Rehabilitation Disciplines Research Articles

Reply to Letter to the Editor: Aseptic Loosening of Total Hip Arthroplasty: Infection Always Should be Ruled Out

We thank Dr. Partridge and his colleagues for their letter. They commented, ”…the distinction between patients with infection and without infection must be questioned as a large proportion of patients deemed to be correctly diagnosed as having aseptic loosening did not have specimens sent for culture.” As we explained [4], before institution of a standard protocol, some patients with aseptic loosening may not have been adequately investigated to rule out periprosthetic joint infection (PJI). The latter explains why intraoperative culture specimens were not sent for some patients. Although their point is valid, it does not detract from the message of the paper. At worst, sending culture specimens for the aseptic cases might have increased the number of “misdiagnosed” aseptic cases adding strength to the message of the article. However, the number of optimal culture specimens is not known. In the recent AAOS Guidelines for Diagnosis of PJI for which a comprehensive literature search was done, Della Valle et al. were not able to address this issue based on evidence [3]. Dr. Partridge and his colleagues also commented, “There is also the likelihood that a proportion of the patients assigned to Group 1 (prosthetic joint infection) on the grounds of definite prosthetic joint infection at the time of subsequent rerevision actually had infection after their revision surgery rather than representing falsely diagnosed aseptic loosening.” We were cognizant regarding the possibility that some of the subsequent infections might have been de novo PJIs and not missed aseptic cases, as we stated in our article. Although plausible, the latter is unlikely as these patients did have abnormal serology, and in some cases synovial cell count, at the time of their index revision. There currently are no definite diagnostic criteria for PJI [1]. We are unaware of any validated criteria specifying the number of culture specimens required to be positive for the case to qualify as PJI, nor is there a definite criterion that specifies the importance of isolation of organisms from broth. Diagnosis of PJI is based on a combination of criteria that may need to be varied on an individual basis. As reported previously, in as much as 7% of PJI cases one is not able to isolate the infecting organism (culture negative cases) [2]. Thus, reliance on isolation of an organism (positive culture) is not accepted as the gold standard for diagnosis of PJI. We disagree with the last comment in the third paragraph that isolation of an organism from a single culture represents contamination. For example, for a patient with abnormal serology and abnormal synovial cell count parameters in whom an organism is isolated from a single culture–even broth, would the latter result not be considered significant? Within the confines of manuscript length, we discussed the details pertinent to transport and processing of culture specimens. We recognize that variations in processing culture specimens might have existed but also acknowledge that this is not unique to this cohort or our institution. We agree that management of patients with PJI requires a team effort. As a center that treats approximately 300 patients with PJI per year, we rely on the expertise of our colleagues from infectious disease, microbiology, pharmacy, rehabilitation, and other disciplines to optimize the care of these patients.

(A314) Role of Medical Rehabilitation in Acute Disaster Response

IntroductionNatural Disasters result in a sudden onslaught of huge numbers of catastrophic and disabling injuries including spinal cord injuries, traumatic brain injuries, limb amputations, long bone fractures and peripheral nerve injuries. In addition to these there are persons with pre-existing disabilities in the affected disaster zones. Oftentimes disasters overwhelm the available resources and rehabilitation services are usually underdeveloped in most parts of the disaster affected zones. Both challenges are frequently neglected and not included in disaster response planning. As a consequence, Physical and Rehabilitation Medicine (PRM) has traditionally played no or little role in the post disaster phase and disaster planning.MethodologyThe data was derived from an English language literature search (1950–2010) using Pubmed, Google Scholar, Sciencedirect, Ovid, and Sagepub. Other sources of data included discussion with subject matter experts and the author's personal experience.ResultsPRM has not historically become actively engaged in medical rehabilitation of injuries until 24-48 hours post-event. The emergence of the discipline of disaster rehabilitation however, advances PMR into the emergency response phase. This paper describes the disability pattern after disasters, shortcomings in the traditional disaster response with reference to PMR interventions and disabled populations and its negative consequences. It then explores the rehabilitation interventions offered in different disaster scenarios during the last decade and its positive impact in achieving a better outcome for the new onset and pre-existing disabled population.ConclusionsThis is the first paper in biomedical literature exploring the possible role of PRM in the post disaster phase. The paper offers recommendations to include PRM in the disaster response phase and possible plans of action for organizations working in the fields of disability and disaster management. It is expected that this paper will guide future research and establishment of the field of Disaster Rehabilitation.

