While mobility in older age is of crucial importance for health and well-being, it is worth noting that currently, there is no German language framework for measuring walkability for older adults that also considers the functional status of a person. Therefore, we combined the results of an expert workshop, a literature review, and a Delphi consensus survey. Through this, we identified and rated indicators relevant for walkability for older adults, additionally focusing on their functional status. The expert workshop and the review led to an extensive list of potential indicators, which we hope will be useful in future research. Those indicators were then adapted and rated in a three-stage Delphi expert survey. A fourth additional Delphi round was conducted to assess the relevance of each indicator for the different frailty levels, namely \"robust,\" \"pre-frail,\" and \"frail.\" Between 20 and 28 experts participated in each round of the Delphi survey. The Delphi process resulted in a list of 72 indicators deemed relevant for walkability in older age groups, grouped into three main categories: \"Built environment and transport infrastructure,\" \"Accessibility and meeting places,\" and \"Attractiveness and sense of security.\" For 35 of those indicators, it was suggested that functional status should be additionally considered. This framework represents a significant step forward in comprehensively covering indicators for subjective and objective walkability in older age, while also incorporating aspects of functioning relevant to older adults. It would be beneficial to test and apply the indicator set in a community setting.

Cognitive deficits are a core impairment across the range of schizophrenia (SZ) spectrum disorders, including schizotypal personality disorder (SPD). The MATRICS Consensus Cognitive Battery (MCCB) was developed to be a robust, specific, and valid cognitive assessment battery to assess cognition in clinical trials for treating cognitive impairments in SZ. Despite the similarity of cognitive impairments shown in SPD and SZ and the clear relevance of uniform assessment across a diagnostic spectrum, the MCCB has yet to be validated in SPD. As such, this is the first study to evaluate the sensitivity of the MCCB for the assessment of cognitive function in individuals with SPD. Participants were 30 individuals with SPD and 54 healthy controls (HC) assessed with the MCCB and supplemental neurocognitive assessments (Trails B, DOT test, Paced Auditory Serial Addition Test (PASAT), AX Continuous Performance Task (AX-CPT), and N-back). Individuals with SPD performed worse than HC participants on all MCCB subtests, as well as on converging supplemental tasks including Trails B, DOT test, PASAT, AX-CPT, and N-back. These results indicate that the MCCB was sensitive to cognitive impairment in SPD compared to controls. SPD participants demonstrate impairments similar to data of SZ participants within the literature, although to a slightly lesser degree of severity. Taken together, these results highlight the generalizability of using the MCCB across SZ spectrum diagnostic groups to assess cognition. Such findings allow for further comparison across disorders, greater understanding of the cognitive characteristics in the spectrum, and use of uniform assessment within cognitive intervention research.

UNASSIGNED: Chronic pain is a public health concern affecting 20-30% of the population of Western countries. Focus groups of people with persistent pain indicated that their overall physical function had deteriorated because of pain, therefore assessment of function should be an integral part of pain assessment. The objective of this study was to establish a consensus on assessment of function in chronic pain primary care patients and to evaluate the use of scales and clinical guidelines in clinical practice.
UNASSIGNED: A Delphi study (CL4VE study) was carried out. A group of primary care physicians, were asked to rate how strongly they agreed/disagreed with the statements in: general functioning data, and functioning outcomes in chronic pain patients.
UNASSIGNED: Seventy-one primary care physicians were invited to participate. Of these, 69 completed Round 1 (98.5% response rate), and 68 completed Round 2 (97.1%). Under the predefined criterion, a high degree of agreement (91.4%) was observed, this was confirmed in 32 of 35 questions in the second round. Discrepancies were noted, firstly, because functioning was only linked to joint recovery; secondly, in the use of specific scales and questionnaires to measure functioning, and thirdly, that no scale of functioning is used in clinical practice due to complexity and lack of time for assessment.
UNASSIGNED: Physicians agreed on the need for a precise definition of the concept of patient functional impediment to facilitate homogeneous recognition, and for the development of simple and practical scales focused on patients with chronic pain and their needs.

Attention-deficit/hyperactivity disorder (ADHD) is associated with significant impairments in social, educational, and occupational functioning, as well as specific strengths. Currently, there is no internationally accepted standard to assess the functioning of individuals with ADHD. WHO\'s International Classification of Functioning, Disability and Health-child and youth version (ICF) can serve as a conceptual basis for such a standard. The objective of this study is to develop a comprehensive, a common brief, and three age-appropriate brief ICF Core Sets for ADHD. Using a standardised methodology, four international preparatory studies generated 132 second-level ICF candidate categories that served as the basis for developing ADHD Core Sets. Using these categories and following an iterative consensus process, 20 ADHD experts from nine professional disciplines and representing all six WHO regions selected the most relevant categories to constitute the ADHD Core Sets. The consensus process resulted in 72 second-level ICF categories forming the comprehensive ICF Core Set-these represented 8 body functions, 35 activities and participation, and 29 environmental categories. A Common Brief Core Set that included 38 categories was also defined. Age-specific brief Core Sets included a 47 category preschool version for 0-5 years old, a 55 category school-age version for 6-16 years old, and a 52 category version for older adolescents and adults 17 years old and above. The ICF Core Sets for ADHD mark a milestone toward an internationally standardised functional assessment of ADHD across the lifespan, and across educational, administrative, clinical, and research settings.

