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Validation of the Comprehensive ICF Core Set for Vocational Rehabilitation From the Perspective of Physical Therapists: International Delphi Survey

Veronika M. Kaech Moll, Reuben Escorpizo, Ruth Portmann Bergamaschi, Monika E. Finger
DOI: 10.2522/ptj.20150365 Published 1 August 2016
Veronika M. Kaech Moll
V.M. Kaech Moll, PT, MScPT, School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland, and ICF Unit, Swiss Paraplegic Research (SPF), Guido A. Zäch Strasse 2, 6207 Nottwil/LU, Switzerland.
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Reuben Escorpizo
R. Escorpizo, PT, DPT, MSc, ICF Unit, Swiss Paraplegic Research (SPF), and Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont.
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Ruth Portmann Bergamaschi
R. Portmann Bergamaschi, PT, MScPT, ICF Unit, Swiss Paraplegic Research (SPF).
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Monika E. Finger
M.E. Finger, PT, PhD, MPTSc, ICF Unit, Swiss Paraplegic Research (SPF).
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Abstract

Background The Comprehensive ICF Core Set for vocational rehabilitation (VR) is a list of essential categories on functioning based on the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF), which describes a standard for interdisciplinary assessment, documentation, and communication in VR.

Objective The aim of this study was to examine the content validity of the Comprehensive ICF Core Set for VR from the perspective of physical therapists.

Design A 3-round email survey was performed using the Delphi method.

Methods A convenience sample of international physical therapists working in VR with work experience of ≥2 years were asked to identify aspects they consider as relevant when evaluating or treating clients in VR. Responses were linked to the ICF categories and compared with the Comprehensive ICF Core Set for VR.

Results Sixty-two physical therapists from all 6 WHO world regions responded with 3,917 statements that were subsequently linked to 338 ICF categories. Fifteen (17%) of the 90 categories in the Comprehensive ICF Core Set for VR were confirmed by the physical therapists in the sample. Twenty-two additional ICF categories were identified that were not included in the Comprehensive ICF Core Set for VR.

Limitations Vocational rehabilitation in physical therapy is not well defined in every country and might have resulted in the small sample size. Therefore, the results cannot be generalized to all physical therapists practicing in VR.

Conclusion The content validity of the ICF Core Set for VR is insufficient from solely a physical therapist perspective. The results of this study could be used to define a physical therapy–specific set of ICF categories to develop and guide physical therapist clinical practice in VR.

There is evidence to suggest that vocational rehabilitation (VR) is effective in reducing workdays lost, facilitating early return to work (RTW), and being an essential process in the care of workers with disability. The goal of VR is to empower clients to optimize work capacity, regain their participation in employment, and achieve their highest level of health.1–10 An interdisciplinary VR framework, including professionals such as physical therapists, occupational therapists, rehabilitation physicians, vocational counselors, psychologists, social workers, and stakeholders from the payer and employer side, is fundamentally important to enable structured rehabilitation programs geared toward RTW.11 Physical therapists are essential members of this interdisciplinary team and are competent to develop and implement RTW strategies.4–12

One major problem in interdisciplinary communication is the use of setting- or profession-specific terminology.12–14 Therefore, the International Classification of Functioning, Disability and Health (ICF), endorsed by the World Health Organization (WHO) in 2001, offers a generic framework that provides a common language to describe functioning related to health and health-related states.15–17 In addition, the ICF enables us to link health care data from different sources, such as clinical tests, medical records, and interviews, to the notion of “functioning” in a systematic way that improves transparency, efficiency, and cost effectiveness in rehabilitation management and health care in general.15 However, the whole ICF classification includes more than 1,200 categories, making its implementation in practice a major challenge.18

To date, different approaches have been carried out to improve the applicability of the ICF in clinical practice and rehabilitation.19–21 One major approach was to develop health condition–specific ICF Core Sets.18,19 An ICF Core Set is an evidence-based short list of ICF categories that reflect the spectrum of typical problems that a client with a health condition or in a specific health care context may experience. An ICF Core Set is developed using information from the literature, experts, and empirical and patient qualitative research. An ICF Core Set represents an international set of domains that should be considered when assessing, treating, and documenting the functioning of individuals for a particular health condition or setting. In general, for any given ICF Core Set, there is a comprehensive version and a brief version (ie, minimum data set).

