in the light of the International Classification of Functioning, Disability and Health. A structure that organizes concepts in relation to a personal factors perspective can enhance the comprehensiveness, transparency and standardization of health information, and contribute to the empowerment of persons with disabilities. Implications for rehabilitation The present study collected data from scientific literature reviews, discussion rounds and qualitative secondary analyses in order to develop a representation and organization of information describing persons' lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health. The following representation structure for health-related information from a personal factors perspective was developed: (i) Individuals facts (i.e., socio-demographical factors, position in the immediate social and physical context, personal history and biography), (ii) subjective experience (i.e., feelings, thoughts and beliefs, motives), and (iii) recurrent patterns of experience (i.e., feelings, thoughts and beliefs) and behavior. With this study, we aim to stimulate further scientific discussion about the personal factors component in the International Classification of Functioning, Disability and Health, including its application and subsequent validation for potential implementation into clinical practice.

Perceived posttraumatic growth and depreciation after spinal cord injury: Actual or illusory?

OBJECTIVE: This study examined whether retrospective reports of posttraumatic growth (PTG) and depreciation (PTD) of individuals recently diagnosed with a spinal cord injury (SCI) coincide with prospectively measured changes in the conceptually close domains of general self-efficacy (SE) and purpose in life (PIL). The study also tested whether PTG/D and changes in SE and PIL independently predict psychological adjustment to the injury (depressive symptoms, anxiety, life satisfaction). METHOD: Adopting a longitudinal design, a sample of 206 newly injured patients admitted to one of the four Swiss SCI rehabilitation centers was analyzed. SE and PIL were assessed one month after injury diagnosis and at rehabilitation discharge, PTG/D and the adjustment indicators only at discharge. Structural equation modeling was used to calculate latent change scores for SE and PIL, to correlate these scores to PTG/D scores, and to regress the adjustment indicators on both of them. RESULTS: PTG/D scores were weakly (rmax = .20, p = .033) correlated to changes in SE and PIL. In the multivariate analyses, positive changes in SE and PIL and PTG scores were all associated with better adjustment (e.g., fewer depressive symptoms). In contrast, PTD scores were related to lower adjustment. CONCLUSIONS: These results suggest that PTG/D in the initial time after a potentially traumatic medical event seem to be illusory to some degree, as indicated by their weak association with "actual" (i.e., longitudinally measured) changes. Nevertheless, both, PTG/D and actual changes, need to be considered by researchers and clinicians, as they seem to be independently related to psychological adjustment. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Coping and posttraumatic growth: A longitudinal comparison of two alternative views.

PURPOSE: In the current study, we aimed to examine two possible explanations for why higher levels of posttraumatic growth (PTG) were repeatedly found to be predicted by both approach- and avoidance-oriented coping, focusing on individuals recently diagnosed with a spinal cord injury (SCI). First, negative changes (posttraumatic depreciation, PTD) may moderate the association between PTG and the two types of coping, indicating that PTG reflects avoidance of PTD for some individuals, but a constructive view on posttraumatic life changes for others. Second, it may be that a flexible use of different types of coping strategies (coping flexibility) enables the experience of PTG. METHOD: We examined a sample of 122 patients admitted to one of the four Swiss SCI rehabilitation centers in a longitudinal study. Hierarchical multiple regression analyses were conducted to test the two competing explanations. RESULTS: Both approach- (ß = .30, p = .001) and avoidance-oriented coping (ß = .23, p = .011) measured 3 months after SCI diagnosis predicted higher PTG levels at discharge from clinical rehabilitation. PTD did not moderate the relationship between approach- (ß = .03, p = .743) and avoidance-oriented coping (ß = -.04, p = .656) and PTG. However, coping flexibility (ß = .23, p = .012) predicted higher PTG levels. CONCLUSION: These results suggest that a flexible use of different coping strategies (potentially, according to situational demands) may explain findings that PTG was predicted by both approach- and avoidance-oriented coping. (PsycINFO Database Record

Posttraumatic growth and adjustment to spinal cord injury: Moderated by posttraumatic depreciation?

