The Rehab-Cycle®

To facilitate the use of the ICF in clinical practice, it is essential to have ICF-based tools that could be integrated into the existing processes. In the rehabilitation setting, ICF-based tools can be employed in rehabilitation management - the multidisciplinary team can use them to comprehensively describe the functioning of patients experiencing or likely to experience disability, to guide the planning of functioning-oriented rehabilitation services and evaluate changes in the functioning status over a certain time period.

Rehabilitation management can be characterized with a problem-solving approach. One such approach based on the ICF is the rehabilitation cycle, called Rehab-Cycle®. The Rehab-Cycle® can facilitate the structuring, organization and documentation of the rehabilitation process, as well as help the professionals involved in a patient's rehabilitation with coordinating their actions. This iterative process includes four key elements: 1) assessment, 2) assignment, 3) intervention and 4) evaluation.

Read more: Introduction to ICF-based Documentation Tools and Rehab-Cycle

The ICF Assessment Sheet provides a comprehensive overview of the patient’s functioning state by presenting the assessment results in all the components of functioning, environmental and personal factors with input from both the health professional and the patient. The ICF Assessment Sheet can help the rehabilitation team to understand the patient's functioning and to identify the needs to be addressed in rehabilitation.

Read more: The ICF Assessment Sheet

The ICF Categorical Profile is a visual depiction of a patient's functioning status at the time of assessment showing the qualifier values for selected ICF categories considered relevant to a individual patient's case. It can facilitate the identification of intervention targets that are related to shared goals, serving as the central source of information for the rehabilitation team for intervention planning.

Completing the ICF Categorical Profile requires the rehabilitation team, with input from the patient, to state long and short-term goals, link these goals with the ICF categories that should be targeted for intervention, and identify a target rating for each ICF category defined.The ICF Categorical Profile is generally set-up using a suitable ICF Core Set. If no ICF Core Set exists for respective health condition, the ICF Categorical Profile should include the ICF categories that are essential for comprehensively describing the health status of the patient at the time of assessment.

icf-categorical-profile

ICF Categorical Profile

An ICF category is marked as an intervention target using the following codes to illustrate the relation to the respective goals. These codes are seen in the column marked 'Goal relation':

  • G = Global Goal; is the highest level goal a patient aims to achieve, and refers to the intended outcome after successful completion of rehabilitation.
  • SP = Service-Program Goal; is an intermediate goal a patient aims to achieve, and refers an endpoint of a specific program of rehabilitation.
  • C = Cycle Goal; is a short term goal that a patient aims to achieve. Several cycle goals are the 'stepping stones' toward achieving the corresponding service-program goal. C1 refers to cycle goal 1, C2 refers to cycle goal 2 and C3 refers to cycle goal 3, etc.

In order to evaluate if a goal has been achieved, a goal value for each targeted ICF category has to be set using ICF qualifiers. Goal values are generally set only for those ICF categories which are considered intervention targets and have a goal relation.

The information found in the ICF Categorical Profile can serve as the basis for completing the next ICF-based documentation tool - the ICF Intervention Table.

Literature

  • Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B Stucki G. ICF linking rules: an update based on lessons learned J Rehabil Med. 2005; 37(4): 212-218.
  • Finger ME, Selb M, De Bie R, Escorpizo R. Using the International Classification of Functioning, Disability and Health in physiotherapy in multidisciplinary vocational rehabilitation: A case study of low back pain.Physiother Res Int. 2014 Apr 15. Epub ahead of print.
  • Glässel A, Rauch A, Selb M, Emmenegger K, Lückenkemper M, Escorpizo R. A case study on the application of the International Classificaiton of Functioning, Disability and Health (ICF)-based tools for vocational rehabilitation in spinal cord injury. Work. 2012; 41(4): 465-474.
  • Peter C, Rauch A, Cieza A, Geyh S. Stress, internal resources and functioning in a person with spinal cord disease. NeuroRehabilitation. 2012;30(2):119-130.
  • Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med 2008; 44:329-342.
  • Rauch A, Escorpizo R, Riddle D, Eriks-Hoogland I, Stucki G, Cieza A. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability and Health (ICF) during patient management. Phys Therapy. 2010; 90(7): 1039-1052.
  • Rauch A, Baumberger M, Moise FG, von Elm E, Reinhardt JD. Rehabilitation needs assessment in persons with spinal cord injury following the 2010 earthquake in Haiti: a pilot study using an ICF-based tool. J Rehabil Med. 2011; 42: 969-975.

Information from the ICF Categorical Profile can be used to complete the ICF Intervention Table.

