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Recent research and the actions of the World Health Organization (WHO) have clarified the nature and value of rehabilitation as a key health strategy of the 21st century. However, strengthening rehabilitation in national health systems around the world is a challenge, partly because there is not an evidence-based argument that rehabilitation is a good economic and social investment. This argument, in turn, depends on characterizing the current and potential beneficiaries of rehabilitation, namely the individuals who could benefit from rehabilitation services whether or not they currently receive these services. Although identifying current beneficiaries is essential for evaluating the current demand for rehabilitation in existing health systems, as well as for making the economic investment case for rehabilitation within national health systems, it is only by characterizing potential beneficiaries that we can identify unmet needs and the potential social effect of rehabilitation. The objective of this study is to take a preliminary step toward both tasks by offering an overview of intuitively plausible approaches to characterizing beneficiaries of rehabilitation and to highlight limitations and challenges with each approach. We rely on the WHO's definition of rehabilitation, particularly the aim of rehabilitation to "optimize functioning and reduce disability," as our starting point., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.

Purpose: To demonstrate the value of the International Classification of Functioning, Disability and Health (ICF) notion of functioning as an operationalisation of health so as to describe, measure, and explain the lived experience of health, which is what matters to people about their health. Methods: Conceptual analysis based on evidence on the need to describe, measure, and compare states of health. Results: The ICF is the ideal framework to operationalise the lived experience of health. Its application in rehabilitation in particular, shows its value for the standardised reporting of outcomes of health interventions, clinical and services quality management, and evidence-informed health policy. Conclusions: The ICF provides both the frame of reference for an operationalisation of health that satisfies the intuitive understanding of what matters to people about their health and the technical tools for both health sciences and practice.Implications for rehabilitationAn operationalisation of health is essential to describe the relative health status of individuals and populations as well as to measure the impact of rehabilitation interventions.An operationalisation of health focuses on the lived experience of health.The International Classification of Health, Functioning and Disability (ICF) is the ideal framework to operationalise the lived experience of health.

There is a need for a comprehensive classification system of health-related rehabilitation services. For conceptual clarity our aim is to provide a health-related conceptual description of the term "rehabilitation service". First, we introduce a common understanding of the term "rehabilitation", based on the current definition in the World Health Organization's World Report on Disability, and a conceptual description of rehabilitation agreed upon by international Physical and Rehabilitation Medicine organizations. From a health perspective, rehabilitation can be regarded as a general health strategy with the aim of enabling persons with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning. Secondly, we distinguish different meanings of the term "service", that have originated in management literature. It is important to distinguish between micro, meso and macro level uses of the term "service". On a meso level, which is central for the classification of rehabilitation services, 2 aspects of a service, i.e. an offer of an intangible product and an organizational setting in which the offer is upheld, are both essential. The results of this conceptual analysis are used to develop a conceptual description of health-related rehabilitation, which is set out at the end of this paper. This conceptual description may provide the basis of a classification of health-related rehabilitation services, and is open for comments and discussion.

Background: To optimize patient functioning, rehabilitation professionals often rely on measurements of functioning as well as on classifications. Although the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) are used, their joint use has yet to become an established practice. To encourage their joint use in daily practice, the World Health Organization (WHO) has invited all rehabilitation practitioners worldwide to support the ICD-11 revision process by identifying the ICF categories that correspond to specific rehabilitation-relevant health conditions. The first step in completing this task, generating the list of these health conditions, was taken at a February 2012 workshop in São Paulo, Brazil., Objectives: The objectives of this paper are to present the results of the São Paulo workshop, and to invite practitioners to participate in the ICD-ICF joint use initiative., Discussion: Alternating plenary and small working group sessions were held and 103 rehabilitation-relevant health conditions were identified. With this list available, WHO together with the International Society of Physical and Rehabilitation Medicine (ISPRM), is reaching out to clinicians of all rehabilitation disciplines to take on the challenge of identifying the ICF categories for at least one of the health conditions listed.