Practice guidelines recommend the use of standardized instruments in the treatment of alcohol use disorders (AUDs); however, the extent to which these instruments assess patients\' functioning is unclear. The aim of this study was to examine the domains of functioning and contextual factors contained in guideline-recommended instruments, using the International Classification of Functioning, Disability, and Health (ICF) as a reference.
We identified instruments by reviewing AUD treatment guidelines used in Germany, Canada, Australia and New Zealand, United Kingdom, and United States. We included instruments which were available in English free of charge, we excluded instruments developed solely for diagnostic or epidemiological purposes and those for children or adolescents. Following a standardized set of rules, two health care researchers identified the concepts contained in the items on the instruments and independently linked them to ICF categories.
A total of 10 instruments were included. Among 517 items, 752 meaningful concepts (MCs) were derived, and 622 of them were linked to the ICF. Inter-rater agreement was κ = 0.61. One hundred eighty eight MCs referred to personal factors, 175 to body functions, 168 to activity and participation, and 91 to environmental factors. The most frequently linked ICF chapter was b1 (mental functions).
Instruments recommended in AUD treatment guidelines vary considerably in their assessment of patients\' functioning and contextual factors. Within the investigated instruments, environmental factors are under-represented in comparison to body functions and personal factors. ICF linkage provides guidance for clinicians and researchers in the selection of appropriate instruments. Implications for rehabilitation Since instruments that are recommended in alcohol treatment guidelines vary considerably in respect the functioning domains and context factors they cover, it may be challenging for clinicians to select instruments relevant to their treatment context. Using the ICF as framework, our results provide guidance for clinicians in how to select appropriate instruments. Within the investigated instruments, environmental factors and activities and participation are under-represented in comparison to body functions and personal factors. Clinicians may employ AUD-unspecific or ICF-based instruments to cover these components if needed.

Criteria developed by the Remission in Schizophrenia Working Group (RSWG), based upon 8 core symptoms of PANSS, are generally used for evaluation of Remission. However, some concerns have arisen as regard to the ability of the RSWG criteria to detect truly remitted cases. This study aims to compare the severity criteria of remission defined by the RSWG (RSWG-cr) with more restrictive criteria, based upon the use of PANSS factor model.
METHODS: 112 chronic psychotic outpatients were examined. Symptomatic remission according to RSWGcr was compared with remission according to criteria based on the 20-items of PANSS considered in the consensus five factor model (PANSS-FCTcr), in relation to functional and neurocognitive outcomes.
RESULTS: Data from the study demonstrated the superiority of PANSS-FCTcr in identifying patients with higher functional and cognitive outcomes.
CONCLUSIONS: PANSS-FCTcr seems to be suitable for use in both common clinical practice and research setting, being associated with improved identification of truly remitted patients.

Autism spectrum disorder is associated with diverse social, educational, and occupational challenges. To date, no standardized, internationally accepted tools exist to assess autism spectrum disorder-related functioning. World Health Organization\'s International Classification of Functioning, Disability and Health can serve as foundation for developing such tools. This study aimed to identify a comprehensive, a common brief, and three age-appropriate brief autism spectrum disorder Core Sets. Four international preparatory studies yielded in total 164 second-level International Classification of Functioning, Disability and Health candidate categories. Based on this evidence, 20 international autism spectrum disorder experts applied an established iterative decision-making consensus process to select from the candidate categories the most relevant ones to constitute the autism spectrum disorder Core Sets. The consensus process generated 111 second-level International Classification of Functioning, Disability and Health categories in the Comprehensive Core Set for autism spectrum disorder-one body structure, 20 body functions, 59 activities and participation categories, and 31 environmental factors. The Common Brief Core Set comprised 60 categories, while the age-appropriate core sets included 73 categories in the preschool version (0- to 5-year-old children), 81 in the school-age version (6- to 16-year-old children and adolescents), and 79 in the older adolescent and adult version (⩾17-year-old individuals). The autism spectrum disorder Core Sets mark a milestone toward the standardized assessment of autism spectrum disorder-related functioning in educational, administrative, clinical, and research settings.

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.

OBJECTIVE: Providing a wheelchair or scooter is a complex therapy intervention aimed at enhancing the person\'s functioning. The research and experience has shown that a wheelchair which is poorly matched to the individual, adversely affects potential activities and participation, lifestyle goals, health status and can be costly. The development of an evidence-based clinical guideline will provide a synthesis of the evidence and recommendations for best practice.
METHODS: The guidelines were developed using a rigorous methodology of systematic search for primary studies, critical appraisal and synthesis of the evidence using an adaptation of the National Health and Medical Research Council recommendation grades in conjunction with a multidisciplinary working party.
RESULTS: Seventy-six recommendations were developed from 44 clinical questions related to goals, assessment and review, capacity and performance, upper limb capacity and injury risk, wheelchair features, propulsion, training, transport and maintenance. Resources were developed to support the use of the guidelines. Only examples of recommendations are provided here. The complete guidelines and technical report should be downloaded from http://www.lifetimecare.nsw.gov.au/Brain_Injury.aspx.
CONCLUSIONS: The guidelines provide appraisal and synthesis of the literature and recommendations for best practice on the prescription of a wheelchair or scooter for adults with spinal cord injury and/or traumatic brain injury. The guidelines are intended to reduce the potential for poor wheelchair prescription, inform and guide practice to enhance outcomes. Through judicious application of the available research, these guidelines provide best practice recommendations for prescribing the most appropriate wheelchair for a person with a traumatic brain injury/spinal cord injury.