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

Frontiers in Rehabilitation Sciences, 2021 · DOI: 10.3389/fresc.2021.720395 · Published: September 13, 2021

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

The Nottwil Standard is an assessment tool designed for use in the rehabilitation of individuals with newly acquired spinal cord injuries (SCI). It aligns with World Health Organization classifications and national quality requirements. The development was driven by an inclusive, consensus-based approach, involving a multidisciplinary team including peer counselors representing the perspective of individuals with SCI. The project incorporated the ICF Generic-7 and -30 Sets, results of a situation analysis, and guidelines on outcome measures to select assessment tools capable of measuring defined ICF categories.

Study Duration

18 months pilot phase

Participants

54 persons with paraplegia and 42 with tetraplegia (75 male; 21 female)

Evidence Level

Not specified

Key Findings

1
A situation analysis revealed that 41 assessments were irregularly performed during initial rehabilitation after newly acquired SCI.
2
The multidisciplinary group agreed on a standard comprised of 10 examinations, 23 assessments, and two questionnaires, covering 55 ICF categories.
3
Implementation of the standard was feasible but required a well-structured process with good communication, control mechanisms, and full engagement from involved professions.

Research Summary

This paper reports on the development of an assessment standard (called Nottwil Standard) for use in the rehabilitation of persons after newly acquired SCI according to the guiding principles and to report on the ﬁrst experiences in implementing it. Developing the Nottwil Standard not only met the challenge of determining a battery of tools that support a comprehensive and accurate assessment of health and functioning of patients with SCI, it showed that it is feasible to develop and implement it in an interprofessional and participatory manner. The pilot study showed that the successful implementation of the Nottwil Standard requires the commitment at the institutional level, active involvement of clinicians and an eﬀective information-sharing strategy.

Practical Implications

Clinical Practice

The Nottwil Standard provides a structured framework for assessing patients with newly acquired SCI, ensuring comprehensive evaluation of their health and functioning needs.

Quality Management

The implementation of the Nottwil Standard contributes to clinical quality management by standardizing assessments and promoting the use of ICF-based measures.

Research

The standardized assessment approach facilitates data collection and analysis, supporting research efforts and continuous improvement in SCI rehabilitation.

Study Limitations

1
No adequate assessment tools were found for seven categories of the combined ICF Generic-30 Set and ICF Core Set for SCI in post-acute care.
2
Applying the Nottwil Standard to other hospitals and clinics will require additional testing and possible adaptation.
3
The controlling mechanism nor all the assessment tools had been integrated in the HIS during the pilot study.

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