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Purpose (1) To perform a cross-cultural adaptation of Work Rehabilitation Questionnaire to Russian (WORQ-R); (2) to report the psychometric properties of WORQ-R in patients with traumatic spinal cord injury (TSCI). Materials and methods WORQ is designed to evaluate the work functioning of individuals who are engaged in vocational rehabilitation. We performed a formal cross-cultural adaptation of WORQ from English to Russian utilizing a standardized 3-step approach. We examined the psychometric properties of WORQ-R in terms of its reliability and construct validity through the use of classical and modern test theory in the TSCI population. Results The adaptation process achieved equivalence between Russian and English versions of WORQ. WORQ-R proved to cover major issues concerning functioning in vocational rehabilitation and was simple to understand. The internal consistency of WORQ-R was good (Cronbach's Alpha = 0.83). Rasch analysis confirmed the unidimensionality of the WORQ-scale and high reliability (PSI = 0.97) based on a testlet solution. WORQ-R score showed a strong negative correlation with the Functional Independence Measure, moderate negative correlation with the Spinal Cord Independence Measure Version III and the SF-36, moderate positive correlation with the Spinal Cord Injury Secondary Conditions Scale. Conclusions WORQ-R showed good validity and reliability in persons with TSCI allowing vocational professionals to have comprehensive information on vocational functioning.IMPLICATIONS FOR REHABILITATIONSCI is a disabling condition that causes impairments in body structure and function leading to activity limitations and participation restrictions.WORQ is a generic tool that allows for an assessment of work-related aspects of functioning in different populations of persons with disabilities.This study demonstrates the psychometric properties of the Russian version of WORQ in the SCI population.WORQ-R is recommended as a tool to describe the biopsychosocial and related vocational background to gain a better understanding of needs among SCI persons in terms of vocational rehabilitation.

Cross-cultural adaptation of the Work Rehabilitation Questionnaire (WORQ) was performed. WORQ is a generic instrument for assessment of social and vocational status and can be applied in different populations. This paper includes Russian version of the Questionnaire and guidelines for filling in the questionnaire.

To compare and cluster the health status and disability restrictions associated with eight major physiological functions of body systems, using functioning domains of WHO Disability Assessment Schedule 2.0.Retrospective analyses of a nation-wide disability database.Population-based study.Records from patients18 years of age with disability were obtained from the Taiwan Data Bank of Persons with Disability (July 2012-November 2017). Disability functioning profile of the following diagnosis were analyzed: stroke, schizophrenia, hearing loss, liver cirrhosis, chronic kidney disease, congestive heart failure, burn, head and neck cancer.Not applicable.Demographic data, severity of impairment, and Disability Assessment Scale scores were obtained and analyzed. Radar charts were constructed using the WHO Disability Assessment Schedule 2.0. functioning domain score. Degree of similarity between any two given diagnosis was assessed by cluster analysis, comparing the Euclidean distances between radar chart data points among the six domains.Based on cluster analysis of similarities between functioning domain profiles, the eight diagnoses were grouped into different disability clusters. Four clusters of disability were named according to the type restriction patterns: global-impact cluster (stroke); interaction-restriction cluster (schizophrenia, hearing loss); physical-limitation cluster, (liver cirrhosis, CKD, and congestive heart failure); and specific-impact cluster (burn, head and neck cancer). The rates of institutionalization and unemployment differed between the four clusters.We converted WHO Disability Assessment Schedule 2.0. functioning domain scores into six-dimensioned radar chart, and demonstrate disability restrictions can be further categorized into clusters according to similarity of functioning impairment. Understanding of disease-related disabilities provides an important basis for designing rehabilitation programs and policies on social welfare and health that reflect the daily-living needs of people according to diagnosis.Implication for RehabilitationThe use of radar charts provided a direct visualization of the scope and severity of disabilities associated with specific diagnoses.Diagnosis-related disabilities can be organized into clusters based on similarities in WHODAS 2.0 disability domain profiles.Knowledge of the characteristics of disability clusters is important to understand disease-related disabilities and provide a basis for designing rehabilitation.

PURPOSE Work participation remains challenging for people with spinal cord injury (SCI), as reflected in lower employment rates compared to the general population. To promote work participation for people with SCI, practitioners and policymakers need a better understanding of the factors associated with sustaining work in the long term. This study aimed to identify such factors. MATERIALS AND METHODS Scoping review synthesizing quantitative and qualitative research published between 2000 and 2021. The databases searched were PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science. RESULTS Initially, 1221 articles were identified. Three quantitative studies investigating socio-demographic and injury-related factors and eight qualitative studies exploring mainly personal and environmental facilitators and barriers to working in the long term were retained. The results of the quantitative studies showed the importance of time since injury, age, and education. The qualitative findings emphasized the positive influence of self-advocacy, managing health behaviors, and a supportive work environment. Main barriers were time organization and societal attitudes. CONCLUSIONS Future interventions should address the identified factors to promote working in the long term of people with SCI. Policymakers should adapt and enforce legal standards that address environmental and social barriers to creating supportive work environments for persons with SCI.Implications for rehabilitationPeople with spinal cord injury (SCI) experience difficulties in maintaining employment.Personal factors identified as crucial for working in the long term, such as self-advocacy and self-management of health behaviors, should be strengthened by future interventions.People with SCI should be offered a supportive work environment with work accommodations and flexible working hours to facilitate their labor market participation.

