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Functioning, Disability, and Health: a Taiwanese Study

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Functioning, Disability, and Health: a Taiwanese Study CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector Journal of the Formosan Medical Association (2013) 112, 691e698 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.jfma-online.com ORIGINAL ARTICLE Evolution of system for disability assessment based on the International Classification of Functioning, Disability, and Health: A Taiwanese study Sue-Wen Teng a, Chia-Feng Yen b, Hua-Fang Liao c, Kwan-Hwa Chang d, Wen-Chou Chi e, Yen-Ho Wang f, Tsan-Hon Liou g,h,*, Taiwan ICF Team a Bureau of Nursing and Health Services Development, Department of Health, Taipei, Taiwan b Department of Public Health, Tzu Chi University, Hualien, Taiwan c Chinese Association of Early Intervention of Professional for Children with Developmental Delays, Hualien, Taiwan d Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan e Department of Information Management, National Chung Cheng University, Chiayi, Taiwan f Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan g Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan h Graduate Institute of Injury Prevention, Taipei Medical University, Taipei, Taiwan Received 26 March 2013; received in revised form 3 September 2013; accepted 3 September 2013 KEYWORDS Background/Purpose: The criteria for disability were mainly based on the medical model, and the disability; candidates for disability benefits were identified by physicians mainly depending on their degree of International bodily impairment, but without sufficient evaluation of their activity, participation, and environ- Classification of ment in Taiwan. According to the People with Disabilities Rights Protection Act, the assessment of Functioning; a person’s eligibility for disability benefits was required to be based on the International Classifica- Disability; tion of Functioning, Disability, and Health (ICF) framework since July 11, 2012. This study investi- and Health; gated a proposed system to assess patients’ eligibility for disability in Taiwan, based on the ICF. * Corresponding author. Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, 291 Jhongjheng Road, Jhonghe, New Taipei City 235, Taiwan. E-mail address: [email protected] (T.-H. Liou). 0929-6646/$ - see front matter Copyright ª 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved. http://dx.doi.org/10.1016/j.jfma.2013.09.007 692 S.-W. Teng et al. World Health Methods: We have initiated a national decision-making process involving members of Taiwan’s ICF Organization Team. We facilitated 16 group discussions on the ICF coding system, in which 199 professionals participated. In each group, one member led the group discussion until a consensus was reached. Results: We have developed a process to determine the eligibility of people with disabilities. This study set up the standards,tools, and practice manuals for eachcategory. We have also developed a core set for disability assessment. Conclusion: We implemented a new system to assess patients’ eligibility for disability. The pro- posed assessment protocol and tools require further validation. Copyright ª 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved. Introduction Functioning, Disability, and Health (ICF) framework since 2012. Disability may be defined as a negative interaction between The ICF framework was developed by the World Health the functional impairments and environment of an indi- Organization (WHO) to describe health and disability at the vidual. People with disabilities often experience difficulty level of both the individual and society. It examines a person’s functioning at the level of body, person, and so- in daily life and are limited in their activities and social 4 participation. The Ministry of the Interior in Taiwan re- ciety, and provides definitions for operational assessment. ported that the number of people with disabilities nation- The ICF system provides a universal framework for assessing wide in 2003 was 861,030 (3.8% of the total population); the functional limitations of any person. The ICF classifi- this figure had increased to 1,100,436 by 2011 (4.6% of the cations are based on the understanding that for any person, total population).1 The percentage of disabled people various factors interact, and all of these factors must be shows a yearly increasing trend (Fig. 1). considered in making a proper assessment; hence, several People with disabilities often require special support in domains of assessment are included, such as body function various areas to assist them in adjusting to normal daily and structure, activity and participation, and environ- life, such as education, housing, work, and social bene- mental and personal factors (Fig. 2). The ICF system has fits.2 Since 1980, the Taiwanese government has applied been universally accepted by the United Nations since 2001. It provides an excellent scientific approach to collect certain legislative procedures to create and revise cate- 5,6 gories of disability. A person who fulfills the criteria to reliable statistics on disabled populations. In Japan, determine eligibility for disability benefits may be granted Italy, and Australia, the ICF framework has been used to cash and in-kind services from the government. However, guide clinical measurement and evaluation of patients requiring rehabilitation, home care, old-age care, and the criteria for disability were mainly based on the medi- 7e9 cal model, which considered disability as a physical and disability support. The ICF framework was also used in mental impairment. Thus, candidates for disability bene- the Multi-Country Survey Study conducted between 2000 fits were identified by physicians mainly depending on and 2001, and the World Health Survey Program of 2002 and 2003, to measure the health status of general populations their degree of bodily impairment, but without sufficient 7 evaluation of their activity, participation, and environ- in 71 countries. ment. In 2007, the Taiwanese Legislative Yuan passed a To prepare for reform in the system of disability constitutional amendment known as the People with Dis- assessment, the Taiwanese government authorized pro- abilities Rights Protection Act.3 Under this act, the fessionals to form a Taiwanese ICF Team. This task force assessment of a person’s eligibility for benefits was includes physicians, dentists, nurses, physical therapists, required to be based on the International Classification of occupational therapists, social workers, psychologists, Figure 1 The trend and estimated prevalence rates for disability in Taiwan between 1997 and 2011. Black bars indicate the number of people with disability each year, and the line shows the percentage of people with disability among the general pop- ulation each year. Disability evaluation based on the ICF in Taiwan 693 Heath condition her ideas on appropriate methods for formulating stan- (disorder or disease) dardized assessment tools. These ideas were communi- cated either during the meetings or by e-mail. The groups then designed suitable assessment tools and proposed the cutoff values for the degree of disability. The cutoff points Body Functions Activities Participation were based on the members’ clinical experience as well as and Structures empirical data. (3) Developing assessment tools for activity and participa- tion (d codes) Environmental Personal Factors Factors Initially, the teams focused on developing an operation manual for the existing 137 categories of d codes. The Figure 2 Framework of International Classification of Func- manual covered assessment procedures, tools, and the tioning, Disability, and Health (ICF) and interactions between criteria for all codes of activities and participation. How- the components. ever, this task force then became aware that the WHO had developed a second edition of the WHO Disability special education teachers, vocational assessment workers, Assessment Schedule, (WHODAS 2.0), which included an assessment of difficulty in daily activities and social public health scholars, and representatives of welfare 10 groups for people with disabilities. The team’s mission was participation. A review of the literature showed that WHODAS 2.0 was compatible with the ICF component ac- to develop a standardized instrument to assess disability 11 and to formulate Taiwan’s policies on disability. The cur- tivities and participation. Furthermore, WHODAS 2.0 can be used cross-culturally and has been tested in more than rent study examines the process of introducing these re- 12 forms, and documents the experience gained in the field of 10 countries. Our group discussed this issue over several disability assessment in Taiwan between 2007 and 2012. meetings and decided to use the 36-item version of WHODAS 2.0 rather than the ICF component activities and participation (d code).11 Methods The WHODAS scoring system is based on itemeresponse theory, with domain scores comprising the sum of all items The process of reforming disability assessment based on the in a domain. A person’s summary score is the sum of the ICF framework began in 2007. The main steps were as scores for all 36 items. The standardized score for each follows: domain and the summary score were calculated based on the manual for WHODAS.13 The standardized
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