Purpose The purposes of this study were to provide an outline of the existing literature on operationalization of the Inter- national Classification of Functioning, Disability and Health (ICF) within vocational rehabilitation (VR) and to explore the ICF utility within VR. Methods The process was undertaken in five stages according to a framework of scoping review. Screening and extraction of data were done by two independent reviewers, and data was summarized according to content analysis. Results Fifty papers (25 qualitative and 25 quantitative) were included. The operationalization of the ICF was described in four different ways: In total 18 (36%) papers described use of the ICF for structuring information, 8 (15%) for linking information to ICF, 12 (24%) for analysis of results, and 12 (24%) for development of a model. In total 15 (29%) papers described VR interventions involving stakeholders, whereas 32 (62%) were reviews. Forty of the papers described all the ICF components. Conclusions The review revealed use of the ICF within the field VR in 50 papers, and in various settings. The ICF framework was most often operationalized for structuring or linking information of functioning. A majority of papers were reviews and involved researchers only, whereas different stakeholders and VR professionals were involved in the interventions. In 40 papers all the ICF components were described, and the ICF was considered a useful tool to inform the VR professionals´ assessment of functioning. However, more research within VR is needed to standardize and ease the use of the ICF. Keywords Occupational health services · Rehabilitation · Return to work · Outcome assessment Background vocational rehabilitation (VR) . The essence of VR is promotion of workers’ health in order to enter or return to Work disability is often associated with personal suffering work (RTW), prevent work disability, and sustain work and loss of income, diminished productivity and increased ability [1–4]. VR professionals have been challenged by medical and societal costs and can be addressed through different perceptions of health, and researchers argue for a definition of health as a dynamic process of adaptation and self-management . The Organisation for Economic Co-operation and Development (OECD) states that several Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s1092 6-018-9788-4) contains countries have made efforts to move away from assessing a supplementary material, which is available to authorized users. * A. H. Momsen Danish Centre of Systematic Reviews: A Joanna Briggs email@example.com Institute Centre of Excellence, Department of Medicine and Technology, University of Aalborg, 9000 Aalborg, Section of Clinical Social Medicine and Rehabilitation, Denmark Department of Public Health, Aarhus University, Section of Nursing Science, Department of Public Health, 8000 Aarhus, Denmark Aarhus University, 8000 Aarhus, Denmark DEFACTUM - Social & Health Services and Labour Market, DEFACTUM, Aarhus University Hospital, Central Denmark Region, 8000 Aarhus, Denmark MarselisborgCentret, P.P. Oerums Gade 11, 8000 Aarhus, Department of Rehabilitation and Movement Science, Denmark University of Vermont, Burlington, VT, USA Swiss Paraplegic Research, Nottwil, Switzerland Vol.:(0123456789) 1 3 Journal of Occupational Rehabilitation Ideally a multi-professional, multimodal approach should be used in VR . Within the WHO a number of ICF core sets have been developed in order to make the ICF more applicable for clinical practice. A third aim was to examine to what extent the components of the ICF framework, the VR core set, and other ICF core sets are used within VR. Core sets are lists of essential ICF-categories in specific health conditions and contexts to describe functioning, e.g. a comprehensive and a brief VR core set were developed and validated for interdis- Fig. 1 The internation classification of functioning, disability and ciplinary assessment, documentation, and communication health (ICF) framework in VR [13, 14]. A preliminary search in PROSPERO and PubMed showed person’s illness, but instead examining the person’s remain- no review on the topic, and to our knowledge there are no ing work capacity . The International Classification of existing systematic reviews or scoping review on how the Functioning, Disability and Health (ICF) (See Fig. 1) was ICF is applied within VR. approved by the World Health Assembly in 2001 , and the ICF framework covers a spectrum of body, personal, and societal aspects of human functioning. Thereby, the ICF Methods captures a comprehensive view of disability relevant to VR, and the integration of “functioning” in VR rather than the The scoping review was conducted according the method- traditional biomedical approach, which is in line with the ology conduced in five steps: (1) identifying the research efforts stated by OECD [2 ]. In VR a comprehensive under- question, (2) identifying relevant studies, (3) study selection, standing of the aspects influencing patients’ functioning is (4) charting the data, and (5) collating, summarizing, and important. Thus, the usefulness of the ICF may be demon- reporting results [15–17]. strated in VR . The ICF framework has been proposed to offer opportunities to optimize VR for patients by providing Identifying the Research Question a universal conceptual reference to improve communication between different users, such as health care professionals, researchers, and policy-makers. (1) How is the ICF operationalized in empirical papers There are several definitions of VR, e.g. medical, psycho- within VR? logical, social and occupational activities aiming to reestab- (2) Who are involved and how does the ICF inform the lish sick or injured peoples work capacity and prerequisites professionals´ assessment of functioning in VR? for returning or entering the labour market, i.e. to a job or (3) Which of the ICF components and core sets are consid- availability for a job, 2009 . In 2011, a broader ICF-based ered when functioning is evaluated in VR? definition of VR was introduced: “A multi-professional evidence-based approach that is provided in different set- Identifying Relevant Studies tings, services, and activities to working age individuals with health-related impairments, limitations, or restrictions with A three-step search strategy was conducted . Firstly, work functioning, and whose primary aim is to optimize initial keywords were identified and secondly all identified work participation” . keywords and index terms were used to build a comprehen- A review showed diversity in the ICF contents of the sive and specific search strategy for each included database: measures used in the literature, and proposed that the ICF PubMed, Embase, Scopus, CINAHL, PsycINFO, Swemed+, and VR interface should be further examined . Know- and PEDro. Thirdly, the search strategies were refined: VR ing more about how and to what extent the ICF framework and RTW (MeSH term) in PubMed and other terms, e.g. is applied and has been utilized is suggested important in sick leave, work disability were used as keywords , and order to optimize VR interventions for patients  and the ICIDH was used as ICF was not a MeSH term until 2012 inter-professional approach in VR processes . [18, 19]. The search was performed in collaboration with a The purposes of this review were to provide an outline of research librarian at Aarhus University Library. The search the existing literature and to explore the ICF utility within was restricted to papers in English, German, Danish, Swed- VR. The primary aim was to examine and map the opera- ish, and Norwegian (Online Appendix A). tionalization of the ICF within VR. The second aim was to examine the different VR professionals´ use of the ICF. 1 3 Journal of Occupational Rehabilitation of the ICF were the most typical descriptions used in a sub- Study Selection set of the papers included: (a) structuring, (b) linking, (c) analysing, or (d) developing instruments or models, respec- Inclusion criteria: ICF or International Classification of Functioning, Disability and Health mentioned in the title tively. All the included papers´ description were categorised in these. Structuring was considered present, when data or or abstract, ICF used in the field of VR research, peer reviewed original papers and reviews, date of publication outcomes were categorized, or themes or information from interviews was coded according to the ICF framework. How- from January 2001 to May 2016, abstract available, and study populations of working age adults. There were no ever, in case structuring was followed by other use, data was extracted according to the latter. Linking was considered limitations regarding including reviews and thereby poten- tial overlap of individual papers included in the reviews. present, when health information (e.g. from questionnaires or interviews) was coded to specific ICF categories, based on There were no context limitations regarding geography or culture, and papers were eligible from any healthcare setting linking rules, e.g. linking items in a questionnaire to catego- ries in a core set [9, 22]. Analysing was considered present if or research setting (e.g. rehabilitation clinic, in-patient or out-patient clinic, hospital, physicians, primary health care, the paper explicitly described that data were analysed, most commonly after data or information had been structured fol- occupational health services, insurance office, and research departments). lowing the ICF framework. Developing instruments or mod- els based on the ICF framework was the last reported usage. Exclusion criteria: papers only mentioning ICF in the abstract, background or discussion, or only mentioning Regarding the second research question the description of VR professionals (e.g. health professionals) involved ICIDH or ICIDH-2, overviews, editorials, comments, theo- retical papers, text and opinion papers, theses/dissertations, were extracted, and a descriptive summary of their use of the ICF in order to inform the assessment of functioning books, and papers on ICF-Children and Youth. The process of study selection was reported using the was presented. Regarding the third question; the use of the ICF components (body function, body structures, activity PRISMA , and eligible studies were screened indepen- dently by two reviewers (AM and MB) followed by consen- and participation, environmental factors) and the ICF core set(s) was extracted based on the information provided in sus discussions. The selection was performed