Graphical models illustrated complex associations between variables describing human functioning.
OBJECTIVE
To examine whether graphical modeling is a potentially useful method for the study of human functioning using data collected by means of the International Classification of Functioning, Disability and Health (ICF).


METHODS
The applicability of the method was examined in a convenience sample of 616 patients from a cross-sectional multicentric study undergoing early postacute rehabilitation. Functioning was qualified using 115 second-level ICF categories. The modeling was carried out on a data set with imputed missing values. The least absolute shrinkage and selection operator (LASSO) for generalized linear models was used to identify conditional dependencies between the ICF categories. Bootstrap aggregating was used to enhance the accuracy and validity of model selection.


RESULTS
The resulting graph showed highly meaningful relationships. For example, one structure centered around speaking and included three paths addressing conversation, speech functions, and mental functions of language.


CONCLUSIONS
Graphical modeling of human functioning using data collected by means of the ICF yields clinically meaningful results. The structures found may be the basis for the identification of suitable targets for rehabilitation interventions, the identification of confounders and intermediate variables, and the selection of parsimonious sets of variables for multivariate epidemiological modeling.
Strobl
Ralf
R
Institute for Health and Rehabilitation Sciences, Ludwig-Maximilian University, Munich, Germany.
Stucki
Gerold
G
Grill
Eva
E
Müller
Martin
M
Mansmann
Ulrich
U
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012046:Rehabilitation; D012047:Rehabilitation Centers; D055815:Young Adult