Physical and Rehabilitation Medicine (PRM) is an independent medical specialty focusing on the improvement of functioning. A shared understanding of concepts is of vital importance for integrated action in this field. The aim of the present paper is to provide a conceptual model of PRM, to give background on its development and adoptions, and to explain the choice of terms, phrases, and concepts. It is based on the terms and concepts of the International Classification of Functioning, Disability and Health (ICF) that provides a widely accepted conceptual model and taxonomy of human functioning. Based on the White Book on Physical and Rehabilitation Medicine in Europe of 2006 a first proposal for a conceptual description of rehabilitation has been published in 2007. This proposal has been subjected to comments for modifications and amendments. E.g. it was underlined that PRM can apply both a health condition perspective including curative approaches and measures aiming at body functions and structures and a multi-dimensional and multi-professional team approach aiming to optimize functioning from a comprehensive functioning and disability perspective. The interaction between the PRM specialist and the person should be characterized as a partnership. PRM specialists work across all areas of health services and across all age groups. In summary, the specialty of PRM is characterized as the medicine of functioning.

Objective: A proposal for a conceptual description of rehabilitation was made in 2007 based on the International Classification of Functioning, Disability and Health. This conceptual description should foster the development of a common understanding of rehabilitation and its professions. The present paper aims to report on the development and current state of the discussions about this conceptual description and to provide the current version, which has been adopted by different European professional and scientific organizations., Methods: First, the history of the development of the conceptual description of rehabilitation is reported. Secondly, suggestions for modifications or amendments are introduced, and the resulting phrases and terms are presented and discussed., Discussion and Conclusion: One major change to the conceptual description of rehabilitation is the explicit integration of the perspective of the disabled person. The relationship between person and provider is characterized as a partnership. However, it is argued that quality of life should not be introduced as a primary goal of rehabilitation. This conceptual description can foster a common understanding of the rehabilitation professions and provide a point of departure for clarifying the role of different professions and services within the broad field of rehabilitation. It can also serve to position rehabilitation as a major health strategy and to sharpen the perception of rehabilitation among external stakeholders.

Purpose: This review provides an overview of the literature on the conceptualisation of the Personal Factors (PF) component of the International Classification of Functioning, Disability and Health (ICF)., Method: A systematic literature review was carried out. Electronic searches were performed in Pubmed, Embase, PsycINFO, CINAHL and SSCI. Qualitative content analysis of statements about PF was conducted using inductive coding., Results: The searches yielded 353 citations, 79 papers were eligible for analyses. Five hundred thirty-eight statements about PF were extracted, condensed and coded. Beside conceptual statements, 238 examples of potential PF as well as five attempts at classifying PF were found in the literature. PF were considered in relation to clinical service provision, assessment and intervention, in research and social security contexts. PF were seen to be related to various aspects of health, functioning, disability and the environment., Conclusions: The analysis of the literature shows that PF is seen as relevant to the application of the ICF in various settings. The review revealed a need for standardisation of PF. The literature points to the potential of PF in enhancing the understanding of functioning, disability and health, in facilitating interventions and services for people with disabilities, and strengthening the perspective of individuals in the ICF.

In 2008 the International Society of Physical and Rehabilitation Medicine (ISPRM) started an initiative to systematically develop its capacity and its internal and external policy agenda. This paper sums up achievements that have been made with this ISPRM initiative as well as pending issues and strategies to address them. The paper treats the following: ISPRM's policy agenda in collaboration with the World Health Organization (WHO), research capacity in functioning and rehabilitation, ISPRM world conferences, relationships with regional societies of Physical and Rehabilitation Medicine (PRM), and ISPRM's membership and governance structure.

International non-governmental organizations (NGOs) in official relation with the World Health Organization (WHO) face organizational challenges against the background of legitimate representation of their membership and accountable procedures within the organization. Moreover, challenges arise in the light of such an international NGO's civil societal mandate to help reach the "health-for-all" goals as defined by WHO and to facilitate the implementation of the United Nations (UN) Convention on the Rights of Persons with Disabilities. The objective of this paper is to examine how such an international NGO using the International Society of Physical and Rehabilitation Medicine (ISPRM) as a case in point can address these challenges. The specific aims are to analyse ISPRM's structures and procedures of internal organs and external relations and to develop solutions. These possible solutions will be presented as internal organizational scenarios and a yearly schedule of meetings closely aligned to that of WHO to facilitate an efficient internal and external interaction.