in two groups for qualitative papers (AM and RR) and quantitative papers individual papers. (AM and CMS), respectively. Collating, Summarizing, and Reporting Results Extraction of Data A descriptive summary of the charted data was done inde- pendently by two authors on all the included papers. The Study characteristics were extracted from the included stud- ies using a pilot-tested non-software template. The papers coded data relevant to inform the three review questions were charted from each paper included and categorized were divided in qualitative and quantitative papers according to qualifications of the review team. Two authors extracted according to content analysis [23–25]. Both deductive and inductive analyses were used, as the results were based on study characteristics independently for qualitative papers (AM and RR) and quantitative papers (AM and CMS), the description in the papers, e.g., of the pre-defined ICF components and core sets. The descriptive summary of the respectively. In case of disagreement, the final decision about characteristics was resolved through discussion. The main results is presented in tables. papers were divided in qualitative and quantitative papers according to the data collection method described. Results Study characteristics according to The Joanna Briggs Institute Reviewers’ Manual included: first author, publica- In total 1343 papers were retrieved from seven databases, of tion year, country, setting, study type (intervention yes/no), population, aims, methods, and outcomes . Intervention which 702 duplicates were removed; thus, 641 papers were assessed for eligibility (Fig. 2). Sixty-four papers from these was defined as “a treatment, whether for preventative or ther - apeutic reasons, an assessment or diagnostic tool or some were read in full text of which 14 papers were excluded, mainly because the ICF was only mentioned in the introduc- other type of service or condition to which a patient might be exposed” . Data from the included studies was coded tion or discussion and lack of information on VR. Thus, 50 papers (25 qualitative and 25 quantitative) were included. by two authors (AM and RR; AM and CMS, respectively) using the three research questions. No additional papers were included. A descriptive summary of the included study character- Regarding the first research question; data was extracted according to the use of the ICF framework as described in the istics is shown in Table 1. The ICF referral in papers within VR was found among Western countries, except one paper individual papers. Four different ways of operationalization 1 3 Journal of Occupational Rehabilitation by comparing the information provided by the ICF and the Records idenﬁed through database searching bio-psycho model to see the extent of match . (n = 1343) PubMed 283 Addional records idenﬁed Embase 317 In total eight papers (15%) used the ICF as a framework through other sources Scopus 283 CINAHL 243 (n = 0) PsychInfo 192 for linking between ICF categories and e.g. items in ques- PEDdro 17 SweMed 8 tionnaires: three qualitative papers [31, 38, 52], and five quantitative papers [32, 33, 39, 71, 75]; e.g. of Italian leg- Records aer duplicates removed (n = 641 ) islative procedures to the ICF , of factors coded on the Records excluded (n = 577) second- level ICF classifications , of items to the core set ICF not mentioned in Records screened and following the linking rules [32, 33, 75]. As an example, title/abstract (n=573) (n = 641 ) Books, thesis (n=4) one paper aimed at merging an ICF core set for a specific health-related condition (spinal cord injury) to the catego- Full-text arcles assessed Full-text arcles excluded, ries of the VR core set . Another paper identified the with reasons for eligibility (n = 64) (n=14) concepts within the functional problems which were coded, ICF only menoned in and linked to ICF categories, or to the categories of the VR discussion (n = 7) Not Vocaonal core set . rehabilitaon (n = 3) Not English, German, The analysis was performed according to the ICF frame- Danish, Swedish or Studies included in Norwegian (n = 4) qualitave synthesis work in 12 papers (24%): five qualitative papers [34, 36, 43, (n = 50) 55, 63], e.g. listing of the respondents´ answers followed by frequency analysis according to the relevant ICF domains  and seven quantitative papers [28, 40, 46, 49, 50, 56, 58]; e.g. rating and analysing problems regarding work , Fig. 2 Flow diagram and extraction of phrases from a patients´ electronic record that could potentially be interpreted as an ICF category . from Taiwan. Thus, nine papers were from Switzerland [10, One of the quantitative papers analysed levels of function 26–33] four were from the USA [34–37], three from Italy and how it correlated with vocational status . [38–40], two from Germany [41, 42], one from Canada , The ICF was used as a framework for the development UK , Portugal , Turkey , Slovenia , Spain of an instrument or a new model for various aspects within , Israel , and Taiwan . Five papers were authored VR in 12 papers (24%) : five qualitative papers [35, 48, 54, by an international [38, 51–54], three were from settings in 65, 67]; e.g. a model relating the levels of activity to the Sweden [55–57], and three from Norway [58–60]. ICF , and a model explaining work disability by health- Although 32 of the papers were reviews, primarily from related problems at work . A paper concluded that the research settings (e.g. rehabilitation social medicine or phys- ICF may contribute by informing our thinking of RTW and iotherapy departments) in Switzerland and the Netherlands; work maintenance by conceptualizing phase-based RTW other VR settings in which the ICF was used were wide- outcomes . Seven quantitative papers reported use of the spread, i.e. hospitals, rehabilitation centres, primary health ICF for development [41, 45, 47, 53, 59, 60, 76]; e.g. relating care centres, and sickness certificate registration offices. with other questionnaires used in VR , and use of the A minority of papers reported interventions within VR; ICF core sets for developing a questionnaire for description only seven of the qualitative papers [34, 36, 38, 55, 61–63], of workplace accommodation . and eight among the quantitative papers [37, 40–42, 46, 57, 60, 64]. Eleven papers were from health care and research Who are Involved and How Does the ICF Inform settings in the Netherlands [61–71]. the Professionals´ Assessment of Functioning in VR? How is the ICF Operationalized in Empirical Papers Four papers described involvement of patients and research- within VR? ers [34, 55] or patients and health professionals [38, 61]. Two papers described involvement of professionals, employ- In total 18 papers (36%) used the ICF as a framework for ers, and employees as informants , medical profession- structuring of information: twelve of the qualitative papers als as evaluators of work disability and researchers , [26, 27, 30, 44, 61, 62, 66, 68–70, 72–74], and six of the respectively. A majority (32) of papers were reviews involv- quantitative papers [29, 37, 42, 57, 64, 74]; e.g. relating ing solely the authors (researchers): twenty of the qualita- information in sickness certificates to the ICF framework tive papers, and eleven of the quantitative papers, respec-  (Table 2). As an example, one paper reported that the tively. Two papers involved a research team, interviewers ICF was used for verifying data on claimants´ disabilities and project staff , researchers and an adjudicator , respectively. Seven papers involved researcher and numerous 1 3 Included Eligibility Screening Idenﬁcaon Journal of Occupational Rehabilitation 1 3 Table 1 Summary of basic characteristics of the included papers, aims, methods, and outcomes Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Qualitative papers Experiences with reha- Abbott  2011 Sweden Orthopaedic Clinic, Yes. Qualitative Lumbar fusion To describe within Mixed method: bilitation post-lum- Karolinska Univer- interview and patients, N = 20 the context of Qualitative content bar fusion. Expecta- sity Hospital self report scales ICF, patients’ analysis of semi- tion with outcome of experiences of structured inter- rehabilitation post-lumbar fusion views 3–6 months ICF categories of all regarding low back after surgery and comparing ICF components problems, recovery with questionnaires. and expectations of ICF linking rules rehabilitation. To were used to code contrast with the meaning units content of outcome measures and the ICF low back pain core sets Aiachini  2015 Team (Italy, USA, Spinal unit at Reha- Yes. Focus group Patients with spinal To validate the Focus group inter- Concepts identified in Switzerland) bilitation hospital, interviews cord injury (SCI), comprehensive ICF views the focus groups and Pavia N = 24 Core Set for VR 7 focus groups were their linking to ICF from the perspec- digitally recorded comprehensive core tive of SCI patients and transcribed set for VR or not To explore the verbatim. The aspects of function- meaning condensa- ing and health tion procedure was important to used for the data patients with SCI analysis regarding RTW, Linking rules were and to examine used to code mean- to what extent ing units these aspects are Adding the specific represented by the ICF Core Set for current version of SCI in long-term VR core set context for not covered concepts Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Core features for Anner  2012 Switzerland Academy of Swiss No. Qualitative Sick-listed and To discuss potential Qualitative method: assessing work dis- Insurance Medi- literature study persons unable to benefits of the ICF a European com- parison. Discussion ability for medical cine, University work (disability to structure and of ICF (in 4 studies experts Hospital Basel evaluation in medi- phrase disability and in general) cal reports) evaluation in the Reporting about work field of social insur - disability in social ance insurance To describe core features of dis- ability evaluation of the ICF across countries, and to address how and to what extent the ICF may be applied in disability evalu- ation Bakker  2006 Netherlands Disability insurance, No. Disabled self- To trace risk fac- Literature study Risk factors and medi- Centre of Health- Literature study, employed persons tors for disability and consulta- cal characteristics in care Research, consultations Four experts amongst the self- tion amongst four long-term disability University Medical amongst experts employed experts/researchers in the employed