Rehabilitationsmanagement in der Praxis unter Anwendung der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF)

Zusammenfassung

Fragestellung: Rehabilitation verfolgt das Ziel, die funktionale Gesundheit von Patienten mit einer Beeinträchtigung oder Behinderung zu verbessern oder zu erhalten. Dementsprechend ist das Assessment der Funktionsfähigkeit der Beginn jedes patienten- und zielorientierten Rehabilitationsprozesses. Mit der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) wird den Ärzten, Pflegepersonal, Psychologen und Therapeuten ein weltweit akzeptiertes Modell an die Hand gegeben, mit dem die funktionale Gesundheit in einer einheitlichen Sprache klassifiziert werden kann. Damit ein Nutzen aus der ICF für das Rehabilitationsmanagement gezogen werden kann, ist es notwendig ein passendes ICF Anwenderinstrument (Tool) für die klinische Praxis zu entwickeln. Solch ein ICF Tool sollte das Modell und die Klassifikation der ICF beinhalten und in einem problemorientierten Ansatz wie dem Rehab-Cycle eingebunden sein.

Ergebnisse: ICF Tools sind für die Anwendung in unterschiedlichen Bereichen des Rehab-Cycles entwickelt worden. Die Grundlagen für die Entwicklung waren die bestehenden ICF Core Sets in Kombination mit den ICF Beurteilungsmerkmale. Diese ICF Tools ermöglichen in der klinischen Praxis die Beschreibung des Gesundheitszustandes, die Abbildung der Patientengeschichte und den Bezug zwischen den Rehabilitationszielen und entsprechenden Interventionszielen, einen Überblick über die bestehenden Wege zur Verbesserung spezifische Aspekte der Funktionsfähigkeit des Patienten und abschließend die Veränderung des Gesundheitszustandes durch die durchgeführten Rehabilitationsinterventionen. Die ICF Tools lassen ein gemeinsames Verständnis für Funktionsfähigkeit sowie die Kommunikation zwischen Teammitgliedern im Rahmen eines multidisziplinären Rehabilitationsansatzes zu.

Diskussion und Schlussfolgerung: Die Entwicklung eines elektronischen Dokumentationssystems, die Zuweisung von standardisierten Instrumenten zu den ICF Kategorien und die Operationalisierung der ICF Beurteilungsmerkmale können zukünftig zur weiteren Verbesserungen im ICF-basierten Rehabilitationsmanagement beitragen.

Abstract

Purpose: Rehabilitation aims to enable people experiencing or likely to experience disability to achieve and maintain optimal functioning. Consequently, the assessment of functioning is the starting point of a patient and goal oriented rehabilitation process. Within the International Classification of Functioning, Disability and Health (ICF) rehabilitation practitioners can rely for the first on a worldwide accepted model providing a universal language for the description and classification of functioning. To take advantage of the ICF in rehabilitation management there is a need to develop appropriate ICF Tools for clinical practice. Such ICF Tools, integrating the model and the classification of the ICF, have to be integrated in a problem solving approach provided by the Rehab-Cycle.

Results: ICF Tools have been developed for the use in the different steps of the Rehab-Cycle. Existing ICF Core Sets in combination with the use of ICF Qualifiers were the basis for this development. In clinical practice, these ICF Tools allow the description of a functioning state, the illustration of the patient's experience of functioning and the relation between rehabilitation goals and appropriate intervention targets, an overview over required resources to improve specific aspects of human functioning and finally, the changes in functioning states following rehabilitative interventions. The ICF Tools support a common understanding of functioning and the communication among team members when used in multidisciplinary rehabilitation.

Discussion and Conclusions: The development of electronic documentation systems, the assignment of standardized instruments to ICF categories and the operationalization of the ICF Qualifiers can contribute to further improvements of ICF based rehabilitation management in the future.

Schlüsselwörter

Rehabilitation - Funktionsfähigkeit - ICF - ICF Tools - Rehab-Cycle - klinische Dokumentation

Key words

rehabilitation - functioning - ICF - ICF tools - rehab-cycle

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