Disabilities of osteoporosis, arthritis, pain better compared using universal standard

The ICF classification, with five musculoskeletal core sets, has been validated in several countries.

VIENNA — The WHO International Classification of Functioning, Disability and Health, a biopsychosocial model for describing and classifying function, can provide a new tool for orthopedists, physiatrists and rehabilitation specialists to measure and assess function, disability and health status in individuals with musculoskeletal conditions.

After it was approved in 2001 and endorsed by the WHO, member states were urged to use the classification tool for research, surveillance and reporting of health and disability status, but adoption has been slow, according to Karsten E. Dreinhöefer, MD.

“This is really a classification that should be used all around the world,” he said at the 10th European Federation of National Associations of Orthopaedics and Traumatology Congress.

Karsten E. Dreinhöefer

New approach

During a symposium on modern rehabilitation tools, Dreinhöefer, a member of the Orthopaedics Today Europe Editorial Board, urged the international orthopedic community to accept and begin using the validated International Classification of Functioning, Disability and Health (ICF) and related tools developed through a worldwide consensus process.

The ICF encompasses a “new” way of evaluating disability by incorporating social aspects of daily living, contextual factors and environmental impact on function and health status, he said.

Starting with a health condition/disease, ICF takes into account the specific domains and categories, or core sets, relevant for assessing an individual’s body structure, functional level, capacity for activity, execution of tasks and participation in life experiences.

In discussing elements of the ICF, Dreinhöefer said, “The ICF uses core sets and categories to help clinicians determine what should be measured, rather than how they should be measured.”

The first drafts of the musculoskeletal medicine core sets have been developed and are being used in clinical practice for osteoarthritis (OA), rheumatoid arthritis, osteoporosis, low back pain and chronic regional pain, he noted.

This diagram is a representation of the model of disability on which the ICF was based. It shows disability and functioning as an interaction of contextual factors — both personal and environmental — and health conditions, which include diseases and injuries.

The OA-specific core sets, for example, that Dreinhöefer and others developed, involve 10 of 485 possible body functions, five of 302 body structures, 11 of 384 activities and 10 of 253 environmental factors.

Immediate family is an example of an OA environmental factor since it impacts health and the ability to function.

Many purposes

Clinicians and health professionals are well equipped to provide needed ICF qualifying information for body function and structure from the history, clinical examination, tests and questionnaires, Dreinhöefer noted.

The classification system affords consistent comparison of the effects of all degrees of loss of function from these five musculoskeletal disorders while permitting a realistic assessment of therapies and their effectiveness, he said.

According to ICF developers, because patients with the same condition/disease are rated using identical core sets, the findings may be useful for research, health education and health policy development. – by Susan M. Rapp

References:

• Dreinhöefer KE. Application of the ICF in orthopaedics and trauma surgery. Presented at the 10th EFORT Congress. June 3-6, 2009. Vienna.
• Dreinhöefer KE, Cieza A, Stucki G. The perspectives when assessing function in patients with osteoarthritis. In Dreinhöefer KE, Dieppe P, Günther KP, Puhl W, eds. Eurohip. Berlin Heidelberg: Springer; 2009:133-143.
• Dreinhöefer K, Stucki G, Ewart T, et al. ICF core sets for osteoarthritis. J Rehabil Med. 2004;Suppl. 44:75-80.
• The ICF and related documents can be found at http://www.who.int/classifications/icf/en/.
• Karsten E. Dreinhöefer, MD, can be reached in the Department of Orthopedics, Traumatology and Sports Medicine, Medical Park Humboldmühle, Berlin Ulm University. An der Mühle 2-9, 13507 Berlin, and Center for Musculoskeltal Surgery, Charité-University Medicine Berlin, Berlin Germany; 49-30 300 240 9212; e-mail: k.dreinhoefer@medicalpark.de.