Note that physical therapy is an intervention at the Activity Limitation level of disability.
Most physical therapists would agree that our specific techniques are addressed towards the Impairment (strength, pain, ROM, swelling, etc.) but that our expected outcomes are at the level of the Activity Limitation.
How the ICF levels of disability are linked to three
different levels of intervention
| Intervention | Prevention | |
|---|---|---|
| Health Condition | Medical treatment Medical care Medication | Health promotion Nutrition Immunization |
| Impairment | Medical treatment Medical care Medication Surgery | Prevention of the development of further activity limitations |
| Activity Limitation | Assistive devices Personal assistance Rehabilitation therapy | Preventive rehabilitation Prevention of the development of participation restrictions |
| Participation Restrictions | Accommodations Public education Anti-discrimination law Universal design | Environmental change Employment strategies Accessible services Universal design Lobbying for change |
There are many ways to assess activity limitations but one of the best clinical ways to assess them is to ask your patient...
Then score the patients' response on a 5-point Likert scale: 1 = no difficulty, 5 = cannot do.
"How have you gotten better?"
Record serial measurements of their activity as you progress them through their physical therapy plan of care.
Remember, pain is an impairment level characteristic.
Physical therapy primarily treats activity limitations.
Tim -
ReplyDeleteI don't disagree that "we" as physical therapists use treatment techniques to address impairments, however I think you fail to address that altough there is a mechanical limit that can hinder function there is also that "chemistry" that also has a role in producing that pain. Not to mention the psychology of pain. Ever do a FABQ on a patient? You may address their impairment, but how does that address the fear they may have of returning to activity? Physical therapist do treat pain. However the role is much larger and it involves diagnosing the structural problem, the functional problem and the psychological barriers. Together these make up the "impairment" that the patient suffers from. Bryan Hannley PT
Brian,
ReplyDeleteYes, I use the FABQ to assess my patients.
Pain is an impairment in the ICF framework.
Depending on how many years you have been practicing you may have been trained to think of impairments mainly as limitations in ROM and strength.
However, impairments can also be emotional or mental.
The FABQ does a nice job of quantifying the emotional component of painful movement.
The issue I address is assessing pain primarily.
Since pain is only one of many impairments that can lead to activity limitation it makes sense to broaden our scope and assess more than pain.
I base my findings on chart audits of physical therapists notes that have as the 'Subjective' only statements qualifying pain and symptoms.
We actually don't write a SOAP notes because of its classic association with symptom language.
Instead, we ask the patient first for an 'Activity Statement' that is scored each session with a 5-point difficulty scale (similar to the OPTIMAL).
Thanks for your response.
Tim
TimRichPT@PhysicalTherapyDiagnosis.com
Tim -
ReplyDeleteI would be very interested to know what your variation from the SOAP note is (not being a fan of them myself). Where could I see an example of the OPTIMAL or your format?
Thanks,
Bryan Hannley PT
Bryan@hannley.com