Do Patient-Reported Outcome Measures describe functioning in patients with low back pain, using the Brief International Classification of Functioning, Disability and Health Core Set as a reference?

OBJECTIVE: To link the items in the Patient-Reported Outcome Measures (PROMs): Roland Morris Disability Questionnaire, Short Form 36 (SF-36) and pain scores, to the Brief International Classification of Functioning, Disability and Health (ICF) Core Set for low back pain, and to examine the extent to which a clinician's assessment of patients' problems according to the Brief ICF Core Set correlates with the scores of matching items from the PROMs. METHODS: The PROMs were linked to the Brief ICF Core Set for low back pain. Secondly, a cross-sectional study was conducted including 70 patients with low back pain. The patients completed the PROMs, and the Brief ICF Core Set for low back pain was assessed by a clinician using qualifiers. RESULTS: The items in the PROMs were successfully linked to the ICF. Twelve of the 38 unique ICF categories derived from the PROMs were covered by the Brief ICF Core Set (34%). A weak correlation was found between the patients' responses and the clinician's assessment. CONCLUSION: The selected PROMs do not cover the prototypical spectrum of problems encountered in patients with low back pain as defined by the Brief ICF Core Set. The clinical assessment of patients' problems according to the Brief ICF Core Set does not correlate with the scores of matching items from the PROMs.

Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context.

We present a systematic review on International Classification of Functioning, Disability and Health (ICF) used in the Nordic countries from 2001 through 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used. A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as "clinical and/or rehabilitation contexts" or "non-clinical contexts". One hundred seventy papers were included, of these 99 papers were from the categories "clinical and/or rehabilitation contexts" or "non-clinical contexts". Forty-two percent of the 170 included papers were published in the period 2011 - 2013. There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories "clinical and/or rehabilitation contexts" and "non-clinical contexts". The most represented focus areas were neurology, musculoskeletal, and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers, and activity was most frequently mentioned.

[Rehabilitation based on the bio-psychosocial model concerns health condition, functioning and contextual factors].

This article describes the core themes in modern rehabilitation and how it can be used in practice. The purpose of rehabilitation is an independent and meaningful life with the greatest possible functional ability. Rehabilitation goals will always be what matters most to the patient (not what health professionals think matters). The doctor's role includes clarification of biomedical issues, but also highlighting resources and barriers in relation to rehabilitation (including practical, economic and social barriers and resources).

Using the International Classification of Functioning, Disability and Health (ICF) to describe the functioning of traumatised refugees.

The aim of this project was to use the International Classification of Functioning, Disability and Health (ICF) to develop an interdisciplinary instrument consisting of a Core Set, a number of codes selected from ICF, to describe the overall health condition of traumatised refugees. We intended to test 1) whether this tool could prove suitable for an overall description of the functional abilities of traumatised refugees before, during and after the intervention, and 2) whether the Core Set could be used to trace a significant change in the functional abilities of the traumatised refugees by comparing measurements before and after the intervention. In 2007, eight rehabilitation centres for traumatised refugees in Denmark agreed on a joint project to develop a tool for interdisciplinary documentation and monitoring, including physical, mental and social aspects of the person's health condition. ICF, developed and approved by WHO in 2001, was found suitable because it offers a common and standardised language and a corresponding frame of reference to describe health and associated conditions in terms of functioning rather than symptoms and diagnosis. Traumatised refugees are in most cases severely affected mentally by the traumas they have been subjected to, physically by injuries suffered during torture and war, psycho-somatically with pain, and socially by cultural uprooting, as well as by social difficulties in the exile community. The rehabilitation perspective thus seems to be more meaningful than the traditional treatment perspective because it takes into account the very complex situation of this group. The aim of the project was to find out whether any functional changes could be monitored using the instrument. The aim was neither to study nor to describe the effect of rehabilitation approaches, such as conditions related to traumatised refugees' networks or environments that might affect the refugees' living conditions. It was also not the intention to discuss the cause of the potential changes of the functional abilities. The project selected a Comprehensive Core Set of 106 codes among 1,464 possible codes (1) used by an interdisciplinary group of international and national experts in rehabilitation of traumatised refugees. The Comprehensive Core Set was furthermore reduced to a Brief Core Set of 32 codes by the interdisciplinary team (key persons) at the centres included in the project. From each centre six clients were randomly selected from those who fulfilled the inclusion criteria. All were scored within a four week period after the start, before any intervention was initiated, and up to a month after the first scoring. The results from this project led us to the conclusion that it is possible to develop an instrument based on the ICF classification. The instrument is useful for a general description of the total health condition (physical and mental functional ability as well as the environmental impact) of traumatized refugees. The tool helps describe changes in the functional abilities used in connection with the preparation of the plan of action. It can also be used to describe the refugees included in the study and their general condition. The ICF Core Set for traumatised refugees has not yet been validated, but the results of the project provide a basis for further development.

[Prehospital treatment of patients with acute exacerbation of chronic pulmonary disease. Before and after introduction of a mobile emergency unit]. / Praehospital behandling af patienter med akut forvaerring af kronisk lungesygdom. Før og efter indførelse af laegeambulance.

INTRODUCTION: A Mobile Emergency Care Unit (MECU), manned by an anaesthesiologist and a member of the ambulance crew, was introduced in the city of Arhus in 1997. Endotracheal intubation is not performed by ambulance personnel in Denmark. The aim of this study was to describe the influence of prehospital treatment given by the MECU on the rate of endotracheal intubation, hospitalisation, and survival rate in patients suffering from acute exacerbation of chronic pulmonary disease. MATERIAL AND METHODS: We examined the data registered for patients with chronic pulmonary disease, who called for an emergency ambulance. The study covered two periods of three months: before the introduction of the MECU (September to November 1996) and after (September to November 1997). RESULTS: The study comprised 139 patients (72 patients before, 67 patients after). The MECU attended 57% of the patients. Endotracheal intubation was performed in eight patients: two before and six patients after, four of whom were intubated on the spot. Owing to the treatment given by the MECU on the spot, fewer patients were hospitalised, i.e. 50 patients (75%) versus 67 patients (93%) (p < 0.01). The survival rates were 76% before and 85% after. DISCUSSION: The MECU was a useful supplement to the ambulance service. The MECU intubated patients with acute exacerbation of pulmonary disease in the case of life-threatening respiratory failure, and in less severe cases treated the patients at home. Thus, prehospital treatment by a physician meant fewer admissions to hospital.