Biopsychosocial approach to the rehabilitation of people with disabilities due to stroke based on the International Classification of Functioning, Disability and Health

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) [1] allows the targeted, comprehensive and unified development of indications for individual rehabilitation and habilitation programs. It can be used throughout the rehabilitation process, from the medical and social examination in a medical institution, to referral to such an institution, or in a rehabilitation organization.

AIM: To formulate proposals for improving the assessment of the comprehensive rehabilitation needs of people with disabilities due to stroke based on the ICF biopsychosocial approach.

MATERIALS AND METHODS: General scientific (analysis, synthesis) and statistical, rehabilitation-expert (expert assessments) methods were used. A cross-sectional study was performed in a group of 345 people, nearly all (97.8%) of whom were in the late recovery period of cognitive impairment (CI). One of the inclusion criteria was working age. The following indicators were assessed: functions (b110–b799) and disability (d110–d999) in people of working age with CI in all significant domains of the ICF. The questionnaires recommended by the WHO were used. The core sets are available on the WHO website (https://icf-core-sets.org/en/page1.php).

RESULTS: In people of working age who were disabled due to CI, a variety of functional disorders was revealed: there were neuromuscular, skeletal, and movement-related disorders, (statodynamic functions) in 100% of cases; dysfunctions of the cardiovascular system in 70%, and speech disorders in 50%. Every sixth disabled person of working age had mental disorders. Among patients with statodynamic disorders, 56.2% were classed as moderate; and 33% were severe. The leading limitations were limited ability to work (in 100% of disabled people), limited ability to self-care (in 88.9% of disabled people), and limited ability to move independently (in 91.0% of disabled people). The functionality indicators, in particular, impairment of function, activity and participation, strongly influence the indications for developing individual rehabilitation and habilitation programs and the setting of specific rehabilitation goals. A multidisciplinary approach to providing medical care for patients with stroke, including the targeted use of rehabilitation measures using the ICF at all stages of care, enabled the improvement of their rehabilitation indicators, reduction of disability, and the resumption of work for some patients.

CONCLUSION: We propose the use of a unified tool like the ICF throughout the rehabilitation process to ensure a comprehensive and targeted approach to rehabilitation. It should be used in medical institutions when referring a patient for medical and social examination, in institutions for medical and social examination, and in rehabilitation organizations. When developing and implementing individual rehabilitation programs, one must consider biopsychosocial factors such as dysfunction, its duration and severity, the duration of the disease, the types and severity of limitations of activity and participation (limitations of life), the safety of activity and participation in everyday life, age, and the ability to work.