Vol.1, No.2, 36-39 (2013) Open Journal of Therapy and Rehabilitation
Associations between rehabilitants’ functional
limitations and conclusions made by a
multidisciplinary team during vocational
rehabilitation evaluation: Turku ICF Study
Mikhail Saltychev1*, Aila Kinnunen2, Katri Laimi1
1Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland;
*Corresponding Author: mikhail.saltychev@gmail.com
2Department of Brain Trauma and Rehabilitation, Turku University Hospital and University of Turku, Turku, Finland
Received 15 August 2013; revised 20 September 2013; accepted 30 September 2013
Copyright © 2013 Mikhail Saltychev et al. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: To investigate associations between
functional limitations experienced by rehabili-
tants and multidisciplinary team’s recommenda-
tions during vocational rehabilitation evaluation.
Methods: The descriptions of functional limita-
tions were retrospectively identified for 32 pa-
tients with chronic musculoskeletal disorders.
Vocational rehabilitation evaluation was con-
ducted by a multidisciplinary team in an out-
patient clinic of a university hospital. The de-
scriptions were converted to ICF second-level
categories. Square contingency coefficient Phi
(φ) was calculated to describe the associations
between ICF-categories appearing 10 times in
the study sample and the recommendations
given by a professional team. Results: In the
study sample, 84 different ICF second-level cate-
gories were identified (average 18 codes/subject,
range 9 - 25). Of them, 18 categories were ob-
served for at least in 10 rehabilitants. Three sta-
tistically significant correlations were observed
between these 18 categories and recommenda-
tions given by a rehabilitation team. Of them,
positive association of moderate strength was
found between joint mobility and muscle power
functions and recommendation for retirement.
Difficulties in walking showed weak negative
correlation with recommendation for vocational
rehabilitation. Conclusions: During vocational
rehabilitation evaluation, the final recommenda-
tions given by rehabilitation professionals were
only weakly correlated with functional limita-
tions experienced by rehabilitants.
Keywords: Occupational Reh abilitation;
Rehabilitation Assessment; Work Ability; Work
Capacity; Correlation
To be successful, vocational rehabilitation evaluation
should be able to answer to at least three questions.
Firstly, if there is a need for rehabilitation measures at all,
secondly, if preconditions for such measures exist, and,
finally, what could be recommended as a concrete start
point of rehabilitation. All three issues may vary widely
in different settings depending on state and local politics,
insurance policies, believes, and economic and employ-
ment situation among other factors. Of these three goals
of vocational rehabilitation evaluation, the need for reha-
bilitation is probably less dependent on societal differ-
ences as it bases on person’s health and restricted func-
tioning and participation.
There are studies describing functional status of em-
ployees leading to a need for vocational rehabilitation, as
well as studies on impact of functioning on rehabilitation
success [1-3]. Different methods have been suggested to
describe the impact of employee’s health and social con-
ditions on his or her engaging in employment. Such
methods are, for example, Personal capability Assess-
ment (PCA), California Functional Capacity Protocol
(Cal-FCP), and International Classification of Function-
ing, Disability and Health (ICF). ICF is accepted by all
members of World Health Organization and it could be
regarded as the most standardized biopsychosocial frame-
work for describing functioning and participation [4,5].
Copyright © 2013 SciRes. OPEN ACCESS
M. Saltychev et al. / Open Journal of Therapy and Re habilitation 1 (2013) 36-39 37
During the evaluation of rehabilitation need, professional
team thoroughly collects data on rehabilitant’s functional
status. So far, however, it is unknown how much these
data on functioning affect the final decisions and rec-
ommendations given by a team. We are not aware of
reports on connection between functional limitations
experienced by rehabilitant and recommendations given
by a professional team. Is it really taken into account or
does the decision mostly base on objective data (like, e.g.,
changes on x-ray images, blood tests, or objectively
measured muscle strength)? Knowledge on how strongly
recommendations made by professionals are driven by
functional limitations which may help multidisciplinary
team focus on the most important topics of collected data.
The purpose of the study was to investigate correla-
tions between rehabilitants’ functional limitations ex-
pressed in the unified form of ICF categories and rec-
ommendations given by a multidisciplinary team during
vocational rehabilitation evaluation.
