Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine

Since its launch in 2001, relevant international, regional and national PRM bodies have aimed to implement the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine (PRM), whereby contributing to the development of suitable practical tools. These tools are available for implementing the ICF in day-to-day clinical practice, standardized reporting of functioning outcomes in quality management and research, and guiding evidence-informed policy. Educational efforts have reinforced PRM physicians' and other rehabilitation professionals' ICF knowledge, and numerous implementation projects have explored how the ICF is applied in clinical practice, research and policy. Largely lacking though is the system-wide implementation of ICF in day-to-day practice across all rehabilitation services of national health systems. In Europe, system-wide implementation of ICF requires the interaction between practice, science and governance. Considering its mandate, the UEMS PRM Section and Board have decided to lead a European effort towards system-wide ICF implementation in PRM, rehabilitation and health care at large, in interaction with governments, non-governmental actors and the private sector, and aligned with ISPRM's collaboration plan with WHO. In this paper we present the current PRM internal and external policy agenda towards system-wide ICF implementation and the corresponding implementation action plan, while highlighting priority action steps - promotion of ICF-based standardized reporting in national quality management and assurance programs, development of unambiguous rehabilitation service descriptions using the International Classification System for Service Organization in Health-related Rehabilitation, development of Clinical Assessment Schedules, qualitative linkage and quantitative mapping of data to the ICF, and the cultural adaptation of the ICF Clinical Data Collection Tool in European languages

Education of physical and rehabilitation medicine specialists across Europe: a call for harmonization

Physical and rehabilitation medicine (PRM) is well established in Europe and officially recognized by the European Union of Medical Specialists (UEMS). The European PRM Board works to promote patient safety and quality of care through the development of the highest standards of medical training and healthcare across Europe as well as the harmonization of PRM specialists' qualifications. In its Action Plan for 2014-2018, the UEMS PRM Board has included the harmonization of the PRM curriculum among the EU countries, as one of its main goals. Based on a European Directive, the Belgian Superior Council is envisaging a reform of the PRM curriculum

Education of physical and rehabilitation medicine specialists across Europe: a call for harmonization

Physical and rehabilitation medicine (PRM) is well established in Europe and officially recognized by the European Union of Medical Specialists (UEMS). The European PRM Board works to promote patient safety and quality of care through the development of the highest standards of medical training and healthcare across Europe as well as the harmonization of PRM specialists' qualifications. In its Action Plan for 2014-2018, the UEMS PRM Board has included the harmonization of the PRM curriculum among the EU countries, as one of its main goals. Based on a European Directive, the Belgian Superior Council is envisaging a reform of the PRM curriculum

Fostering the highest educational standards in Physical and Rehabilitation Medicine: the European PRM board strategy for ensuring overall quality of rehabilitation education and care

The harmonization of staff education is a key element for ensuring the highest standard of rehabilitation care across Europe. With this aim, the European Union of Medical Specialists (UEMS) has created a Common Training Framework, which consists of a common set of knowledge, skills and competencies for postgraduate medical training. As a body linked to the Physical and Rehabilitation (PRM) Section of the UEMS, the European PRM Board is committed to promoting the harmonization of PRM physicians' qualifications. The European PRM Board accomplishes this mission, not only by determining the theoretical knowledge necessary for the practice of the PRM specialty, and the core competencies (training outcomes) to be achieved at the end of training, but also by ascertaining that a standard level of education is achieved and maintained by PRM physicians, through a medically driven system of certification. This paper provides an overview of the methodology and outcomes of the European PRM Board examination, while showing how the approach to PRM education should be considered as a reference point by scientific societies, higher education institutions, health policymakers, patients' associations, and all the other bodies caring for high-quality rehabilitation provision to disabled people, at the national and European level

Evidence based position paper on physical and rehabilitation medicine (PRM) professional practice for people with respiratory conditions. The European PRM position (UEMS PRM Section)

Chronic respiratory conditions are among the top causes of death and disability

Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey.

BackgroundAs the European population with Spinal Cord Injury (SCI) is expected to become older, a better understanding of ageing with SCI using functioning, the health indicator used to model healthy ageing trajectories, is needed. We aimed to describe patterns of functioning in SCI by chronological age, age at injury and time since injury across eleven European countries using a common functioning metric, and to identify country-specific environmental determinants of functioning.MethodsData from 6'635 participants of the International Spinal Cord Injury Community Survey was used. The hierarchical version of Generalized Partial Credit Model, casted in a Bayesian framework, was used to create a common functioning metric and overall scores. For each country, linear regression was used to investigate associations between functioning, chronological age, age at SCI or time since injury for persons with para- and tetraplegia. Multiple linear regression and the proportional marginal variance decomposition technique were used to identify environmental determinants.ResultsIn countries with representative samples older chronological age was consistently associated with a decline in functioning for paraplegia but not for tetraplegia. Age at injury and functioning level were associated, but patterns differed across countries. An association between time since injury and functioning was not observed in most countries, neither for paraplegia nor for tetraplegia. Problems with the accessibility of homes of friends and relatives, access to public places and long-distance transportation were consistently key determinants of functioning.ConclusionsFunctioning is a key health indicator and the fundament of ageing research. Enhancing methods traditionally used to develop metrics with Bayesian approach, we were able to create a common metric of functioning with cardinal properties and to estimate overall scores comparable across countries. Focusing on functioning, our study complements epidemiological evidence on SCI-specific mortality and morbidity in Europe and identify initial targets for evidence-informed policy-making

Fig 4 -

a. Trends of functioning scores by type since injury groups and type of injury in countries with representative samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of 1 person. b. Trends of functioning scores by time since injury groups and type of injury in countries with convenience samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown).</p

Basic sociodemographic and lesion characteristics of European country study participants by collaborating country.

Basic sociodemographic and lesion characteristics of European country study participants by collaborating country.</p

Fig 3 -

a. Trends of functioning scores by age at SCI groups and type of injury in countries with representative samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of 1 person. b. Trends of functioning scores by age at SCI groups and type of injury in countries with convenience samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of 1 person.</p

Fig 5 -

a. Relative importance of each environmental factors in explaining the total variation of functioning scores in countries with representative samples, when controlling for chronological age and type of injury. For each country, the full model variation when considering EFs and chronological age and type since injury as predictors is indicated in each country figure’s title. b. Relative importance of each environmental factors in explaining the total variation of functioning scores countries with convenience samples, when controlling for chronological age and type of injury. For each country, the full model variation when considering EFs and chronological age and type since injury as predictors is indicated in each country figure’s title.</p