Assessment of participation disorders: A cross-sectional study with patients and health care providers

Background: The International Classification of Functioning, Disability and Health (ICF) offers a comprehensive framework for assessing health and participation, yet its clinical integration is hampered by complexity and limited digital infrastructure. Digital tools like the ICFx web application may bridge this gap by enabling structured, patient-centered documentation. This study investigates the feasibility and value of patient-led, digital ICF documentation in orthopedic rehabilitation, comparing patient and professional assessments and evaluating usability and acceptance. Methods: A cross-sectional study was conducted at a German rehabilitation clinic with adult inpatients suffering from chronic musculoskeletal conditions. Patients completed digital self-assessments using the ICFx app, including WHODAS 2.0, SF-36, and usability questionnaires. Healthcare professionals (physicians, physiotherapists, nurses, psychologists, care managers) independently coded ICF categories, first without and then with access to patient data. Agreement between patient and professional ICF selections, usability (System Usability Scale, SUS), and digital stress (Digital Stressors Scale, DSS) were analyzed using descriptive and inferential statistics. Results: Of 268 invited patients, 130 participated; 36 professionals contributed data. Patients selected more ICF categories (mean 27) than professionals (mean 13). Initial overlap between patient and professional ICF selections was 20–30%, rising to over 60% when professionals reviewed patient input. Professional-to-professional agreement was lower (10–20%). Professionals, especially physicians, tended to underestimate patient-reported impairments, but discrepancies diminished after reviewing patient data. Usability ratings were moderate (mean SUS 49), with physiotherapists and care managers rating the app as acceptable. Digital stress was generally low, though higher among professionals. Patient feedback highlighted usability challenges and limited perceived personal benefit. Conclusions: Digital, patient-led ICF documentation using the ICFx app is feasible and yields substantial agreement with professional assessments, particularly when patient input is integrated. Patients can independently report meaningful participation restrictions, supporting patient-centered care and interprofessional collaboration. While professional input adds value, patient self-assessment alone provides a robust foundation for functional health profiling. Usability improvements and broader validation in diverse settings are recommended to enhance adoption and impact.