The definition of disability: what is in a name?
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Persons with Disabilities↗
Biomedical subjects
Somnath Chatterji
Publications and source records attributed to Somnath Chatterji.
Identification of candidate categories of the International Classification of Functioning Disability and Health (ICF) for a Generic ICF Core Set based on regression modelling.
BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) is the framework developed by WHO to describe functioning and disability at both the individual and population levels.While condition-specific ICF Core Sets are useful, a Generic ICF Core Set is needed to describe and compare problems in functioning across health conditions. METHODS: The aims of the multi-centre, cross-sectional study presented here were: a) to propose a method to select ICF categories when a large amount of ICF-based data have to be handled, and b) to identify candidate ICF categories for a Generic ICF Core Set by examining their explanatory power in relation to item one of the SF-36. The data were collected from 1039 patients using the ICF checklist, the SF-36 and a Comorbidity Questionnaire.ICF categories to be entered in an initial regression model were selected following systematic steps in accordance with the ICF structure. Based on an initial regression model, additional models were designed by systematically substituting the ICF categories included in it with ICF categories with which they were highly correlated. RESULTS: Fourteen different regression models were performed. The variance the performed models account for ranged from 22.27% to 24.0%. The ICF category that explained the highest amount of variance in all the models was sensation of pain. In total, thirteen candidate ICF categories for a Generic ICF Core Set were proposed. CONCLUSION: The selection strategy based on the ICF structure and the examination of the best possible alternative models does not provide a final answer about which ICF categories must be considered, but leads to a selection of suitable candidates which needs further consideration and comparison with the results of other selection strategies in developing a Generic ICF Core Set.
Adolescent↗
Quality of life in the Palestinian context: an inquiry in war-like conditions.
This study aims to elucidate the concept of quality of life (QOL) in a unique environment characterized by protracted and ongoing conflict, beginning with the utilization of the WHOQOL-Bref as a starting point for discussion. It works to determine important health-related quality of life domains and items within each domain, and evaluate issues pertinent to the Palestinian population's understanding of life quality in the Occupied Palestinian Territory. Focus group discussions (FGD) were conducted with individuals living in the Gaza Strip and Ramallah District of the West Bank. Participants were asked if they understood the term QOL; and about the determinants of their own QOL, using open-ended questions. Participants were then presented with the WHOQOL-Bref questions and requested to assess their relevance and importance in determining their own QOL, and encouraged to suggest additional ones. A total of 150 men and women of various ages and socioeconomic classes participated in 13 FGD. A major finding is the all-encompassing impact of the political context on Palestinians' QOL assessment. The study demonstrates that political freedom, self-determination, participation in democratic processes and feeling involved in political decision-making are considered important contributors to people's QOL. The study raises the option of adding a new domain to the WHOQOL-Bref, allowing the study of its psychometric properties and its relationship to the rest of the instrument. This contribution should be particularly relevant to societies and cultures in conflict-affected zones and locales where violence and insecurity constitute an important part of life. The documentation of QOL, beyond fatal and non-fatal health outcomes, must remain an important objective of all evaluations in order to guide policy and resource allocation decisions directed towards improving peoples' lives in general and their health in particular.
Adolescent↗
Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey.
BACKGROUND: Mental disorders are believed to account for a large portion of disease burden worldwide. However, no national studies have been undertaken to assess this assumption in the Arab world. METHODS: As part of the WHO World Mental Health (WMH) Survey Initiative, a nationally representative psychiatric epidemiological survey of 2857 adults (aged 18 years) was done in Lebanon between September, 2002, and September, 2003, through a study called LEBANON (Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation). 12-month prevalence and severity of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) disorders, and treatment were assessed with the WHO Composite International Diagnostic Interview (CIDI, version 3.0). Information was also obtained for sociodemographics and exposure to traumatic events in the Lebanon wars. FINDINGS: 308 (17.0%) of respondents met criteria for at least one 12-month DSM-IV/CIDI disorder, 108 (27.0%) of whom were classified serious and an additional 112 (36.0%) moderate. Nearly half of respondents had a history of exposure to war-related traumatic events. Significantly elevated odds ratios (OR) of mood, anxiety, and impulse-control disorders were associated with two (OR 2.0-3.6) or more (2.2-9.1) war-related traumatic events, resulting in substantially higher proportions of moderate and severe 12-month mental disorders in respondents exposed to multiple war-related traumata (16.8-20.4%) compared with other respondents (3.3-3.5%). Only 47 (10.9%) respondents with 12-month disorders obtained treatment. 85% of people were treated in the general medical sector and the mental-health-care system, and the rest by religious or spiritual advisers, counsellors, herbalists, or fortune-tellers. INTERPRETATION: Mental disorders are common in Lebanon, with a prevalence equivalent to that in Western Europe. However, the number of individuals with mental disorders who are not receiving treatment is considerably higher in Lebanon than in Western countries.
Adult↗
Content comparison of low back pain-specific measures based on the International Classification of Functioning, Disability and Health (ICF).