OBJECTIVE: Findings on the relationship of posttraumatic growth (PTG) with adjustment to potentially traumatic events are inconsistent, whereupon posttraumatic depreciation (PTD) has been suggested as a possible moderator. The objective of this study is to investigate the associations between PTG and PTD on one side and life satisfaction and indicators of mental and physical health on the other side in individuals with spinal cord injury (SCI). The primary study aim is to test whether PTD moderates the relationships of PTG and different adjustment indicators. METHOD: A total of 141 patients administered to one of the four Swiss SCI rehabilitation centers completed questionnaires assessing PTG and PTD and different indicators of mental and physical health as well as life satisfaction at discharge from first rehabilitation. Correlational and regression methods were used to examine the research question. RESULTS: PTG and PTD were significantly positively correlated (rs = .47). PTD was significantly associated with lower mental and physical health and lower life satisfaction, with small to large effect sizes. PTD moderated the associations of PTG with symptoms of depression and life satisfaction (ß of interaction term = -.18 and .24, respectively). PTG was significantly related to lower levels of symptoms of depression and higher life satisfaction in individuals experiencing moderate to high levels of PTD. In contrast, PTG was not significantly related to these outcomes in individuals with low PTD levels. CONCLUSION: The neglect of PTD in research partially explains mixed findings on the relationship of PTG and adjustment to potentially traumatic events. (PsycINFO Database Record

Describing functioning and health after spinal cord injury in the light of psychological-personal factors.

OBJECTIVE: To describe and explore functioning and health of persons with spinal cord injury from the perspective of psychological-personal factors in the light of the International Classification of Functioning, Disability and Health (ICF) framework. METHODS: Data from 511 participants regarding feelings, thoughts and beliefs, motives, and patterns of experience and behaviour were analysed. Measurement instruments included the Mental Health Index-5, Positive and Negative Affect Schedule, Hospital Anxiety and Depression Scale, Appraisal of Life Events Scale, 5 items from the World Health Organization Quality of Life Scale, Purpose in Life Test-Short Form, General Self-Efficacy Scale, Big Five Inventory-21, Social Skills Inventory-SF, Brief COPE. The distribution of the selected psychological-personal factors-indicators was examined using descriptive statistics. Differences between SCI subgroups by sex, age, age at injury, time since injury, aetiology and severity of injury were explored using analysis of variance (ANOVA) and F-tests. RESULTS: Participants who were older and sustained their spinal cord injury more recently experienced more depressed mood, less positive affect, less challenge appraisal, lower life satisfaction, lower purpose in life, and lower self-efficacy. They reported lower social skills, less usage of the coping strategies humour, positive reframing, and acceptance, and more usage of the coping strategies denial and self-distraction. Overall, effect sizes were small. DISCUSSION: Although study participants appeared to be well adjusted to spinal cord injury, those who sustained their injury at an older age and more recently reported more negative experiences. Quantitative description and exploration of the psychological-personal aspects of health will enable hypotheses to be formulated for further research, and suggest a need for tailored interventions for those at risk of less favourable outcomes.

Rasch analysis of measurement instruments capturing psychological personal factors in persons with spinal cord injury.

OBJECTIVE: To evaluate the metric properties of distinct measures of psychological personal factors comprising feelings, beliefs, motives, and patterns of experience and behaviour assessed in the Swiss Spinal Cord Injury Cohort Study (SwiSCI), using Rasch methodology. METHODS: SwiSCI Pathway 2 is a community-based, nationwide, cross-sectional survey for persons with spinal cord injury (SCI) (n = 511). The Rasch partial credit model was used for each subscale of the Positive Affect Negative Affect Scale (PANAS), Appraisal of Life Events Scale (ALE), Purpose in Life test - Short Form (PIL-SF), and the Big Five Inventory-K (BFI-K). RESULTS: The measures were unidimensional, with the exception of the positive affect items of the PANAS, where pairwise t-tests resulted in 10% significant cases, indicating multidimensionality. The BFI-K subscale agreeableness revealed low reliability (0.53). Other reliability estimates ranged between 0.61 and 0.89. Ceiling and floor effects were found for most measures. SCI-related differential item functioning (DIF) was rarely found. Language DIF was identified for several items of the BFI-K, PANAS and the ALE, but not for the PIL-SF. CONCLUSION: A majority of the measures satisfy the assumptions of the Rasch model, including unidimensionality. Invariance across language versions still represents a major challenge.