The study was conducted in the out-patient clinic of
the Department of Rehabilitation in Turku University
Hospital, Finland. The clinic is specialized in compre-
hensive rehabilitation evaluation with an emphasis on
determining abilities, skills, and motivational factors for
the employment of persons with deteriorated work ability
due to chronic medical conditions. In this study, all pa-
tients, referred for this evaluation because of a chronic
musculoskeletal disorder and entered the clinic between
1 January 2011 and 31 December 2011, were included.
Data from the electronic patient records were obtained
for 32 persons (53% women). None was excluded from
the study .The study was approved by the Ethics Com-
mittee of the Turku University Hospital.
All participants had a history of a chronic muscu-
loskeletal disorder confirmed by a physician. Their ca-
pacity for work had started to deteriorate, and work dis-
ability was probable. The rehabilitation evaluation was
conducted by a multi-professional team consisting of a
physician, a rehabilitation planner, and a psychologist.
The main goal of the evaluation was to form a compre-
hensive rehabilitation plan regarding a diagnostic and
treatment strategy and appropriate medical and voca-
tional rehabilitation measures with an emphasis on the
vocational content. The final statement of the evaluation
contained an opinion on the severity of the unemploy-
ment handicap. Patients, their earning-related pension
insurance company, and the local employment agencies
carried the responsibility for the practical implementa-
tion of the rehabilitation plan. The process of evaluation,
the definitions of demographic variables, and the code
extraction process have been previously described [6].
Each rehabilitant’s electronic patient record was stud-
ied retrospectively, and each phrase that could poten-
tially be interpreted as an ICF code was extracted and
converted into appropriate ICF codes. The codes were
extracted with as high a precision as possible. Due to the
qualitative nature of the used patient records, no attempts
were made to define the ICF quantitative qualifiers. Due
to the retrospective nature of the study and the impre-
ciseness of descriptions of s- and e-components (s =
body structures and e = environmental factors), we
agreed to include only b- and d-components (b = body
functions, d = activities and participation) of ICF for
further analysis.
The recommendations given by a rehabilitation team
at the end of an evaluation process were defined by using
two dichotomous variables: “recommendation of a long-
term sick leave or disability pension—Yes/No”, and
“recommendation of further vocational rehabilitation
Statistical Analysis
The identified ICF categories were truncated to a form
of second-level ICF category (letter with three digits).
For practical reasons, further analysis included only
categories which appeared >10 times in the study sam-
ple. Square contingency coefficient Phi (φ) was calcu-
lated for each frequent code along with a two-tailed
Fisher’s exact test for significance set at <0.05. Correla-
tion strength of 0 - 0.19 was regarded as very weak, 0.2 -
0.39 as weak, 0.40 - 0.59 as moderate, 0.6 - 0.79 as
strong, and 0.8 - 1 as very strong. All of the statistical
analyses were performed using IBM® SPSS® Statistics
version 21.
The mean age of rehabilitants (53% women) was 46.4
(range 29 - 60, standard deviation [SD] 8.9) years. The
general educational level was low, and only four persons
(13%) had a high school education. Most of the patients
(78%) had some vocational education, mostly compara-
ble to vocational school. Half of patients still had a valid
job contract. Over 60% had a work history >20 years,
and over 50% were manual workers.
In the study sample, 84 different ICF second-level
categories were identified (average 18 codes/subject,
range 9 - 25). Of these 84 categories, 18 were observed
for >10 times. The multidisciplinary team recommended
a long-term sick leave or disability pension for 8 and
vocational rehabilitation measures for 10 rehabilitants.
Three statistically significant correlations were observed
between these categories and conclusions made by a re-
habilitation team (Table 1). Of them, positive association
of moderate strength was found between joint mobility
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M. Saltychev et al. / Open Journal of Therapy and Re habilitation 1 (2013) 36-39
Copyright © 2013 SciRes. OPEN ACCESS
Table 1. Correlations between frequent functional limitations identified during vocational rehabilitation evaluation and recommenda-
tions made by a professional team. Results are reported as mean square contingency coefficient Phi (φ) values and Fisher’s exact test
for significance.
