This study was the first attempt in South Korea to develop a practical tool for using the generic functioning domains of ICD-11 Chapter V in clinical rehabilitation settings. The first step in this process was the drafting of the Korean SID initial proposals by referencing results from overseas studies using the SID development methodology for clinical use of the ICF. Among the components of the generic functioning domains, the initial proposals for the rehabilitation sets were prepared by referencing results from overseas studies and ICF original descriptions. The initial proposals for the remaining items were also prepared based on the original ICF descriptions. The final revisions were made based on the opinions of Korean language scholars from an expert advisory meeting.
The second step included the multi-stage consensus conference, for which experts in multi-disciplinary rehabilitation fields were selected and divided into three WGs. The final proposals for the Korean version of the SIDs were selected through three rounds of voting.
Lastly, a four-member multi-disciplinary panel was requested to translate the final proposals for the Korean version of the SIDs into English. During the translation process, revisions were made to expressions that did not accurately convey the meaning or were not consistent with the original ICF definitions. In addition, an expert in the medical field with English editing experience was requested to edit the English-translated material to develop the English version of the Korean SIDs.
This study followed the same SID development process used in China, Italy, and Japan [4, 6]. However, the implementation of the process differed from that of the previous studies. One of the major differences is that the conference was carried out via virtual meetings, unlike the methodology used by the other studies, due to the circumstances surrounding the COVID-19 pandemic.
Since the initial outbreak of COVID-19 in China in December 2019, video conferencing programs have seen exponential growth. For example, the number of Zoom users was approximately 10 million toward the end of 2019, but the number increased explosively to 300 million by April 2020 . This was due to the growing global demand from schools holding online classes and businesses relying on remote work and meetings. Further, Zoom meetings have the advantage of being a safe option with low infection risk when distancing between people has become essential.
According to studies from other countries, the medical environment in the US and Europe is using video conferencing to diagnose patients and make internal decisions among medical staff . Moreover, the UN General Assembly, an international organization, also held remote sessions for multilateral decision-making during the COVID-19 pandemic.
In this study, Zoom was used as a tool for virtual meetings. The virtual meeting format was being used for the first time, and some advisors may not have been familiar with virtual meetings. Moreover, there were internal opinions among the research team members that longer discussion time may be needed to prepare a new SID proposal after reviewing and discussing relevant materials. This was more so because the workshop was being held in a non-face-to-face format. Therefore, the number of workshop sessions was changed from one to two. Further, attempts were made to shorten the duration of the workshops by having the materials and data submitted to the participants in advance.
People were somewhat unfamiliar with the virtual meeting format during the actual workshop. Nonetheless, the discussions within each WG for the new proposal for SID development were active. Moreover, the plenary session, where the final voting took place, was carried out without major difficulties. When using Zoom for future decision-making meetings, it may be necessary to conduct such meetings by also considering methods that can overcome Zoom fatigue experienced while conducting the workshop in this study.
This study was conducted in compliance with the contents of the “Instructions: Country Version of the ICF Clinical Tool” from the ICF Research Branch. In particular, efforts were made to recruit experts from various disciplines. The aforementioned studies from China and Italy mentioned that participation by multi-disciplinary expert panels is important for the developed ICF tools to be applicable in clinical settings [4, 6]. They also reported that cooperation from such multi-disciplinary panels could enhance the quality of the consensus process and final SID development. Therefore this study also selected multi-disciplinary participants from various fields of occupation, ensuring that experts from different disciplines were distributed evenly in each WG. Regarding sex, the overall percentage of females was higher. However, this result reflects the characteristics of the nursing, psychology, and social welfare fields. Among rehabilitation fields, these typically have a higher percentage of females.
In the SID development process, maintaining the equivalence of concepts and meanings between the ICF concepts and the SIDs was important. The ICF is an international standard tool developed for collecting functioning and disability-related data. The SIDs developed in Italy, China, and Japan must show a conceptual (terms must have the same meaning) and semantic (meaning must be the same as the association with the concept) match with the original ICF ; this is important for comparison with data collected from other parts of the world. We also considered this to be important. Accordingly, we contacted the authors of the other studies and obtained their initial proposals. However, when applying the ICF concepts, we faced difficulties during the process of translating the initial proposals into Korean. For example, when an ICF concept was included as an example, such addition made it intuitive, but not simple, raising concerns about use in actual clinical settings. In addition, there were concerns about the original concept becoming distorted when translating English content into Korean or when Korean cultural characteristics needed to be reflected.
