RESUMO
OBJECTIVE: To evaluate how the practice of specialist speech-language pathologists (SLPs) working with young children with cleft palate ± cleft lip (CP±L) maps onto the International Classification of Functioning, Disability, and Health - Children and Youth version (ICF-CY) and consider the functionality of the categories of the ICF-CY for this specialist area of practice. DESIGN: Cross-sectional, qualitative study. SETTING: Semistructured face-to-face interviews were conducted with SLPs working in tertiary-level hospitals, universities, and public clinics. PARTICIPANTS: Six specialist SLPs with 17 to 39 years of experience working with young children with CP±L as researchers and clinicians in Australia, Brazil, Denmark, Ireland, New Zealand, and the United States. MAIN OUTCOME MEASURE(S): Specialists' practices were captured using in-depth, semistructured interviews. Data collected were analyzed by directed content analysis applying the ICF-CY as a coding schema. RESULTS: In total, 4077 data points were coded. Most mapped onto Body Structures (684, 16.8%), Body Functions (906, 22.2%), and Environmental Factors (1626, 39.9%) with less emphasis on Activities and Participation (560, 13.7%). A "best fit" approach was taken to topics that did not map exactly onto categories of the ICF-CY (eg, velopharyngeal insufficiency [VPI]); however, there was not always an ideally suitable category available. CONCLUSIONS: The current study revealed strengths and challenges in categorizing practice within the ICF-CY for children with CP±L, including collaboration with parents and significant others, specificity around speech, language, and articulation, and the different types of VPI. Therefore, future discussion around how best to use the framework with children with CP±L is needed.
Assuntos
Fissura Palatina , Fala , Adolescente , Austrália , Brasil , Pré-Escolar , Estudos Transversais , Avaliação da Deficiência , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Irlanda , Nova Zelândia , Patologistas , EspecializaçãoRESUMO
The International Classification of Functioning, Disability and Health (ICF), approved and recommended by the World Health Organization (WHO), established the beginning of a new era for the patient-oriented clinical practice. Conceived as a clinical, research, statics, social policy and educational tool, the ICF's main objective is to unify and standardize the language used to describe health and its related status, improving communication and facilitating data comparison among professionals from different fields, at an international level. Based on the bio-psycho-social model from the WHO, the different components emerge as a base for the classification of 1454 categories, allowing a description of a functionality or disability profile for individuals and populations. To be able to apply the ICF to the field of rehabilitation, it is necessary to make a selection of its category groups or generic core sets. This would allow a description of the appropriate level of functioning for specific health conditions. Under the ICF's model, the multidisciplinary management, based on the rehabilitation cycle (assessment- goal definition- intervention- evaluation), is implemented in a comprehensive manner, facilitating the understanding and description of levels of functionality/disability, throughout the different stages of the patient's rehabilitation process.
La Clasificación Internacional del Funcionamiento, de la discapacidad y de la salud aprobada y recomendada por la OMS, establece el comienzo de una nueva era en la práctica clínica orientada al paciente. Concebida para ser aplicada como herramienta clínica, de investigación, estadística, política social y educacional. Su principal objetivo es unificar y estandarizar el lenguaje para la descripción de la salud y sus estados relacionado, mejorando la comunicación y facilitando la comparación de datos entre profesionales de los distintos campos a nivel internacional. La CIF se basa en el modelo biopsicosocial de la OMS, del cual surgen sus componentes sobre los que se estructura la clasificación que consta de 1454 categorías, permitiendo describir ampliamente el perfil de funcionamiento o discapacidad de las personas o poblaciones. Para su aplicación en rehabilitación es necesario el empleo de selección de agrupaciones de categorías CIF, Core Sets genéricos, que permiten describir el perfil de funcionamiento apropiado a condiciones de salud específicas; bajo el modelo CIF, el manejo multidisciplinario, basado en el ciclo de rehabilitación (valoración-definición de metas-intervención-evaluación) es llevado a la practica de una manera comprensible, facilitando el entendimiento y la descripción del funcionamiento/discapacidad a lo largo de las distintas etapas del proceso de rehabilitación de los pacientes.