Description of the person-environment interaction: methodological issues and empirical results of an Italian large-scale disability assessment study using an ICF-based protocol

摘要

Background There is a connection between the definition of disability in a person-environment framework, the development of appropriate assessment strategies and instruments, and the logic underpinning the organization of benefits and services to confront disability. Methods The Italian Ministry of Health and Ministry of Labor and Social Policies supported a three-year project for the definition of a common framework and a standardised protocol for disability evaluation based on ICF. The research agenda of the project identified 6 phases: 1) adoption of a definition of disability; 2) analytical breakdown of the contents of disability definition, so as to indicate as clearly as possible the core information essential to guide the evaluation process; 3) definition of a data collection protocol; 4) national implementation of the protocol and collection of approximately 1,000 profiles; 5) proposal of a profile analysis and definition of groups of cases with similar functioning profiles; 6) trial of the proposal with the collected data. The data was analyzed in different ways: descriptive analysis, application of the person-environment interactions classification tree, and cluster analysis. Results A sample of 1,051 persons from 8 Italian regions was collected that represented different functioning conditions in all the phases of the life cycle. The aggregate result of the person-environment interactions was summarized. The majority of activities resulted with no problems in all of the A&P chapters. Nearly 50.000 facilitators codes were opened. The main frequent facilitators were family members, health and social professionals, assistive devices and both health and social systems, services and politics. The focus of the person-environment interaction evaluation was on the A&P domains, differentiating those in which performance presented limitations and restrictions from those in which performance had no or light limitations and restrictions. Communication(d3) and Learning and Applying Knowledge(d1) appeared as the more problematic A&P areas. Self Care(d5) was the domain in which facilitators were more effective in supporting functioning, suggesting that the Italian welfare system is mainly focused on providing care services for activities of daily living, jointly with the family. The cluster analysis was limited to those categories that were common to all age classes (38 categories out of 55). For a final representation, a solution with 6 clusters was chosen. Conclusions An example is provided of how it is possible to plan empirical studies in which theoretical advances and operative goals on disability in a person-environment framework can support the definition of a research design, measurement strategies, and data analysis. The description of functioning and disability at population level is no more based on individual deficits or limitations. Personal profiles may be elaborated and groups created based on the characteristics of the person-environment interactions. Personal profiles may also be used as a “rationale” for defining personalized intervention programs.