The ICF Intervention Table can facilitate the coordination of interventions, roles and resources within a multidisciplinary team. It provides a comprehensive overview of all the intervention targets (as represented by ICF categories), the interventions themselves and the corresponding rehabilitation professional(s) who is (are) assigned to address each intervention target. It also shows the initial ICF qualifier rating of the intervention targets, the goal value i.e. the ICF qualifier expected to be achieved after intervention, and the end or final value i.e. the ICF qualifier rating at a second assessment or evaluation. Logically, the end value is entered in the table after completion of intervention.

icf-intervention-table

ICF Intervention Table

More than one rehabilitation professional may be assigned to a specific intervention target. The discipline of each rehabilitation profession is abbreviated on the table. Suggestions for abbreviating are:

  • 'Doc' for medical doctor
  • 'PT' for physical therapist
  • 'OT' for occupational therapist
  • 'Psych' for psychologist
  • 'SW' for social worker
  • 'Arch' for architect responsible for adaptation of the home

Literature

  • Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B Stucki G. ICF linking rules: an update based on lessons learned J Rehabil Med. 2005; 37(4): 212-218.
  • Finger ME, Selb M, De Bie R, Escorpizo R. Using the International Classification of Functioning, Disability and Health in physiotherapy in multidisciplinary vocational rehabilitation: A case study of low back pain.Physiother Res Int. 2014 Apr 15. Epub ahead of print.
  • Glässel A, Rauch A, Selb M, Emmenegger K, Lückenkemper M, Escorpizo R. A case study on the application of the International Classificaiton of Functioning, Disability and Health (ICF)-based tools for vocational rehabilitation in spinal cord injury. Work. 2012; 41(4): 465-474.
  • Peter C, Rauch A, Cieza A, Geyh S. Stress, internal resources and functioning in a person with spinal cord disease. NeuroRehabilitation. 2012;30(2):119-130.
  • Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med 2008; 44:329-342.
  • Rauch A, Escorpizo R, Riddle D, Eriks-Hoogland I, Stucki G, Cieza A. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability and Health (ICF) during patient management. Phys Therapy. 2010; 90(7): 1039-1052.
  • Rauch A, Baumberger M, Moise FG, von Elm E, Reinhardt JD. Rehabilitation needs assessment in persons with spinal cord injury following the 2010 earthquake in Haiti: a pilot study using an ICF-based tool. J Rehabil Med. 2011; 42: 969-975.

The ICF Evaluation Display is based on the ICF Categorical Profile. In comparison to the ICF Categorical Profile, the ICF Evaluation Display includes only the ICF categories that were defined as intervention target i.e. those categories that were related to a specific goal (global goal, service-program goal and/or cycle goal). The ICF Evaluation Display is also enlarged to include a visual depiction of the patient's functioning status at the time of the second assessment or 'evaluation' and a column indicating goal achievement. It provides a picture of the change between functioning status before and after intervention. It is important to note however that this before-after picture of change does not necessarily signify that the change is due to the intervention itself, but only that there was a change.

icf-evaluation-diplay

ICF Evaluation Display

Regardless the ICF Evaluation Display can be useful for the rehabilitation team in their discussions about the course of rehabilitation and further intervention planning, including deciding on additional cycles (if the desired result was not achieved during the current cycle), continuing rehabilitaton with an additional service program or to end the rehabilitation.

Literature

  • Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B Stucki G. ICF linking rules: an update based on lessons learned J Rehabil Med. 2005; 37(4): 212-218.
  • Finger ME, Selb M, De Bie R, Escorpizo R. Using the International Classification of Functioning, Disability and Health in physiotherapy in multidisciplinary vocational rehabilitation: A case study of low back pain.Physiother Res Int. 2014 Apr 15. Epub ahead of print.
  • Glässel A, Rauch A, Selb M, Emmenegger K, Lückenkemper M, Escorpizo R. A case study on the application of the International Classificaiton of Functioning, Disability and Health (ICF)-based tools for vocational rehabilitation in spinal cord injury. Work. 2012; 41(4): 465-474.
  • Peter C, Rauch A, Cieza A, Geyh S. Stress, internal resources and functioning in a person with spinal cord disease. NeuroRehabilitation. 2012;30(2):119-130.
  • Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med 2008; 44:329-342.
  • Rauch A, Escorpizo R, Riddle D, Eriks-Hoogland I, Stucki G, Cieza A. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability and Health (ICF) during patient management. Phys Therapy. 2010; 90(7): 1039-1052.
  • Rauch A, Baumberger M, Moise FG, von Elm E, Reinhardt JD. Rehabilitation needs assessment in persons with spinal cord injury following the 2010 earthquake in Haiti: a pilot study using an ICF-based tool. J Rehabil Med. 2011; 42: 969-975.