Clinical and functional model of stroke survivors structured according with the ICF as a basis for personalized rehabilitation

BACKGROUND: Stroke is an urgent medical and social problem. The success of treatment and rehabilitation depends on an integrated approach and an individual medical rehabilitation plan (MR) that means the clinical and functional state of the patient. The variety of symptoms due to the variability of brain damage and individual characteristics requires medical decisions to optimize MR programs. The clinical and functional model of the patient, based on a biopsychosocial approach, is the basis for systematizing aspects of health and improving the effectiveness of MR. AIM: To develop clinical and functional rehabilitation models for stroke patients in the ICF categories for the subsequent formation of an individual medical rehabilitation plan. METHODS: A single-centre prospective cohort continuous uncontrolled study was conducted on the basis of the Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky of Moscow Healthcare Department. 957 patients after ischemic stroke (IS) were included. At stage 1, the clinical and functional parameters of the patient after ischemic stroke were evaluated, as reflected in the ICD-10 diagnosis and the International Classification of Functioning, Disability and Health (ICF) categories. At stage 2, clinical and functional models of a stroke survivors were formed. A clinical examination, assessment using unified scales and questionnaires, and ICF domains were conducted. RESULTS: The most common patterns of dysfunction and functioning in patients with IS were performed. The most relevant categories of ICF domains were analyzed to describe each of the models. Based on clinical data and ICF, 9 clinical and functional models of patients after stroke were formed. Each model was characterized by a set of functional disorders (predominant dysfunction of the upper limb, predominant dysfunction of the lower limb, combined disturbances), divided by severity (mild, moderate, severe). CONCLUSION: Individualized rehabilitation strategies informed by a stroke survivor's clinical and functional profile, structured according to the ICF, contributes to the improvement of rehabilitation programs and improved outcomes after stroke.