Fheodoroff Klemens, Scheschonka Astrid, Wissel Jörg
Department of Neurorehabilitation, Gailtal-Klinik Hermagor, Hermagor, Austria.
Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.
Disabil Rehabil. 2022 Apr;44(8):1367-1373. doi: 10.1080/09638288.2020.1804627. Epub 2020 Aug 17.
To map spasticity-related goals using the International Classification of Functioning, Disability and Health (ICF) linking rules, and review goal syntax to direct future goal setting.
1633 treatment goals, set during the TOWER study, were linked to the ICF framework and EQ-5D domains. Goals were mapped independently by two investigators with expertise in ICF linking rules.
In total, 1630 (99.8%) goals could be mapped to the ICF (inter-rater agreement on the main ICF category 96.1%). Most goals (80.2%) were mapped to a single ICF category and were related to activities/participation (54.9%). 170 (10.4%) goals were related to general tasks and activities, such as positioning, stretching, and strengthening. In total, 1072 goals (65.6%) mapped to the EQ-5D domains (inter-rater agreement 90.8%). Analysis of the goal syntax highlighted the need to include a verb in patient-centered goals to direct active behavior.
The ICF offers a broad framework for setting patient-centered, easily understandable goals for patients with spasticity, including goals related to (guided) self-management activities. This analysis sheds new light on patient needs and could direct future goal-driven botulinum toxin spasticity treatment focused on enabling patients to better manage activity limitations imposed by their body function impairments. NCT01603459 registered with ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT01603459).Implications for RehabilitationThe ICF offers a broad framework for setting patient-centered, easily understandable goals for patients with spasticity.ICF domains that include general tasks and demands can be used to establish goals relating to (guided) self-management of spasticity.An ICF-based goal-setting framework may increase the comparability of clinical data across studies.
运用《国际功能、残疾和健康分类》（ICF）关联规则来梳理与痉挛相关的目标，并审视目标句法以指导未来的目标设定。
在TOWER研究期间设定的1633个治疗目标与ICF框架及EQ-5D领域进行了关联。由两名精通ICF关联规则的研究人员独立对目标进行映射。
总计1630个（99.8%）目标可映射至ICF（在主要ICF类别上的评分者间一致性为96.1%）。大多数目标（80.2%）映射至单一ICF类别，且与活动/参与相关（54.9%）。170个（10.4%）目标与一般任务和活动相关，如体位摆放、伸展和强化训练。总计1072个目标（65.6%）映射至EQ-5D领域（评分者间一致性为90.8%）。对目标句法的分析突出表明，以患者为中心的目标中需要包含一个动词来指导积极行为。
ICF为为痉挛患者设定以患者为中心、易于理解的目标提供了一个广泛框架，包括与（引导式）自我管理活动相关的目标。该分析揭示了患者需求的新情况，并可指导未来以目标为导向的肉毒杆菌毒素治疗痉挛，重点是使患者能够更好地应对因身体功能障碍所导致的活动受限。在ClinicalTrials.gov（https://clinicaltrials.gov/ct2/show/NCT01603459）注册，编号为NCT01603459。
对康复的启示
ICF为为痉挛患者设定以患者为中心、易于理解的目标提供了一个广泛框架。
包括一般任务和要求的ICF领域可用于确立与痉挛（引导式）自我管理相关的目标。
基于ICF的目标设定框架可能会提高各研究间临床数据的可比性。