Rehabilitation recommended Long-term sick leave or pension recommended
ICF category
φ Fisher’s exact testφ Fisher’s exact test
b130 Energy and drive functions 0.12 0.70 0.15 0.68
b134 Sleep functions 0.06 1.00 0.33 0.10
b140 Attention functions 0.20 0.43 0.08 1.00
b152 Emotional functions 0.02 1.00 0.00 1.00
b265 Touch function 0.33 0.14 0.14 0.69
b280 Sensation of pain 0.09 1.00 0.15 0.44
b710 Joint mobility 0.20 0.45 0.55 <0.01
b730 Muscle power functions 0.25 0.25 0.49 0.01
d240 Handling stress and other psychological demands 0.22 0.25 0.23 0.38
d410 Changing basic body position 0.02 1.00 0.18 0.42
d415 Maintaining a body position 0.12 0.70 0.15 0.43
d430 Lifting and carrying objects 0.13 0.64 0.25 0.30
d450 Walking 0.39 0.05 0.15 0.68
d540 Dressing 0.15 0.47 0.30 0.12
d640 Doing housework 0.09 0.67 0.04 1.00
d825 Vocational training 0.20 0.43 0.23 0.22
d850 Remunerative employment 0.22 0.27 0.19 0.56
d920 Recreation and leisure 0.06 1.00 0.11 0.68
and muscle power functions and recommendation for
long-term sick leave or disability pension (φ = 0.55 and
0.49, respectively). Difficulties in walking showed weak
negative correlation (φ = 0.39) with recommendation
for vocational rehabilitation.
In this retrospective study of 32 participants in a voca-
tional rehabilitation evaluation due to chronic muscu-
loskeletal disorders, we found only few statistically sig-
nificant associations between different functional limita-
tions described in terms of ICF and final recommenda-
tions made by a multidisciplinary team. Namely, moder-
ate positive associations were observed between joint
mobility and muscle power functions and recommenda-
tion for long-term sick leave or disability pension. Diffi-
culties in walking showed a weak negative correlation
with recommended rehabilitation.
As far as we know, this is the first study on associa-
tions between functional limitations experienced by reha-
bilitants in vocational rehabilitation evaluation and con-
clusions made by a multidisciplinary team. We observed
that the associations between functioning and recom-
mendations may be described in unified terms of ICF and
also quantitatively assessed. As this study is a descriptive
evaluation of 32 cases, no strong inferences concerning
the entire population with need for vocational rehabilita-
tion should be made. The role of environment in person’s
participation level is one of the cornerstones of ICF, but
due to a retrospective design of the study, the obtained
data on environmental factors (e-component) were not
considered to be reliable.
There is no doubt that recommendations made during
vocational rehabilitation evaluation have to be affected
not only by functional limitations experienced by reha-
bilitant but also by more objective data on health status
collected through e.g. clinical examination, x-ray imag-
ing, laboratory testing, previous documented history of
illness etc. However, one could expect that experienced
difficulties in daily functioning and participation would
also have a great role in recommendations given by a
professional team. Surprisingly, in this study, no strong
M. Saltychev et al. / Open Journal of Therapy and Re habilitation 1 (2013) 36-39 39
correlations between experienced functional limitations
and final recommendations of disability or vocational
rehabilitation were found. We can speculate that in our
study settings, rehabilitation team made its decisions
knowing that insurance policy requires objective data on
rehabilitant’s functional restrictions before pension or
even vocational rehabilitation can be accepted. In this
situation, functional obstacles experienced by rehabili-
tant may play an important role in detecting rehabilita-
tion need but do not significantly affect the final recom-
This kind of assessment can be suggested to any mul-
tidisciplinary team focusing on vocational rehabilitation
evaluation. While the exact results probably vary widely
depending on different settings, further studies, con-
ducted on larger samples and in prospective design, may
help professionals to recognize what type of data sig-
nificantly affects their recommendations.
We thank statistician Jaana Pentti from Finnish Institute of Occupa-
tional Health for her advices when planning statistical analysis of this
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