In 2010, the ICF Core Set for VR was developed as a means to capture those functioning aspects of workers relevant to an RTW program, including physical therapists as health care service providers.22 The Comprehensive ICF Core Set for VR contains 90 ICF categories and the Brief ICF Core Set contains 13 categories.23 The Comprehensive ICF Core Set for VR was designed as an overarching, multidisciplinary standard to cover all relevant aspects of the vocational rehabilitation process. The Brief ICF Core Set for VR represents a minimal and essential subset of categories of the Comprehensive ICF Core Set for VR that is neither specific nor exclusive to one discipline; professionals from other disciplines, such as occupational therapists, physicians, rehabilitation counselors, and job coaches, to name a few, also are involved. It remains unclear, however, as to what extent the ICF Core Set for VR is representative of physical therapist practice in VR. Thus, the overall objective of this study was to establish the content validity of the ICF Core Set for VR from the physical therapists' perspective. The specific aims were: (1) to determine the aspects, relevant for physical therapists working in VR, that are included and not included in the ICF Core Set for VR and (2) to discuss the relevance of the findings regarding its value and benefit for physical therapists practicing in VR.

Method

Study Design

An international 3-round survey, based on a consensus-building Delphi method, was conducted with physical therapists who are working in a VR setting. The Delphi method is a structured multistage process to collect and distribute information about a certain topic with 4 main characteristics: anonymity, iteration with controlled feedback, statistical group response, and informed input.24–26

Participants

Initially, an international data pool was established with physical therapists working in VR and willing to participate in the study. Therefore, we asked the coordinator of the work and health subgroup of the World Confederation for Physical Therapy (WCPT) and the representatives of the national physical therapy associations, by email, to provide the contact information of physical therapists working in VR. Furthermore, VR sites on the Internet and on social-professional Web networks such as LinkedIn were searched for potential participants. The identified contact people were provided with the study information.

Physical therapists who agreed to participate received information concerning the study objective and the time needed to participate. In addition, they were asked to suggest other physical therapists experienced in the practice of VR and who might be interested to participate in the study. Inclusion criteria for the survey participants included: (1) currently working as a physical therapist in a VR setting, (2) general experience ≥2 years and, (3) ability to understand and communicate in English. Physical therapists who had participated in an earlier stage of the development of the ICF Core Set for VR were excluded.

Data Collection

To collect first-round answers of the Delphi survey, a Web-based survey was created (http://www.umfrageonline.com/ © 2007–2013, enuvo GmbH). All potential participants received an email with the link to the survey homepage and instructions. They were asked to list all aspects that they consider as relevant when evaluating or treating clients in VR following the 6 standardized statements below, representing the ICF components of body structures, body functions, activities and participation, environmental factors, and personal factors (Fig. 1)17:

  1. If you think about the body parts of individuals participating in VR, list all of the items (body structures) that you consider as relevant when evaluating or treating them.

  2. If you think about the body and mind of individuals participating in VR, list all of the items (body functions) that you consider as relevant when evaluating or treating them.

  3. If you think about the daily life and work activities and the involvement in the society of individuals participating in VR, list all of the items (activities and participation) that you consider as relevant when evaluating or treating them.

  4. If you think about the environment and the living conditions of individuals participating in VR, list all of the items that you consider as helpful (facilitators) for them.

  5. If you think about the environment and the living conditions of individuals participating in VR, list all of the items that you consider as hindering (barriers) for them.

  6. If you think about individuals participating in VR, list all of personal characteristics that you consider as important to the way they handle their situation (personal factors).

The participants provided demographic data and specified their number of years (professional experience) working in VR, as well as their current condition area of clinical practice (eg, musculoskeletal, neurology), if any. Finally, they were asked for a valid email address, as the Excel (Microsoft Excel for Macintosh 2011, version 14.2.5, Microsoft Corp, Redmond Washington) files for the second and third rounds were sent out by email, and for further survey communication. The time allotted for answering the first round was 3 weeks; a reminder was sent 1 week and then 2 days before the deadline.

Figure 1.
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Figure 1.

Description of the course of the Delphi exercise. ICF=International Classification of Functioning, Disability and Health; VR=vocational rehabilitation.