Objective: To examine whether graphical modeling is a potentially useful method for the study of human functioning using data collected by means of the International Classification of Functioning, Disability and Health (ICF)., Study Design and Setting: The applicability of the method was examined in a convenience sample of 616 patients from a cross-sectional multicentric study undergoing early postacute rehabilitation. Functioning was qualified using 115 second-level ICF categories. The modeling was carried out on a data set with imputed missing values. The least absolute shrinkage and selection operator (LASSO) for generalized linear models was used to identify conditional dependencies between the ICF categories. Bootstrap aggregating was used to enhance the accuracy and validity of model selection., Results: The resulting graph showed highly meaningful relationships. For example, one structure centered around speaking and included three paths addressing conversation, speech functions, and mental functions of language., Conclusion: Graphical modeling of human functioning using data collected by means of the ICF yields clinically meaningful results. The structures found may be the basis for the identification of suitable targets for rehabilitation interventions, the identification of confounders and intermediate variables, and the selection of parsimonious sets of variables for multivariate epidemiological modeling.

This paper describes the history of the International Society of Physical and Rehabilitation Medicine (ISPRM). Past achievements and current challenges are outlined. ISPRM has been successful in setting up a central office, attracting individual and national members, holding international congresses, and establishing relations with the Journal of Rehabilitation Medicine (JRM) as the organization's official journal. ISPRM is currently in official relations with the World Health Organization (WHO) and collaborates closely with WHO's Disability and Rehabilitation team. ISPRM, however, also faces challenges with regard to its growth and the realization of its goals. These include boundaries of voluntary leadership, limited economic resources, the need for enhancing the central office, variations in membership, limits of the current congress bidding system and structure, relations with regional societies, and the need to further develop policies within the field of Physical and Rehabilitation Medicine (PRM) and in relation to WHO and the United Nations system. It is concluded that ISPRM must evolve from an organization, of which the main activities are to hold a biennial congress hosted by a member nation and to provide input to WHO on request, into a professional non-governmental organization (NGO). ISPRM should embark on assuming a leadership role in the further development of PRM within the broader area of human functioning and rehabilitation.

Using the International Society of Physical and Rehabilitation Medicine (ISPRM) as a case in point, the paper describes the complex world societal situation within which non-governmental organizations that address health issues have to operate.This paper describes the complex world societal situation within which non-governmental organizations (NGOs), that are addressing health issues have to operate. In particular, as an international organization in official relation with the World Health Organization (WHO), ISPRM is confronted with a variety of responsibilities and a true world health political mandate. The accompanying rights need to be played out in relation to its own internal member organization and external allies. The theory of the world society and the current situation are briefly reviewed. The role of international NGOs within the world health polity, rehabilitation and Physical and Rehabilitation Medicine (PRM) is highlighted, whilst special emphasis is placed on NGOs in official relation with WHO. Functions, dysfunctions and challenges of international NGOs operating in the health sector are discussed. Against this background, key approaches to enhance ISPRM's political role are analysed. These include transparent and accountable development of the organization, the differentiation between internal and external policy relations, the harmonization of organizational structures and procedures, the consequential use of political structures available to influence WHO's agenda, and the identification of other policy players of major relevance to PRM in order to build strategic alliances with external partners and to enhance ISPRM's membership base.

The politics of international non-governmental organizations (NGOs) such as the International Society of Physical and Rehabilitation Medicine (ISPRM) serve the function of selecting and attaining particular socially valued goals. The selection and attainment of goals as the primary function of political action can be structured along a policy process or cycle comprising the stages of strategic goal setting and planning of strategic pathways, agenda setting, resource mobilization, implementation, evaluation and innovation. At the various stages of this policy process different policy tools or instruments, which can be used to influence citizen and organizational behaviour in the light of defined goals, can be applied. The objective of this paper is to introduce and describe policy tools of potential relevance to ISPRM with regard to different policy functions and stages of the policy process.

