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.
Example:
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 - code | Body Functions - code | Body Structures - code |
| Difficulty Lying - d4150 | Pain in leg - b28015 | Lumbar vertebral column - s76002 |
| Difficulty rolling - d4201 | Stability of several joints - b7151 | |
| Tone of trunk muscles- b7355 |
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.
Hey, Tim,
ReplyDeleteI 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.
Steven,
ReplyDeleteThanks 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.
Tim
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