Inpatient treatment time across disciplines in spinal cord injury rehabilitation

Background/objectiveLength of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs.MethodsSix hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline.ResultsAverage LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics.ConclusionsVariations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with positive outcomes (at 1 year post injury), after controlling for patient and injury differences.

Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study

Whiteneck GG, Gassaway J, Dijkers MP, Lammertse DP, Hammond F, Heinemann AW, Backus D, Charlifue S, Ballard PH, Zanca JM. Inpatient and postdischarge rehabilitation services provided in the first year after spinal cord injury: findings from the SCIRehab study. Objective To examine the amount and type of therapy services received in inpatient and postdischarge settings during the first year after spinal cord injury (SCI). Design Prospective observational longitudinal cohort design. Data were obtained from systematic recording of interventions by clinicians and from patient interview. Setting Inpatient and postdischarge rehabilitation programs. Participants Patients (N=493) with traumatic SCI admitted to 6 rehabilitation centers participating in the SCIRehab study. Interventions Not applicable. Main Outcome Measures Hours of therapy by physical therapy (PT), occupational therapy (OT), speech therapy, recreation therapy, psychology, social work/case management, and nursing education during initial inpatient rehabilitation and postdischarge up to the first anniversary of injury. Inpatient data were collected prospectively by the treating clinicians; postdischarge service data were collected by patient self-report during follow-up interviews. Results Of the total hours spent on these rehabilitation interventions during the first year after injury, 44% occurred after discharge from inpatient rehabilitation. Participants received 56% of their PT hours after discharge and 52% of their OT hours, but only a minority received any postdischarge services from other rehabilitation disciplines. While wide variation was found in the total hours of inpatient treatment across all disciplines, the variation in the total hours of postdischarge services was greater, with the interquartile range of postdischarge services being twice that of the inpatient services. Conclusions SCI rehabilitation is often given in a care continuum, with inpatient rehabilitation being only the beginning. Reductions in inpatient SCI rehabilitation length of stay are well documented, but the postdischarge services that may replace some inpatient treatment appear to be greater than previously reported. The availability and impact of postdischarge care should be studied in greater detail to capture the wide array of postdischarge services and outcomes.

Immediate and follow-up effects of a brief disability curriculum on disability knowledge and attitudes of PM&R residents: A comparison group trial

Background: Humanistic attitudes are essential in physicians and therefore supporting them is a key component in graduate medical education (GME). The importance of a physician's attitude toward people with disability is especially relevant within the rehabilitation discipline, as prevailing attitudes and misconceptions can be potential barriers to successful diagnosis and treatment.Aim: This study was designed to examine the relationship between participation in a brief disability sensitivity training and knowledge of disability and attitudes of physical medicine and rehabilitation (PM&R) residents toward people with disability.Methods: A daylong training for residents consisted of lectures and a panel presentation that covered (1) disability facts, (2) personal stories of people with disabilities, and (3) medical evaluation of disability. The presentations were followed by a simulation experience where resident pairs (one assigned to a wheel chair, the other a “caretaker”) performed various tasks. This was followed by a group discussion of their experience. Three instruments were administered prior to the training: (1) a brief demographic questionnaire, (2) 30 multiple choice questions measuring various aspects of knowledge about disability, and (3) the Scale of Attitudes toward Disabled Persons, Form R (SADP). After the training experience, the knowledge instrument and the SADP were re-administered along with a series of items to measure various aspects of students’ satisfaction with the training. The three instruments described were re-administered 3 months post-training.Results: There was significant immediate gain in both the disability knowledge and the attitude scores among trainees as compared to a control group of physiatry residents in standard medical training. Knowledge gains of the disability sensitivity training group did not persist, but attitude toward disability gains remained at the 3 months follow up.Conclusion: After a brief curriculum in disability knowledge and sensitivity for PM&R physicians in training, there was a short-term improvement in disability knowledge and an improvement in disability attitudes sustained at 3 months.

