Development of ICF Core Sets for Hand Conditions

Sandra Kus (Munich, Germany)

With the recent approval of the International Classification of Functioning, Disability, and Health (ICF) by the World Health Assembly there is now an universally accepted framework to classify and describe functioning, disability and health in individuals with a health condition, and, more specifically, with conditions of the hand or conditions involving the hand. The ICF framework is based on the bio-psycho-social model covering functioning and disability with its components Body Structures and Functions, Activities and Participation as well as Personal Factors and Environmental Factors. Since its classification with more than 1400 categories can serve as a reference but is not applicable in clinical practice, tools such as ICF Core Setsare needed to make the ICF useful for medicine. To date, ICF Core Sets have been developed for 15 different health conditions and for the acute hospital and early post-acute rehabilitation setting. However, ICF Core Sets for patients with conditions of the hand or conditions involving the hand are not available so far.
Since functioning is an important outcome for individuals with conditions of the hand or conditions involving the hand, the ICF Core Sets for Hand Conditions are being developed to link this health conditions to salient ICF categories of functioning. The project is being funded by the German Social Accident Insurance (DGUV) and is a cooperative effort of the Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany, the Department of Hand surgery, Plastic- and Microsurgery, Burns Unit at the Hospital of Workmens Compensation Hamburg, Germany, the ICF Research Branch of the WHO at the Ludwig-Maximilian University in Munich and the Classification, Assessment and Surveys (CAS) team at WHO.
The objective of the project is the development of ICF Core Sets for Hand Conditions. The ICF Core Sets for Hand Conditions will be defined at an ICF Core Set Consensus Conference which will integrate evidence from the following preparatory studies:

(a) Systematic review: The objective of the systematic review is (1) to identify outcomes and parameters focusing on individuals with hand conditions and (2) to identify and quantify the concepts contained in these outcomes and parameters using the ICF as a reference.
(b) Qualitative study: The objectives of the qualitative study are (1) to explore and understand the perspective of individuals with hand conditions on functioning and health using focus groups and individual interviews and (2) to identify concepts of functioning and health important to these individuals using the ICF as a reference.
(c) Expert survey: The objective of the expert survey is to gather the opinion of experts based on their clinical experience about the most relevant and typical areas to be considered in persons with hand conditions. Experts from all over the world and from different health professions and backgrounds (e.g. physicians with different specialisations, nurses, physical therapists, occupational therapists, psychologists, and social workers) will be included in the survey.
(d) Empirical study: The objective of the empirical study is to describe functioning and health of patients with hand conditions using an extended version of the ICF Checklist of the WHO. In addition the EuroQol (EQ-5D), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Comorbidity Questionnaire (SCQ), and five questions of the World Health Organization Quality of Life Questionnaires (WHOQoL) to assess the subjective appraisal of health and well-being will be used.
The information collected from these preparatory studies will be presented 2009 at an ICF Core Set Consensus Conference to selected experts in the field of surgery and therapy of the hand. Following a multi-stage decision process, the experts will agree on the ICF categories to be included in the ICF Core Set for Hand Conditions.

For more information contact:Sandra Kus