Implementation of ICF-based Assessment and Treatment Course for Children with Cerebral Palsy by Health Professionals of Nepal: A Cross-Sectional Study

Abstract

The International Classification of Functioning, Disability and Health (ICF) provides a holistic framework for the assessment and management of cerebral palsy. Although ICF-based training was provided to Nepalese health professionals between 2016 and 2018, its implementation in clinical practice has not been evaluated. This study assessed the implementation of ICF-based practice among trained health professionals in Nepal and identified barriers, facilitators, and prerequisites for successful implementation. A cross-sectional survey was conducted from June 2020 - June 2021 using a pilot-tested, self-developed questionnaire based on normalisation process theory. The questionnaire assessed four domains: coherence, cognitive participation, collective action, and reflexive monitoring. Data were collected through Google Forms or direct administration. Of the 48 eligible health professionals, 32 responded (response rate: 66.7%). Most participants considered the ICF approach valuable, and 84.4% supported its integration into routine clinical practice. Family-centred care was identified as a major advantage over previous approaches. Most respondents believed ICF could be implemented with minor modifications. Time constraints were the most commonly reported barrier (24/32), with streamlined outcome measures and improved team workload distribution suggested as potential solutions. Overall, health professionals perceived the ICF framework as beneficial for multidisciplinary, standardized, and comprehensive care. Addressing organizational barriers and adapting implementation strategies may facilitate successful integration of ICF-based practice in Nepal.