OA_ICF Core Sets.numbers

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1 Demographic information ICF CORE SETS FOR OSTEOARTHRITIS H 1 checklist [1] [2] [3] [4] H2 Date / / H3 Case ID,, H4 Participant No,, day month year CE or CS Case No 1st or 2nd Evalu FTC Site Participant A DEMOGRAPHIC INFORMATION A 1 : : A 2 : : A 3 A 4 ( ) A 5 ( ) A 6 [1] [4] [2] [5] [3] [6] A 7 [1] [6] [2] [7] ( ) [3] [8] ( ) [4] [9] [5] A 8, [1] [2] ICD code : [3] ICD code : [4] ICD code : [5],, [ ] ICF Checklist 1 : ICF CORE SETS FOR OSTEOARTHRITIS 2 :,,,,,,,,,,, 3 : Karsten Dreinho fer et al ICF CORE SETS FOR OSTEOARTHRITIS J Rehabil Med 2004; Suppl 44: 75 80

2 Body functions PART 1a: IMPAIRMENTS OF BODY FUNCTIONS : Extent of impairments Short List of Body Functions b1 MENTAL FUNCTIONS b130, Energy and drive functions b1300 Energy level b1301 Motivation b1302 Appetite b1303 Craving b1304 Impulse control b1308 Energy and drive function, other b134 b152 b1309 Energy and drive function, Sleep functions b1340 Amount of sleep b1341 Onset of sleep b1342 Maintenance of sleep b1343 Quality of sleep b1344 Function involving the sleep cycle b1348 Sleep functions, other b1349 Sleep functions, Emotional functions b1520 Appropriateness of emotion b1521 Regulation of emotion b1522 Regulation of range b1528 Emotional functions, other b1529 Emotional functions, b2 SENSORY FUNCTION AND PAIN b280 Sensation of pain b2800 Generalized pain b2801 Pain in body part b28010 Pain in head and neck b28011 Pain in Chest b28012 Pain in stomach or abdomen b28013 Pain in back b28014 Pain in upper limb b28015 Pain in lower limb b28016 Pain in joints

3 Body functions Short List of Body Functions b28018 Pain in body part, other b28019 Pain in body part, b2802 Pain in multiple body parts b2803 Radiating pain in a dermatome b2804 Radiating pain in a segment or region b7 NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED FUNCTIONS b710 Mobility of joint functions b7100 Mobility of a single joint b7101 Mobility of a several joints b7102 Mobility of joints generalized b7108 Mobility of joint functions, other b7109 Mobility of joint functions, b715 Stability of joint functions b7150 Stability of a single joint b7151 Stability of a several joints b7152 Stability of a joints generalized b7158 Stability of joint functions, other b7159 Stability of joint functions, b720 Mobility of bone functions b7200 Mobility of scapula b7201 Mobility of pelvis b7202 Mobility of carpal bones b7203 Mobility of tarsal bones b7208 Mobility of bone functions, other b7209 Mobility of bone functions, b730 Muscle power functions b7300 Power of isolated muscles and muscle groups b7301 Power of muscles of one limb b7302 P o w e r o f m u s c l e s o f o n e s i d e o f t h e b o d y b7303 Power of muscles in lower half of the body b7304 Power of muscles of all limbs b7305 Power of muscles of the trunk b7306 P o w e r o f a l l m u s c l e s o f t h e b o d y b7308 Muscle power functions, other b7309 Muscle power functions, b735 Muscle tone functions b7350 Tone of isolated muscles and muscle groups b7351 Tone of muscles of one limb b7352 Tone of muscles of one side of body b7353 Tone of muscles of lower half of body

4 Body functions Short List of Body Functions b7354 Tone of muscles of all limbs b7355 Tone of muscles of trunk b7356 Tone of muscles of the body b7358 Muscle tone functions, other b7359 Muscle tone functions, b740 Muscle endurance functions b7400 Endurance of isolated muscles b7401 Endurance of muscle groups b7402 Endurance of all muscles of the body b7408 Muscle endurance functions, other b7409 Muscle endurance functions, b760 Control of voluntary movements functions b7600 Control of simple voluntary movements b7601 Control of complex voluntary movements b7602 Coordination of voluntary movements b7603 Supportive functions of arm or leg b7608 Control of voluntary movements functions, other b7609 Control of voluntary movements functions, b770 Gait pattern functions b780 Sensation related to muscles and movement functions b7800 Sensation of muscle stiffness b7801 Sensation of muscle spasm b7808 Sensation related to muscles and movement functions other b7809 Sensation related to muscles and movement functions,

