Clinical and functional model of patients with a stroke under the International classification of functioning, disability and health as a basis for personalized rehabilitation

BACKGROUND: Stroke is a pressing healthcare and social issue. The treatment and rehabilitation outcome relies on a comprehensive approach and an individual medical rehabilitation (MR) plan based on the clinical manifestations and functional status of the patient. Diverse symptoms caused by variable brain damage and individual characteristics require medical decisions to improve MR programs. The clinical and functional patient model based on the biopsychosocial approach is the basis for the classification of health and improved MR programs. AIM: To develop clinical and functional rehabilitation models for patients with a stroke based on the International Classification of Functioning, Disability and Health (ICF) for the further development of a personalized MR plan. METHODS: A single-center, prospective, cohort, continuous uncontrolled study was conducted at the Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky of Moscow Healthcare Department. The study included 957 patients with ischemic stroke. Stage 1 involved the clinical and functional evaluation of patients with ischemic stroke according to the International Classification of Diseases, 10th Revision, and the ICF classification. Stage 2 involved the development of clinical and functional models of patients with a stroke. We conducted a clinical examination; the assessment was made using standardized scales and questionnaires and ICF domains. RESULTS: The study identified the most common patterns of dysfunction and performance impairment in patients with ischemic stroke. The most relevant ICF domains were analyzed to describe each model. Nine clinical and functional models of patients with a stroke were developed based on clinical evidence and ICF. Each model has a set of functional disorders (predominant dysfunction of the upper limb, predominant dysfunction of the lower limb, and coexistent disorders) grouped by severity (mild, moderate, and severe). CONCLUSION: Clinical and functional models of patients with a stroke based on the clinical manifestations and ICF functional status allows developing a personalized MR program for optimal recovery and improved quality of life. Further development of the methodology for personalization of model formation will allow to improve rehabilitation programs and outcomes in patients with a stroke.