ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery

Background. Heart surgery is a frequent reason for admission to in-patient cardiac rehabilitation programmes. ICF approach has never been used to evaluate cardiac patients after major heart surgery. Aim. The aim was to evaluate and measure functionality in cardiac patients who have undergone heart surgery, using for the first time the ICF-based approach and to assess whether such approach can be feasible and useful in cardiac rehabilitation. Design. Observational study. Setting. In-patients cardiac Rehabilitation Unit in Milan. Population. Fifty consecutively admitted patients who had undergone heart surgery (34 males, 16 females; mean age 65.7 +/- 12.5 years). Methods. We prepared a ICF-core set short enough to be feasible and practical. Patients were individually interviewed by different healthcare professionals (randomly selected from a group of two physicians, two physiotherapists and two psychologists) at the beginning (T1) and end of cardiac rehabilitation (T2) Results. The sum of the scores of each ICF body function, body structure, activity and participation code significantly decreased between T1 and T2 (P<0.001). The environmental code scores significantly decreased in the case of facilitators between T1 and T2 (P=0.0051), but not in the case of barriers. There were significant correlations between the ICF body function scores and Barthel's index (rho=0.381; P=0.006), NYHA class (rho=0.404; P=0.004) and plasma Cr-P levels (r=0.31; P=0.03), between the ICF body structure codes and the Conley scale (rho=0.306; P=0.02), and between the activity/participation codes and SpO(2) (rho=0.319; P=0.04). There were no correlations between the ICF environmental codes and clinical parameters. Conclusion. The ICF-based data provided functional information that was consistent with the patients' clinical course. Clinical Rehabilitation Impact. The core set used allowed to quantify important body functions and activities, including some areas that are generally insufficiently considered by healthcare professionals during cardiac rehabilitation, and document their improvement.