icf aktuelle entwicklungen aus der internationalen · pdf fileosteoarthritis osteoporosis...

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ICF – Aktuelle Entwicklungen aus der

internationalen Perspektive

ICF Anwendertagung

REHAB Basel, 05. Dezember 2013

Birgit PRODINGER, PhD, MSc Projektleitung, ICF Unit, Schweizer Paraplegiker Forschung (SPF)

Lehrbeauftragte, Seminar Health Sciences and Health Policy, Universität Luzern

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Herausforderungen, gegenwärtige Entwicklungen und damit verbundene

Risiken und Nebenwirkungen in der Implementierung der ICF als

internationalen Standard zur Beschreibung und Messung von Gesundheit und

Behinderung

http://www.who.int/classifications/icf/en/

05.12.2013, Birgit Prodinger

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Ausgangssituation: Internationaler Kontext


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Information als Entscheidungsgrundlage


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Information als ein Baustein von

Gesundheitssystemen

http://www.biomedcentral.com/1472-698X/11/13/figure/F1


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Beispiel: Schweizer Gesundheitssystem

http://www.public-health.ch/logicio/pmws/publichealth__home__de.html

http://www.samw.ch/de/Publikationen/Bulletins/Archiv.html


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GesundheitsINFORMATIONsysteme

http://www.samw.ch/de/Publikationen/Bulletins/Archiv.html


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Interoperabilität Nahtlose Zusammenarbeit unterschiedlicher Systeme

Technisch

Syntaktisch Systeme

Semantisch Konzepte

Organisatorisch Normen, Standards, Richtlinien, Gesetze


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WHO’s Familie der Klassifikationen

http://www.who.int/classifications/en/FamilyDocument2007.pdf

http://www.who.int/classifications/icf/en/

Semantic interoperability


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Chancen von Standardisierung

- Fragmentierte Datenerhebung

- Mangelnde Kommunikation und Koordination

- Mangelnde Verfügbarkeit von Informationen über den Kontext der

Datenerhebung hinaus

- Redundante Datenerhebung

http://www.wdpo.org/world-data-protection-harmonization-standardization/


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Kostensenkung

Effizienz

Einheitliche Terminologie

Vergleichbarkeit

Planung und Kontrolle

Innovation

Rasche Umsetzung

Differenzierung (abhängig von z.B. Kontext und Zweck)

Standardisierung – Chancen und Risiken

Harmonisierung ist nicht ausreichend für Interoperabilität


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Konzeptualisierung und Klassifizierung

Was beschreiben? Messung

Wie messen? Berichterstattung

Wie berichten?

http://www.dwaynebaraka.com/blog/2013/06/17/gris-g4-materiality-transparency-comparability-fight/

Klassifikation: Einteilung von Objekten anhand bestimmter Merkmale http://touque.ca/EC/students/GuptaR/html/Assig

nments/what_if_my_name_was.html

http://www.kpn.de/smart-reporting


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Vergleichbarkeit von Inhalten

«Was beschreiben?»

ICF Core Sets

Comprehensive ICF Core Sets

Brief ICF Core Sets


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Verfügbare ICF Core Sets

Further ICF Core Sets are in development • E.g. after lower

limb amputation

ACUTE EARLY-POST ACUTE LONG-TERM

Neurological conditions Neurological conditions Multiple sclerosis

Stroke (also as a cardiopulmonary condition)

Traumatic brain injury

Spinal Cord Injury Spinal Cord Injury

Cardiopulmonary

conditions

Cardiopulmonary

conditions

Chronic ischemic heart disease

Diabetes mellitus

Obesity

Obstructive pulmonary diseases

Musculoskeletal

conditions

Musculoskeletal

conditions

Ankylosing spondylitis

Chronic widespread pain

Low back pain

Osteoarthritis

Osteoporosis

Rheumatoid arthritis

Acute inflammatory

arthritis

For geriatric patients

Bipolar disorders

Depression

Breast cancer

Head and neck cancer

Hand conditions

Hearing loss

Inflammatory bowel diseases

Sleep

Vertigo

Vocational Rehabilitation

http://www.icf-research-branch.org/


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Generic Set

Extended Generic Set

Generic Set

Disability Set (Extended Generic Set)

ICF Core Set for specific health condition, e.g. Spinal cord injury

b110 Consciousness functions

b126 Temperament and personality functions

b130 Energy and drive functions b130 Energy and drive functions b130 Energy and drive functions

b134 Sleep functions b134 Sleep functions

b140 Attention functions

b152 Emotional functions b152 Emotional functions b152 Emotional functions

… …

b280 Sensation of pain b280 Sensation of pain b280 Sensation of pain

… …

b455 Exercise tolerance functions b455 Exercise tolerance functions

… …

b640 Sexual functions b640 Sexual functions

b670

Sensations associated with genital and

reproductive functions

b710 Mobility of joint functions b710 Mobility of joint functions

b715 Stability of joint functions

b730 Muscle power functions b730 Muscle power functions

… …

s120 Spinal cord and related structures

s430 Structure of respiratory system

… …

d230 Carrying out daily routine d230 Carrying out daily routine d230 Carrying out daily routine

d240 Handling stress and other psychological

demands d240 Handling stress and other psychological

demands

d360 Using communication devices and techniques

… …

d450 Walking d450 Walking d450 Walking

d455 Moving around d455 Moving around d455 Moving around

d460 Moving around in different locations

d465 Moving around using equipment

d470 Using transportation d470 Using transportation

… … … …

d850 Remunerative employment d850 Remunerative employment d850 Remunerative employment d870 Economic self-sufficiency

d910 Community life

d920 Recreation and leisure d920 Recreation and leisure

d930 Religion and sprituality

+ Environmental factors + Environmental factors

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Beispiel Querschnittlähmung

«Was beschreiben?»

