Abstract

In 2001, the World Health Assembly (WHA) approved the International Classification of Functioning, Disability and Health (ICF). The approval of the ICF marks a paradigm shift from a purely disease-oriented model of health towards a more comprehensive model of the person's lived experience of health in light of the resources the person has and in interaction with the environment. This view is in line with the clinical practice, research and policy related to RMD. RMDs were at the forefront of the efforts to implement the ICF in clinical practice, research and policy. Standards for the assessment of functioning in RMDs were developed as ICF Core Sets for the most relevant RMDs including rheumatic arthritis, ankylosing spondylitis, low back pain, osteoporosis, and hand conditions. In full alignment with the conceptual model of OMERACT in emphasizing the need to specify what to measure before deciding on how to measure, the ICF Core Sets for RMDs were integrated as a core element in the OMERACT process. In addition, the 11th revision of the International Classification of Diseases (ICD) will include a specification for functioning properties that correspond to ICD codes used classifying RMDs. Information about ICF Core Sets and functioning properties can be retrieved from the website of the ICF Research Branch, a partnerwithin the WHO collaboration centre for the Family of International Classifications in Germany (http://www.icf-research-branch.org).

This website also provides some information on a manual that describes an approach for applying the ICF in clinical practice. This manual includes a RMD case and is now available in four European languages – Spanish, Italian, German and English as well as three Asian languages – Japanese, Korean and Chinese.

The Assessment of SpondyloArthritis international Society (ASAS) has taken the lead to develop a measurement instrument based on the ICF Core Set for ankylosing spondylitis. ASAS has laid the groundwork for a model for developing ICF-based assessment instruments.(http://www.asas-group.org/mission-statement.php) that has been taken up in similar efforts in other disease areas e.g. inflammatory bowel diseases

The most important next step is the integration of functioning, more concretely the specification of functioning elements as specified in ICF Core Sets, into RMD cohort studies – in both surveys and long-term clinical quality management programs. As the first ICF-based cohort study developed for spinal cord injury, the SwiSCI study (http://www.swisci.ch/de/) can serve as a model for integrating functioning elements in RMD cohort studies.

Building on valuable input already provided by RMD professionals, research groups with expertise in RMDs are welcome to continue contributing to the development of generic measurement tools based on the ICF 7-category Generic Set and the 30-category ICF Disability Set. Moreover, RMD groups with expertise in functioning are invited to contribute to the scientific endeavour to cross-walk the most important measurement instruments used in RMDs with the ICF, both qualitatively and quantitatively. This project, referred to as ICF INFO and, under the leadership of Professor Alan Tennant, provides the universal metric necessary for ICF-based reporting using RMD assessment instruments. Project information can be found on the (ICF Research Branch website www.icf-research-branch.org.