The Nottwil Standard-Development and Implementation of an International Classification of Functioning, Disability and Health-Based Clinical Standard Assessment for Post-acute Rehabilitation After Newly Acquired Spinal Cord Injury

Anke Scheel-Sailer; Patricia Lampart; Melissa Selb; Michael Baumberger; Hans Peter Gmünder; Diana Sigrist-Nix; Klaus Schmitt; Gerold Stucki

doi:10.3389/fresc.2021.720395

The Nottwil Standard-Development and Implementation of an International Classification of Functioning, Disability and Health-Based Clinical Standard Assessment for Post-acute Rehabilitation After Newly Acquired Spinal Cord Injury

Front Rehabil Sci. 2021 Sep 13:2:720395. doi: 10.3389/fresc.2021.720395. eCollection 2021.

Authors

Anke Scheel-Sailer^{1

2}, Patricia Lampart¹, Melissa Selb^{3

4}, Michael Baumberger¹, Hans Peter Gmünder¹, Diana Sigrist-Nix¹, Klaus Schmitt¹, Gerold Stucki^{2

3

4}

Affiliations

¹ Swiss Paraplegic Centre, Nottwil, Switzerland.
² Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
³ Swiss Paraplegic Research, Nottwil, Switzerland.
⁴ ICF Research Branch, Nottwil, Switzerland.

Abstract

Introduction: Assessments during rehabilitation of spinal cord injury (SCI) align with the World Health Organization's classifications and national quality requirements. This paper aims to report on the development and first implementation experiences of an institutional standard of assessments performed after newly acquired SCI. Setting: Specialized SCI acute care and post-acute rehabilitation clinic in Switzerland. Methods: A situation analysis of an interdisciplinary post-acute SCI rehabilitation program was performed. The results informed a subsequent consensus-based selection of assessments, and an information and implementation strategy. Linking to the ICF Core Set for SCI in post-acute settings and ICF Generic-30 Set was performed. The Nottwil Standard was piloted for 18 months. Results: Situation analysis: A battery of 41 assessments were irregularly performed during initial rehabilitation after newly aquired SCI. Selection of assessments: A multidisciplinary group of clinicians agreed on 10 examinations, 23 assessments and two questionnaires that make up the Nottwil Standard. In total, 55 ICF categories are covered, including most of the ICF Generic-30 Set categories. The implementation strategy included Executive Board commitment, a structured improvement project, guidelines for documentation and assessments, a manual controlling system, and staff training on the Nottwil Standard. Pilot phase: 54 persons with paraplegia and 42 with tetraplegia (75 male; 21 female) were included. Twenty-seven assessments out of 33 assessments were performed in more than 80% of all observed patients' rehabilitation. Conclusion: Implementation of a standard assessment schedule was feasible but required a well-structured process with good communication strategy and controlling mechanism, and full engagement of involved professions.

Keywords: assessment 2; disability and health; functioning; international classification of functioning; post-acute care; rehabilitation; spinal cord injury.