bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2025–08–31
nine papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica



  1. Int J Environ Res Public Health. 2025 Aug 15. pii: 1277. [Epub ahead of print]22(8):
      Stroke rehabilitation requires comprehensive assessments aligned with the International Classification of Functioning, Disability, and Health (ICF) biopsychosocial model. Linking assessment tools to the ICF helps integrate this approach by identifying aspects of functioning they address. This study aimed to analyze the content of the most used assessment tools for post-stroke rehabilitation through systematic linkage with the ICF. A scoping review was conducted, including (1) the identification of clinical trials on post-stroke rehabilitation published between 2014 and 2024 in the PubMed, LILACS, SciELO, and PEDro databases to select the most commonly used assessment tools, followed by (2) the ICF linkage methodology to map the most cited tools to the content of ICF categories and domains. From the 897 studies reviewed, 29 tools were identified-21 were newly linked and 8 had pre-existing ICF links. The analysis identified 261 ICF categories: 53% related to Activities, 31% to Body Functions, 15% to Participation, and 1% to Environmental Factors. No tool covered the Body Structure domain. The findings highlight a focus on Activities and Body Functions, reinforcing the need to integrate Participation and Environmental Factors into post-stroke rehabilitation assessments. The results offer an overview of ICF categories covered by each tool, supporting informed decisions in rehabilitation research and practice.
    Keywords:  cerebrovascular disorders; community participation; neurological rehabilitation; scoping review; surveys and questionnaires
    DOI:  https://doi.org/10.3390/ijerph22081277
  2. Eur J Phys Rehabil Med. 2025 Jun;61(3): 363-375
       BACKGROUND: Individuals with dysphagia typically experience multiple co-occurring symptoms, whose interrelationships can vary in strength. The significance and impact of each symptom within dysphagia also differ. However, the intricate web of connections among these symptoms remains poorly understood, making it challenging to assess the importance of individual symptoms from a relational perspective.
    AIM: The aim of this study was to: 1) construct a correlation map that identifies the risk associations within dysphagia-related syndromes; and 2) rank syndromes according to the Overall Benefit Index (OBI) of a specific functional intervention, which varies in their impact on the overall functional status.
    DESIGN: This study has a cross-sectional design.
    SETTING: The setting of this study was a tertiary hospital in Hunan Province, China.
    POPULATION: Population considered in this study included patients with non-esophageal dysphagia.
    METHODS: Adopting convenience sampling, we recruited 150 patients with dysphagia to assess their health-related quality of life through the dysphagia-specific International Classification of Functioning, Disability and Health (ICF) Scale. A network structure of 50 second-level or third-level ICF categories was investigated by the Ising model. The Bayesian model was applied to determine the probability of the existence of the connection among ICF functional categories.
    RESULTS: The resulting network consisted of 50 nodes and 64 connections. 48 functional categories demonstrated a significant OBI, with "d9102 Ceremonies" (OBI=1.00) achieving the highest OBI. "d9204 Hobbies" (OBI=0.862), and "d9205 Socializing" (OBI=0.847) were another top two categories with the 2nd and 3rd highest OBI. There was a significant correlation between network parameters, OBI, and item difficulty. Specifically, item difficulty showed a positive correlation with OBI (P<0.001, rPearson=0.712), indicating that more challenging items tend to correspond with higher OBIs.
    CONCLUSIONS: The Ising model is a powerful tool that can assist rehabilitation clinicians in better understanding the complex functional network and guide specific rehabilitation interventions for patients with dysphagia.
    CLINICAL REHABILITATION IMPACT: Cooperating the item difficulties from the Item Response Theory (IRT) into the OBI from the Ising model could guide individualized clinical decisions based on item difficulties and importance.
    DOI:  https://doi.org/10.23736/S1973-9087.25.08862-8
  3. Geriatr Nurs. 2025 Aug 20. pii: S0197-4572(25)00428-8. [Epub ahead of print]66(Pt A): 103585
       OBJECTIVE: To identify key indicators hospital-based allied healthcare professionals can use to determine patients' allied healthcare needs after hospitalization.
    METHODS: Semi-structured interviews were conducted with allied healthcare professionals at a Dutch hospital. Findings were triangulated in multidisciplinary focus groups and analyzed thematically using Braun & Clarke. Indicators were categorized using the International Classification of Functioning, Disability and Health (ICF).
