Environmental factors: a systematic review of instruments and content analysis using the International Classification of Functioning, Disability and Health

Purpose: This study aims to describe and compare the content of instruments that assess environmental factors (EF) using the International Classification of Functioning, Disability and Health (ICF). Relevance: Assessing the impact of EF on patients' functioning is an important part of the rehabilitation process. Physiotherapists need to know which instruments assess EF, which EF these instruments assess and which methodology of assessment they use, in order to choose the appropriate instrument. The ICF provides a universal framework that can be used to describe and compare the health of patients and that serves as a reference for the documentation in physiotherapy. Therefore it can be used to characterise existing instruments. Participants: Not applicable. Methods: A systematic search of 3 databases (PubMed, CINAHL and PEDro) was conducted to identify all instruments that assess EF. Combinations of the following key words were used without language restriction: environment, factors, components, barriers to participation, facilitators to participation, International Classification of Functioning, Disability and Health, social participation. Two investigators independently screened all instruments identified, which were included if developed for adults, addressed more than one 2nd level category of any of the 5 Chapters on EF and not specific to a health condition. Analysis: Included instruments had their content examined independently by 2 investigators that identified all meaningful concepts and linked them to the most precise ICF category according to published rules. Percentage agreement between the 2 investigators varied between 84% and 95%. Results: 8 instruments met the inclusion criteria containing 558 meaningful concepts linked to 2nd or 3rd level ICF categories from one of the 5 EF chapters (1. Products and technology, 2. Natural Environment, 3. Support and relationships, 4. Attitudes, 5. Services, systems and policies). 5/8 instruments cover all the 5 chapters; 1/8 instrument covers 4/5 chapters (1, 3-5); 1/8 instrument covers chapters 1 and 2 and 1/8 instrument covers chapter 1 only. 5/8 instruments had between 61% and 100% of their items linked to categories in Chapter 1. In contrast, the highest percentage of items from one instrument linked to categories in Chapter 2 was11%, Chapter 3 was 30%, Chapter 4 was 20% and Chapter 5 was 49%. 3/8 instruments assessed whether EF were present or absent in a specific context, 3/8 assessed the intensity of EF' impact and 2/8 assessed the intensity and frequency of the EF' impact. Conclusions: Instruments assessing EF differ in their content and type of assessment and have several items linked to the same ICF category. Most instruments are designed to assess primarily products and technology (Chapter 1) and only a minority assesses the intensity and frequency of EF' impact, which is of great relevance to rehabilitation. Different instruments are needed that assess the intensity and frequency of EF' impact and that use ICF categories as the items for assessment. Implications: The results of this study can guide physiotherapists in clinical practice and research in selecting an appropriate EF instrument for a specific purpose

