Exploration of some personal factors with the International Classification of Functioning, Disability and Health Core Set for Stroke

Objective: The aim of this study was to explore the influence of personal factors (i.e. age, gender, place of residence and time since onset of stroke) on self-perceived functioning and environmental factors, using the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke (extended version) as a framework. Design: Cross-sectional study. Participants: A total of 243 community-dwelling persons (53% men) with prior stroke (6 months to 13 years) with a mean age of 68 years (age range 24-95 years). Methods: Regression analysis of 4 personal factors (age, gender, place of residence, and time since onset of stroke) was used to explore their influence on different components, domains and categories of functioning and environmental factors, evaluated with the extended version of the Comprehensive ICF Core Set for Stroke. Results: The personal factors had statistically significant predictive values for almost all the categories, domains and components of functioning and environmental factors examined in this study. These factors influence self-perceived functional outcome and environmental factors in terms of being barriers or facilitators in various ways. Conclusion: Personal factors, such as age, gender, place of residence and time since onset of stroke, influence self-perceived functioning and environmental factors.publishersversionPeer reviewe

Applying Comprehensive International Classification of Functioning Disability and Health

Abstract Stroke is the second most common cause of death worldwide and the most common cause of long-term disability in adults. Disability following stroke results from the interaction between persons with impairments and environmental barriers that hinder full participation in society. The International Classification of Functioning, Disability and Health (ICF) is intended to standardize the assessment of functioning of individuals in everyday life. To facilitate the use of the ICF in clinical practice purpose specific category-lists as Comprehensive ICF Core Sets for stroke were developed. The overall aim of this research project was to explore if the Comprehensive ICF Core Set for Stroke could serve as a basis for understanding the person with previous stroke perspective on functioning problems in daily activities. The face validity of the Comprehensive ICF Core Set for stroke was explored in study I and II by individual interviews in two different environments (in Sweden and in Finland). In study III the construct validity of the Comprehensive ICF Core Set for stroke was explored by the distribution of patient-reported item scores from the Stoke Impact Scale with respect to the ICF category scores linked to SIS items assessed by health-professionals. In study IV the influence of personal factors (PF) age, gender, place of residence and time since onset of stroke on self-perceived functioning was explored using the Comprehensive ICF Core Set for stroke as a framework. A total of 357 community-dwelling persons (45 % women) with previous stroke participated in studies I to IV. The face validity of the Comprehensive ICF Core Set for stroke was largely confirmed in study I and II. The construct validity of most of the ICF categories linked to SIS items was supported by the findings. The health professionals did not capture the magnitude of patient-reported emotional or social participation problems among the participants in study III. The selected personal factors had statistically significant predictive values for almost all the categories, domains and components of functioning and environmental factors examined. Conclusion: The results support the assumption that the categories included in the Comprehensive ICF Core Set for stroke represent the typical spectrum of functioning problems among people with previous stroke. In conclusion, the use of the Comprehensive ICF Core Set for stroke can provide a wider perspective of and a systematic coding system for understanding the needs of persons with previous stroke and has the potential to be used in the development of measures used in the assessment of stroke related functioning problems and stroke rehabilitation ultimately leading to better person centred care and outcomes. Keywords: Stroke, ICF, Core Set, person perspective, validation

Functioning and Disability in Community-Living People with Perceived Cognitive Impairment or Dementia: A Mixed Methods Study using the World Health Organization Disability Assessment Schedule

Objective: To explore how community-living people with perceived cognitive impairment or dementia and their next-of-kin perceive functioning and disability in major life domains. Methods: Individual interviews guided by the World Health Organization Disability Assessment Schedule (WHODAS 2.0) were conducted with 26 people with perceived cognitive impairment or dementia (age range 38–87 years) and 26 next-of-kin. Qualitative content analysis- and International Classification of Functioning, Disability, and Health (ICF) linking methods were used to analyse the transcripts. The perceived degree of disability in daily functioning was calculated and compared between people with perceived cognitive impairment or dementia and next-of-kin, using a Mann–Whitney U test. Results: A total of 38 of 47 (81%) established ICF categories corresponding to WHODAS items and 38 additional International Classification of Functioning, Disability, and Health (ICF) categories describing participants perceived cognitive and physical impairments, activity limitations and participation restrictions in interaction with the environmental factors were confirmed from the transcripts. The perceived disability of people with perceived cognitive impairment or dementia was scored higher by next-of-kin (48%) than by people with perceived cognitive impairment or dementia (16%, p < 0.0001). Conclusion: Interviews provided a comprehensive picture of participants’ perceived activity limitations and participation restrictions in the life domains cognition, mobility, self-care, getting along, life activities, and participation. For a better understanding of the impact of cognitive impairment on people’s daily lives, inclusion of the perspective of the next-of-kin and the factors that hinder or facilitate daily living in the community setting is necessary. LAY ABSTRACT Dementia is one of the leading causes of disability in Sweden, and most of the people with dementia and those with perceived cognitive impairment, i.e. persons not diagnosed with dementia, live at home. A comprehensive understanding of their needs is required in order to develop dementia care in the community. The aim of this study was to explore what kind of difficulties community-living people with perceived cognitive impairment or dementia and their next-of-kin perceive in their daily lives. Twenty-six people with perceived cognitive impairment or dementia and their next-of-kin were interviewed in their homes, and the perceived degree of difficulties was compared between the 2 groups. The interviews provided a broad picture of how people with perceived cognitive impairment or dementia and nextof-kin perceive difficulties in their daily lives. The nextof-kin perceived the difficulties as greater than did the persons with dementia. For a better understanding of the impact of dementia on people’s daily lives, inclusion of the perspective of the next-of-kin and the factors that hinder or facilitate daily living in the community setting are necessary