Achieving a holistic perspective in stroke rehabilitation: An overview of the use of the ICF by Danish physiotherapists and occupational therapists

Abstract
Background/Aims:
Holistic, multidisciplinary rehabilitation is often the most appropriate for stroke patients. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a comprehensive conceptual framework and systematic terminology used by health professionals worldwide. The purpose of this study was to explore how the components of the ICF were addressed by physiotherapists and occupational therapists in stroke rehabilitation.

Methods:
A prospective cohort study, including all service levels within Danish stroke rehabilitation, was carried out. Consecutive patients with a diagnosis of stroke (n=131; 70 males and 61 females; mean age: 72 years) admitted to a university hospital between May and December 2012 were enrolled by 13 physiotherapists and occupational therapists. Physiotherapist and occupational therapist documentation was collected from participants' medical records and analysed using deductive content analysis until saturation was reached. Data were generated in four settings that encompass the general Danish health care service to adult stroke patients in hospitals and community-based settings.

Results:
Patient data were documented according to three of the ICF components, i.e. body functions and structures, activity and participation, and environmental factors. No distinct pattern emerged that would enable a differentiation between therapists' notes in the four settings.

Conclusions:
The ICF framework may contribute to a holistic approach in stroke rehabilitation, including an understanding of functioning and the ability to participate in everyday life. Using this approach to rehabilitation, disability is not only perceived as a consequence of stroke but also in the context of the individual person, where interactions between the biological, psychological, social and environmental aspects must be taken into account in order to provide an adequate rehabilitation service. Nevertheless, more attention seems to be paid to health components at the expense of the contextual factors; this needs to be addressed to augment the holistic approach.