Applying the ICF codes, flag model and C-OAR-SE in the development of return-to-work assessment scale for stroke survivors

BACKGROUND: The Return-to-Work Assessment Scale (RAS) was developed in 2021 by Ibikunle et al. to assess return to work among post stroke survivors. OBJECTIVE: The aim of this study was to describe how the conceptual (flag model and ICF) and theoretical framework (C-OAR-SE) were used in developing the RAS. METHOD: The development of the RAS consisted of three phases: (i) Initial item generation (ii) face and content validity (iii) Psychometric testing. With each phase embracing the flag model, international classification of functioning, disability and health (ICF) and the C-OAR-SE an acronym for the six aspects of the theory: ‘C’ [construct definition], ‘OAR’ [object representation, attribute classification, and rater entity identification], and ‘SE’ [selection of item type and answer scale, as well as, enumeration. RESULTS: A triangulated approach drawn on three separate theories and models. Phase one was developed by using the Flag model which provided the semi structured open ended questions that materialized into the draft instrument while phases two and three were developed using the ICF and the C-OAR-SE. The scale consists of two sections, A and B. Section A comprises general information about post-stroke survivors, which would not be scored, while section B includes three parts that are important to consider when deciding to return to work. CONCLUSION: An instrument called RAS was developed, an excellent, internally consistent, as well as reliable tool that has demonstrated good group and structural validity.