Centre Groningen To contribute to more and self-employed evidence-based populations underwriting cri- teria for disability insurance Culler  2011 USA Rehabilitation Insti- Yes. Qualitative Stroke survivors, To identify factors Qualitative methods: Barriers and facilita- tute of Chicago interviews employers, voca- that facilitate or act Interviews with tors to RTW for tional specialists as a barrier to RTW stroke survivors stroke survivors from N = 10, 7, 21 for stroke survivors about their RTW three perspectives experience post were illustrated stroke Identified components Survey with voca- were mapped based tional specialists on the ICF about barriers and facilitators of RTW based on their clini- cal practice. Inter- views with employ- ers experienced in interviewing Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Dalemans  2008 Netherlands Health care, Zuyd No. Systematic Stroke survivors To describe what Systematic literature Four social life University, Heerlen review is known in the searching for the domains literature about period 1960–2005 (1) domestic life participation in on participation: (2) interpersonal life working-age per- the performance (3) education and sons with aphasia of people in actual employment after stroke activities in social (4) community, civic, life domains and social life, including religion, through interaction politics, recreation, with others in the and leisure context in which they live Daniel  2009 UK Stroke rehabilitation; No. Systematic Stroke survivors To identify the social Review of quantita- Prevalence of work Division of Health review of quanti- consequences of tive and qualitative after stroke and Social Care tative and quali- stroke in working- studies identifying Social consequences of Research tative studies aged adults, which social consequences stroke for working- might imply for working-aged aged adults social needs to be adults with stroke addressed by health using multiple and social care search strategies services. Inform the development and evaluation of services for this group De Boer  2009 Netherlands Social insurance, Yes. Descriptive Social Insurance To investigate to Mixed methods: Application of Dutch Association Survey and a Physicians (SIPs), what extent SIPs Survey among protocol(s) of Insurance Medi- questionnaire N = 98 are familiar with experienced SIPs Training in and actual cine the protocols, and Qualitative study: use. Construction to what extent comparison of the of own protocol. they adhere to three protocols Answers to questions the principles of with each other and noted in %, in total the expert- and with ICF topics. and per protocol practice-based pro- Development of tocols developed to a questionnaire to conduct interviews elicit the adher- with claimants for ence SIPs have to long-term incapac- the protocols, their ity for work underlying princi- ples and topics Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Desiron  2013 Belgium Department of No. Qualitative Persons with breast To identify a theoreti- Literature searching: OT models to facilitate Occupational, literature study cancer cal framework for Research specific RTW in breast cancer, matches Environmental and occupational thera- criteria derived between literature Insurance Medi- pist (OT) interven- from OT literature and care-models cine, Leuven tion by questioning conceptual OT- regarding RTW in how OT models can model, multidisci- breast cancer be used in OT inter- plinary, referring ventions in RTW to the ICF. Content of breast cancer analysis. Checking patients for breast cancer specific issues Escorpizo  2013 Team (USA, Germany, Department of No. Presentation Aimed at persons to To present the ICF Illustration of opera- Sample of ICF cat- Switzerland) Physical Therapy, paper evaluate disability as a standard in tionalizing the ICF egories Louisiana State disability evalua- in a hypothetical Uni-versity Health tion and to discuss case of a construc- Sciences Center the usefulness and tion worker who challenges of the has chronic low ICF when applied back pain. Assess- in disability evalu- ment of sample ation including the ICF categories ICF core set for and their integra- VR. tion in developing goals and planning intervention Escorpizo  2009 Team (Switzerland, ICF Research Branch No. Aimed at researchers To describe the con- Literature search, Meaningful concepts Germany, Canada, of the WHO Literature review to select an appro- tent of self-report content examina- were identified Netherlands) Collaborating priate questionnaire questionnaires tion and use of and linked to the Center for a specific study that assess worker ICF categories corresponding ICF question productivity and as a reference for category that are being used comparison of or could potentially questionnaires be used in arthritis and other musculo- skeletal conditions using the ICF as reference Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Categories included Finger  2014 Switzerland Swiss Paraplegic No. 42-year-old teacher, To illustrate an Assessment in the ICF-based Research, Nottwil Case study (teach- who was on sick application of of employed discipline-specific tool (Rehabilitation ing case) leave for 10 weeks ICF-based tools in clinical tests and Management-Sheet) due to non-specific a multidisciplinary measures tak- and clinical tests and low back pain N = 1 RTW program ing into account measures for patients with the assigned ICF non-specific low categories from the back pain from the checklist. The team perspective of the allocated the ICF physiotherapist categories included To guide the reha- in the Rehabilita- bilitation process tion Management- and facilitate Sheet to the most team-based and appropriate long- physiotherapist term or short-term goal setting and goals documentation The team and patient agreed on the inter- ventions that would target the specific goals and responsi- bilities Glassel  2012 Switzerland Swiss Paraplegic No. Patients with spinal To illustrate the sys- Development of ICF- Presentation of ICF- Research Nottwil Case study cord injury. Aimed tematic application based documenta- based documentation at VR professionals of ICF-based docu- tion tools taking tools: ICF Interven- mentation tools by into account the tion Table and the using ICF Brief ICF SCI Core Sets ICF Evaluation Core Sets in VR to facilitate the Display of a client shown with a case documentation and with SCI in a VR example of a client planning of reha- program with traumatic bilitation services spinal cord injury The tools include (SCI) the ICF Assess- ment Sheet, ICF Categorical Profile, ICF Intervention Table and the ICF Evaluation Display Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Glassel  2011 Switzerland Swiss Paraplegic No. Professionals in VR, To explore the lived Focus group inter- Identified concepts Research Nottwil Mixed-methods N = 26 experiences of views related to the ICF components multicenter persons in VR with 7 focus groups Classification of con- study, focus regard to function- yielding relevant cepts with ICF as a group design ing and contextual concepts by reference factors 6 open-ended ques- tions Linking to the ICF categories based on established linking rules: Transcription— Concept—ICF cat- egory—Qualitative analysis—Linking Hoefsmit  2014 Netherlands Department of Social No. Qualitative Employees, employ- To identify which Interviews with Factors that support Medicine, Maas- study ers, occupational and how environ- employees, employ- employees’ early tricht University physicians, N = 14, mental and personal ers and OPs from RTW and factors 15, 4 factors support multiple organisa- that can or cannot early RTW, and tions with varying be described and examine whether organisational classified using ICF the ICF can be used sizes and types coding to describe these of industry such factors as healthcare and education. Qualita- tive data analysis partially based on the Qualitative Analysis Guide of Leuven Homa  2007 USA Department of Reha- No. Overview, Aimed at profes- To provide an Use of the ICF Description of ICF bilitation and Coun- descriptive sionals in VR and overview of the framework in job used in job place- seling, University researchers ICF, highlight its placement as a tem- ment of Wisconsin-Stout applicability in job plate to organize placement, and client information, describe future highlight strengths possibilities for and limitations, and research and out- provide guidance come measurement for interventions in VR in the placement process Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Problems and obstacles Koolhaas  2013 Netherlands Department of Health Yes. Workers, > 45 years, To understand the Survey among work- regarding work; age, Sciences, Commu- Survey of perspec- N = 3008 number and type ers in 9 companies. gender, education, nity and Occupa- tives of experienced Classification using occupation, sector tional Medicine, ageing problems ICF Occupation was and whether the University Medical and obstacles to divided into four worker experienced Center Groningen perform work groups: executive, a chronic health tasks, retention secretarial, policy condition factors to maintain and management work and support Chronic health condi- needs to continue tion was defined working life in the as the subjective next years among experience of long- workers with and term irreversible without a chronic disease > 3 months health condition Minis  2009 Netherlands Department of No. Systematic Patients with neuro- To identify health Literature search, Disease related factors, Occupation and review muscular diseases and contextual extraction of functions (physi- Health, prevention (NMD) factors associated factors related to cal, muscle power), and reintegration with employment in employment status personal factors (age, HAN University of patients with NMD Results of the factor gender and educa- Applied Sciences and to perform extraction related tion), work related a best evidence to employment personal factors synthesis were included (type of occupation, in the scheme of expressed interest in Heerkens´ extended employment) ICF model Sevilla  2013 Spain Electrical and Elec- No. Persons with disabili- To propose a hier- Literature review: Applications of the tronic Engineering Literature review ties and intended archical model of Approach to the model to each of the Department, Uni- users (employees, accommodation hierarchical model cases´ core activi- versidad Publica de employers, or VR assessment based was tested against ties of occupations, Navarra staff) on level of specific- several