ICF-Core-Sets in Acute Settings and Early Rehabilitation for Patients with Musculo-Skeletal Conditions

Background: The International Classification of Functioning, Disability and Rehabilitation has significant influence on the theoretical basis of rehabilitation. It defines a comprehensive psychosocial model taking into account relevant contextual factors. For use in daily practise in rehabilitation the ICF-classification is much too extensive. In order to identify the most relevant categories for daily clinical routine as well as for rehabilitation research ICF-Core-Sets were developed. Experts identified the most relevant ICF-categories for special health conditions in multiple voting processes on the basis of scientific data (systematic reviews, patient assessments, Delphi exercises). As contextual factors and the process of disease are relevant for functioning and therefore influence the rehabilitation process ICF-core sets for acute hospitals and early post-acute facilities were identified. Material and Methods: Consensus conferences of rehabilitation experts identified the most relevant ICF-categories for patients with musculo-skeletal disorders in acute hospitals and early post-acute rehabilitation facilities on the basis of preliminary scientific data (systematic reviews, patient assessments, Delphi exercises). The working groups consisted of physicians, physiotherapists, occupational therapists and nurses who worked ill Multiple discussion and voting processes. Categories which were seen as relevant for the patients in the respective setting by more than 75% of the experts were included in the core sets. Categories with votes between 40 and 75% were re-cliscussed. This paper compares the core sets for acute hospitals and post acute rehabilitation facilities which have been developed independently. Results: 17 categories of the chapter body functions, 9 body structures 11 categories representing activities and participation and 10 contextual factors were identified for acute hospitals. They include symptoms specific for the underlying health conditions such as pain, movement restriction and related activity limitations and participation restrictions. Additionally body functions and structures affected by the acute health condition or the acute interventions were recognised (e.g. cardiovascular and pulmonary functions, For the early post-acute rehabilitation facilities 23 body functions, 7 body structures, 22 categories from the chapter activities and participation and 18 contextual factors were identified. Compared to the core sets for acute hospitals the core set for early post-acute rehabilitation facilities focuses more on activities and participation as well as contextual factors related to the increased activity during this phase. This reflects the increased functional capacity and independence of the patients as well as the rehabilitation goals and the progress of recovery from acute illness. Discussion and Conclusion: Using systematic discussion and voting processes relevant ICF-categories for patients with musculo-skeletal conditions in acute hospitals and early post-acute facilities Could be identified. The core sets have to be tested in future multi-centre Studies.