Occupational Therapy International

Occupational Therapy International / 2021 / Article

Research Article | Open Access

Volume 2021 |Article ID 6666203 | https://doi.org/10.1155/2021/6666203

Shigehito Shiota, Makiko Naka, Toshiro Kitagawa, Takayuki Hidaka, Naoki Mio, Kana Kanai, Mariko Mochizuki, Hiroaki Kimura, Yasuki Kihara, "Selection of Comprehensive Assessment Categories Based on the International Classification of Functioning, Disability, and Health for Elderly Patients with Heart Failure: A Delphi Survey among Registered Instructors of Cardiac Rehabilitation", Occupational Therapy International, vol. 2021, Article ID 6666203, 9 pages, 2021. https://doi.org/10.1155/2021/6666203

Selection of Comprehensive Assessment Categories Based on the International Classification of Functioning, Disability, and Health for Elderly Patients with Heart Failure: A Delphi Survey among Registered Instructors of Cardiac Rehabilitation

Academic Editor: Claudia Hilton
Received09 Nov 2020
Accepted15 Jun 2021
Published28 Jun 2021

Abstract

The development of a comprehensive assessment tool based on the International Classification of Functioning, Disability, and Health (ICF) for elderly patients with heart failure is urgently required. In this study, we classified the ICF categories relevant to heart failure in the elderly through a Delphi survey (3-step questionnaire survey) of 108 Registered Instructors of Cardiac Rehabilitation in the Hiroshima Prefecture. Questionnaires were conducted using postal mail or a web-based platform. The survey was conducted three times, and the survey results were provided as feedback to the participants in the second and third rounds. More than 80% of the respondents selected categories according to the ICF core set methodology. Data were collected from December 2018 to March 2019, with 67, 54, and 46 participants in the first, second, and third rounds, respectively. A total of 58 ICF items were adopted based on the results: 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items. This study is characterised by the inclusion of a large number of ICF items for mental function. This result seems to be influenced by the increasing interest in cognitive dysfunction in elderly patients with heart failure. The ICF categories selected for this study allow for a comprehensive assessment of clients for occupational therapy. The findings of this study are expected to provide a basis for an outcome measure to determine the effectiveness of occupational therapy for these patients.

1. Introduction

The elderly population with heart failure is increasing globally with the increase in the aging population, and the number of patients with heart failure is estimated to exceed 1.3 million by 2030 in Japan [1]. Previous studies have shown that approximately 35% of patients with heart failure are rehospitalised within 1 year [2]. Many lifestyle-related factors, such as high salt and water intake, poor medication adherence, overwork, and physical and mental stress, are known to exacerbate heart failure [3]. Furthermore, comprehensive factors that are reported to be associated with readmission include physical functioning, such as exercise tolerance [4] and walking speed [5]; mental functioning, such as cognitive functioning [6], depression [7], and anxiety [8]; personality [9], activity and participation, such as activities of daily living [10], instrumental activities of daily living (IADL) [5], and leisure [11]; and social support [12]. Comprehensive cardiac rehabilitation that is managed by a multidisciplinary team reduces mortality and readmissions in elderly patients with heart failure [1319]. In Japan, there is a qualifying program for the provision of comprehensive cardiac rehabilitation: the Registered Instructors of Cardiac Rehabilitation (RICRs), issued by the Japanese Association of Cardiac Rehabilitation (JACR). The RICRs are accredited by the JACR and consist of doctors, nurses, physiotherapists, occupational therapists, management dietitians, pharmacists, and clinical psychologists. As part of the multidisciplinary team, occupational therapists have the responsibility to promote the quality of life and health of elderly patients with heart failure. In multidisciplinary team management, it is important to share not only disease information but also information on functioning, disability, environmental factors, and personal factors based on the International Classification of Functioning, Disability, and Health (ICF) framework [20]. The ICF is a health and health-related framework, published by the World Health Organization (WHO) in 2001, which classifies human life into approximately 1500 codes. The ICF is strongly relevant from the perspective of occupational therapy. In Japan, the Japanese Association of Occupational Therapists has developed the Management Tool for Daily Life Performance (MTDLP) by utilising the ICF framework and has reported its effect on quality-adjusted life-year improvement for elderly participants in a randomised controlled trial (RCT) [2123]. In an RCT of patients with cardiovascular disease, Fukui et al. showed that the MTDLP improves depression and IADL [24].