This paper suggests a comprehensive policy agenda and first steps to be undertaken by the International Society of Physical and Rehabilitation Medicine (ISPRM) in order to realize its humanitarian, professional and scientific mandates. The general aims of ISPRM, as formulated in its guiding documents, the relations with the World Health Organization (WHO) and the United Nations system, and demands of ISPRM's constituency herein form the basis of this policy agenda. Agenda items encompass contributions to the establishment of rehabilitation services worldwide and the development of rapid rehabilitation disaster response, the enhancement of research capacity in Physical and Rehabilitation Medicine (PRM), and the development of PRM societies. ISPRM's possible input in general curricula in disability and rehabilitation, and in fighting discrimination against people experiencing disability are discussed. Moreover, the implementation of the International Classification of Functioning, Disability and Health (ICF) in medicine, contributions to WHO guidelines relevant to disability and rehabilitation, the provision of a conceptual description of the rehabilitation strategy and the outline of a rehabilitation services matrix are seen as important agenda items of ISPRM's external policy. With regard to its constituency and internal policy, a definition of the field of competence and a conceptual description of PRM, as well as the development of a consistent and comprehensive congress topic list and congress structure appear to be crucial items. The proposed agenda items serve as a basis for future discussions.

This paper outlines approaches to developing the International Society of Physical and Rehabilitation Medicine (ISPRM) and addresses many current challenges. Most importantly, these approaches provide the basis for ISPRM to develop its leadership role within the field of Physical and Rehabilitation Medicine (PRM) and in relation to the World Health Organization (WHO) and the United Nations (UN) system at large. They also address a number of specific critiques of the current situation. A positioning of ISPRM within the world architecture of the UN and WHO systems, as well as the consideration and fostering of respective emerging regional PRM societies, is central to establishing networking connections at different levels of the world society. Yearly congresses, possibly in co-operation with a regional society, based on a defined regional rotation, are suggested. Thus, frustration with the current bidding system for a biennial congress and an intermediate meeting could be overcome. Yearly congresses are also an important step towards increasing the organization's funding base, and hence the possibility to expand the functions of ISPRM's Central Office. ISPRM's envisioned leadership role in the context of an international web of PRM journals complementing the formally defined official journal of ISPRM, regional societies, and so forth, is an inclusive rather than exclusive approach that contributes to the development of PRM journals worldwide. An important prerequisite for the further development of ISPRM is the expansion and bureaucratization of its Central Office, adding professionalism and systematic allocation of resources to the strengths of the voluntary engagement of individual PRM doctors.

With the International Classification of Functioning, Disability and Health (ICF) the World Health Organization (WHO) has prepared the ground for a comprehensive understanding of Human Functioning and Rehabilitation Research, integrating the biomedical perspective on impairment with the social model of disability. This poses a number of old and new challenges regarding the enhancement of adequate research capacity. Here we will summarize approaches to address these challenges with respect to 3 areas: the organization of Human Functioning and Rehabilitation Research into distinct scientific fields, the development of suitable academic training programmes and the building of university centres and collaboration networks.

Objective: To identify the impairments and limitations that indicate loss of independence in older patients after discharge from post-acute rehabilitation., Design: Prospective cohort study., Subjects/patients: A total of 128 patients in the development cohort and 137 patients in the validation cohort., Methods: Data on functioning and previous living situation were collected at admission; data on prospective living situation were collected at discharge. Multivariable logistic and non-parametric (CART) analyses were carried out with the development cohort. The resulting models were validated in a validation cohort., Results: Development cohort: mean age was 80.3 years (95% confidence interval (CI) 79.1-81.6), 52% of patients experienced loss of independence. The International Classification of Functioning, Disability and Health (ICF) category d465 "moving around using equipment"(odds ratio (OR) = 2.7, 95% CI 1.2-5.8) and a dichotomous indicator variable for fractures or joint replacement (OR = 2.3, 95% CI 1.1-4.9) remained in the logistic model. CART yielded the ICF categories d465 "moving around using equipment", and b765 "involuntary movement functions" conditional on d465. Validation cohort: mean age was 72.6 years (95% CI 70.3-74.9). 40% experienced loss of independence. d465 (OR = 7.6, 95% CI 1.6-35.5) and b765 (OR = 5.9, 95% CI 2.6-13.4) were also significant predictors in the logistic model., Conclusion: Older patients who are not able to move around with the help of equipment at the beginning of post-acute rehabilitation are 3 times as likely to lose independence when discharged. It may be important for patients' independent living to encourage the use of wheelchairs and walking aids at very early stages of rehabilitation.