Purpose Maintaining work in the long term represents a major challenge for people with acquired brain injury (ABI) as evidenced by a high rate of premature labour market dropouts. The present study aimed to compile factors associated with working in the long term after sustaining an ABI. Materials and methods We carried out a scoping review synthesizing quantitative and qualitative research conducted between 2000 and 2021. Databases searched comprised PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science. Results Ten quantitative and nine qualitative studies were included, all but one from high-resource countries. Quantitative research predominantly comprised longitudinal follow-ups on individuals' work status several years post ABI onset, showing an effect of injury-related and sociodemographic factors. Qualitative studies mostly dealt with work maintenance and revealed a key role of cognitive difficulties, psychological personal factors (e.g., adequate coping strategies) and environmental factors (e.g., flexible work schedules, supportive colleagues). Conclusions The factors identified in our review should receive particular attention in vocational integration and job retention programs to support work participation of people with ABI in the long term. There is a need for measures that regularly monitor and promote a good match between individuals and their work environment.Implications for RehabilitationPeople with acquired brain injury (ABI) often have long-lasting and invisible injury-related difficulties that hamper their labour market participation.Factors identified as positively associated with working in the long term, such as coping strategies and self-awareness, should be strengthened.Future interventions should educate affected persons, employers and health care professionals about long-lasting injury-related difficulties and promote a supportive work environment for people with ABI.Prolonged availability of vocational services could be beneficial for supporting work maintenance of people with ABI.

Purpose: Patients with traumatic brain injury often experience cognition-related problems and difficulty in returning to work. This study analyzed the accuracy of a modified version of World Health...

Purpose The International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for Vocational Rehabilitation (CSVR) is a shortlist of functioning domains developed for use with people of working age that experience limitation in their work-related functional capacity. Functional capacity can be measured by, for example, Spinal Function Sort pictorial questionnaire and Functional Capacity Evaluation tests such as the: Complete Minnesota Dexterity Test, grip strength test, pushing, pulling, progressive iso-inertial lifting and carrying. However, these tests have not yet been linked to the CSVR. The objective of this study was to evaluate the extent to which the Spinal Function Sort and Functional Capacity Evaluation tests could be mapped to the ICF categories of the CSVR. Methods Two raters independently performed the linking of the Spinal Function Sort and the Functional Capacity Evaluation related tests to the CSVR according to established ICF linking rules. If an item could not accurately be linked to a CSVR category, the item was linked to the most fitting ICF category. Disagreements were resolved in a consensus meeting. Interrater agreement between raters was expressed in percentage agreement. Results The Spinal Function Sort and Functional Capacity Evaluation tests described a total of 39 unique ICF categories, out of which only six (15%) came from the CSVR. Interrater agreement ranged between 17 and 91%. Conclusions The study found six categories including vestibular functions, muscle power functions, writing, lifting and carrying objects, fine hand use and hand and arm use within the CSVR using the Spinal Function Sort and The Complete Minnesota Dexterity Test. With the rest of the items, the CSVR was considered too broad.

Work disability is the inability or decreased ability of an individual to work due to illness or injury. It may be associated with personal suffering, decreased functioning, loss of income, increased medical costs, and strained relationships. In order to mitigate and resolve work disability, we must be able to better recognize and define the factors surrounding work. The International Classification of Functioning, Disability and Health (ICF) is a comprehensive classification system that utilizes a bio-psycho-social perspective to identify factors that affect human functioning and health. Integration of the ICF into vocational rehabilitation assessment and intervention will provide a conceptual framework to describe and quantify the impact of disease or injury on an individual. By implementing a standardized language and framework for researchers and clinicians, we can reduce variability of care currently pervasive in vocational rehabilitation practice. Integrating the ICF into vocational rehabilitation assessment and intervention will improve patient outcomes.

The ability to work is not only an important reflection of a person’s functional capacity but can also impact their sense of self-worth, independence, purpose and calling. An individual’s employment status is meaningfully linked to both one’s financial security and long-term health. The inability to attain, maintain, or return to gainful employment may cause hardship to the physical and psychosocial aspects of a person’s life. Therefore, society and the health care community together have a role in optimizing the work environment to safely accommodate people with a diverse range of abilities. When work-related injuries or illnesses occur, Occupational Medicine and Vocational Rehabilitation are instrumental in addressing the needs of our workforce. From prevention to treatment and functional assessment to restoration, these two interrelated disciplines provide a comprehensive approach to preserve job performance respectful of any limitations. This chapter introduces key concepts in the fields of Occupational Medicine and Vocational Rehabilitation, presents epidemiology of work-related hazards with evidence-based strategies for prevention and accommodation, highlights a biopsychosocial model approach to work disability, and describes rehabilitative interventions to maximize return to work.