Perceived needs and experiences with healthcare services of women with spinal cord injury during pregnancy and childbirth - a qualitative content analysis of focus groups and individual interviews.

BACKGROUND: Women after a spinal cord injury (SCI), who decide to get pregnant and to become mothers, have special health care service needs. This study aims to identify the perceived service needs of woman with SCI during pregnancy and childbirth in Switzerland and to reconstruct their experiences of healthcare service utilization based on their accounts. METHODS: A qualitative content analysis based on focus groups and individual interviews was conducted. 17 mothers with SCI who had given birth following SCI within the past 15 years participated. The data were transcribed verbatim before content analyses were carried out. Primary data was collected from August 2012 to September 2013 at the Swiss Paraplegic Research Centre, Nottwil; the University of Lausanne and at the homes of the participants. RESULTS: Mothers reported a broad spectrum of medical needs, including the need for access to improved integrated care. They also reported difficulties finding providers with knowledge of both paraplegiology (i.e. spinal cord medicine) and gynaecology. Mothers preferred using local health care services and regular birth hospitals, and reported receiving no additional benefit from the services of specialised SCI centres during pregnancy. A pre-existing provider-patient relationship was helpful for optimizing care processes. CONCLUSION: This study showed that pregnant women with SCI have various perceived healthcare needs and health care service use. Effective programs to improve these women's access to integrated care during pregnancy and childbirth and policies requiring the provision of specific pregnancy information and pre-birth services are necessary.

Depression in spinal cord injury: assessing the role of psychological resources.

PURPOSE: To test the spinal cord injury adjustment model (SCIAM) and to examine how psychological resources may influence depressive symptoms in persons with spinal cord injury (SCI). We expect that (a) higher general self-efficacy (GSE) and higher purpose in life (PIL) are associated with lower levels of depressive symptoms, and that (b) the effect of GSE and PIL on depressive symptoms is mediated by appraisals and coping strategies, as proposed by the SCIAM. METHOD: A nationwide cross-sectional survey (the Swiss Spinal Cord Injury Cohort Study) was conducted with individuals with SCI living in the Swiss community (N = 516). Structural equation modeling was used to test relationships between variables as specified in the SCIAM. RESULTS: Higher GSE (r = -.54) and PIL (r = -.62) were significantly associated with lower depressive symptoms. The initial model yielded poor model fit. However, the final modified model fitted well, with χ2(21) = 54.00, p < .01, RMSEA = .055 (90% CI [.038, .073]), CFI = .98, explaining 62.9% of the variance of depressive symptoms. PIL had a direct large effect and an indirect effect on depressive symptoms via appraisals and coping strategies. The influence of GSE on depressive symptoms was fully mediated by appraisals and coping strategies. CONCLUSIONS: Psychological resources of individuals with SCI can have a direct effect on depressive symptoms. The mediated pathways are present, but not exclusive in our data, yielding only partial support for the mechanism proposed by the SCIAM.

Social skills: a resource for more social support, lower depression levels, higher quality of life, and participation in individuals with spinal cord injury?