There is a need to organize rehabilitation and related research into distinct scientific fields in order to overcome the current limitations of rehabilitation research. Based on the general distinction in basic, applied and professional sciences applicable to research in general, and the rehabilitation relevant distinction between the comprehensive perspective based on WHO's integrative model of human functioning (ICF) and the partial perspective focusing on the biomedical aspects of functioning, it is possible to identify 5 distinct scientific fields of human functioning and rehabilitation research. These are the emerging human functioning sciences and integrative rehabilitation sciences from the comprehensive perspective, the established biosciences and biomedical rehabilitation sciences and engineering from the partial perspective, and the professional rehabilitation sciences at the cutting edge of research and practice. The human functioning sciences aim to understand human functioning and to identify targets for comprehensive interventions, with the goal of contributing to the minimization of the experience of disability in the population. The biosciences in rehabilitation aim to explain body injury and repair and to identify targets for biomedical interventions. The integrative rehabilitation sciences design and study comprehensive assessments and interventions that integrate biomedical, personal factor and environmental approaches suited to optimize people's performance. The biomedical rehabilitation sciences and engineering study diagnostic measures and interventions suitable to minimize impairment, including symptom control, and to optimize people's capacity. The professional rehabilitation sciences study how to provide best care with the goal of enabling people with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction with the environment. The organization of human functioning and rehabilitation research into the 5 distinct scientific fields facilitates the development of academic training programs and career building as well as the development of research structures dedicated to human functioning and rehabilitation research.

Objective: The variety of human functioning and rehabilitation research makes it difficult to overview the whole area with respect to journals, societies and conferences of potential relevance to a research question in focus. The objective of this paper is thus to provide an outline of scientific journals, societies and conferences of major relevance to human functioning and rehabilitation research., Methods: A systematic search for journals relevant to human functioning and rehabilitation research was performed. The resulting journal list was used to identify affiliated societies and conferences. In addition, an informal expert survey was conducted for the identification of further relevant societies, conferences and additional journals., Results: A total of 6416 journal articles referring to human functioning and rehabilitation research were identified and analysed. A total of 231 journals, 153 societies and 115 conferences relevant to human functioning and rehabilitation research were selected from the systematic search and the informal expert survey. The societies and conferences are published via the website of this journal., Conclusion: The list of journals presented will be of use to scientists entering human functioning and rehabilitation research or engaging in an interdisciplinary perspective. It may serve as an initial guide for identifying possibilities for the submission of publications, sources of scientific information and platforms for the scientific exchange and discourse.

There is a strong movement towards interdisciplinary research around common and scientifically competitive themes, both at universities and at the national and regional level. Human functioning and rehabilitation is a new, highly innovative and relevant theme. It has the potential to attract researchers from a wide range of disciplines, institutions and organizations. It is thus of interest for universities seeking to embark upon a new and unique research area. Similarly, it is a promising theme for individual researchers, institutions and organizations aiming to develop a national or regional collaboration network for interdisciplinary research. Human functioning and rehabilitation complements established themes from the biomedical perspective. In the context of the life sciences, it can be seen as an extension of the biosciences towards a comprehensive understanding of human life, including human interaction and communication, against the background of the natural and social environment. Based on a better understanding of human functioning and disability, there is a wide range of largely unexplored possibilities to optimize populations' functioning and minimize persons' experience of disability in the presence of a health condition. Rehabilitation research is uniquely positioned to integrate and translate scientific advances into benefits for people and the society. Rehabilitation research from the comprehensive perspective can thus become a catalyst of interdisciplinary research that crosses the boundaries of the natural sciences and engineering research, the human and behavioral sciences, the social sciences and a wide range of related scientific areas. Rehabilitation research is also uniquely positioned to cross the boundaries of medicine and the health sector at large, and to translate knowledge across sectors including education, labor and social affairs.

There is a need to develop a contemporary and internationally accepted conceptual description of physical and rehabilitation medicine (PRM). The process of evolving such a definition can now rely on the unifying conceptual model and taxonomy of the International Classification of Functioning, Disability and Health (ICF) and an ICF-based conceptual description of rehabilitation understood as a health strategy. The PRM section of the European Union of Medical Specialists (UEMS) has endorsed the application of the ICF as a unifying conceptual model for PRM and supports the process of moving towards an "ICF-based conceptual description and according definitions of PRM". With this goal in mind, the authors have developed a first tentative conceptual description in co-operation with the professional practice committee of the UEMS-PRM-section. A respective brief definition describes PRM as the medical specialty that, based on the assessment of functioning and including the diagnosis and treatment of health conditions, performs, applies and co-ordinates biomedical and engineering and a wide range of other interventions with the goal of optimizing functioning of people experiencing or likely to experience disability. Readers of the Journal of Rehabilitation Medicine are invited to contribute to the process of achieving an internationally accepted ICF-based conceptual description of PRM by submitting commentaries to the Editor of this journal.

