Dr. José Luis Ayuso-Mateos Professor of Psychiatry Universidad Autónoma de Madrid, Spain WP4 Leader.

Dr. José Luis Ayuso-MateosProfessor of Psychiatry

Universidad Autónoma de Madrid , SpainWP4 Leader

1. Use the functioning and disability model of the ICF to analyze health surveys in the general population and existing statistics about education.

General Objetives

2. Demonstrate how the ICF model is appropriate for describing disability patterns in the clinical population.

3. Demonstrate ICF validity and usefulness in compiling educational databases.

4. Formulate recommendations for the development of health and social policies in the UE.

How do we measure the impact of disease?

2000 World - Deaths

0 5 10 15

Road Traff ic

Child Cluster

TB

Diarrhea

Perinatal

COPD

HIV

ARI

Stroke

Cancer

Heart (Ischaemic)

Percent of Total

2000

1. Ischaemic heart disease 10.5%

2. Cerebrovascular disease 6.8%

3. Unipolar depressive disorders

6.1%

4. Alzheimer and other dementias

3.0%

5. Alcohol use disorders 2.9%

6. Hearing loss, adult onset 2.6%

7. COPD 2.4%

8. Road traffic accidents 2.4%

9. Osteoarthritis 2.4%

10. Self-inflicted injuries 2.3%

Need for instruments that use the biopsychosocial model in the assesment of functioning and

disability

Full Version of ICF

ICF Checklist

WHO-DAS II

ICF Core Sets

ICF Checklist

Selection of the most relevant ICF categories (169 from 1494):

- Alterations in:- body functions- body structures

- Activities and participation- Environmental factors

- Other information about environment- Used by:

- clinical- patients / relatives- researchers

WHO-DAS II

Assesses 6 domains:

1. Understanding and communication

2. Getting around3. Self-care4. Interpersonal interactions

and relationships5. Daily activities6. Participation

http://www.who.int/icidh/whodas/index.html

Objectives To demonstrate the applicability of ICF-

linked measurement instruments, the ICF Checklist and the WHODAS II in a variety of clinical settings and by different professionals

To evaluate the quality of care in patient clinical settings by using functioning levels as outcome indicators in a range of clinical conditions

To evaluate disability profiles obtained from ICF-linked assessment instruments

Clinical and rehabilitation centres

UAM Instituto Nazionale

Neurologico Ludwig-Maximilians

Uni Charles Uni. Rehabilitation Institute

Slovenia Malarden University

Statistical centres IMIM ARS WHO

AA A total of 74 researchers

Reumathology

Bipolar Dis. Depressión

StrokeBrain injury

Reumathoid DisMusculoskeletal Dis

Ischaemic Coronary disease

Parkinson M. SclerosisMigraine

Rehabilitacion

Neurology

Psychiatry

Cardiology

ICF

Unipolar Depression

Bipolar Disorder

MigraineParkinson DiseaseMusc conditionsIschaemic Heart Disease

Stroke

Multiple sclerosis

Traumatic Brain Injury

Rheumathoid Arthritis

Musculoeskeletal diseases

ICF in clinical and rehabilitation settings

N = 1200 patients

METHOLOGY

• Dependent Variable:

• Functioning and disability (defined by the ICF model)

• Common Instruments for evaluation:

• Sociodemografic characteristics

• ICF-Checklist

• WHODAS-II

• SF-36

Disease-specific instruments for evaluation• Time points of assessment:

• Baseline assessment• 6 weeks• 3 months

• Design: multicentre, transversal and longitudinal study

ICF Checklist and WHODAS II have good psychometric properties

Structural validity indicates that they are closely related to the underlying conceptual model (ICF)

They have sensibility to change

Evolution of symptomatology after 6 weeks and 3 months:

Clinical remission: 53.8% at 6 weeks and 71.8% at 3 months

RESULTS:Depression sample treated in

Primary Care

0,00 5,00 10,00 15,00 20,00

time.weeks

0,00

25,00

50,00

75,00

100,00

DA

ST

OT

Overall and Individual Fitted Regression Lines For the Whole Sample (unipolar depression N=97)

DEPRESSION

NORMAL MOOD

MANIA

HYPOMANIA

MIXED EPISODE

More than 6 months

facilitators barriers

◦health professional◦support of family

members and friends

attitudes of immediate family members and friends

social norms practices and

ideologies health services,

systems and policies

Stroke - Capacity

0

20

40

60

80

100d1

d2

d3

d4

d5d6

d7

d8

d9

Reference Group Area

Patient A Area

Stroke - Capacity

0

20

40

60

80

100d1

d2

d3

d4

d5d6

d7

d8

d9

Reference Group Area

Patient B Area

Stroke - Performance

0

20

40

60

80

100d1

d2

d3

d4

d5d6

d7

d8

d9

Reference Group Area

Patient A Area

Stroke - Performance

0

20

40

60

80

100d1

d2

d3

d4

d5d6

d7

d8

d9

Reference Group Area

Patient B Area

Stroke - Environmental - Barriers

0

20

40

60

80

100e1b

e2b

e3be4b

e5b

Reference Group Area

Patient A Area

Stroke - Environmental - Barriers

0

20

40

60

80

100e1b

e2b

e3be4b

e5b

Reference Group Area

Patient B Area

Identifying gaps between Capacity and Performance

.4 .3 .2 .1 .0

Performance

Capacity

= positive effect of environment

Uses of disability profiles

D470 Using Transportation- MS (N=100)

0

10

20

30

40

50

60

70

80

% o

f M

S P

atie

nts

(N

=10

0)

Performance

Capacity

= Positive Effect of Environment

Identifying gaps between Capacity and Performance

.4 .3 .2 .1 .0

Performance

Capacity

= negative effect of environment

Uses of disability profiles

D770 Intimate Relationships- Bipolar (N=110)

0

10

20

30

40

50

60

% o

f B

ipo

lar

Pat

ien

ts (

N=

110)

Performance

Capacity

= Negative Effect of Environment

Diagnoses alone are not sufficient in clinical settings to guide care and management. MHADIE researchers recommend that the ICF model and its related instruments be used as complementary tools for:

1.define person’s functioning2. identifying patient’s needs 3.planning interventions, and evaluating

clinical outcomes

Since MHADIE data have shown that the ICF notions of the patient’s capacity andperformance play a crucial role in explainingthe impact of a health condition on theperson’s life, in a reliable and valid manner,MHADIE researchers recommend thatICF-based clinical instruments be developedfor routine clinical use in order to assessboth capacity and performance.

MHADIE research shows that environmental factors have an influence on patient’sperformance independent of their capacity, MHADIE researchers therefore recommendthat these factors be taken in account when assessing and planning clinical aswell as social interventions.◦ environmental factors should be taken into

account when assessing and planning all interventions, both medical and social

MHADIE researchers recommend that the impact of disability must be assessed, notmerely at the clinical level, but also at the levelof the person’s social and economic

participation. MHADIE project proves that information about

interpersonal interactions, major life areas and community and social life, can be successfully collected and evaluated.

MHADIE researchers recommend that, in the clinical setting, the ICF model be used as a common language across levels of care and for different intervention purposes (prevention, treatment, rehabilitation, public health);

ICF is useful as a common language across professions and for collecting

information for multidisciplinary treatment.