Functioning and Methods
The research group Functioning and Methods focuses on the development and implementation of methods for the standardized documentation of information on the functioning of persons with spinal cord injury (SCI) and other health conditions. This is based on the International Classification of Functioning, Disability and Health (ICF). Various qualitative (e.g. interviews and content analyses) and statistical (e.g. Rasch model and graphical models) methods are applied in combination.
It is the goal for these methods to support the mapping and availability of information on functioning in various areas of the health system. This mapping makes it possible to make optimal use of and exchange the information, to learn from it and to ensure a comprehensive, patient-centered treatment. Examples therefore are computer-assisted clinical decision making or quality management on a national level in rehabilitation. For this purpose, we collaborate with our partners within the Swiss Paraplegic Group (SPG), with all paraplegic centers in Switzerland and other national and international collaboration partners in clinical practice and research.
Clinical decision-making during initial rehabilitation
In Switzerland, data on persons with spinal cord injury (SCI) going through initial rehabilitation have been collected in the course of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) since 2010. The data have been collected in four paraplegic centers, based on standards defined in the International Classification of Functioning, Disability and Health (ICF). These data are used to identify and analyze patterns and interdependencies during rehabilitation with regard to the functioning of patients with SCI. We want to use this information in the form of a computer-aided application, in order to optimize the complex process of clinical decision-making during rehabilitation in the future. The computer-aided application will be developed in close collaboration with the participating rehabilitation centers to ensure that it meets the needs and requirements of the experts involved in clinical decision-making. The use of such a computer-aided application offers multiple opportunities: It can make the clinical decision-making process more transparent and increases the efficiency of the provided services. Thus it supports a targeted rehabilitation leading to an optimization of the patients’ functioning.
Epidemiology of functioning
The Epidemiology of Functioning aims at describing and understanding functioning of people living with spinal cord injury (SCI). Functioning is the overall lived experience of health, which comprises «biological health» and «lived health» in light of the person’s health conditions, given his/her resources, and in interaction with the environment. This results in many intrinsic linkages between body functions and structures and the many activities that humans perform in interaction with the environment. Our research in the Epidemiology of Functioning employs suitable statistical approaches to understand the complexity of these interactions and to describe the prevalence of functioning problems.
The Swiss Spinal Cord Injury Cohort Study (SwiSCI) serves as our main data source. Our approach to illustrate the prevalence of functioning problems in the Swiss SCI population uses so-called heat maps. Heat maps are a user-friendly statistical method that allows clinicians and researchers to see at a glance in a visually displayed way the frequency of problems experienced by persons with SCI.
Likewise, graphical modelling is another way to study the associations among functioning domains. For example, the association between impairments in body functions and the performance of activities can be studied without any preconceptions about these associations. This information is helpful for clinicians and researchers to gain further insight into complex problems and to better explain and understand potential consequences. Furthermore, future research questions on the functioning of people living with SCI can be developed with more focus.
Case studies for patients with spinal cord injury
Understanding functioning is essential for the successful rehabilitation of persons living with spinal cord injury (SCI). Since 2001, the International Classification of Functioning, Disability and Health (ICF) has been available to clinicians as the basis for the assessment and documentation of functioning. To illustrate the use of the ICF in rehabilitation practice Swiss Paraplegic Research (SPF) together with Swiss Paraplegic Centre performed a series of ICF-based case studies. This project promotes SPF's aim to contribute to optimal functioning, social integration, health and quality of life for persons with SCI through clinical and interdisciplinary research. It also fosters SCI education by providing detailed information about SCI-relevant topics in each case. In this project, patients were followed during their rehabilitation, and the rehabilitation process was described following the Rehab-Cycle®, a multidisciplinary rehabilitation management approach, and using corresponding ICF-based documentation tools. Since persons with SCI are faced with diverse physical, psychological and social challenges, each case study highlights a specific theme of SCI rehabilitation, such as return-to-work or pain management. For more information and the results of each case study go to www.icf-casestudies.org.
Quality management in rehabilitation
Swiss rehabilitation clinics are legally required to document and disclose their treatment quality. In order to assess the treatment, it needs to be measurable. Since 2013, in Switzerland these measurements are performed on a national level by ANQ, the National Association for Quality Development in Hospitals and Clinics. Inter alia, tools are used for these ANQ measurements that measure the functioning of a patient at the beginning and at the end of his/her stay in the clinic. Since the rehabilitation clinics can choose between various measurement tools for these ANQ measurements, it is difficult to compare the clinics with each other.
The project «Quality Management in Rehabilitation» uses the International Classification of Functioning, Disability and Health (ICF) as neutral standard that shows which areas of functioning are covered by the ANQ measurement tools. Furthermore we apply statistical methods in order to make the various measurement tools comparable with each other. Thus the data collected by ANQ on the functioning of a patient can be documented regardless of the tool used for their collection. The various clinics can thus be better compared, learn from each other and therefore improve the treatment quality.