Purpose Since the vocational outcomes of people with schizophrenia should be viewed in a holistic way, the second edition of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) might provide an evaluation regarding employment potential. To determine whether the WHODAS 2.0 scores can be used to predict employment status, we examined the probabilistic cut-off values of the scores and analyzed the relationship between work status and demographic characteristics. Methods We selected 31,793 people aged between 18 and 65 with schizophrenia or schizoaffective disorder from the disability evaluation database in Taiwan and separated them into two groups based on employment status (employed and unemployed). We used logistic regression to explore the association between employment and demographic characteristics. Moreover, we conducted a receiver operating characteristic (ROC) analysis to determine the cut-off point to assist in determining employment potential based on the WHODAS 2.0 score. Results Among the 31,793 participants, 3367 were employed and 18,801 were unemployed. The unemployed participants accounted for a higher percentage of disability in each domain of the WHODAS. The ROC analysis revealed that the optimal cut-off point of the WHODAS score to distinguish the people who were employed and unemployed was 25.78 (area under curve = 0.80). Conclusions The present study indicated that work status can be determined by the total score across the six domains of the WHODAS score. Furthermore, the probability of employment may be determined initially by the cut-off point of the WHODAS score in order to economize evaluation time and prepare prevocational training for those with scores above 25.78.

Purpose The Work Rehabilitation Questionnaire (WORQ) is a patient-reported instrument to assess work related functioning in vocational rehabilitation (VR) and work, based on the International Classification of Functioning, Disability and Health (ICF) core set for VR. The objective of this study was to cross-culturally adapt WORQ to French and to evaluate its psychometric properties. Methods The cross-cultural adaptation followed a dual-panel approach. Psychometrics was examined in one VR-centre in the French speaking part of Switzerland. Test-retest reliability was analyzed with intraclass correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha. Construct validity was determined by convergence to the self-reported general functioning scale and the Hospital Anxiety and Depression Scales (HADS). The association of patient's return-to-work expectation within 6-months and having a case manager was examined. The usability of WORQ-French was tested in 10 VR patients. Results Eighty-nine patients with musculoskeletal injuries were included. WORQ-French showed excellent internal consistency (0.968) and a high test-retest reliability (0.935). WORQ-French was positively associated with self-reported general functioning (r = 0.662) and both HADS scales (r = 0.56-0.57). Neither the patient's return-to-work expectation nor having a case manager were significantly correlated with WORQ-French. Usability in terms of understandability of questions and response options was found to be good. Seven patients rated the length of WORQ-French as good, while two found the instrument a little too long and one found it too long. Conclusions WORQ French is a valid, reliable, and easy to administer instrument to assess self-reported work functioning given our study setting and sample characteristics.

Purpose The purposes of this study were to provide an outline of the existing literature on operationalization of the International Classification of Functioning, Disability and Health (ICF) within vocational rehabilitation (VR) and to explore the ICF utility within VR. Methods The process was undertaken in five stages according to a framework of scoping review. Screening and extraction of data were done by two independent reviewers, and data was summarized according to content analysis. Results Fifty papers (25 qualitative and 25 quantitative) were included. The operationalization of the ICF was described in four different ways: In total 18 (36%) papers described use of the ICF for structuring information, 8 (15%) for linking information to ICF, 12 (24%) for analysis of results, and 12 (24%) for development of a model. In total 15 (29%) papers described VR interventions involving stakeholders, whereas 32 (62%) were reviews. Forty of the papers described all the ICF components. Conclusions The review revealed use of the ICF within the field VR in 50 papers, and in various settings. The ICF framework was most often operationalized for structuring or linking information of functioning. A majority of papers were reviews and involved researchers only, whereas different stakeholders and VR professionals were involved in the interventions. In 40 papers all the ICF components were described, and the ICF was considered a useful tool to inform the VR professionals´ assessment of functioning. However, more research within VR is needed to standardize and ease the use of the ICF. Electronic supplementary material The online version of this article (10.1007/s10926-018-9788-4) contains supplementary material, which is available to authorized users.

To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan.Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age, ≥18 years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire.Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3 ∼ 0.4) and its item of long interval (0.2 ∼ 0.6). Contrariwise, the probability was high for the other subscales (3.9 ∼ 13.7) and the item of identifying needs (21.9 ∼ 23.4).Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system's quality of process and facilitate its usability. IMPLICATIONS FOR REHABILITATION Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation. The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.

BACKGROUND Labour market participation (LMP) represents a key goal of rehabilitation for individuals with spinal cord injury (SCI). To achieve this goal, Swiss SCI rehabilitation centres seek, together with their clients, viable follow-up solutions for returning to work after initial rehabilitation. However, the long-term outcomes of such vocational follow-up solutions have not been investigated so far, and there is a paucity of knowledge regarding the various types of employment pathways that persons with SCI living in Switzerland may experience. OBJECTIVE To examine long-term employment pathways as experienced by individuals with SCI living in Switzerland. METHODS A qualitative descriptive study design involving narrative interviews with individuals who completed vocational rehabilitation (VR) during their initial rehabilitation. Interviews were transcribed verbatim, and data analysed using an inductive thematic analysis approach. RESULTS The analysis of the 15 interviews revealed four employment pathways: the pathway of no paid work, the pathway of retraining, the pathway of job adaptation and the pathway of continuing work. CONCLUSIONS Apart from three pathways leading towards paid employment, our results revealed one pathway that was characterized by permanent unemployment. Individuals facing a pathway of no paid work may benefit from more custom-made vocational follow-up solutions and prolonged job coaching after initial VR.