Key to building research capacity is the development of a qualified workforce. This requires the establishment of academic training programs and the creation of attractive research career opportunities. The adoption of the International Classification of Functioning, Disability and Health as unifying conceptual model for rehabilitation, the emergence of distinct scientific fields of human functioning and rehabilitation research, and the change to Bachelor and Master degrees in Europe provide opportunities to initiate academic training programs in human functioning and rehabilitation research. Applied training includes certificate programs in rehabilitation effectiveness and Masters and Doctoral programs in rehabilitation with specializations, e.g. in rehabilitation studies, management, education and rehabilitation counseling. Scientifically-oriented training includes Masters of Science and PhD programs in human functioning sciences and integrative rehabilitation sciences. There is also potential for collaborative Masters and Doctoral programs with the rehabilitation professions, movement sciences, psychology and the behavioral and social sciences. When initiating the process to develop these programs, one may learn from and co-operate with established programs in public health.

Human functioning and rehabilitation research can be organized into 5 distinct scientific fields. The objective of this paper is to provide conceptual descriptions and to outline selected research domains for 4 of the 5 distinct scientific fields. A conceptual description of the biosciences in rehabilitation and the presentation of respective research domains are beyond the scope of this paper. The research domains of the human functioning sciences can be identified and described according to the generic research process, which involves theory building and observation. The according domains include theory and models of human functioning, classification and measurement of functioning, functioning epidemiology and functioning impact assessment. The research domains of the integrative rehabilitation sciences can be identified and described by drawing on the public health approach. They include rehabilitation services research, rehabilitation intervention research and rehabilitation administration and management. There are many conceivable research domains within the realms of the biomedical rehabilitation sciences and engineering. They are often defined in relation to an organ system or in relation to an intervention approach. The research domains of the professional rehabilitation sciences are well established and include professional standards and guidelines for the provision of best care, rehabilitation quality management, scientific education and training of professionals in rehabilitation, and development and evaluation of the rehabilitation team.

An important basis for the successful development of rehabilitation practice and research is a conceptually sound description of rehabilitation understood as a health strategy based on a universally accepted conceptual model and taxonomy of human functioning. With the approval of the International Classification of Functioning, Disability and Health (ICF) by the World Health Assembly in 2001 and the reference to the ICF in the World Health Assembly's resolution on "Disability, including prevention, management and rehabilitation" in 2005, we can now rely on a universally accepted conceptual model. It is thus time to initiate the process of evolving an ICF-based conceptual description that can serve as a basis for similar conceptual descriptions and according definitions of the professions applying the rehabilitation strategy and of distinct scientific fields of human functioning and rehabilitation research. In co-operation with the Physical and Rehabilitation Medicine (PRM) section of the European Union of Medical Specialists (UEMS) and its professional practice committee, we present a first tentative version of an ICF-based conceptual description in this paper. A brief definition describes rehabilitation as the health strategy applied by PRM and professionals in the health sector and across other sectors that aims to enable people with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction with the environment. Readers of the Journal of Rehabilitation Medicine are invited to contribute towards achieving an internationally accepted ICF-based conceptual description of rehabilitation by submitting commentaries to the Editor of this journal.