    RESULTS: Fourteen professionals were interviewed and nine joined focus groups. Seventeen indicators were identified across ICF components: Health condition, Body functions and structures, Activities, External factors, and Personal factors. Three themes emerged regarding the identification process: 1) Timing, 2) Uniformity, and 3) Roles and collaboration. Sample questions were developed to support use in clinical practice.
    CONCLUSIONS: Key indicators were identified to help standardize screening for allied healthcare needs post-hospitalization. Future research should focus on integrating these into a user-friendly tool-such as a checklist or decision aid-for routine use during discharge planning.
    Keywords:  Allied health professional; Hospitalization; Rehabilitation; Transitional care
    DOI:  https://doi.org/10.1016/j.gerinurse.2025.103585
  4. Front Public Health. 2025 ;13 1590401
       Background: Mobile health applications and artificial intelligence (AI) are increasingly utilized to streamline clinical workflows and support functional assessment. The International Classification of Functioning, Disability and Health (ICF) provides a standardized framework for evaluating patient functioning, yet AI-driven ICF mapping tools remain underexplored in routine clinical settings.
    Objective: This study aimed to evaluate the efficiency and accuracy of the MedQuest mobile application-featuring integrated AI-based ICF mapping-compared to traditional paper-based assessment in hospitalized patients.
    Methods: A parallel-group randomized controlled trial was conducted in two medical centers in Astana, Kazakhstan. A total of 185 adult inpatients (≥18 years) were randomized to either a control group using paper questionnaires or an experimental group using the MedQuest app. Both groups completed identical standardized assessments (SF-12, IPAQ, VAS, Barthel Index, MRC scale). The co-primary outcomes were (1) total questionnaire completion time and (2) agreement between AI-generated and clinician-generated ICF mappings, assessed using quadratic weighted kappa. Secondary outcomes included AI sensitivity/specificity, confusion matrix analysis, and physician usability ratings via the System Usability Scale (SUS).
    Results: The experimental group completed questionnaires significantly faster than the control group (median 18 vs. 28 min, p < 0.001). Agreement between AI- and clinician-generated ICF mappings was substantial (κ = 0.842), with 80.6% of qualifiers matching exactly. The AI demonstrated high sensitivity and specificity for common functional domains (e.g., codes 1-2), though performance decreased for rare qualifiers. The micro-averaged sensitivity and specificity were 0.806 and 0.952, respectively. Mean SUS score among physicians was 86.8, indicating excellent usability and acceptability.
    Conclusion: The MedQuest mobile application significantly improved workflow efficiency and demonstrated strong concordance between AI- and clinician-assigned ICF mappings. These findings support the feasibility of integrating AI-assisted tools into routine clinical documentation. A hybrid model, combining AI automation with clinician oversight, may enhance accuracy and reduce documentation burden in time-constrained healthcare environments.
    Trial registration: ClinicalTrials.gov, identifier NCT07021781.
    Keywords:  artificial intelligence; disability and health; international classification of functioning; mobile applications; rehabilitation; surveys and questionnaires
    DOI:  https://doi.org/10.3389/fpubh.2025.1590401
  5. PLoS One. 2025 ;20(8): e0330617
       INTRODUCTION: Up to 50% of adult patients with epilepsy experience comorbid depression or anxiety, complicating post-treatment recovery and requiring tailored outcome assessment. No core outcome set (COS) exists for this dual-diagnosis population, unlike broader epilepsy COSs or quality-of-life COSs for drug-resistant epilepsy, which do not prioritize mental health comorbidities. This protocol outlines the development of a standardized COS to evaluate post-treatment recovery in adults with epilepsy and comorbid depression or anxiety, using the International Classification of Functioning, Disability, and Health (ICF) framework to ensure a biopsychosocial perspective. This COS aims to enhance cross-study comparability and inform personalized care for this underserved group.
    METHODS AND ANALYSIS: This study will employ a three-phase process: (1) A systematic review of outcomes in epilepsy with comorbid depression or anxiety in adult patients, searching PubMed, Embase, and Cochrane Library per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including outcomes such as seizure control, mood stability, cognitive function, social reintegration, and suicide-related outcomes; (2) Mapping outcomes to ICF domains (body functions, activities, participation) for comprehensive coverage; and (3) A three-round Delphi survey using a 9-point Likert scale to achieve consensus among an international panel of ≥60 stakeholders, including neurologists, psychiatrists, psychologists, patients, and caregivers, with ≥20% from low- and middle-income countries. Consensus requires ≥70% agreement on scores of 7-9 (critically important) and ≤15% on 1-3 (low importance). The COS will capture domains like seizure control, mood stability, cognitive function, and social reintegration.