OBJECTIVE: To examine the relevance of social skills and their different dimensions (ie, expressivity, sensitivity, control) in relation to social support, depression, participation, and quality of life (QOL) in individuals with spinal cord injury (SCI). DESIGN: Cross-sectional data collection within the Swiss Spinal Cord Injury Cohort. SETTING: Community-based. PARTICIPANTS: Individuals with SCI (N=503). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Depression, participation, and QOL were measured using the Hospital Anxiety and Depression Scale, the Utrecht Scale for Evaluation of Rehabilitation-Participation, and 5 selected items of the World Health Organization Quality of Life Scale. The Social Skills Inventory and the Social Support Questionnaire were used to assess social skills (expressivity, sensitivity, control) and social support, respectively. RESULTS: Structural equation modeling was conducted. In model 1 (χ(2)=27.81; df=19; P=.087; root mean square error of approximation=.033; 90% confidence interval=.000-.052), social skills as a latent variable was related to social support (ß=.31; R(2)=.10), depression (ß=-.31; total R(2)=.42), and QOL (ß=.46; R(2)=.25). Social support partially mediated the effect of social skills on QOL (indirect effect: ß=.04; P=.02) but not on depression or participation. In model 2 (χ(2)=27.96; df=19; P=.084; root mean square error of approximation=.031; 90% confidence interval=.000-.053), the social skills dimension expressivity showed a path coefficient of ß=.20 to social support and ß=.18 to QOL. Sensitivity showed a negative path coefficient to QOL (ß=-.15) and control a path coefficient of ß=-.15 to depression and ß=.24 to QOL. CONCLUSIONS: Social skills are a resource related to more social support, lower depression scores, and higher QOL.

Lessons learned from different approaches towards classifying personal factors.

PURPOSE: To examine and compare existing suggestions towards a classification of Personal Factors (PF) of the International Classification of Functioning, Disability and Health (ICF). METHODS: Qualitative and quantitative content analyses of available categorizations of PF are conducted. RESULTS: While the eight categorizations greatly differ in their background and structure, the broad content areas covered seem to be similar and reflect the ICF definition of PF. They cover to various degrees 12 broad content areas: socio-demographic factors, behavioral and lifestyle factors, cognitive psychological factors, social relationships, experiences and biography, coping, emotional factors, satisfaction, other health conditions, biological/physiological factors, personality, motives/motivation. CONCLUSIONS: In comparing these categorizations, a common core of content issues for a potential ICF PF classification could be identified and valuable lessons learned. This can contribute to future classification development activities in relation to PF.

Modeling life satisfaction in spinal cord injury: the role of psychological resources.

PURPOSE: The aims of the study were (1) to examine the associations between the psychological resources general self-efficacy (GSE) and purpose in life (PIL), appraisals, coping and life satisfaction, and (2) to examine whether the effects of the psychological resources on life satisfaction are mediated by appraisals and coping, as proposed by the spinal cord injury adjustment model (SCIAM). METHODS: Cross-sectional multicenter study conducted with persons with spinal cord injury (SCI) living in the community in Switzerland (N = 516). Pearson's correlations were calculated for aim 1, and structural equation modeling was conducted to address aim 2. RESULTS: GSE (r = .48) and PIL (r = .58) were positively related to life satisfaction. The initial model corresponding to the SCIAM yielded a poor model fit. The final model had a good model fit [χ (2) = 66.0, df = 21, p < .01, RMSEA = .065 (90 % confidence interval .048-.082), CFI = .97] explaining 57 % of variance of life satisfaction. PIL had a direct large effect on life satisfaction (ß = .54). The influence of GSE on life satisfaction was mediated by loss appraisals. Avoidance, active and humor coping had small effects on life satisfaction. CONCLUSIONS: Psychological resources have a substantial effect on life satisfaction in persons with SCI. Our results correspond with the SCIAM and its conceptualization of adjustment as a multifactorial process, but did not fully support the hypothesized mediation. PIL was strongly related to higher life satisfaction and may be a suitable intervention target to support persons with SCI.

Psychological resources, appraisals, and coping and their relationship to participation in spinal cord injury: a path analysis.

