Using the ICF to Facilitate Clinical Reasoning in Physiotherapy Practice: A Systematic - Literature review Example

Systematic literature review s Submitted by s: 10th March, 11th March, Systematic Literature Review The international classification of functioning, disability and health is a tool that is largely advocated for in the structuring of the rehabilitation. In addition, a universal language is often used in the facilitation of communication between the multi-disciplinary teams that are used in the modern treatment approaches (Allet and B\"Urge et al., 2008, pp. 127--137). The ICF framework may also be used in the clarification of the team role and interventions for clinical reasoning (Hoffmann and Bennett et al., 2013). The attainment of the best communication and the attainment of objective communication between the experts lead to the creation of synergy and an ideal working organization that will eventually lead to the creation of the best scenarios for the rehabilitation of a patient in physiotherapy (Atkinson and Nixon-Cave, 2011, pp. 416--430). Various researches have acknowledged that the common approaches in the treatment of the patients in need of physiotherapy care fail due to the adoption of a unidirectional approach. The research went ahead to promote the use of multidimensional approaches in the treatment of such patients. This led to the coining of the term biophysiosocio approach. The term has been adopted and used in various researches even without providing a definition. The continued use of the term without a definition means that this approach has come to be largely accepted by the practitioners in the physiotherapy care (Bilbao and Kennedy et al., 2003, pp. 239--250). The paper will seek to make a systemic literature review in order to evaluate how well the current practitioners use the approach in the reasoning (Hoffmann and Bennett et al., 2013). It will also seek to find out the ICF framework is applied in the clarification of roles in a multidimensional care team (Atkinson and Nixon-Cave, 2011, pp. 416--430). The main goal of rehabilitation is to provide the patients with a leeway to interact with the environment in the same or at least similar manner with the one that they had before having the disability (Allan and Campbell et al., 2006, pp. 235--245). The rehabilitation approach leads to the optimization of the functionality of a human body in order to attain the maximum capacity possible for the person. The approaches used in the rehabilitation process drawn from the resources that the patient has which will lead in the effectual development of an interaction with the environment (Bornman and Murphy, 2006, pp. 145--154). The rehabilitation process is a relevant strategy over the lifetime of a condition. The care continuum could be ranging from the acute hospitalization to the rehabilitation facilities as well as the community (Boshuizen and Schmidt, 1992, pp. 153--184). The approaches used in the rehabilitation are relevant to a large number of people or professionals. Therefore, the adequate form of rehabilitation is multidirectional. Accordingly, many professionals are involved in the rehabilitation process and the provision of care. The core of the rehabilitation care presents various evolving problems as well as the need of the patients in relation to the attainment of optimal functionality. The attainment of the functionality levels is the starting point of the development of a patient and goal oriented rehabilitation that is interactive (Conti-Becker, 2009, pp. 2125--2129). As a matter of consequence, the models and classifications of the roles shared among the professionals is important in the management of rehabilitation in the real sense. The approval of the ICF framework by the world health organization in 2001 opened a new vista in the rehabilitation process. The ICF is the first model that has universal acceptance of the provision of care and rehabilitation to the people. The ICF is a source of the international language when it comes to the provision of care to the patient that is in need of physiotherapy. This section of the paper will provide the best approaches that the health providers use in the provision of care to the patients suffering from the physiotherapy conditions (Allet and B\"Urge et al., 2008, pp. 127--137). The attainment of the best approaches in the rehabilitation of patients follows that the professionals adopt the rehab- CYCYLE. This is a problem solving approach in the rehabilitation management that facilitates the structuring and documentation of the rehabilitation process. The structure facilitates the coordination of the activities of all the professionals involved in the provision of care (Hoffmann and Bennett et al., 2013). The cycle is made of four processes. These processes are; assessment, assignment, intervention and evaluation (Crist and Scaffa, 2001). As indicated earlier, the main goal of the assessment is the realization of the needs of the patient and the understanding of the functioning. The understanding of the patient is instrumental in the recognition of elements that ought to be under the rehabilitation. This means that the effectual assessment of the needs of the patients ought to be carried out in a successful manner in order for the rehabilitation process to be a success (Dalen and Nyquist et al., 2013, pp. 198--205). The assessment stage of the cycle starts with the description of the needs of the patient and the resources. The second step in the assessment tier of the cycle is the determination of the goals of the rehabilitation that are mutually accepted by all the professionals in the multidimensional team. The final step in the assessment is the identification of the intervention targets (Dalen and Nyquist et al., 2013, pp. 198--205). The attainment of the effective description of the needs of the patients calls for the creation of a functioning state. This state is the mirror through which the care professionals can understand the extent of the limitation of the functioning of the patient. This assessment of the limitations involves both the perspectives of healthcare professionals in the MDT and the patient. The perspective of the patient can be attained by questioning the patient. The professional’s opinion on the limitations of the patient’s functionality may be attained by the comparison of the assessment of the multidimensional teams. The assessment of the personal and environmental factors is important in the identification of the effects of the above factors in the optimal functioning of the person (Darrah, 2008, pp. 146--151). In the MDT and systematic analysis, the norm involves the adoption of all the core sets in the ICF framework. There is an adoption of the cores from the brief framework. The assessment then expands to other parts of the core system that are more comprehensive than in the previous