OBJECTIVES: The objective of this study was to compare the content covered by the North American Spine Society Lumbar Spine Outcome Assessment Instrument, the Oswestry Low Back Disability Questionnaire, and the Roland-Morris Disability Questionnaire based on the International Classification of Functioning, Disability and Health (ICF). METHODS: The linkage of items of the three measures to the ICF involved three steps, which were performed by two different health professionals and in which 10 different linking rules were applied. RESULTS: In the 48 items of the three instruments, a total of 123 concepts were identified and linked to the ICF. The concepts contained in the items were linked to 10 ICF categories of the component "body functions," 27 of the component "activities and participation," and 4 of the component "environmental factors." The estimated kappa coefficients ranged from 0.67 to 1.00. CONCLUSION: Comparison based on the ICF provides insight into both the breadth of health dimensions measured as well as the thoroughness and depth of measurement. Therefore, it can be a useful tool when selecting specific measures for a study. Compared with other types of qualitative review, the most important advantage of the content comparison of measures based on the ICF is the use of an external and independent reference to which all the instruments can be linked and by which all the instruments can be compared. The three back-specific measures are comparable, with their common focus on physical aspects of body functions and activities and participation.
Activities of Daily Living↗
ICF linking rules: an update based on lessons learned.
OBJECTIVE: Outcome research seeks to understand the end results of health services. Researchers use a wide variety of outcome measures including technical, clinical and patient-oriented measures. The International Classification of Functioning, Disability and Health (ICF) as a common reference framework for functioning may contribute to improved outcome research. The objective of this paper is to provide an updated version of the linking rules published in 2002 and illustrate how these rules are applied to link technical and clinical measures, health-status measures and interventions to the ICF. RESULTS: Three specific linking rules have been established to link health-status measures to the ICF and one specific linking rule has been created to link technical and clinical measures and interventions. A total of 8 linking rules have been established for use with all different outcome measures and with interventions. CONCLUSION: The newly updated linking rules will allow researchers systematically to link and compare meaningful concepts contained in them. This should prove extremely useful in selecting the most appropriate outcome measures among a number of candidate measures for the applied interventions. Further possible applications are the operationalization of concrete ICF categories using specific measures or the creation of ICF category-based item bankings.
Activities of Daily Living↗
Global patterns of healthy life expectancy in the year 2002.
BACKGROUND: Healthy life expectancy--sometimes called health-adjusted life expectancy (HALE)--is a form of health expectancy indicator that extends measures of life expectancy to account for the distribution of health states in the population. The World Health Organization reports on healthy life expectancy for 192 WHO Member States. This paper describes variation in average levels of population health across these countries and by sex for the year 2002. METHODS: Mortality was analysed for 192 countries and disability from 135 causes assessed for 17 regions of the world. Health surveys in 61 countries were analyzed using new methods to improve the comparability of self-report data. RESULTS: Healthy life expectancy at birth ranged from 40 years for males in Africa to over 70 years for females in developed countries in 2002. The equivalent "lost" healthy years ranged from 15% of total life expectancy at birth in Africa to 8-9% in developed countries. CONCLUSION: People living in poor countries not only face lower life expectancies than those in richer countries but also live a higher proportion of their lives in poor health.
Cross-Cultural Comparison↗
Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.
CONTEXT: Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. OBJECTIVE: To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. DESIGN, SETTING, AND PARTICIPANTS: Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. MAIN OUTCOME MEASURES: The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. RESULTS: The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. CONCLUSIONS: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
Adult↗
Development of ICF Core Sets for patients with chronic conditions.
OBJECTIVE: The objective of the ICF Core Sets project is the development of internationally agreed Brief ICF Core Sets and Comprehensive ICF Core Sets. METHODS: The methods to develop both ICF Core Sets, the Comprehensive ICF Core Set and the Brief ICF Core Set, involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies and expert opinion. RESULTS: The results regarding the development of the ICF Core Sets for 12 health conditions (chronic widespread pain, low back pain, osteoarthritis, osteoporosis, rheumatoid arthritis, chronic ischemic heart disease, diabetes mellitus, obesity, obstructive pulmonary diseases, breast cancer, depression, and stroke) are presented in this supplement. CONCLUSION: Both, the Brief ICF Core Sets and the Comprehensive ICF Core Sets are preliminary and need to be tested in the coming years based on a standardized protocol in close cooperation with the ICF research branch of the WHO FIC CC (DIMDI) in Munich and the CAS team at WHO. The final goals are valid and globally agreed tools to be used in clinical practice, research and health statistics.
Chronic Disease↗
Identification of the most common patient problems in patients with chronic conditions using the ICF checklist.
OBJECTIVE: To identify the most common patient problems in patients with 12 different chronic conditions using the ICF checklist. METHODS: A multi-centre, cross-sectional study with convenient samples of patients who had received a clinical diagnosis of any of 12 different chronic conditions undergoing inpatient or outpatient rehabilitation. To describe the population, age, gender, and the SF-36 were recorded. Data for 917 patients from 33 rehabilitation centres were analysed. RESULTS: Most of the ICF-checklist categories were common to at least 1 condition. Pain was the sole category of 125 ICF-checklist categories that was common to all chronic conditions. Patients with low back pain, rheumatoid arthritis, and diabetes mellitus did not often experience the problems listed in the ICF-checklist. CONCLUSION: The main finding, that in most conditions categories from each component were common, underscores the need to address all components when assessing functioning and health in patients with chronic conditions.