case study such as: cook, office ity of job activity scenarios to check assistant, gardener, its feasibility and sewing machine completeness operator, or real estate broker Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Key factors and Stergiou-Kita  2013 Canada Toronto Reha- No. Systematic Individuals with burn To gather evidence to Literature review; processes relevant to bilitation Institute, review to outline injuries (BI) develop a guide- Searching in data- a vocational evalu- University Health guidelines line for vocational bases and websites ation in relation to Network evaluation follow- Quality assessment: individual’s body ing burn injuries Using the ICF functions, activity (BI) model and VR core limitations and par- To identify the sets and directed ticipation restrictions key processes content analysis, key processes and and personal and evaluators should factors were ana- environmental sup- follow and the key lysed and synthe- ports to successful factors they should sized RTW consider when completing such evaluations Trenaman  2015 Canada/Switzerland Department of Occu- No. Systematic Individuals with To review factors that Literature search Modifiable and non- pational Science review spinal cord injury are consistently and identified stud- modifiable factors and Occupational independently asso- ies published in the context of Therapy, University ciated with employ- 1952–2014. Data employment follow- of British Columbia ment outcomes in were categorized ing SCI individuals with based on the ICF spinal cord injury with each domain To understand the sub-categorized by magnitude of their modifiability influence van Velzen  2011 Netherlands Academic Medical Yes. Semi-struc- Persons with To describe the Semi-structured Aspects that were Center, University tured interviews acquired brain factors experi- interviews with 12 experienced as being of Amsterdam injury, N = 12 enced by adults adults who were important during the with moderate-to- working before process of RTW after severe acquired acquiring traumatic ABI brain injury as or non-traumatic either limiting or brain injury facilitating during (2–3 years earlier) the RTW process in order to give an advice about the VR process Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Vooijs  2015 Netherlands Amsterdam No. Systematic People of working To search system- Literature search in Factors associated with review age with a chronic atically for disease- databases, on syno- work participation disease generic factors nyms of the terms: for participants with associated with chronic disease, a chronic disease either work reten- work retention and (15–67 years) tion or RTW in RTW people of working age with a chronic disease Wasiak  2007 USA, NZ, Netherlands Liberty Mutual No. Development Workers To operationalize Review of existing Use of measurement Research Institute study the conceptual- instruments for tools that do not for Safety, Center ization of RTW, their use as meas- capture a complete for Disability which argues for an ures of RTW picture of workers’ Research, Hopkin- expanded aware- Where gaps in RTW experiences ton, MA ness that encom- instrumentation passes 4 phases: were found, a wider off work, work search was done reintegration, work for instruments that maintenance and could be adapted advancement for use in RTW research Young  2010 USA Liberty Mutual Yes. Quantitative Occupationally To determine post- Semi-structured Factors experienced Research Institute and qualitative injured workers RTW disability in-depth interviews regarding RTW. for Safety, Center components after VR, N = 150 and functioning about partici- Functional restric- for Disability amongst occupa- pants´ post-VR tions, activity-based-, Research, Hopkin- tionally injured RTW experiences or contextual- ton, MA, USA workers regarding important Factors differentiating To test the extent to factors determining those employed from which demographic their continuation those not and other variables of work relate to employ- ment maintenance, and to document what workers believe determined their work continu- ation Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Quantitative papers Andelic  2012 Norway Hospital outpatient No. Patients with neck To describe com- Self-reported func- Functional problems fit clinic, Oslo Cross-sectional pain referred to the monly reported tional problems on with the ICF model; study neck and back self-determined the Patient-Specific 13 meaningful ICF N = 249 functional problems Functional Scale. domains were identi- in patients with The ICF was used fied: 4 domains in neck pain as a tool for analy- body function (= 12 E.g. problems with sis. Meaningful underlying catego- work participation concepts within the ries). 13 domains in To evaluate their fit functional problems activity and partici- to the components were identified, pation (= 31 underly- of the ICF coded, and linked ing categories) to second-level categories within the components of body functions, activities and participation. The ICF categories were presented by percentage of the total number of functional problems linked to the ICF Chow  2014 USA Eight states Yes. Longitudinal, Psychiatric disability To evaluate the Interview protocols, How job accommoda- 4 year 8-state out-patients: Severe impact of an structured assess- tions that are moder- multisite demon- and persistent men- evidence-based ments, weekly ated by clinical and stration project, tal illness, N = 1654 approach to recording, and contextual factors are quasi-experi- Referred by provider, delivering employ- detailed description related to mental design self, family, word ment services to of accommoda- (1) average-monthly of mouth, newspa- individuals with tions-summarized hours worked in per ads psychiatric disabili- Effects assessed with competitive employ- ties between 1996 models informed ment across multiple and 2000 by ICF and other. spells of employ- To compare those Generalized linear ment? with/without model (number of (2) the duration of reported work hours of overtime job tenure across accommodations work after job multiple spells of accommodation) employment and survival analy- sis (time until job shift/accommoda- tion) Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Tools Conclave  2009 Italy Nationwide, ordered No. Aimed for evaluation To develop a nation- Development of Two main tools have by Italian Minis- Experimental of Persons with dis- wide ICF-based the dedicated been produced by try of Labour and application of ability (PwD) worker checklist ICF-based worker the ICF and labour Social Policies the ICF based To present the pro- checklist on the policies project: the method and cess and the results basis of the ministe- worker checklist and development of ICF and Labour rial schedule for the the protocol Policies Project evaluation of PwD with a special focus and the WHO’s ICF checklist, (a list of on the development 128 ICF categories of the checklist employed during ICF’s field trial) Standardised linking rules were followed to identify concepts contained in the ministerial schedule de Beer  2014 Netherlands Department Occupa- No. Persons with dys- To determine hinder- Systematic literature Effect size of factors tion & Health, Systematic review lexia or (specific) ing and facilitating search of quantita- between dyslexia HAN University of learning/reading factors associated tive or qualitative or learning/reading Applied Sciences disorder with participation methodology, pub- disorder/disability Nijmegen, The Neth- in work of individu- lished after 1995. and work erlands als with develop- ICF-expanded with The manifest fre- mental dyslexia two subdivisions: quency effect size is (DD), classified one that made the presented: calculated according to the environmental by dividing the dimensions of the factors more work- number of all studies ICF related and one of (that met the quality To explore and fully personal factors. criterion) and in understand factors For data extraction: which a factor was associated with qualitative meta found by the total work participation summary was used number of studies of adults with DD and the manifest frequency effect size (MFES) for each category Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Escorpizo  2011 Switzerland Swiss Paraplegic No. Persons with spinal To develop a set of Merging of the ICF ICF categories based Research, Notwill Development cord injury (SCI) ICF-based SCI Core Set for SCI on the existing ICF study Participation and and categories from core sets for SCI and SCI Environment the ICF Core Set VR Domain Set and for VR measurement instruments that intend to measure those domains, based on the ICF Core Sets for SCI Escorpizo  2011 Switzerland Department of No. VR professionals and Presentation of five Different perspectives Distribution of ICF Health Sciences Development stud- researchers articles in an effort on ICF/VR categories across and Health Policy, ies, international to advance our ICF components Notwill consensus understanding and and across studies. 3 conference measurement of VR core sets (2 SCI + 1 and RTW process VR) and 6 instru- ments that measure environment and participation Escorpizo  2011 Switzerland International survey No. VR professionals, Survey the experts Survey with VR List of ICF categories Internet-based sur- (experts from in the VR field experts. Question that were considered vey with expert 6 WHO Regions), with regard to what was related to a to be important in the participants N = 151 factors are consid- component of the VR process from six WHO ered important to ICF, responses Regions patients participat- linked to ICF ing in VR using the ICF as the language to summarize the results Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Comparison of work- Ferrario  2014 Italy Occupational Medi- Yes. Outpatients under- To provide evalu- ICF questionnaire; ing ability evaluation cine Department, Cross- sectional gone heart trans- ation of possible 10 questions were and employment sta- Turin University study plantation, liver -, RTW and of fitness further applied to tus. Internal compari- and kidney- and for specific and those who were son among different survived at least adequate tasks of employed at the organ recipients 12 months, N = 150 surviving transplant time of the study. Questions regard- 61% of patients were recipients and to ing the following: in paid employment, compare the results time to RTW after 4% of students and with the assess- surgery, jobs per- housewives. 