Background In 2010, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed, based on the concept of the International Classification of Functioning, Disability and Health (ICF). The ICF provides a common language and framework for health and health-related status and attempts to integrate the biopsychosocial model as a multidimensional perspective in understanding functioning. Activities and participation (AP) is one salient component of the ICF refers to the execution of a task by an individual, and how such tasks are involved in their daily life. It is essential to examine the gap between the general adult population and adults with disabilities. This gap may be attributed to health status, personal factors, and natural and social environments, which include social and health services and policies. The purposes: (1) To develop a normative activity and participation (AP) value for the adult population and people with disabilities; and (2) to compare the gap in AP normative values between the two groups in Taiwan. Methods We use the WHODAS 2.0 to survey and develop a normative AP value for the general adult population, and used secondary data from National Disability Eligibility Determination System (NDEDS) of Taiwan to describe the AP functioning distribution of adult with disability. There were 1100 participants, selected by stratified proportional sampling from two cities. There were also 144,850 participants who were adults with disability, selected from the secondary database in Taiwan. Results and conclusions The AP curve for the disabled population increased rapidly at the beginning. The summary score was 13.21 in the performance at 90 percentile for the general population and 82.61 score for disabled adults that the similar gap in every domain, its means that there are significant functioning difference and health equality in general adults population and adults with disabilities. This presents a substantial challenge for both the government and the whole population of Taiwan, to begin considering how to reduce the gap in AP functioning and promote equality for people with disabilities, using social welfare policy. It is important to make sure disabled people have the same rights to be included in society as anybody else and better access to things in all areas of life that are according to Convention on the Rights of Persons with Disabilities (CRPD).

Objective To provide prevalence estimates for problems in functioning of community-dwelling persons with spinal cord injury (SCI) and to examine associations between various areas of functioning with the purpose of supporting countries in identifying targets for interventions. Design Cross-sectional survey. Setting Community, 22 countries including all World Health Organization regions. Participants Persons (N=12,591) with traumatic or nontraumatic SCI aged 18 years or older. Interventions Not applicable. Main Outcome Measures We estimated the prevalence of problems in 53 areas of functioning from the Brief International Classification of Functioning, Disability and Health (ICF) core set for SCI, long-term context, or ICF rehabilitation set covering 4 domains: impairments in body functions, impairments in mental functions, independence in performing activities, and restrictions in participation. Associations between areas of functioning were identified and visualized using conditional independence graphs. Results Participants had a median age of 52 years, 73% were male, and 63% had paraplegia. Feeling tired, bowel dysfunction, sexual functions, spasticity, pain, carrying out daily routine, doing housework, getting up off the floor from lying on the back, pushing open a heavy door, and standing unsupported had the highest prevalence of problems (>70%). Clustering of associations within the 4 functioning domains was found, with the highest numbers of associations within impairments in mental functions. For the whole International Spinal Cord Injury sample, areas with the highest numbers of associations were circulatory problems, transferring bed-wheelchair, and toileting, while for the World Health Organization European and Western Pacific regions, these were dressing upper body, transferring bed-wheelchair, handling stress, feeling downhearted and depressed, and feeling happy. Conclusions In each domain of functioning, high prevalence of problems and high connectivity of areas of functioning were identified. The understanding of problems and the identification of potential targets for intervention can inform decision makers at all levels of the health system aiming to improve the situation of people living with SCI.

The assessment of work-related functioning is a key process in vocational rehabilitation to identify specific domains of disability that can be considered within return to work strategies. The Work Rehabilitation Questionnaire (WORQ) was developed to evaluate work-related functioning based on the International Classification of Functioning, Disability, and Health (ICF) framework and is available in different languages. The aim of this study was to assess the French version of the WORQ using item response theory to further validate the scale. Rasch analysis of WORQ and the WORQ-BRIEF (a brief version of the WORQ) was performed using a calibration sample of 221 persons with musculoskeletal injuries. A four-testlet solution indicated the unidimensionality of WORQ, with no differential item functioning for age, education, physical job demands, and injury severity. Reliability was 0.969 and 0.918 for WORQ and WORQ-BRIEF, respectively. The minimal detectable change was calculated to be 4.2% of its operational range for WORQ and 8.5% for WORQ-BRIEF. Consequently, the French version of WORQ can be considered a good measure of work-related functioning in musculoskeletal conditions. WORQ can be used in rehabilitation practice to comprehensively identify the disability and guide clinical decision making and intervention planning. Further studies are needed to evaluate the psychometric properties of WORQ in other health conditions.

Purpose: To develop a set of quality indicators (QIs) for managing the International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan.Method: Using...

