Operationalization and reliability testing of ICF categories relevant for physiotherapists' interventions in the acute hospital

Objective: To operationalize items based on categories of the International Classification of Functioning, Disability and Health (ICF) relevant to patient problems that are addressed by physiotherapeutic interventions in the acute hospital, and to test the reliability of these items when applied by physiotherapists. Methods: A selection of 124 ICF categories was operationalized in a formal decision-making and consensus process. The reliability of the newly operationalized item list was tested with a cross-sectional study with repeated measurements. Results: The item writing process resulted in 94 dichotomous and 30 polytomous items. Data were collected in a convenience sample of 28 patients with neurological, musculoskeletal, cardiopulmonary, or internal organ conditions, requiring physical therapy in an acute hospital. Fifty-six percent of the polytomous and 68% of the dichotomous items had a raw agreement of 0.7 or above, whereas 36% of all polytomous and 34% of all dichotomous items had a kappa coefficient of 0.7 and above. Conclusion: The study supports that the ICF is adaptable to professional and setting-specific needs of physiotherapists. Further research towards the development of reliable instruments for physiotherapists based on the ICF seems justified. Key words: ICF; classification; reliability; outcome measures; health status assessment

Patients' functioning as predictor of nursing workload in acute hospital units providing rehabilitation care: a multi-centre cohort study

<p>Abstract</p> <p>Background</p> <p>Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite of the patients' individual health status, particularly with respect to functioning status, individual need for nursing care, and severity of symptoms. The International Classification of Functioning, Disability and Health (ICF) and the derived subsets, the so-called ICF Core Sets, are a standardized approach to describe patients' functioning status. The objectives of this study were to (1) examine the association between patients' functioning, as encoded by categories of the Acute ICF Core Sets, and nursing workload in patients in the acute care situation, (2) compare the variance in nursing workload explained by the ICF Core Set categories and with the Barthel Index, and (3) validate the Acute ICF Core Sets by their ability to predict nursing workload.</p> <p>Methods</p> <p>Patients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression.</p> <p>Results</p> <p>In patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%).</p> <p>Conclusions</p> <p>A substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial.</p

Gender differences in patients with dizziness and unsteadiness regarding self-perceived disability, anxiety, depression, and its associations

BACKGROUND: It is known that anxiety and depression influence the level of disability experienced by persons with vertigo, dizziness or unsteadiness. Because higher prevalence rates of disabling dizziness have been found in women and some studies reported a higher level of psychiatric distress in female patients our primary aim was to explore whether women and men with vertigo, dizziness or unsteadiness differ regarding self-perceived disability, anxiety and depression. Secondly we planned to investigate the associations between disabling dizziness and anxiety and depression. METHOD: Patients were recruited from a tertiary centre for vertigo and balance disorders. Participants rated their global disability as mild, moderate or severe. They filled out the Dizziness Handicap Inventory and the two subscales of the Hospital Anxiety Depression Scale (HADS). The HADS was analysed 1) by calculating the median values, 2) by estimating the prevalence rates of abnormal anxiety/depression based on recommended cut-off criteria. Mann-Whitney U-tests, Chi-square statistics and odds ratios (OR) were calculated to compare the observations in both genders. Significance values were adjusted with respect to multiple comparisons. RESULTS: Two-hundred and two patients (124 women) mean age (standard deviation) of 49.7 (13.5) years participated. Both genders did not differ significantly in the mean level of self-perceived disability, anxiety, depression and symptom severity. There was a tendency of a higher prevalence of abnormal anxiety and depression in men (23.7%; 28.9%) compared to women (14.5%; 15.3%). Patients with abnormal depression felt themselves 2.75 (95% CI: 1.31-5.78) times more severely disabled by dizziness and unsteadiness than patients without depression. In men the OR was 8.2 (2.35-28.4). In women chi-square statistic was not significant. The ORs (95% CI) of abnormal anxiety and severe disability were 4.2 (1.9-8.9) in the whole sample, 8.7 (2.5-30.3) in men, and not significant in women. CONCLUSIONS: In men with vertigo, dizziness or unsteadiness emotional distress and its association with self-perceived disability should not be underestimated. Longitudinal surveys with specific pre-defined co-variables of self-perceived disability, anxiety and depression are needed to clarify the influence of gender on disability, anxiety and depression in patients with vertigo, dizziness or unsteadiness

Operationalisierung von ICF-Kategorien für physiotherapeutische Interventionen im Akutkrankenhaus