Objective: The International Classification of Functioning, Disability and Health (ICF) is used increasingly to describe and classify functioning in medicine without being a psychometrically sound measure. All categories of the ICF are quantified using the same generic 0-4 scale. The objective of this study was to assess observer agreement when describing and classifying functioning with the ICF., Design: A second-level category of the ICF, d430 lifting and carrying objects, was used as an example. To the qualifiers of this category, clinically meaningful definitions were assigned. Data were collected in a cross-sectional survey with repeated measurement. We report raw, specific and chance-corrected measures or agreement, a graphical method and the results of log-linear models for ordinal agreement., Subjects/patients: A convenience sample of patients requiring physical therapy in an acute hospital., Results: Twenty-five patients were assessed twice by 2 observers. Raw agreement was 0.52. Kappa was 0.36, indicating fair agreement. Different hierarchical log-linear models indicated that the strength of agreement was not homogeneous over all categories., Conclusion: Observer agreement has to be evaluated when describing and classifying functioning using the ICF Qualifiers'scale. When assessing inter-observer reliability, the first step is to calculate a summary statistic. Modelling agreement yields valuable insight into the structure of a contingency table, which can lead to further improvement of the scale.

As a result of the continuing development in recent medicine, and improvements of emergency services, an increasing number of patients are surviving serious disease and injury. This has increased the need for rehabilitation, starting already during the acute hospital stay. Early identification and rehabilitation may reduce overall costs and help patients to regain independence earlier. Since the eighties specialized early post-acute rehabilitation units have been increasingly implemented in German hospitals. With book 9 of the German Social Code (SGB IX) coming into effect in July 2001, early post-acute rehabilitation care in hospitals became accepted as a social right. However, the specifics of early rehabilitation care have not been defined. There is a lack of generally accepted indication criteria for early rehabilitation services. Similarly, the aims, objectives and methods need to be specified. It was the objective of a group of interested experts from different fields and backgrounds to achieve an interdisciplinary consensus in terms of conceptual definitions and terminology for all early rehabilitation care services in the acute hospital. The development of the definitions and criteria was achieved by using a modified Delphi-technique. By publishing this paper the group is providing information about its activities and results. Examples of typical cases from the various fields of early rehabilitation care were identified and described. Furthermore, the report points out a number of other problems in the area of early rehabilitation care, which have yet to be solved.

All industrialized nations are facing a crisis in health care financing. Rising expectations coupled with increasing specialization and technologic capacities have forced health care payers to examine their assumptions and to seek data on the outcomes of medical interventions. Clinical investigators who have been taught to use randomized controlled trials that evaluate efficacy under experimental conditions have been redirected toward studies that can help answer health policy questions. Such studies examine the effectiveness of interventions in more realistic settings on a richer array of patient-centered outcomes such as function and consider cost effectiveness and relative cost effectiveness. Rehabilitation interventions, which are by and large pragmatic, have never had a strong scientific basis grounded in controlled trials, and this lack of evidence has put tremendous pressure on clinicians to justify their practices. In this article, we review the recent literature on effectiveness of rehabilitation interventions in rheumatic disorders.

Objective of this study was to examine the effectiveness of a coordinated, community based 3-year advisory program in 1534 patients with acquired brain injury. Patients and caregivers were offered a coordinated advisory program after discharge from rehabilitation. Patients in the historical control group received standard aftercare. The main outcomes were functional status [Functional Independence Measure (FIM)], and days spent in the acute hospital. The secondary outcome was survival. Patients were comparable for sex (intervention: 41.3% female, control: 38.0%), and younger in the control group (mean age intervention: 55.3, control: 49.6). Functional status at discharge was lower in the intervention group (mean FIM intervention: 66.2, control: 80.3). Patients in the intervention group experienced a moderate gain in FIM. Rate of days in hospital was 15.4 per 1000 person days (intervention) and 15.5 per 1000 person days (control). Patients of the intervention group had an increased rate of days in hospital. A total of 16.0% of patients in the intervention group and 19.3% in the control group died during follow-up. Patients in the intervention had a significant lower mortality risk depending on follow-up period and discharge FIM. The advisory program may be effective for all patients with acquired brain injury. [ABSTRACT FROM AUTHOR]