In the first round, all answers were collected, tabulated, and linked to the most fitting ICF categories according to established linking rules.27 Statements that were not clear enough and could not be linked to any ICF category were assigned a “not covered” (nc) classification. Statements where it was not sufficient to make a decision regarding the most fitting ICF category were assigned a “not definable” (nd) classification. Furthermore, statements that belong to “personal factors” or “health conditions” were assigned either a “pf” or “hc” classification, respectively. As “pf” statements are not categorized in the current ICF, they were not contained in the ICF Core Set for VR, but as they are relevant in assessment and intervention planning, “pf” concepts were summarized according to an existing “pf” classification.28 They were not considered in further rounds.

The linking of the statements to distinct ICF categories was performed independently by 2 physical therapists (V.KM., R.P.B.) according to the linking rules.27 Both physical therapists were trained in linking ICF and had an understanding of VR. Linking results were compared and disagreement, if any, was discussed with a third expert (M.E.F.).

In the second round, all participants received an email with an Excel file containing all linked ICF categories with their respective code and description. In addition, an average percent for each category was shown to inform the participant of how many times each category was named by participants in the first round. Furthermore, a second file with the respective definition for each category was provided. Participants were asked to judge for each category whether they think the category is relevant for physical therapists evaluating or treating clients in VR, recognizing that the final list should be as short as possible to be practical but as comprehensive as needed to capture the most relevant needs of the clients who are in VR. In this process, the participants should take into consideration all information provided in the survey and their clinical experience and knowledge. The answers were analyzed descriptively.

In the third round, participants received an Excel file containing the ICF categories with the respective percentage of approval by the physical therapists in the second round. They again were asked to answer, for each category, whether they found it relevant or not relevant for physical therapists in VR. The time allotted to respond to the third round was 3 weeks; a reminder was sent 1 week and then 2 days before the deadline, and 1 week and then 9 days after the deadline, if missed.

Data Analysis

Descriptive statistics were performed to analyze the sample and frequencies of rating the second and third rounds. A subgroup analysis by WHO region was undertaken to better understand potential cultural influences, using Excel.

For calculating the interrater reliability of linking to the ICF between the 2 physical therapists, a kappa coefficient with bootstrapped 95% confidence interval (CI) was calculated using the R statistics program.29–31

The ICF categories identified in the survey were presented on the first and second levels of the ICF classification to be comparable to the ICF Core Set for VR. As, due to the hierarchy of the ICF, lower-level and more specific categories share the attributes of the less specific higher-level (broader) categories, answers linked to the third or fourth level of a category can be presented by “folding up” to the higher-level category. The transformation to the second level was done after the third round. Second, only ICF categories with an agreement of at least 75% among the physical therapists in the third round of the Delphi survey were considered for comparison with the Comprehensive ICF Core Set for VR. This strategy has already been used in previous studies, and to make results comparable within the ICF research, the same or similar procedures and cutoffs were used in this study.32,33 For example, category b164 (higher-level cognitive functions) received an agreement of only 71.1% of the participants and, therefore, did not meet the cutoff, whereas category b760 (control of voluntary movement functions) had an agreement of 86.8% and was considered for the comparison.

For the validation process, the ICF categories identified in the survey as relevant for physical therapists in VR were compared with the ICF categories of the Comprehensive ICF Core Set for VR. Three groups of ICF categories were defined: (1) ICF categories that were identified as relevant by physical therapists and are represented in the Comprehensive ICF Core Set for VR, (2) ICF categories that were represented in the Comprehensive Core Set but are not considered as relevant by physical therapists, and (3) ICF categories that are relevant for physical therapists but were not represented in the Comprehensive ICF Core Set for VR.

Role of the Funding Source

The Zurich University of Applied Sciences and the Swiss Paraplegic Research provided kind support.

Results

The 3-round Delphi process took place between August and December 2013, where each round lasted between 3 and 5 weeks (Fig. 2).

Figure 2.
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Figure 2.

Flow diagram: Delphi survey. WHO=World Health Organization, VR=vocational rehabilitation.

