Félix M.A.1, Fleig T.C.M.2, Jahn N.3, Martins A.C.4, Medina G.G.5, Oliveira M.R.6, Pivetta H.M.F.7, Ruiz P.O.5, Vasconcelos A.B.4
1Universidade do Vale do Rio dos Sinos - UNISINOS, Departamento de Fisioterapia, São Leopoldo, Brazil, 2Universidade de Santa Cruz do Sul - UNISC, Physical Therapy Course, Santa Cruz do Sul, Brazil, 3Universidade do Vale do Rio dos Sinos - UNISINOS, Health School. Physical Therapy Course, São Leopoldo, Brazil, 4Institute Polytechnic of Coimbra, ESTeSC - Coimbra Health School, Department of Physiotherapy, Coimbra, Portugal, 5Universidad de Cádiz, Departamento de Enfermería y Fisioterapia, Cádiz, Spain, 6Universidade Federal de Santa Maria - UFSM, Programa de Pós-Graduação em Reabilitação Funcional, Santa Maria, Brazil, 7Universidade Federal de Santa Maria - UFSM, Departamento de Fisioterapia e Reabilitação, Santa Maria, Brazil
Background: Rationale for person-centred health care and health systems is supported by a model that describes health and health-related status under a biopsychosocial and spiritual framework. The International Classification of Functioning, Disability and Health (ICF) is a widely used tool, based on that conceptual framework, conceptualising functioning as a 'dynamic interaction between a person's health condition, environmental factors and personal factors', with a common language between all professionals. Physiotherapy is concerned with identifying and maximizing quality of life, functioning and movement potential, an essential element of health and wellbeing, being central to determining strategies for diagnosis and intervention. The diagnosis is the result of a process of clinical reasoning that results in the identification of existing or potential impairments, activity limitations, participation restrictions, environmental influences or abilities/disabilities.
Purpose: Linking the terms/concepts of diagnosis pointed by the physiotherapists to the ICF components, namely, impairments of body function and body structure, activity limitations, participation restrictions and contextual factors and ICD-10.
Methods: Qualitative study based on an online questionnaire in three idioms (English, Portuguese and Spanish) permitted respondents to point two diagnosis based on their regular practice. Responses were grouped together by area (musculoskeletal, neuromuscular and cardiovascular/pulmonary). Content experts on ICF and ICD-10 were given the task to link those answers to the components.
Results: A total of 429 physiotherapists (66% female), from 14 countries participated in the survey, referring the diagnosis should result from a list of practice patterns associated to their own words. They had bachelor (48%), post-graduation (26%), master (19%) and doctoral (7%) degrees. Experience ranged from 2 to 51 years. Answers were grouped into areas. In musculoskeletal, from the total of 947 terms/concepts, 648 (68%) reflected the ICF language, 190 (20%) the ICD-10, and 108 (12%) were excluded for diverse reasons. From the total categories linked to the ICF, 320 (49%) were body functions, 224 (35%) structures and 104 (16%) activities/participation. In neuromuscular, from the total of 234 terms/concepts, 223 (95,3%) reflected the ICF language, with 189 (85%) categories linked to body function, 8 (4%) to structures and 26 (11%) to activities/participation. Eleven (4,7%) answers were linked to the ICD-10. In pulmonary, from the total of 266 terms/concepts, 262 (99%) reflected the ICF language, with 146 (56%) categories linked to body function, 92 (35%) to structures and 24 (9%) to activities/participation. Four (1%) answers were linked to the ICD-10.
Conclusion(s): Physiotherapy diagnosis included, mainly, impairments of body function and body structure. Activity limitations and participation restrictions were scarce. There were no responses associated with contextual factors, which may produce some weakness in the process of clinical reasoning based on functioning.
Implications: Diagnosis is an element of the patient/client management process which must be consistent with ICF language and current terminology in the diverse areas. It is a label encompassing a cluster of signs and symptoms commonly associated with a disorder or impairments in body structures and function. However, associate activity limitations, participation restrictions and environmental categories is recommended. This study contributes to that discussion.
Funding acknowledgements: This work was unfunded.
Topic: Professional practice: other
Ethics approval: All research procedures were conducted under the Declaration of Helsinki.
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