The ICF is an effective tool for the management of occupational therapy for elderly patients with heart failure; however, the ICF has not been used sufficiently in clinical practice in Japan. To address the complexity of the ICF codes, the WHO developed the ICF core set [25], which is a short list of evidence-based ICF categories that reflect the spectrum of typical problems that are experienced by patients with a particular health condition. The ICF core set is a collection of information based on the literature, expert opinion, and empirical information that will be further developed by using information from research and patient qualitative studies. Thus far, several ICF core sets have been developed [2628]; however, there is no ICF core set that is specific to heart failure in elderly patients. In addition, due to the differences in medical systems in each country, evaluation tools developed in other countries may not be suitable for the Japanese medical and social systems. Therefore, it is necessary to develop assessment tools by using the ICF adapted to the Japanese culture and medical system.

This study was conducted with the aim to collect expert (RICR) opinions to select ICF categories for the comprehensive assessment of elderly patients with heart failure.

2. Materials and Methods

2.1. Study Design

We conducted a prospective questionnaire survey by using the Delphi method to select ICF categories for the comprehensive assessment of elderly patients with heart failure. Three rounds of mail and web-based questionnaires were administered to RICRs in accordance with the Delphi method, which is a structured consensus-building method with four characteristics: anonymity, repetition with controlled feedback, statistical group responses, and input from experts [2931]. Figure 1 shows a flowchart describing the research process.

2.2. Participants

The study participants were 108 RICRs from the Hiroshima Prefecture. The participants were listed with their names and affiliations on the JACR website and were registered by the Heart Failure Center (HFC).

2.3. Data Collection and Measures
2.3.1. Preparation of the Questionnaire

The ICF checklist is a tool designed for the clinical use of the ICF and consists of a face sheet, listening item assessment, health information, general questions about activity and participation, and guidelines for use. We prepared a questionnaire based on the ICF checklist by following the methodology of the ICF core set [28]. An expert panel comprising multidisciplinary heart failure team members (two cardiologists: T.K. and T.H.; two nurses: M.N. and H.T.; two physiotherapists: K.K. and N.M.; one occupational therapist: S.S.; and one care manager: M.M.) discussed the ICF categories specific to heart failure that were to be added to the ICF checklist. The expert panel members had sufficient experience in medical care and rehabilitation of elderly patients with heart failure. The expert panel conducted round-table and e-mail discussions until they all agreed on the survey items.

2.3.2. Delphi Survey among RICRs

In the first round, we sent general information, instructions, and questionnaires to 108 RICRs. The RICRs responded to the HFC with a selection of ICF categories deemed necessary for intervention in elderly patients with heart failure. The HFC calculated the selection rate of ICF categories.

In the second round, we sent again the same questionnaire as that in the first round to the participants along with the results of the first-round survey. The participants selected the ICF categories relevant to elderly patients with heart failure, and they responded through Google Forms or a reply envelope. The HFC calculated the selection rate of ICF categories.

In the third round, the HFC sent the same questionnaire again along with the results of the second-round survey. Based on the results of the second round, the RICRs selected the ICF categories required for intervention in elderly patients with heart failure. Thus, in this study, three surveys were conducted using the same questionnaire.

2.4. Statistical Analysis

We computed the percentage score after a simple tabulation of the collected data. In reference to a previous report [32], we adopted an ICF item as an assessment item if at least 80% of the respondents answered that it was “necessary.”

2.5. Ethical Considerations

This research was approved by the Hiroshima University Epidemiological Research Ethics Review Board (approval number: E-1176). Moreover, we explained to the participants that there were no disadvantages if they did not take part in the surveys, how we would handle their personal information on the survey sheets, and that responding to the survey implied consent for participation in the study.

3. Results

3.1. Preparation of the Questionnaire

The expert panel prepared the questionnaire and added ICF categories specific to heart failure to the ICF checklist. A total of 143 categories were included in the questionnaire—namely, 39 body function categories (categories specific to heart failure: b126, b172, b250, b45, b455, b460, b545, and b740), 18 body structure categories (categories specific to heart failure: s140 and s150), 54 activity and participation categories (categories specific to heart failure: d155, d177, d230, d240, d420, and d855), and 32 environmental factor categories.

