Concept to Practice: "Moving Physical Therapy Forward using the ICF"

Jette A.M.^1,2, Escorpizo R^_.3,4,5, Maart S.⁶, Okochi J.^7,8

¹Boston University, School of Public Health, Boston, United States of America, ²Boston University, Health and Disability Research Institute, Boston, United States of America, ³University of Lucerne and SPF, Department of Health Sciences and Health Policy, Lucerne, Switzerland, ⁴Swiss Paraplegic Research (SPF), Nottwil, Switzerland, ⁵ICF Research Branch, WHO FIC CC Germany (DIMDI) at SPF, and at IHRS, Ludwig Maximilian University, Munich, Germany, ⁶University of Cape Town, Division of Physiotherapy, School of Health and Rehabilitation Sciences, Cape Town, South Africa, ⁷Tatsumanosato Geriatric Facility, Nara, Japan, ⁸Japan Association of Geriatric Health Services Facilities, Nara, Japan

Learning objectives:

1. To learn current and concrete applications of the ICF and how it can be used in physical therapy research and clinical care. 2. To recognize the challenges and opportunities of using the ICF in a clinical setting. 3. To recognize limitations in the current version of the ICF and promising areas for future research to advance the ICF within physical therapy.

Description:

The International Classification of Functioning, Disability, and Health (ICF) was approved by the World Health Assembly in 2001. Eight years later, we have seen strong arguments on how the ICF can add value to patient management and to investigating outcomes in rehabilitation.We see growing literature on the use of ICF in physical therapy research and practice.

As a conceptual framework, the ICF has universality because of its inclusive and comprehensive view of human functioning and disability regardless of the health condition. The ICF captures disability as the result of the interaction between a person with impairment and his/her environment (measured through activity limitation or participation restriction), while at a practical level the ICF can be used to quantify the impact of impairment on an individual's ability to function in his/her environment. This provides an important tool for research. Similarly the ICF can be used to assess interventions to minimize the impact of disability. As a classification system, the ICF provides a broad description of functioning in the form of hierarchical categories. While there are many discussions on the ICF, physical therapists are still unsure on the ICF's usefulness.

This symposium will seek to address the advantages, opportunities and challenges, and limitations of the ICF within the context of its use by physical therapy researchers and clinicians. A systematic presentation will be provided by four speakers. The presenters come from various fields in physical therapy and rehabilitation.

Operationalization and measurement issues concerning the ICF concepts have been raised while potential solutions to address these issues have been also proposed. ICF as an element to content validity of existing and would-be developed measures has been established. However, the operationalization of the ICF categories still poses a major issue in outcome measurement particularly around reliability and tracking “meaningful” changes of patient's health status over time. Attractive means of how to tackle these issues will be presented in the first two presentations. The first presentation by Alan M. Jette (USA) will discuss recent efforts and concrete applications of the ICF in physical therapy practice and research. ICF-relevant issues on research methodology will be discussed. Jiro Okochi (Japan) will do another presentation on the issues of measuring ICF concepts. He will specifically discuss the reliability challenge of the ICF in the geriatrics setting and present a case example of developing an ICF-based assessment tool by using Rasch method.

The ICF as a tool for implementing and monitoring global health and professional practice agenda of the WCPT will be covered by the final two presentations. The relative lack of data on disability could potentially jeopardize allocation of resources. In South Africa, disability appears to be particularly disadvantaged as it is not seen as a priority for intervention. Within this context, Soraya Maart (South Africa) will give a presentation on using the ICF as an instrument to identify environmental barriers to participation among people with disability and she will also discuss the use of the ICF to conceptualize the impact of disability in an under resourced community in South Africa. Finally she will present a case example of using the ICF to identify indicators for intervention.

Reuben Escorpizo (Switzerland) will present two ways by which the ICF can be integrated in clinical documentation templates. Specifically, he will make use of the ICF Generic Core Set as an indicator of functional activity and functional status level (first proposal). Further, he will present a documentation template consisting of the condition-specific ICF core set using the elements of patient management of The Guide to Physical Therapist Practice (second proposal). A core set refers to a short list of ICF categories that are relevant to a specific health condition or health-related event.

Implications / Conclusions:

This symposium will inform physical therapy clinicians and researchers on how the ICF can be translated to scientific research and clinical practice. The ICF can be a foundation for outcomes measurement to facilitate and improve clinical care of physical therapists from around the world.

Discussion:

Israel Cruz Velandia (Colombia) will join the panel discussion.

Keywords:

ICF; Outcomes measurement; Physical therapy

Funding acknowledgements:

Alan M. Jette is supported by NIA/NIH R41 AG027620 and NIA/NIH P30AG031679.

Relevance to WCPT and expected audience:

The proposed symposium will focus on the current state and application of the ICF in physical therapy. This topic is relevant to WCPT’s aim of encouraging international collaboration between the academic, scientific, and clinical communities on the use of the ICF to advance the field of physical therapy. The symposium will consider the ICF as an integral component of physical therapy care and research.

Target audience:

Physical therapy clinicians and researchers, physical therapist assistant clinicians and researchers, academics and other rehabilitation professionals.  

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