Does the extended international classification of functioning disability and health core set for stroke, capture community stroke intervention?
The aim of the study was to evaluate whether the Extended ICF Core Set for Stroke (EICSS), which is intended to represent the functional problems of people with stroke, captured the interventions of a community stroke rehabilitation team. The study was initiated as the EICSS may not represent the diverse cultures and environments in which it will be used, it may over represent the body function categories, and it may not adequately represent the perspective of patients who live in the community. In order to achieve the aim, interventions from 18 patient case notes from a community stroke rehabilitation service in New Zealand were extracted and retrospectively linked to codes in the EICSS. Data were gathered on the type and frequency of coded interventions provided to Māori and non-Māori and by each team member. Analysis revealed that 98.8% of interventions provided by the community stroke rehabilitation team could be linked to the EICSS, which supports the validity of the ICF and EICSS in NZ. The interventions that could not be coded were linked to the categories d660 assisting others, s760 structure of trunk and e535communication services, systems and policies. It was also found that the walking and moving around codes had duplicate meanings and posture and neglect of the body were not clearly described. These findings can be considered by the ICF update committee for inclusion in new versions of the ICF. Comparing the EICSS and the interventions of the community stroke rehabilitation service revealed that the service is providing limited emotional and relationship interventions, which indicates that patients may not be receiving appropriate support. Additionally, more interventions were focused on body impairment rather than activities and participation, and this trend was more pronounced for Maori patients. These findings were corroborated by the rehabilitation team members. The predominance of impairment focused interventions may mean that patients are not receiving interventions that will help them develop or return to valued activities. This research confirms that by comparing interventions to the EICSS, it is possible to evaluate whether the service is addressing the full range of patient problems identified by the EICSS. Due to the small sample of patient case notes and because the case notes were not randomly selected, the results cannot be generalised to other community stroke rehabilitation services. Further research is recommended with other community stroke rehabilitation services to further validate the use of the EICSS in NZ and to collect information which would serve as benchmark to compare community stroke rehabilitation services. This study will be of interest to people who either provide community stroke rehabilitation services or are patients of this type of service. It will also be of interest to health professionals and managers of health services who wish to introduce the International Classification of Functioning Health and Disability (ICF) as a guiding health model on which to structure delivery of services.