BACKGROUND: In the last few years the International Classification of Functioning, Disability and Health (ICF) has become a widely known and useful reference classification in vocational rehabilitation. It would be equally important to know which aspects of work-related health information cannot be assigned to distinct ICF categories. OBJECTIVE: The objective of this study is to examine the concepts derived from three studies conducted within the ICF Core Set for vocational rehabilitation project, which could not be linked to distinct ICF codes in order to complement the current understanding of functioning in vocational rehabilitation. METHODS: Secondary data analysis of the concepts from the systematic literature review, expert survey and patient focus group study of the ICF Core Set for vocational rehabilitation project that were marked as nd = not definable, nc = not covered or pf = personal factor. Nd-concepts were assigned to the biopsychosocial model of the ICF; additional ICF categories were formulated where needed. Nc-concepts were grouped into common themes not covered by the ICF. Pf-categories were linked to a proposed personal factors classification. RESULTS: 1093 nd-concepts were matched to overarching terms in the ICF, and "other specified"-categories were detailed. 1924 pf-concepts were linked to 31 second level categories of a proposed personal factors classification. 441 nc-concepts were grouped into six themes including the concept of well-being and attributes related to processes and time. CONCLUSIONS: With concepts that emerged from the secondary analysis of data gathered during the vocational rehabilitation ICF Core Set project, we have enriched the ICF model with constructs specific to vocational rehabilitation. However, additional research is needed to further explore personal factors specific to vocational rehabilitation. The influence of themes complementary to the ICF such as well-being and quality of life on return-to-work should be further investigated.

Background: Vocational rehabilitation (VR) is aimed at engaging or re-engaging individuals with work participation and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be operationalized in the context of VR. The objective of this study is to review the literature to identify outcomes or measures being used in VR using a systematic review methodology and link those measures to the ICF. Methods: We applied a structured search strategy using multiple databases. Items or constructs of the measures or outcomes identified were linked to the ICF by two trained individuals. Results: We have identified 648 measures which contained 10,582 concepts that were linked to the ICF which resulted in 87 second-level ICF categories. Out of the 87 categories, 31 (35.6%) were related to body functions, 43 (49.4%) were related to activities and participation, and 13 (14.9%) were related to environmental factors. No category was related to body structures. Conclusions: Our review found great diversity in the ICF contents of the measures used in different VR settings and study populations, which indicates the complexity of VR. This systematic review has provided a list of ICF categories which could be considered towards a successful VR.

Based on the International Classification of Functioning, Disability, and Health (ICF) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), The Functioning Disability Evaluation Scale-Adult version (FUNDES-Adult) began development in 2011. The FUNDES-Adult was designed to assess the difficulty level of an individual’s activities and participation in daily life. There is a lack of research regarding the profile of activity and participation for the general adult population. The purposes of this study were to establish activity and participation norms for the general adult population in Taiwan and to describe, discuss, and compare the activity and participation profile with other population. Method: A population-based survey was administered in 2013 using a computer-assisted telephone interviewing system (CATI system). Using probability proportional to size (PPS) sampling and systematic sampling with random digit dialing (RDD), 1500 adults from Taiwan’s general population were selected to participate in the survey. The FUNDES-Adult with six domains and two dimensions (performance and capability) was used to obtain data on activities and participation levels. A higher domain score indicated higher participation restriction. Results: Approximately 50% of the respondents were male, and the average age of the respondents was 45.23 years. There were no significant differences in the demographic features between the sample and the population. Among the six domains, the self-care domain score was the lowest (least restriction) and the participation domain score was the highest (most restriction). Approximately 90% of the sample scored were less than 15, and only 0.1% scored more than 80. This is the first cross-national population-based survey to assess norms of activity and participation relevant to the general population of Taiwan. As such, the results of this survey can be used as a reference for comparing the activity and participation (AP) functioning of other countries and subgroups.

The definition of disability had been unclear until the International Classification of Functioning, Disability, and Health was promulgated in 2001 by the World Health Organization (WHO). Disability is a critical but relatively neglected public-health concern. We conducted this study to measure disabilities by using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and identify the factors that contribute to disabilities. We obtained and analyzed the data on people who applied to Taiwan’s disability registration system between September 2012 and August 2013. A total of 158,174 cases were selected for this study. Among the people included in this study, 53% were male, and the females were on average 3 years older than the males. More males than females were of a low socioeconomic status, but the rate of employment was higher among the males than among the females. Age, sex, place of residence, and types and severity of impairment were all determined to be factors that independently contributed to disability. This study has demonstrated that disability can be measured and compared using WHODAS 2.0. Increasing the public-health attention devoted to disability and identifying the factors associated with disability can promote independence and social participation in people with disabilities.

To explore the environmental effects on the disabilities of people post stroke and to search for the best probabilistic cut-off value of the WHO Disability Assessment Schedule second edition (WHODAS 2.0) scores to predict people post stroke experiencing an access barrier to the International Classification of Functioning, Disability and Health category e120 products and technology for personal indoor and outdoor mobility and transportation (PMT). We analyzed data of 162 younger (aged 18–64 years) and 202 older (aged ≥65 years) people post stroke from the databank of persons with disability between June 1, 2011 and February 29, 2012. All participants rated each WHODAS 2.0 item with environmental intervention (performance score) and without any intervention (capacity score). We used the paired capacity–performance score difference to assess the whole environmental effects on the participants’ disability, evaluated each participant’s access barrier to PMT (negative PMT), and used a receiver-operating characteristic curve to predict patients having a negative PMT. The whole environment acted as a barrier on mobility and self-care in >10 % of older people post stroke. Older patients having a summary index performance score of ≥78.8 points and younger patients having an index of ≥56.0 points were likely to experience a negative PMT. Older patients who have an access to PMT were possible to improve their daily activities performance, and younger patients could report less disability. An environmental support to improve the PMT accessibility is important for people post stroke to reduce their disability.

