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Identification of the Most Common Problems by Patients with Ankylosing Spondylitis Using the International Classification of Functioning,
Disability and Health
IRENE van ECHTELD, ALARCOS CIEZA, ANNELIES BOONEN, GEROLD STUCKI, JANE ZOCHLING, JÜRGEN BRAUN, and DÉSIRÉE van der HEIJDE ABSTRACT. Objective. The International Classification of Functioning, Disability and Health (ICF) aims to classify functioning and health by a number of categories divided over 3 components: body functions and body structures, participation and activities, and environmental factors. We identified the common health problems of patients with ankylosing spondylitis (AS) based on the ICF from the perspective of the patient. Methods. During structured interviews with the extended ICF checklist, trained assessors collected data from 111 patients with AS. ICF categories identified by more than 5% of the patients as at least mildly impaired or restricted were selected. Categories identified by less than 5% were removed. Additional impairments/restrictions reported by more than 5% of the patients, after the structured interviews and not yet included in the checklist, were added. Results. One hundred nineteen (72%) out of 165 categories of the extended ICF checklist were identified to be at least mildly impaired or restricted. Within each of the 4 components of the ICF, at least one-third of the categories were impaired or restricted for more than 50% of the patients. Thirty-nine (33%) categories were related to movement and mobility. Within the component "environmental factors" the categories "support of immediate family" and "health professionals" were the most important facilitators, "climate" was the most important barrier. Eight impairments were additionally mentioned as relevant. These were hierarchically lower levels of ICF categories previously included and they were added. Conclusion. One hundred twenty-seven ICF categories represent the comprehensive classification of functioning in AS from the patients' perspective. The results underscore the need to address the 4 ICF components when classifying functioning and to emphasize that functioning implies more than physical functioning. (First Release Oct 1 2006; J Rheumatol 2006;33:2475-83) Key Indexing Terms:
ANKYLOSING SPONDYLITIS From the Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany; Department of Internal Medicine, Division of Rheumatology, and Caphri Research Institute, University Hospital Maastricht, Maastricht, The Netherlands; Ruhrgebiet Centre for Rheumatology, Herne, Germany; and Department of Rheumatology, Benjamin Franklin Free University of Berlin, Berlin, Germany. I. van Echteld, Medical Student, Faculty of Medical Sciences, University of Maastricht; A. Cieza, PhD, MPH, Psychologist, ICF Research Branch, WHO FIC Collaborating Center (DIMDI), IMBK, and Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians-University; A. Boonen, MD, PhD, Rheumatologist, Department of Internal Medicine, Division of Rheumatology, and Caphri Research Institute, University Hospital Maastricht; G. Stucki, MD, PhD, Professor, Department of Physical Medicine and Rehabilitation, and ICF Research Branch, WHO FIC Collaborating Center (DIMDI), IMBK, Ludwig-Maximilians-University; J. Zochling, MBBS, Med (Clinical Epidemiologist), PhD, Postdoctoral Research Fellow, Ruhrgebiet Centre for Rheumatology; J. Braun, MD, PhD, Professor of Rheumatology, Postdoctoral Research Fellow, Ruhrgebiet Centre for Rheumatology and Department of Rheumatology, Benjamin Franklin Free University of Berlin; D. van der Heijde, MD, PhD, Professor of Rheumatology, Department of Internal Medicine, Division of Rheumatology, and Caphri Research Institute, University Hospital Maastricht. Address reprint requests to Dr. A. Boonen, Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: aboo@sint.azm.nl Accepted for publication July 27, 2006.
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