Introduction to the Special Section on the International Classification of Functioning, Disability and Health: Implications for Rehabilitation Psychology.

This introduction to the special section of Rehabilitation Psychology on the International Classification of Functioning, Disability and Health (ICF) previews how implications for rehabilitation psychology are explored through 4 articles, each designed to build on the presentation and discussion of the prior piece: an overview of the ICF classification system; a review of contemporary applications of the ICF to clinical, government, and research uses; an update on clinical implementation efforts and related conceptual issues; and a specific application of the ICF to assistive technology service provision. The special section presents the ICF as a compelling development in the classification of functioning and health in health care service provision and, in particular, rehabilitation psychology practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Operationalizing the International Classification of Functioning, Disability and Health in Clinical Settings.

Functional status may be a better indicator of health care needs and outcomes than diagnosis. Appropriate use of the International Classification of Functioning, Disability and Health (ICF) in health service settings can provide a standardized way for clinicians to communicate complex clinical assessments to other professionals, administrators, and payers. The American Psychological Association is working with the World Health Organization to develop a Procedural Manual and Guide for a Standardized Application of the ICF for use by multidisciplinary health professionals. The Procedural Manual includes operational definitions of concepts, examples of each code, and assessment information relevant to each qualifier. The purpose of the Procedural Manual is to provide health professionals with the guidance necessary for reliable, valid, and clinically useful classification. This article discusses a range of issues and problems in the application of individual ICF codes in the context of health care and offers some potential solutions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing the Benefits of Assistive Technologies for Activities and Participation.

Purpose: Assistive technologies (ATs) are a key component of the Environmental Factors domain of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This article defines the Environmental Factors of the ICF and describes how ATs can improve the functioning of individuals with disabilities in community environments. Emphasis is placed on the need for comprehensive assessment before selecting ATs, particularly of the individual's current goals, past experiences with the use of technologies and other supports, and predisposition to use the AT as well as alternative or additional supports. Method: Previous research identified correlates of successful AT use and other supports by persons with disabilities. Key studies are reviewed with a discussion of the implications of findings on the further development of the ICF. Conclusion: Effective use of ATs and other supports will be maximized by matching device and support features to users' goals, preferences, and environmental resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy, optimism, health competence, and recovery from orthopedic surgery.

The authors tested whether self-efficacy for orthopedic rehabilitation tasks accounted for significant variance in rehabilitation outcome, over the variance accounted for by dispositional optimism, health competence, and health value. Whether health value moderated expectancy-outcome relationships also was examined. One hundred five older clients at 2 orthopedic rehabilitation facilities completed a battery of instruments; physical functioning also was assessed. After controlling for physical functioning at admission and for other variables, self-efficacy predicted significant variance in rehabilitation outcome. Health value did not moderate expectancy-outcome relationships. Results suggest that psychologists can improve patients' recovery from serious orthopedic problems by augmenting their self-efficacy beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The International Classification of Functioning, Disability and Health: Contemporary Literature Overview.

This article reviews the literature from the 3 years since the International Classification of Functioning, Disability and Health's (ICF's) endorsement, focusing on those articles that discuss (a) what the ICF means and how it can be used; (b) the general utility of the ICF for specific fields, such as nursing, occupational therapy, speech-language pathology, and audiology; (c) examples of applications for classification in particular disorders, such as chronic health conditions, neuromusculoskeletal conditions, cognitive disorders, mental disorders, sensory disorders, and primary and secondary conditions in children; (d) uses of the ICF to recode prior work across multiple surveys and across country coding schemes on disability-related national survey items; and (e) governmental uses of the ICF in the United States and selected countries abroad. Future directions needed to effectively implement the ICF across rehabilitation policy, research, and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the ICF and psychological models of behavior to predict mobility limitations.