Objective:The objective of this paper is to outline the proposed development process for the ICF Core Sets for Spinal Cord Injury (SCI) and to invite clinical and consumer experts to actively participate in this process. ICF Core Sets are selections of categories of the International Classification of Functioning, Disability and Health (ICF) that are relevant to persons with a specific condition or in a specific setting.Method:The project is a cooperation between the ICF Research Branch of the World Health Organization (WHO) Collaboration Centre of the Family of International Classifications (DIMDI, Germany), the Classification, Assessment and Terminology (CAT) team and the Disability and Rehabilitation (DAR) team at WHO, the International Spinal Cord Society (ISCoS) and International Society for Physical and Rehabilitation Medicine (ISPRM) and partner institutions across the world. The project will consist of four worldwide studies to be conducted from 2006 to 2007 with a proposed ICF Core Set Consensus Conference to be held in 2007. ICF categories relevant for SCI are to be identified by means of (I) an empirical study, (II) a systematic review of outcomes and measures used in SCI research (III) an expert survey and (IV) focus groups and semistructured interviews with persons with SCI. Consensus about items that have to be part of a Comprehensive and of a Brief ICF Core Set for SCI will be reached in a final ICF Core Set Consensus Conference. Subsequent field testing will be necessary to validate this first version of ICF Core Sets for SCI.Invitation for participation:The development of ICF Core Sets is an inclusive and open process. Anyone who wishes to actively participate in this process is invited to contact the project coordinator (Monika.Scheuringer@med.uni-muenchen.de or http://www.icf-research-branch.org/research/spinalcord-injuries.htm). Individuals, institutions and associations can be formally associated as partners of the project.Spinal Cord (2006) 44, 541–546. doi:10.1038/sj.sc.3101918 [ABSTRACT FROM AUTHOR]

Objective: To identify pre-treatment predictors of who will benefit from a 3-4-week comprehensive rehabilitation intervention in patients with osteoarthritis (OA) of the knee or hip.Methods: A prospective cohort study with assessments at admission to the clinic and after 6 months was conducted. Two hundred and fifty patients from the rehabilitation clinic Rehaclinic Zurzach, Switzerland, were included. Three different measures of response to a 3-4-week comprehensive rehabilitation intervention were used: one indirect measure (minimal clinically important difference (MCID) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score=18% improvement), one direct measure (transition question) and a combination of both criteria. Responders were predicted by a sequential logistic regression analysis with nine personal variables, five lifestyle risk factors, seven psychological status variables and the WOMAC global baseline score.Results: The set of statistically significant predictors was dependent on the definition of response. The comparison of predictors that were statistically significant in any of the prediction models showed similar odds ratios (ORs) for the majority of predictors across three regression models with the different response definitions as dependent variable. Female gender, absence of depressive symptoms (dep), history of complementary medicine (cm) and low comorbidity (com) were the most stable predictors and had ORs above 2.0 (female) and above 1.5 (dep, cm, com) across the three regression models with different response definitions.Conclusion: A set of predictors for the outcome of rehabilitation in patients with OA was identified. If these predictors could be confirmed in future research, this knowledge might help to adopt and individualize the treatment of patients who are, at present, less likely to respond. [ABSTRACT FROM AUTHOR]

Introduction/Background Functioning is the primary outcome of rehabilitation. Currently functioning outcomes are collected with a variety of assessment tools. Unless standards for reporting are in place, data derived from various assessment tools has only applicability within the individual clinical encounter, but cannot be aggregated across and within institutions, thus, lack comparability. Consequently, there is a need for a standardized reporting system to ensure that functioning information can be aggregated, compared, made available for decision-making and continuous improvement at individual, institutional and national levels. The aim is to develop and implement a standardised reporting system for national quality improvement in Swiss rehabilitation, accounting for different assessment tools used for functioning information. Material and method We build upon existing data collected for Swiss national quality monitoring to derive a harmonized data set irrespective of the assessment tool used, based on a conceptually and psychometrically-sound system for standardized reporting of functioning outcomes. Change in functioning status within and across health condition groups, and its determinants, throughout the rehabilitation process will be identified. ICF linking rules, Rasch Measurement Theory and regression modelling will be used. The results will be presented to relevant stakeholders conducting Stakeholder Dialogues to develop strategies of how such a system can be implemented for quality improvement. Results 30 Swiss rehabilitation clinics participate in the project using either the assessment tools FIM ® , Barthel Index, or Health Assessment Questionnaire. First results will be available in April. This poster aims to outline the project–its background, methodology and clinical relevance. Conclusion First, this project recognizes the important role of functioning as primary health outcome in rehabilitation. Second, the standardized reporting system enables clinicians to maintain their existing data collection practice, while at the same time being able to aggregate and compare information. Third, this project builds upon a learning system, with emphasis on transparency and stakeholder engagement. [ABSTRACT FROM AUTHOR]