title: The applicability of the international classification of functioning, disability, and health to study lifestyle and quality of life of colorectal cancer survivors.
abstract: BACKGROUND
  Well-designed studies on lifestyle and health-related quality of life (HRQoL) in colorectal cancer survivors based on a biopsychosocial instead of a traditional biomedical approach are warranted. We report on the applicability of the International Classification of Functioning, Disability, and Health (ICF) as useful biopsychosocial framework to improve research on how lifestyle influences colorectal cancer survivors' HRQoL, using the Energy for life after ColoRectal cancer (EnCoRe) study as an example.
  
  
  METHODS
  The ICF was used to develop a conceptual model for studying lifestyle and colorectal cancer survivors' HRQoL, by identifying relevant factors from literature and mapping them within the ICF. Subsequently, this model was used for selection of measurement instruments and biomarkers. By linking meaningful concepts within selected measures to the ICF, we could assess the ICF coverage of our developed conceptual model.
  
  
  RESULTS
  Within selected measures, 450 meaningful concepts were identified, of which 88% were linked to the ICF. The linking process resulted in 132 distinctive ICF categories assigned (38% within "Body Functions," 2% within "Body Structures," 46% within "Activities and Participation," and 14% within "Environmental Factors").
  
  
  CONCLUSIONS
  The selected EnCoRe study measures broadly cover ICF domains relevant to colorectal cancer survivors, stressing the relevance of using a biopsychosocial approach for studying this population's HRQoL.
  
  
  CONCLUSIONS
  The developed conceptual model will guide data analyses and interpretation, and facilitate early transfer of results for development, evaluation, and implementation of personalized multidisciplinary lifestyle interventions. We recommend the ICF as an invaluable framework for improving the quality and scope of HRQoL studies.
authors.affiliation: Authors' Affiliations: Department of Epidemiology, GROW - School for Oncology and Developmental Biology; and eline.vanroekel@maastrichtuniversity.nl.
authors.forename: Eline H
authors.initials: EH
authors.lastname: van Roekel
authors.affiliation: Authors' Affiliations: Department of Epidemiology, GROW - School for Oncology and Developmental Biology; and.
authors.forename: Martijn J L
authors.initials: MJ
authors.lastname: Bours
authors.affiliation: Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands;
authors.forename: Carin P M
authors.initials: CP
authors.lastname: de Brouwer
authors.affiliation: WHO-FIC Collaborating Centre, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Huib
authors.initials: H
authors.lastname: Ten Napel
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology;
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanduleanu
authors.affiliation: Oncology Center University Hospital Maastricht; and Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; and.
authors.forename: Geerard L
authors.initials: GL
authors.lastname: Beets
authors.affiliation: Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands;
authors.forename: I Jmert
authors.initials: IJ
authors.lastname: Kant
authors.affiliation: Authors' Affiliations: Department of Epidemiology, GROW - School for Oncology and Developmental Biology; and.
authors.forename: Matty P
authors.initials: MP
authors.lastname: Weijenberg
mesh_terms: D015179:Colorectal Neoplasms / Q000523:psychology*; D006801:Humans; D038801:International Classification of Diseases; D008019:Life Style; D011446:Prospective Studies; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*