RESEARCH REPORT PLATFORM PRESENTATION

CONTENT VALIDITY OF THE FIRST VERSION OF INTERVENTION CATEGORIES FOR PHYSICAL THERAPISTS BASED ON THE ICF: MUSCULOSKELETAL DOMAIN. Allet L¹, Cieza A², Bürge E³, Finger M⁴, Stucki G², Huber E⁵; ¹University hospital of Geneva, Switzerland. ²Ludwig-Maximilians-University Munich, Germany. ³Haute Ecole de Sante, Geneva, Switzerland. ⁴Rehaklinik Bellikon, Switzerland. ⁵University hospital of Zürich, Switzerland

PURPOSE: The International Classification of Functioning, Disability and Health (ICF) holds great promise for providing the rehabilitation disciplines, including physical therapy, with a universal language with which to discuss human functioning. A first version of intervention goals for physical therapists treating patients with musculoskeletal (MS) conditions in acute, rehabilitation and community health-care situations based on the ICF has been developed based on a methodologically sound process including Delphi-exercises and a consensus conference. However, its content validity has not yet been studied. The aim of this study was therefore to investigate the content validity of the ICF intervention categories for physical therapists treating patients with MS conditions. RELEVANCE: The ICF, containing a list of 1454 categories which constitute the units of the classification, is hierarchically organized and very exhaustive. It thus becomes highly complex for daily use. In order to initiate its use in clinical practice it has to be transformed into a user-friendly tool. PARTICIPANTS: The study was performed with convenience samples of 300 physical therapy clinical records of patients with MS conditions, treated in 3 health-care situations: acute, rehabilitation and community. Clinical records written in German, French or Italian were included in the study if the patients to whom they corresponded were at least 18 years old and had been treated at any time from January 2003 to November 2005. METHODS: The study was conducted as a retrospective cross-sectional multi-center study in the three different language regions of Switzerland. The heads of the physical therapy departments of 62 health-care institutions were asked to send a pre-defined number of clinical records to the study leader. The study leader extracted all treatment goals and all interventions contained in the records and linked them to ICF categories. The inter-rater agreement of this linking process was established. ANALYSIS: Descriptive statistics were used to describe the study population and to analyse how often a goal, intervention or technique had been named in the clinical records. A cutoff point of a frequency of 5% was chosen in order to include the category in the checklists. RESULTS: Kappa coefficients and nonparametric bootstrapped confidence intervals showed that linker agreement exceeds chance (Kappa value 0.71-0.9). Most of the ICF categories contained in the first version of ICF intervention categories for physical therapists working in these health-care situations have been confirmed and three checklists with 38 second-level intervention categories for the acute, 46 for the rehabilitation and 38 for the community health-care situation are proposed. CONCLUSIONS: This study represents the first step towards the validation of intervention categories for physical therapists treating patients with MS conditions. These three checklists have now to be applied in clinical practice and their usefulness assessed. The data provide a promising approach for future research. IMPLICATIONS: These lists form a user-friendly tool and may also have wider implications by contributing to the definition of the scope of the physical therapy profession and by providing the transparency increasingly demanded of health-care providers in the current political climate. KEYWORDS: International Classification of Functioning, Disability and Health, Intervention, physical therapy, musculoskeletal. FUNDING ACKNOWLEDGEMENTS: We gratefully acknowledge the Swiss Physiotherapy Association for its financial support and the cooperation of all participants in this study. CONTACT: lara.allet@hcuge.ch

ETHICS COMMITTEE: The study was approved by the local ethics committees: University hospital of GENEVA and ZURICH