I am a physical therapist in an outpatient setting (a spine clinic). I went to a series of physical therapy meetings where they talked about using the ICF model now instead of the Nagi model. I am only familiar with the old model. How does this new model work with the kind of patients I see everyday?
The International Classification of Functioning, Disability, and Health or ICF as it is called has been endorsed by your organization (the American Physical Therapy Association). It is a framework for organizing physical therapist evaluations, treatment, and follow-up of all patients with chronic or complex problems.
Within that framework, there ia a subset of categories called the ICF Core Sets for Low Back Pain (LBP). The Core Sets for low back pain actually contain 78 ICF categories. They range from mobility and self care to sleep, energy and drive, and mental function. Other examples of categories include muscle tone and power, ability to maintain or change position, dressing, toileting, and mobility skills such as crawling, walking, or running. Once these categories have been assessed for a patient, there is a very comprehensive picture of the problems that person is having with function, health, and life situations.
Even though there are multiple ICF categories, the beauty of the model is that it allows for one instrument that can be used around the world. Results of research and clinical study can be combined and compared for better statistical significance. In this way, research results can be unified. The ICF provides a standard now for describing function in patients with chronic low back pain. That may not sound like much, but it's the first time any such standard has become available.
The ICF Core Sets provide the basis for what should be assessed as a measure of outcome. It tells us how to measure what we measure. And we don't have to throw out popular instruments already in use for assessing low back pain. Tools such as the commonly used North American Spine Society Lumbar Spine Outcome Assessment Instrument, Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire can be linked to the ICF.
Clinicians treating patients with chronic low back pain can use the ICF Core Sets right from the start. At the first appointment, the patient's history, symptoms, and clinical presentation can all be documented in the medical record using the ICF Core Sets. Documentation can be done quickly and easily with a checklist on paper or electronically.
The data can be used to set goals, manage rehab, and assess the effectiveness of treatment. These elements are referred to as the Rehab-Cycle. The Core Set has a place to record how the patient feels about his or her situation. There's a separate section for the health professional to document all clinical findings. In this way, a systematic approach makes it possible to identify and record all potential problems to be considered.