Health measurement using the ICF: Test-retest reliability study of ICF codes and qualifiers in geriatric care

Abstract

BackgroundThe International Classification of Functioning, Disability and Health (ICF) was published by the World Health Organization (WHO) to standardize descriptions of health and disability. Little is known about the reliability and clinical relevance of measurements using the ICF and its qualifiers. This study examines the test-retest reliability of ICF codes, and the rate of immeasurability in long-term care settings of the elderly to evaluate the clinical applicability of the ICF and its qualifiers, and the ICF checklist.MethodsReliability of 85 body function (BF) items and 152 activity and participation (AP) items of the ICF was studied using a test-retest procedure with a sample of 742 elderly persons from 59 institutional and at home care service centers. Test-retest reliability was estimated using the weighted kappa statistic. The clinical relevance of the ICF was estimated by calculating immeasurability rate. The effect of the measurement settings and evaluators' experience was analyzed by stratification of these variables. The properties of each item were evaluated using both the kappa statistic and immeasurability rate to assess the clinical applicability of WHO's ICF checklist in the elderly care setting.ResultsThe median of the weighted kappa statistics of 85 BF and 152 AP items were 0.46 and 0.55 respectively. The reproducibility statistics improved when the measurements were performed by experienced evaluators. Some chapters such as genitourinary and reproductive functions in the BF domain and major life area in the AP domain contained more items with lower test-retest reliability measures and rated as immeasurable than in the other chapters. Some items in the ICF checklist were rated as unreliable and immeasurable.ConclusionThe reliability of the ICF codes when measured with the current ICF qualifiers is relatively low. The result in increase in reliability according to evaluators' experience suggests proper education will have positive effects to raise the reliability. The ICF checklist contains some items that are difficult to be applied in the geriatric care settings. The improvements should be achieved by selecting the most relevant items for each measurement and by developing appropriate qualifiers for each code according to the interest of the users.

Developing the ICF-CY for AAC Profile and Code Set for Children Who Rely on AAC

“…Other researchers have suggested eliminating qualifier Level 8 (not specified) and Level 9 (not applicable) and collapsing other categories (kronk et al, 2005;Okochi et al, 2005;Starrost et al, 2008). In practical applications, however, the complete Profile rating system could be applied quite accurately from group consensus, providing good clinical validity as well as an opportunity for team discussion and collaboration.…”

“…Studies that have investigated the reliability of other core sets related to specific disease groups have shown how difficult it is to achieve high reliability on ICF items (e.g., Okochi, utsunomiya, & Takahashi, 2005;uhlig et al, 2007). We chose to use a stringent approach, examining agreement among large numbers of raters who were inexperienced and untrained in using the ICF, reflecting the conditions under which the Profile will be used practically in school settings.…”

Staging of mobility, transfer and walking functions of elderly persons based on the codes of the International Classification of Functioning, Disability and Health

“…First, it was difficult to select relevant ICF codes from the approximately 1434 ICF codes, and if we selected ICF codes for each person, we could not compare the specific function to other persons, because the ICF codes selected for various individuals may not be the same. Second, the reliability of a qualifier for quantification of severity of a disability was not always satisfactory [4,5]. …”

“…There have been several studies aimed at tailoring the number of ICF codes [4,6-9]. ICF codes related to condition-specific ICF items, such as the codes for osteoarthritis and other chronic conditions, were selected in the development of ICF Core Sets [2,10].…”

“…This developmental effort facilitated condition-specific selection of ICF codes, but the ICF codes selected for one chronic condition may not necessarily be adaptable to other chronic conditions. The WHO provided the ICF checklist as a simple version of the ICF; however, the broad and vague definitions of the ICF codes used in the checklist limit its use in a target population such as elderly patients, because some ICF codes do not have high reliability for the intended population [4,5]. …”