Aims and objectives. To compare a functioning assessment based on the International Classification of Functioning, Disabilityand Health (ICF) with a conventional medical assessment, in terms of their respective consequences for health professionals’clinical decision-making and the fit with patient’s own perspective of health.Background. In chronic diseases, pathogenic-oriented health care falls short in generating all the information required fordetermining healthcare provision to improve health. A broader, so-called salutogenic approach, by using the ICF, focusingon how to stay healthy, rather than on what causes diseases, seems more appropriate.Design. A cross-sectional comparative study using data from a randomised controlled trial.Methods. Data about patient problems and professional healthcare activities were collected from a total of 81 patients withsevere multiple sclerosis who were randomly assigned to one of two groups: the ICF group, assessed with a functioningassessment (n = 43), and the medical group, assessed with a conventional medical assessment (n = 38). Data were analysedstatistically using descriptive and inferential statistics.Results. A functioning assessment resulted in the registration of significantly more patient problems in the health components‘participation’ and ‘environmental factors’, as well as significantly more professional healthcare activities befitting thesecomponents. The ICF group had a significant positive correlation between registered problems by health professionals andpatients’ self-reported problems, whereas the medical group had several negative correlations.Conclusion. A functioning assessment resulted in a care plan that not only was broader and more complete but also reflectedthe patients’ self-reported problems more closely than a medical assessment, without a loss of focus on medical problems.Relevance to clinical practice. This study has shown that some health problems remain unnoticed by a medical assessmentalone, which is especially important for the chronically ill. A functioning assessment provides a strong foundation for identifyingall relevant information related to health.
Abstract: Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged 75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. ‘Difficulty in walking’ and ‘unexplained weight loss’ appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.
Enhancing communication performance skills may help children with Down Syndrome (DS) to expand their opportunities for participation in daily life. It is a clinical challenge for speech-language pathologists (SLP) to disentangle various mechanisms that contribute to the language and communication problems that children with DS encounter. Without clarity of different levels of functioning, appropriate interventions may be poorly conceived or improperly implemented. In the present study, the International Classification of Functioning, Disability and Health – Children and Youth Version (ICF-CY) framework was used to classify contributing factors to communication performance in a multiple case study of six young children with DS. Within a comprehensive assessment, we identified individual and environmental facilitators and barriers, leading to an integrative profile of communication performance (IPCP) for each child. Whereas these six children shared a developmental, and/or expressive vocabulary age and/or level of communicative intent, the children faced similar but also unique personal and environmental factors that play an important role in their communication performance. Our data reveal that a combination of different factors may lead to the same language outcomes and vice versa, based on a unique pattern of interdependency of ICF-CY domains. Planning SLP interventions for enhancing communication performance in children with DS should therefore be based on a comprehensive view on the competences and limitations of every individual child and its significant communication partners. This evaluation should address facilitators and barriers in body functions, structures, activities, participation and environment, with a specific focus on individual strengths. The ICF-CY provides a useful framework for constructing an IPCP that serves this purpose.
