ICF core sets for low back pain: do they include what matters to patients?

Area of Science:

• Rehabilitation Medicine
• Health Services Research
• Disability Studies

Background:

• Low back pain (LBP) significantly impacts patients' daily lives and functional abilities.
• The International Classification of Functioning Disability and Health (ICF) provides a standardized framework for describing health and disability.
• ICF Core Sets are subsets of ICF categories tailored for specific health conditions, aiming to capture the most relevant aspects of functioning.

Purpose of the Study:

• To evaluate whether the existing ICF Core Sets for low back pain adequately represent the functional problems experienced by patients.
• To identify potential gaps in the ICF Core Sets based on patient-reported difficulties and limitations.

Main Methods:

• A cross-sectional study involving 402 patients with acute or subacute low back pain in the UK.
• Patients were asked to identify their most difficult daily task and an enjoyable activity they could no longer perform.
• Responses were classified using the ICF, and inter-rater reliability was assessed. The inclusion of patient-reported problems within the ICF Brief and Comprehensive Core Sets was examined.

Main Results:

• High inter-rater agreement was achieved for classifying patient-reported problems (kappa = 0.78 for difficulties, kappa = 0.91 for limitations).
• The ICF Brief Core Set covered 83% of the most difficult tasks but missed significant patient-reported limitations, such as recreation (d920) and caring for household objects (d650), which were not included.
• The ICF Comprehensive Core Set encompassed nearly all reported problems.

Conclusions:

• The ICF Brief Core Set for low back pain requires updates to better reflect the functional limitations patients experience.
• Incorporating codes for recreation (d920) and caring for household objects (d650) into the Brief Core Set would substantially enhance its clinical utility and representativeness for low back pain patients.