3.2. Delphi Survey among RICRs

Data were collected from December 2018 to March 2019. There were 67, 54, and 46 respondents in the first, second, and third rounds, respectively. Table 1 summarizes the characteristics of participants who responded in all Delphi survey rounds. With respect to profession, 56.5% of the participants were physiotherapists, 28.3% were doctors, and 10.9% were occupational therapists. Acute care wards accounted for 71.7% of facilities, followed by the rehabilitation wards and clinics.


Characteristics%

Profession
 Physicians1328.3
 Physiotherapists2656.5
 Occupational therapists510.9
 Nurses24.3
Type of facilities
 Acute care ward3371.7
 Rehabilitation ward48.7
 Clinic36.5
 Long-term care ward12.2
 Visiting nursing station12.2
 Day service center12.2
 Others36.5
Duration of experience of cardiac rehabilitation experts (years)
 1–52452.2
 6–101839.1
 ≥1148.7

Table 2 shows the consensus process for the ICF categories that were selected by more than 80% of participants from the first to the third Delphi rounds. There were 51, 45, and 58 ICF categories with a consensus of ≥80% per component in the first, second, and third rounds, respectively. Therefore, we adopted 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items. Tables 36 present the results for the ICF categories (body function, body structure, activity and participation, and environmental factors) that were selected by ≥50% of participants in the third round; items with ≥80% consensus are shown in bold.


CharacteristicsRound 1Round 2Round 3

Number of participants ()1086754
Number of respondents ()675446
Response rate (%)62.080.685.2
ICF categories with a consensus of ≥80% per component
 Components combined ()514558
 Body function ()201927
 Body structure ()334
 Activity and participation ()211720
 Environmental factors ()767


ICF codeICF category titleRound 1 (%)Round 2 (%)Round 3 (%)

b410Heart function9996100
b455Exercise tolerance function9998100
b730Muscle power function9994100
b440Respiration function999698
b710Mobility of joint function938696
b114Orientation function889294
b415Blood vessel function909494
b420Blood pressure function979294
b460Sensations associated with cardiovascular and respiratory functions949894
b110Consciousness function819091
b545Water, mineral, and electrolyte balance functions818691
b126Temperament and personality functions678089
b430Haematological system function848089
b740Muscle endurance function889089
b164Higher-level cognitive functions859087
b530Weight maintenance functions818087
b620Urination function918487
b130Energy and drive function848485
b140Attention function737685
b144Memory function817885
b515Digestive function727183
b117Intellectual function818680
b134Sleep function707880
b210Sight function737880
b235Vestibular function706580
b435Immunological system function666380
b525Defecation function827880
b152Emotional function647578
b280Sensation of pain737578
b230Hearing function697176
b555Endocrine gland function606174
b250Taste function485372
b735Muscle tone function645767
b167Mental functions of language576363
b310Voice function464963
b765Involuntary movement function544557
b172Calculation function424554


ICF codeICF category titleRound 1 (%)Round 2 (%)Round 3 (%)

s410Structure of the cardiovascular system939289
s430Structure of the respiratory system888687
s750Structure of the lower extremity858683
s760Structure of the trunk797780
s140Structure of the sympathetic nervous system757378
s150Structure of the parasympathetic nervous system727376
s730Structure of the upper extremities756776
s740Structure of the pelvic region616567
s110Structure of the brain666165
s720Structure of the shoulder region575563
s610Structure of the urinary system697159
s710Structure of the head and neck region606157
s120Spinal cord and related structures465152


ICF codeICF category titleRound 1 (%)Round 2 (%)Round 3 (%)

d450Walking9994100
d530Toileting969096
d550Eating979496
d560Drinking979494
d710Basic interpersonal interactions909094
d230Carrying out daily routine919291
d420Transferring oneself948691
d570Looking after one’s health938891
d175Solving problems848089
d177Making decisions858889
d310Communicating and receiving spoken messages888689
d540Dressing938689
d330Speaking767887
d620Acquisition of goods and services767687
d760Family relationships889087
d510Washing oneself888485
d210Undertaking a single task797383
d470Using transportation827880
d520Caring for body parts848080
d920Recreation and leisure827880
d115Listening787878
d350Conversation817878
d430Lifting and carrying objects706378
d240Handling stress and other psychological demands818076
d630Preparing meals817776
d640Doing housework818076
d740Formal relationships666576
d110Watching696574
d440Fine hand use646174
d910Community life525967
d860Basic economic transactions696165
d140Learning to read555763
d315Communicating and receiving nonverbal messages556163
d335Producing nonverbal messages524963
d720Complex interpersonal interactions545163
d770Intimate relationships646163
d220Undertaking multiple tasks635561
d750Informal social relationships605161
d870Economic self-sufficiency615761
d155Acquiring skills584959
d475Driving645359
d850Remunerative employment514957
d660Assisting others585150
d940Human rights464350


