Rehabilitation potential for CNS pathology in patients with musculoskeletal dysfunction using the categories of the International Classification of Functioning, Disability and Health (ICF)

Vollständiger Abstract

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Introduction.Determining the rehabilitation potential (RP) is a key stage in planning medical rehabilitation (MR). The International Classification of Functioning, Disability and Health (ICF) provides a standardized method for assessing impairments, including from the perspective of a physical therapist (PT) as a leading member of the multidisciplinary rehabilitation team (MDRT). The assessment of the musculoskeletal system in patients with CNS pathology is particularly important, as it serves as the primary effector component of motor activity. Objective.To study the relationship between ICF domain indicators reflecting the state of the musculoskeletal system, as assessed by a physical therapist, and the level of rehabilitation potential in patients with central nervous system (CNS) pathology. Materials and methods.The study included 226 patients undergoing the 2nd stage of MR for CNS conditions. Fifty-two ICF domain indicators (covering musculoskeletal functions and mobility) were assessed before and after the MR course. RP was classified as high, medium, or low. Statistical analysis was performed using the Kruskal–Wallis test and Dunn's test with Holm correction. Differences were considered significant at p 0.05. Results.Significant differences between groups with different RP levels were found for 26 indicators before rehabilitation and for 28 indicators after rehabilitation. The most pronounced differences were for indicators of muscle strength (b7301), control of voluntary movements (b760), walking (d4500, d4502, d4551), and maintaining a sitting position (d415). Patients with low RP had the most severe musculoskeletal disorders, while those with high RP had minimal impairments. Conclusion.ICF domain indicators reflecting the state of the musculoskeletal system in patients with CNS diseases, as assessed by a physical therapist, demonstrate a significant association with rehabilitation potential. The most informative domains are those characterizing muscle strength, postural control, and mobility. These findings confirm the validity of multidisciplinary RP assessment involving a physical therapist and are consistent with research in traumatology and orthopedics [20, 21].