Physical therapists: Use the Internacional Classification Functioning Browser to make your diagnosis

Wow!

The new ICF Browser is an exciting tool. I'm not kidding.

The new International Classification of Functioning (ICF) Browser has the capability to specify exactly what physical therapists do and how we work on patients.

Example:

Today I evaluated a 50-year old female office worker before lunch. She had tried to lift a heavy piece of furniture five days ago and developed sudden-onset right lower back pain.

She presented today with a lateral shift in standing, positive right sciatic tension test, good (>35 degrees) hip external rotation, negative Gower's sign and a stiff back (P/A).

She was in no apparent distress (low fear-avoidance) and had no prior episodes of lateral shift.

Should I classify her in a manipulation or a stabilization group? Are the two groups mutually exclusive?

Anyway, I have started using the new ICF Browser to classify my patients according to my findings.

I have begun to avoid diagnostic labels altogether.

The physical therapy diagnostic process has more potential to inform physical therapist decision-making than does classification with diagnostic labels.

Here is my decision-making process and the ICF codes that go with my findings:

Activities - code	Body Functions - code	Body Structures - code
Difficulty Lying - d4150	Pain in leg - b28015	Lumbar vertebral column - s76002
Difficulty rolling - d4201	Stability of several joints - b7151
	Tone of trunk muscles- b7355

I will primarily address the loss of function: impairments in strength, endurance and mobility (ROM) in outpatient physical therapy.

Note how the link between the measured activity limitation is the physical therapist's diagnosis. Treat the findings and don't worry about the label.

Re-measure the findings (activity limitations and impairments) to assess success.

Every physical therapist should be comfortable making a functional diagnosis.

Our patients deserve one.

Tim Richardson, PT in http://physicaltherapydiagnosis.blogspot.pt