CIF: Metodologias de Avaliação

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), publicada pela OMS em 2001, tem como objectivos gerais proporcionar uma linguagem unificada e padronizada e uma estrutura de trabalho para a descrição da saúde e de estados relacionados com a saúde. A CIF é uma ferramenta com grande potencial, mas apresenta alguma complexidade de utilização e ainda a limitação de não possuir metodologias de avaliação padronizadas. A presente comunicação compõe-se de quatro partes que visam contextualizar a CIF e identificar algumas questões que é necessário aprofundar. Na primeira, Modelos Históricos, faz-se uma resenha histórica da evolução dos modelos explicativos do conceito de incapacidade e dos conceitos associados à CIF. Na segunda, Problemas na Utilização da CIF, elencamos um conjunto de dificuldades que é premente resolver. Na terceira parte, Estratégias de Medição, referem-se algumas estratégias utilizadas na operacionalização da CIF. Finalmente, na última parte, Contributos para um Modelo de Avaliação, apresenta-se o trabalho dos autores no âmbito da medição de acordo com a CIF. i) Modelos Históricos: - Evolução dos indicadores de saúde, dos modelos de avaliação das consequências dos problemas de saúde, dos conceitos de incapacidade, de desvantagem e da avaliação da funcionalidade (do modelo hierárquico ao modelo CIF). ii) Problemas na Utilização da CIF - Inexistência de instrumentos de medição padronizados. - Não normalização da terminologia relacionada com as condições de saúde. - Inexistência de transposição automática do registo clínico para a codificação CIF. - Dificuldades na valorização dos factores contextuais: a influência dos factores pessoais não está contemplada e ainda está pouco desenvolvido o estudo dos factores ambientais e do seu impacto no desempenho da pessoa. - Dificuldade no tratamento dos resultados obtidos. iii) Estratégias de Medição - Mapeamento de instrumentos já existentes com as categorias da CIF. - Desenvolvimento de core sets (categorias significativas) contendo qualificadores por observação, entrevista e consulta do processo clínico. - Desenvolvimento de instrumentos específicos por patologia ou por áreas da CIF. iv) Contributos para um Modelo de Avaliação - Critérios de avaliação que englobam três componentes para a definição do nível de codificação (0 a 4) tal como proposto na CIF: o grau (i.e. a intensidade); a interferência na vida diária; o número de dias que esteve presente nos últimos trinta dias. - Construção do padrão diário de actividades da pessoa, englobando diferentes grupos de ocupação para minimizar o erro na decisão do nível de codificação. - Definição de perguntas-chave para cada categoria, baseadas na descrição da CIF. - Tratamento consistente e normalizado de resultados. - Validação desta nova metodologia que pode servir as várias categorias da CIF (funções e estruturas do corpo, actividades e participação, e factores ambientais)

Assessing the Adequacy of the Physical, Social and Attitudinal Environment to the Specific Needs of Young Adults with Cerebral Palsy: the European Adult Environment Questionnaire

Objectives: To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP). Design: Cross-sectional. Setting: Administrative regions in France, Germany, Italy, Portugal, and Sweden. Participants: Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20). Interventions: Not applicable. Main Outcome Measure(s): Physical, social, and attitudinal environment unmet needs. Results: Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants’ needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment. Conclusion: The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framewor

Measurement properties of the Portuguese version of Pulmonary Functional Status and Dyspnea Questionnaire - modified version (PFSDQ-M) and the Canadian Occupational Performance Measure (COPM) in interstitial lung disease