OBJECTIVE: To test the Spinal Cord Injury Adjustment Model and gain a better understanding about whether and how the psychological resources general self-efficacy (SE), purpose in life (PIL), appraisals, and coping influence participation in persons with spinal cord injury (SCI). DESIGN: Cross-sectional data collection within the Swiss Spinal Cord Injury Cohort. SETTING: Community setting. PARTICIPANTS: Persons with SCI (N=516) who are ≥ 16 years old and living in the community in Switzerland. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation was measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation, General SE with the General Self-Efficacy Scale, PIL with the Purpose in Life Test-Short Form, appraisals with the Appraisal of Life Events Scale, and coping with the Brief COPE. RESULTS: General SE (r=.32) and PIL (r=.23) were associated with less participation restrictions. The initial model yielded a poor model fit. The modified final model had an acceptable fit (χ(2)11=36.2; P<.01; root mean square error of approximation=.067 [90% confidence interval: .045-.09]; comparative fit index=.98). A total of 15% of the variance of participation was explained. In the final model, general SE had a moderate direct effect (ß=.24) and mediated effects via threat appraisal and challenge appraisal and humor on participation, indicating a partial mediation effect. The association between PIL and participation was indirect: challenge appraisal and humor acted as mediators. CONCLUSIONS: The results only partly support the double-mediating effect as suggested in the SCI adjustment model because both direct and indirect effects on participation were observed. Individuals with higher general SE and PIL perceive less participation restrictions. General SE seems an appropriate target to enhance participation. Longitudinal studies are needed to support our findings.

Rasch analysis of the General Self-Efficacy Scale in spinal cord injury.

This study examined the psychometric properties of the General Self-Efficacy Scale by applying Rasch analysis to data from 102 persons with spinal cord injury. Our results suggest that the General Self-Efficacy Scale is a psychometrically robust instrument suitable for application in a spinal cord injury population. The General Self-Efficacy Scale shows an overall fit to the Rasch model (χ(2) = 15.5, df = 20, p = .75), high reliability (rp = 0.92), ordered response scale structure, and no item bias by gender, age, education, and lesion levels. However, the analyses indicate a ceiling effect and potential to enhance the differentiation of the General Self-Efficacy Scale across self-efficacy levels.

Participation in physical activity in persons with spinal cord injury: a comprehensive perspective and insights into gender differences.

BACKGROUND: To prevent secondary conditions and to improve and maintain health, regular physical activity is recommended as an important component of a health-promoting lifestyle for persons with spinal cord injury (SCI). However, participation in physical activity is low in persons with SCI, especially in women. OBJECTIVE: The objective of this study is to identify (1) categories of functioning, the environment and personal factors that influence participation in physical activity in persons with SCI and (2) gender differences within identified factors. METHODS: An explorative qualitative study design using both focus groups and individual interviews based on a semi-structured interview guide was used. Statements were linked to categories or chapters of the four components of functioning (body structures, body functions, activities and participation) and of the environment included in the International Classification of Functioning, Disability and Health (ICF) and a recently developed list of personal factors. An in-depth analysis of the statements was performed to identify relevant associations and gender differences. RESULTS: Twenty-six persons (13 female, 13 male) participated in the study. Sixty-seven categories and four chapters from all components of functioning and environmental factors included in the ICF and 33 subdivisions of personal factors were found to be associated with physical activity in persons with SCI. Gender differences could be assigned to areas of gender roles, social support, athletic identity, interests, and general behavioral patterns. CONCLUSION: This study contributes to a comprehensive understanding of participation in physical activity in persons with SCI and presents a first step toward the identification of gender differences. The results should be validated by further quantitative research.

Toward transparent documentation in medical work capacity evaluations: identifying personal factors in medical reports on Swiss disability claimants with chronic widespread pain.