24% ment of their actual formed after RTW, unemployed related employment status part-time or fixed- or not to health shift job assigna- conditions, 11% were tion, difficulties retired in performing the previous or the new job, possible peri- ods of unemploy- ment, satisfaction with the job gained after transplanta- tion, the relations with the employer and the occupa- tional physician, the support received Finger  2011 Switzerland VR centres; 4 in No. Persons with various To describe persons Case Record Form Categories from all Switzerland 1 in Cross-sectional health prob- undergoing VR based on an four ICF components Germany multicenter study lems > 18 years To identify the most extended version of N = 152 common problems the ICF Checklist around work and in containing 292 and VR using the ICF SES Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Items of WORQ, Finger  2014 Switzerland VR centres No. Psychologist. Test- To develop an inter- Mixed methods the ICF category Development and sample of patients viewer adminis- including sophis- measured validation study 18–65 years, par- tered ICF-based ticated statistical ticipating in VR questionnaire approach and N = 74 (WORQ) to assess qualitative content functioning in VR assessment. cat. To report prelimi- from ICF VR-Core nary psychometric Sets, explorative evidence Rasch-analysis and VR literature review. Questions were worded to assess identified ICF categories. WORQ was translated from English to German. Examination of psychometrics for the German version of WORQ Kuijer  2006 Netherlands Centre for Rehabili- Yes. Patients with To explore which Questionnaires Work status, variables tation, University Cross. sectional chronic low back variables are related (health, limitation), of functioning Medical Centre study pain referred for to work status test of physical Groningen multidisciplinary according to ICF performance treatment Logistic regression N = 92 analysis was per- formed to explain work status (out- come) from the included variables of functioning Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Leyshon  2008 Canada University of West- No. Injured workers To introduce an ICF- Traditional model: Model, in order to ern Ontario Literature review (musculoskel- based new practice Micro better describe interventions, as etal disorders most model of occupa- /macro-ergonomics interventions carried common) tional rehabilitation have been defined out in the workplace ergonomics as “the study and appear to be “very process of design- heterogeneous and ing and/or modify- ill-defined” ing tools, materials, equipment, work spaces, tasks, jobs, products, systems, and environments to match the abilities, limitations, and social needs of human beings in the workplace” Linden  2010 Germany Inpatients, depart- Yes. Patients admitted to To examine the rela- Special clinical Assessment of capaci- ment of behavioural Cross-sectional, the Department of tionship between interview and ties (work-related and psychosomatic examination and Behavioral Medi- measures of capac- questionnaires attitudes, volition and medicine, Teltov interview cine, N = 213 ity*, motivation and observer rating for motivation) performance Mental Disorders *inability to perform (Mini-ICF-APP), activities (i.e. dys- work performance functions) Endicott Work Productivity Scale (EWPS), and volitional and moti- vational problems Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Determinants for Martins  2015 Portugal Coimbra Health No. Working-age persons To explore key Questionnaires: social participation, School, Physiother- Explorative, cross- with disabilities liv- indicators of social Attitudes Towards employment (self- apy Department sectional study ing in community participation (life Disabled Persons efficacy, QoL) dwelling settings. habits) of persons Questionnaire, Severe limitations with disabilities, self-efficacy and the in mobility due to particularly related LIFE-H (77 items across 12 a chronic disease to work primary domains, or injury, using a including nutrition, wheelchair for > 1 fitness, personal year, N = 149 care, communi- cation, housing, mobility, responsi- bility, interpersonal relations, com- munity, education, employment, and recreation) Nilsing  2012 Sweden Hospital physicians No. All new sick leave To compare quality Pearson’s chi2 and Quality in sickness and GPs, Ostergot- Comparative study certificates during of sickness certifi- t-test was per- certificates, descrip- land County 2-week period in cates between 2007 formed to test tion of functioning 2007 and 4-week and 2009. (Dif- differences between and prescriptions of period in 2009, ferences between variables early rehabilitation N = 475501 ICF-codes in 2007 and 2009) Ptyushkin  2011 Slovenia Organisations No. Psychologists, social To review use of the Review of the Main advantages/ granted to assess Review, survey workers and occu- ICF in VR and dis- Slovenian law, dis-advantages and persons with disabili- pational therapists ability assessment survey, group and qualities/deficien- ties and to operate individual inter- cies; whether the ICF their VR views. Nine of 13 helps to establish a organisations were common language surveyed totally or partially Reichel  2010 Germany Inpatient rehabilita- Yes. Patients with gastro- To link ICF to other Screening files; Variables linked with tion centre, Bad Chart review intestinal diseases, specific instruments Crohn’s Disease clinical improve- Brückenau N = 355 and compare with Activity Index vari- ment (decrease in other predictors ables were linked Harvey-Bradshaw of rehabilitation with ICF categories Index of ≥ 2 U) and outcomes using linking rules VR success Journal of Occupational Rehabilitation 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Saltychev  2013 Turkey Turkish University Yes. Retrospective Patients with chronic To identify the most Each phrase from the ICF codes categorized Hospital cohort study musculoskeletal frequent functional patients’ electronic 141 different were disorders, undergo- limitations accord- record that could identified with a ing VR-evaluation, ing to ICF potentially be inter- preciseness of three N = 32 preted as an ICF or more digits code was extracted Sturesson  2015 Sweden Swedish Social Insur- Yes. Patients at To evaluate the Evaluation was Sufficient information ance Agency Quality assess- primary health care quality of sickness performed in concerning the diag- 146 different GPs, at ment, based on centres, sick- certificates issued accordance with the nosis, level of sick 29 centres an intervention ness certificates, in primary health same criteria as in leave and time period N = 323 care and examine the national ‘Sick for the sick leave if the patients’ or Leave Billion’ physicians’ gender influences Varekamp  2013 Netherlands/Germany Current Health in No. Population 18–65 To explore problems Telephone surveys Chronic disease, Germany Descriptive study, year, N = 35,574 or solutions for conducted from participation (work registers workers with a July 2008 to July disability) chronic disease; 2010 among adults from quantitative and qualitative research Wang  2013 Taiwan University College of No. Labour force with To explore ICF Survey: Life situa- Employment, type of Social Science Survey, secondary disability living at factors association tion for disabled; disability and ICF analyses home, N = 2,909 with employment in secondary data category disabled analysis, regression model Zeilig  2012 Israel Post-polio outpatient No. Patients with long- To determine the Review of the Employment; assistant clinic. Tel- Data extraction standing poliomye- effects of a number medical records. devices for mobility, Hashomer from records litis (LSP), N = 123 of social and Employment dependent for basic functional vari- defined as > = 20 h ADL associated with ables as barriers or of regular remu- lower employment. facilitators to work nerative activity Driving positive participation in associations persons with LSP Østerås  2007 Norway Ullensaker munici- Yes. Seven birth cohorts, To provide measure- Postal questionnaire Instrument based on pality Survey N = 1620 ment of population in 2004 ICF-functional abil- functional levels, ity; derived from the assessment of activities/participa- reliability of a Nor- tion component wegian scale based on ICF Journal of Occupational Rehabilitation VR professionals [32, 39, 40, 42, 46, 47, 59], e.g. psycholo- gists, social workers, technologists, occupational therapists, occupational physicians, education counsellor, rehabilitation counsellor. Two papers involved health professionals and patients , and solely health professionals , respec- tively. A paper described all professionals involved in reha- bilitation research (experienced physiotherapists, certified physiotherapist/movement scientist, research assistant) , another paper involved independent insurance specialists, who were trained to assess the quality of information in sick- ness certificates . How the ICF Inform Assessment of Functioning Regarding to what extent the ICF informed professionals´ assessment of functioning; several papers reported discus- sions on the ICF´s applicability for VR, service delivery, and RTW support. As examples were papers reporting on potential benefits of the ICF: to structure and phrase dis- ability evaluation in the field of social insurance , on tracking risk factors for disability amongst the self-employed , highlight its applicability in job placement , and to identify the most common problems around work and in VR. One paper concluded that a questionnaire based on the ICF proved to be a “useful framework that can be used for research but also by occupational physicians in their usual practice after specific training” . A paper reported on an expert survey on use of the ICF as the language to sum- marize the results in VR . Another paper concluded, that although the procedure using the ICF was “complex, time-consuming, and requires specific training of the staff involved in its use”; the occupational physicians were pro- vided with a standardized procedure to evaluate working ability and suggest re-employment for transplant recipients . A paper described how VR professionals used the ICF to guide assessment in the job placement process and used the appropriate ICF domains and categories as a template to determine what specific information needed to be obtained, and how to organize it in a systematic way. Thus, an inter- view format informed by the ICF structure enabled the pro- fessionals to highlight the needs for assessment information . Criticism of the ICF One paper involving several health and non-health profes- sionals concluded, that disadvantages of the ICF are the “complicated terminology, perceived subjectivity of the assessor in coding” and that ‘it is too bulky’ . Another paper described factors that support employees’ early RTW and reported that some factors cannot be described and clas- sified using the existing coding system of the ICF . 