Purpose: To identify outcome measures cited in published studies focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities, and to identify and quantify the concepts contained in these measures using the ICF as a reference.Methods: Electronic searches of Medline, Embase, CINAHL, Pedro and the Cochrane Library from 1997 to March 2002 were carried out. In a first step, abstracts of the retrieved studies were checked and data on the outcome measures and certain characteristics of the included studies were extracted. In a second step, the items of the questionnaires and their underlying concepts were specified. These concepts were then linked to ICF categories using standardized linkage rules.Results: From the 1,657 abstracts retrieved, 259 studies met the inclusion criteria. In a second step, 277 formal assessment instruments and 351 single clinical measures were retrieved. A total of 1,353 concepts were extracted from the clinical and technical measures. Ninety-six percent of these concepts could be linked to ICF categories. Fifty-six second-level ICF categories representing the concepts contained in the measures. Twenty-six (46%) of the 56 categories belong to the component Body Functions, five (9%) to the component Body Structures, and 25 (45%) to the component Activities and Participation.Conclusions: The ICF provides a valuable reference to identify and quantify the concepts of outcome measures focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities. Our findings indicate a need to define and to agree on 'what should be measured' in rehabilitation care to allow for a comparison of patient populations.
Purpose: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in the acute hospital.Methods: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients.Results: Twenty-one experts selected a total of 47 second-level ICF categories. The largest number of categories was selected from the ICF component Body Functions (17 categories or 36%). Nine (19%) of the categories were selected from the component Body Structures, 11 (23%) from the component Activities and Participation, and 10 (21%) from the component Environmental Factors.Conclusion: The Acute ICF Core Set for patients with musculoskeletal conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.
The study is part of the project "Orthopaedics 2010 -- evaluation of the demand for the orthopaedic work force in the year 2010", initiated by the professional association of orthopaedists (BVO). The aim is to estimate the prospective number of orthopaedists for the sufficient medical care of musculoskeletal disorders and injuries.The main data source was the official statistics of discharge rates from 1994 to 1999 and the German population forecasts from 1994 to 2010 of the Federal Office of Statistics, Wiesbaden, Germany. An univariate forecasting analysis was done using the Granger and Newbold method.All diagnostic categories of musculoskeletal disorders (arthropathies, dorsopathies, rheumatism, osteopathies) will increase up to four-fold from 1994 to 2010. Three of the four diagnostic categories of injuries (dislocations, sprains and strains; contusion; injuries and open wounds) will decrease by up to 15 percent, the diagnostic category of fractures will increase (10 percent). The stratified analyses by gender and age reveal that women and persons over 65 years old are more often affected by musculoskeletal disorders and injuries.Both demographic changes and changes in the utilization of inpatient care will lead to a substantial increase of hospital cases up to 2010. The presented results should be looked at together with their confidence limits as interval estimations. In addition, there are independent external factors such as the new prospective payment system (G-DRGs) that will influence the hospital admission rates as well.
Grill E, Stucki G, Scheuringer M, Melvin J: Validation of International Classification of Functioning, Disability, and Health (ICF) Core Sets for early postacute rehabilitation facilities: Comparisons with three other functional measures. Am J Phys Med Rehabil 2006;85:640–649. Objective: Short lists of International Classification of Functioning, Disability, and Health (ICF) categories, ICF Core Sets, have been developed as reference standards for clinical practice and research. The objective of this study was to validate the ICF Core Sets for early postacute rehabilitation facilities against the measures most commonly used in early postacute rehabilitation, the FIM™ instrument, the Functional Assessment Measure, and the Barthel index. Design: Linking study matching the concepts of three commonly used outcome measures to corresponding ICF categories. Results: Corresponding ICF categories could be found for all of the items of the FIM™ instrument + Functional Assessment Measure and Barthel index. The 40 items of these three measures were linked to 33 different ICF categories. Four items could be linked to ICF categories that were not part of any of the Postacute ICF Core Sets. Conclusions: The Postacute ICF Core Sets cover the concepts of the most frequently used measures in early postacute rehabilitation. Yet, many aspects of human functioning are not measured by the FIM™ instrument + Functional Assessment Measure and the Barthel index. If this information is considered relevant, these items would have to be added by using supplementary measures. Our comparison demonstrates the benefit of using a common language when comparing items using different wordings and concepts.
Guidance from the Institute for Quality and Efficiency in Health Care (IQWiG) on cost estimation in cost–benefit assessments in Germany acknowledges the need for standardization of costing methodology. The objective of this review was to assess current methods for deriving clinical event costs in German economic evaluations. A systematic literature search of 24 databases (including MEDLINE, BIOSIS, the Cochrane Library and Embase) identified articles, published between January 2005 and October 2009, which reported cost-effectiveness or cost-utility analyses. Studies assessed German patients and evaluated at least one of 11 predefined clinical events relevant to patients with diabetes mellitus. A total of 21 articles, describing 199 clinical cost events, met the inclusion criteria. Year of costing and time horizon were available for 194 (97%) and 163 (82%) cost events, respectively. Cost components were rarely specified (32 [16%]). Costs were generally based on a single literature source (140 [70%]); where multiple sources were cited (32 [16%]), data synthesis methodology was not reported. Cost ranges for common events, assessed using a Markov model with a cycle length of 12 months, were: acute myocardial infarction (nine studies), first year, 4,618–17,556 €; follow-up years, 1,006–3,647 €; and stroke (10 studies), first year; 10,149–24,936 €; follow-up years, 676–7,337 €. These results demonstrate that costs for individual clinical events vary substantially in German health economic evaluations, and that there is a lack of transparency and consistency in the methods used to derive them. The validity and comparability of economic evaluations would be improved by guidance on standardizing costing methodology for individual clinical events.
