Koehler, Barbara; Kirchberger, Inge; Glaessel, Andrea; Kool, Jan; Stucki, Gerold; Cieza,

Alarcos. Validation of the International Classification of Functioning, Disability and

Health Comprehensive Core Set for Osteoporosis: The Perspective of Physical
Therapists. Journal of Geriatric Physical Therapy. April/June 2011.

Abstract:

Objective: The "Comprehensive ICF Core Set for Osteoporosis" is an application of the
International Classification of Functioning, Disability and Health (ICF) and represents
the typical spectrum of functioning problems of patients with osteoporosis. The objective
of this study was to validate this ICF Core Set from the perspective of physical therapists.

Methods: Using a 3-round Delphi technique survey, physical therapists, experienced in

the treatment of patients with osteoporosis, were surveyed about patient problems,
resources, and aspects of the environment relevant to the physical therapy management of
individuals with OP. Responses were translated ("linked") into ICF language by using
standardized rules.

Results: Fifty-seven physical therapists across 25 countries representing each World

Health Organization region named 816 factors (patient problems, available resources, and
environmental influences). These 816 factors were linked to 160 ICF categories. Twenty-
five categories with an agreement among the participants exceeding 75% were not
represented in the Comprehensive ICF Core Set for Osteoporosis. Fifteen concepts were
linked to the as yet undeveloped ICF component. Personal Factors and 9 concepts were
found not to be covered by the ICF.

Conclusion: The validity of the Comprehensive ICF Core Set for Osteoporosis was
largely supported by the participants. Nine concepts (eg, "posture," "alignment,"
"ergonomics") identified by participants are not covered by the ICF and require further
investigation. Copyright (C) 2011 the Section on Geriatrics of the American Physical Therapy Association

A project of the World Health Organization, the ICF (International Classification

of Functioning, Disability and Health) is designed to provide a comprehensive
understanding of patients’ functioning and health. The ICF Core Set uses an
“integrative biopsychosocial model” of functioning and disability in various
diseases to promote understanding and communication among health
professionals involved in patient care and research.

Fifty-seven experienced physical therapists in 25 countries provided input into

the patient problems, patient resources, and environmental factors affecting their
work with osteoporosis patients. Osteoporosis is a major public health problem
worldwide, causing major functional and social limitations and disability for
older adults—especially women. Because physical therapists play a central role in
the management of osteoporosis, it was important to get their input in developing
and validating the ICF Core Set.

The results “largely supported” the previously developed ICF Core Set. However,
the physical therapists identified several ICF concepts as important for inclusion
in the osteoporosis Core Set. Several concepts fell into the category of “Body
Functions”—including mental functions such as confidence, energy and
motivation, which may affect how well patients follow recommended physical
therapy treatments. “Patients with osteoporosis require high levels of attention
and motivation when being treated and educated by physical therapists over a
long period,” the researchers write.

The physical therapists also identified concepts related to balance problems and
dizziness, which contribute to the risk of falls in patients with osteoporosis.
Additionally, they targeted problems related to muscle tone and control and co-
ordination of voluntary movements. “Restoration of muscle balance using
exercise therapy is a central task of physical therapists,” Dr. Koehler and co-
authors note.

Other factors fell under the ICF category of “Personal factors,” reflecting patients’
independence in managing their disease, which physical therapists seek to
improve through education. Some concepts identified as important by physical
therapists—such as posture, alignment, and ergonomics—weren’t previously
included in the ICF classification at all. These require “further investigation,” the
researchers write.

The findings provide valuable input on what factors physical therapists deem
important in maximizing function and reducing disability among their patients
with osteoporosis. When finalized, the ICF Core Set “can be used as a starting
point in the assessment of osteoporosis providing a common standardized
language for all health professions,” Koehler and colleagues conclude. The
criteria included in the Core Set will provide the world healthcare community
with a valuable new tool for planning and evaluating treatment and monitoring
progress in patients with this common and disabling disease.