Langzeit-versorgung

Querschnitt-lähmung

(Biering-Sorensen et al. 2006; Cieza et al. 2010;

Kirchberger et al. 2010)

Validierungsstudien, zB ICF Core Sets für Rückenmarksverletzungen (Langzeitversorgung) - ErgotherapeutInnen (Hermann et al., 2011)

- PhysiotherapeutInnen (Hermann et al., 2011)

PatientInnenperspektive (Lüthi et al. 2011)

Akutver-sorgung

Neurologische Erkrankungen

Post-akute Versorgung oder

Frührehabilitation

Querschnitt-lähmung

Statistisches Set: Querschnitt-

lähmung (Ballert et al. 2012)


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Vergleichbarkeit und Anwendbarkeit von

Instrumenten in einem bestimmten Kontext

«Was messen?»

Inhaltlich angemessen

Verlässlich

Zweckmässig und praktikabel


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…

b1 b130 b134 b152 b180 b1801 • • • s299 s710 s720 s730 s73001 s73011 • • • d170 d230 d360 d410 d415 d430 • • •

e110 e115 e120 e125 e135 e150 • •

RAQoL

Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep

HAQ Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep

SF-36 INSTRUCTIONS: This survey asks for your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities. Answer every question by marking the answer as indicated. If you ar unsure about how to answer a question, please give the best answer you can.

EQ-5D

Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep

MFI Joint mobility Mobility (general) Muscle power / Strength Pain Stability of joints Emotional function Engergy & Drive functions Gait / Ambulation Stiffness Muscle endurance Sexual functions Sleep

CES-D INSTRUCTIONS: This survey asks for your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities. Answer every question by marking the answer as indicated. If you ar unsure about how to answer a question, please give the best answer you can. ICF Linking rules

(Cieza et al. 2002; 2005)

Vergleichbarkeit von Inhalten

Instruments, assessments and clinical tests Regardless of mode of administration - Paper-pased - Computer-based - Interviewer-administered - Self-reported - Proxy-reported - Expert-conducted


19 05.12.2013, Birgit Prodinger

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Vergleichbarkeit der Inhalte

MFI-20 (Multidimensional Fatigue Inventory)

I feel fit.

I feel very active.

I feel tired.

I am rested.

Physically, I feel only able to do a little.

Physically, I can take on a lot.

I tire easily.

Physically, I feel I am in excellent condition.

CES-D (Center for Epidemiologic Studies Depression Scale)

I felt that everything I did was an effort.

I could not get “going”.

SF-36 (Short form Health Survey)

Did you have a lot of energy?

Did you feel worn out?

Did you feel tired?

RAQOL (Rheumatoid Arthritis Quality of Life)

It’s too much effort to go out and see people.

I have to keep stopping what I am doing, to rest.

I feel tired whatever I do.

b130 Energy and drive functions

Cieza et al. (2009) 05.12.2013, Birgit Prodinger

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Vergleichbarkeit der Metrik

http://www.cosmin.nl/images/upload/File/checklist%20final%20feb%202010.pdf


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Magasi & Post (2010)

IMPACT-S: ICF Measure of Activity and Particiaption – Screener; IPA: Impact on Autonomy and Participation; KAP: Keele Assessment of Participation; LIFE-H: Assessment of Life Habits; PAR-PRO: Participation Profile; PARTS/M: Participation Survey/Mobility; PM-PAC: Participation Measure for Post Acute Care; P-Scale: Participation Scale


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0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 10

0

SF_4i Did you feel tired?

M FI_20 I could not get “going”

QoLRA I feel tired whatever I do.

QoL10 I have to keep stopping what I am doing to rest

M FI_12 I am rested

M FI_16 I tire easily

M FI_1 I feel fit

M FI_8 Physically I can take on a lot

M FI_5 I feel tired

M FI_3 I feel very active

SF_4e Did you have a lot of energy?

M FI_2 I did not feel like eating; my appetite was poor

SF_4g Did you feel worn out?

DE_07 I felt that everything I did was an effort

CES_20 I could not get “going”

QoLRA_25 It’s too much effort to go out and see people

0

MFI 2: Physically, I feel only able

to do a little

SF-36 9e: Did you have a lot of

energy?

MFI 3: I feel very active

MFI 5: I feel tired

RAQoL 25: It’s too much effort

to go out and see people

CES-D 20: I could not get „going“

CES_D 07: I felt that everything I

did was an effort

SF-36 9g: Did you feel worn out?

