Functional changes during inpatient pulmonary rehabilitation in Poland: an ICF-based analysis of functioning relevant...

The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework for assessing rehabilitation outcomes beyond traditional physiological measures.

This retrospective observational study used a longitudinal pre-post design and involved a secondary analysis of anonymized data collected during a national pilot implementation of an ICF-based functional assessment system in routine Polish rehabilitation services It aimed to characterize within-patient changes in functioning observed between admission and discharge among 100 adults undergoing inpatient pulmonary rehabilitation, with a mean age of 68.7 ± 10.8 years (with 75% in the ≥65 years group), at baseline and 2-3 weeks post-rehabilitation. Changes in ICF qualifiers for Body Functions (B), Activities and Participation (D), and Environmental Factors (E) were evaluated using paired comparisons.

At baseline, the greatest impairments were observed in energy and drive functions (b130), sleep functions (b134), pain (b280), exercise tolerance functions (b455), joint mobility (b710), muscle power (b730), muscle endurance (b740), changing basic body position (d410), maintaining a body position (d415), and walking (d450). Between admission and discharge, significant reductions in impairment severity were observed in several body function categories, including muscle power (median qualifier 3 → 1), muscle endurance (3 → 2), joint mobility (3 → 1), pain (b280), exercise tolerance (1 → 0), and sensations associated with cardiovascular and respiratory functions (2 → 1) (all adjusted p < 0.01). Significant reductions in activity limitations were also observed for changing basic body position (3 → 2), maintaining a body position (3 → 2), walking (2 → 1), transfers (severe/complete limitation: 17% → 4%), daily routines (severe/complete limitation: 36% → 19%), and multiple self-care activities multiple self-care activities, including washing (1 → 0), caring for body parts (1 → 0), toileting (severe/complete limitation: 2% → 0%), and dressing (1 → 0) (all adjusted p < 0.01). Environmental factors remained stable, with medications, assistive products and technologies and family support consistently identified as facilitators of functioning.

These findings describe differences across several dimensions of ICF-rated functioning between admission and discharge during inpatient pulmonary rehabilitation. They suggest that routine ICF-based assessments may provide a useful multidimensional description of functioning. Future controlled studies could examine the extent to which these differences are attributable to rehabilitation, while dedicated validation studies could assess the responsiveness of the ICF-based assessment system and the clinical meaning of changes in qualifier scores.