Dr. José Luis Ayuso-Mateos Professor of Psychiatry Universidad Autónoma de Madrid , Spain

1. Application of the ICF model in clinical and rehabilitationsettings: Presentation of MHADIE results Dr. José Luis Ayuso-Mateos Professor of Psychiatry Universidad Autónoma de Madrid , Spain WP4 Leader

2. General Objetives • Use the functioning and disability model of the ICF to analyze health surveys in the general population and existing statistics about education. • Demonstrate how the ICF model is appropriate for describing disability patterns in the clinical population. • Demonstrate ICF validity and usefulness in compiling educational databases. • Formulate recommendations for the development of health and social policies in the UE.

3. How do we measure the impact of disease?

4. 2000 2000

5. EURO: Top Ten DALYs 2000

6. Need for instruments that use the biopsychosocial model in the assesment of functioning and disability

7. ICF TOOLS Full Version of ICF ICF Checklist WHO-DAS II ICF Core Sets

8. ICF Checklist Selection of the most relevant ICF categories (169 from 1494): • Alterations in: • body functions • body structures • Activities and participation • Environmental factors • Other information about environment • Used by: • clinical • patients / relatives • researchers

9. WHO-DAS II Assesses 6 domains: Understanding and communication Getting around Self-care Interpersonal interactions and relationships Daily activities Participation http://www.who.int/icidh/whodas/index.html

10. WP 4: Application of the ICF model in clinical and rehabilitation settings Objectives • To demonstrate the applicability of ICF-linked measurement instruments, the ICF Checklist and the WHODAS II in a variety of clinical settings and by different professionals • To evaluate the quality of care in patient clinical settings by using functioning levels as outcome indicators in a range of clinical conditions • To evaluate disability profiles obtained from ICF-linked assessment instruments

11. Clinical and rehabilitation centres UAM Instituto NazionaleNeurologico Ludwig-MaximiliansUni Charles Uni. RehabilitationInstituteSlovenia MalardenUniversity WP4 Participantsinvolved Statistical centres • IMIM • ARS • WHO AA A total of 74 researchers

12. Reumathoid Dis Musculoskeletal Dis Bipolar Dis. Depressión Reumathology Psychiatry Neurology ICF Cardiology Rehabilitacion Parkinson M. Sclerosis Migraine Ischaemic Coronary disease Stroke Brain injury

13. ICF in clinical and rehabilitation settings N = 1200 patients Rheumathoid Arthritis Musculoeskeletal diseases Multiple sclerosis Traumatic Brain Injury Stroke Unipolar Depression Bipolar Disorder Migraine Parkinson Disease Musc conditions Ischaemic Heart Disease

14. METHOLOGY • Design:multicentre, transversal and longitudinal study • Dependent Variable: • Functioning and disability (defined by the ICF model) • Common Instruments for evaluation: • Sociodemografic characteristics • ICF-Checklist • WHODAS-II • SF-36 • Disease-specific instruments for evaluation • Time points of assessment: • Baseline assessment • 6 weeks • 3 months

15. Objective 1: To demonstrate the validity and applicability of ICF-linked measurement instruments, the ICF Checklist and the WHODAS II in a variety of clinical settings • ICF Checklist and WHODAS II have good psychometric properties • Structural validity indicates that they are closely related to the underlying conceptual model (ICF) • They have sensibility to change

16. RESULTS:Depression sample treated in Primary Care Evolution of symptomatology after 6 weeks and 3 months: Clinical remission: 53.8% at 6 weeks and 71.8% at 3 months

17. Overall and Individual Fitted Regression Lines For the Whole Sample (unipolar depression N=97)

18. Within Variance

19. Between Variance

20. Objective II : To evaluate the quality of care in patient clinical settings by using functioning levels as outcome indicators in a range of clinical conditions

21. MANIA MIXED EPISODE HYPOMANIA NORMAL MOOD DEPRESSION More than 6 months

22. Euthymic patients Functioning was impaired in at least 35 ICF categories in more than 75% of participants

23. The gap betweenclinicalrecovery and functionalrecovery

24. Euthymic patients Environmental Factors • health professional • support of family members and friends • attitudes of immediate family members and friends • social norms • practices and ideologies • health services, systems and policies facilitators barriers

25. Objective III: To evaluate disability profiles obtained from ICF-linked assessment instruments

26. Difference in proportions of Capacity, Performance, Barriers and Facilitators code counts for two Stroke patients compared with the average Stroke group profile

27. Uses of disability profiles Identifying gaps between Capacity and Performance .4 .3 .2 .1 .0 Performance Capacity = positive effect of environment

29. Uses of disability profiles Identifying gaps between Capacity and Performance .4 .3 .2 .1 .0 Performance Capacity = negative effect of environment

31. Recommendation 1 Diagnoses alone are not sufficient in clinical settings to guide care and management. MHADIE researchers recommend that the ICF model and its related instruments be used as complementary tools for: • define person’s functioning • identifying patient’s needs • planning interventions, and evaluating clinical outcomes

32. Recommendation 2 Since MHADIE data have shown that the ICF notions of the patient’s capacity and performance play a crucial role in explaining the impact of a health condition on the person’s life, in a reliable and valid manner, MHADIE researchers recommend that ICF-based clinical instruments be developed for routine clinical use in order to assess both capacity and performance.

33. Recommendation 3 MHADIE research shows that environmental factors have an influence on patient’s performance independent of their capacity, MHADIE researchers therefore recommend that these factors be taken in account when assessing and planning clinical as well as social interventions. • environmental factors should be taken into account when assessing and planning all interventions, both medical and social

34. Recommendation 4 • MHADIE researchers recommend that the impact of disability must be assessed, not merely at the clinical level, but also at the level of the person’s social and economic participation. • MHADIE project proves that information about interpersonal interactions, major life areas and community and social life, can be successfully collected and evaluated.

35. Recommendation 5 • MHADIE researchers recommend that, in the clinical setting, the ICF model be used as a common language across levels of care and for different intervention purposes (prevention, treatment, rehabilitation, public health); • ICF is useful as a common language across professions and for collecting information for multidisciplinary treatment.