    DISCUSSION: This COS will address a critical gap by standardizing outcome measurement for adults with epilepsy and mental health comorbidities, complementing broader COSs, such as the Epilepsy Outcome Set for Effectiveness Trials (EPSET), by focusing on mental health recovery, including suicide-related outcomes, and extending quality-of-life-focused sets, such as those using the Quality of Life in Epilepsy (QOLIE) scales, to include neurological and functional outcomes. The ICF-guided, patient-inclusive approach ensures global relevance. Potential limitations, including stakeholder bias, will be mitigated through diverse recruitment and robust consensus methods.
    CONCLUSION: This protocol leverages Delphi methodology and ICF principles to develop a novel COS for a complex dual-diagnosis population. By prioritizing mental health recovery in adults, including critical outcomes like suicide prevention, it offers a distinct tool to enhance research and clinical practice, with future validation planned to ensure applicability across settings.
    PROSPERO REGISTRATION NUMBER: CRD42024576141.
    DOI:  https://doi.org/10.1371/journal.pone.0330617
  6. Arch Phys Med Rehabil. 2025 Aug 18. pii: S0003-9993(25)00850-0. [Epub ahead of print]
    Recovery of Consciousness (RECON) Study Team
       OBJECTIVE: The primary purpose of our scoping review was to evaluate the range and typology of primary clinical outcome assessments used in intervention studies promoting recovery of consciousness for patients with disorders of consciousness (DoC). A secondary aim was to examine the extent to which the introduction of common data elements (CDE) has reduced the heterogeneity of primary clinical outcome assessments in DoC studies.
    DATA SOURCES: We searched for articles across five databases: Cochrane, Embase, PsycInfo, PubMed, and Scopus.
    STUDY SELECTION: We selected articles that focused on facilitating recovery of consciousness among adults with DoC following severe traumatic brain injury.
    DATA EXTRACTION: We extracted the study year, primary clinical outcome assessment, and funding source.
    DATA SYNTHESIS: We classified the primary clinical outcome by International Classification of Functioning, Disability and Health (ICF) domain and CDE status. 75 primary clinical outcome assessments were extracted from 307 included articles; 45 primary clinical outcome assessments (60%) aligned with the ICF Body Function domain. The proportion of articles with US federal funding that reported a CDE as the clinical outcome assessment did not differ by year published.
    CONCLUSION: Implementation of CDEs in 2010 did not substantively change the utilization of clinical outcome assessments that are CDEs because these were already more likely to be reported than non-CDEs. Overall, the wide variation in primary clinical outcome assessments utilized in intervention studies facilitating recovery of consciousness limits the ability to conduct meta-analyses, which are needed to increase the strength of evidence for DoC interventions.
    Keywords:  Common Data Element; Disorders of Consciousness; Outcomes; Traumatic Brain Injury
    DOI:  https://doi.org/10.1016/j.apmr.2025.07.021
  7. PLoS One. 2025 ;20(8): e0330448
       CONTEXT AND OBJECTIVES: The type 2 diabetes mellitus (T2DM) negatively impacts patients' quality of life, affecting their physical and mental functioning as well as social relationships. Self-management is essential for T2DM control, as it involves self-care behaviors and self-efficacy, leading to better health outcomes such as better glycemic control. There are a variety of instruments in the literature capable of measuring self-management in T2DM population. Therefore, the aim of this review is to identify the available T2DM self-management instruments and evaluate their measurement properties, as well as to analyze their contents based on the international classification of functioning, disability and health.
    METHODS: The systematic review will follow the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines, and its protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration CRD42024605840). Searches will be conducted in MEDLINE, Web of Science, Scopus, PsycINFO, Embase, and CINAHL. Additionally, a manual search will be conducted in the databases: PROQOLID, PROMIS, and Medical Outcome Trust. Studies on the development and validation of patient-reported outcome measures assessing self-management in individuals with T2DM will be included, with no restrictions on language or publication date. Data extraction will use tools recommended by COSMIN. The modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will determine the quality of the evidence. Instruments will be categorized according to COSMIN recommendations. All steps will be conducted by two independent reviewers, with a third reviewer consulted in case of discrepancies. Additionally, the content of the instruments will be analyzed and linked to the ICF.
