Vol. 89, No. 3, March 2009, p. 308
DOI: 10.2522/ptj.2009.89.3.308
Letters and Responses |
On "Physical therapist management..." Rundell SD, et al. Phys Ther. 2009;89:82–90.
We read with interest Rundell and colleagues’ case report on the International Classification of Functioning, Disability and Health (ICF) and its application to low back pain (LBP).1 The article clearly presented the role of the ICF as a unifying framework that clinicians and researchers (eg, in clinical trials) can use. It also solidified the role of physical therapists’ clinical decision-making skills in effectively managing patients on the basis of the ICF. However, we have some comments regarding the way the authors represented the conceptual model of functioning and disability behind the ICF and practical tools developed based on this classification, such as the ICF Core Sets.
Figure 1 does not represent the official depiction of the model as it is in the ICF book2 and can be misleading. The health condition in their figure seems to represent a background experience that directly interacts with all other components of the model. In addition, although the possible direct relationship between contextual factors and activity was mentioned in the text, it was not represented in the figure. The authors did not provide any further explanation of the need for and usefulness of the changes made to the original model. On one hand, readers who are not familiar with the ICF might have the impression that the authors’ presented model is the official model. On the other hand, readers who are familiar with the ICF would have difficulty understanding the rationale behind the changes that were made.
It probably would have been helpful to introduce explicitly the difference between the ICF as a model and the ICF as a classification. The model has 6 interrelated components of health: health condition, body functions and structures, activities, participation, environmental factors, and personal factors. The ICF classification concretizes all of the components except for health conditions and personal factors in the form of ICF categories. The ICF contains a total of 1,454 categories that are hierarchically organized. Health conditions are classified in the International Classification of Diseases (ICD-10).3 Thus, the ICD-10 and the ICF are complementary classifications, and the World Health Organization envisions a common application of these classifications in clinical medicine and research.
The authors mentioned the ICF Core Set for LBP.4 However, they did not state its value for clinical practice and research. An ICF Core Set is a list of ICF categories relevant to people with a health condition or health-related event, such as LBP. Thus, the ICF Core Set for LBP contains all areas of functioning that are evaluated and treated by all health care professionals, including physical therapists, as part of a multidisciplinary team. The ICF Core Sets represent the basis to guide multidisciplinary assessment and treatment.5,6
Finally, in the case description of the use of the ICF model in physical therapist management for the patient with chronic LBP, environmental factors were identified, but not in the "Intervention" section and not until later in the "Outcome" section, thus leaving a gap between the ICF and physical therapist management.
R Escorpizo, PT, DPT, is Physical Therapist and ICF Core Set Project Leader, Swiss Paraplegic Research (SPR), Nottwil, Switzerland, and ICF Research Branch of the WHO Collaborating Center for the Family of International Classifications at the German Institute of Medical Documentation and Information (DIMDI) SPR site.
A Cieza, PhD, MPH, is Research Scientist and Group Leader, Swiss Paraplegic Research (SPR), Nottwil, Switzerland; Research Scientist and Group Leader, ICF Research Branch of the WHO Collaborating Center for the Family of International Classifications at the German Institute of Medical Documentation and Information (DIMDI) SPR site; and Research Scientist and Group Leader, ICF Research Branch of the WHO Collaborating Center for the Family of International Classifications at the German Institute of Medical Documentation and Information (DIMDI), IHRS, Ludwig-Maximilian University, Munich, Germany
This letter was posted as a Rapid Response on January 12, 2009, at www.ptjournal.org.
References
- Rundell SD, Davenport TE, Wagner T. Physical therapist management of acute and chronic low back pain using the World Health Organization's International Classification of Functioning, Disability and Health. Phys Ther. 2009;89:82–90.
[Abstract/Free Full Text] - International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; 2001.
- International Classification of Diseases (ICD-10). Available at: http://www.who.int/classifications/icd/en/.
- Cieza A, Stucki G, Weigl M, et al. ICF core sets for low back pain. J Rehabil Med Suppl. 2004;36:69–74.
- Allet L, Cieza A, Burge E, et al. Intervention categories for physiotherapists treating patients with musculoskeletal conditions on the basis of the International Classification of Functioning, Disability and Health. Int J Rehabil Res. 2007;30:273–280.[Web of Science][Medline]
- Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med. 2008;44:329–342.[Web of Science][Medline]
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  S. D Rundell, T. E Davenport, and T. Wagner Author Response Physical Therapy, March 1, 2009; 89(3): 309 - 310. [Full Text] [PDF]
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