Full Length Article| Volume 36, ISSUE 1, P74-84, January 2023

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ICF linking of patient-reported therapy goals for children with acquired upper extremity impairment


      • For children (age 6-18) the greatest proportion of their treatment priorities align with specific aspects of hand and arm use (ICF chapter d445).
      • Participation in sports and fitness, performing arts, and play are of greater priority that participation in self-care for the population.
      • The body functions priorities for the population include: pain, joint mobility and strength.



      Patient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy.


      To determine the desired treatment outcomes of children with acquired upper extremity impairments.

      Study design

      Descriptive case series


      Two raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of the linked codes.


      Following consensus, two independent raters linked 894 meaningful concepts to the study population's 501 goals derived from the Canadian Occupational Performance. Ninety-two unique ICF codes were linked to these 894 meaningful concepts. Twenty-three ICF codes account for 77.2% of the most frequently linked codes. For these top 23 codes, the greatest proportion (51.4%) of ICF codes are in the d4 mobility chapter representing specific constructs of hand and arm use. The second largest proportion (14.2%) of linked codes are in the d9 Community, society and civic life chapter aligning with participation in sports, music, performing arts and play. Within the d5 self-care chapter, the study population's top priorities included hair care, fitness and drinking. The primary concerns within the b body functions domain are reduced pain, improved joint mobility and strength.


      The study population's top priorities align with specific dimensions of hand and arm use and participation in sports and fitness, performing arts, and play. Further research may elucidate alignment of these patient-desired outcomes and the item banks of commonly used patient reported outcome measurement scales in this population.


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      JHT Read for Credit

      Quiz: # 928

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
        • b.
          case study
        • c.
          case series
        • d.
      • # 2.
        Linkage was evaluated looking at
        • a.
          frequency distributions
        • b.
          amplitude distributions
        • c.
          a limited sample of responses
        • d.
          mega data
      • # 3.
        Surveyed children participants identified approximately _______ goals
        • a.
        • b.
        • c.
        • d.
      • # 4.
        Nearly 25 ICF codes accounted for approximately ______ of the most frequently linked codes
        • a.
        • b.
        • c.
        • d.
      • # 5.
        The linkages found were sufficient to warrant further investigation
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.