"You trade in a man for the man": Domestic Violence and the U.S. Welfare State

The Family Violence Option, an amendment that sought to mitigate the effects that "welfare reform" would have on victims of domestic violence, embodied the quintessential arguments for feminist reform. Accepting the larger transformations within the welfare system as inevitable, mainstream feminist activists chose to link their political claims to both a law and order agenda that emphasized criminalizing individual acts of violence rather than addressing structural violence and to neoliberal forms of governance that emphasized individual rehabilitation and labor discipline as the solutions to economic inequality. In analyzing the political struggle over the Family Violence Option during the mid-1990s, this essay demonstrates the many pitfalls of looking to the state to protect women from violence in a context in which the state is itself a major perpetrator of gendered violence and advocates instead for the necessity of feminist social movements that challenge rather than accommodate state violence.

Community rehabilitation: ‘home versus centre’ guidelines for choosing the optimal treatment location

This study aimed to produce indicators and guidelines for clinician use in determining whether individual therapy sessions for community rehabilitation services should be delivered in a home/community-based setting or centre-based setting within a flexible service delivery model. Concept mapping techniques as described by Tochrim and Kane (2005) were utilized within two forums. The first forum consisted of 12 health professionals representing key community rehabilitation disciplines. The second forum consisted of seven clients or carers, who had been part of an active community rehabilitation admission. Each forum produced a concept map of ideas, a table indicating how these ideas tended to favour centre-based or home-based community rehabilitation and the importance of these ideas in choosing the location for community rehabilitation treatment. The five key themes generated were (1) service delivery issues, occupational health and safety; (2) interaction between the goals and the environment; (3) client physical and psychological considerations; (4) service delivery issues, efficiency and (5) service delivery issues, transport issues/logistics. From these themes, a series of specific indicators and associated guidelines were established to direct the decision-making process of staff. Through this research, we now have a tool that facilitates well-informed decisions about the most appropriate, physical environment for individual therapy sessions.

Overcoming the Barriers for Participation by the Disabled: An appraisal and global view of community-based rehabilitation in community development

The discipline of rehabilitation developed after the Second World War. Some disabled people were reintegrated into the society due to advances in technical aids, appliances and assistive technology. The transfer of these aids and technology to developing countries was facilitated by the United Nations Organization (UNO). The results, however, did not get to the rural communities. The number of people with disability worldwide, and particularly in the developing countries, is increasing due to wars, conflicts, vehicular accidents, chronic diseases, mental impairment, birth defects and malnutrition. Many of these people face participation-restriction in activities of life. This paper appraises the emergence and the global view of community-based rehabilitation (CBR). The review and remodelling of CBR in developing countries, and its inclusion in community development will enhance the reintegration of the disabled individuals into the society. KEY WORDS: disabled, community based rehabilitation, reintegration, community development

Differential Item Functioning in rehabilitation research

Measurement is critical to Rehabilitation practice and research. To provide effective services and to have valid research results, it is imperative to have valid and reliable assessment tools. Differential Item Functioning (DIF) is a statistical procedure which better enables us to assess both the validity and the results of measurement instruments. As such, it is a methodology that can be very beneficial to the field of Rehabilitation. The purposes of this article are to (a) explain the fundamental principles and components of DIF, (b) discuss the practical implications of DIF for the Rehabilitation discipline, and (c) provide an example of DIF implementation and interpretation of results.

The Roles of Occupational Therapy, Physical Therapy, and Speech/Language Pathology in Primary Care

Occupational therapy, physical therapy, and speech language pathology services may be of significant help to patients of nurse practitioners (NPs) in primary care. NPs should be aware of the depth and breadth of services offered by these colleagues, and consider early referral to them. This article describes the different rehabilitation disciplines and some of the ways in which their services may benefit patients.

Construct validity of an attention rating scale for traumatic brain injury.

