Introduction to Special Section: Advancing the Field of Vocational Rehabilitation with the International Classification of Functioning, Disability and Health (ICF)

Background Work disability is a major burden to individuals and the society. To mitigate this burden, vocational rehabilitation has been at the forefront of facilitating work participation. With the complexity of vocational rehabilitation, we need a unifying framework to capture the essential domains of functioning. The International Classification of Functioning, Disability and Health (ICF) could serve as the common reference and language. The purpose of this special section is to demonstrate the use and benefits of the ICF to stakeholders and advocates of vocational rehabilitation. Methods The project on the ICF Core Set for vocational rehabilitation was conducted in collaboration with national and international organizations. The project consisted of three sequential phases: (1) four development studies, (2) international consensus conference, and (3) testing and validation of the ICF Core Set. Results In the first article, a conceptual definition of vocational rehabilitation based on the ICF is proposed. Findings from the first phase of the project are presented in the following four articles. Our findings reflected a wide range of factors that could influence success (or failure) in vocational rehabilitation. Conclusion This special section has presented five articles in an effort to advance our understanding and measurement of vocational rehabilitation process and outcomes. This special section also illustrates the complexity of the contents of vocational rehabilitation and offers the vocational rehabilitation community the added value of integrating the ICF in practice and researc

Occupational Rehabilitation Policy and Practice in the Philippines: Initiatives and Challenges

Introduction Challenges to occupational rehabilitation or work integration or reintegration which include the socio-political system, poor labour infrastructure, legislation implementation and monitoring limit work participation of an estimated eight million Filipinos with disabilities. This paper aims to present government-level initiatives and ongoing challenges of occupational rehabilitation as a field of practice and research in the Philippines. Methods We performed a review of occupational rehabilitation literature relevant to the Philippines looking at legislation, policies, and practice. Results While several socio-political mechanisms exists, we found no concrete information on the surveillance or distinction of services and their effectiveness provided under occupational rehabilitation and there was also no systemic reporting of the characteristics of the population (persons with disabilities vs. injured workers) requiring those services—despite the effort of the Philippines in adopting a state policy for the total development of persons with disabilities towards gainful employment. Conclusions The dearth of information and literature in occupational rehabilitation is likely related to the scarcity of research in the broader area of occupational safety and health and work disability management in the Philippines. The findings of this study could guide work disability management and address further development of infrastructure in occupational rehabilitation in the Philippine

An International Expert Survey on Functioning in Vocational Rehabilitation Using the International Classification of Functioning, Disability and Health

Background Vocational rehabilitation (VR) is a key process in work disability (WD) management which aims to engage or re-engage individuals to work and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO) can be interfaced with VR but there is a lack of evidence of what ICF contents experts in the field consider. The objective of this study is to survey the experts in the VR field with regard to what factors are considered important to patients participating in VR using the ICF as the language to summarize the results. Methods An internet-based survey was conducted with experts from six WHO Regions (Africa, the Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). Experts were asked six open-ended questions on factors that are important in VR. Each question was related to a component of the ICF (body functions, body structures, activities and, environmental factors, and personal factors). Responses were linked to the ICF. Results Using a modified stratified randomized sampling, 201 experts were sent the survey and 151 experts responded (75% response rate). We identified 101 ICF categories: 22 (21.8%) for body functions, 13 (12.9%) for body structures, 36 (35.6%) for activities and participation, and 30 (29.7%) for environmental factors. Conclusions There was a multitude of ICF functioning domains according to the respondents which indicates the complexity of VR. This expert survey has provided a list of ICF categories which could be considered in V

Factors influencing sustainable employment of persons with acquired brain injury (ABI) or spinal cord injury (SCI): A qualitative study evaluating the perspective of health and work professionals

BackgroundThe number of persons with acquired brain injury (ABI) or spinal cord injury (SCI) who leave the labor market early despite successfully return to work post-injury, demonstrates the challenge for them to remain employed. Evidence on how enabling and hindering factors influence daily work across the lifespan and how they affect employment-related services is scarce. Professionals directly involved in work integration can add to this evidence through their experiential knowledge.PurposeTo identify and explore the factors that enable or hinder sustainable employment for persons with ABI or SCI from the perspective of health and work professionals.MethodsWe conducted 23 semi-structured interviews with professionals in Switzerland, directly involved in work reintegration and retention of persons with ABI or SCI. Interviews were transcribed verbatim and thematically analyzed.ResultsParticipants identified three main themes related to the concept of “sustainable employment”. First, the value and impact of initial work integration; an early, multidisciplinary, person-centered work integration, with the early involvement of employers is ideal. A good match between the worker and the workplace is sought. Second, critical factors for long-term sustainable work: the main risks for persons with ABI are changing supervisors, workplace restructuring and the introduction of new technologies, while deteriorating health and the occurrence of secondary health problems are the greatest risk for persons with SCI. Third, the relevance of knowledge, experience and attitudes of professionals; Knowledge of the consequences of an ABI or SCI, the legal basis and the social security process, and the attitude of professionals towards the injured worker were considered important.ConclusionsFrom the professional's perspective, enabling and hindering factors for sustainable employment in the long-term are fundamentally very similar for persons with ABI and SCI. But different physical, mental and neuropsychological effects call for individually adapted measures. While persons with SCI primarily require ongoing medical care, conscious management of changes in the workplace is critical for persons with ABI. For both groups, an easily accessible counseling and support service should be established for work-threatening problems in the long-term. Furthermore, diagnosis-specific training programs for professionals of employment-related services and disability management should be developed

