JMIR Publications

ABSTRACT

Background:

The International Classification of Functioning, Disability, and Health (ICF) is a unified terminology system issued by the World Health Organization. Considering its comprehensive perspective on functioning and interdisciplinary focus, many electronic health records and assessment instruments have been developed based on the ICF to capture people’s functioning information. However, several challenges limited the application of the ICF, including the complexity of the terminology, too many categories, the lack of operationalization of the ICF qualifiers, and the training overload for ICF users. With the popularity of personal mobile devices, mobile health applications (apps) have been gradually used in the field of health care. In China, most spinal cord injury (SCI) patients live at home after early treatment and rehabilitation, but the limited community medical resources could not meet their complex long-term health needs. The study team developed an ICF-based app called “Together” for the transitional care of SCI patients, aiming to fill the gap between the qualified medical institutions and home-dwelling SCI patients. The core framework of the app is an ICF set reflecting the functioning level of SCI patients. Several strategies were employed to overcome the barriers related to the ICF, including selecting fewer and more specific categories, setting operationalization rating guidelines and achieving automatic transformation from the routine assessment results to the ICF qualifiers based on the guidelines.

Objective:

To use a Rasch analysis to examine the suitability of the ICF set in the app “Together” for use as an assessment instrument for the functioning of SCI patients.

Methods:

A cross-sectional study was conducted among 112 SCI patients recruited before discharge from four rehabilitation centers in Guangzhou, Chengdu, and Shiyan in China between May 2018 and October 2019. After nurses assessing the patients’ performance regarding 31 ICF categories using the app via face-to-face interviews, the data of the ICF qualifiers were analyzed by Rasch analysis.

Results:

After deleting two categories (d760 Family relationships and d9205 Socializing) and one personal factor (Knowledge about spinal cord injury) that unfit to the Rasch model, the three components of the ICF set, Body Functions and Body Structures, Activities and Participation, and Contextual Factors, exhibited adequate fit to the Rasch model, based on the Bonferroni-adjusted P values (χ2=41.458, P=.080; χ2=24.659, P=.076; χ2=13.639, P=.190). The person separation indexes of the three components were 0.5, 0.89, and 0.68, respectively. All the 28 categories retained in the set were free of differential item functioning by gender, age, education level, and etiology.

Conclusions:

Overcoming the obstacles in the practical application of the ICF, the ICF set in the app “Together” was verified to be a reliable assessment tool for assessing the functioning of SCI patients.