Development and implementation of ICF-based functioning assessment in polish medical rehabilitation: a comprehensive...

Area of Science:

• Rehabilitation Medicine
• Health Services Research
• Biopsychosocial Health

Background:

• The International Classification of Functioning, Disability and Health (ICF) offers a biopsychosocial framework but presents challenges for clinical and reporting use.
• Polish rehabilitation services lacked standardized functioning assessment, hindering coordinated care and national outcome comparability.
• A need existed for a standardized tool to assess patient functioning within rehabilitation settings in Poland.

Purpose of the Study:

• To describe the development and implementation of a quality assessment tool for therapeutic rehabilitation in Poland.
• To standardize patient functioning assessment using the International Classification of Functioning, Disability, and Health (ICF) framework.
• To support coordinated care and comparable outcome documentation at individual, hospital, and national levels.

Main Methods:

• Developed an ICF-based functioning assessment system, including categorical profiles, intervention sheets, and post-rehabilitation assessment tools.
• Created auxiliary tools like Short Intuitive Descriptions, rating guides, and conversion protocols, supported by an IT application.
• Pilot-tested the system in 12 rehabilitation centers with 1,800 patients (inpatients and outpatients), using pre/post-assessments and WHO's WHODAS 2.0.

Main Results:

• The ICF-based system proved feasible and sensitive to changes in patient functioning during rehabilitation.
• The system effectively differentiated outcomes between centers and demonstrated moderate to high inter-rater agreement for most ICF categories.
• WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) scores generally aligned with ICF-based profiles, especially in activity and participation.

Conclusions:

• The pilot suggests an ICF-based system can enhance standardized, biopsychosocial rehabilitation in Poland.
• Implementation challenges include resource demands, staff training, and assessing environmental factors.
• Further research is required to assess long-term outcomes, refine psychometrics, and evaluate cost-effectiveness.