ICF codeICF category titleRound 1 (%)Round 2 (%)Round 3 (%)

e310Immediate family939493
e410Individual attitudes of immediate family members938493
e580Health services, systems, and policies858685
e315Extended family847184
e355Health professionals827882
e575General social support services, systems, and policies828482
e570Social security services, systems, and policies818081
e325Acquaintances, peers, colleagues, neighbours, and community members797379
e320Friends787178
e340Personal care providers and personal assistants768076
e540Transportation services, systems, and policies727372
e115Products and technology for personal use in daily living707770
e120Products and technology for personal indoor and outdoor mobility and transportation707770
e450Individual attitudes of health professionals636563
e525Housing services, systems, and policies637363
e440Individual attitudes of personal care providers and personal assistants616761
e125Products and technology for communication606160
e535Communication services, systems, and policies586358
e110Products or substances for personal consumption575757
e420Individual attitudes of friends545354
e455Individual attitudes of other professionals545354
e330People in positions of authority525752

4. Discussion

In this study, through a survey of RICRs, we selected 58 ICF categories for a comprehensive assessment of elderly patients with heart failure. The 58 ICF categories consisted of 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items.

4.1. Validity of the Research Method

First, we examined the appropriateness of the sample size in this study. The response rate for all rounds of this study was 42.6%, which was higher than that of previous studies where the average response rate for the ICF core set was 20.3 (6–73%) [25]. Second, we examined the validity of the study population. The study participants were RICRs living in a limited area within the Hiroshima Prefecture. Therefore, they had similar knowledge and attitudes, which possibly contributed to their ability to build consensus smoothly during the study. However, limiting the geographical area of the study participants would undeniably have fostered a bias in the responses. Furthermore, there was a bias with regard to the occupation and affiliation of the respondents; therefore, the results need to be interpreted with caution.

4.2. Characteristics of ICF Categories Extracted in This Study

The ICF core set for cardiovascular disease includes a core set for chronic ischemic heart disease (CIHD) in patients receiving long-term care [27]. The ICF core set for CIHD consisted of 61 ICF categories: 14 for body function, 1 for body structure, 17 for activity and participation, and 29 for environmental factors. A comparison of the categories in this study with those in the ICF core set for CIHD shows that the assessment set in this study has more body function categories and fewer environmental factors. In particular, the number of mental function items was nine as compared to the three items of the ICF core set of CIHD. A systematic review reported that approximately 43% of patients with heart failure have cognitive disability [33]. Furthermore, if the cognitive disability of heart failure patients is missed during hospitalisation, the risk of rehospitalisation may increase fivefold [6]. The prognostic factors for heart failure (b152: emotional function (depression and anxiety)) were also selected in this study, although their selection did not exceed 80% (78%) of consensus. These results indicate that RICRs consider mental function to be important in clinical practice.

This study is unique in that we selected “d177: decision making” from the activity and participation set. The Japanese Society of Cardiology’s 2018 Guidelines for the Management of Acute and Chronic Heart Failure [34] recommend palliative care and advanced care planning (ACP) as a way to facilitate decisions by patients on how to spend the rest of their lives.

Furthermore, the results of this study showed the selection of items “d5: self-care,” “d6: home life,” and “d920: recreation and leisure,” which is similar to the results of the ICF core set for CIHD. Heart failure in elderly patients is often associated with problems such as living alone and caregiving by an elderly caregiver. Previous studies have reported that IADL (e.g., cooking, shopping, and medication management) in heart failure patients is associated with life prognosis and rehospitalisation [35, 36]. In addition, recreation and leisure have been associated with cardiovascular risk and the degree of independence in IADL [11]. Therefore, we think that it was appropriate to choose these ICF codes.

