Enhanced clarity and holism: the outcome of implementing the ICF with an acute stroke multidisciplinary team in England

Abstract

Purpose:Although it is recommended that the ICF (International Classification of Functioning, Disability and Health) should be implemented to aid communication within multidisciplinary stroke services, there is no empirical evidence to demonstrate the outcomes of such implementation. Working with one stroke service, this project aimed to address this gap and sought to evaluate the outcomes of implementing an ICF-based clinical tool into practice. Method:Using an action research framework with mixed methods, data were collected from individual interviews, a focus group, questionnaires, email communications, minutes from relevant meetings and field notes. Thematic analysis was undertaken, using immersion and crystallisation, to define overall themes. Descriptive statistics were used to analyse quantitative data. Data from both sources were combined to create key findings.Results:Three findings were determined from the data analysis. The ICF (1) fosters communication within and beyond the multidisciplinary stroke team; (2) promotes holistic thinking; and (3) helps to clarify team roles.Conclusions:The ICF enhanced clarity of communication and team roles within the acute stroke multidisciplinary team as well as with other clinicians, patients and their relatives. In addition, the ICF challenged stroke clinicians to think holistically, thereby appropriately extending their domain of concern beyond their traditional remit.Implications for RehabilitationThe ICF is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the outcomes of using it in clinical practice have yet to be fully explored.This study found that the ICF enhanced clarity of communication and team roles within an acute stroke multidisciplinary team and to others beyond the team, including clinicians, patients and their relatives.Using the ICF also challenged clinicians to think holistically about patient needs following a stroke.

IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors

“…Beneficial aspects include higher adherence to rehabilitation, increased personal satisfaction, shorter inpatient stays and greater goal attainment [6,8]. This is also in line with the International Classification of Functioning, Disability and Health (ICF) [9], which promotes patient-professionals communication, and the terminology of which can be used to structure assessments, goals and plan interventions [10,11]. However, patient participation in the process of goal setting is not standard clinical practice and even less so in geriatric rehabilitation, despite the fact that older persons need, due to their several comorbidities and various degrees of frailty, more guidance in defining their rehabilitation goals [12].…”

Accounting for What Matters to Patients in the G-DRG System: A Stakeholder’s Perspective on Integrating Functioning Information

“…We already know from existing studies that using functioning information enhances clarity and holism in interprofessional communication, 25 clarifies the roles of team members, and fosters communication within and beyond multidisciplinary teams. 26 However, to achieve these goals, integrating functioning information in the G-DRG system is not sufficient. As Hopfe et al 27 argued, a systems approach must be used, one that takes into account all of the components of the health system as well as their interplay, to improve interprofessional collaboration and strengthen health systems response to patients functioning needs to ultimately improve patients outcomes.…”

Engaging with clinicians to implement and evaluate the ICF in neurorehabilitation practice

“…Participants chose to focus on developing an ICF-based transfer of care report, with an ICF glossary (using the detail from the core set for stroke) to aid its completion. On reviewing the outcome from the project, it was concluded that the use of the ICF enhanced communication within and beyond the stroke team, aided holistic thinking and helped to clarify team roles (Tempest et al 2013). However, in order to implement it into practice, the participants (including the multidisciplinary stroke team, patients, their families, and community neurorehabilitation colleagues) needed to adapt some of the language and adopt it in a way that met their local needs (Tempest, Harries, Kilbride and De Souza, 2012).…”