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

Abstract

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.

Sarcoidosis and frailty: recognizing factors that foster holistic resilience

“…Frailty is an important global concern and is accelerated in pulmonary and multiorgan inflammatory conditions, like sarcoidosis. Our prior qualitative and consensus research in ILD and sarcoidosis [3,5,6 ▪▪ ,7,9 ▪▪ ,10 ▪ ,58,68 ▪ ], coupled with scoping reviews on frailty, informed the development of this preliminary open framework. The framework centres on universal enablement with respect to resilience fortification and in response to risk assessment of biopsychosocial factors associated with biophysical vulnerability.…”

“…Sub-domains and their items reflect content from scoping literature reviews and from patient-derived content, voiced concerns and language selection [3,5,6 ▪▪ ,10 ▪ ,19 ▪ ]. A person-centred approach to resilience necessarily views language as a crucial underpinning, which unconsciously impacts perception, motivation and process for both patients and clinicians [3,6 ▪▪ ,16,17 ▪▪ ,18,19 ▪ ].…”

“…Although WHO-ICF codification was considered and might have been a reasonable mapping choice, restrictions in utility and symptom specification render WHO-ICF less than ideal. Further, a WHO-ICF Core Set has not been developed for sarcoidosis, and the WHO-ICF is not yet optimized to represent respiratory symptoms for ILD and other lung diseases [10 ▪ ]. However, the ICF is an application that can be superimposed on many frameworks if desired.…”

“…Concepts of frailty risk are presented from the lens of preserving holistic well-being when living with sarcoidosis, with the consideration of ageless holistic resilience as a unifying concept in frailty prevention. The framework is informed by previous work [3,6 ▪▪ ,9 ▪▪ ,10 ▪ ] on patient-experiences in sarcoidosis, in interstitial lung disease (ILD) and frailty in ILD. This study sets out to support clinicians in considering early, ageless and positive health-centred strategies for frailty prevention in sarcoidosis [11]…”

Comparative Pharmacokinetics Research of 13 Bioactive Components of Jieyu Pills in Control and Attention Deficit Hyperactivity Disorder Model Rats Based on UPLC-Orbitrap Fusion MS

“…According to the World Health Organization, depression ranks as the third most prevalent cause of illness in the world [ 1 , 2 , 3 ]. By 2030, it is projected to surpass all other diseases and become the leading cause of morbidity.…”