ICF-basierte multidisziplinäre Therapie bei Arthrose – Ein Fallbeispiel

PURPOSE: Multidisciplinary treatment is an option for patients with osteoarthrits of the knee, if monomodal therapy has failed, but a joint arthroplasty is not indicated. The primary objective of this case study of a patient with osteoarthritis of the knee was to demonstrate the potential effects of a multidisciplinary day care program after indication was determined in a multidisciplinary assessment and after individual goals were defined. The second objective was to present an example of the practical application of the ICF in a structured rehabilitation management based on the Rehab-CYCLE ® . MATERIALS AND METHODS: The Rehab-CYCLE ® includes the steps assessment, assignment, intervention und evaluation. In the assessment step patients problems in all areas of functioning were collected. This was done by a detailed medical history, patient-oriented questionnaires and a clinical examination including standardized clinical tests. All results were documented on an assessment sheet according to the structure of the ICF. In the assignment the intervention categories were assigned to 3-week multidisciplinary day care program. The intervention included exercise therapy, occupational therapy, psychology, balneotherapy and patient education as well as additional medical care if necessary by a physician. Evaluation of effects at the end of treatment was performed by means of the ICF qualifiers. Long-term effects were assessed by the WOMAC and the SF-36 at follow-ups after 3 and 6 months. RESULTS: Every predefined treatment goal showed improvement. The effects in the osteoarthritis specific treatment goals pain and physical function persisted at both follow ups at 3 and 6 months. DISCUSSION: In this case study a multidisciplinary day care program based on an assessment improved functioning after a number of previously monomodal interventions had failed. The application of the ICF facilitated a patient-oriented description of the functioning status and supported the planning of the intervention that was based on the Rehab-CYCLE ® . CONCLUSION: An important question of future research is the effectiveness of this treatment concept in a clinical study with a sufficient number of patients. Furthermore, controlled studies should evaluate the effects of the application of the ICF combined with the Rehab-CYCLE ® on the outcome of interventions.