A patient-centred ICF-based comprehensive framework for rehabilitation in Austria: Development and implementation

Abstract

Objective

Austria's rehabilitation system lacked personalisation, alignment with the International Classification of Functioning, Disability, and Health (ICF), and measurable quality indicators. To address these gaps, a unified change management approach aligned with international standards and the biopsychosocial model was developed. The resulting Comprehensive Framework for Rehabilitation Standards, Practices, and Services aimed to establish a patient-centred, evidence-informed model integrating policy, quality, and practice.

Local context

Rehabilitation in Austria is provided by social insurance institutions, including the Pension Insurance Austria, which defines medical and therapeutic specifications for rehabilitation services. Historically, these were disease-centred, heterogeneous, and lacked individualisation.

Methods

The development followed a co-creation process involving focus groups with interdisciplinary staff from rehabilitation centres. Implementation in 17 centres across Austria required process and information technology adaptations as well as capacity building. Thirteen key performance indicators were established for monitoring, evaluation, and benchmarking.

Results

After three quarters of implementation, all centres adhered to six key performance indicators, including staff and patient satisfaction, functional status assessment, quality of life screening, work-related rehabilitation needs, and follow-up rehabilitation referrals. Challenges included consistent ICF application, individual goal-setting, and therapy planning tailored to impairment severity. Implementation problems mirrored those reported internationally. Strong leadership, interdisciplinary collaboration, and early information technology engagement were key enablers.

Conclusion

The framework operationalised international rehabilitation standards into a scalable national model. Its ICF-based design demonstrated that large-scale, patient-centred, participation-oriented rehabilitation is achievable through structured change management. Future evaluations should assess long-term outcomes and adaptability across health systems with varying digital maturity.