Participants

For recruiting the participants, more than 600 emails were sent out. Additionally, links were posted on 8 LinkedIn groups* to recruit participants and to ask them to forward the information to interested colleagues. Of the 101 physical therapists who expressed an interest in participating, 86 were physical therapists who had a valid email address and practical experience and completed the first-round questionnaire. Of the 86 participants, 62 (53%) completed at least 2 rounds of the survey (63% female, median age=36 years) and thus were valid for being analyzed regarding the inclusion criteria and completeness. The main areas of practice were musculoskeletal (58%), neurology (23%), and “other” (19%). Most of the participants (52%) worked in a secondary care setting (eg, a rehabilitation or outpatient center) or at a university as an academician or researcher (34%). The participants came from all 6 WHO regions. Further demographic and participant characteristics from the first round are shown in Table 1.

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Table 1.

Demographics and Professional Characteristics of Participantsa

Twenty-four participants were excluded due to missing answers despite being sent 3 reminders for each round (African=2, Americas=4, European=13, South-East Asia=2, Western Pacific=3). Seven of them had an advanced postprofessional degree in physical therapy, and 9 of them had 10 or more years of experience.

Identified ICF Categories

In the first round, participants provided 3,917 statements. Depending on the level of specification, these statements were linked to one of the 30 ICF chapters or to 308 different ICF categories: 72 categories from the component body functions (53 second-level categories and 19 third-level categories), 51 categories from the component body structures (21 second-level categories, 19 third-level categories, and 11 fourth-level categories), 116 categories from the component activities and participation (65 second-level categories and 51 third-level categories), and 69 categories from the component environmental factors (52 second-level categories and 17 third-level categories). All of these results and the percentages of agreement among the participants in rounds 2 and 3 regarding the ICF categories are presented in the eTable.

Confirmed ICF Categories

Fifteen (17%) of the 90 categories in the Comprehensive ICF Core Set for VR were confirmed by the physical therapists at the second level: 6 categories from the component body functions (b126, b130, b280, b455, b730, and b740) and 9 categories from the component activity and participation (d410, d415, d430, d440, d445, d450, d455, d470, and d825) (Tab. 2).

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Table 2.

ICF Categories From ICF Core Set for VR Selected by Physical Therapistsa

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Table 3.

Subgroup Analysis: ICF Categories by WHO Regionsa

Additional ICF Categories

Twenty-three ICF categories were identified by more than 75% of the physical therapists as additional ICF categories that were not included in the ICF Core Set for VR or were only represented at the chapter level. The Comprehensive ICF Core Set for VR has no body structure categories; nevertheless, the participants identified 9 body structure categories relevant for their daily practice: s1, s410, s7, s710, s720, s730, s750, s760, and s770. Fifty categories from the ICF Core Set were not identified by the physical therapists as relevant.

Statements Not Covered by the ICF

Several statements were identified as personal factors, health conditions, or not covered by a specific ICF code. Statements assigned to personal factors (pf) were summarized in 7 groups: sociodemographics, thoughts, knowledge, goals, behavior, social skills, and lifestyle.28 Statements related to health condition (hc) were related to 4 groups: diagnosis, comorbidity, prognosis, and general health information. Finally, 34 responses were not covered by an existing ICF code (nc).

Five of the 62 physical therapists had less than 2 years of VR experience. Their answers were examined for a qualitative “sensitivity” analysis regarding its impact on the survey results. These 5 therapists added 13 additional concepts in the first round that were all linked to third-level categories, of which 2 were confirmed by more than 25% of all participants in the second and third rounds. In the final stage of transforming all third-level categories to the second level, none of the identified third-level categories from the 5 therapists influenced the final list (eTable).

In the subgroup analysis, 84 ICF categories (of the 167 categories generated by this study) had been chosen at least 3 times by all 6 WHO regions (African, Americas, Eastern Mediterranean, European, South-East Asia, and Western Pacific), and 31 categories had been chosen by at least 5 regions. The Americas, European, and South-East Asia regions were similar in their responses and chose between 30 and 37 categories, whereas the African, Eastern Mediterranean, and Western Pacific regions chose about 80 categories.

