Application of International Classification of Functioning, Vital Disabilities and Health to assess the effectiveness of rehabilitation in a psychiatric hospital

Abstract

BACKGROUND: The International Classification of Functioning, Disability and Health ICF is an important tool for planning, implementing and evaluating the effectiveness of the rehabilitation process. In addition, the use of the ICF makes it possible to objectify the level of quality of medical care. However, this classification is not quite enough used in practice still, including psychiatric practice, where (due to the specifics of these patients) a certain adaptation is required (in terms of choosing the set of the most informative domains).
 AIM: To evaluate the effectiveness of the rehabilitation of patients with mental disorders based on the use of the ICF.
 MATERIALS AND METHODS: Using data from case histories and special questionnaires, 500 patients of the psychiatric hospital were studied — a number of domains included in the ICF were identified and analyzed (domains characterizing “body functions”, “activity and participation”, “environmental factors”): upon admission, on 10th day of treatment, upon discharge. The study was conducted for 6 months by an all-over method. The exclusion criteria were: age under 18 and over 80; the presence of acute psychotic symptoms at the time of examination; the presence of severe cognitive dysfunctions that prevent the assessment of functional limitations, vital activity and health; duration of hospitalization less than 10 days. Statistical analysis of the collected material was carried out using application programs in Microsoft Office Excel.10.
 RESULTS: Among the examined patients, women accounted for 52.6% (263 people). In the age structure, 30.8% (154 people) were patients under 30 years of age; 24.2% (121 people) — 30–39 years old; 13.2% (96 people) — 40–49 years old; 12.8% (64 people) are 50–59 years old and 13.0% (65 people) are 60 years old and older. Average age — 39.5±0.6 years. In the nosological structure, 16.8% (84 people) were patients with organic mental disorders; 12.8% (64 people) — with mental and behavioral disorders associated with the use of psychoactive substances; 19.8% (99 people) — with schizophrenia, schizotypal and delusional disorders; 16.2% (81 people) — with mood disorders; 17.0% (85 people) — with stress-related neurotic disorders and somatoform disorders; 17.4% (87 people) with personality and behavior disorders in adulthood. Upon admission, the following disorders were the most pronounced: mental stability (which occurred in 80.6% of patients — 403 people); regulation of emotions — 390 people (78.0%); control of impulsive impulses — 382 people (76.4%); stability of attention — 388 people (77.6%); switching of attention — 376 people (75.2%); separation of attention — 374 people (74.8%); concentration of attention — 371 people (74.2%); psychomotor control — 354 people (70.8%). During the treatment, the prevalence of all identified disorders significantly decreased (differences in the proportion of patients with various disorders upon admission — on 10th day of treatment — upon discharge are statistically significant with a reliability of more than 95.5%).
 CONCLUSION: This dynamic proves the effectiveness of rehabilitation in general and the importance of nursing intervention in particular.