1 3 Table 1 (continued) Author Year Country Setting Intervention (yes/ Population Aims Methods Outcomes (primary/ no) Study type secondary) Aas  2007 Norway Community-based No. Cross- Clients in commu- To describe socio- Community occupa- Coded diagnoses OT services sectional postal nity health care, demographic factors tional therapy -according to the survey N = 168 and the occurrence International Clas- of diseases and sification of Primary disabilities among Care (ICPC-2) a representative sample of clients who were using community OT services Aas  2011 Norway Cochrane Back No. Systematic Adult workers with To determine the Literature search, Two main outcomes Group review neck pain effectiveness of workers at work Pain relief and reduced workplace interven- or absent from sickness absence/ tions compared to work. Workers with RTW. Pain severity no treatment, usual acute, sub-acute or or pain prevalence care or other work- chronic neck pain place interventions for adult workers with neck pain Journal of Occupational Rehabilitation 1 3 Table 2 Summary of the included papers´ operationalization of ICF, persons involved in VR, and ICF components used Author Operationalization of ICF (i.e. as a framework for: Who are involved (stakeholders, patients) ICF components used structuring, linking, analysis or development) Qualitative structuring Anner  Framework to structure and phrase disability evaluation Researchers, medical evaluators of work disability All components except personal factors by use of ICF. Medical Evaluation of work disability. The ICF framework distinguishes the domains and their interaction but does not foresee a restricted causal relation Dalemans  Framework for categorizing. Search terms were derived Researchers Participation only from ICF. Aspects of domestic life, interpersonal In domestic life, inter-personal life, education, commu- interactions and relationships, education and employ- nity, civic, and social life ment, and community, civic, and social life were included Researchers Participation only Daniel  Framework for categorizing. Defining social conse- In work only quences according as those pertaining to the ICF domain of “participation”. Social consequences grouped into 5 domains reflecting the topics investi- gated: RTW, family relationships, sexual, finances, and social activities. Developing a standardized instrument, which takes into account specific needs of working-aged people. This scale should be in line with the ICF De Boer  Framework and verification according to ICF catego- Researcher and social insurance physicians All components ries. The topics that address a claimant’s disability were compared to ICF and a bio-psycho-social approach to see the extent of match Escorpizo  Framework. Description and use of ICF categories. Researchers All components Use of ICF as a language of disability, a common ICF generic set, core sets for VR and Disability Evalua- reference framework to provide disability criteria in tion in Social Security determining functional and work capacity, and to help facilitate a common ground of understanding Finger  Framework of structuring. Application and compari- Researcher and stakeholders: rehabilitation physician, All components son of ICF-based tools the Rehabilitation Manage- a physiotherapist, a psychologist and a vocational Except personal factors ment Sheet, the Work Rehabilitation Questionnaire counsellor Core set of low back pain (LBP) (WORQ, the generic and brief core set of low back pain). ICF structures used to facilitate communication between stakeholders, to help structure rehabilitation plans and for setting goals, and clarifying team roles Glassel  Framework for a systematic application of ICF-based Researcher and VR team OT, physical therapist, All components documentation tools by using ICF Core Sets in VR. nurses, vocational Core set for VR Use of the ICF Core Sets in VR allows a comprehen- Counsellor, social worker, physician, and psychologist sive assessment Hoefsmit  Framework for description of environmental and per- Researcher and persons interviewed: 14 employees, All components. Except personal factors sonal factors regarding support of employees´ RTW. 15 employers and 4 OPs from multiple organisations Professionals´ use of the ICF (healthcare and education) Journal of Occupational Rehabilitation 1 3 Table 2 (continued) Author Operationalization of ICF (i.e. as a framework for: Who are involved (stakeholders, patients) ICF components used structuring, linking, analysis or development) Koolhaas  Framework for categorization. ICF used for classifica- Researcher All components tion and comparing the workers’ perspectives Minis  Framework, ICF used as a structure for factor extrac- Researcher All components tion indicative for association with employment status from studies. Factors related to health state, work and other environmental and personal factors is needed to improve care and services by allied health profession- als and organisations involved in the (re-) integration process Trenaman  Framework for categorization. Factors categorized Researchers All components based on the ICF with each domain sub-categorized by modifiability Vooijs  Framework for categorization. Factors associated Researchers All components with work participation were categorized according to ICF. Various disease-generic factors are associ- ated with work participation, of which most of the reported factors are independent of diagnosis Qualitative linking Aiachini  Framework for linking. Validation of core set for VR. Spinal cord injury patients, two health professionals All components. Comprehensive core set for VR Concepts were linked to ICF categories according to linked the concepts to ICF established linking rules. 70% of 90 categories in VR core set were found Escorpizo  Framework for linking, ICF used as a reference to Researchers All components describe and compare the contents Health and Work Q. the only including environmental of these questionnaires: Health and Work Q., Work and personal factors Role Functioning Q. Rheumatoid Arthritis-Work Instability Scale, Health and Labour Q Glassel  Framework for linking. Reference to ICF categories Researcher All components according to established linking rules Qualitative analysing Abbott  Framework for analysing interviews. Based on ICF Patients, researchers All components a qualitative content analysis of semi-structured Core set for low back pain interviews post-surgery was performed. ICF was applied to identify and code meaningful units, which were compared with the ICF related content of the Oswestry Disability Index, SF-36, EQ5D and the ICF LBP core sets Journal of Occupational Rehabilitation 1 3 Table 2 (continued) Author Operationalization of ICF (i.e. as a framework for: Who are involved (stakeholders, patients) ICF components used structuring, linking, analysis or development) Culler  Framework for analysing interviews. Components iden- 10 stroke survivors, 21 vocational specialists, 7 All components. Impairments of body, activity limita- tified in 3 perspectives (patients, vocational experts employers (experienced in interviewing persons tions to participation. Restrictions by environmental and employers) were illustrated and mapped onto the with disabilities and with authority to make hiring and personal factors ICF coding decisions) Stergiou-Kita  Framework for data analysis. Utilized as guiding Researcher All components frameworks during data analysis. ICF focused more specifically on identifying key domains or factors and failed to capture the processes relevant to a rigorous evaluation Van Velzen  Framework for the interview and the analysis Researchers All components Young  Framework for analysing interviews. Results were Researchers and post VR participants All components interpreted using the health and health-related domains from the ICF. Interviews were conducted to inquire about participant’s post-VR RTW experi- ences. Coding of the qualitative data and analysis was conducted in tandem Qualitative development Bakker  Framework for developing a risk assessment model, Researchers All components with a strong focus on personal and environmental Focus on environmental and personal factors in addition factors, as it will affect claim behaviour. The model to medical data will bring the current medical model at the under- writing stage more in line with the social model at claim stage Desiron  Framework used to identify elements in OT models. Researcher All components. Identified elements: functional, medi- Research specific criteria derived from OT literature cal, RTW (conceptual OT multidisciplinary model referring to the ICF) Homa  Framework for development of interview format Researcher All components informed by the ICF structure. Used in job placement Except personal factors as a template to organize client information, highlight strengths and limitations, and provide guidance for interventions Sevilla  Framework for development of a model of which the Researcher All components levels of activity can be cross-walked to the ICF The new model include more than ICF Wasiak  Framework for developmental conceptualization of Researchers All components RTW. Using the ICF to inform our thinking and coding structure, conceptualizing phase-based RTW outcomes and categorization in ‘tasks and actions’, ‘contextual’ or ‘process driven’. Awareness of RTW encompassing four phases: off work, work reintegra- tion, work maintenance and advancement Journal of Occupational Rehabilitation 1 3 Table 2 (continued) Author Operationalization of ICF (i.e. as a framework for: Who are involved (stakeholders, patients) ICF components used structuring, linking, analysis or development) Quantitative structuring Chow  Framework for categorization and description on how Research team; trained interviewers; project staff All components limitations in functioning and the environment are members Personal characteristics related to employment outcomes Finger  Framework for structuring. ICF core set basis for Professionals, 25 patients, vocational counsellors, and All components developing an instrument. Participants commented on a work reintegration specialist Except