title: The selection of core International Classification of Functioning, Disability, and Health (ICF) categories for patient-reported outcome measurement in spine trauma patients-results of an international consensus process.
abstract: There is no outcome instrument specifically designed and validated for spine trauma patients without complete paralysis, which makes it difficult to compare outcomes of different treatments of the spinal column injury within and between studies.
  
  
  
  The paper aimed to report on the evidence-based consensus process that resulted in the selection of core International Classification of Functioning, Disability, and Health (ICF) categories, as well as the response scale for use in a universal patient-reported outcome measure for patients with traumatic spinal column injury.
  
  
  
  The study used a formal decision-making and consensus process.
  
  
  
  The sample includes patients with a primary diagnosis of traumatic spinal column injury, excluding completely paralyzed and polytrauma patients.
  
  
  
  The wide array of function and health status of patients with traumatic spinal column injury was explored through the identification of all potentially meaningful ICF categories.
  
  
  
  A formal decision-making and consensus process integrated evidence from four preparatory studies. Three studies aimed to identify relevant ICF categories from three different perspectives. The research perspective was covered by a systematic literature review identifying outcome measures focusing on the functioning and health of spine trauma patients. The expert perspective was explored through an international web-based survey among spine surgeons from the five AOSpine International world regions. The patient perspective was investigated in an international empirical study. A fourth study investigated various response scales for their potential use in the future universal outcome instrument. This work was supported by AOSpine. AOSpine is a clinical division of the AO Foundation, an independent medically guided non-profit organization. The AOSpine Knowledge Forums are pathology-focused working groups acting on behalf of AOSpine in their domain of scientific expertise.
  
  
  
  Combining the results of the preparatory studies, the list of ICF categories presented at the consensus conference included 159 different ICF categories. Based on voting and discussion, 11 experts from 6 countries selected a total of 25 ICF categories as core categories for patient-reported outcome measurement in adult traumatic spinal column injury patients (9 body functions, 14 activities and participation, and 2 environmental factors). The experts also agreed to use the Numeric Rating Scale 0-100 as response scale in the future universal outcome instrument.
  
  
  
  A formal consensus process integrating evidence and expert opinion led to a set of 25 core ICF categories for patient-reported outcome measurement in adult traumatic spinal column injury patients, as well as the response scale for use in the future universal disease-specific outcome instrument. The adopted core ICF categories could also serve as a benchmark for assessing the content validity of existing and future outcome instruments used in this specific patient population.
authors.affiliation: Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA Utrecht, The Netherlands. Electronic address: s.sadiqi-3@umcutrecht.nl.
authors.forename: Said
authors.initials: S
authors.lastname: Sadiqi
authors.affiliation: Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA Utrecht, The Netherlands.
authors.forename: A Mechteld
authors.initials: AM
authors.lastname: Lehr
authors.affiliation: Rehabilitation Center "De Hoogstraat", Rembrandtkade 10, 3583TM Utrecht, The Netherlands; Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Hanzeplein 1, 9713 Groningen, The Netherlands.
authors.forename: Marcel W
authors.initials: MW
authors.lastname: Post
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands.
authors.forename: Wilco C H
authors.initials: WC
authors.lastname: Jacobs
authors.affiliation: Department of Neurosurgery, University of Maryland, 22 S Greene St, Suite S-12-D, Baltimore, MD, USA.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: Department of Neurosurgery, Swedish Neurosciences Institute, 500 17th Ave, Seattle, WA, USA.
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Division of Orthopedic Surgery, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, 7935, Cape Town, South Africa.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Dunn
authors.affiliation: Department of Orthopaedics, University of British Columbia, 818 10th Avenue West, Vancouver, British Columbia, V5Z 1M9 Canada.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: Division of Neurosurgery, 4W449, Toronto Western Hospital, 399 Bathurst St, Toronto, M5T 2S8, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Department of Orthopaedic and Spine Surgery, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India.
authors.forename: S
authors.initials: S
authors.lastname: Rajasekaran
authors.affiliation: Department of Orthopaedics, Catholic University of Parana, Brigadeiro Franco 979 80.430-210, Curitiba, Brazil.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Vialle
authors.affiliation: Department of Orthopaedics, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA Utrecht, The Netherlands.
authors.forename: F Cumhur
authors.initials: FC
authors.lastname: Oner
mesh_terms: D000203:Activities of Daily Living; D032921:Consensus; D006801:Humans; D064702:International Classification of Functioning, Disability and Health / Q000592:standards*; D010361:Patients; D057566:Self Report; D013124:Spinal Injuries / Q000145:classification* / Q000473:pathology
keywords: Consensus process; Core ICF categories; Functioning; ICF; Outcome instrument; Spine trauma