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

Self-perceived functioning, goals and action plans: an evaluation of an ICF-based E-health application in an intervention for people with a combination of mental and physical health conditions

PURPOSE

In the BigMove intervention, people with physical and mental health conditions assess their functioning, set goals, and define action plans to achieve their goals recorded in an e-health application using all categories of the International Classification of Functioning, Disability, and Health (ICF). This study investigates whether data from this application can provide insight into participants' self-perceived functioning, goals and action plans and observe changes over time.

METHODS

Data from 446 participants were analysed with descriptive statistics to describe self-perceived functioning and the ICF categories related to the 15 most frequently chosen goals. Action plans were analysed using inductive analysis. Changes over time were investigated by comparing assessments before and after at least 4 months in the intervention.

RESULTS

The data provided insight into the self-perceived functioning, goals and action plans. Also, changes over time were observed. Self-perceived functioning changed from being mainly negative before, to mainly positive after the intervention. While goals were mostly related to the same ICF categories, the action plans changed from more specific short-term to more general long-term plans.

CONCLUSIONS

Our study demonstrates that all categories of the ICF can be used to record self-perceived functioning, goals and action plans and monitor changes over time.

Health-related quality of life, needs, and concerns among cancer survivors referred to rehabilitation in primary healthcare setting

BACKGROUND AND PURPOSE

There is a growing need for rehabilitation services beyond hospitals. This study aims to describe challenges faced by cancer survivors (CSs) referred for rehabilitation in primary healthcare, employing standardized scales measuring health-related quality of life (HRQOL) and open-ended questions. Furthermore, the study explores the applicability of patient-reported outcomes (PROs) in comprehensively understanding challenges encountered by CSs.

MATERIAL AND METHODS

This cross-sectional study involves CSs referred for cancer rehabilitation in a primary healthcare setting, including those participating in PROs as a part of routine practice. HRQOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The International Classification of Functioning, Disability and Health (ICF) framed the analysis of responses to open-ended questions 'what concerns you the most?' and 'what matters to you?'  Results: FACT-G showed the lowest scores for functional well-being (14.4) and emotional well-being (16.6), with higher scores for physical well-being (18.9) and social/family well-being (21.1). Responses to open-ended questions unveiled worries about everyday life and how cancer will impact family well-being presently and in the future. Furthermore, CSs reported a need to maintain normality and proactively address the challenges posed by the disease.

INTERPRETATION

CSs referred for rehabilitation in primary healthcare experience comprehensive challenges necessitating a holistic rehabilitation approach. This includes interventions supporting CSs in dealing with uncertainty, regaining a sense of control, and addressing family well-being concerns. When using PROs for need assessment, the combination of validated HRQOL scales and open-ended questions is crucial for an in-depth understanding of CSs' challenges.

ICF classification of therapeutic goals for outpatient episodes of neurorehabilitation in post-stroke and Parkinson disease

PURPOSE

To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF).

MATERIALS AND METHODS

Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life.

RESULTS

776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life.

CONCLUSIONS

While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this.

Use of Assistive Technologies and Alternative Means by Older People: The "Actional Model of Older People´s Coping with Health-Related Declines"

This paper presents the "Actional Model of Older people´s Coping with Health-Related Declines" to explain the use of a broad range of action alternatives of older persons for dealing with current or anticipated diseases, functional declines, activity limitations and participation restrictions. The general background is the action-theoretical model of intentional self-regulation of human development (e.g., Brandtstädter, 2006; Rothermund & Brandtstädter, 2019). Yet, our model provides an increased specification of major model components toward the situation of older people coping with current or anticipated health-related declines. The model development follows an adapted theory construction methodology (TCM) by Borsboom et al. (Perspectives on Psychological Science, 16(4), 756-766, 2021) and adapted principles for constructing practically useful theories by Berkman & Wilson (Perspectives on Psychological Science, 16(4), 864-874, 2021). Regarding content, we further draw on models of the use of assistive technologies (ATs) and medical services, qualitative studies on reasons for using ATs, and quantitative studies on health-related goals. The resulting model includes these components: (1) Discrepancies between perceived or anticipated and desired health-related development, (2) health-related discrepancy reduction and prevention goals, (3) action possibilities for reducing or preventing health-related discrepancies, (4) further motivating and demotivating goals, (5) beliefs about effective means for reaching the goals (2) and (4), (6) generation of the particular coping actions by goals (2) and (4) in combination with beliefs about effective means, (7) external context factors, and (8) modes of joint decision-making and decision-making on behalf of older people. The explanatory and practical value of the model are discussed as well as its implications for future research and geropsychology teaching.

Expert's View on Central Components of the Actional Model of Older People's Coping with Health-Related Declines: A Pilot Study with Professional Caregivers

Abri & Boll (2022) proposed the "Actional Model of Older People´s Coping with Health-Related Declines" to explain the use of various action alternatives of older persons for dealing with diseases, functional declines, activity limitations, and participation restrictions. It draws on a broad knowledge base: an action-theoretical model of intentional self-development, models of the use of assistive technologies (ATs) and medical services, qualitative studies on reasons for using or not-using ATs, and quantitative studies on older people's health-related goals. The present study aims to gather evidence to further refine this model by additionally relying on expert knowledge from professional caregivers serving older people. Six experienced geriatric nurses working in mobile care services or residential care facilities were interviewed about key components of the above model in relation to 17 older people aged 70 to 95 with stroke, arthrosis, or mild dementia. The results revealed additional goals of reducing or preventing health-related discrepancies beyond those already included in the model (e.g., moving without pain, doing things alone, driving a car again, social return). Moreover, new motivating or demotivating goals for using certain action possibilities were found (e.g., to be at home, to be alone, to rest, to motivate other older people). Finally, some new factors were identified from the biological-functional (e.g., illness, fatigue), technological (e.g., pain inducing ATs, maladaptive devices), and social contexts (e.g., lack of staff time) that are likely to promote or hinder the use of certain action possibilities. Implications for refining the model and future research are discussed.