Activities of Daily Living↗
Healthy life expectancy: comparison of OECD countries in 2001.
OBJECTIVES: To compare average levels of population health for Australia and other OECD countries in 2001. METHODS: Healthy life expectancies (HALE) for OECD countries for 2001 are based on analysis of mortality data for OECD countries, country-specific estimates of health state prevalences for 135 causes from the Global Burden of Disease 2000 study, and an analysis of 34 health surveys in 28 OECD countries, using novel methods to improve the comparability of self-report data. RESULTS: HALE at birth ranges from a low of 59.8 years for Turkey to a high of 73.6 years in Japan in 2001. Australia ranks fourth among OECD countries at 71.6 years with a 95% uncertainty interval of 70.9 to 72.8 years, ahead of New Zealand in 13th place at 70.3 years. The equivalent 'lost' healthy years at birth range from around 10 years in OECD countries with lowest life expectancies to around eight years in those with high life expectancies at birth. There is a statistically significant association between higher levels of health expenditure and higher healthy life expectancy across OECD countries, although causal inferences require more sophisticated analyses of the health system and non-health system determinants of levels of health. CONCLUSIONS: The new methods used in the WHO Multi-Country Household Survey Study have increased the comparability of self-report data across OECD countries, a major step forward in the use of self-reported data on health. Building on this experience, WHO is developing improved health status measurement techniques for a World Health Survey to be carried out in 2002/03.
Aged↗
WHO's ICF and functional status information in health records.
A common framework for describing functional status information (FSI) in health records is needed in order to make this information comparable and of value. The World Health Organization's (WHO's) International Classification of Functioning, Disability and Health (ICF), which has been approved by all its member States, provides this common language and framework. The biopsychosocial model of functioning and disability embodied in the ICF goes beyond disease and conceptualizes functioning from the individual's body, person, and lived experience vantage points, thereby allowing for planning interventions targeted at the individual's body, the individual as a whole or toward the environment. This framework then permits the evaluation of both the effectiveness and cost effectiveness of these different interventions in devising programs at the personal or societal level.
Activities of Daily Living↗
The ICF: Applications of the WHO model of functioning, disability and health to brain injury rehabilitation.
The traditional disease and diagnostic medical model is not always useful to brain injury professionals who need to describe, measure, and compare deficits associated with neurologic insult. Professionals in neurorehabilitation are in need of new systems that will assist them in identifying impairments and areas of intervention. The aim of this article is to present the International Classification of Functioning, Disability and Health (ICF), and its applications to brain injury rehabilitation. This taxonomy, developed by the WHO, allows the classification and assessment of functioning and disability in everyday activities and social involvement for individuals with medical conditions. Multi-disciplinary teams from 65 countries have collaborated in the development of the ICF to develop a tool that serves different purposes and disciplines with high trans-cultural validity. It can be of great value for professionals working in the field of brain injury who need to describe and quantify in detail neurocognitive, emotional, and sensory-motor functions as well as their impact on activities and participation in life situations. Its applications also extend to the domains of epidemiology, public health and public policy.
Activities of Daily Living↗
Linking health-status measurements to the international classification of functioning, disability and health.
With the approval of the International Classification of Functioning, Disability and Health by the World Health Assembly in May 2001, the concurrent use of both health-status measures and the International Classification of Functioning, Disability and Health is expected. It is therefore important to understand the relationship between these two concepts. The objective of this paper is to provide a systematic and standardized approach when linking health-status measures to the International Classification of Functioning, Disability and Health. The specific aims are to develop rules, to test their reliability and to illustrate these rules with examples. Ten linking rules and an example of their use are presented in this paper. The percentage agreement between two health professionals for 8 health-status instruments tested is also presented. A high level of agreement between the health professionals reflects that the linking rules established in this study allow the sound linking of items from health-status measures to the International Classification of Functioning, Disability and Health.
Activities of Daily Living↗
ICF Core Sets development for the acute hospital and early post-acute rehabilitation facilities.
The goal of this paper is to report on the background and the methods used in the ICF Core Set development for patients in the acute hospital and early post-acute rehabilitation facilities. ICF Core Sets are sets of categories out of the International Classification of Functioning, Disability and Health (ICF) which can serve as minimal standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. The ICF Core Sets were developed in a formal decision-making and consensus process, integrating evidence gathered from preliminary studies and expert opinion. The Acute ICF Core Sets for patients with neurological, musculoskeletal and cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals working in the acute hospital on medical, surgical or other units not specialised in rehabilitation. The Post-acute ICF Core Sets for geriatric patients and patients with neurological, musculoskeletal or cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals involved in early post-acute rehabilitation. The Acute and Post-acute ICF Core Sets are first versions and need to be tested and validated in the patient and professional perspective and in different countries, regions, health care and provider settings.
Activities of Daily Living↗