personal factors the usability Core set Kuijer  Framework for classification. Variables classified Research assistant; 2 physiotherapists (PT); PT/move- All components according to the ICF ment scientist, trained, certified and experienced Part 1, functioning and disability Part 2, contextual factors Reichel  Framework for categorization. Linking each meaning- Physicians specialized in gastroenterological rehabili- Body functions/body structures only ful concept and objective with the most precise ICF tation category Sturesson  Framework for categorization and verifying the Independent insurance specialist from the SSIA, edu- Impairment of body function, limitation of activity only information of sickness certificates. The assessment cated and trained to assess the quality of Swedish Social Insurance Agency (SSIA) has to verify that the information clarifies a logical link between diagnoses, impairment of body function and activity limitation (the ‘DFA chain’). The vocabulary and definitions in the DFA chain are in accordance with the ICF Aas  Framework for categorization. ICF terminology was Researchers All components used to classify the intervention components. ICF could have contributed to a conceptual frame of refer- ence based on common terminology Quantitative linking Conclave  Framework for structuring followed by linking Italian Professionals in job placement of persons with dis- All components legislative procedures to the ICF domains and catego- abilities. Participants: 895 in Basic ICF training, 552 ries, and adding standard ICF checklist categories. in Advanced The ICF-based worker checklist is composed of 183 ICF categories de Beer  Framework for linking, coding. The factors from all Research team All components studies coded on the two-level classifications of ICF. Work-related activities, participation, environmental and Frequency and consistency in hindering or facilitating personal factors made visible by use of ICF categories Escorpizo  Framework for structuring followed by linking. Items Researcher, two coders All components except body factors of measurement instruments were linked to the ICF Activities, participation and environment components. core sets, applying the linking rules Comprehensive ICF Core Set for SCI, VR Journal of Occupational Rehabilitation 1 3 Table 2 (continued) Author Operationalization of ICF (i.e. as a framework for: Who are involved (stakeholders, patients) ICF components used structuring, linking, analysis or development) Escorpizo  Framework for structuring followed by linking. Linking International team of researchers All components between 3 core sets of 6 questionnaires assessing Except personal factors environment and participation by two independent researchers. Merging ICF categories Escorpizo  Framework for linking. ICF applying published linking Responders (151), experts from 47 countries, random All components rules; responses were listed and frequency analysis sample of professions, WHO regions, countries was performed Quantitative analysing Andelic  Framework, tool for analysis. Linking of self-reported Research team All components except environmental factors. Domains problems related to neck pain to domains of the ICF loading on the activities and participation Nilsing  Framework for analysis. Free text on functioning was Researchers and an adjudicator. Consensus meeting Body and activity only analysed deductively using the ICF framework and between the researchers and adjudicator (Sensations of pain or emotional functions. Walking or placed into categories handling stress) Wang  Framework for analysis. Dependent and independent Researcher All components variables based on ICF, and their operational defini- tion were used for coding; e.g. 0 = not employed/no, 1 = employed/yes Ferrario  Framework for analysis. ICF questionnaire; used the Occupational physician of the Occupational Medicine All components ICF to evaluate working ability of transplant recipi- Department, researcher ents to provide the occupational physicians a stand- ardized procedure to suggest the best possibility of re-employment in close co-operation with the patient Finger  Framework for analysis. Identification of the most com- Health professionals All components mon problems around work and in VR. Examine the Except personal factors frequency and rate problems based on the extended ICF checklist (the ICF Checklist version 2.1a) Saltychev  Framework for coding followed by analysis of com- Multi-professional team. (Specialist in physical and All components parison. Descriptions of functional limitations were rehab. medicine, rehab. planner, psychologist and the Except personal factors converted to ICF codes, and the most frequent were patients) Core set for VR compared with the ICF Checklist and VR core sets Zeilig  Framework for analysis. Barriers and facilitators of Researcher Body functions and activities only. Focus on mobility in working participation defined according to the ICF regard to employment status categories. Levels of function were then analysed for correlation to the vocational status Quantitative development Leyshon  Framework, basis for a new model. Discussion of Researcher All components opportunities to use this model in researching out- comes of ergonomic interventions. Illustrate how the ICF framework could be applied to a worker with a low back disorder Journal of Occupational Rehabilitation 1 3 Table 2 (continued) Author Operationalization of ICF (i.e. as a framework for: Who are involved (stakeholders, patients) ICF components used structuring, linking, analysis or development) Linden  Framework for evaluation. Use of mini ICF to assess Researcher All components its clinical relevance. Correlations made with other instruments. Functions, capacities and participation are not linear but interactive, as known from occupa- tional psychology Martins  Framework for evaluation. To explore correlations Researcher All components except body functions and activity between social participation, employment and personal factors such as self-efficacy and attitudes towards disability Body functions component only Ptyushkin  Framework for development of questionnaire. Subject 45 professionals involved in VR (Psychologists, social workers, technologists, OTs, physicians, education for questionnaire: VR professionals´ opinions about counsellor, rehabilitation counsellor) ICF. (How would you define the ICF? What is the ICF for you? and ‘In your opinion, what is the pur- pose of the ICF’) Integration of the ICF into the Slovenian VR and Employment of Persons with Disabilities Act made the use of ICF obligatory Varekamp  Framework for evaluation. Understanding and consid- Researcher All components ering health-related problems at work and finding Focus on environmental and organisational factors solutions; ICF used as a model to explain work disability. Prevalence of chronic medical conditions (non-communicable diseases) is strongly related to age Østerås  Framework for development. ICF used as basis for Researcher Activities/participation components development of national questionnaire (Norwegian Function Assessment Scale) Aas  Framework for development. ICF used as basis for Occupational therapists (OT) and clients Body, activity and participation components questionnaire in survey of impairment, activity limi- tations, and participation restrictions (e.g. participa- tion in ordinary working life) 9 OTs from 4 municipal areas tested the questionnaire on 18 clients Journal of Occupational Rehabilitation The ICF is seen as a useful tool for describing, compar- Which of the ICF Components and Core Sets are Considered When Functioning is Evaluated in VR? ing and contrasting information from outcome measures and clinical patient reports across diagnoses, settings, languages Except in 10 papers all the ICF components were described. and countries . A review showed that linking health and health-related information to the ICF is a useful way to apply Two papers commented on personal factors, despite the fact they are part of the ICF there are no categorizations [29, 35]. the ICF in research . Evaluation of functioning is relevant early in VR , and Only two papers described the component participation [44, 66]. One paper described all components but environmental this review found several presentations of the applicability for VR and use of the ICF to examine and measure VR pro- factors . Six papers evaluated the body functions compo- nent only [42, 47, 49, 56, 57, 59], and three papers reported cesses and outcomes. The findings show that the ICF was useful in providing a clear description of the consequences on all components except body functions or participation components [45, 60, 75]. of diseases, and of the factors that can be described using the ICF coding, which may potentially support the VR pro- Seven papers used the ICF core set [27, 29, 30, 38, 46, 51, 55], among which four studies reported on the core set for fessionals, e.g. factors that support employees’ early RTW . The ICF can help VR professionals gain a more pre- VR [30, 38, 46, 72]. The VR core set was used for valida- tion of another ICF core set , development of ICF-based cise understanding of the impact of disability on individu- als’ ability to perform life tasks or activities. Thus, the ICF documentation tools , comparison of the most frequent ICF coding of functional limitations with the ICF Checklist might contribute to a more informative description in multi- professional assessments, because healthcare professionals and VR core sets . have different perspectives on the health-care process . However, a paper concluded that in primary care there seem Discussion to be a lack of knowledge about the ICF, and that increased cooperation between GPs and other health-care professions The ICF was primarily used in Western VR contexts. The may require learning as well as a change of attitudes . Furthermore, an ICF-based questionnaire regarding time ICF used as a framework was the most prevalent operation- alizing of ICF (18 papers), whereas linking, analysing and to RTW, work difficulties, job satisfaction, and work rela- tions was reportedly useful for occupational physicians developing appeared in 8, 12 and 12 papers respectively. As 32 of the 50 included papers were reviews the predominant assessing patients after transplant procedures . Thus, the ICF framework provided an effective evaluation of possible profession involved in ICF were researchers. Among the original papers no single profession stood out as particularly RTW and capabilities