Objective: To test the ability of a model that integrates the theory of planned behavior (TPB) into the International Classification of Functioning, Disability and Health (ICF), to predict walking limitations in adults awaiting hip or knee replacement surgery. Study Design and Participants: Cross-sectional structural equation modeling study of activity limitations in 190 adults. Method: A postal questionnaire measuring TPB, ICF, and walking limitations. Results: The integrated model accounted for more variance in activity limitations (57%) than did either TPB or ICF alone. Control beliefs (TPB) significantly mediated the relationship between impairment (ICF) and activity limitations. Conclusions: The integrated model provides an interdisciplinary, theoretical framework that identifies intervention targets to effect reductions in disability without the need for concomitant reductions in impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward ICD-11: Improving the clinical utility of WHO's International Classification of mental disorders.

This article describes the current revision by the World Health Organization (WHO) of the International Classification of Diseases and Related Health Problems (ICD-10). ICD-10 is the basis for ICD-10-CM, which will be introduced in 2013 as the official U.S. system. U.S. psychologists will be required to use ICD-10-CM for all third-party billing and reporting, but are generally not familiar with the ICD or WHO's role in global health classification. Although the U.S. lags behind other countries on the implementation of WHO's international classification systems, psychologists and other health professionals will be affected by ICD-11, so it is important to understand its development. WHO views the current revision as an important opportunity to improve the clinical utility of the classification system for mental disorders. Serious problems with the clinical utility of both the ICD and the DSM are widely acknowledged. Clinical utility affects the daily lives of practitioners and is also a global public health issue. Most people with mental disorders worldwide receive no treatment. A diagnostic system with greater clinical utility can be a tool to improve identification and treatment, helping WHO member countries to reduce the disease burden of mental disorders. Consistent with this goal, WHO's revision process is global, multilingual, and multidisciplinary and will produce different versions of the classification for clinical use, research, and primary care. A systematic program of studies being undertaken by WHO aimed at improving clinical utility is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to special issue: Rehabilitation psychology and persons with psychiatric disabilities: Are they mutually exclusive?

This guest-edited issue of the journal illustrates the relevance of psychiatric rehabilitation to rehabilitation psychologists. It demonstrates that the focus of psychiatric rehabilitation includes some areas of functioning typically identified with rehabilitation psychologists, for example, vocational, residential, and family functioning. Further, it shows that traditional assessment methodologies and treatment settings are beginning to reflect a psychiatric rehabilitation orientation. Finally, it illustrates the philosophy and treatment models that form the basis of physical rehabilitation as also underlying psychiatric rehabilitation. It is hoped that this issue of Rehabilitation Psychology will assist in the resolution of the debate over contextual issues by considering why psychologists working with psychiatrically impaired persons may be identified as rehabilitation psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health condition, impairment, activity limitations: Relationships with emotions and control cognitions in people with disabling conditions.

Objectives: To gain a better understanding of the influence of the health condition on emotions and control cognitions by using the International Classification of Functioning, Disability and Health (ICF) framework. The relations between health condition, impairment, activity limitations, and emotions or control cognitions were investigated in people with 1 of 2 different disabling conditions, chronic idiopathic axonal polyneuropathy (CIAP) or stroke. Method: Two existing databases were used: cross-sectional data from 56 participants with CIAP; longitudinal data of 100 participants with stroke. Participants were assessed on measures of the health condition, impairment, activity limitations, emotions, and control cognitions. Results: In participants with CIAP, impairment explained variance in concurrent control cognitions (9%-25%), activity limitation in concurrent depression (8%), and control cognitions (26%-36%). In stepwise regression activity, limitation was more powerful in explaining variance in emotions and control cognitions than impairment. In people with stroke, only activity limitations explained variance in emotions (4%-9%) and control cognitions (4%-7%). Conclusions: These results suggest that targeting activity limitations in rehabilitation efforts is likely to relate to control cognitions, which in themselves have been shown to benefit recovery of physical consequences in chronic illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation Psychology, Medical Psychology, Health Psychology, and Behavioral Medicine.