This study illustrates the use of the ICF in vocational rehabilitation and disability assessment in Slovenia.A review of the Slovenian law about vocational rehabilitation was performed. A survey was developed and group and individual interviews were conducted with professionals involved in vocational rehabilitation who use the ICF.The vast majority of the respondents believe that ICF helps to create a common language for multidisciplinary communication. The main advantages of the ICF identified by the respondents are that it provides a holistic view of the person, assesses complexities of functioning, provides a unified language and offers a quick and easy insight into functioning. The disadvantages of ICF are complicated terminology and subjectivity of the assessor. A difficulty encountered by the users is that by law, only body functions of the ICF are assessed. Additional qualitative analysis of the users' understanding of ICF and its purpose revealed heterogeneity. Significant differences between public and private organisations were found.ICF is a promising tool for use in vocational rehabilitation and disability assessment in Slovenia. A major challenge is the lack of interface between ICF and policies on vocational rehabilitation in Slovenia.

The International Classification of Functioning, Disability and Health (ICF) Core Set for Vocational Rehabilitation is an application of the ICF of the World Health Organization with the purpose of identifying problems and resources relevant for people in a vocational rehabilitation given a health condition.The objective of the study was to validate the Comprehensive ICF Core Set for Vocational Rehabilitation from the perspective of patients with spinal cord injury (SCI). The specific aims were to explore the aspects of functioning and health important to patients with SCI regarding return to work and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for Vocational Rehabilitation.Focus group interviews were conducted. The sampling of patients followed the maximum variation strategy. Sample size satisfied saturation criterion. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. After qualitative data analysis, the resulting concepts were linked to ICF categories according to established linking rules.Twenty-four SCI patients participated in seven focus groups. Sixty-three ICF categories out of 90 ICF categories contained in the Comprehensive ICF Core Set for Vocational Rehabilitation were reported by the patients. Forty-two additional categories that are not covered in the Comprehensive ICF Core Set for Vocational Rehabilitation were found but adding the health condition-specific ICF Core Set for SCI in long-term context, only 11 categories were not covered.The existing version of the Comprehensive ICF Core Set for Vocational Rehabilitation was confirmed almost entirely by the focus groups to explore the vocational situation of patients with SCI. Implications for Rehabilitation Validation of the ICF Core Set for Vocational Rehabilitation as a useful tool to facilitate social reintegration and rehabilitation of patients with SCI. Return to work is a key outcome in vocational rehabilitation of patients with SCI including those who are young with long-term employment prospects. The results of this study could provide a foundation in utilizing the ICF Core Set for Vocational Rehabilitation to guide rehabilitation goals, service planning and evaluation, and fostering an engaging relationship with employers in the context of SCI rehabilitation. SCI patients have specific needs, not entirely covered by the both ICF Core Set for SCI long-term context and for Vocational Rehabilitation. Our results underline some of the second level categories, probably related to specific SCI impairment, which can be useful to plan specific rehabilitation programs to improve the return to work after SCI.

This chapter will identify and survey standard patient-reported questionnaires (PRQs) which were linked to the Brief Core Set for Vocational Rehabilitation based on the International Classification of Functioning, Disability and Health (ICF). Using data from a previous literature review, a database was created showing items within PRQs that have been linked to the ICF categories in the Brief ICF Core Set. The database showed a wide variety of questionnaires (N = 68) covering different health condition groups, settings, and from various health disciplines. The results of this study will assist health practitioners in vocational rehabilitation and occupational medicine in choosing, implementing, and operationalising the ICF Core Set for Vocational Rehabilitation into their daily practice using PRQs.

Disability represents a major challenge that societies worldwide have to address and poses a burden at different levels: individual, societal, and economic. Disability can substantially and significantly impact work participation of individuals and hence may result in work disability. Assessment of disability in the context of work and employment is essential to guide and facilitate appropriate and adequate return-to-work (RTW) strategies and help ensure that the individual remains to be at work. Disability evaluation is crucial to determine a claimant’s eligibility for disability benefits as well as to establish appropriate levels of benefits. Disability evaluation also provides necessary information whether assignment to an RTW program is required before receiving disability benefits. Because the key information in disability evaluation refers to functioning and disability, standards for functioning assessment are instrumental in ensuring comparability, transparency, and fairness in disability evaluation. The internationally accepted standard for reporting information on functioning and disability is the International Classification of Functioning, Disability and Health (ICF) which could contribute to a transparent illustration of how impairments affect a claimant’s work activities, work participation, and work disability and identify the role of contextual factors in the process. The ICF can also be used to promote standardized reporting of work disability.

