Construction Of Evaluation Category For Patients With Chronic Heart Failure Using ICF Framework

BackgroundNowadays,there are approximate 37.7 million people living with HF globally.Chronicity,progressive and poor prognosis are primary characteristic of chronic heart disease(CHF).Scottish Intercollegiate Guidelines Network(SIGN)refreshed its agenda for improving the management of heart disease including all diagnostic subgroups and among the priorities listed are the need to implement modern cardiac rehabilitation(CR)services.What was highlighted by the guideline is that all patients should undergo an individualized assessment leading to an integrated,clinically competent,multidisciplinary care plan specific to their needs to enable them to successfully self-manage their condition to live a longer,healthier and more independent life.Nowadays,patients with CHF still suffer from a serious physical and mental burden,and environmental factors have a significant impact on them.There are many instruments to evaluate the quality of life and health status of CHF,but there is no evaluation tool that can specifically capture the interaction between CHF patients’ status and the environment.The International Classification of Functioning,Disability,and Health(ICF)has been developed by WHO and relevant hindering or facilitating environmental factors according to a bio-psychosocial model.Existing studies have shown that the quality of life model or evaluation tool based on ICF can improve the quality and scope of research related to the quality of life.At the same time,it can achieve effective characteristic analysis,so as to make the functional evaluation more comprehensive.However,tailored ICF-based instrument for patients with CHF is still lacking.Therefore,the objective of this study was to construct the category of CHF patient evaluation based on ICF classification framework using method of literature review,empirical survey and comprehensive analysis.ObjectiveThe overall objective of our study was to build up a set of standard pools for evaluation of body function,body structure,activity and participation and environmental factor of patients with CHF through a variety of research methods.Finally,a category for the assessment of patients with CHF was constructed.Methods 1.Clinical researches on patients with chronic heart failure nearly five years were recalled from several databases.Two researchers extract and link the concept with ICF through standard link rules independently.2.A process to develop the adapted ICF-Checklist was undertaken following the literature review.The adapted ICF-Checklist was used which enabled the clinic to obtain a host of the problems experienced by the patient being evaluated.Individuals from five general hospitals and four elder nursing homes in Jiangsu and Henan provinces were recruited by the method of convenience sampling.3.We conducted a series of qualitative semi-structured interviews with patients with CHF,his family members and medical personnel.The interviews were analyzed to identify categories of the International Classification of Functioning,Disability and Health(ICF)addressed by patients’ statements using method of Colaizzi and Cieza.4.By using the relative number of proportion from the comprehensive analysis method and taking the b410 cardiac function category in the quantitative empirical study as the benchmark.Then make above three results of research results standardized for integrated analysis.Results 1.16 researches were recalled,including 177 function assessment index nonredundantly.The concepts linked with ICF in 116 second categories.Of these,66 categories were considered most relevant to CHF(identified in at least 5% of the studies),of which 25 were related to Body Functions,2 were related to Body Structure,31 were related to Activities and Participation,8 were related with Environmental Factors.The six most frequently identified categories were heart function(n=90),cardiovascular system structure(n=49),blood vessel function(n=43),respiratory function(n=41),motor tolerance function(n=40)and walking(n=40).2.Finally,298 patients with CHF were included.The ICF categories of more than 5% were reported as: 28 categories of Body Function,10 categories of Body Structure,42 categories of Activities and Participation and 17 categories of Environment Factor.Overall,the top five were b410 Heart functions(n=296),s410 Structure of cardiovascular(n=279),e110 Products or substances for personal consumption(n=275),b130 Energy and drive functions(n=267)and d450 Walking(n=222).3.Finally,28 respondents were included and their statements were linked to 80 unique ICF categories,including 31 categories in body function(38.8%),5 categories in body structure(6.2%),28 categories in activities and participation(35%)and 16 categories in environmental factors(20%).Another 482 concepts could not be linked to the ICF,with health status accounting for the most(hc = 30.7%),followed by personal factors(pf = 27.4%).Overall,the top five were e580 Health services,systems and policies(n=153),e1101Drug(n=149),b410 Heart functions(n=147),b460 The sensation associated with cardiovascular and respiratory function(n=126),and b152 Emotional function(n=110).4.The relative proportions of the first part and the second part,the third part and the second part were 296/90 and 296/147 respectively.Finally the ICF categories were reported as: 41 categories of Body Function,11 categories of Body Structure,54 categories of Activities and Participation and 25 categories of Environment Factor.After standardization,the top five were b410 Heart functions(n=888),s410 Structure of cardiovascular(n=567),e110 Products or substances for personal consumption(n=614),e580 Health services,systems and policies(n=557),and b130 Energy and drive functions(n=467).ConclusionThe broad variety of ICF categories identified in this study reflects the heterogeneity of functional differences found in CHF and underlines the potential value of the ICF as a framework to capture an individual’s functioning.The current results in combination with further clinical researches will provide the scientific basis for defining the CHF-ICF coresets.Finally,it is conducive to the follow-up development of individualized,detailed and dynamic treatment and nursing interventions for patients with CHF based on comprehensive evaluation.