Development and evaluation of an ICF-based patient training program for stroke patients in phases C and D

The goal of the project was to develop and test a patient training program based on the model of the ICF and the ICF core set for strokes. The aim of the training was to deepen patients’ understanding of the factors influencing their functional ability, to extend the self-assessment of their competencies with regard to overcoming difficulties and barriers which influence their functional ability in everyday life (self-efficacy), to strengthen their autonomous dealing with their illness (self-management) and to support them in their ability to represent and organise their issues in everyday life with as much autonomy and self-determination as possible (empowerment).

The developed ICF-based patient training consists of three modules and is conducted in a closed group with a maximum of 4 patients, who work together for 60 minutes per day for five days:

• In the first module (first day), the functional ability of the patient from the patient’s own perspective is systematically measured using the ICF Core Set for strokes.
• In the second module (second to fourth day), the categories of the first module are selected which were most problematic for most patients. Two categories are then discussed per day by asking all patients in turn which concrete problems they have with it and what solutions they see for these problems. In this respect, the patients’ experiences in rehabilitation are repeatedly addressed. The search for relevant offers of help in a brochure developed for the project is prompted as often as possible.
• In the third module (fifth day), a systematic summary of the themes addressed ensues.

Ease of implementation and acceptance of the training were examined in a pilot study in August 2008 [Neubert & Sabariego, 2010]. The evaluation of the patient training took place in the framework of a prospective, randomised controlled intervention study (RCT) with three measurement time points: pre, post and 6 months after the intervention. The ICF-based patient training was carried out in stroke patients during their stay in a rehabilitation establishment and a total of 260 participants in seven neurology clinics were recruited. The primary dependent variable was defined as self-efficacy, and secondary dependent variables were functional ability and general life satisfaction. The longitudinal data were analysed with the “Multilevel Model for Change”. A positive effect was observed in both groups regarding self-efficacy and participation. By contrast, the emotional functional ability deteriorated in both groups. Contrary to expectation, no statistically significant effect was found between the intervention and control group. The concept of ICF patient training was therefore critically examined and changed based on the experiences gathered. An examination of the improved version in the framework of a pilot study is planned.