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.
2. MATERIALS AND METHODS
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
measures—Yes/No”.
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.
3. RESULTS
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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