The aim of this study was to determine personal factors that are reported in medical work capacity evaluations of Swiss disability claimants with chronic widespread pain. A mixed-methods study, involving a retrospective qualitative and quantitative secondary analysis of the content of medical reports, was carried out. Two personal factor categorizations (the Geyh categorization and the Grotkamp categorization) were used for coding and specifying the personal factors in the reports. The most relevant personal factor categories were determined by calculating their relative frequency across reports and setting a relevance threshold. Using the Geyh categorization, 27 personal factor categories passed the relevance threshold and six of them appeared in all medical reports. Applying the Grotkamp categorization, 32 personal factor categories passed the threshold and four of them showed up in all reports. The most relevant personal factors identified in medical reports on Swiss disability claimants with chronic widespread pain refer to biographical, occupational, and educational background, behavior patterns as well as personal feelings and cognitions. The development of a standardized documentation involving these personal factors could contribute to more transparency and better comparability of medical work capacity evaluations.

Social support and functioning in a patient with spinal cord injury: the role of social skills.

This study reports on a patient with spinal cord injury (SCI) in whom the interaction between social skills and social support seems to influence functioning. The International Classification of Functioning, Disability and Health (ICF) was used as a reference framework. Qualitative (i.e. observation, structured, and open interviews with the patient and health professionals) and quantitative data (i.e. spinal cord independence measure, medical records) were collected. Content analysis of the interviews was carried out to identify aspects of social skills and social support. An ICF-based documentation tool (i.e. ICF Assessment Sheet) was used to structure information about the level of functioning of body functions and structures, activity and participation, and environmental and personal factors of a 57-year-old man with incomplete paraplegia during first rehabilitation. The patient presented a variety of effective social skills (i.e. assertiveness, goal direction). However, the adaptation of skills, such as asking for help social problem-solving, sensitivity, and expressivity in social relations, became necessary to acquire. The patient received different types of social support (i.e. emotional, informational, and instrumental) from different sources (e.g. family and friends). The qualitative interviews provided indications for an interaction between social skills and social support. The impact of social skills and social support on functioning is discussed. Social skills can mobilize social support and enhance functioning. However, better understanding of social skills, social support, and their interaction in relation to functioning in SCI is required to develop targeted and effective interventions to strengthen psychosocial resources for the enhancement of functioning in patients with SCI.

Rasch analysis of the Hospital Anxiety and Depression Scale in spinal cord injury.

PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Hospital Anxiety and Depression Scale (HADS), applied among persons with spinal cord injury (SCI), using Rasch analysis. METHODS: A cross-sectional multicenter study was conducted and the data of 102 people with SCI were analyzed. Rasch analyses were performed to assess dimensionality, overall and individual item fit, response scale structure, targeting, and differential item functioning. RESULTS: The anxiety and depression subscales showed unidimensionality, that is, model and item fit. The two subscales are reliable (r = .72, 0.82) in SCI. No disordered structure of the response scales or differential item functioning in age, gender, education, relationship status, level of spinal lesion were found. Stepwise deletion of the misfitting items did not produce a total score that fulfilled the statistical criteria for unidimensionality. CONCLUSIONS: The results of the Rasch analyses support the use of the anxiety and depression subscales among people with SCI. However, further research is needed to confirm these findings and examine sensitivity to change of the HADS in SCI, which would support its use in longitudinal observational and intervention studies.

Stress, internal resources and functioning in a person with spinal cord disease.

INTRODUCTION: Spinal cord lesion due to injury or disease (SCD) has a severe impact on the level of functioning, results in body function impairments, causes restrictions in everyday life, and stress. This stress experience can have an additional negative impact on well-being and health of persons with SCD. Stress reduction is therefore an important aim in order to achieve and maintain health in SCD. Strengthening internal resources of a person can support this endeavor. OBJECTIVE: To describe the role of internal resources for stress reduction as rehabilitation target in the context of interdisciplinary clinical rehabilitation of SCD using ICF-based rehabilitation management tools. METHODS: Single Case Study. RESULTS: Strengthening internal resources contributed to stress reduction in the rehabilitation of a person with SCD. Active involvement in decision taking increased the patient's perceived self-determination and reduced stress. Impairments in urination function remained a major stressor and negatively affected the patient's self-esteem. ICF-based documentation tools highlighted the role of internal resources, stress and functioning in rehabilitation management. CONCLUSION: Internal resources should be strengthened when aiming at stress reduction in a patient with SCD. ICF-based documentation tools support this undertaking.

