"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Thursday, October 25, 2007

The Disablement Model

The Disablement Model

The Disablement Model is a great way for physical therapists and physical therapist students to begin thinking about physical therapy diagnosis.

My undergraduate physical therapy education at the University of Florida in 1992 did not have any mention of Nagi or WHO (World Health Organization) or the process that leads from tissue pathology to physical handicaps.

Physical therapist assistants, however, that graduate in 2008 will have had 4 semesters of information that is permeated with information on the disablement model and they should be comfortable with practice patterns that incorporate ‘disablement thinking’.

Disablement thinking was a concept in 1992 but disablement thinking should be common practice in 2008. If physical therapists are not practicing with disablement concepts firmly in mind then it is because there are not sufficient tools in place to bridge the gap between concept and practice. I have designed the SIMPLE system to be one of those tools.

The SIMPLE system is a decision-making tool for physical therapists to decide on a diagnosis, to decide on goals and to decide on physical therapy interventions.

Pathology doesn’t do a good job of guiding the decision-making process for the physical therapist (see Sandstrom RW in PT Journal).

The Nagi Model

The SIMPLE system adheres to the Nagi disablement model and to the Guide to Physical Therapist Practice regarding the relationship among disability, functional limitations and impairments.

The SIMPLE system also adheres to the recommendations in the latest updates to the Medicare Benefit Policy Manuals and in the state-specific Local Coverage Determination
(here is the link for Florida) for the purpose of creating compliant physical therapy plans of care and for physical therapy goal setting.

Begin with the physical therapy diagnosis

The diagnosis is the link between the measured impairments and the measured functional limitations. The SIMPLE system cannot make the diagnosis – only the physical therapist can make the diagnosis. The SIMPLE system automates the charting and the documentation once the physical therapist makes the diagnosis.

Physical therapists’ time is far too costly and their expertise too valuable to spend in their back office making up new goals for certain high-volume diagnoses.

Physical therapists need an easy way to put on paper the skilled stuff they do with patients. If a physical therapist doesn’t have to worry about “What do I have to write down to pass a Medicare audit?” then they can spend more time with their patient doing the skilled care that gets people better.

Skilled care is not complicated but it is hard work. Medicare documentation is complicated but it doesn’t need to be hard work. Not if you use the SIMPLE system.

It’s a simple process.

It’s a simple system.

Bottom line, it’s better physical therapy.

Tim Richardson, PT


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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

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