Implementation and use of the ICF Core Sets for Hand Conditions in clinical practice, rehabilitation and research: Lighthouse Project Hand

Status:

completed 09/2016

Aims:

The aim of the project was the implementation and application of the ICF Core Sets for Hand Conditions in clinical practice, rehabilitation and research. For guidance on content and structure of the work within the project two working groups were established – the "Working Group DGUV" with members of the statutory accident insurance agencies and the "Working Group BG Kliniken" with physicians, therapists and psychologists of the cooperating hospitals.

Activities/Methods:

The project was realised as a collaborating project with the following steps and subprojects:

• Development of the ICF-based assessment set hand (ICF HandA) based on the Brief ICF Core Set for Hand Conditions
• Validation of the ICF HandA in a multicentre cross-sectional study
• Development of treatment standards with reference time points for the application of the ICF HandA
• Development of a computer-based application (e-tool) for standardised data collection using the ICF HandA at the defined reference time points
• mplementation of the treatment standards and reference time points in a multi-centre longitudinal study
• Development of an ICF-based reporting system for standardised documentation and reporting of functioning and contextual Factors using the ICF HandA along the continuum of care
• Development of a score (ICF Score Hand) for the assessment of functioning and disability in hand injuries and diseases
• Development of materials and a learning programme as well as case studies for demonstrating the application of the ICF HandA.

Results:

The ICF-based assessment set hand (ICF HandA) was developed applying evidence of preparatory studies (expert-survey, systematic literature reviews) in a consensus process and based on the Brief ICF Core Set for Hand Conditions. With the ICF HandA a selection of measurement instruments and assessments becomes available to capture functioning and contextual factors in patients with injuries and diseases of the hand. Using the ICF HandA functioning can be described in a standardised way for all BG hospitals and along the continuum of care – from acute care to recovery of work ability. The ICF HandA enables the development of a prospective data pool that can be used to evaluate quality of results, to revise surgical and rehabilitative treatment strategies, to predict recovery of work ability and to assess disability of hand injuries (ICF Score Hand). In addition, the use of the ICF HandA entails adopting a comprehensive approach paying attention to the professional and social background of the patient – for the first time within hand surgical care and rehabilitation.

The ICF HandA was validated regarding its clinical relevance and applicability in a multicentre cross-sectional study comprising 294 patients with a broad range of injuries and diseases of the hand. Using data of this study, prevalence (frequencies) of the several aspects of functioning was assessed and pre-sented in a categorical functioning profile.

To investigate whether changes in functioning can be displayed over time using the ICF HandA, treatment standards for six injuries and diseases of the hand (traumatic amputation, flexor tendon injury, finger fracture, thumb basal joint arthritis, Dupuytren's contracture and complex regional pain syndrome) with corresponding reference time points were developed. Moreover, the treatment standards comprise recommendations for acute care and rehabilitative treatment procedure of the respective injuries and diseases, as well as recommendations for therapeutic interventions within rehabilitative care. The treatment standards thus represent a “guideline” for physicians and therapists for acute and rehabilitative care of patients with injuries and diseases mentioned above.

Furthermore, an automated and standardised reporting system can be generated using the ICF HandA. The content of these ICF-based reports are automatically generated by a computer-based application within the clinic system “medico” (e-tool). The traffic light system within the reporting system offers an overview of the present status of functioning and possible changes along the continuum of care. A same-day forwarding of the ICF-based report from hospitals to the statutory accident insurance agencies or to registered physicians is conceivable. However, further IT-adjustments are still required for application in clinical routine.

A comprehensive data pool was created within a prospective longitudinal study with 241 patients com-prising seven injuries and diseases applying the ICF HandA. To include additional diagnoses, a supplementary study with 301 patients was conducted at the BG trauma hospital Hamburg. With this overall data pool, a prediction of work ability could be modelled, which offers important information to optimise the care process.

Based on data of the three studies conducted within the project (cross-sectional, longitudinal and supplementary study) a score of functioning (ICF Score Hand) could be developed using Rasch analyses. With this score, functioning can be presented either regarding specific time points or changes over time. Moreover, associations between functioning and aspects such as work ability and time off work can be investigated and crucial information for management of care and rehabilitation can be gathered.

The developed materials were provided on the internet platform which had been developed within the project. The ICF HandA is presented in a user manual with extensive text, image and film materials; it was made accessible on the platform and linked as an official assessment instrument by the German Society for Hand Surgery. In addition, case studies demonstrate the application of the ICF HandA embedded in the treatment standards. A modular learning programme (ICF-Lernplattform Hand) offers a possibility for clinicians as well as staff of the statutory accident insurance agencies to gain knowledge on the ICF in general and the application of the ICF in practice.

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