Forschungsprojekt
Projektart: Gefördertes Projekt Wissenschaftliche Arbeit
Anwendung der ICF Core Sets in der Begutachtung von Patienten mit lumbalen Rückenschmerzen und generalisiertem Schmerzsyndrom

Medical reports of the national pension insurance are essential for the national pension regulatory authority to decide on granting services regarding participation as well as retirement pensions due to inability to work. There are guidelines regarding the content of medical reports. It is also generally accepted that the evaluation of functioning is an essential component of them. However, it is still an open question to what extent the standardization and the objectiveness of medical reports can be improved. The ICF (International Classification of Functioning, Disability and Health) is a framework as well as a common language for describing functioning and disability. ICF Core Sets are lists of disease-specific relevant ICF categories and can be a useful practicable tool for medical reports for national pension insurance. They could support the standardization of the medical reports.
Objective: The aim of this project was to examine whether the ICF Core Sets for low back pain and chronic widespread pain could serve as a useful basis for medical reports for national pension insurance regarding the patients suffering low back pain or chronic widespread pain or whether additional ICF categories should be considered.
Method: Medical reports from patients with low back pain or chronic widespread pain, respectively, were translated into the language of the ICF using a retrospective qualitative study design. For this translation (‘Linking’) process specialized physicians from the national pension insurance and members of the Institute for Health- and Rehabilitations Science were trained to use established linking rules. The content of the first 200 medical reports were independently linked by two health professionals in order to determine inter-rater-reliability. The number of medical reports to be translated was decided based on saturation.
Results: A total of 542 medical reports from the national pension insurance with the health conditions low back pain or chronic widespread pain were selected by members of the national pension insurance. The medical reports are anonymized in different federal states according to the appropriate requirements.
A total of 294 medical reports were analyzed. The weighted Kappa statistic for the agreement between the two health professionals who have linked the content of the first 200 medical reports on the second level of the ICF for the health condition low back pain was 0.73 with a 95% bootstrapped confidence interval of 0.71 - 0.74 as well as for the health condition chronic widespread pain was 0,69 with a 95% bootstrapped confidence interval of 0.67 - 0.71. The ICF categories of the ICF Core Sets captured the content of the medical reports largely. From the linked 165 medical reports with the health condition low back pain weren’t 10 ICF categories out of 78 ICF categories of the ICF Core Set for low back pain covered. From the linked 138 chronic widespread pain medical reports were not covered two ICF categories, b740 muscle endurance functions and e465 social norms, practices and ideologies, out of the 67 ICF categories of the ICF Core Set for chronic widespread pain.
Conclusion: Analyses of the linked medical reports show that their content is comprehensive A well-grounded bases for the standarization of the information contained in the medical reports for national pension insurance could be achieved by taking into account the ICF Core Set of the corresponding health condition, all ICF categories from the linked medical reports on the second level that were included in ≥50% of the reports, the short ICF Core Set for vocational rehabilitation and the ICF Core Set for Disability evaluation in social security