[Patient orientation and reference to the ICF as challenges in outcome assessment in rehabilitation].
Measuring the results of rehabilitation interventions presents a number of issues regarding content and method, two of which have been selected for discussion in view of the findings of current research--the significance of patient orientation and the relation to the International Classification of Functioning, Disability and Health, ICF. Compilation of patients' treatment goals, expectations and preferences, patient participation in the development of assessment instruments, compilation of patients' evaluations of treatment results and consideration of the subjectivity of the physician as well as interaction between patient and physician were discussed with respect to involving patients in measuring results. The ICF is a terminology system presenting a uniform international classification for describing health conditions that could assume the function of a common language for the members of various occupations involved in medical rehabilitation. Orienting the measurement of results to the ICF is an obvious next step. This can promote patient orientation, as the categories used by the ICF--in particular for the domains of activities and participation--are formulated in terms relevant to daily routine and are thus pertinent to the patients' lifestyle. The consequences resulting from this overview concern future research needs on the one hand, and on the other hand tips for carrying out a patient-oriented, ICF-based measurement of results. The need for research becomes especially clear regarding the measurement of results based on patient preferences, the determination of the participation relevance perceived by the patient as a criterion for "patient significance" (analogous to "clinical significance"), the integration and weighting of patient and physician assessments of success, the consideration of physicians' subjective concepts and patients' communication preferences, and the design of new, ICF-oriented assessment instruments.
Farin
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Universitätsklinikum Freiburg, Abteilung Qualitätsmanagement und Sozialmedizin (AQMS). erik.farin@uniklinik-freiburg.de
D000203:Activities of Daily Living / Q000145:classification; D001294:Attitude to Health; D003142:Communication; D004185:Disability Evaluation; D005858:Germany; D038801:International Classification of Diseases; D008019:Life Style; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D017060:Patient Satisfaction; D012046:Rehabilitation / Q000193:education*; D014944:World Health Organization