Reliability and applicability of the ICF in coding problems, resources and goals of persons with multiple injuries

A fundamental prerequisite for applying the International Classification of Functioning, Disability and Health (ICF) in practice and research is its demonstration of reliability and applicability. The aim of this study was to examine the inter-rater and intra-rater reliability in assigning ICF codes to physiotherapists' descriptions of problems, resources and goals in rehabilitation of severely injured persons, and to explore the feasibility of the ICF for capturing the described functional status.

Six raters identified meaningful concepts in the descriptions and assigned them to the most precise ICF code. Ten groups of concepts were formed to increase the clinical relevance of the analyses. Percentage agreement and pooled Kappa statistics for inter-rater and intra-rater reliability were calculated.

The 373 coded concepts described 192 problems, 38 resources and 143 goals. In total, 88 codes were used. They covered 20 of 30 chapters in the ICF. Kappas for inter-rater reliability were moderate to good ranging from 0.41-0.73. Intra-rater reliability performed by experienced raters, showed excellent agreement with most Kappas above 0.80.

The results showed at least moderate inter-rater and excellent intra-rater reliability for the ICF classification of physiotherapist's descriptions of problems, resources and goals in persons with multiple injuries. The ICF also proved to be applicable for use in clinical practice. Results from this study might contribute to development of core sets for use in rehabilitation of this patient group.