of these patients, who had undergone transplants and survived at least 12 months. However, the ICF users. In general the ICF enabled the various profes- sions involved in VR in a structured way to obtain relevant procedure of for assessment of self-reported work ability was reported as complex and required specific training of need assessments and communicate this across professions. The majority (40) of papers described all factors, which the staff involved . The present review illustrates how the ICF may support support the bio-psycho-social approach. However, it was not clear if the ICF was suitable as an instrument for goal development of questionnaires [59, 60], like e.g. the Work Rehabilitation Questionnaire (WORQ). The WORQ has setting and evaluation as merely single papers mentioned these properties. Moreover, the ICF was criticised for being proven to be a valuable instrument within VR , e.g. as to support the physiotherapist´s role within the rehabilitation time consuming. Unexpectedly four papers described the ICF components body and acidity only, despite participation team by enhancing transparency in goal setting and interven- tion planning across disciplines . and environmental factors seem inseparable from VR. The VR core set was not the primary tool when functioning was Although the ICF is a reasonable starting point in efforts to harmonize terminologies , the framework is also criti- evaluated within VR. Compared to the findings in another review where quali- cised for limitations. This scoping review reported on the ICF components only. However, each of the components tative papers only constituted a tenth , and despite some papers with a mixed study designs were defined as qualita- (except for personal factors) is further divided into domains and underlying categories providing more detail of a com- tive in this review, the number of qualitative and quantitative papers was more balanced in this review. ponent. The ICF coding system is intended to describe a per- son’s functioning at a specific time, in that person’s normal The ICF defines functioning as the interaction between an individual and that individual’s environmental and per- circumstances and environment. Qualifiers are built into the coding system to indicate the magnitude of the impairment, sonal factors; accordingly a paper illustrated the problems of functioning in a person with low back pain by use of the limitation or restriction for each category. framework . 1 3 Journal of Occupational Rehabilitation A review on the use of ICF in outcome measures used The reviewers experienced difficulties in study selection, within VR identified that a third of categories were related despite the method by two reviewers and how to ensure to body functions . This review also identified some eligibility criteria is a limitation. In a scoping review the papers solely reporting on body functions, which is not rep- extracted data is based on information provided in individ- resenting a bio-psycho-social approach. It should be recog- ual papers without critical assessment, which is a limitation nized that the ICF is limited with respect to comprehensive despite no scope of synthesizing evidence. Furthermore, descriptions of work disability, e.g. the cause why a person the categories of operationalization may not be mutual is not able to work is an important part of disability evalu- exclusive. ation. The ICF however, cannot describe causal relation- The sixth and optional stage of involving relevant stake- ship , and a solution may be to use the ICF combined holders was not included but may have contributed with with other instruments, which can reveal causal relations. other VR professionals´ views . It was pointed out that although the framework includes personal factors, they cannot be classified in the ICF [ 68]. Implications for Practice within VR This is a limitation of the framework, as e.g. motivation is important to consider when making prognosis of work abil- This review confirm challenges with the use of the ICF: e.g. ity and RTW. Personal factors also include an individual’s it cannot infer causality in disability  and not categorize lifestyle, habits, social background, education, life events, personal factors. The content of VR varies widely among race/ethnicity, sexual orientation, and coping mechanisms countries because of differing insurance policies and dis- . Work participation relies on both personal and environ- ability attitudes; e.g. in Slovenia the ICF for work assess- mental factors, which in addition to the medical data, affect ment was made obligatory but the lack of interface between functioning and participation, e.g. a paper concluded these the ICF and policies on VR was a challenge . The ICF factors affect claim behaviour . Factors that are likely to may be used to ensure comprehensiveness of evaluation in be emphasized in a VR setting are within the components: study populations with chronic diseases . Furthermore, activities, participation and environmental factors . A the framework may cover all relevant aspects of disability Cochrane review found a lack of interventions targeting and may encourage the VR professionals to draw a holistic the ICF-domains: attitudinal and social environment . picture . The ICF “corresponds closely to this ecological However, this review found only a few papers lacking the systems approach and could help rehabilitation practitioners environmental factors. more specifically and precisely identify those subsystems or Unexpectedly, the review revealed a limited use of the environmental factors that have an impact on successful job ICF VR core sets. These include environmental factors that placement” . The ICF may be combined with existing may prove to be useful when disability evaluation and work measures and incorporated in daily practice . capacity is being assessed. However, a validation study of the comprehensive VR core set concluded, that it was insuf- Implications for Future Research in Work Disability ficient from a sole physiotherapist perspective, there was a and VR need for additional ICF categories. Although the VR core set was considered useful to clarify responsibilities and for Our findings revealed that the ICF has been applied in differ - communication in a multidisciplinary setting, it was too ent settings and for different purposes, which has important comprehensive for mono-disciplinary use of physiothera- implications for future research. In order to ensure compara- pist . The core sets in general were not recognized to bility across studies and robust testing of hypotheses the use provide an exhaustive list but rather the minimum number of the ICF needs to be clarified. Furthermore, how data are of categories to be assessed . Therefore practice may sup- collected, assessed and classified based is lacking in the field ply the VR core set with other instruments in order to fully of VR. Hence, research on the practical utility of the ICF assess functioning. across different assessment instruments is crucially needed to inform a feasible framework development in VR. Although the ICF provides a framework to evaluate contextual factors, this review finds there is a gap between Strengths and Limitations the knowledge of the impact of personal factors and actual assessment within VR and more research is needed. One strength was the inclusion of both qualitative and quan- titative papers from multiple settings and countries. Further- more, the scoping review format offers an overview of study findings in a field where the knowledge is still limited. 1 3 Journal of Occupational Rehabilitation 3. Larsson A, Gard G. How can the rehabilitation planning process at Conclusions the workplace be improved? A qualitative study from employers’ perspective. J Occup Rehabil. 2003;13(3):169–181. The scoping review revealed use of the ICF within the field 4. Chamberlain MA, Fialka Moser V, Schuldt Ekholm K, O’Connor VR in 50 papers, and in various settings; e.g. hospitals, RJ, Herceg M, Ekholm J. Vocational rehabilitation: an educational review. J Rehabil Med. 2009;41(11):856–869. rehabilitation centres, primary health care centres, sickness 5. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad certificate registration offices, and research departments. The AR, Kromhout D, et al. How should we define health? BMJ. operationalization of the ICF was described in four ways: 2011;343:d4163. for structuring information, linking of categories or content, 6. Organisation for Economic Co-operation and Development. Sick- ness, disability, and work: breaking the barriers : a synthesis of analysis according to the ICF framework, or development of findings across OECD countries. Paris: Organisation for Eco- instruments or models based on the ICF. nomic Co-operation and Development; 2010. A majority of papers were reviews and involved research- 7. World Health Organization. How to use the ICF: a practical man- ers only, whereas different stakeholders and VR profession- ual for using the international classification of functioning and health (ICF). exposure draft for comment. Geneva: WHO; 2013. als were involved in the interventions. The components of 8. Escorpizo R, Brage S, Homa D, Stucki G, SpringerLink (Online the ICF that depict functioning and disability were largely service). Handbook of vocational rehabilitation and disability incorporated in the VR research. This observation points evaluation: application and implementation of the ICF. Cham: to the benefit of using a common set of ICF components Springer International Publishing; 2015. 9. Marnetoft S. The challenges of vocational rehabilitation in Swe- to inform the selection of set of measurement instruments. den. Kuntoutus Fin J Rehabil. 2009;4:5–10. Such a process would lead to a single set of standardized 10. Escorpizo R, Finger ME, Glässel A, Gradinger F, Lückenkemper measures looking at similar outcomes and make compa- M, Cieza A. A systematic review of functioning in vocational rability across studies possible However, more research is rehabilitation using the international classification of functioning, disability and health. J Occup Rehabil. 2011;21(2):134–146. needed to develop and validate instruments measuring rel- 11. World Health Organization. International classification of func- evant domains including personal factors and to standardize tioning, disability and health: ICF. Geneva: World Health Organi- and ease the VR professionals´ use of the ICF. zation; 2001. 12. Escorpizo R, Glässel A. 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