5 Body structures PART 1b: IMPAIRMENTS OF BODY STRUCTURES : Extent of impairment 0 No impairment 1 Mild impairment 2 Moderate impairment 3 Severe impairment 4 Complete impairment 8 Not 9 Not applicable : Nature of the change 0 No change in structure 1 Total absence 2 Partial absence 3 Additional part 4 Aberrant dimensions 5 Discontinuity 6 Deviating position 7 Qualitative changes in structure, including accumulation of fluid 8 Not 9 Not applicable : Location 0 More than one region 1 right 2 left 3 both sides 4 front 5 back 6 proximal 7 distal Short List of Body Structures s7 STRUCTURES RELATED TO MOVEMENT s720 Structure of shoulder region s7200 Bones of shoulder region s7201 Joints of shoulder region s7202 Muscle of shoulder region s7203 Ligament and fasciae of shoulder region s7208 s7209 Structure of shoulder region, other Structure of shoulder region, s730 Structure of upper extremity s7300 Structure of upper arm s73000 s73001 s73002 Bones of upper arm Elbow joint s73003 Muscles of upper arm Ligaments and fascia of upper arm s73008 Structure of upper arm, other s73009 s7301 Structure of forearm s73010 s73011 s73012 Bones of forearm Wrist joint Muscle of forearm Structure of upper arm, 1 Extent 2 Nature 3 Locations

6 Body structures Short List of Body Structures s73013 s73018 s73019 s7302 Structure of head s73020 Bone of hand s73021 s73022 s73023 Muscle of hand s73028 s73029 Ligaments and fascia of forearm Structure of forearm, other Structure of forearm, Joints of hand and fingers Ligaments and fasciae of hand Structure of head, other Structure of head, s7308 Structure of upper extremity, other s7309 Structure of upper extremity, s740 Structure of Pelvis region s7400 Bones of pelvic region s7401 Joints of pelvic region s7402 Muscle of pelvic region s7403 Ligaments and fasciae of pelvic region s7408 Structure of Pelvis region, other s7409 Structure of Pelvis region, s750 Structure of lower extremity s7500 Structure of thigh s75000 s75001 s75002 Bones of thigh Hip joint s75003 Muscle of thigh Ligament and fascia of thigh s75008 Structure of thigh, other s75009 s7501 Structure of lower leg s75010 s75011 s75012 Bones of lower leg Knee joint s75013 s75018 s75019 Structure of thigh, Muscles of lower leg Ligaments and fascia of lower leg Structure of lower leg, other Structure of lower leg, s7502 Structure of ankle and foot s75020 s75021, toes Bones of ankle and foot Ankle joint and joints of foot and 1 Extent 2 Nature 3 Locations

7 Body structures Short List of Body Structures s75022 s75023 foot s75028 other s75029 Muscle of ankle and foot Ligaments and fascia of ankle and Structure of ankle and foot, Structure of ankle and foot, s7508 Structure of lower extremity, other s7509 Structure of lower extremity, s770 Additional musculoskeletal structure related to movement s7700 Bones s7701 Joints s7702 Muscles s7703 (Extra-articular ligament), (Fasciae), (Extramuscular aponeuroses), (Retinacula), (Septa), (Bursae), (Un) s7708 Additional musculoskeletal structure related to movement, other s7709 Additional musculoskeletal structure related to movement, 1 Extent 2 Nature 3 Locations

