ICF-Based Tools in Rehabilitation Toward Return to Work: Facilitating Inter-professional Communication and Comprehensive Documentation



Fig. 22.1
Integration of ICF documentation tools into the Rehab-Cycle [17, 29]



The ICF Assessment Sheet helps rehabilitation professionals to understand the client’s functioning and to identify the needs to be addressed in rehabilitation. It provides an overview of the client’s functioning state with input from both the client and the rehabilitation professional [31]. Considering the client’s own perspective of his/her functioning problems enriches the information provided by the rehabilitation professional and can later guide intervention planning [32]. See Table 22.1.


Table 22.1
ICF assessment sheet







































































































 
Body functions/structure

Activities and participation

Client

I have some pain when moving my legs

I can’t sit without using my arms to prop up

I used to go motorcycling, play golf

I have spasticity, in particular when moving myself

Moving with the wheelchair is improving, but I still have problems overcoming obstacles

I want to do some kind of sports

I still get fungal skin infection

I am now able to dress my lower extremities

I like meeting my friends (at least once a week)

I am able to manage my bladder and control defection well

I take care of my medication and treatment schedule

I want to go home for the weekend

I have problems with my body balance
 
I want to work again but I can’t imagine working at the computer all day
   
I am willing to learn a new profession
 
Body functions/structures

Activities and participation

Health professionals

Power of isolated muscles (arms)

Changing basic body positions

Remunerative employment

Power of muscles in the lower half of the body

Maintaining a sitting position
 

Power of muscles of the trunk

Moving around in different locations
 

Supportive functions of the arms

Moving around using equipment
 

Structure of areas of the skin – at risk

Driving motorized vehicles
 
 
Caring for the skin
 
 
Regulating urination
 
 
Regulating defection
 
 
Environmental factors

Personal factors

Health professionals and client

Wheelchair does not fit ideally

26 years old, male

Is able to cope with health situation

Car is not wheelchair adapted

Sharing a flat with a friend

Has a strong will to be able to walk again

Accident insurance is paying for health services

Trained as a salesperson for home electronics, but worked as a mover before accident

Willing to learn a new profession

Parents support him

Very motivated to clarify vocational future
 

Friends support him
   

Health professionals
   

To facilitate the identification of intervention targets that are related to common goals identified by the client and the rehabilitation professional, an ICF Categorical Profile is generated. The ICF Categorical Profile serves as the central source of information for the rehabilitation team for intervention planning. It is generally set up using a suitable ICF Core Set in combination with a rating of the respective ICF categories using ICF qualifiers. ICF qualifiers are used to rate the extent of a problem for each ICF category by estimating the level of difficulties (“0” = no problem; “1” = mild problem; “2” = moderate problem; “3” = severe problem; “4” = complete problem). Environmental factors can be rated either as a barrier or as a facilitator, and in some cases an environmental factor can be rated as both a barrier and a facilitator [17], e.g., a spouse can be a facilitator by providing essential care but can also be a barrier if this care becomes too sheltering and prevents the person from becoming more independent. Although personal factors are not yet classified in the ICF, they have an influence on the client’s functioning in terms of the rehabilitation process [33, 34], including vocational rehabilitation [35]. Thus, personal factors are rated as having a positive, neutral, or negative influence on the client’s functioning. See Table 22.2.


Table 22.2
ICF categorical profile

A313355_1_En_22_Tab2_HTML.gif

To facilitate the coordination of interventions, roles, and resources within an inter-professional team in vocational rehabilitation, the ICF Intervention Table provides a comprehensive overview of all the intervention targets (represented by ICF categories), the interventions, and the corresponding rehabilitation professional who is assigned to address each intervention target. More than one rehabilitation professional may be assigned to one intervention target. The ICF Intervention Table also displays the expected goals (goal value) for each target. See Table 22.3.


Table 22.3
ICF intervention table






























































































































































































































































































































































 
Intervention targets

Intervention

Psych

OT

SW

Voc trainer

Phys

PT

Nurse

First value

Goal value

Body function

b130

Energy and drive functions

Psychological therapy

x
           
2

1

b280a

Sensation of pain

Medication
       
x
   
3

0

Manual therapy
         
x
 

b455

Exercise tolerance functions

Movement training
         
x
 
3

0

b730a

Muscle power functions

Training with equipment
         
x
 
3

1

b810a

Protective functions of the skin

Instruction for skin control
           
x

1

0

Activities and participation

d155

Acquiring skills

Skill training
 
x
 
x
     
3

2

d177a

Making decisions

Counseling

x
 
x
       
4

2

d240

Handling stress and other psychological demands

Counseling

x
           
3

1

d410a

Changing basic body positions

Training of changing body positions
 
x
     
x

x

3

1

d415a

Maintaining a sitting position

Reaction training
         
x
 
3

2

d430a

Lifting and carrying objects

Training with equipment
         
x
 
3

1

d465a

Moving around using equipment

Wheelchair training
         
x
 
3

1

Instruction of “Swiss trac®”
 
x
         

d475a

Driving

Counseling for adapted devices
 
x
         
4

2

Driving lessons
 
x
         

d825a

Vocational training

Vocational training
 
x
 
x
     
2

1

d840a

Apprenticeship

Counseling/instruction
     
x
     
3

1

d845

Acquiring, keeping and terminating a job

Counseling/instruction
     
x
     
4

2

d850

Remunerative employment

Vocational testing and training, coaching/liaison with former employer

x
 
x

x
     
4

0

Environmental factors

e115a

Assistive products and technology for personal use in daily living

Choice of assistive devices
 
x
 
x
     
2

+4
 
e120a

Assistive products and technology for personal mobility …

Choice of wheelchair
 
x
         
2

+2
 
e310

Immediate family

Counseling/ instruction

x
     
x
 
x

+2

+3
 
e330

People in positions of authority

Coaching/Liaison with former employer
   
x

x
     
+2

+3
 
e590

Labour and employment services, systems and policies

Counseling
   
x

x
     
+2

+4



































































Influence of personal factors
   
Intervention targets

Intervention

Responsible Professional

First Value

Goal Value

Pos.

Neutral

Neg.

Pos

Neutral

Neg.

Personal factors

PF

Coping with health situation

Psychological therapy

Psych

x
   
x
   

PF

Motivated to clarify vocational situation

Counseling/instruction

Voc trainer, Psych

x
   
x
   

PF

Willing to learn new profession

Counseling/instruction Skill training

Voc trainer, OT

x
   
x
   


aICF categories added from the Comprehensive ICF Core Set for vocational rehabilitation

Abbreviations: OT occupational therapist, Phys physician, PT physical therapist, Psych psychologist, SW social worker, Voc trainer vocational trainer, EF environmental factors, PF personal factors

The ICF Evaluation Display based on ICF Core Set categories illustrates the results of the assessment and reexamination of the client’s functioning. It displays long-term and short-term goals and reflects the extent of a problem the client is experiencing in a particular ICF category as rated with ICF qualifiers before (first value) and after intervention (final value). A goal value is defined, in order to determine whether a goal has been achieved following an intervention (see Tables 22.2, 22.3, and 22.4).
Sep 25, 2016 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on ICF-Based Tools in Rehabilitation Toward Return to Work: Facilitating Inter-professional Communication and Comprehensive Documentation

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