    DISCUSSION: This systematic review may guide researchers and healthcare professionals to choose the most suitable instrument for their target population.
    ETHICS AND DISSEMINATION: Ethical approval is not required, as this study is a review of published data. The results will be disseminated through publication in peer-reviewed journals.
    DOI:  https://doi.org/10.1371/journal.pone.0330448
  8. Medicina (Kaunas). 2025 Jul 23. pii: 1327. [Epub ahead of print]61(8):
      Introduction: Breast cancer therapy is a common cause of lymphedema. The accumulation of protein-rich fluid in the affected extremity leads to a progressive path-swelling, inflammation, and fibrosis-namely, irreversible changes. Methods: A scientific literature analysis was performed on PubMed/Medline, Scopus, Web of Science (WoS), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) from inception until 30 June 2024. Results: Breast cancer-related lymphedema (BCRL) is indeed an important healthcare burden both due to the significant patient-related outcomes and the overall social impact of this condition. Even though lymphedema is not life-threatening, the literature underlined harmful consequences in terms of pain, infections, distress, and functional impairment with a subsequent and relevant decrease in quality of life. Currently, since there is no cure, the therapeutic approach to BCRL aims to slow disease progression and prevent related complications. A comprehensive overview of postmastectomy lymphedema is offered. First, the pathophysiology and risk factors associated with BCRL were detailed; then, diagnosis modalities were depicted highlighting the importance of early detection. According to non-negligible changes in patients' everyday lives, novel criteria for patients' functioning assessment are reported. Regarding the treatment modalities, a wide array of conservative and surgical methods both physiologic and ablative were analyzed with their own outcomes and downsides. Conclusions: Combined strategies and multidisciplinary protocols for BCRL, including specialized management by reconstructive surgeons and physiatrists, along with healthy lifestyle programs and personalized nutritional counseling, should be compulsory to address patients' demands and optimize the treatment of this harmful and non-curable condition. The Lymphedema-specific ICF Core Sets should be included more often in the overall outcome evaluation with the aim of obtaining a comprehensive appraisal of the treatment strategies that take into account the patient's subjective score.
    Keywords:  BCRL; ICF; LVA; breast cancer-related lymphedema; disability assessment; lymphatic surgery; lymphedema; manual lymphatic drainage; plastic surgery; quality of life; rehabilitation; vascularized lymph node transfer
    DOI:  https://doi.org/10.3390/medicina61081327
  9. J Neurol Phys Ther. 2025 Aug 27.
       BACKGROUND AND PURPOSE: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a well-established tool for assessing disability. However, diverse factor structures complicate its interpretation, necessitating further validation. This study examined the factorial validity of the 32-item WHODAS 2.0 in persons with stroke using 1-factor, 6-factor, and 2-level hierarchical structures.
    METHODS: A cross-sectional design was used with data from 1343 persons with stroke in the Taiwan Databank of Persons with Disabilities. Confirmatory factor analysis (CFA) was used to determine the valid structure of the 32-item WHODAS 2.0.
    RESULTS: The 1-factor structure exhibited poor model fits, while the 6-factor and the overall 2-level hierarchical structure had acceptable model fits. However, the relationships between domains and overall score of the 2-level structure yielded poor fits. Excellent internal consistencies (Cronbach's α ≥ 0.90) were obtained for the 6 domain scores and the overall score.
    DISCUSSION AND CONCLUSIONS: Our results revealed poor model fit for the 1-factor model, whereas the 6-factor structure and the overall 2-level hierarchical structure were both acceptable. However, the relationships between domains and the overall score within the 2-level structure were poor. The 6-factor model is preferable due to its better fit and alignment with WHODAS 2.0's design to assess multiple life perspectives. The 6-domain structure appears the most robust for persons with stroke. Thus, the 6 domain scores of the 32-item WHODAS 2.0 are recommended.
    Keywords:  32-item WHODAS 2.0.; CFA; stroke
    DOI:  https://doi.org/10.1097/NPT.0000000000000536