Significantly fewer environmental factors were selected in our study, 9 compared with the 27 items of the ICF core set for CIHD. We infer ICF categories unrelated to elderly patients (e.g., work and friends) because the study questionnaire focused on elderly patients. The ICF items selected by Japanese cardiac rehabilitation experts differed in some categories from the ICF core set developed in other countries. Therefore, we need to develop an evaluation tool that is customised for Japanese cultural and social systems.

4.3. Implication for Occupational Therapy Practice

The ICF categories selected for this study allow for a comprehensive assessment of clients for occupational therapy. We can use these ICF categories as a common medium for sharing information among multiple professionals and caregivers. In addition, a comprehensive assessment based on the ICF combined with the MTDLP can provide effective occupational therapy for elderly patients with heart failure. The findings of this study are expected to provide a basis for an outcome measure to determine the effectiveness of occupational therapy for these patients.

4.4. Limitations of This Study

This study had some limitations. First, the study participants were RICRs from Hiroshima Prefecture, with physiotherapists accounting for approximately 60% of the study population. Therefore, one should be cautious in generalising the results because there exists the possibility of bias with regard to area and profession. Second, problems with the Delphi method have been identified with respect to the validity of the questionnaire and the risk of inducing consensus. To increase the validity of the questionnaire, we included multidisciplinary teams comprising professionals who are engaged in the provision of comprehensive care for heart failure. In addition, we tried to provide as much fair feedback as possible; however, it is unknown whether the abovementioned factors affected the outcome of the ICF selection. Third, we did not include categories related to personal factors in this study. As personal factors are essential for understanding the health process, they need to be assessed in future studies. Fourth, because we set a cut-off value of 80% consensus for ICF categories in this study, we had to exclude categories with a very similar agreement of 79% or 78%. Fifth, because the purpose of this study was to develop a comprehensive assessment tool for the elderly with heart failure, we did not adhere to the steps prescribed in the development of the ICF core set. These issues suggest the need for careful attention in the development of ICF-based assessment tools. Additionally, further studies are necessary in the future to develop a comprehensive framework for functioning and disability evaluation in elderly patients with heart failure based on the results of this research, to confirm their reliability and effectiveness.

5. Conclusions

The ICF categories relevant to elderly patients with heart failure included a total of 58 categories consisting of 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items. The development of a functioning and disability evaluation tool that utilises the ICF categories based on this research is necessary. The ICF categories selected for this study allow for a comprehensive assessment of clients for occupational therapy. The findings of this study are expected to provide a basis for an outcome measure to determine the effectiveness of occupational therapy for these patients.

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

Acknowledgments

This study was conducted as a part of the Hiroshima Heart Health Promotion Project. This work was supported by the Grants-in-Aid for Scientific Research from the Ministry of Health, Labour and Welfare, Japan (grant number: JPMH20AB1002).