Attention deficits are nearly ubiquitous after traumatic brain injury (TBI). In the subacute phase of moderate to severe TBI, these deficits may be difficult to measure with the precision needed to predict outcomes, assess degree of recovery, and monitor treatment response. This article reports the findings of four studies, three observational and one a randomized, controlled treatment trial of methylphenidate (MP), designed to provide construct validation of the Moss Attention Rating Scale (MARS), an observational measure of attention dysfunction following TBI. One hundred seven participants with moderate to severe TBI were enrolled during treatment on an inpatient rehabilitation unit. MARS scores were provided independently by four rehabilitation disciplines (Physical, Occupational and Speech Therapies and Nursing). Results indicated that the MARS: (1) is more strongly related to concurrent measures of cognitive versus physical disability, supporting its validity as a measure of cognition, (2) is more strongly related to concurrent psychometric measures of attention versus measures thought to rely less on attention, supporting its validity as a measure of attention; and (3) predicts 1-year outcomes of TBI better than psychometric measures of attention. However, the MARS (4) was not differentially affected by MP versus placebo treatment. Results support the construct validity and utility of the MARS, with further research needed to clarify its role in treatment outcome assessment.

Grade IV frostbite requiring bilateral below knee amputations: a case report.

A rare case of grade IV frostbite is presented resulting in bilateral below knee amputations. This case highlights the importance of early versus late amputation as well as the importance of close collaboration between the rehabilitation, surgical, psychosocial, and public health disciplines in this rare and challenging problem that still may be encountered in the United Kingdom.

Grade IV frostbite requiring bilateral below knee amputations: a case report

A rare case of grade IV frostbite is presented resulting in bilateral below knee amputations. This case highlights the importance of early versus late amputation as well as the importance of close collaboration between the rehabilitation, surgical, psychosocial, and public health disciplines in this rare and challenging problem that still may be encountered in the United Kingdom.

Clinical Taxonomy Development and Application in Spinal Cord Injury Research: The SCIRehab Project

Background/Objective: Applying practice-based evidence research methodology to spinal cord injury (SCI) rehabilitation requires taxonomy (typology or classification) of rehabilitation interventions provided by every discipline contributing to SCI rehabilitation. The rehabilitation field currently lacks such taxonomy. Methods: SCIRehab project researchers and clinicians representing 7 rehabilitation disciplines from 6 US inpatient SCI rehabilitation facilities worked in discipline groups during 2 face-to-face meetings and weekly discipline-specific teleconferences for 9 months to identify key contributions of each discipline to SCI rehabilitation and to develop a classification of treatment interventions used by each discipline. These clinician groups were charged with designing documentation systems that collected enough details to describe treatment adequately while not imposing an unrealistic data collection burden on clinicians. Completed documentation systems were programmed onto handheld personal digital assistants (PDAs) to facilitate data entry by clinicians at the point of care.Results: Seven discipline-specific SCI rehabilitation taxonomies were developed that describe and quantify intervention activities (major categories of treatment offered by the discipline) and the activity-specific details (variables deemed important to fully describe the interventional process). Much treatment information is unique to each discipline; some is common across disciplines.Conclusions: The taxonomies provide a format with which clinicians document actual interventions performed with or for patients. The SCIRehab project has developed the first comprehensive multidisci-plinary taxonomy for describing the details of the SCI rehabilitation process and designed a PDA-based documentation system based on that taxonomy that allows clinicians to describe the specifics of their interactions with their patients.

New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

Background/Objective: Limited research evidence is available to show the effectiveness of the many specific interventions provided in spinal cord injury (SCI) rehabilitation; what is available typically focuses on effects of the full rehabilitation package but not specific therapy interventions, medical procedures, patient education, or counseling. Given the problems of conducting randomized controlled trials (RCTs) in rehabilitation, practice-based evidence (PBE) research has been suggested as an alternative methodology for identifying which rehabilitation interventions are associated most strongly with positive outcomes, after controlling for patient differences. Using the PBE research methodology, the SCIRehab project attempts to "open the black box" of acute SCI rehabilitation, provide detailed information on treatments delivered by all rehabilitation disciplines, and contribute to outcomes-based guidelines for clinical decision-making. Methods: The SCIRehab project includes 1,500 patients with acute SCI, consecutively admitted to 1 of 6 US inpatient rehabilitation facilities. Details of the rehabilitation process are captured by clinicians from multiple disciplines documenting their interventions in handheld personal digital assistants after sessions with their patients. Outcome data are abstracted from medical records (clinical outcomes data) and obtained from patient interviews at 6 and 12 months after injury. Extensive patient, injury, and other treatment characteristics are abstracted from medical records. SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team.Results: SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. These findings are presented in a series of 9 articles.Conclusions: To date, SCIRehab's major contribution is a system for categorizing specific contributions of each discipline and a technology for documenting that detail. After data collection is complete, future manuscripts will relate those process elements to outcomes. The SCIRehab Project is an important step toward establishing outcomes-based guidelines for SCI rehabilitation.

