Clinical+decision-making+in+pediatric+PT

Model of evidence-informed decision-making
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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
 * <span style="font-family: Arial,Helvetica,sans-serif;">Is flexible. For example, it distinguishes activities from participation while allowing overlap. It allows qualifiers for clarification
 * <span style="font-family: Arial,Helvetica,sans-serif;">Is beneficial for our profession and our families. It provides a "common language" for providers to discuss health and disability.

**<span style="font-family: Arial,Helvetica,sans-serif;">Considerations for Using the International Classification of Functioning, Disability, and Health as a Framework for Clinical Decision Making **
<span style="font-family: Arial,Helvetica,sans-serif;">(from Campbell et al 2012, page 13)

<span style="font-family: Arial,Helvetica,sans-serif;">Impairments <span style="font-family: Arial,Helvetica,sans-serif;">• Not all impairments are modified by physical therapy <span style="font-family: Arial,Helvetica,sans-serif;"> • Not all impairments cause activity limitations and participation restrictions <span style="font-family: Arial,Helvetica,sans-serif;"> • Relate impairments to activity limitations and participation restrictions <span style="font-family: Arial,Helvetica,sans-serif;"> • Impairments are identified from examination and evaluation of body functions and structures

<span style="font-family: Arial,Helvetica,sans-serif;">Activities <span style="font-family: Arial,Helvetica,sans-serif;">• Relate activity limitations to participation restrictions <span style="font-family: Arial,Helvetica,sans-serif;"> • Activity limitations can cause secondary impairments <span style="font-family: Arial,Helvetica,sans-serif;"> • Activities are often measured by norm-referenced and criterion-referenced assessments

<span style="font-family: Arial,Helvetica,sans-serif;">Participation <span style="font-family: Arial,Helvetica,sans-serif;">• Reflects child and family perspectives <span style="font-family: Arial,Helvetica,sans-serif;"> • Is context-dependent (environmental and personal factors) <span style="font-family: Arial,Helvetica,sans-serif;"> • Is one aspect of health-related quality of life <span style="font-family: Arial,Helvetica,sans-serif;"> • Is measured by child and parent self-report <span style="font-family: Arial,Helvetica,sans-serif;">• 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]