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Implementation and use of the ICF Core Sets for hand conditions in clinical practice, rehabilitation and research: Lighthouse Project Hand

In January 2012, the Lighthouse Project Hand started as a cooperation project between the Department of Hand Surgery, Plastic- and Microsurgery, Trauma Hospital Hamburg (Germany) and the Research Unit for Biopsychosocial Health at the Department of Medical Informatics, Biometry and Epidemiology - IBE, Ludwig-Maximilian University (LMU) Munich (Germany). The aim of the project is to operationalize, implement and use the ICF Core Sets for hand conditions as a monitoring tool in the treatment and rehabilitation of persons with hand conditions along the continuum of care in the institutions of the statutory accident insurance in Germany.

In order to achieve this aim we will:

  • use the ICF as a basis for communication among health professionals involved in the treatment and rehabilitation of patients with hand conditions, researchers and health scientists in the field of hand conditions, medical document specialists and statisticians, rehabilitation managers and members of (health) insurance companies and services,
  • develop an ICF-based assessment procedure and treatment guidelines for clinical practice in institutions of the statutory accident insurance in Germany along the continuum of care from the acute phase to the (re-)integration into work,
  • implement ICF-based documentation modules to improve communication among hospitals, clinical departments and the statutory accident insurance institutions,
  • develop teaching materials, manuals and an (e-)learning tool for clinical practice and research.

Up to now we have conducted systematic literature reviews to identify adequate assessment instruments and to operationalize the ICF categories of the Brief ICF Core Set for hand conditions. We also carried out an e-mail-based expert survey (N=161 hand specialists of different health professions) to identify assessment instruments that are used in clinical practice in German-speaking countries. A multi-step consensus process involving 41 experts in the field of hand conditions was carried out by providing evidence retrieved from the results of the systematic literature reviews and the expert survey. The experts determined a two-step assessment procedure including instruments that capture the categories of the Brief ICF Core Set for hand conditions. Additionally, the DASH (Disability of the arm, shoulder and hand) questionnaire was selected to address the patient perspective.

A multicenter cross-sectional study involving 294 patients at 11 study sites has been carried out in 2013 by using the ICF-based two-step assessment procedure. Based on the data obtained an ICF-based Hand Score was developed aiming to quantify the functioning status of persons with hand conditions. Besides this, a decision-making process has been established to develop ICF-based treatment guidelines for the following injuries and diseases of the hand: flexor tendon injuries, hand fractures, amputations at the hand, M. Dupuytren, arthrosis of the carpometacarpal joint, complex regional pain syndrome and hand eczema.

At the end of 2014, a multicenter longitudinal study will begin. This study intends to implement the ICF-based assessment procedure and the treatment guidelines along the continuum of care. Data will be documented by using an electronic data collection tool.

A German website ( has already been established to provide information on the project. The website will additionally be used as a platform to present teaching materials and manuals developed during the project, as well as an e-learning tool for clinical practice and research and case studies demonstrating the implementation of the treatment guidelines and the ICF-based assessment. See also the poster C533 presented at the WHO-FIC Annual Meeting 2013.

The project is funded by the German Social Accident Insurance (DGUV).

For more information, please contact Dr. Michaela Coenen