World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set Development for Interstitial Lung Disease

Background: The World Health Organization (WHO) introduced the International Classification of Functioning, Disability, and Health (ICF) as a scientific method of disability data collection comprised of >1,200 categories describing the spectrum of impairment types (functional, symptoms-based and anatomical) under the bio-psycho-social model with consideration of environmental and personal factors (pf). ICF Core Sets and ICF Checklists are streamlined disease-specific resources for clinical use, service provision, and for use in health economics and health policy. ICF can disclose strengths and weaknesses across multiple patient-reported outcome measures (PROMs) and help consolidate best-fitting question-items from multiple PROMs. Interstitial lung diseases (ILDs), are generally progressive, with restrictive physiology sometimes occurring in the context of multi-organ autoimmunity/inflammatory conditions such as connective tissue diseases (CTDs). In spite of significant associated morbidity and potential disability, ILD has yet to be linked to the ICF. Methods: Each instrument and their question-items within the consensus-recommended core sets for clinical trials in ILD were deconstructed to single concept units, and then linked per updated ICF linkage rules. Inter-linker agreement was established. Three additional subsequently validated measures were also included. Results: One-hundred-eleven ICF categories were identified for ten PROMs and three traditional objective measures that were amenable to ICF linkage. The proportion of agreement ranged from 0.79 (95% CI: 0.62, 0.91) to 0.93 (0.76, 0.99) with the overall proportion of inter-linker agreement being very high 0.86 (0.82, 0.89) for the initial instruments, with 94-100% for the three additional PROMs. Thirty-four new 'Personal Factors' emerged to capture disease-specific qualities not elsewhere described in ICF, e.g. 'pf_embarrassed by cough' or 'pf_panic/afraid when can't get a breath'. Conclusion: This first known effort in ICF linkage of ILD has provided important revelations on the current utility of the ICF in lung disease. Results have indicated areas for meaningful assessment of ICF descriptors for lung impairment. The mapping across PROMs provides insight into possibilities of developing more streamline and precise instrumentation. Finally, familiarity with the ICF in ILD may enable clinicians to experience a smoother transition with the imminent harmonization of ICD and ICF, ICD-11

A Systematic Review of Functioning in Vocational Rehabilitation Using the International Classification of Functioning, Disability and Health

Background: Vocational rehabilitation (VR) is aimed at engaging or re-engaging individuals with work participation and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be operationalized in the context of VR. The objective of this study is to review the literature to identify outcomes or measures being used in VR using a systematic review methodology and link those measures to the ICF. Methods: We applied a structured search strategy using multiple databases. Items or constructs of the measures or outcomes identified were linked to the ICF by two trained individuals. Results: We have identified 648 measures which contained 10,582 concepts that were linked to the ICF which resulted in 87 second-level ICF categories. Out of the 87 categories, 31 (35.6%) were related to body functions, 43 (49.4%) were related to activities and participation, and 13 (14.9%) were related to environmental factors. No category was related to body structures. Conclusions: Our review found great diversity in the ICF contents of the measures used in different VR settings and study populations, which indicates the complexity of VR. This systematic review has provided a list of ICF categories which could be considered towards a successful V

International Classification of Functioning, Disability and Health Core Set construction in systemic sclerosis and other rheumatic diseases: a EUSTAR initiative

Objectives. To outline rationale and potential strategies for rheumatology experts to be able to develop disease-specific Core Sets under the framework of the International Classification of Functioning, Disability and Health (ICF). ICF is a universal framework introduced by the World Health Organization (WHO) to describe and quantify the impact and burden on functioning of health conditions associated with impairment/disability. Methods. A combined effort of the EULAR Scleroderma Clinical Trial and Research and the ICF Research Branch was initiated to develop an ICF language for scleroderma. From our Medline literature review, using the abbreviation and spelled out version of ICF, we assembled approaches and methodological reasoning for steps of core set development. Results. The ICF can be used for patient care and policy-making, as well as the provision of resources, services and funding. The ICF is used on institutional, regional, national and global levels. Several diseases now have ICF Core Sets. Patients with complex rheumatologic diseases will benefit from a disease-specific ICF Core Set and should be included in all stages of development. ICF Core Set development for rheumatic diseases can be conducted from a number of feasible strategies. Conclusion. This overview should help to clarify useful processes leading to development of an ICF Core Set, and also provide a platform for expert groups considering such an endeavou