MFI 8: Physicaly, I can take a lot

MFI 1: I feel fit

MFI 16: I tire easy

MFI 12: I am rested

RAQoL 10: I have to keep

stopping what I am doing, to rest

RAQoL 21: I feel tired whatever I

do

MFI 20:Physically, I feel I am in a

excellent condition

SF-36 9i: Did you feel tired? 43.3

45.5

46.4

47.9

48.1

48.1

50.8

52.0

52.6

52.6

54.8

56.1

60.6

62.1

62.9

67.7

4% 24% 49% 95%

Raw Score (16 Items)

Logit scale ICF category interval scale

(0 to 100)

ICF Qualifier

0 -6.36 0 0

1 -4.72 14

2 -3.81 21 1

3 -3.29 26

4 -2.94 29

5 -2.66 31

6 -2.43 33

7 -2.23 35

8 -2.05 36

9 -1.9 37

10 -1.75 39

11 -1.62 40

12 -1.49 41 2

13 -1.37 42

14 -1.26 43

15 -1.15 44

16 -1.04 45

17 -0.94 45

18 -0.84 46

19 -0.74 47

20 -0.64 48

21 -0.54 49

22 -0.45 49

23 -0.35 50

24 -0.25 51

25 -0.15 52

26 -0.05 53

27 0.05 54

28 0.15 54

29 0.26 55

30 0.36 56

31 0.47 57

32 0.59 58

33 0.7 59

34 0.82 60

35 0.95 61

36 1.08 62 3

37 1.22 63

38 1.36 65

39 1.51 66

40 1.67 67

41 1.84 69

42 2.03 70

43 2.23 72

44 2.45 74

45 2.7 76

46 2.97 78

47 3.28 81

48 3.65 84

49 4.1 88

50 4.72 93

51 5.59 100 4

Conversion table: Mapping on to ICF

qualfifier

Cieza et al. (2009)

Psychometrische Analyse zur Erstellung einer gemeinsamen Metrik


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UBS: Unified Balance Scale BBS: Berg Balance Scale; POMA: Performance Oriented Mobility Assessment; TUG: Time Up and Go Test; TB: Tinetti balance; TW: Tinetti Walking; FAB: Fullerton Advanced Balance Scale.

La Porta et al. (2011) 05.12.2013, Birgit Prodinger

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Standardisierte Berichterstattung

«Wie berichten?»

Standardisierte Berichterstattung erfordert

Vergleichbarkeit der Inhalte und Metrik.

ICF

Instrumente, Assessments, Tests zur Datenerhebung in der

Praxis


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ICF Qualifier als Messskala

Standardisierte Berichterstattung

«Wie berichten?» Spinal Cord Independence Measure (SCIM)

10 meter walk test (10MWT)

Walking Index for Spinal Cord Injury (WISCI II)

Graded and Refined Assessment of Strength, Sensibility, and Prehension (GRASSP)

usw.

Hospital Anxiety and Depression Scale (HADS)

Hospital Anxiety and Depression Scale (HADS)

Positive and Negative Affect Scale (PANAS)

ICF-basierte Berichterstattung

ICF Core Sets

Item Bank

Co-Kalibrierung der Items

Item Pool

Vergleich von Inhalten und Metrik

ICF Qualifier als Referenzskala


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(Cieza et al. 2009)

La Porta et al. (2011)

(Fellinghauer et al. 2010) (Van Buuren et al. 2005) (Spreyermann et al. 2011)

Berichterstattung


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Psychometrische Architektur der

Funktionsfähigkeit braucht «Cross-walk»


Existierende

Instrumente

ICF qualifiers

als

Messinstrument

- Lokale, nationale, und internationale Vergleichbarkeit von Testwerten in Praxis und Forschung (zB Meta-Analysen)

- Universelle anwendbar, d.h. unabhängig von lokalen Ressourcen

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Entwicklung einer Architektur zur ICF-basierten

Berichterstattung und Datenerhebung

Prof. Dr. Gerold Stucki Prof. Dr. Jerome Bickenbach

Dr. Birgit Prodinger Prof. Dr. Alan Tennant Prof. Dr. Alarcos Cieza

Carolina Ballert Maren Hopfe Mirjam Brach


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GesundheitsINFORMATIONsysteme

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Elektronische Kranken-

geschichten

Klinische Terminologie

Klassifikation

- Supportsystem für klinische Entscheidungen

- Semantisch interoperabler Informationsaustausch

- Krankheits-, Gesundheits- und Behinderungsstatistiken


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WHO’s Familie der Klassifikationen – Joint use

http://www.who.int/classifications/en/FamilyDocument2007.pdf Functioning Topic Advisory Group (fTAG)

Revisions of ICD-10


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«Risiken und Nebenwirkungen»

• Operationalisierung

• Klinische Terminologie <-> Klassifikation

• Implementierung von ICF-basierter Berichterstattung auf allen Systemebenen

• Anwendung ICF-basierter Information als Entscheidungsgrundlage


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Birgit Prodinger [email protected]


mailto:[email protected]

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