8 Activities & Participation PART 2: ACTIVITIES LIMITATION & PARTICIPATION RESTRICTION : (Performance) (Participation Restriction) 0 (No difficulty) 1 (Mild difficulty) 2 (Moderate difficulty) 3 (Severe difficulty) 4 (Complete difficulty) 8 (Not ) 9 (Not applicable) : (Capacity; ) (Activity Limitation) 0 (No difficulty) 1 (Mild difficulty) 2 (Moderate difficulty) 3 (Severe difficulty) 4 (Complete difficulty) 8 (Not ) 9 (Not applicable) d4 MOBILITY Short List of A&P domains d410 Changing basic body position d4100 Lying down d4101 Squatting d4102 Kneeling d4103 Sitting d4104 Standing d4105 Bending d4106 Shifting the body s centre of gravity d4108 Changing basic body position, other d4109 Changing basic body position, d415 Maintaining a body position d4150 Maintaining a lying position d4151 Maintaining a squatting position d4152 M a i n t a i n i n g a k n e e l i n g p o s i t i o n d4153 Maintaining a sitting position d4154 Maintaining a standing position d4158 Maintaining a body position, other d4159 Maintaining a body position, d430 Lifting and carrying objects d4300 Lifting d4301 Carrying in the hands d4302 Carrying in the arms d4303,, Carrying on shoulders, hip and back d4304 Carrying on the head Performance Capacity

9 Activities & Participation d4305 Putting down objects Short List of A&P domains d4308 Lifting and carrying objects, other d4309 Lifting and carrying objects, d440 Fine hand use d4400 Picking up d4401 Grasping d4402 Manipulating d4403 Releasing d4408 Fine hand use, other d4409 Fine hand use, d445 Hand and arm use d4450 Pulling d4451 Pushing d4452 Reaching d4453 Turning or twisting the hands or arms d4454 Throwing d4455 Catching d4458 Hand and arm use, other d4459 Hand and arm use, d450 Walking d4500 Walking short distances d4501 Walking long distances d4502 Walking on different surfaces d4503 Walking around obstacles d4508 Walking, other d4509 Walking, d455 Moving around d4550 Crawling d4551 Climbing d4552 Running d4553 Jumping d4554 Swimming d4558 Moving around, other d4559 Moving around, d470 Using transportation (car, bus, train, plane, etc) d4700 Using human-powered vehicles d4701 Using private motorized transportation d4708 Using transportation, other d4709 Using transportation, Performance Capacity

10 Activities & Participation Short List of A&P domains d475 Driving (riding bicycle and motorbike, driving car, etc) d4750 Driving human-powered transportation d4751 Driving motorized vehicles d4752 Driving animal-powered vehicles d4758 Driving, other d4759 Driving, d5 SELF CARE d510 Washing oneself (bathing, drying, washing hands, etc) d5100 Washing body parts d5101 Washing whole body d5102 Drying oneself d5108 Washing oneself, other d5109 Washing oneself, d530 Toileting d5300 Regulating urination d5301 Regulating defecation d5302 menstrual care d5308 Toileting, other d5309 Toileting, d540 Dressing d5400 Dressing d5401 Taking off clothes d5402 Putting on footwear d5403 Taking off footwear d5404 Choosing appropriate clothing d5408 Dressing, other d5409 Dressing, d6 DOMESTIC LIFE d620 Acquisition of goods and services d6200 Shopping d6201 Gathering daily necessities d6208 Acquisition of goods and services, other d6209 Acquisition of goods and services, d640 Doing housework d6400 Washing and drying clothes and garments d6401 Cleaning cooking area and utensils d6402 Cleaning living area d6403 using household appliances d6404 Storing daily necessities Performance Capacity

11 Activities & Participation Short List of A&P domains d6405 Disposing of garbage d6408 Doing housework, other d6409 Doing housework, d660 Assisting others d6600 Assisting others with self-care d6601 Assisting others in movement d6602 Assisting others in communication d6603 Assisting others in interpersonal d6604 Assisting others in nutrition d6605 Assisting others in health maintenance d6608 Assisting others, other d6609 Assisting others, d7 INTERPERSONAL INTERACTIONS AND RELATIONSHIPS d770 Intimate relationships d7700 Romantic relationships d7701 Spousal relationships d7702 Sexual relationships d7708 Intimate relationships, other d7709 Intimate relationships, d8 MAJOR LIFE AREAS d850 Remunerative employment d8500 Selp-employment d8501 Part-time emploument d8508 Remunerative employment, other d8509 Remunerative employment, d9,, COMMUNITY, SOCIAL AND CIVIC LIFE d910 Community life d9100 Informal associations d9101 Formal associations d9102 Ceremonies d9108 Community life, other d9109 Community life, d920 Recreation and leisure d9200 Play d9201 Sports d9202 Arts and cultures d9203 Crafts d9204 Hobbies d9205 Socializing Performance Capacity