Capturing the psychologic-personal perspective in spinal cord injury.

OBJECTIVE: The overall objective of this study was to illustrate a systematic approach for capturing the psychologic-personal perspective in International Classification of Functioning, Disability and Health-based comprehensive research on spinal cord injury (SCI) in terms of what and how to measure. The specific aims were to identify (1) relevant areas of research for capturing the psychologic-personal factors in a study that is planned and conceptualized according to the comprehensive context of the International Classification of Functioning, Disability and Health, using SCI as a case in point; (2) a set of domains relevant for SCI research from a psychologic-personal perspective; and (3) suitable measurement instruments that can be considered for the assessment of those identified domains based on a set of predefined guiding principles. DESIGN: The psychologic-personal factor structure was developed based on an item pool of 1246 entries from secondary analyses of available data from SCI studies. The domain set for psychologic-personal factors was identified through reviewing the scientific literature in PubMed and PsycInfo. The set of measurement instruments was collected using available measurement reviews, searches in the literature, instrument databases, and further sources and was selected using guiding principles. RESULTS: Forty specific psychologic-personal factors, subdivided into seven areas of research, were identified: (1) sociodemographic personal characteristics, (2) the position in the immediate social and physical context, (3) personal history and biography, (4) feelings, (5) thoughts and beliefs, (6) motives, and (7) patterns of experience and behavior. The psychologic-personal factors domain set contains both cross-cutting outcome domains, namely quality-of-life, life satisfaction, subjective well-being, and sociodemographic personal characteristics, life events, positive and negative affect, perceived stress, locus of control, self-efficacy, purpose in life, coping, lifestyle, and personality. For each of the identified domains, a pool of measurement instruments was listed, and the application of predefined guiding principles for measurement instrument selection was exemplified for self-efficacy. It resulted in the selection of the General Self-Efficacy Scale by Schwarzer and Jerusalem (Measures in Health Psychology: A User's Portfolio. Causal and Control Beliefs. pp. 35-37; 1995). CONCLUSIONS: The results of the current article contributed to creating a transparent protocol for the Swiss Spinal Cord Injury Cohort study, coordinated by the Swiss Paraplegic Research in Nottwil, Switzerland. This article also stresses the relevance of the comprehensive approach to SCI and the consideration of the psychologic-personal perspective in this approach. The study, therefore, hopes to encourage scientists to use the International Classification of Functioning, Disability and Health and the psychologic-personal perspective as a frame of reference for their research. Furthermore, the research reported in this article can inform the World Health Organization's future development of the personal factors classification in the International Classification of Functioning, Disability and Health.

The Personal Factors of the International Classification of Functioning, Disability and Health in the literature - a systematic review and content analysis.

PURPOSE: This review provides an overview of the literature on the conceptualisation of the Personal Factors (PF) component of the International Classification of Functioning, Disability and Health (ICF). METHOD: A systematic literature review was carried out. Electronic searches were performed in Pubmed, Embase, PsycINFO, CINAHL and SSCI. Qualitative content analysis of statements about PF was conducted using inductive coding. RESULTS: The searches yielded 353 citations, 79 papers were eligible for analyses. Five hundred thirty-eight statements about PF were extracted, condensed and coded. Beside conceptual statements, 238 examples of potential PF as well as five attempts at classifying PF were found in the literature. PF were considered in relation to clinical service provision, assessment and intervention, in research and social security contexts. PF were seen to be related to various aspects of health, functioning, disability and the environment. CONCLUSIONS: The analysis of the literature shows that PF is seen as relevant to the application of the ICF in various settings. The review revealed a need for standardisation of PF. The literature points to the potential of PF in enhancing the understanding of functioning, disability and health, in facilitating interventions and services for people with disabilities, and strengthening the perspective of individuals in the ICF.