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

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Presentation on theme: "Dr. José Luis Ayuso-Mateos Professor of Psychiatry Universidad Autónoma de Madrid, Spain WP4 Leader."— Presentation transcript:

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

2 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.

3 How do we measure the impact of disease?

4 2000

5 1. Ischaemic heart disease10.5% 2. Cerebrovascular disease6.8% 3. Unipolar depressive disorders 6.1% 4. Alzheimer and other dementias 3.0% 5. Alcohol use disorders2.9% 6. Hearing loss, adult onset2.6% 7. COPD2.4% 8. Road traffic accidents2.4% 9. Osteoarthritis2.4% 10. Self-inflicted injuries2.3%

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

7 Full Version of ICF ICF Checklist WHO-DAS II ICF Core Sets

8 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

9 WHO-DAS II Assesses 6 domains: 1.Understanding and communication 2.Getting around 3.Self-care 4.Interpersonal interactions and relationships 5.Daily activities 6.Participation

10 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

11 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

12 Reumathology Bipolar Dis. Depressión Stroke Brain injury Reumathoid Dis Musculoskeletal Dis Ischaemic Coronary disease Parkinson M. Sclerosis Migraine Rehabilitacion Neurology Psychiatry Cardiology ICF

13 Unipolar Depression Bipolar Disorder Migraine Parkinson Disease Musc conditions Ischaemic Heart Disease Stroke Multiple sclerosis Traumatic Brain Injury Rheumathoid Arthritis Musculoeskeletal diseases ICF in clinical and rehabilitation settings N = 1200 patients

14 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

15 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

16 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

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







24 facilitatorsbarriers 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



27 Identifying g aps between Capacity and Performance. Performance Capacity = positive effect of environment Uses of disability profiles


29 Identifying g aps between Capacity and Performance. Performance Capacity = negative effect of environment Uses of disability profiles


31 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 persons functioning 2. identifying patients needs 3. planning interventions, and evaluating clinical outcomes

32 Since MHADIE data have shown that the ICF notions of the patients capacity and performance play a crucial role in explaining the impact of a health condition on the persons life, in a reliable and valid manner, MHADIE researchers recommend that ICF-based clinical instruments be developed for routine clinical use in order to assess both capacity and performance.

33 MHADIE research shows that environmental factors have an influence on patients performance independent of their capacity, MHADIE researchers therefore recommend that these factors be taken in account when assessing and planning clinical as well as social interventions. environmental factors should be taken into account when assessing and planning all interventions, both medical and social

34 MHADIE researchers recommend that the impact of disability must be assessed, not merely at the clinical level, but also at the level of the persons 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 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.

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