Application of the International Classification of Functioning, Disability and Health (Children and Youth Version) in the Evaluation of Rehabilitation Measures of Patients with Cerebral Palsy

Abstract

Rehabilitation of children with cerebral palsy (CP) requires a systematic approach and dynamic evaluation of results. The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) is used to describe and measure the extent ofhealth disorders in children with CP. This classification allows to unify of identification of an individual profile of functioning of the child taking into account environmental and personal factors, to estimate changes of disorders of health in the course of rehabilitation. However, at the moment there are no clear quantitative criteria that allow using ICF-CY to determine the effectiveness of medical rehabilitation of patients with CP, which is relevant in clinical practice and research. The aim is to develop a criterion for evaluating the effectiveness of medical rehabilitation of children with CP based on the use of ICF-CY. Materials and methods. The study included 29 patients (mean age 5.4±1.05) with various forms of CP, who received medical rehabilitation courses in the hospital and polyclinic for 12 months. All patients, in addition to general physical and clinical neurological examination, were tested before and after rehabilitation courses using specialized questionnaires and scales, as well as evaluated using a brief core set of ICF-CY for children/youth with CP. Groups of patients with and without improvement in the first stage of the study were identified using expert evaluation. The sensitivity and specificity of the proposed criterion for assessing the effectiveness of rehabilitation are calculated at the second stage. The degree of consistency of experts‘ opinions and the developed evaluation criterion is analyzed. Results. The rehabilitation effect was determined on the basis of the dynamics of domain assessments on the components of the ICF-CY “functions”, “activities and participation” 12 months after the beginning of rehabilitation. The criterion of improvement is the positive dynamics of the child’s condition in at least 3 domains with a change in the assessment, at least 1 point. Improvement was achieved in 18 patients with CP 12 months after rehabilitation, according to the expert method. Improvement was observed in 16 patients with CP according to our criterion for evaluating the effectiveness of medical rehabilitation. Improvement was observed in 16 patients with CP according to our criterion for evaluating the effectiveness of medical rehabilitation. The sensitivity of our criterion for assessing the effectiveness of medical rehabilitation of patients with cerebral palsy was 89%, the specificity of 91%, which allows us to recommend the use of this criterion to assess the improvement of the effectiveness of medical rehabilitation of children with CP.