Hintergrund: Im Akutkrankenhaus spielen Physiotherapeuten eine Schlüsselrolle bei der Behandlung der Funktionsfähigkeit akut erkrankter Menschen. Um die funktionsorientierten Ziele der physiotherapeutischen Intervention festzulegen und die Ergebnisse interdisziplinär zu kommunizieren, sind spezifische Messinstrumente notwendig, die in einem fach- und berufsübergreifenden Rahmen die Patientenprobleme darstellen. Die ICF könnte diesen Rahmen bieten, muss aber in eine passende Form gebracht werden. Ziel: Die Ausprägungsmerkmale von für die Physiotherapie relevanten ICF-Kategorien werden so definiert, dass Physiotherapeuten damit im Akutkrankenhaus beurteilbare Patienteneigenschaften beschreiben können (operationalisieren). Methode: 6 Experten operationalisierten 124 ICF-Kategorien durch einen formalen Entscheidungs- und Konsensusprozess. Anschließend prüften 6 Physiotherapeuten deren Nutzbarkeit an 28 Patienten. Ergebnisse: Auf einer ordinalen Skala wurden 30 und auf einer dichotomen Skala 94 ICF-Kategorien operationalisiert. Die Anwendung der operationalisierten ICF-Kategorien am Patienten erwies sich als unproblematisch. Schlussfolgerungen: ICF-Kategorien können für Physiotherapeuten nutzbar operationalisiert werden. Für die Entwicklung eines validen und reliablen Messinstruments sind weitere Untersuchungen notwendig

The ICF as a way to specify goals and to assess the outcome of physiotherapeutic interventions in the acute hospital

Objective: The aim of this study was to demonstrate the use of the International Classification of Functioning, Disability and Health (ICF) to measure the effect of physiotherapy treatment. Design: A prospective cohort study with an additional case report. Patients: Individuals were eligible for the study if they were patients at the University Hospital of Zurich and had received physiotherapeutic interventions during their inpatient stay. Methods: Patient’s functioning was assessed by physiotherapists at initiation of physiotherapeutic treatment and at discharge using ICF Core Sets. Results: A total of 425 patients were analysed, mean age 60 years, 42% female. The median of treatment days varied between 4 (intensive care unit) and 19 (low back pain). The majority of patients had improved or stable results; improvement was most prominent in the surgical and internal medicine group. The ICF category d450 “Walking” appears in 4 out of 6 ICF Core Sets, being only infrequently treated in intensive care unit and low back pain. Conclusion: Analysis showed that the ICF can be used to record precise information on patients’ functioning in the acute hospital. Typical impairments and restrictions, intervention goals and trajectories of functioning could be documented. The qualifiers used in our clinical example were sensitive to change. Definitions of qualifiers, however, should be the subject of further research. Key words: ICF; physiotherapy; physical therapy; goals; outcome assessment; classification

Translation, cross-cultural adaptation and reliability of the German version of the dizziness handicap inventory

To translate the Dizziness Handicap Inventory into German (DHI-G) and investigate reliability, assess the association between selected items of the University of California Los Angeles Dizziness Questionnaire and the DHI-G, and compare the scores of patients and healthy participants. STUDY DESIGN:: Cross-sectional design. SETTING:: Tertiary center for vertigo, dizziness, or balance disorders. PATIENTS:: One hundred forty-one patients with vertigo, dizziness, and unsteadiness associated with a vestibular disorder, with a mean age (standard deviation) of 51.5 (13.2) years, and 52 healthy individuals participated. INTERVENTIONS:: Fourteen patients participated in the cognitive debriefing; 127 patients completed the questionnaires once or twice within 1 week. MAIN OUTCOME MEASURES:: The DHI-G assesses disability caused by dizziness and unsteadiness; the items of the University of California Los Angeles Dizziness Questionnaire assess dizziness and impact on everyday activities. Internal consistency was estimated using Cronbach alpha, reproducibility by calculating Bland-Altman limits of agreement and intraclass correlation coefficients. Associations were estimated by Spearman correlation coefficients. RESULTS:: Patients filled out the DHI-G without problem and found that their self-perceived disabilities were mostly included. Cronbach alpha values for the DHI-G and the functional, physical, and emotional subscales were 0.90, 0.80, 0.71, and 0.82, respectively. The limits of agreement were +/-12.4 points for the total scale (maximum, 100 points). Intraclass correlation coefficients ranged from 0.90 to 0.95. The DHI-G correlated moderately with the question assessing functional disability (0.56) and fairly with the questions quantifying dizziness (0.43, 0.35). The DHI-G discriminated significantly between healthy participants and patients. CONCLUSION:: The DHI-G demonstrated good reliability and is recommended as a measure of disability in patients with dizziness and unsteadiness