ICF Model and Documentation Flashcards
What is health?
-biomedical model: absence of disease; treat the symptoms, treat the disease -WHO: physical, mental, social well-being (our approach); works with the living better aspect, not necessarily living longer; looks at person as a whole, we treat function not diseases
What is disability?
-relevance of environmental and personal factors in manifestations of a “disability” -how do we define it? Inability or limitation in performing socially defined roles and/or tasks that would normally be expected of an individual within a given culture and/or environment (self care skills, function in home, attain gainful employment, participate in community events)
Nagi Model of Disability
Pathology Impairments Functional Limitations Disability -pathology: interruption or interference with normal processes (ex: spinal cord injury) -impairments: anatomical, physiological, mental or emotional abnormality or loss (ex: weakness, muscle tightness) -functional limitations: limitation in performance at level of person (ex: stairs) -disability: limitation in performance of socially defined roles and tasks within environment (limits them from going out into society in a way they normally would)
ICIDH
-International Classification of Impairments, Disease, and Handicap -disease –> impairment –> disability –> handicap -disease: cellular, tissue, organ level -impairment: anatomy, physiology, emotional abnormalities -disability: limitation in components of physical function -handicap: societal expectation roles
ICF Upgrades
-impairment=body function and structure -disability-activity -handicap-participation -bidirectional arrows -visual representation of concept that any aspect of function can affect another -addition of contextual factors (factors about life, context in which they function: how they move through the environment, personal factors like how they react to change): environmental and personal allows a more comprehensive picture of the patient
ICF
-practice drawing ICF model with examples and definitions
Health Condition Definition
-disease, disorder, trauma, congenital abnormality, genetic predisposition, stress, aging
Body Function/Structure Definition
-physiologic function of the body systems -in other models, impairment
Activities Definition
-execution of a task or action by an individual
Participation Definition
-involvement in a life situation
Contextual Factors Definition
-physical, societal, personal, environmental
Contextual Factors: Environmental
-external influences on function and disability -facilitating or hindering aspects of physical, social, attitudinal world -ex: stairs, curbs, wheelchair ramps, opinions of others, financial assets, expectations within a culture -someone’s feelings may be perceptible to a person with a disability that may dissuade them from going out into the world
Contextual Factors: Personal
-internal influences on function and disability -impact of attributes of the person -ex: age, race, gender, fitness level, comorbidities, height, weight, personal coping mechanisms
Clinical Usefulness of ICF
-emphasis on disease vs. health -capacity (what they can do in ideal environment) vs. performance (what they can do in given environment) -personalize evaluation: selection of outcome measures-interest and function of patients -create universal terminology for clinicians -link between ICF and documentation
Clinical Implications of ICF
-personalize assessment -personalize intervention: promotes family involvement, goals derived from patient interest-motivation -prevention of secondary impairments -captures relevant environments -managerial decision (policy development) -universal understanding of health related information in research -DOCUMENTATION
ICF and Documentation
-consistency in terminology -identification of impairment is not enough-need to link impairment with consequences of disease: not just about functional consequences!! link to participation
Reasons for Documeting
- record patient-client interaction
- communicate with others
- demonstrate clinical problem solving
- support reimbursement and need for services
- provide proof that care is reasonable and necessary
- provide proof of skilled care
- facilitae administrative duties
- serve as legal record of care
Prove Reasonable and Necessary
- accepted standards of medical practice for the condition
- services are at a level of complexity that can be provided only by a PT (or PTA under supervison of PT)
- condition requires services be provided by PT (condition may require PT, but condition alone does not mandate medical necessity)
- expectation that condition will improve in a reasonable/predictable time
- amount, frequency, duration reasonable under accepted standards
Skilled Care
- ex: patient amb 50’ with WBQC and min A1
- patient amb 50’ with WBQC while PT provided physical A1 tactile cues to facilite swing/prevent toe drag
- maintenance service: intermittent to advance HEP, safety concerns, when is maintaining gaining?, progressive disease: need to prove that they’re not getting worse
Final Remarks About ICF
- profession neutral: walking activity means something different to each discipline; orthopedics-surgical outcome, neurologists-pharmacologic outcome, PT-effect of rehab
- delineates the complexity and individuality of health condition in the presence of disease
- personalizes care
