Elsevier

Physiotherapy

Volume 97, Issue 1, March 2011, Pages 33-46
Physiotherapy

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer capture the problems in functioning treated by physiotherapists in women with breast cancer?

https://doi.org/10.1016/j.physio.2010.08.010Get rights and content

Abstract

Objective

The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer is an application of the ICF, and represents the typical spectrum of problems in functioning and contextual factors that may influence functioning of patients with breast cancer. The objective of this study was to examine the content validity of this ICF core set from the perspective of physiotherapists.

Design

Physiotherapists from around the world experienced in the treatment of patients with breast cancer were interviewed about patients’ problems, patients’ resources and environmental aspects that physiotherapists take care of in a three-round survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated by means of the Kappa statistic.

Participants

Physiotherapists experienced in breast cancer treatment.

Results

Fifty-nine physiotherapists from 19 countries named 769 problems treated by physiotherapists in patients with breast cancer. One hundred and sixty-six ICF categories were linked to these answers. Nineteen ICF categories reached >75% agreement among the physiotherapists but are not represented in the Comprehensive ICF Core Set for Breast Cancer. Ten concepts were linked to the not-yet-classified personal factors component. Eleven concepts are not covered by the ICF. The Kappa coefficient for the agreement between the two persons who performed the linking was 0.66 (95% bootstrapped confidence interval 0.63 to 0.68).

Conclusions

The content validity of the Comprehensive ICF Core Set for Breast Cancer was largely supported by the physiotherapists. However, several issues were raised which were not covered and these need to be investigated further.

Section snippets

Background

Breast cancer is the most common type of cancer among women worldwide [1]. The projected mortality from breast cancer in women worldwide in 2010 is 437 000 [2], and approximately 1 million women are diagnosed with breast cancer each year. However, incidence and mortality rates vary widely in different countries; they are high in most industrialised countries (except Japan), intermediate in Eastern and Southern Europe, and low in central and tropical South America, Africa and Asia [3].

Due to

Methods

A three-round e-mail survey of physiotherapists using the Delphi technique was conducted [26], [27], [28], [29]. The Delphi technique aims to gain consensus from a group of individuals who have knowledge of the investigated topic [30]. These informed persons are commonly titled ‘experts’ [31]. The Delphi method is a multistage process with each stage building on the results of the previous stage, and a series of rounds are used to both gather and provide information about a particular subject.

Recruitment and participants

One hundred and thirty-seven associations of physiotherapists were contacted, including the World Confederation of Physical Therapy (WCPT), members of the European region of the WCPT and different national physical therapy associations. Nineteen experts were recruited by this strategy. Additionally, 565 international universities were contacted which named 68 experts, of whom four agreed to participate. One hundred and ninety-one experts in lymphoedema treatment were contacted. Thereof, 13

Discussion

This study found that the categories of the current version of the Comprehensive ICF Core Set for Breast Cancer largely represent what physiotherapists agreed that they take care of in their interventions. Eighty-nine percent of the 166 ICF categories linked to the answers of the participants are represented in the Comprehensive ICF Core Set for Breast Cancer. However, 19 ICF categories considered by >75% of participants in the third Delphi round are not represented in the Comprehensive ICF

Conclusion

Although some restrictions of the current version of the Comprehensive ICF Core Set for Breast Cancer were detected in this study, the categories largely represented what the physiotherapists in the study agreed that they take care of in their interventions. Demonstrating that physiotherapy is not limited to body functions, all ICF components need to be considered in assessment and outcome evaluations. As emphasised by Kirchberger et al. [52], [53], ICF core sets and profession-specific

Acknowledgements

The authors wish to thank Barbara Schurig for her great work in this study, and also all the participants in the Delphi exercise for their valuable contribution and their time spent responding to the demanding questionnaires.
Ethical approval: None required.
Funding: Institute for Health and Rehabilitation Sciences at the Ludwig-Maximilian-University Munich, Germany.
Conflict of interest: None declared.

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