Disability evaluation is crucial for deciding on claimants’ eligibility for disability benefits or their assignment to appropriate return to work programs. Recently emerging criticism points to low transparency and comparability of the evaluations. They are often reported in a poorly standardized way and focus on the determination of a claimant’s health condition rather than on a comprehensible documentation of his or her functioning at work. In addition, the evaluations hardly explain how the claimant’s work functioning is influenced by impairments and contextual factors. The International Classification of Functioning, Disability and Health (ICF) represents the worldwide standard for reporting on functioning and disability. Based on a biopsychosocial framework, the ICF conceptualizes human functioning holistically as the interplay between body functions and structures, activities and participation, as well as contextual factors and thus promises transparent reporting in disability evaluation. Moreover, the ICF taxonomy provides a comprehensive spectrum of categories for standardized documentation of functioning assessments which represent core elements of disability evaluation. ICF Core Sets preserve the ICF in a useable mode and may serve as practical tools for reporting on functioning assessments. This chapter illustrates how ICF Core Sets should be selected for functioning assessments in the context of disability evaluation toward the assignment to return to work programs and/or eligibility determination for disability benefits.

A landmark convention by the United Nations (UN) that is likely to have the most impact on persons with disability in recent history is the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) [1]. The UN adopted the UNCRPD in 2006 with the intent to change the attitudes and approaches to persons with disability, including children. The convention is premised on providing the foundation of human rights for all persons with disability regardless of their disability; it puts persons with disability in equal position to those persons without disability in terms of rights of access to services and opportunities. This is a critical piece to current efforts by the community advocating for persons with disability whether in the realm of vocational rehabilitation or return-to-work and social security and disability evaluation. The guiding principles of the UNCRPD emphasize the rights of persons with disability with regard to nondiscrimination, full and effective participation and inclusion in society, acceptance of persons with disability as part of humanity, and having equal opportunity, and accessibility [1]. These are essential principles when assessing persons with disability and will need to be integrated in health and health-related policy by the government and organizations that provide services and care for persons with disability so as to optimize their functioning and mitigate their disability. As a major life area of participation for most individuals, work is an integral part of life and everyday living and can have serious consequences with the presence of a health condition. Hence, our ability to capture disability and work disability in particular is critical.

The experience of work and employment is universal; hence, any form of disability that may affect work can become a crucial issue. In this chapter, the International Classification of Functioning, Disability and Health (ICF) model of the World Health Organization (WHO) will be discussed and how the ICF model can help us to understand and examine the broader context of work disability, vocational rehabilitation, and disability evaluation.

Traumatic brain injury (TBI) impacts on all aspects of the injured person’s lived experience including work participation. Considering that a majority of persons who survive a TBI are of working age, the person with TBI still has many years to fulfill his vocational potential. Recognizing the individual factors that contribute to increasing vocational potential in persons following a TBI as well as understanding the dynamic interaction of influencing factors can facilitate the planning and implementation of strategies and interventions. The International Classification of Functioning, Disability and Health (ICF), an internationally accepted standard for describing functioning of individuals with a health condition, can provide the foundation for identifying factors and understanding how their interaction contributes to an increased or reduced potential for work participation. Using a hypothetical case example (based on clinical experience), this chapter demonstrates the use of the ICF-based Work Rehabilitation Questionnaire or WORQ (self-report version) together with the ICF Core Set for TBI for facilitating interprofessional communication, assessing work-oriented functioning in VR, creating an ICF-based functioning profile (Categorical Profile), and setting appropriate VR goals.

Purpose The International Classification of Functioning, Disability and Health (ICF) has proven to be a valuable framework for vocational rehabilitation (VR). No reliable and valid ICF-based instruments to capture work functioning is known, hence, the aims of this study were: (1) to outline the process for developing an ICF-based questionnaire, the Work Rehabilitation Questionnaire (WORQ) to assess functioning in VR and (2) to report preliminary psychometric evidence. Methods ICF categories were selected from the ICF Core Sets for VR using explorative Rasch-analysis and VR literature review. Questions were worded to assess identified ICF categories. WORQ was translated from English to German. Psychometrics for the German version of WORQ was examined in one VR centre in Switzerland. Results 44 ICF categories were selected which resulted in 36 questions related to functioning. The psychometric evaluation of WORQ showed high test-retest reliability (Spearman correlation 0.79) (n = 53) and good internal consistency (Cronbachs Alpha 0.88) (n = 74) WORQ showed moderate correlation with Beck Depression Inventory II (Spearman correlation 0.511) and low correlation (Spearman correlation -0.353) with SF-36. Conclusions WORQ appears to be a reliable, ICF-based questionnaire to evaluate functioning in VR, easy to administer by health or vocational professionals. The additional information gained when using WORQ would contribute to improving interdisciplinary understanding of the patient's situation and therefore support the integrative planning of the return-to-work process or engagement in gainful employment. However, further studies are needed to further examine its use in clinical practice and research, when validated in other patient populations and settings.