In their recent article, "The Distinctiveness of Rehabilitation Psychology," Shontz and Wright (see record 1981-26520-001) attempt to differentiate rehabilitation psychology from other areas of applied and professional psychology in health settings. Although the authors' historical recounting of early research and theory in rehabilitation psychology is informative, too little emphasis is placed on the relationship between rehabilitation psychology and "mainstream" professional psychology, particularly with regard to its health-setting applications. There appear to be more similarities than differences. The authors' argument runs full circle, namely, that rehabilitation psychology is distinct because of its philosophy, but its philosophy and "principles are valuable to psychologists in many specialties" (p. 919). The notion of involving a patient in his/her care and treatment planning also is not unique to rehabilitation psychology. Shontz and Wright state that rehabilitation psychology is not medical psychology; however, instead of defining medical psychology, they go on to talk about medical care. Medical care is not medical psychology. Further confusion is added by the statement that medical psychology should be a component of rehabilitation psychology. The authors are using medical psychology, health psychology, and behavioral medicine as if they are synonymous, when they are not. Each discipline is made distinct here. Shontz and Wright do not address what the majority of psychologists in rehabilitation do, that is, provide services. In short, although the authors complain about the unfamiliarity of rehabilitation psychology relative to the profession as a whole, their article does little to promote rehabilitation psychology as an area of interest important to professional psychologists in health care and/or rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology in primary care: Preparing for a changing health care environment.

Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family Caregivers of Stroke Survivors: Characteristics of Caregivers at Risk for Depression.

Objective: To examine characteristics that best predict family caregivers of stroke survivors at risk for depression. Survivor and caregiver demographic variables and caregiver general health, problem-solving skills, social support, satisfaction with rehabilitation health care services, preparedness, and burden were examined. Design: A correlational design. Participants: Seventy-four family caregivers of individuals receiving inpatient stroke rehabilitation were interviewed 1-2 days prior to their relative's discharge. Main Outcome Measure: The Center for Epidemiologic Studies Depression Scale (L. S. Radloff. 1977). Results: Caregivers at risk for depression had a negative orientation toward solving problems, a lack of caregiver preparedness, and impaired social functioning secondary to their own health. Conclusions: Rehabilitation psychologists should be aware that these variables are important in predicting family caregivers of stroke survivors at risk for depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Health personnel requirements, service delivery, and national policy: A conversation with Thomas D. Hatch.

Topics discussed include the configuration of the Health Resources and Services Administration and one of its units, the Bureau of Health Professions; expansion of the number of health professionals through grants to schools and student assistance; funding opportunities for psychologists in prevention, geriatrics, and health psychology; determining personnel shortage in mental health areas; interprofessional rivalries between physicians and nonphysicians; defining the boundaries of roles/competence for health care professionals. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A contextual cognitive-behavioral analysis of rehabilitation workers' health and well-being: Influences of acceptance, mindfulness, and values-based action.

Purpose: Rehabilitation settings can be extremely demanding, and sometimes stressful, places to work. It is important, therefore, to consider influences on rehabilitation workers' health and general well-being and on their ability to face emotional, physical, or mental challenges at work. The purpose of this study was to examine a set of psychological processes, including psychological acceptance, mindfulness, and values-based action, that may be relevant to this problem. Method: Ninety-eight rehabilitation workers at the Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, completed measures of background variables, health, and functioning, in addition to the 3 psychological variables of primary interest. Results: Correlation analyses demonstrated significant relations of the acceptance, mindfulness, and values measures with the measures of stress, burnout symptoms, health, and well-being, particularly general health perception, vitality, social functioning, and emotional functioning. In regression analyses, the process variables accounted for significant, and in some cases practically meaningful, increments in explained variance in 10 key outcomes related to work experience and health. Conclusion: Acceptance, mindfulness, and values-based action deserve further consideration in relation to burnout, health, and well-being among rehabilitation workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and HMOs: New partnership or new adversary?

