Value of using the international classification of functioning, disability, and health for stroke rehabilitation assessment

Zhang, Tong; Liu, Lixu; Xie, Rong; Peng, Ying; Wang, Hong; Chen, Zhuoming; Wu, Shizheng; Ni, Chaomin; Zheng, Jicui; Li, Xueping; Liu, Heyu; Xu, Guangxu; Fan, Jie; Zhu, Yu; Zhang, Fang; Du, Yasong; Wang, Xin; Wang, Yulong; Xiao, Weimin; Liu, Ming; Mou, Xiang; Zhao, Jun; Song, Lina; Li, Bingjie

doi:10.1097/md.0000000000012802

Cited by 16 publications

(17 citation statements)

References 25 publications

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“…These limitations may be attributed to the inability of single measurements to detect varying subtle processes which may underlie the complex event of a fall (i.e., inefficient integration of motor, sensory and cognitive information). Accordingly, fall prevention researchers have highlighted the need for a multifactorial approach [15] for fall risk assessment in MS, which aligns with the multimodal assessment recommended in the ICF Model [26]. Our study sheds light on the importance of combining tests and their respective information to enhance identification of fallers.…”

Section: Discussionmentioning

confidence: 67%

“…Neuroimaging measures were collected within 1 month of demographic and functional strength and walking measures. Such multimodal assessment of impairments that may limit activity and restrict participation is in line with the International Classification of Functioning, Disability, and Health (ICF) for use in neurological rehabilitation assessment [26].…”

Section: Methodsmentioning

confidence: 92%

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Combining Magnetization Transfer Ratio MRI and Quantitative Measures of Walking Improves the Identification of Fallers in MS

et al. 2020

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Multiple sclerosis (MS) impacts balance and walking function, resulting in accidental falls. History of falls and clinical assessment are commonly used for fall prediction, yet these measures have limited predictive validity. Falls are multifactorial; consideration of disease-specific pathology may be critical for improving fall prediction in MS. The objective of this study was to examine the predictive value of clinical measures (i.e., walking, strength, sensation) and corticospinal tract (CST) MRI measures, both discretely and combined, to fall status in MS. Twenty-nine individuals with relapsing-remitting MS (mean ± SD age: 48.7 ± 11.5 years; 17 females; Expanded Disability Status Scale (EDSS): 4.0 (range 1–6.5); symptom duration: 11.9 ± 8.7 years; 14 fallers) participated in a 3T brain MRI including diffusion tensor imaging and magnetization transfer ratio (MTR) and clinical tests of walking, strength, sensation and falls history. Clinical measures of walking were significantly associated with CST fractional anisotropy and MTR. A model including CST MTR, walk velocity and vibration sensation explained >31% of the variance in fall status (R2 = 0.3181) and accurately distinguished 73.8% fallers, which was superior to stand-alone models that included only MRI or clinical measures. This study advances the field by combining clinical and MRI measures to improve fall prediction accuracy in MS.

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Section: Discussionmentioning

confidence: 67%

Section: Methodsmentioning

confidence: 92%

Combining Magnetization Transfer Ratio MRI and Quantitative Measures of Walking Improves the Identification of Fallers in MS

et al. 2020

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“…This system of classification is known as a generic scale and can be used in conjunction with first, second, and third qualifiers. It is possible to compare data from before and after treatments in a biopsychosocial model, considering patients' physical functioning, participation ability, and the influence of environmental factors (29). Zhang et al (29)…”

Section: Introductionmentioning

confidence: 99%

Analyzes of the ICF Domain of Activity After a Neurological Early Mobility Protocol in a Public Hospital in Brazil

Lima¹,

Carvalho²,

Bittencourt³

et al. 2022

Front. Rehabilit. Sci.