Level of Linking Agreement

The unweighted kappa statistic for linking agreement was .63 (95% CI=.59, .68) for the ICF codes transformed to the second level. For the linking of the original codes, kappa statistics were slightly lower at .56 (95% CI=.53, .63). Following Landis and Koch, values of agreement between .41 and .60 are indicated as moderate and values between .61 and .80 are indicated as substantial.29 Hence, linking agreement for this study was moderate to substantial.

Discussion

In an international 3-round email Delphi survey, consensus was reached among physical therapists working in VR concerning the domains on functioning that are relevant when evaluating or treating clients in VR. Consensus was assumed if at least 75% of the participants agreed on a domain. This cutoff was chosen based on previous ICF validation studies.32,33 The 75% arbitrary cutoff supports core responsibilities of physical therapists in VR, whereas using a lower cutoff of 70%, for example, would have included ICF categories such as b164 (higher cognitive function) (71%) and d240 (handling stress) (73.6%), which may or may not directly relate to entry-level physical therapist practice. These results added knowledge and identified the gap and future opportunities for further examining the role of physical therapists in the field of VR. The existing ICF and the ICF Core Set for VR, which was developed as a multidisciplinary standard to evaluate the whole continuum of VR, were used for reference.

In the Brief ICF Core Set for VR, our survey participants identified only one category, b455 (exercise tolerance function), as relevant when evaluating and treating clients in VR. This finding is consistent with the WCPT description of physical therapy, as exercise tolerance function is the only category in the Brief Core Set that is closely related to movement and functioning compared with the remaining 12 categories, which are related to cognitive or social functioning, employment, and environmental factors.

In the Comprehensive ICF Core Set, the participants identified 15 (17%) of the categories as relevant targets for physical therapists in VR: 6 categories from the component body functions and 9 categories from the component activities and participation. In addition, 9 chapter-level categories (3 body functions, 2 body structures, 3 activities and participation, and 1 environmental factor) and 13 second-level categories not included in the ICF Core Set for VR (3 body functions, 7 body structures, and 3 activities and participation) were identified as relevant for physical therapists in VR (Tab. 2). On the other hand, the current Guide to Physical Therapist Practice (the Guide) defines the role of physical therapists, in part, as: “use[s] tests and measures to make judgment as to whether an individual is prepared to assume or resume work-related roles, including activities of daily living (ADL) and instrumental activities of daily living (IADL), or to assess the need for assistive technology or environmental adaptations.”34 Thereby, the Guide refers to ADL and IADL activities that are only partially included in the ICF Core Set for VR but identified to be relevant in VR to a lesser extent by the study participants.34 For example, although the assessment of assistive technology and environmental adaptations is recommended by the Guide as interventions to be considered in physical therapy treatment in VR and is covered in the ICF Core Set for VR in the chapter “e1: products and technology,” these interventions were not confirmed by the physical therapists in our survey. The physical therapists identified only the environmental factor (eg, “social support at home and work,” “support from family,” “cooperative colleagues,” or “social workers”) covered by the ICF chapter “e3: support and relationship” as relevant for their work. It remains unclear whether, in interdisciplinary teams, these interventions are carried out by other health professionals,35 or if contrary to recommendation (eg, the Guide or the ICF Core Set), assistive technology assessment and environmental adaptations are not considered.

When looking at the level of specificity that was considered as relevant in VR, both the Guide and the ICF Core Set for VR describe the relevant factors in VR from a broader perspective than some of the physical therapists who reported relevant factors on a more specific level (third and fourth levels of the ICF). The broader perspective of the Guide and the Core Set might be needed to integrate the perspective of physical therapists into a comprehensive overall take on VR covered by the multiple disciplines engaged in the field of VR. On the other hand, the physical therapist clinician might need a more detailed view with regard to daily clinical routine with a client.36 For example, in the interdisciplinary setting, addressing pain in a more generic way, as described in the second-level category b280 (pain functions), may be sufficient, whereas a physical therapist will evaluate and document pain problems in a more detailed way (eg, b28013: pain in back). For the same reason, physical therapists might have agreed on the 22 additional aspects of functioning or ICF categories not covered by the present ICF Core Set for VR but considered relevant in day-to-day practice of VR (eg, b710: mobility of joint functions, d920: recreation and leisure). Especially for the category d920 (recreation and leisure), there is increasing evidence that keeping a healthy balance between work and recreation as a basis for sustained work productivity is important.37,38

