Rationale and principles of early rehabilitation care after an acute injury or illness

Abstract

Patients hospitalized for an acute illness or injury are at risk of experiencing a significant loss of functioning as defined by the International Classification of Functioning, Disability and Health (ICF). The risk of a significant loss of functioning is increased in critically ill patients, in patients with complications or long-term intensive care stays, in persons with disabilities or with pre-existing chronic conditions and in the elderly. Early identification of rehabilitation needs and early start of rehabilitation can reduce healthcare costs by reducing dependence and nursing care, length of stay and prevention of disability. Two principles of rehabilitation for acute and early post-acute care can be distinguished. First, the provision of rehabilitation by health professionals who are generally not specialized in rehabilitation in the acute hospital. And second, specialized rehabilitation care provided by an interdisciplinary team. There is large variation how this specialized, typically post-acute rehabilitation care is organized, provided, and reimbursed in different countries, regions, and settings. For instance, it may be provided either in the acute hospital or in a rehabilitation or nursing setting. Most in-patients do not receive specialized rehabilitation at all during their whole stay in the acute hospital. But, it is important to point out that health professionals working in acute hospitals and who are not specialized in rehabilitation need to be able to recognize patients' needs for rehabilitation care and to perform rehabilitation interventions themselves or to assign patients to appropriate rehabilitation care settings. The principles outlined in this paper can serve as a basis for the development of clinical assessment instruments to describe and classify functioning, health and disability of patients receiving acute or early post-acute rehabilitation care.

Sickness certificates: what information do they provide about rehabilitation?

“…Because the goals of early rehabilitation are to address bio-psychosocial obstacles to recovery and RTW and to increase functioning [33,34], the patient's functioning should provide the basis for rehabilitation decisions. In this study, the description of functioning was not associated with a prescription of early rehabilitation in comparison with diagnosis, age, and physician type.…”

Developing core sets for persons with spinal cord injuries based on the International Classification of Functioning, Disability and Health as a way to specify functioning

“…To address the need for interventions in a specific setting, separate ICF Core Sets have been developed for use in the acute hospital and early postacute rehabilitation facilities. [39][40][41] Objective The objective of this paper is to outline the proposed development process for the ICF Core Sets for Spinal What types of ICF Core Sets need to be developed? A key issue when developing ICF Core Sets for SCI is the decision of what core sets should be developed for, that is, which situation and which purpose.…”

“…In addition to their rehabilitation care, they also have needs for ongoing medical and nursing care. 40 As the spectrum of problems encountered in patients with SCI is very broad, it is unlikely that one of the currently developed ICF Core Set for chronic SCI Currently, there is no ICF Core Set for chronic SCI. The ICF Core Set for Chronic SCI is intended to represent the prototypical spectrum of problems that persons with SCI could experience in real life.…”

Developing Core Sets for Persons Following Amputation Based on the International Classification of Functioning, Disability and Health as a Way to Specify Functioning

“…To address the need for interventions in a specific setting, separate ICF Core Sets have been developed for use in the acute hospital and early post-acute rehabilitation facilities. [44][45][46] Recently work has been carried out to demonstrate that ICF Core Sets can also be used as an outcome measure and this may also be a longer term benefit of ICF Core sets for amputees. 47,48 Objective The objective of this paper is to outline the proposed development process for the ICF Core Sets for Amputees and to invite clinical and consumer experts to actively participate in this process.…”