Presentation on theme: "Dr. José Luis Ayuso-Mateos Professor of Psychiatry"— Presentation transcript:
1 Application of the ICF model in clinical and rehabilitation settings: Presentation of MHADIE results Dr. José Luis Ayuso-MateosProfessor of PsychiatryUniversidad Autónoma de Madrid , SpainWP4 Leader
2 General ObjetivesUse the functioning and disability model of the ICF to analyze health surveys in the general population and existing statistics about education.Demonstrate how the ICF model is appropriate for describing disability patterns in the clinical population.Demonstrate ICF validity and usefulness in compiling educational databases.Formulate recommendations for the development of health and social policies in the UE.
5 EURO: Top Ten DALYs 2000 1. Ischaemic heart disease 10.5% Cerebrovascular disease6.8%Unipolar depressive disorders6.1%Alzheimer and other dementias3.0%Alcohol use disorders2.9%Hearing loss, adult onset2.6%COPD2.4%Road traffic accidentsOsteoarthritis10. Self-inflicted injuries2.3%
6 Need for instruments that use the biopsychosocial model in the assesment of functioning and disability
7 ICF TOOLSFull Version of ICFICF ChecklistWHO-DAS IIICF Core Sets
8 ICF ChecklistSelection of the most relevant ICF categories (169 from 1494):Alterations in:body functionsbody structuresActivities and participationEnvironmental factorsOther information about environmentUsed by:clinicalpatients / relativesresearchers
9 WHO-DAS II Assesses 6 domains: Understanding and communication Getting aroundSelf-careInterpersonal interactions and relationshipsDaily activitiesParticipation
10 WP 4: Application of the ICF model in clinical and rehabilitation settings ObjectivesTo demonstrate the applicability of ICF-linked measurement instruments, the ICF Checklist and the WHODAS II in a variety of clinical settings and by different professionalsTo evaluate the quality of care in patient clinical settings by using functioning levels as outcome indicators in a range of clinical conditionsTo evaluate disability profiles obtained from ICF-linked assessment instruments
11 WP4 Participants involved Statistical centresIMIMARSWHOClinical and rehabilitation centresUAMInstituto Nazionale NeurologicoLudwig-Maximilians UniCharles Uni.Rehabilitation Institute SloveniaMalarden UniversityAA A total of 74 researchers
13 ICF in clinical and rehabilitation settings N = 1200 patients Rheumathoid ArthritisMusculoeskeletal diseasesMultiple sclerosisTraumatic Brain InjuryStrokeUnipolar DepressionBipolar DisorderMigraineParkinson DiseaseMusc conditionsIschaemic Heart Disease
14 Design: multicentre, transversal and longitudinal study METHOLOGYDesign: multicentre, transversal and longitudinal studyDependent Variable:Functioning and disability (defined by the ICF model)Common Instruments for evaluation:Sociodemografic characteristicsICF-ChecklistWHODAS-IISF-36Disease-specific instruments for evaluationTime points of assessment:Baseline assessment6 weeks3 months
15 ICF Checklist and WHODAS II have good psychometric properties Objective 1: To demonstrate the validity and applicability of ICF-linked measurement instruments, the ICF Checklist and the WHODAS II in a variety of clinical settingsICF Checklist and WHODAS II have good psychometric propertiesStructural validity indicates that they are closely related to the underlying conceptual model (ICF)They have sensibility to change
16 RESULTS:Depression sample treated in Primary Care Evolution of symptomatology after 6 weeks and 3 months:Clinical remission: 53.8% at 6 weeks and 71.8% at 3 months
17 Overall and Individual Fitted Regression Lines For the Whole Sample (unipolar depression N=97)
20 Objective II : To evaluate the quality of care in patient clinical settings by using functioning levels as outcome indicators in a range of clinical conditions
21 DEPRESSIONNORMAL MOODMANIAHYPOMANIAMIXED EPISODEMore than 6 months
22 Euthymic patients Functioning was impaired in at least 35 ICF categories in more than 75% of participants
23 The gap between clinical recovery and functional recovery
24 Euthymic patients Environmental Factors facilitatorsbarriersattitudes of immediate family members and friendssocial normspractices and ideologieshealth services, systems and policieshealth professionalsupport of family members and friends
25 Objective III: To evaluate disability profiles obtained from ICF-linked assessment instruments
26 Difference in proportions of Capacity, Performance, Barriers and Facilitators code counts for two Stroke patients compared with the average Stroke group profile
27 Uses of disability profiles Identifying gaps between Capacity and PerformancePerformanceCapacity= positive effect of environment
31 Recommendation 1Diagnoses 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:define person’s functioningidentifying patient’s needsplanning interventions, and evaluating clinical outcomes
32 Recommendation 2 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.
33 Recommendation 3MHADIE 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
34 Recommendation 4 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.
35 Recommendation 5MHADIE 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 languageacross professions and for collecting information for multidisciplinary treatment.