You are not logged in. Press here to login.


List volumes - List articles in this issue

Original report

Linking Crohn's disease health status measurements with International Classification of Functioning, Disability and Health and vocational rehabilitation outcomes

doi: 10.2340/16501977-0478

Open access


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.


Christoph Reichel, Jürgen Streit, Steffen Wunsch


  1. World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva: WHO; 2001.
  2. Stucki G, Melvin J. The International Classification of Functioning, Disability and Health: a unifying model for the conceptual description of physical and rehabilitation medicine. J Rehabil Med 2007; 39: 286–292.
  3. Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology 1976; 70: 439–444.
  4. Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet 1980; 1: 514.
  5. Gazzard BG, Price HL, Libby GW, Dawson AM. The social toll of Crohn’s disease. BMJ 1978; 2: 1117–1119.
  6. Hendriksen C, Binder V. Social prognosis in patients with ulcerative colitis. BMJ 1980; 281: 581–583.
  7. Feurle GE, Keller O, Hassels K, Jesdinsky HJ. Soziale Auswirkungen des Morbus Crohn. Dtsch Med Wochenschr 1983; 108: 971–975.
  8. Binder V, Hendriksen C, Kreiner S. Prognosis in Crohn’s disease – based on results from a regional patient group from the country of Copenhagen. Gut 1985; 26: 146–150.
  9. Hendriksen C, Kreiner S, Binder V. Long term prognosis in ulcerative colitis – based on results from a regional patient group from the country of Copenhagen. Gut 1985; 26: 150–163.
  10. Sørensen VZ, Olsen BG, Binder V. Life prospects and quality of life in patients with Crohn’s disease. Gut 1987; 28: 382–385.
  11. Wyke RJ, Edwards FC, Allan RN. Employment problems and prospects for patients with inflammatory bowel disease. Gut 1988; 29: 1229–1235.
  12. Drossmann DA, Patrick DL, Mitchell CM, Zagami EA, Appelbaum MI. Health-related quality of life in inflammatory bowel disease. Dig Dis Sci 1989; 34: 1379–1386.
  13. Tragone A, Lanfranchi GA. Quality of life and inflammatory bowel disease. Gut 1989; 30: 1788–1789.
  14. Boonen A, Dagnelie PC, Feleus A, Hesselink MA, Muris JW, Stockbrügger RW, et al. The impact of inflammatory bowel disease on labor force participation: results of a population sampled case-control study. Inflamm Bowel Dis 2002; 8: 382–389.
  15. Eckardt VF, Lesshaft C, Kanzler G, Bernhard G. Disability and health care use in patients with Crohn’s disease: a spouse control study. Am J Gastroenterol 1994; 89: 2157–2162.
  16. Mayberry MK, Probert C, Sirivastava E, Rhodes J, Mayberry JF. Perceived discrimination in education and employment by people with Crohn’s disease: a case control study of educational achievement and employment. Gut 1992; 33: 312–314.
  17. Pinchbeck BR, Kirideikis J, Thomson AB. Inflammatory bowel disease in northern Alberta: an epidemiologic study. J Clin Gastroenterol 1988; 10: 505–515.
  18. Sonnenberg A. Disability and need for rehabilitation among patients with inflammatory bowel disease. Digestion 1992; 51: 168–178.
  19. Nordgren SR, Fast SB, Oresland TO, Hulten LA. Long-term follow-up in Crohn’s disease: mortality, morbidity, and functional status. Scand J Gastroenterol 1994; 29: 1122–1128.
  20. Post S, Kunhardt M, Herfarth C. Subjective assessment of quality of life, pain and surgical success after laparotomy for Crohn’s disease. Chirug 1995; 66: 800–806.
  21. Thompson NP, Fleming DM, Charlton J, Pounder RE, Wakefield AJ. Patients consulting with Crohn’s disease in primary care in England and Wales. Eur J Gastroenterol Hepatol 1998; 10: 1007–1012.
