Model of evidence-informed decision-making

Model of evidence-informed decision making (from Campbell et al 2012; page 3)
Model of evidence-informed decision making (from Campbell et al 2012; page 3)


The Guide to Physical Therapist Practice

The Elements of Patient/Client Management Leading to Optimal Outcomes (from The Guide to Physical Therapist Practice, http://guidetoptpractice.apta.org)
The Elements of Patient/Client Management Leading to Optimal Outcomes (from The Guide to Physical Therapist Practice, http://guidetoptpractice.apta.org)


World Health Organization International Classification of Functioning, Disability, and Health (ICF)


The ICF is a framework for evaluating health and disability. It has is made of up two parts: Functioning and Disability (components of health) and Contextual Factors.

Components of health:
  • Body functions: physiologic and psychologic functions of the body (in PT, we are often most concerned with functions of the joints and bones, muscle functions, and movement functions such as reflexes, involuntary reactions, voluntary movement, involuntary movement, gait)
  • Body structures: anatomic parts of the body (brain, organs, bones, muscles, etc)
  • Activities: performance of a task or action
  • Participation: involvement in a life situation

Impairments are problems with body functions & structures.
Activity limitations are difficulty executing actions.
Participation restrictions are problems with life situations.

Contextual factors:
  • Environmental factors: physical, social, and attitudinal environment in which people conduct their lives
  • Personal factors: particular background of a person’s life and ARE NOT part of the health condition

The ICF...
  • Offers a new perspective of "health" & "disablity"
  • Recognizes that everyone has health problems
  • Shifts the focus from causes of problems to social & environmental aspects that may be managed
  • Gives equal emphasis to all conditions
  • Is flexible. For example, it distinguishes activities from participation while allowing overlap. It allows qualifiers for clarification
  • Is beneficial for our profession and our families. It provides a "common language" for providers to discuss health and disability.

ICF application to pediatric physical therapy - two examples

Application of the ICF to clinical decision-making for a child with CP (from Campbell et al 2012, page 12)
Application of the ICF to clinical decision-making for a child with CP (from Campbell et al 2012, page 12)



Illustration of how the evaluation section of the Physical Therapy Clinical Reasoning and Reflection Tool (PT-CRT) was utilized for a 17-year-old boy with leukemia and methotrexate toxicity (Atkinon & Nixon-Cave, 2011)
Illustration of how the evaluation section of the Physical Therapy Clinical Reasoning and Reflection Tool (PT-CRT) was utilized for a 17-year-old boy with leukemia and methotrexate toxicity (Atkinon & Nixon-Cave, 2011)



Considerations for Using the International Classification of Functioning, Disability, and Health as a Framework for Clinical Decision Making
(from Campbell et al 2012, page 13)

Impairments
• Not all impairments are modified by physical therapy
• Not all impairments cause activity limitations and participation restrictions
• Relate impairments to activity limitations and participation restrictions
• Impairments are identified from examination and evaluation of body functions and structures

Activities
• Relate activity limitations to participation restrictions
• Activity limitations can cause secondary impairments
• Activities are often measured by norm-referenced and criterion-referenced assessments

Participation
• Reflects child and family perspectives
• Is context-dependent (environmental and personal factors)
• Is one aspect of health-related quality of life
• Is measured by child and parent self-report
• Is measured by observations in natural environments as well as parent and child self-report

Resources for pediatric PT providers and families


American Physical Therapy Association Section on Pediatrics

Beach Center on Disability

Pediatric Physical Therapy Journal

Pathways Awareness Foundation

Zero to Three

References

Campbell S, Palisano R, Orlin M. Physical Therapy for Children. 4th ed. St. Louis, Missouri: Saunders; 2012.

Atkinson HL, Nixon-Cave K. A Tool for Clinical Reasoning and Reflection Using the International Classification of Functioning, Disability and Health (ICF) Framework and Patient Management …. Physical Therapy. 2011. Available at: http://ptjournal.apta.org/content/91/3/416.short.

Effgen, SK. Meeting the Physical Therapy Needs of Children. Philadelphia, Pennsylvania: FA Davis Company; 2005.

The Guide to Physical Therapist Practice: http://guidetoptpractice.apta.org/, Accessed September 5, 2012.

Palisano R. A collaborative model of service delivery for children with movement disorders: a framework for evidence-based decision making. Physical therapy. 2006. Available at: http://www.physther.net/content/86/9/1295.short.

World Health Organization: http://www.who.int/classifications/icf/en/. Accessed September 5, 2012