Introduction and objectives: There are several instruments to assess functional status, however, their measurement properties for specific populations are often unknown. The aim of this study was to assess the reliability and validity of the Pulmonary Functional Status and Dyspnea Questionnaire - modified version (PFSDQ-M) and the Canadian Occupational Performance Measure (COPM) for Portuguese adults with interstitial lung disease (ILD). Methods: An observational study was conducted with people with ILD. Sociodemographic and clinical data [lung function and 6-minute walk test (6MWT)] were retrieved from participants’ medical notes. At baseline, the PFSDQ-M, the COPM, the St. George’s Respiratory Questionnaire for idiopathic pulmonary fibrosis (SGRQ-I) and the London Chest Activities of Daily Living (LCADL) were first collected face-to-face, in an interview form. PFSDQ-M and COPM were repeated 48h-72h after by two raters, via phone call. Reliability measures included Cronbach’s to test internal consistency, intraclass correlation coefficient (ICC2,1) and respective 95% confidence intervals (95%CI) for test-retest/intra-rater and inter-rater reliability, Bland & Altman 95% limits of agreement (95%LoA), standard error of measurement (SEM) and minimal detectable change (MDC95) for test-retest measurement error. For COPM, two raters classified all activities mentioned by the International Classification of Functioning, Disability and Health (ICF) second level classification. Interrater agreement was assessed through Cohen’s kappa. Validity was assessed with the Spearman correlation coefficient (rho): criterion validity between LCADL and PFSDQ-M and COPM, and construct/ divergent validity between lung function, 6MWT, SGRQI and PFSDQ-M and COPM. Floor and ceiling effects were explored and considered existing If more than 15% of participants were at the maximum or minimum score. Results: 167 people with ILD (64 ± 14 years old; 49% male; FVCpp 87 ± 20; DLCOpp 62 ± 21) participated. PFSDQ-M showed excellent internal consistency (= 0.92 a = 0.97), good test-retest and interrater reliability (ICC2,1 = 0.76-0.87, 95%CI [0.65,0.91] and ICC2,1 = 0.84-0.87, 95%CI [0.75,0.92], respectively), and good agreement between moments (mean = 7.47, LC95% [-46.06, 61.00]) and raters (mean = -0.24; LC95% [-52.63; 52.14]), without evidence of systematic bias. SEM and MDC95 ranged from 0.56-2.38 e 1.56-6.60, respectively. Correlations between PFSDQ-M and: SGRQ-I and LCADL were significant, positive, and moderate to high (= 0.59 to 0.82, p < 0.01; lung function and 6MWT were significant, negative, and small to moderate (= -0.23 a -0.44; p < 0.01). COPM showed good to excellent test-retest/intra-rater and inter-rater (ICC2,1 = 0.78- 0.86, 95%CI [0.66,0.91] and ICC2,1 = 0.73-0.92, 95%CI [0.58,0.95], respectively) reliability, and good agreement between moments (mean = -0.07 e - 0.33; LC95% [-2.12; 1.98] and [-3.32; 2.66]) and raters (mean = -0.04 e -0.29; LC95% [-1.42; 1.35] and [-3.27; 2.69]) for total scores, without evidence of systematic bias. SEM and MDC95 ranged from 0.25-0.32 and 0.70-0.88, respectively. Interrater agreement for the COPM’s classification using ICF two-level was almost perfect (k = 0.86). Correlations between COPM and: SGRQ-I and LCADL were significant, negative, and moderate (= -0.47 to -0.65, p < 0.01); lung function and 6MWT were non- significant (p < 0.05), except for performance and 6MWT distance, FEV1 e FVC (= 0.26 to 0.36, p < 0.01) and for satisfaction and FEV1 and FVC (= 0.22 and 0.24, p < 0.05). Floor effects were found in PFSDQ-M. Conclusions: PFSDQ-M and COPM have good reliability and validity indicators to assess HRQoL in Portuguese adults with ILD.publishe

Measurement properties of the Portuguese version of the Kings’s Brief Interstitial Lung Disease (KBILD) in interstitial lung disease

