Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI

Abstract

BackgroundThe assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective.MethodsIn a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale.ResultsThe mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%.ConclusionsOur findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.

Are Patients Improving during and after a Psychiatric Hospitalisation? Continuity of Care Outcomes of Compulsory and Voluntary Admissions to an Italian Psychiatric Ward

“…Considering both types of hospitalisations, we observed, for instance, a reduction of more than 40% of the Mini-ICF APP items, and likewise a change of more than 8 points on the HoNOS, which are considered an indication of good response to treatment. Consistently, we also observed a decrease in illness severity and an improvement in drug's efficacy related to side effects, according to CGI-S and CGI-EI 44,45 .…”

“…This did not allow, for instance, to assess whether the changes in the scores on the evaluation scales correlated with different diagnostic subsamples and to which extent this could have influenced the scores 45 . However, the last seems a minor shortcoming, since psychometric tests, such as CGI or Mini-ICF-APP, can be considered diagnosis-independent for clinical assessment or judgment of functionality 28,44 . Second, it is not easy to assess whether the differences in scores of psychometric tests indicate a real variation between inpatient and community patients' functioning, or rather a vulnerability in the reliability of measurement.…”

Feasibility and Efficacy of a Psychological Therapy for Patients With a Schizophrenic Psychosis in an Inpatient Setting: Study Protocol of a Randomized Switch Controlled Trial

“…The MCCB is regarded as the standard test battery for use with patients diagnosed with schizophrenia; it is claimed as both robust to learning effects and sensitive to change ( 47 ). Taking into account that improvements in symptomatology and neuro-cognition should lead to increased autonomy, we have chosen the mini-ICF-APP to assess psychosocial-functioning independently of the main diagnosis ( 40 , 64 , 65 ). Using this set of outcome measures, we expect to assess all facets of the interventions, whilst facilitating the interpretation and comparison of our results with those from previous studies ( 63 ).…”

Arbeits(un)fähigkeit bei psychischen Erkrankungen

“…Kann einem Patienten, der eine Arbeit als "unzumutbar und kränkend" erlebt, zugemutet werden, dieses Gefühl zu überwinden [32]? In solchen Fragen hilft auch die ICF(International Classification of Functioning, Disability and Health)-Klassifikation nicht weiter, da darin im Arbeitsalltag relevante Faktoren wie "Arbeitsmotivation" [40,41] oder "Zumutbarkeit von Gratifikationskrisenkonstellationen" [42,43] unberücksichtigt bleiben [10,44] ▶Weitere Fragen auf der folgenden Seite ……”