Discusses the provision of psychological services in health maintenance organizations (HMOs) with regard to the level of the legal recognition of the autonomous functioning of psychologists. Professional concerns over the role of psychologists in HMOs and over incentives to provide quality mental health care in such organizations are also discussed. The need is stressed for psychologists to be recognized as autonomous providers under the basic federal health programs. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation relevant diagnostic procedures

Presented are four instruments current in rehabilitation diagnostics. They are investigated concerning their usefulness and merit as well as their possibly specific approach, starting out from the World Health Organization's International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which so far has hardly been commented on in the German-language area, with its effort of enabling severity-specific assessment of need and its extensive exposition on the part of the editor of "problem awareness" in relation to the subsequent planes of consideration. The EAM system is focussed on occupationally integrative, job-specific appraisal, attempting to implement standardized performance/adaptation analysis. This is contrasted with the subjective criteria-based, very consistent IRES questionnaire, which however lacks objective severity appraisal. Additionally dealt with is the "RPK" procedure used in evaluating the rehabilitation of persons with chronic mental illness. Overall, it is found that each of the different instruments has its value and merits, although major aspects of rehabilitation and, above all, integration prognosis require differentiated, systemic appraisal and on-going rehabilitation-specific consideration. What is needed is "understanding" the nature of disease consequences at the different planes of experience.     

Health psychology specialty practice opportunities in a rural community hospital: Practicing local clinical science.

There is currently considerable interest in opportunities for collaboration between psychologists and primary care providers, particularly in rural settings. This article is an attempt to expand this discussion by focusing on opportunities for more specialized health psychology practices within tertiary care settings. Two examples are provided of collaborative projects recently implemented in a rural community hospital in southern New Hampshire—1 in the department of surgery, the other in the department of cardiac rehabilitation. The process of developing these practice opportunities is described within the context of the psychologist functioning as a local clinical scientist. The article concludes with a discussion of practical issues, including staffing and funding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of pain interference in multiple sclerosis.

Objectives: To describe pain interference and explore its associations with several indexes of health and psychosocial functioning among veterans with multiple sclerosis (MS). Study Design: Cohort study linking computerized medical records and survey questionnaire. Participants: Four hundred fifty-one veterans with MS. Outcome Measures: Pain Effects Scale, Patient Health Questionnaire, Modified Social Support Survey, items from the Short Form Health Survey and the North American Research Consortium on MS Registry Survey (NARCOMS) Performance Scales. Results: Participants reported a moderate level of overall pain interference. Increased fatigue, poorer general health, and greater depression symptom severity each were significantly associated with higher levels of pain interference. Conclusions: Pain interference in MS is associated with a variety of other clinically meaningful indexes of functioning. Pain in MS should be treated aggressively to minimize functional impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cost-effective delivery of rehabilitation psychology services: The responsible utilization of paraprofessionals.

The new and rapidly changing health care environment necessitates innovation on the part of rehabilitation psychology to achieve cost-effectiveness. This innovation could take the form of rehabilitation psychologists' responsibly using bachelor's-level technicians, or paraprofessionals, in the delivery of clinical services. This article proposes a pyramid model of rehabilitation psychology service delivery using paraprofessionals and psychology trainees. Specific clinical activities appropriate for paraprofessionals are outlined. Controversies regarding use of bachelor's-level paraprofessionals and the inflationary process of over-credentialing doctoral-level psychologists are discussed. It is proposed that psychology interns and residents be cross-trained in allied health skills so that psychology trainees can provide clinical support to other health care disciplines, thereby improving the cost-effectiveness of, and preserving, hospital-based psychology training programs. The article emphasizes the need for doctoral-level rehabilitation psychologists to adopt administrative roles in medical settings in order to implement innovative service models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of rehabilitation psychologists in the treatment of disease and disability.

It is contended that rehabilitation psychologists have remained content to continue using the same techniques for the same types of problems that they used more than a decade ago. Because of a temerity of thought, rehabilitation psychologists have not extended their particular research and technological expertise into the more major areas of health care. Examples are presented in which such psychological techniques as conditioning and biofeedback were employed to treat successfully a variety of serious health problems. Rather than leave the major areas of investigation and treatment to others, as has traditionally been the case, rehabilitation psychologists are urged to utilize their skills in studying and treating the major physical problems of their patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)