Rehabilitation outcomes are an important measurement of trauma system effectiveness. However, currently there is no clinically applicable trauma rehabilitation score or framework available to evaluate health and rehabilitation needs after trauma. The World report on Disability (2011) recommended the application of the World Health Organisation International Classification of Function, Disability and Health (ICF) as a framework for all aspects of rehabilitation. A standardised language, based on coded categories would aid in international efforts to evaluate health and disability globally. The ICF framework has not been applied in trauma rehabilitation or trauma systems to date. The objectives were to investigate rehabilitation needs of trauma patients and evaluate to what extent the ICF can be used as a framework to capture and assess health and rehabilitation outcome of patients following traumatic injuries. Two cohort studies with 103 and 308 patients respectively demonstrated the utility of the Rehabilitation Complexity Scale (RCS) in an acute trauma setting. The RCS outperformed other acute measures and rehabilitation complexity correlated with length of stay and discharge destination. A systematic review of 34 articles confirmed that outcome measures frequently used in trauma outcome studies represent only six percent of health concepts contained in the ICF. A quantitative international on-line questionnaire with expert clinicians working in trauma (n=217), identified 121 ICF categories pertinent to rehabilitation and health outcome of trauma patients. Qualitative patient interviews (n=32) identified nearly double the amount of ICF categories (n=234) compared to clinicians. Combined analysis of qualitative and quantitative data presents 109 ICF categories important for rehabilitation and health outcome assessment of trauma patients, using the ICF as a framework. This thesis describes the need for improved outcome evaluation of trauma patients. It demonstrates the acceptability of the ICF language and framework amongst clinicians and suggests the application of the ICF as a framework for trauma service delivery and outcome assessment.

Background: The International Classification of Function, Disability and Health (ICF) describes health using 1424 categories from 4 components: body functions (BF), body structures (BS), activities and participation (AP) and contextual factors (environmental (EF) and personal (PF)). In this study the ICF was used to describe and compare aspects of ANCA-Associated Vasculitis (AAV) measured in clinical trials and those important to clinicians and patients. Methods: Individual interviews and focus groups were used to capture the perspective of AAV patients. Clinicians’ perspective was obtained with an email-based questionnaire. Outcomes used in AAV randomized trials were extracted from results of a systematic review of literature. Identified concepts were mapped to the ICF according to previously published ICF linking rules, and the resulting lists of relevant AAV outcomes were compared descriptively. Results: Twelve individual interviews and 2 focus groups represented the patient perspective while responses from 27 clinicians yielded the clinicians’ perspective. Systematic literature review identified 67 clinical trials and 28 abstracts from which measured outcomes were extracted. All three perspectives demonstrated detailed coverage of ICF components BF and BS. In the component AP patients and clinicians identified similar ICF categories, a number of which were under-sampled by AAV trials. Contextual factors appear to be significantly more relevant to patients than clinicians and researchers. Conclusion: Patients and clinicians have different views of the relevance of various AAV outcomes, and these views differ from what is measured in clinical trials of AAV. This highlights the need for a broad and standardized approach to developing and selecting outcomes for complex medical conditions such as AAV.

Increasingly, disability related literature recognizes the environment as an important factor in the participation in roles and in engagement in activities for individuals with disabilities; which would naturally make the environment an important concern for occupational therapists (Hammel et al., 2015). The language and methods to describe and analyze the characteristics of the environment that support or limit client participation in occupations are not as well developed in occupational therapy (Whiteneck & Djickers, 2009). This is an important gap in our practice that must be addressed. Guided by Person-Environment-Occupation Theory (Baptiste, 2017), this project attempted to address this need by developing a typology of terms for contextual factors that affect participation. It was completed with the belief that providing the terminology will increase the attention provided to these factors in practice. Environmental interventions can be more universal, are often less expensive, and change the focus from the individual’s deficits to how society can be more just and inclusive. We created the typology using a scoping review methodology to identify source literature and by searching through the selected literature for the environmental and contextual terms describing factors that impact participation. The resulting typology is divided into four areas with twelve categories of terms and 54 total terms. It aligns with the International Classification of Function (WHO, 2001) and the performance factors in the Occupational Therapy Practice Framework (AOTA, 2014). The typology is designed and meant for use across OT practice areas, in OT education, research and scholarship. This will require wide spread dissemination. A dissemination plan based on Diffusion of Innovations Theory (Rogers ,2010) starts by refining the typology with the guidance of assessment from stakeholders. After this refinement process, the typology will be introduced via outreach to occupational therapy programs, publications, and conference presentations. Widely used, this typology has the potential to expand the scope of occupational therapy and to make our interventions more effective in improving and increasing participation for more people.

Polytrauma is a severe multiple injury posing an imminent threat to human life. Such trauma will then significantly affect the quality of client's life and, consequently, also the constituent parts of his or her personality. The research has shown that, the therapy succes, which is realised in the system of comprehensive rehabilitation, depends on an effective medical care delivered by a multidisciplinary team of specialists and also on an active involvement in the treatment by the clients themselves.The quality of clients' life that the polytraumas entaile is influenced by their age, sex, education, profession, classification of multiple injury and also by harmonious family relationships and support offered by the clients' partners.