ICF core sets for low back pain: Do they include what matters to patients?

doi: 10.2340/16501977-0059

Abstract:

Objective: To investigate whether the International Classification of Functioning Disability and Health (ICF) Core Sets for low back pain encompass the key functional problems of patients.
Design: Cross-sectional evaluation of patient-centred problems with low back pain.
Subjects: A total of 402 patients living in the UK recruited into a randomized clinical trial.
Methods: Patients with acute or subacute low back pain were asked to identify: (i) the one thing they find most difficult to do, and (ii) something they usually enjoyed but were unable to do because of their back pain. Two raters classified responses according to the ICF. Inter-rater agreement was measured using the kappa statistic. The response categories were examined for inclusion within the Core Sets.
Results: For question (i) above, agreement between raters was 323/397 (81%), kappa (95% confidence interval (95% CI)) = 0.78 (0.73–0.82). A total of 329 (83%) fell within the ICF Brief Core Set; all except 3 were contained within the Comprehensive Core Set. For question (ii) agreement was 290/312 (93%), kappa (95% CI) = 0.91 (0.87–0.95). Only 54 (17%) of these fell within the Brief Core Set; the 2 most chosen categories (recreation and leisure: d920; caring for household objects: d650) accounted for 70% of responses, and were not included. All except 2 responses were encompassed by the Comprehensive Core Set.
Conclusion: Addition of codes d920 and d650 to the low back pain Brief Core Set would significantly increase the inclusion rate in this cohort.

Authors:

Ricky Mullis, Julie Barber, Martyn Lewis and Elaine Hay

Key words:

ICF, Core Sets, low back pain, outcome assessment.

References

  1. World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva: WHO; 2001.
  2. Stucki G, Ewert T, Cieza A. Value and application of the ICF in rehabilitation medicine. Disabil Rehabil 2002; 24: 932–938.
  3. Stucki G, Cieza A, Ewert T, Konstanjsek N, Chatterji S, Bedirhan Ustun T. Application on the International Classification of Functioning, Disability and Health (ICF) in clinical practice. Disabil Rehabil 2002; 24: 281–282.
  4. Stucki G. Applying the ICF in Medicine. J Rehabil Med 2004; Suppl 44: 5–6.
  5. Cieza A, Stucki G, Weigl M, Disler P, Jäckel W, Vvan der Linden S, et al. ICF Core Sets for Low Back Pain. J Rehabil Med 2004; Suppl 44: 69–74.
  6. Hay EM, Mullis R, Lewis M, Vohora K, Main CJ, Watson P, et al. Comparison of physical treatments versus a brief pain management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet 2005; 365: 2024–2030.
  7. Office for National Statistics. National Statistics Socio-Economic Classification (NS-SEC 2002). London: Stationery Office; 2002.
  8. Wolfe F, Smyth HA, Yunus MB, Bennett RM, Bombadier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160–172. Link to article
  9. Roland M, Morris R. A study of the natural history of back pain: Part 1: development of a reliable and sensitive measure of disability in low back pain. Spine 1983; 8: 141–144. Link to article
  10. Sigl T, Cieza A, Brockow T, Chatterji S, Kostanjsek N, Stucki G. Content comparison of low back pain-specific measures based on the International Classification of Function, Disability and Health (ICF). Clin J Pain 2006; 22: 147–153.
  11. Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ. Outcome of low back pain in general practice: a prospective study. BMJ 1998; 316: 1356–1359.
  12. Altman DG, editor. Practical statistics for medical research. London: Chapman & Hall; 1991.