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BackgroundEarly Mobility (EM) has been recognized as a feasible and safe intervention that improves functional outcomes in hospitalized patients. The International Classification of Functioning, Disability and Health (ICF) supports understanding of functioning and disability in multidimensional concepts and efforts have been taken to apply ICF in a hospital environment. EM protocols might be linked with the ICF component of activity and participation. The correlations between ICF, EM, and functional scales might help the multidisciplinary team to conduct the best rehabilitation program, according to patients' functional demands.ObjectivesThe primary outcome is to analyze the activity level of neurological inpatients on admission and delivery after a Neurological Early Mobility Protocol (NEMP) at intermediate care settings in a public hospital in Brazil using Activity Level categories, HPMQ, and MBI scores. The secondary outcome is to analyze the ICF performance qualifier, specifically in the activity domain, transposing HPMQ and MBI scores to the corresponding ICF performance qualifiers.DesignAn international prospective study.MethodsNEMP was used to promote patients' mobility during a hospital stay in neurological ward settings. First, patients were categorized according to their Activity Levels (ALs) to determine the NEMP phase to initiate the EM protocol. ALs also were evaluated in the first and last sessions of NEMP. Thereafter, the Hospitalized Patient Mobility Questionnaire (HPMQ) was applied to identify whether patients needed assistance during the performance of hospital activities as well as the Modified Barthel Index (MBI). Both measures were applied in NEMP admission and discharge, and the Wilcoxon Signed Rank Test was used to compare data in these two time points. HPMQ and MBI scores were re-coded in the correspondent ICF performance qualifier.ResultsFifty-two patients were included with age of 55 ± 20 (mean ± SD) years and a length of hospital stay of 33 ± 21 days. Patients were classified along ALs categories at the admission/discharge as follows: AL 0 n = 6 (12%)/n = 5 (9%); AL 1 n = 12 (23%)/n = 6 (12%); AL 2 n = 13 (25%)/n = 8 (15%); AL 3 n = 10 (19%)/n = 13 (25%); AL 4 n = 11 (21%)/n = 20 (39%). HPMQ data revealed progressions for the activities of bathing (p < 0.001), feeding (p < 0.001), sitting at the edge of the bed (p < 0.001), sit to stand transition (p < 0.001), orthostatism (p < 0.001) and walking (p < 0.001). Transposing HPMQ activities into ICF performance qualifiers, improvements were shown in bathing (d510.3 to d510.1—severe problem to mild problem) and sitting at the edge of the bed (d4153.2 to d4153.1—moderate problem to mild problem). At MBI score were observed an average of 36 [IQR−35. (95% CI 31.5; 41.1)] on NEMP admission to 52 at discharge [IQR−50 (95% CI 43.2; 60.3)] (p < 0.001). Recoding MBI scores into ICF there were improvements from severe problem (3) to moderate problem (2).LimitationsThe delay in initiating NEMP compared to the period observed in the literature (24–72 h). The study was carried out at only one center.ConclusionsThis study suggests that neurological inpatients, in a public hospital in Brazil had low activity levels as could be seen by MBI and HPMQ scores and in the ICF performance qualifier. However, improvements in the evaluated measures and ICF activity domain were found after NEMP. The NEMP protocol has been initiated much longer than 72 h from hospital admission, a distinct window than seen in the literature. This enlargement period could be a new perspective for hospitals that are not able to apply mobility in the earliest 24–72 h.

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“…The International Classification for Functioning Disability and Health (ICF) [1] provides a framework to consider the impact of a neurological condition on a person, highlighting both the breadth and complexity of potential issues. While the ICF can classify areas that may be impacted by neurological conditions, and some rating of impairment and limitation is possible using the ICF core sets [2,3], precise measurement of factors known to be related to activity is essential.…”

Section: Introductionmentioning

confidence: 99%

Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation–A systematic review

et al. 2021

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Introduction This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. Methods 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. Results 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). Conclusions The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. Systematic review registration PROSPERO CRD42014013190.

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Value of using the international classification of functioning, disability, and health for stroke rehabilitation assessment

Abstract: Supplemental Digital Content is available in the text

Cited by 16 publications

References 25 publications

Combining Magnetization Transfer Ratio MRI and Quantitative Measures of Walking Improves the Identification of Fallers in MS

Combining Magnetization Transfer Ratio MRI and Quantitative Measures of Walking Improves the Identification of Fallers in MS

Analyzes of the ICF Domain of Activity After a Neurological Early Mobility Protocol in a Public Hospital in Brazil

Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation–A systematic review

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