Categories defining ADL and IADL were named by participants in the study but were mostly eliminated in further rounds (eg, d510: washing oneself, d540: dressing, d420: transferring oneself). It is an issue as to what extent physical therapists in VR have to examine and treat ADL or IADL or whether these categories belong to a general rehabilitation setting. Interestingly, the results of our study show that physical therapists do not feel the relevance of assessing assistive technology in RTW strategies. On the other hand, when looking at the results, physical therapists in VR considered evaluating and treating categories from the component body structures (ie, naming 13 categories from that component) to be relevant. However, the assessment and treatment of body structures is not recommended in the Guide, nor are body structures included in the ICF Core Set for VR.34 A body structure–focused examination and intervention has been the traditional approach for many decades in medicine, as it brings impairment-related information that might be important in mitigating the consequences of work disability. However, complementing body structure information with a focus on activities and participation and environmental factors can facilitate optimal RTW by considering the broader aspect of the client's functioning.

Even though physical therapy in VR seems to be a specialized field, it stands out that body functions, such as the categories b280 (sensation of pain), b455 (exercise tolerance functions), b730 (muscle power functions), and b740 (muscle endurance functions), address common physical therapy target goals in other settings as well.34–36 However, the categories b126 (temperament and personality functions) and b130 (energy and drive functions) can generally be considered as essential prerequisites for successful VR outcome. The latter 2 categories emphasize the need for physical therapists in their clinical decision-making process to identify and refer to other disciplines to address those aspects of functioning that do not necessarily fall directly within the scope of physical therapist practice.

When looking at the identified activities and participation categories, it is remarkable that 8 of the 9 categories belonged to “mobility.” These findings are consistent with the definition of general physical therapy core domains, which states, “Physical therapists are health care professionals who help…maintain, restore and improve movement.”35 One category—d825 (vocational training)—represents a major strategy in VR, which is commonly not part of traditional physical therapy treatment and is often addressed separately by vocational rehabilitation counselors and job coaches.

Another 5 categories of the Core Set are covered only by the chapter level: b1 (mental functions), b2 (sensory functions and pain), d5 (self-care), d7 (interpersonal interactions and relationships), and e3 (support and relationships). This finding means that physical therapists acknowledged the importance of these broad domains but may not need the specific information afforded by second-level categories or that more detailed information is implicitly subsumed using the broad domains (at the chapter level). Noteworthy to mention is the difference between experts and novice therapists (≤2 years of experience). The novice therapists named relevant factors to consider in their daily practice in a detailed manner, whereas experts often use only information on a chapter level, implying that experts may not necessarily exclude specific information but use a broad overview of the domain for guidance. On one hand, this possibly raises the issue of the confidence of being able to discern the need for specific information or not depending on the context of the VR situation, which can be influenced by a lengthy experience in clinical practice. On the other hand, recent physical therapy graduates may not yet have sufficient experience to acquire a comprehensive overview of functioning and thus resort to more detailed information.

However, this study also had some limitations. Despite the broad recruitment of experts by contacting the WCPT and the representatives of the national physical therapy associations, via their websites on the Internet and on LinkedIn, the number of physical therapists in VR willing to participate in the survey was limited in comparison with the theoretically large sampling frame of physical therapists available who may be practicing in a VR-like setting. This low participation might have been due to the fact that VR is internationally still seen as a developing practice area of physical therapy, and even though physical therapists may commonly address RTW as a goal with their clients, they might not consider themselves to be experts in the field of VR. The lack of infrastructure and establishment of a VR program in some regions of the world also poses another challenge. Having analyzed the subgroup data by WHO region, it was interesting to see how different regions had answered, and the data showed that the therapists from strongly represented regions with multiple participants (Americas=7, European=26, and South-East Asia=7) had agreed in choosing much more specific categories than therapists from regions with fewer participants. This finding may indicate that these effects are due to differences in professional education and diverse representation of international “standards” concerning VR. Participants from countries with more differentiated answers have facilitated access to VR programs. Moreover, there might be a lack of established infrastructure concerning the delivery of VR in a particular country or region.38

The diverse backgrounds of the experts with respect to experience or expertise in a wide range of health conditions and VR settings, as well as in education and research, and the global distribution of participants from all 6 WHO regions provided heterogeneity of participants, which would probably reflect a realistic global composition of physical therapists practicing in VR. The composition of participants, therefore, supports the first requirement on validity in a Delphi exercise, which is to identify diverse sources of information.39

Nevertheless, the external validity of the results has to be investigated in specific cultural or health care settings. The International Federation of Physical Therapists Working in Occupational Health and Ergonomics Group, formed at WCPT Congress in Vancouver, Canada, in 2007, can further advance and support this development from a global perspective, alongside the support of national physical therapy associations.