  22. Hanauer SB, Sandborn WJ. Practice Parameters Committee of the American College of Gastroenterology. Management of Crohn’s disease in adults. Am J Gastroenterol 2001; 96: 635–643.
  23. Zilly W, Goischke EM. Curriculum chronisch entzündliche Darmerkrankungen. In: Bundesversicherungsanstalt für Angestellte. Gesundheitstraining in der medizinischen Rehabilitation. Berlin 2003, p. 1–30.
  24. Gesellschaft für Rehabilitation bei Verdauungs- und Stoffwechselkrankheiten e. V. [homepage on the Internet]. Leitlinien für die Rehabilitation bei Verdauungs- und Stoffwechselkrankheiten 1999. Available from
  25. Cieza A, Geyh S, Chatterji S, Kostanjsek N, Üstün B, Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med 2005; 37: 212–218.
  26. Best WR. Predicting the Crohn’s disease activity index from the Harvey-Bradshaw Index. Inflamm Bowel Dis 2006; 12: 304–310.
  27. Cieza A, Brockow T, Ewert T, Amman E, Kollerits B, Chatterji S, et al. Linking health-status measurements to the international classification of functioning, disability and health. J Rehabil Med 2002; 34: 205–210.
  28. Platz T, Winter T, Müller N, Pinkowski C, Eickhof C, Mauritz K-H. Arm ability training for stroke and traumatic brain injury patients with mild arm paresis. A single-blind, randomized, controlled trial. Arch Phys Med Rehabil 2001; 82: 961–968.
  29. Feagan BG, Bala M, Yan S, Olson A, Hanauer S. Unemployment and disability in patients with moderately to severely active Crohn’s disease. J Clin Gastroenterol 2005; 39: 390–395.
  30. Gibson PR, Weston AR, Shann A, Florin TH, Lawrance IC, Macrae FA, et al. Relationship between disease severity, quality of life and health-care resource use in a cross-section of Australian patients with Crohn’s disease. J Gastroenterol Hepatol 2007; 22: 1306–1312.
  31. Kuhli R, Grünhage F, Reuß HP, Franke W, Reichel C. Erkrankungsaktivität und arbeitsbezogenes Verhaltens- und Erlebensmuster bei Rehabilitanden mit Morbus Crohn. Phys Med Rehab Kuror 2009; 19: 169–174.
  32. Bernklev T, Jahnsen J, Schulz T, Sauar J, Lygren I, Henriksen M, et al. Course of disease, drug treatment and health-related quality of life in patients with inflammatory bowel disease 5 years after initial diagnosis. Eur J Gastroenterol Hepatol 2005; 17: 1037–1045.
  33. Samkange-Zeeb F, Altenhöner T, Berg G, Schott T. Predicting non-return to work in patients attending cardiac rehabilitation. Int J Rehabil Res 2006; 29, 43–49. 
  34. Slebus FG, Sluiter JK, Kuijer PP, Willems JH, Frings-Dresen MH. Work-ability evaluation: a piece of cake or a hard nut to crack? Disabil Rehabil 2007; 29: 1295–1300.
  35. Hansen A, Edlund C, Henningsson M. Factors relevant to a return to work: a multivariate approach. Work 2006; 26: 179–190.
  36. Wasiak R, Verma S, Pransky G, Webster B. Risk factors for recurrent episodes of care and work disability: case of low back pain. J Occup Environ Med 2004; 46: 68–76.
  37. Van der Giezen AM, Bouter LM, Nijhuis FJ. Prediction of return-to-work of low back pain patients sicklisted for 3–4 months. Pain 2000; 87: 285–294.
  38. Muche R, Rösch M, Flierl S, Alt B, Jacobi E, Gaus W. Entwicklung und Validierung eines Prognosemodells zur Vorhersage der Arbeitsfähigkeit nach Rehabilitation anhand routinemäßig erhobener Parameter. Rehabilitation 2000; 39: 262–267.

Related articles

There are no related articles.



Full text



There is no supplementary for this article.

Related articles

Click here to show related articles

Print information

Volume 42, Issue 1

DOI: 10.2340/16501977-0478

Pages: 74-80

View at PubMed