In the case of Italy, Japan, and China, the SID versions were developed to enhance the clinical use of the ICF rehabilitation set. The ICF Generic-30 set (rehabilitation set) is a useful tool for assessing and reporting disabilities and functioning for continued treatment of clinical patients . However, it is difficult to use in clinical settings because it has too many categorized items. Consequently, the ICF core set was developed, and there have been various efforts to use it in a wide range of health statuses and specific environments. In addition, the SID versions were also developed because the ICF definitions were difficult to understand. The advantages of the SID version include the fact that function-related data could be compared and shared between countries for international projects. Further, it is a tool that allows clinicians to easily understand the concepts in clinical settings and make assessments accordingly. Moreover, many countries have already completed SID development, or the developments are in progress. Accordingly, the present study also developed the SID version described in the report to promote international cooperation for the activation of the ICF and to enable its use in clinical settings.
The present study can be differentiated from the other studies in that it was the first study in Korea to develop a Korean version of SIDs for the ICD-11 Chapter V generic functioning domains. Furthermore, existing studies on SID development developed a version of SIDs for 30 rehabilitation sets. The present study expanded on the 30 rehabilitation sets and also added ICD-11 Chapter V items (47 items). WHODAS 2.0 and MDS brief versions comprising items from ICD-11 Chapter V are based on self-reporting by the user . Conversely, the biggest characteristic of SIDs is that the results are based on the determination (assessment) by rehabilitation specialists in clinical practice. Moreover, rehabilitation specialists could complimentarily use SIDs for “subjective reporting” and “objective assessment.”
Therefore, the findings of the present study could be used broadly in the field when ICD-11 is adopted for use in Korean clinical settings. Moreover, the accumulation of a significant volume of data regarding rehabilitation patients would enable international comparisons.
For actual clinical use of ICD-11 Chapter V, additional efforts are needed, such as coding and insurance fee development based on the development of a rating scale. Once such a tool is developed for clinical use, both the assessment in a single field and the assessment of overall function will become easier. Moreover, the tool development underwent a consensus-building process involving various multidisciplinary clinicians. Therefore, the tool could also be used as a link between various clinicians in actual clinical settings. The functions could include patient assessment, the detection of functional changes in patients, and the sharing of information regarding patient functioning. Furthermore, if the same reference guidelines are available, then it offers the advantage of enabling mutual assessment of a single patient. Therefore, Korea also needs to develop a manual that includes a rating scale.
Italy, for instance, developed SIDs for the ICF Generic-30 set (rehabilitation set) for assessing and reporting disabilities and functioning. A study that applied the SIDs to outpatients in clinical settings was then conducted to examine their convenience of use . In Taiwan, WHODAS has been applied to patients with dementia since 2012, and such a policy is also applicable to people with disabilities . In Korea, ICF has been studied and Korean versions of WHODAS and MDS have been developed for use in the treatment environment, but they are not actively used as in other countries. Therefore, just as in the study from Japan, Korea also has an urgent need to develop a SID rating reference guide and interrater reliability . This way a tool suitable for clinicians in various fields of rehabilitation medicine could be used to assess actual rehabilitation patients. Once the usefulness of the tool in clinical settings is validated, such data could be used as evidence when establishing policies regarding rehabilitation medicine, as well as for actualization of insurance fee policies.
In addition, strengthening of the international network is needed. China developed SIDs for ICF categories and created a multi-stage national consensus process through the cooperation of experts from the Chinese Association of Rehabilitation Medicine and the Chinese Society of Physical Medicine and Rehabilitation. This allowed China to implement the ICF system nationally by improving its clinical utilization and utility. In Italy, an Italian version of SIDs was developed through a multi-stage national consensus process, together with PRM experts in China, to establish a standardized reporting system for functioning in ICF rehabilitation-related fields. Additionally, the development of SIDs has been completed in Japan, Belgium, and the Netherlands . As shown, major decision-makers in rehabilitation medicine from countries outside of Korea are forming ICF meetings and networks to share their research findings and usage experience.
There is also a need to build a stronger international network with ICF researchers who are actively working abroad. This could help in the sharing of information about the clinical use of ICF for each country and the establishment of a national research conference for accumulating data related to functioning properties. Such international research conferences could be used to compare disabilities and functioning between countries through the sharing of a network with major decision-makers in each country. The conferences could also provide basic data that could be used as evidence when establishing policies in the field of rehabilitation medicine in the Korean healthcare system.
The present study did not consider regional representation. The participants in the studies from other countries were selected by considering regional representation. The study from Italy included participants from northern (n = 8), southern (n = 6), and central (n = 5) Italy .
All participants in the present study were residents of the national capital region (Seoul and Gyeonggi region; data not shown). Because Korea has a single geographical/cultural characteristic, regional representation was not applied. However, the participants were enrolled from the public and private sectors. This ensured the inclusion of experts from the public sector, private sector and associations.