12 Activities & Participation Short List of A&P domains d9208 Recreation and leisure, other d9209 Recreation and leisure, Performance Capacity ANY OTHER ACTIVITY AND PARTICIPATION

13 Environmental factors PART 3: ENVIRONMENTAL FACTORS in environment: Barriers or facilitator 0 No barriers ( ) 1 Mild barriers ( ) 2 Moderate barriers ( ) 3 Severe barriers ( ) 4 Complete barriers ( ) 0 No facilitator ( ) +1 Mild facilitator ( ) +2 Moderate facilitator ( ) +3 Substantial facilitator ( ) +4 Complete facilitator ( ) Short List of ENVIRONMENT e1 PRODUCTS AND TECHNOLOGY e110 Products or substances for personal consumption (food, medicines) e1100 Food e1101 Drugs e1108 Products or substances for personal consumption, other e1109 Products or substances for personal consumption, e115 Products or substances for personal use in daily living e1150 General products and technology for personal use in daily living e1151 Assistive products and technology for personal use in daily living e1158 Products or substances for personal use in daily living, other e1159 Products or substances for personal use in daily living, e120 Products and technology for personal indoor and outdoor mobility and transportation e1200 General products and technology for personal indoor and outdoor mobility and transportation e1201 Assistive products and technology for personal indoor and outdoor mobility and transportation e1208 Products and technology for personal indoor and outdoor mobility and transportation, other e1209 Products and technology for personal indoor and outdoor mobility and transportation, e135 Products and technology for employment e1350 General products and technology for employment e1351 Assistive products and technology for employment e1358 Products and technology for employment, other e1359 Products and technology for employment, e150 Design, construction and building products and technology of buildings for public use ( ) ( )

14 Environmental factors Short List of ENVIRONMENT e1500 Design, construction and building products and technology for entering and exiting building for of buildings for public use e1501 Design, construction and building products and technology for gaining access to facilities buildings for public use e1502, Design, construction and building products and technology for way finding, path routing and designation of locations in building for public use e1508 Design, construction and building products and technology for entering and exiting building for of buildings for public use, other e1509 Design, construction and building products and technology for entering and exiting building for of buildings for public use, e155 Design, construction and building products and technology of buildings for private use e1550 Design, construction and building products and technology for entering and exiting building for of buildings for private use e1551 Design, construction and building products and technology for gaining access to facilities inside building for private use e1552 Design, construction and building products and technology for way finding, path routing and designation of locations in building for private use e1558 Design, construction and building products and technology of buildings for private use, other e1559 Design, construction and building products and technology of buildings for private use, ( ) ( ) e2 CHANGES TO ENVIRONMENT NATURAL ENVIRONMENT AND HUMAN MADE e225 Climate e2250 Temperature e2251 Humidity e2252 Atomspheric pressure e2253 Precipitation e2254 Wind e2255 Seasonal variation e2258 Climate, other e2259 Climate, e3 SUPPORT AND RELATIONSHIPS e310 Immediate family e320 Friends e340 Personal care providers and personal assistants e355 Health professionals e4, Attitudes e410 Individual attitudes of immediate family members

15 Environmental factors Short List of ENVIRONMENT e450 Individual attitudes of health professionals e460 Societal attitudes e5,, SERVICES, SYSTEMS AND POLICIES e540, Transportation services, systems and policies e5400 Transportation services e5401 Transportation systems e5402 Transportation policies e5408, Transportation services, systems and policies, other e5409, Transportation services, systems and policies, e575, General social support services, systems and policies e5750 General social support services e5751 General social support systems e5752 General social support policies e5758, General social support services, systems and policies, other e5759, General social support services, systems and policies, e580,, Health services, systems and policies e5800 Health services e5801 Health systems e5802 Health policies e5808, Health services, systems and policies, other e5809, Health services, systems and policies, ( ) ( ) ANY OTHER ENVIRONMENTAL FACTORS

stroke_Comprehensive ICF Core Sets.numbers

stroke_Comprehensive ICF Core Sets.numbers Demographic information ICF CORE SETS FOR STROKE H 1 checklist [1] [2] [3] [4] H2 Date / / H3 Case ID,, H4 Participant No,, day month year CE or CS Case No 1st or 2nd Evalu FTC Site Participant A DEMOGRAPHIC