References

  1. Y. Okura, M. M. Ramadan, Y. Ohno et al., “Impending epidemic: future projection of heart failure in Japan to the year 2055,” Circulation Journal, vol. 72, no. 3, pp. 489–491, 2008. View at: Publisher Site | Google Scholar
  2. H. Tsutsui, M. Tsuchihashi Makaya, S. Kinugawa, D. Goto, A. Takeshita, and The JCARE-CARD Investigators, “Clinical characteristics and outcome of hospitalized patients with heart failure in Japan. Rationale and design of Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD),” Circulation Journal, vol. 70, no. 12, pp. 1617–1623, 2006. View at: Publisher Site | Google Scholar
  3. M. Tsuchihashi, H. Tsutsui, K. Kodama, F. Kasagi, and A. Takeshita, “Clinical Characteristics and Prognosis of Hospitalized Patients With Congestive Heart Failure,” Japanese Circulation Journal, vol. 64, no. 12, pp. 953–959, 2000. View at: Publisher Site | Google Scholar
  4. C. M. O'Connor, V. Hasselblad, R. H. Mehta et al., “Triage After Hospitalization With Advanced Heart Failure,” Journal of American College of Cardiology, vol. 55, no. 9, pp. 872–878, 2010. View at: Publisher Site | Google Scholar
  5. A. X. Lo, J. P. Donnelly, G. McGwin, V. Bittner, A. Ahmed, and C. J. Brown, “Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults ≥65 years with heart failure,” The American Journal of Cardiology, vol. 115, no. 6, pp. 797–801, 2015. View at: Publisher Site | Google Scholar
  6. Q. L. Huynh, K. Negishi, L. Blizzard et al., “Mild cognitive impairment predicts death and readmission within 30days of discharge for heart failure,” International Journal of Cardiology, vol. 221, pp. 212–217, 2016. View at: Publisher Site | Google Scholar
  7. R. Faris, H. Purcell, M. Y. Henein, and A. J. S. Coats, “Clinical depression is common and significantly associated with reduced survival in patients with non-ischaemic heart failure,” European Journal of Heart Failure, vol. 4, no. 4, pp. 541–551, 2002. View at: Publisher Site | Google Scholar
  8. T. Suzuki, T. Shiga, K. Kuwahara et al., “Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure,” Journal of Cardiology, vol. 64, no. 6, pp. 456–462, 2014. View at: Google Scholar
  9. J. Denollet, H. Rombouts, T. C. Gillebert et al., “Personality as independent predictor of long-term mortality in patients with coronary heart disease,” The Lancet, vol. 347, no. 8999, pp. 417–421, 1996. View at: Publisher Site | Google Scholar
  10. K. Takabayashi, S. Kitaguchi, K. Iwatsu et al., “A decline in activities of daily living due to acute heart failure is an independent risk factor of hospitalization for heart failure and mortality,” Journal of Cardiology, vol. 73, no. 6, pp. 522–529, 2019. View at: Publisher Site | Google Scholar
  11. P. FJG, M. SMA, A. MDC, S. M. Barreto, and A. EML, “Leisure-time physical activity, but not commuting physical activity, is associated with cardiovascular risk among ELSA-Brasil participants,” Arquivos Brasileiros de Cardiologia, vol. 110, no. 1, pp. 36–43, 2018. View at: Google Scholar
  12. C. Löfvenmark, A.-C. Mattiasson, E. Billing, and M. Edner, “Perceived loneliness and social support in patients with chronic heart failure,” European Journal of Cardiovascular Nursing, vol. 8, no. 4, pp. 251–258, 2009. View at: Publisher Site | Google Scholar
  13. European Society of Cardiology, “2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure,” European Heart Journal, vol. 37, pp. 2129–2200, 2016. View at: Google Scholar
  14. C. M. O’Connor, D. J. Whellan, K. L. Lee et al., “Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure,” JAMA, vol. 301, no. 14, pp. 1439–1450, 2009. View at: Publisher Site | Google Scholar
  15. R. S. Taylor, V. A. Sagar, E. J. Davies et al., “Exercise-based rehabilitation for heart failure,” Cochrane Database Systematic Review, vol. 4, p. CD003331, 2014. View at: Publisher Site | Google Scholar
  16. C. O. Phillips, S. M. Wright, D. E. Kern, R. M. Singa, S. Shepperd, and H. R. Rubin, “The Journal of the American Medical Association,” JAMA, vol. 291, no. 11, pp. 1358–1367, 2004. View at: Publisher Site | Google Scholar
  17. S. Stewart, A. J. Vandenbroek, S. Pearson, and J. D. Horowitz, “Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure,” Archives of Internal Medicine, vol. 159, no. 3, pp. 257–561, 1999. View at: Publisher Site | Google Scholar
  18. M. A. FA, S. Stewart, S. Ferrua, and M. M. JJ, “Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials,” Journal of the American College of Cardiology, vol. 44, no. 4, pp. 810–819, 2004. View at: Publisher Site | Google Scholar
