Should rehabilitation goals reflect all aspects of functioning in relation to a biopsychosocial ICF perspective?

Abstract

Purpose

To classify short-term and long-term rehabilitation goals and analyse how they capture functioning in a biopsychosocial International Classification of Functioning, Disability and Health (ICF) perspective.

Materials and methods

A retrospective study was conducted at two specialised outpatient multidisciplinary rehabilitation centres for polio survivors and accident victims. Rehabilitation goals extracted from patient journals were linked to the ICF according to linking rules.

Results

One hundred patients were included. Four hundred and eighty-seven short-term and long-term rehabilitation goals were linked to the ICF. Fifty-seven per cent were linked to Activity and Participation, 22% to Body Functions, 1% to Body Structure, 4% to Environmental Factors, 4% to Personal Factors, whereas 11% were not defined and 1% was not covered. The identified categories covered all ICF domains. The most frequent categories for short-term goals were d450 “Walking” and d570 “Looking after one’s health.” For long-term goals, d850 “Remunerative Employment” and d920 “Recreation and Leisure” were the most frequent.

Conclusion

The study showed challenges in capturing all aspects of biopsychosocial functioning in rehabilitation goals, particularly Contextual Factors. This study indicates that rehabilitation goals capture capacity rather than performance. Further research could highlight if functioning is captured in the rehabilitation plan, and in this way include both capacity and performance.

Implications for rehabilitation

• Health professionals in a post-acute or long-term rehabilitation setting should pay attention to capacity and performance when rehabilitation goals are set.

• The rehabilitation plan should contain goals and a description of patient’s contextual factors and both should be equally valued and combined in a description of functioning.

• In a post-acute or long-term rehabilitation setting short-term and long-term goals are affected by the context. A longer rehabilitation intervention lead to goals linked to activity and participation.

Keywords:

• Functioning
• ICF
• classification
• goals
• rehabilitation

Acknowledgements

We would like to thank the staff at the Specialised Hospital for Polio and Accident Victims in Denmark for their kindness and help, and for giving us access to their practice.

Disclosure statement

The authors report no conflicts of interest.