Beyond diagnosis: the Core Sets for persons with schizophrenia based on the World Health Organization’s International Classification of Functioning, Disability, and Health

Abstract

Purpose: Based on the International Classification of Functioning, Disability and Health (ICF), this paper presents the results of the process to develop the Comprehensive and Brief Core Sets for schizophrenia that allow to comprehensively describe functioning in persons with schizophrenia.

Methods: Twenty health professionals from diverse backgrounds participated in a formal and iterative decision-making process during an international consensus conference to develop these Core Sets. The conference was carried out based on evidence gathered from four preparatory studies (systematic literature review, qualitative study, expert survey, and empirical study). The first step of this decision-making and consensus process comprised of discussions and voting in working groups and plenary sessions to develop the comprehensive version. The categories of the Comprehensive ICF Core Set for schizophrenia served as the basis for the second step –a ranking and cutoff procedure to decide on the brief version.

Results: Of the 184 candidate categories identified in the preparatory studies, 97 categories were included in the Comprehensive Core Set for schizophrenia. A total of 25 categories were selected to constitute the Brief Core Set.

Conclusions: The formal decision-making and consensus process integrating evidence from four preparatory studies and expert opinion led to the first version of the Core Sets for schizophrenia. Comprehensive and Brief Core Sets for schizophrenia may provide a common language among different health professionals and researchers, and a basic international standard of what to measure, report, and assess the functioning of persons with schizophrenia.

Implications for rehabilitation

• Schizophrenia is a chronic mental disorder that has a tremendous impact on functioning and daily life of persons living with the disorder. The International Classification of Functioning, Disability and Health (ICF) offers an internationally recognized standard for describing the functioning status of these individuals.

• The Core Sets for schizophrenia have potential use in supporting rehabilitation practice such as for planning mental health services and other interventions or defining rehabilitation goals, and documenting patient care.

• The Core Sets for schizophrenia may also be used to promote interdisciplinary coordination and facilitate communication between members of a multidisciplinary rehabilitation team.

• Rehabilitation research is another potential area of application of the Core Sets for schizophrenia. This is valuable, since rehabilitation research provides crucial evidence for optimizing rehabilitation practice.

Keywords:

• International classification of functioning
• disability and health
• ICF core set
• functioning
• schizophrenia
• health-status measures

Acknowledgements

We thank all the persons living with schizophrenia, caregivers, clinicians, and scientists for their contributions to the preparatory studies. We are most grateful for the creative contributions made by the following experts who participated in the consensus conference: Marta Anczewska, Ulrika Bejerholm, Morris Bell, Cecilia Brando, Raymond C. K. Chan, Mahmoud El-Wasify, Michael F. Green, Shaher Hamaideh, Matti Isohanni, Cille Kennedy, Terry Krupa, Samuel Mampunza, Peter McKenna, Natalia Ojeda, Sarah Phillips, Sandra Saldiva, Cecilia Villares, Vishanthie Sewpaul, Pere Bonet, Stephen Wood. We would also like to acknowledge Lucas Blasco, Lidia Ortega, and Ana Querol, for their excellent job as research assistants, and thank Amaya Cuevas, Birgit Prodinger, Cristina Pulido, Wolfgang Segerer, and Clara Torroja for their invaluable support during the consensus conference. Likewise, we would like to thank to WHO Regional Office for Europe in Barcelona for providing us with infrastructure for the consensus conference.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Spain’s Ministry of Economy and Competitiveness [grants number PSIC2012–32275 and FECYT-9206]; the Agency for the Management of University and Research Grants from the Government of Catalonia [grants number 2009SGR822 and 2014SGR1139].