Introduction and objectives: People with interstitial lung diseases (ILD) present a decline in functional status and health-related quality of life (HRQoL). There are several instruments to assess these patient-centered outcomes, however, their measurement properties for specific populations are often unknown. The aim of this study was to assess the reliability and validity of the King’s Brief Interstitial Lung Disease (KBILD) for Portuguese adults with ILD. Methods: An observational study was conducted with people with ILD recruited from routine pulmonology appointments. Sociodemographic and clinical data [lung function and 6-minute walk test (6MWT)] were retrieved from participants’ medical notes and/or gathered with a structured specific questionnaire. At baseline, the KBILD, the St. George’s Respiratory Questionnaire for idiopathic pulmonary fibrosis (SGRQ-I) and the London Chest Activities of Daily Living (LCADL) were first collected face-to-face, in an interview form. The KBILD was repeated 48h-72h after, via phone call, by two raters (2nd moment and 2nd rater). Reliability measures included Cronbach’s to test internal consistency, intraclass correlation coefficient (ICC2,1) and respective 95% confidence intervals (95%CI) for test-retest and interrater reliability, Bland & Altman 95% limits of agreement (95%LoA) to test the agreement, standard error of measurement (SEM) and minimal detectable change (MDC95) for test-retest measurement error. Validity was assessed with the Spearman correlation coefficient (rho): criterion validity between SGRQ-I and KBILD and construct/divergent validity between lung function, 6MWT and KBILD and between LCADL and KBILD. Floor and ceiling effects were explored by quantifying the number of participants who scored at the maximum (ceiling) or at the minimum (floor) of each questionnaire. If more than 15% were at the maximum or minimum, the questionnaire was considered to have ceiling or floor effect, respectively. Results: 167 people with ILD (63.6 ± 13.8 years old; 48.5% male; FVCpp 86.5 ± 19.7; DLCOpp 61.7 ± 21.0) participated. KBILD showed good to excellent internal consistency (= 0.74 for chest symptoms, = 0.87 for breathlessness and activities, = 0.89 for psychological and = 0.92 for total score), good to excellent test-retest (ICC2,1 = 0.79, 95%CI [0.70;0.85] for chest symptoms, ICC2,1 = 0.83, 95%CI [0.76;0.88] for breathlessness and activities, ICC2,1 = 0.78, 95%CI [0.67;0.86] for psychological and ICC2,1 = 0.83, 95%CI [0.73;0.89] for total score) and inter-rater (ICC2,1 = 0.95, 95%CI [0.92;0.97] for chest symptoms, ICC2,1 = 0.89, 95%CI [0.83;0.93] for breathlessness and activities, ICC2,1 = 0.89, 95%CI [0.82;0.93] for psychological, and ICC2,1 = 0.93, 95%CI [0.88;0.95] for total score) reliability, and good agreement between moments (mean = -3.97, 95%LoA [- 24.16;16.21]) and raters (mean = -0.27, 95%LoA [-14.42;13.88]) for total score, without evidence of systematic bias. The SEM and MDC95 were: 0.40 and 1.10 for chest symptoms, 0.57 and 1.59 for breathlessness and activities, 0.46 and 1.29 for psychological, and 1.16 and 3.22 points for total score. Correlations between KBILD and: i) SGRQ-I were significant, negative, and moderate to high (= -0.54 to -0.86; p < 0.01); ii) LCADL were significant, negative, and moderate to high (= -0.47 to -0.71; p < 0.01); iii) lung function and 6MWT were significant, positive, and small to moderate (= 0.23; p < 0.05 to 0.49; p < 0.01). No floor nor ceiling effects were found. Conclusions: KBILD has good reliability and validity indicators to assess HRQoL in Portuguese adults with ILD.publishe

Immediate Effects of Aquatic Therapy on Balance in Older Adults with Upper Limb Dysfunction: An Exploratory Study

Background: Aquatic physiotherapy has been shown to be effective in developing balance, strength, and functional reach over time. When dealing with immediate effects, the literature has concentrated more on the body&rsquo;s physiological response to the physical and mechanical properties of water during passive immersion. The purpose of this study was to evaluate the effects of a single 45-min active aquatic physiotherapy session on standing balance and strength, and its relationship with functional reach in persons 55 years and older with upper limb dysfunction. Methods: The intervention group (n = 12) was assessed before and after a single aquatic physiotherapy session, while the control group (n = 10) was evaluated before and after 45 min of sitting rest. Functional assessment was made using the visual analogue pain scale (points), step test (repetitions), functional reach test (cm), and global balance-standing test on a force platform (% time). A two-way repeated-measures ANOVA was applied (p &lt; 0.05). Results: The intervention group showed non-significant improvements between measurement before and after the intervention: Pain: 6.2 &plusmn; 1.9 vs. 5.2 &plusmn; 2.3 cm, steps: 7.0 &plusmn; 2.0 vs. 7.4 &plusmn; 1.8 repetitions, reach: 9.1 &plusmn; 2.8 vs. 10.4 &plusmn; 3.8 cm, and balance: 61.7 &plusmn; 5.9 vs. 71.3 &plusmn; 18.2% time in balance on the platform. The control group showed fewer changes but had better baseline values. A comparison between groups with time showed no significant differences in these changes. Conclusions: No significant immediate effects were found for one session of aquatic physiotherapy applied to patients older than 55 years with upper limb dysfunction