To be able to compare the findings of the Delphi survey with the ICF Core Set for VR, all final ICF codes derived from the survey were transformed to the second level. Therefore, more specific information relevant to physical therapists might have been lost in the process. For example, category b1301 (motivation), which was chosen by 92.5% of the respondents, was aggregated for comparison reasons to the second-level category b130 (energy and drive functions). The aspect of motivation might be lost to physical therapists not so familiar with the ICF taxonomy, such that the aspect of “motivation” is subsumed by the concept of “energy and drive.”

To conclude, it can be shown that physical therapists treating clients in VR consider aspects of functioning to be relevant and to belong to the common domains of physical therapist practice. In daily practice, physical therapists are responsible for a specific part of the ICF Core Set for VR that belong to the core competencies of physical therapy, such as d4 (mobility) and b7 (neuromusculoskeletal and movement-related functions). In addition, the results show that physical therapists consider additional aspects of functioning to gain a broader overview of their client's situation in RTW. Further categories as identified in this study may be used by the physical therapists to evaluate and document functioning of their clients in VR. It can be stated that the content validity of the Comprehensive ICF Core Set for VR is insufficient from solely a physical therapist's perspective. However, the Comprehensive ICF Core Set makes sense to clarify competencies and responsibilities of physical therapists in a multidisciplinary setting or when communicating with other professionals and to facilitate an integrative and comprehensive rehabilitation management. Even though, in its entirety, the ICF Core Set for VR is too comprehensive for monodisciplinary use in physical therapist practice, the results of this study could be used to define a physical therapy–specific set of ICF categories to guide clinical physical therapist practice in VR.

With this survey, the core competencies for physical therapists treating clients in VR could be clarified at least from a global perspective. This clarification would allow an allocation of the competencies and responsibilities in an interdisciplinary team in the context of VR, which leads to optimal RTW outcomes.

Footnotes

  • Mrs Kaech Moll, Dr Finger, and Dr Escorpizo provided research idea/concept/design, analysis, and writing. Mrs Kaech Moll provided data collection. Mrs Kaech Moll, Mrs Portmann Bergamaschi, and Dr Finger provided linking. All authors provided help and revision support.

  • The authors thank Carolina Ballert for her statistical support. Furthermore, they thank all participating experts for their commitment and the considerable time spent to make this study possible: Abdul Almalty, Agne Laansalu, Akira Kimura, Alex Woo, Alicia Savona, Ana Cristhina de Oliveira Brasil de Araújo, Anita Gross, Anja Raab, Anna Sproμe, Anne Kumurenzi, Anneliis Jaanus, Annie Au, Binil Pillai, Bulent Elbasan, Carien Beurskens, Caroline Speksnijder, Catharina Broberg, Catherine Sykes, Christine Parker, Chung Tok Wong (Richard Wong), David Worth, Deborrah Thornhill, Dee Daley, Ernest Roy, Gerard Urimubenshi, Gunvor Gard, Helene L. Soberg, Jana Skoblíková, Jean Baptiste Sagahutu, Jenis Bhalavat, Jessica Decker, Jill Galper, Joel Booth, Kadri Joost, Larry Koyama, Lee Gardiner, Lindi Christensen, Luísa Cardoso, Margaret Mweshi, Margarida Florindo, Maria Soberanis-Reyes, Michael Sleap, Mohamed Sherif Sirajudeen, Monika Löfgren, Nadia Ittehadi, Niels Veldhuijzen, Noel Matereke, Patcharee Kooncumchoo, Piret Tiits, Priscilla Poon, Rasa Gaidlazda, Roongtiwa Vachalathiti, Sai Kishore, Sharad Kulathnal Soman, Shiv Idwani, Susanne Spillmann Zoller, Svenja Janssen, Tak Hang Yeung, Umesh Gyawali, Veronica Ntsiea, Wade Russell, and Yngve Roe.