  19. C. Feltner, C. D. Jones, C. W. Cené et al., “Transitional Care Interventions to Prevent Readmissions for Persons With Heart Failure,” Annals of Internal Medicine, vol. 160, no. 11, pp. 774–784, 2014. View at: Publisher Site | Google Scholar
  20. Japan Heart Failure Society Guidelines Committee, “Statement on the treatment of elderly heart failure patients,” 2016, http://www.asas.or.jp/jhfs/pdf/Statement_HeartFailurel.pdf, [cited 2020 September 30]. View at: Google Scholar
  21. The Japanese Association of Occupational Therapists, “Management tool for daily life performance,” 2020, https://www.jaot.or.jp/files/page/MTDLP/%28A4%20%29MTDLP-english.pdf. View at: Google Scholar
  22. S. Noto, C. Murai, S. Takeuchi, Y. Iwase, and H. Nakamura, “Effect of occupational therapy using “the management tool for daily life performance” for dependent community-dwelling elderly: a randomized controlled multi-center trial,” Japanese occupationai therapy research, vol. 33, no. 3, pp. 259–269, 2014. View at: Google Scholar
  23. K. Iokawa, K. Hasegawa, and T. Ishikawa, “Usefulness of the daily life performance transfer sheet in care management of people with stroke,” American Journal of Occupational Therapy, vol. 73, no. 4, p. 7304205080p1, 2019. View at: Publisher Site | Google Scholar
  24. M. Fukui, Y. Yoshida, and K. Hgaki, “Effect of the management tool for daily life performance on patients with cardiovascular disease: a randomized controlled trial,” Progress in Rehabilitation Medicene, vol. 5, no. 4, 2019. View at: Publisher Site | Google Scholar
  25. T. Ewert, T. B. ÜstÜn, S. Chatterji, N. Kostanjsek, G. Stucki, and A. Cieza, “Development of ICF Core Sets for patients with chronic conditions,” Journal of Rehabilitation Medicine, vol. 44, pp. 9–11, 2004. View at: Google Scholar
  26. A. Cieza, G. Stucki, M. Weigl et al., “ICF Core Sets for chronic widespread pain,” Journal of Rehabilitation Medicine, vol. 44, pp. 63–68, 2004. View at: Publisher Site | Google Scholar
  27. A. Cieza, A. Stucki, S. Geyh et al., “ICF Core Sets for chronic ischaemic heart disease,” Journal of Rehabilitation Medicine, vol. 44, pp. 94–99, 2004. View at: Google Scholar
  28. R. Escorpizo, J. Ekholm, H.-P. Gmünder, A. Cieza, N. Kostanjsek, and G. Stucki, “Developing a Core Set to describe functioning in vocational rehabilitation using the international classification of functioning, disability, and health (ICF),” Journal of Occupational Rehabilitation, vol. 20, no. 20, pp. 502–511, 2010. View at: Google Scholar
  29. C. M. Goodman, “The Delphi technique: a critique,” Journal of Advance Nursing, vol. 12, no. 6, pp. 729–734, 1987. View at: Publisher Site | Google Scholar
  30. F. Hasson, S. Keeney, and H. Mckenna, “Research guidelines for the Delphi survey technique,” Journal of Advance Nursing, vol. 32, no. 4, pp. 1008–1015, 2000. View at: Google Scholar
  31. S. Shoji, S. Kohsaka, Y. Shiraishi et al., “Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients,” ESC Heart Fail, vol. 8, no. 1, pp. 300–308, 2020. View at: Publisher Site | Google Scholar
  32. M. Weigl, A. Cieza, C. Andersen, B. Kollerits, E. Amann, and G. Stucki, “Identification of relevant ICF categories in patients with chronic health conditions: a Delphi excise,” Journal of Rehabilitation Medicine, vol. 44, pp. 12–21, 2004. View at: Google Scholar
  33. J. A. Cannon, P. Moffitt, A. C. Perez-Moreno et al., “Cognitive impairment and heart failure: systematic review and meta-analysis,” Journal of Cardiac Failure, vol. 23, no. 6, pp. 464–475, 2017. View at: Google Scholar
  34. The Japanese Circulation Society and Heart Failure Society guideline, “The guidelines for the management of acute and chronic heart failure,” pp. 111–115, 2018, http://asas.or.jp/jhfs/pdf/topics20180323.pdf, [cited 2020. August 25]. View at: Google Scholar
  35. M. L. Alosco, M. B. Spitznagel, R. Cohen et al., “Cognitive impairment is independently associated with reduced instrumental activities of daily living in persons with heart failure,” Journal of Cardiovascular Nursing, vol. 27, no. 1, pp. 44–50, 2012. View at: Publisher Site | Google Scholar
  36. M. L. Alosco, M. B. Spitznagel, N. Raz et al., “Executive dysfunction is independently associated with reduced functional independence in heart failure,” Journal of Clinical Nursing, vol. 23, no. 5-6, pp. 829–836, 2014. View at: Publisher Site | Google Scholar

Copyright © 2021 Shigehito Shiota et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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