APTA guide to physical therapist practice 4.0 and the international classification of function, disability, and health

concepts that drive physical therapist practice

ICF/biopsychosocial model

social determinants of health

movement system

evidence-based practice

quality assessment and outcomes

professional values

internation classification of functioning, disability, and health

a way to describe functioning of an individual to allow for identification of a health status and needs of an individual or population

international classification of diseases

common way to categorize people receiving health care by their disease to allow for systematic recording, analysis, interpretation, and comparison of morbidity and mortality data

ICF

components of health classification

each person is effected differently by injury / recovery

interplay with biopsychosocial model

considers impact of environment

ICF model flow chart

functioning and disability exist along a continuum of health

many steps between functioning and disabled

*discuss what body can and cannot do

what guides our interactions

dynamic systems

health and wellness model

body functions

physiological functions of body systems (including psychological functions)

body structures

anatomical parts of the body such as organs, limbs, and their components

impairments

problems in body function or structure such as a significant deviation or loss

activity

execution of a task or action by an individual

participation

involvement in a life situation

activity limitations

difficulties an individual may have in executing activities

participation restrictions

problems an individual may experience in involvement in life situations

environmental factors

make up the physical, social, and attitudinal environment in which people live and conduct their lives

social determinants of health

education access and quality

health care access and quality

economic stability

social and community context

neighborhood and built environment

the movement system

integration of body systems that generate and maintain movement at all levels of bodily function

what is the primary way people interact and engage with their world

movement is the primary way people interact and engage with their world

our work is to optimize that movement and allow participation

parts of evidence based practice

best available evidence

clinical expertise

patient or client values and circumstances

guiding documents for physical therapists

core values

code of ethics

standards of practice

list of core values for the PT

1. accountability

2. altruism

3. collaboration

4. compassion and caring

5. duty

6. excellence

7. inclusion

8. integrity

9. social responsibility

what is the purpose of the core values

guide the behavior of PTs to provide highest quality of PT services

code of ethics for the PT

1. respect the inherent dignity and rights of all individuals

2. be trustworthy and compassionate in addressing the rights and needs of patients and clients

3. be accountable for making sound professional judgments

4. demonstrate integrity in relationships with patients, families, colleagues, students, etc

5. fulfill their legal and professional obligations

6. enhance their expertise through life long acquisition and refinement of knowledge, skills, abilities, and professional behaviors

7. promote organizational behaviors and business practices that benefit patients and society

8. participate in efforts to meet health needs of people locally, nationally, and globally

standards of physical therapy practice

1. ethical / legal considerations

2. administration of PT service

3. patient / client management

4. education

5. advocacy

6. research

7. community responsibility

what else is defined in the guide

role of PT: through lifespan

description of PT workforce

career advancement opportunities: clinical specialization, residency / fellowship, advanced practice

what does the physical therapist do in order to manage

-develops plan of care / management plan

-retains accountability for plan of care

-defines boundaries within which others assisting with service delivery operate

-always has option to perform all elements or to direct and supervise PTAs and techs

-shares info about the management plan with the individual’s provider as indicated

episode of care

the care provided for a specific health condition or conditions in a set period of time

what does an episode of care consist of

visits

-can be short, continual, or series of intervals of care

what must an episode be

1. provided by a PT or PTA

2. provided in an unbroken sequence (open plan of care)

3. related to management of given condition or problem

parts of patient client management model

**CYCLE

examination

evaluation

diagnosis

prognosis / plan of care

intervention

outcomes

review of systems

information relevant to major body systems that suggest the need for referral for additional medical evaluation

informs the physical examination

**always comes in subjective history

systems review

brief examination of major body systems for concerns

sometimes called screening

1. cardiovascular / pulmonary, integumentary, and neuromuscular systems

2. communication abilities

3. movement

4. clinical measures (can have a range)

5. diagnostic tests

should you start examination task or impairment oriented

can be either

task oriented examination

screening by functional abilities

ex: can you roll to one side in bed?

what is goal of task oriented examination

figure out what impairment testing you need to do after observing the functional task

determine what is different and what to test next / how to fix it

impairment oriented examination

how can a PT examine impairments

ex: if in a bed, can they lift legs off the surface of the bed?

what is the goal of impairment oriented examination

find what functional examination or task do we need to observe after impairment testing

why do we complete a screen

assists with:

predicting level of assistance needed from the PT to perform a functional task

determining where to focus time and energy with examination

reexamination

includes the application of selected items from the history and physical examination and comparing them to initial examination findings

may be indicated more than once during a single episode of care and often is performed over the course of a disease / condition

can be used to see how progression is going

evaluation

interpretation and synthesis of the findings from the examination in order to

1. establish a DIAGNOSIS

2. determine a PROGNOSIS (which includes goals)

3. develop a MANAGEMENT PLAN / PLAN OF CARE

4. REFER or CONSULT with another health care provider if indicated

diagnosis

used to encompass the signs and symptoms

with proper conclusion, a management plan and intervention can be pursued

3 major categories of diagnosis

ICD-10

ICF

movement systems

PT diagnosis versus Medical diagnosis

PT: right ankle pain with inability to weight bear. signs and symptoms consistent with a fracture of the right ankle

medical: trimalleolar fracture of right ankle

prognosis

predicted optimal level of improvement

-do this all the time when we write goals

-can be influenced by contextual factors (how often they can come in)

what should every goal be

measurable

functionally driven

time limited

plan of care

part of management care that includes

-goals

-predicted level of optimal improvement (prognosis)

-interventions to be used (including duration and frequency of interventions)

-summary of plan for referral, consultation, co-management

intervention

the things you do throughout your plan of care and during each visit

-educational and procedural

outcomes

the results of implementing the management plan and indicate an impact on functioning

did it work? how do you know?