Treatment across cultures: Is there a model?

Aims: The increase of cultural diversity in countries worldwide impacts on health-care providers, who are required to provide culturally-appropriate care to patients from culturally and linguistically diverse (CALD) backgrounds. Cultural differences may impact both on treatment processes and patient responses to treatment. This article aimed to explore how cultural issues and cultural sensitivity uniquely infl uence the rehabilitation process of individuals from various ethnic and cultural backgrounds; and give an insight into cross-cultural issues pertaining to health-care delivery from an American physical therapy perspective. Content: A literature review on issues facing health-care providers—;specifi cally physical therapists—;in delivery of culturally-appropriate care was undertaken. Key areas are discussed and a culturally sensitive treatment model for health-care providers to use when working with CALD patients is proposed. Discussion and conclusions: A review of the literature revealed limited research in this area from physical rehabilitation disciplines; although there was an encouraging proportion of articles on the culture-oriented trend in professional education. It is suggested that professional education of physical therapists should include a cultural component; focusing on particular cultures, culturally sensitive behaviour based on knowledge of cultures, and assistance with return to work or pre-morbid activities. Piloting of the proposed model is suggested to add to the literature in this area.

The Oncology-Rehabilitation Interface: Better Systems Needed

The enormous discrepancy between the incidence of disabling physical impairments among individuals with cancer and the provision of medical rehabilitation services to address these problems has once again been documented by Cheville et al in this issue of Journal of Clinical Oncology. In particular, the difference between receipt of rehabilitation care during acute hospitalization and the extremely low rate for outpatients is impressive, but hardly surprising. The extent to which presence of advanced cancer has accentuated the magnitude of the differences between inpatient and outpatient rehabilitation service delivery is unclear, because similar trends would likely be found even among those with less extensive disease. In the inpatient setting, rehabilitation services such as physical and occupational therapy are often readily available, and are integral to the discharge-planning process to attain basic function sufficient for homegoing and avoid costly prolonged hospitalization. On the other hand, rehabilitation goals among outpatients are typically more varied and focused on specific impairments, such as lymphedema, contracture, motor-sensory deficits, deconditioning, and musculoskeletal pain syndromes. Active recognition of the impairments as remediable issues is required. Additional barriers not seen during inpatient care may be present, such as insurance authorization obstacles and inconvenience. The main problem, however, is that more effective systems are needed to recognize rehabilitation needs, provide rehabilitation care, and facilitate evidencebased outcomes of rehabilitation in the cancer population. Multiple studies have documented increased levels of disability among cancer patients and survivors. Yet, many gaps exist in our knowledge of how this broad-based information can be applied clinically. Which impairments justify vigilant screening? In which situations are the problems most remediable? What are best practices for treatment? How does the presence of advanced cancer affect appropriate rehabilitation management? Some cancer-related impairments, such as amputation, and conditions affecting the brain or spinal cord produce obvious and devastating clinical care needs. A wide range of treatable musculoskeletal disorders can also occur in the setting of cancer, a fact that is probably underappreciated, including among many rehabilitation practitioners. There is a need to more closely examine the extent of rehabilitation needs in historically elusive, yet common, cancer subpopulations, including those with advanced cancer. In depicting a model of rehabilitation care that has worked in a major cancer hospital, Grabois described “lessons learned,” including the need for a core triad of strong administrative support, a physiatrist as medical director of rehabilitation services, and effective marketing. Clinical service lines including inpatient, consultative, and outpatient rehabilitation should be present, as well as an emphasis on scientific productivity, and educational dimensions including medical student and resident rotations, sponsorship of seminars, and development of cancer rehabilitation fellowships. Significantly, Grabois also spoke of the real-world importance of having adequate staff capacity to minimize patient waiting times, and of maintaining a convenient location. Such a model immerses rehabilitation