Linking Crohn's disease health status measurements with International Classification of Functioning, Disability and Health and vocational rehabilitation outcomes
Christoph Reichel, Jürgen Streit, Steffen Wunsch
Objective: The International Classification of Functioning, Disability and Health (ICF) serves as a unifying model for rehabilitation medicine. Variables of the health status measurements, the Crohn’s Disease Activity Index and the Harvey-Bradshaw Index, have not been linked with the ICF categories and compared with other predictors of rehabilitation outcomes.
Methods: Crohn’s Disease Activity Index variables were linked with ICF categories using linking rules. A chart review included the patients of our in-patient rehabilitation centre during one year (n = 355) with International Classification of Disease Codes for Crohn’s disease (ICD K50). We identified variables linked with clinical improvement (decrease in the Harvey-Bradshaw Index of ≥ 2 U) and rehabilitation success (conversion from unfit-to-work to fit-to-work) by multivariate logistic regression.
Results: The ICF component, activities and participation, was not represented in the Crohn’s Disease Activity Index and the Harvey-Bradshaw Index. A Harvey-Bradshaw Index
≥ 5 U was associated with clinical improvement during rehabilitation (odds ratio 5.65 (95% CI 3.41–9.35)). Normal C-reactive protein (odds ratio 2.8 (95% CI 1.1–7.0)) and higher body mass index (odds ratio (per 1 kg/m2 increase) 1.1 (95% CI 1.0–1.2)), but not Harvey-Bradshaw Index, were associated with vocational rehabilitation success in 124
patients who were initially unfit-to-work.
Conclusion: Variables representing activities and participation as well as immune functions may improve Crohn’s disease health status measurements on the basis of better prediction of vocational rehabilitation success.