"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

Friday, September 26, 2008

Physical therapists: Use the ICF Browser to make your diagnosis


The new ICF Browser is an exciting tool. I'm not kidding.

The new International Classification of Functioning (ICF) Browser has the capability to specify exactly what physical therapists do and how we work on patients.


Today I evaluated a 50-year old female office worker before lunch. She had tried to lift a heavy piece of furniture five days ago and developed sudden-onset right lower back pain.

She presented today with a lateral shift in standing, positive right sciatic tension test, good (>35 degrees) hip external rotation, negative Gower's sign and a stiff back (P/A).

She was in no apparent distress (low fear-avoidance) and had no prior episodes of lateral shift.

Should I classify her in a manipulation or a stabilization group? Are the two groups mutually exclusive?

Anyway, I have started using the new ICF Browser to classify my patients according to my findings.

I have begun to avoid diagnostic labels altogether.

The physical therapy diagnostic process has more potential to inform physical therapist decision-making than does classification with diagnostic labels.

Here is my decision-making process and the ICF codes that go with my findings:
Activities - codeBody Functions - codeBody Structures - code
Difficulty Lying - d4150Pain in leg - b28015Lumbar vertebral column - s76002
Difficulty rolling - d4201
Stability of several joints - b7151

Tone of trunk muscles- b7355
I will primarily address the loss of function: impairments in strength, endurance and mobility (ROM) in outpatient physical therapy.

Note how the link between the measured activity limitation is the physical therapist's diagnosis. Treat the findings and don't worry about the label.

Re-measure the findings (activity limitations and impairments) to assess success.

Every physical therapist should be comfortable making a functional diagnosis.

Our patients deserve one.


  1. Hey, Tim,
    I stumbled upon your blog today and I am glad I did. I really enjoyed this idea on using the ICF model. I am curious about what you would put for diagnosis for a Medicare patient's paperwork if you are really going through with this process as you have indicated? Thanks and keep up the great work.

  2. Steven,

    Thanks for asking...

    Diagnosis descriptors are currently a hot topic in physical therapy with labels such as 'Loss of joint mobility associated with hypertrophic scar' which is then expected to improve decision making and direct treatment selection.

    I find labels long and confusing - I rely of the ICF Activity and Participation domain to state the patient's complaint and list the impairments in keeping with Body Structure and Function limitations.

    Interestingly, pain is listed as a Body Function limitation which I can then treat alongside ROM, strength and other impairment-level limitations.

    For example, my physical therapy diagnosis might look like this...

    "Patient has difficulty looking up, turning head, driving and sleeping due to...
    - thoracic manipulation classification
    - stiff cervical extension ROM
    - stiff cervical rotation ROM -bilateral
    - weak shoulder flexion - bilateral
    - weak deep cervical flexor muscles.

    BTW, I use classification predictor variables to show Medical Necessity and Skilled Physical Therapy for Medicare compliance.


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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 .

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