in the culture and workings of the facility. Despite examples such as this, integration of rehabilitation into cancer care remains problematic. In a survey of National Cancer Institute–designated cancer centers, 70% of facilities reported services to treat lymphedema, but there was little discussion of other mainstream rehabilitation services. Challenges are even greater in institutions that are not dedicated cancer hospitals, where the majority of cancer patients are treated, and where rehabilitation services simultaneously need to meet the needs of other patient populations. What specific strategies can be employed to improve rehabilitation access for oncology patients? Lehmann, O’Toole, and Mosvas describe consultative models to screen oncology patients for rehabilitation needs, such as assigning rehabilitation personnel to meet regularly with the oncology team or using information such as the Karnofsky score to trigger rehabilitation assessment. However, data on long-term results of such screening systems are highly limited. Among inpatients, including those with advanced cancer, gains in functional status have been reported with both traditional acute rehabilitation and with interdisciplinary rehabilitation provided on a consultative basis, suggesting that future efforts at optimizing the rehabilitation screening process among oncology inpatients would be highly worthwhile. Among outpatients, screening presents even greater challenges. For example, do best care outcomes and cost effectiveness happen when a physiatrist sees all at-risk patients and triages the rehabilitation interventions, or when the patients go directly to other rehabilitation disciplines such as physical or occupational therapy, with physiatrist care reserved for those with the most complicated needs? Empirically, successful outpatient programs have cultivated specific service lines and consistent processes. Historically, many programs have been directed towards lymphedema and postmastectomy management, or other postsurgical issues. But there are other problems, often more global, to which there is a need to respond, especially as the evidence grows stronger. For example, because multiple studies have shown that individuals with cancer benefit from exercise programs, processes that routinely expedite exercise are needed. Areas JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 26 NUMBER 16 JUNE 1 2008

ICF: Clinical relevance for physiotherapy? A critical review

The International Classification of Functioning, Disability and Health (ICF) holds great promise for providing the rehabilitation disciplines with a universal language. However, the ICF is still hi...

Sexological Competence of Different Rehabilitation Disciplines and Effects of a Discipline-specific Sexological Training

Dealing with sexual problems due to disease or disability is part of medical rehabilitation, but both patients and professionals experience barriers to discuss sexual issues. A brief discipline-specific sexological training for rehabilitation professionals was therefore developed and evaluated in two rehabilitation centers in The Netherlands. Among the 283 participants were physicians (42), physical therapists (38), occupational therapists (40), psychologists and social workers (26), nurses (101), and other disciplines (36). Measurements before training, after training, and at 3–4 months follow-up showed increase of self-rated sexological competence and of scores on the Knowledge, Comfort, Approach, and Attitudes towards Sexuality Scale (KCAASS) during the training that were maintained at follow-up. Disciplines differed in sexual competence before training and in increase of sexual competence after training. Implementation of the training in other rehabilitation centers is recommended.

Intervention categories for physiotherapists treating patients with musculoskeletal conditions on the basis of the International Classification of Functioning, Disability and Health

The International Classification of Functioning, Disability and Health holds great promise for providing rehabilitation disciplines including physiotherapy, with a universal language. The aim of this study was to investigate the content validity of the International Classification of Functioning, Disability and Health intervention categories for physiotherapists treating patients with musculoskeletal conditions. The study was conducted as a retrospective cross-sectional multicenter study in Switzerland. It was performed with convenience samples of 300 clinical records of patients with musculoskeletal conditions. This study recommends three checklists with 38 second-level intervention categories for acute, 46 for rehabilitation, and 38 for the long-term context. The practical application of three lists, each containing second level intervention categories, should improve the standardization of documentation in physiotherapy practice. This may also provide the transparency increasingly demanded in the current political climate.