The Patient-Reported Outcomes Measurement Information System (PROMIS ® ) is a US National Institutes of Health initiative that has produced self-reported item banks for physical, mental and social health. To describe the content of PROMIS at the item level using the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). All PROMIS adult items (publicly available as of 2012) were assigned to relevant ICF concepts. The content of the PROMIS adult item banks was then described using the mapped ICF code descriptors. The 1,006 items in the PROMIS instruments could all be mapped to ICF concepts at the second level of classification, with the exception of three items of global or general health that mapped across the first-level classification of ICF activity and participation component (d categories). Individual PROMIS item banks mapped from 1 to 5 separate ICF codes indicating one-to-one, one-to-many and many-to-one mappings between PROMIS item banks and ICF second-level classification codes. PROMIS supports measurement of the majority of major concepts in the ICF body functions (b) and activity and participation (d) components using PROMIS item banks or subsets of PROMIS items that could, with care, be used to develop customized instruments. Given that the focus of PROMIS is on measurement of person health outcomes, concepts in body structures (s) and some body functions (b), as well as many ICF environmental factor, have minimal coverage in PROMIS. The PROMIS–ICF mapped items provide a basis for users to evaluate the ICF-related content of specific PROMIS instruments and to select PROMIS instruments in ICF-based measurement applications.

Objective To present the International Classification of Functioning, Disability and Health (ICF) as a standard in disability evaluation and to discuss the usefulness and challenges of the ICF when applied in disability evaluation. Conclusions Disability evaluation can be described and measured using the ICF and ICF-related tools such as the Generic Set, ICF Core Sets specific to health conditions or settings, and measurement instruments that have been linked to the ICF. Wide implementation of the ICF in disability evaluation, specifically in work disability and social security, is needed along with education on the ICF of those in occupational medicine, work rehabilitation, disability adjudication, policy and legislation, and government agencies. The ICF can be used to provide disability criteria in determining functional and work capacity and as a reference framework and a language of disability to help facilitate a common ground of understanding.

Vocational rehabilitation (VR) programs aim to facilitate work participation. However, there is no universal framework to describe the functioning of individuals who participate in VR. The objective of this paper is to report on the Core Set for VR based on the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO).A formal decision-making and consensus-based process was conducted based on the evidence from four preparatory studies. Twenty-three international experts chosen by WHO Region and expertise in VR attended the consensus conference.Ninety ICF categories were included in the comprehensive Core Set (activities and participation = 40, environmental factors = 33, body functions = 17), while the brief Core Set included 13 second-level categories (activities and participation = 6, environmental factors = 4, body functions = 3).The expert opinion and evidence-based Core Set could serve as an international standard for what to measure and report concerning functioning of individuals in VR. The Core Set could also provide a common language among clinicians, researchers, insurers, and policymakers in the implementation of successful VR. Further testing and validation studies are encouraged.

Background Work disability is a major burden to individuals and the society. To mitigate this burden, vocational rehabilitation has been at the forefront of facilitating work participation. With the complexity of vocational rehabilitation, we need a unifying framework to capture the essential domains of functioning. The International Classification of Functioning, Disability and Health (ICF) could serve as the common reference and language. The purpose of this special section is to demonstrate the use and benefits of the ICF to stakeholders and advocates of vocational rehabilitation. Methods The project on the ICF Core Set for vocational rehabilitation was conducted in collaboration with national and international organizations. The project consisted of three sequential phases: (1) four development studies, (2) international consensus conference, and (3) testing and validation of the ICF Core Set. Results In the first article, a conceptual definition of vocational rehabilitation based on the ICF is proposed. Findings from the first phase of the project are presented in the following four articles. Our findings reflected a wide range of factors that could influence success (or failure) in vocational rehabilitation. Conclusion This special section has presented five articles in an effort to advance our understanding and measurement of vocational rehabilitation process and outcomes. This special section also illustrates the complexity of the contents of vocational rehabilitation and offers the vocational rehabilitation community the added value of integrating the ICF in practice and research.

Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participation.

Introduction A mixed-methods (qualitative-quantitative), multicenter study was conducted using a focus group design to explore the lived experiences of persons in vocational rehabilitation (VR) with regard to functioning and contextual factors using six open-ended questions related to the ICF components. The results were classified by using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Methods The meaningful concepts within the transcribed data were identified and linked to ICF categories according to established linking rules. Results The seven focus groups with 26 participants yielded a total of 4,813 relevant concepts which were linked to a total of 160 different second-level ICF categories. From the client perspective, the ICF components (a) body functions, (b) activities and participation and (c) environmental factors were equally represented, while (d) body structures appeared less frequently. Out of the total number of concepts, 864 concepts (18%) were assigned to the ICF component personal factors which is not yet classified but could indicate important aspects of resource management and strategy development of patients in VR. Conclusion Therefore, VR of patients must not be limited to anatomical and pathophysiologic changes, but should also consider a more comprehensive view which includes client’s demands, strategies and resources in daily life and the context around the individual and social circumstances of their work situation.

We read with interest Rundell and colleagues’ case report on the International Classification of Functioning, Disability and Health (ICF) and its application to low back pain (LBP).1 The article clearly presented the role of the ICF as a unifying framework that clinicians and researchers (eg, in clinical trials) can use. It also solidified the role of physical therapists’ clinical decision-making skills in effectively managing patients on the basis of the ICF. However, we have some comments regarding the way the authors represented the conceptual model of functioning and disability behind the ICF and practical tools developed based on this classification, such as the …