ICF and Clinical Reasoning
ICF and Clinical Reasoning
ICF Framework
The instrument should also be convenient to apply for the therapist and
comfortable for the patient
Outcomes and ICF
The domains of ICF describe the three parts of therapy typically documented:
Darrah, 2008
Outcomes and ICF
Therapist’s goal Intervention Expected outcome
For example,
A child may be able to improve his or her ability to climb the stationary stairs in the
physiotherapy department, but he or she may not be able to extrapolate this
improvement to the stairs in school due to have a different rise and the skills
required to navigate among other students crowding the stairs
Intervention
A similar matrix may also be very useful in clinical practice to assist therapists to reflect
on the assumptions being made in clinical practice about what kind of intervention they
are using and what the expected outcome will be
If outcomes are not as expected, identification of the reasons also becomes simpler.
E.g. A child is discharged form active therapy with a clear home programme for
maintenance of function. The child returns after 3 months with 80% loss of skills gained
in therapy prior to discharge. It might become necessary to adopt a strategy of
continuous therapy at intervals to avoid such an outcome
Using matrix system
ICF as a ‘‘guiding system’’ - ICF provides an opportunity for therapists to
consider many intervention ‘‘points of entry’’ when making therapy plans
ICF when used with CBR matrix gives a long term view of goal setting needs
Using matrix system
Outcome measures are used to find out whether the therapy gains are meaningful to
patients. Eg. We might notice an improvement in ROM of 15 degrees in shoulder
abduction
The patient’s goal was not Body Function but activity of doing her hair
If this aspect is not evaluated using an outcome measure, management may appear to
be unsatisfactory
Choice of outcome measure must consider which domain is important to the patient
Mapping outcomes
ICF has been used in rehabilitation is as a tool to categorize outcome
measures
Body structure and function Activity Participation
Range of motion (Goniometry ) GMFM CHIEF
Muscle strength (Dynamometer) PEDI Life H
Construct Domain
E.g. A child with CP- initial expectation is to walk Body Functions
Once achieved walk to the bathroom Activity
Once achieved walk in school Participation
Gait training would have started with a walker in the gym - (10ft) Body functions
Walking endurance to cover 5 m Activity
Walking with crutches on different surfaces for school 50m Participation
ICF Core sets
Comprehensive ICF Core Set –includes spectrum of typical problems that
persons with specific health condition may face; allows thorough and
interdisciplinary assessment.
Brief ICF Core Set –is derived from Comprehensive Core set, used when
brief assessment of functioning is necessary; for describing functioning
and disability in clinical and epidemiological studies.
Generic Core Set –important for health statistics and public health, can be
part of patient`s medical history.
ICF Core sets
Core Sets assists in evaluation of the condition
Core sets for CP list pain. This is normally not a focus of PT but something
to be considered during surveillance programs
Educational strategies
Patient and caregiver education programs can be made more focussed
using ICF domains and core sets
Steiner, 2002
How does ICF fit in clinical reasoning
Knowledge and psychomotor ability, including observational analysis and
interviewing skills , are important in the development of higher-level skill
demonstrative of expert practice
Frew, 2008
How does ICF fit in clinical reasoning
Scientific reasoning and the Body Structures and Functions Dynamic
Narrative Reasoning and the Activities, Participation and Contextual Factors Dynamic
Frew, 2008
How does ICF fit in clinical reasoning
Frew, 2008
How does ICF fit in clinical reasoning
Frew, 2008
How does ICF fit in clinical reasoning
Frew, 2008
How does ICF compare to traditional methods
Method Value Limitations