  • This study was done as a project for Mrs Kaech Moll's master of science diploma in physical therapy.

  • This study complied with the Declaration of Helsinki and was exempt from ethics approval.

  • The Zurich University of Applied Sciences and the Swiss Paraplegic Research kindly provided support.

  • ↵* LinkedIn groups: Florida Vocational Rehabilitation, PhysioUK, Rehab Summit, Rehabilitation Medicine, Return-to-Work Evaluation (OccuPro), Return-to-Work Resources, Vocational Rehabilitation Association, WCPT Network for ICF.

  • Received July 2, 2015.
  • Accepted January 24, 2016.
  • © 2016 American Physical Therapy Association

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View Abstract
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Vol 96 Issue 8 Table of Contents
Physical Therapy: 96 (8)

Issue highlights

  • Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community
  • Prevalence of Wheelchair and Scooter Use Among Community-Dwelling Canadians
  • Metatarsophalangeal Hyperextension Movement Pattern Related to Diabetic Forefoot Deformity
  • Coordination and Symmetry Patterns During the Drop Vertical Jump in People With Chronic Ankle Instability and Lateral Ankle Sprain Copers
  • Critical and Theoretical Perspective on Scapular Stabilization: What Does It Really Mean, and Are We on the Right Track?
  • Effects of Pilates-Based Core Stability Training in Ambulant People With Multiple Sclerosis: Multicenter, Assessor-Blinded, Randomized Controlled Trial
  • Adding Psychosocial Factors Does Not Improve Predictive Models for People With Spinal Pain Enough to Warrant Extensive Screening for Them at Baseline
  • Cervico-ocular Reflex Is Increased in People With Nonspecific Neck Pain
  • Expanded Distribution of Pain as a Sign of Central Sensitization in Individuals With Symptomatic Knee Osteoarthritis
  • Obstacle Crossing During Gait in Children With Cerebral Palsy: Cross-Sectional Study With Kinematic Analysis of Dynamic Balance and Trunk Control
  • Medial Longitudinal Arch Development of Children Aged 7 to 9 Years: Longitudinal Investigation
  • Limitations in the Activity of Mobility at Age 6 Years After Difficult Birth at Term: Prospective Cohort Study
  • From Persuasion to Coercion: Responding to the Reluctant Patient in Rehabilitation
  • “Crawling Out of the Cocoon”: Patients' Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression
  • Preliminary Evaluation of a Modified STarT Back Screening Tool Across Different Musculoskeletal Pain Conditions
  • Validation of the Comprehensive ICF Core Set for Vocational Rehabilitation From the Perspective of Physical Therapists: International Delphi Survey
  • Test-Retest Reliability of Dual-Task Outcome Measures in People With Parkinson Disease
  • Development of a Feasible Implementation Fidelity Protocol Within a Complex Physical Therapy–Led Self-Management Intervention
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Validation of the Comprehensive ICF Core Set for Vocational Rehabilitation From the Perspective of Physical Therapists: International Delphi Survey
Veronika M. Kaech Moll, Reuben Escorpizo, Ruth Portmann Bergamaschi, Monika E. Finger
Physical Therapy Aug 2016, 96 (8) 1262-1275; DOI: 10.2522/ptj.20150365

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Validation of the Comprehensive ICF Core Set for Vocational Rehabilitation From the Perspective of Physical Therapists: International Delphi Survey
Veronika M. Kaech Moll, Reuben Escorpizo, Ruth Portmann Bergamaschi, Monika E. Finger
Physical Therapy Aug 2016, 96 (8) 1262-1275; DOI: 10.2522/ptj.20150365
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More in this TOC Section

  • Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease
  • Predictors of Reduced Frequency of Physical Activity 3 Months After Injury: Findings From the Prospective Outcomes of Injury Study
  • Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury
Show more Measurement

Subjects

  • Examination/Evaluation
    • Tests and Measurements
  • Intervention
    • Work and Community Reintegration
  • International Classification of Functioning, Disability and Health (ICF)
  • Disability Models

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