"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

Saturday, March 7, 2009

'Fancy Theory' in Physical Therapy

Outpatient physical therapists don't often deal with life and death issues.

We may help patients with...
  • back and neck pain
  • walking difficulty
  • stiffness
  • sports injuries
  • balance problems
...to name a few.

We make decisions, however, that affect patients' quality of life based on their self-reported activity limitations and their performance on standardized tests and measures.

That's why I was surprised day-before-yesterday (March 5th) when I gave a presentation to a class of Physical Therapist Assistant students and I mentioned the International Classification of Functioning (ICF).

I described the ICF disablement model as THE most important decision-making tool in my practice.

I got some blank stares.

I have heard other, experienced physical therapists describe disablement models as "too theoretical" for day-to-day decision-making.

Physical therapists' decisions are often made independent of the physicians' diagnosis and may not immediately impact a patients' pain.

This is where the ICF helps me.

Diagnosis and Prognosis

The physician may send the patient with a request for ultrasound (a technique).

The patient may show up in my office expecting a massage.

I may examine the patient and find the underlying cause of her dysfunction and decide that ultrasound and massage are irrelevant to the patient's long term goals.

For example, I examined a marathon runner this week with left lumbar and hip pain at rest and right knee pain while running. Previous treatments had focused palliative modalities on the left hip region. My examination found a stiff right hip (non-painful) and lumbar hypermobility.

I treated the right hip, explained to her why right knee ultrasound and lumbar massage would not be expected to help and asked her to return Friday.

She was quite a bit better and is running a 5k on Saturday.

My physical therapist assistant students listened intently to my story and jotted down the reference for review of the ICF.

Is it just me?

I came upon disablement models later in my career (2001) and I am still impressed with their elegance.

They have simplified my day-to-day decision-making and clarified my treatments.

My mission is to train PTs and PTAs to explicitly use the ICF to make decisions.

It's not just another fancy theory.

Hopefully new grads and students, with training that I never had, will segue into their careers using disablement models as a matter of course to improve patients quality of life.

It's not life or death but the ICF does make a difference.

Free Tutorial

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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"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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