Vocational Rehabilitation From the Client's Perspective Using the International Classification of Functioning, Disability and Health (ICF) as a Reference

Introduction A mixed-methods (qualitative-quantitative), multicenter study was conducted using a focus group design to explore the lived experiences of persons in vocational rehabilitation (VR) with regard to functioning and contextual factors using six open-ended questions related to the ICF components. The results were classified by using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Methods The meaningful concepts within the transcribed data were identified and linked to ICF categories according to established linking rules. Results The seven focus groups with 26 participants yielded a total of 4,813 relevant concepts which were linked to a total of 160 different second-level ICF categories. From the client perspective, the ICF components (a) body functions, (b) activities and participation and (c) environmental factors were equally represented, while (d) body structures appeared less frequently. Out of the total number of concepts, 864 concepts (18%) were assigned to the ICF component personal factors which is not yet classified but could indicate important aspects of resource management and strategy development of patients in VR. Conclusion Therefore, VR of patients must not be limited to anatomical and pathophysiologic changes, but should also consider a more comprehensive view which includes client's demands, strategies and resources in daily life and the context around the individual and social circumstances of their work situatio

Developing a Core Set to Describe Functioning in Vocational Rehabilitation Using The International Classification of Functioning, Disability, and Health (ICF)

Introduction the consequences of accidents, injuries, and health conditions that prevent workers from engaging in employment are prevailing issues in the area of work disability. Vocational rehabilitation (VR) programs aim to facilitate return-to-work process but there is no universal description of functioning for patients who participate in VR. Our objective is to develop a Core Set for VR based on the international classification of functioning, disability, and health (ICF). An ICF Core Set is a short list of ICF categories with alphanumeric codes relevant to a health condition or a health-related event. Methods development process consists of three phases. First is the preparatory phase which consists of four parallel studies: (1) systematic review of the literature, (2) worldwide survey of experts, (3) cross-sectional study, and (4) focus group interview. Patients with various health conditions are to be recruited from five VR centers located in Switzerland and Germany. The second phase is a consensus conference where findings from the preparatory phase will be presented followed by a multi-stage consensus process to determine the ICF categories that will comprise the Core Set for VR. The final phase consists of validation studies in several health conditions and settings. Conclusions we expect the first version of the ICF Core Set for VR to be completed in 2010. The Core Set can serve as a guide in the evaluation of patients and in planning appropriate intervention within VR programs. This Core Set could also provide a standard and common language among clinicians, researchers, insurers, and policymakers in the implementation of successful V

Employment Among People With Spinal Cord Injury in 22 Countries Across the World:Results From the International Spinal Cord Injury Community Survey

Objectives: To describe the employment situation of individuals with spinal cord injury (SCI) in 22 countries participating in the International Spinal Cord Injury community survey, to compare observed and predicted employment rates, to estimate gaps in employment rates among people with SCI compared with the general population, and to study differences in employment between men and women. Design: Cross-sectional survey. Setting: Community. Participants: People of employable age (N=9875; 18-64 y) with traumatic or non-traumatic SCI (including cauda equina syndrome) who were at least 18 years of age at the time of the survey, living in the community, and able to respond to one of the available language versions of the questionnaire. Interventions: Not applicable Main Outcome Measures: The observed employment rate was defined as performing paid work for at least 1 hour a week, and predicted employment rate was adjusted for sample composition from mixed logistic regression analysis. Results: A total of 9875 participants were included (165-1174 per country). Considerable differences in sample composition were found. The observed worldwide employment rate was 38%. A wide variation was found across countries, ranging from 10.3% to 61.4%. Some countries showed substantially higher or lower employment rates than predicted based on the composition of their sample. Gaps between the observed employment rates among participants with SCI and the general population ranged from 14.8% to 54.8%. On average, employment rates were slightly higher among men compared with women, but with large variation across countries. Employment gaps, however, were smaller among women for most countries. Conclusions: This first worldwide survey among people with SCI shows an average employment rate of 38%. Differences between observed and predicted employment rates across countries point at country-specific factors that warrant further investigation. Gaps with employment rates in the general population were considerable and call for actions for more inclusive labor market policies in most of the countries investigated. (C) 2020 by the American Congress of Rehabilitation Medicin