Personalized Rehabilitation

2/9/2017
Rehazentrum Kitzbühel | Aussen 2

The basic approach to and the mode of operation in medical rehabilitation have changed considerably in recent years: Today, the activities of doctors, nurses and physiotherapists are supplemented by massage and lymphatic therapy, occupational therapy, psychology, dietetics, speech therapy, sports science, orthopedic technology and social services. Here the physicians play a central role: They coordinate the interdisciplinary team, treat (concomitant) diseases and ultimately decide what treatment steps are to be taken at which time. In this process, the physician performs and supervises at the same time:  He or she analyzes, controls and monitors the entire rehabilitation process. This is likewise explained in the current rehabilitation plan 2016, which states that “…rehabilitation is always tied to a physician bearing the ultimate responsibility…”.

In the beginning, as well as during the rehabilitation, using objective measurements, tests and questionnaires it is ascertained which status of “functional health” exists, what skills (functional abilities) are present, and what progress takes place (= assessment). The rehabilitation objectives are based primarily on the patient’s expectations and on the specifications on the part of acute-care medicine (curative medicine). In the therapeutic team, these objectives are determined in cooperation with the patient and continuously evaluated. Accordingly, the individual treatment plan is then drawn up (= assignment), and the therapeutic measures are performed (= intervention). It must be clarified whether a need for rehabilitation exists, whether rehabilitation is possible, and what the rehabilitation prognosis is. All these parameters ultimately determine the accessibility of the defined rehabilitation goals.

If, despite appropriate steps, no improvement can be seen, or even new problems occur, the strategy initially defined by the physician is revised and adapted. Feedback to the relevant department of “acute care” may have to be provided (e. g. to the surgeon).

*Funktionsfähigkeit

Functional capability

However, the seamless collaboration of the entire rehabilitation team is no less important. All persons involved in the rehabilitation process (including the family members, if possible) must be in close information exchange and should at all times have the same level of information. Team meetings are an important platform for this. Here, the “International Classification of Functioning, Disability and Health (ICF)” provides the basis for a common language.

The treatment strategy is continuously coordinated within the treatment team: Important contextual factors are reconciled, stagnant progress is discussed, and general questions are answered. Understanding the needs and goals of everyone involved in the treatment process is crucial for good communication and the quality of the result.

Defining Individual Goals by Use of the ICF

Based on the ICF, the wishes and circumstances of the patient are also included. Two patients with the same condition or the same physical limitations may still have very different needs in everyday life. Thus, for example, one hemiplegic stroke patient may receive much support from his family members, while another lives alone in a floor apartment without a lift.

The ICF thus allows describing the functional health of the patient and the accompanying social impairment, and thus performing transparent and comprehensible rehabilitation.

Personalization for Better Therapeutic Results

Especially in recent decades, a uniform system has become indispensable: Life expectancy continues to increase, and so does the number of chronic diseases. Not least for this reason, the need for rehabilitation is continuously growing. Health, mobility, communication, gainful employment, as well as self-determination and participation in social life are increasingly important aspects that must be incorporated into rehabilitation goals in order to relieve the burden on the health care system over the long term. A treatment plan according to the criteria of the ICF is thus not only economically advantageous, but also individually the best for the patient.

Another advantage of the ICF compared to previous models is its updated access. Here the approach is no longer deficit-oriented but resource-oriented, and it can be applied to any persons, with and without disabilities, on a completely objective basis. This makes the ICF not only more practical, but also more advanced in terms of its mindset. Here the question of what the patient cannot do is deliberately waived. Instead, the focus is on what the patient needs. Here the ICF can be used at an individual level, at an institutional level, and at a social level. It is based on a multi-axis model, since it involves the bio-psycho-social aspects.

 Measuring and Evaluating Successes

The ICF is also what makes rehabilitation results measurable: On this basis, systematic result quality measurements are to be performed, and the process and the results continuously evaluated. The ICF is also used all around the world for the description and evaluation of healthcare facilities, such as rehabilitation clinics and nursing homes. Today, the measurement and evaluation of individual and systematized processes in terms of quality management (viz.: structure, process and outcome quality) is essential and a requirement for constantly ongoing development of rehabilitation programs. Using the ICF, furthermore data on health economy are collected that enable us to monitor health-related and medical expenses and can reveal health strategies for the future as a further consequence. The ICF is therefore a method suitable for everyday use to obtain data for rehabilitation research.

 Personalized Therapy Concepts

In medicine, individualization and personalization are becoming more and more important across disciplines: Never before has research focused so comprehensively on targeted, individualized therapies. Especially in rehabilitation, this has a particular meaning: For athletes, individual training programs have long been established practice – it is just obvious that rehabilitation patients will benefit from this as well.

Gesundheitsproblem (Gesundheitsstörung oder Krankheit)

Health problem (disorder or disease)

 

Körperfunktionen und –strukturen

Bodily functions and structures

Aktivitäten

Activities

Partizipation (Teilhabe)

Participation

Umweltfaktoren

Environmental factors

Personenbezogene Faktoren

Personal factors

 

These articles might also interest you:

+  Part 1"What is Gender Medicine?" - from Univ. Prof. Dr. Alexandra Kautzky-Willer
+ "ICF: Individual rehabilitation Systems" - from Univ. Doz. Dr. Thomas Bochdansky
+ "The Orpheus Program" - from Prim. Univ. Prof. Dr. Michael Musalek 
+ "The mode of operation in medical Rehabilitation" - from Prim. PD. Dr. Michael Fischer

 

 

 

 

 

AUTHOR

Prim. PD. Dr. Michael Fischer Rehazentrum Kitzbühel & VAMED - Chief Medical Director

Hornweg 32 6370 Kitzbühel
E-Mail