case. Assignment is concerned with the allocation of relevant intervention targets. The assignment may also allocate the specific interventions in the process (Darrah, 2008, pp. 146--151). The last stage of the assignment is the allocation of the targets to the specific health care professionals. The intervention could be assigned to the respective care providers that perform the suitable interventions. The interventions are allocated based on the nature of the problem or need. The specialists deal with a particular intervention (Dcruz and Jacobs et al., 2009). Intervention techniques will be selected by the individual team members to improve the intervention targets. In each of the intervention procedures, there might be the adoption of the evidence-based approaches that rely on the information provided by the patient and the professionals. In other instances, the intervention approaches may assume a hypothesis driven approach (Delany and Molloy, 2009). The individual specialists selected the suitable instruments that facilitate the intervention for the initial assessment, progress and the ultimate evaluation. The instruments adopted may be from specific tests or examinations or even simple observation. The goal value that is under the pursuance of the professional has to be defined by the instrument scales or ICF qualifier. Evaluation step of the ICF framework is an evaluation of the Interventional targets that reflect on the effectiveness of the entire rehabilitation intervention. This means that before the end of the corresponding rehab-CYCLE each of the professionals involved in the professional care has to evaluate the intervention targets using the previously selected intervention targets. The end value of the cycle can be documented using the existing qualifiers. The documentation process is instrumental in that it leads to the effectual discussion and appraisal of the performance of the cycle at the end of the process (Frew and Joyce et al., 2008, pp. 68--72). The documentation is also a source of comprehensive determination of the success of the process (Furze and Nelson et al., 2013, pp. 222--231). It is also important in the identification of areas that the multidimensional team has to correct on in the future. In the event that the goal of the team was not attained in the cycle, it will be arrived at in the successful period. The team may also decide to extend the time of the cycle in order to attain the instruments identified in the previous levels. The problems that were not addressed in the right manner might be handled in the consequential periods or in the successive cycles (Ford, 2000). The framework, therefore, has a practical application in the real care of the patients suffering from conditions that demand for physiotherapy care. In this case, the attainment of the objectives of a correct rehabilitation calls for the interventions of all the professionals involved and the use of a coordinated approach in order to attain synergy and diversity in the provision of care (Kellett and Mpofu et al., 2013, pp. 1048--1054). The entire process of clinical reasoning takes place throughout the interaction between the professionals in the multidimensional teams with the patients. In these interactions, the treatment plans and strategies are often devised according to the available data, knowledge, choices of the patients and the professional judgment. The process of clinical reasoning using the ICF framework included the section of the approaches that the treatment will adopt in the treatment process. The selection is undertaken among various options and it is an ongoing process throughout the treatment of the patient (Molenaers and Calders et al., 2012, pp. 396--405). The more the practitioners gain experience the more the clinical decisions making becomes more effective. The attainment of effective decision-making is dependent on the extent of the knowledge of the practitioner. This could be termed as propositional knowledge. The propositional knowledge is the knowledge that the practitioners gain from the theory or research knowledge. It is also attained from the class work the knowledge comes from textbooks and the previous clinical placements (Ford, 2000). On the other hand, the non-propositional knowledge is attained through the practice of the practitioners. The knowledge plays a vital role in the conversion of the propositional knowledge. This makes the team members of an interdisciplinary team to have adequate information that they use in the creation of the best approaches to the situations found in the provision of physiotherapy care. The reasoning process in the ICF framework calls for the determination of the most suitable reasoning while taking into consideration the context of the patient and the environmental impact on the functionality (Power and Anderson et al., 2011, pp. 261--275). The therapists that work in multidimensional or interdisciplinary teams have to consider the implications of their decisions in the end to the patient and to the other players. The ability of the therapists to make the correct decisions on the dexterous environment demands for the development of adequate and deep knowledge and experience on the various aspects of therapy that they work on for them to make sound clinical decisions (Ford, 2000). The practitioners’ decision-making may be subject to some influences. The values and the beliefs of the patient and the team members may determine the ability of the person to attain the necessary levels of rehabilitation that will facilitate his functionality. The knowledge of the care providers may also influence the success of the clinical reasoning. This knowledge could be the propositional or otherwise. The interpersonal skills of the care providers determine the ability of the team to deliver quality and adhere to the timelines. The environment in which the treatment takes place is also an important factor that influences the success of the treatment process. The practitioners may use narrative reasoning to identify the past of the patients. This information is instrumental in the determination of the effectiveness of the treatment process v. Use of narrative reasoning also helps the therapists to identify the potential influence of the past of the patient on the current attitude towards therapy (Power and Anderson et al., 2011, pp. 261--275). It could be an expression of failure of the previous therapy attempts of the manner that the therapy was undertaken. This information will prove to be important to the therapists that so that he may identify the problem, and design the instruments that he will use in order to fit the needs of the patients while cushioning the process form the inhibitions and reservations of the patient (Ford, 2000). The reasoning of the clinician often plays a vital role in the success of the therapy sessions. In order for the process to be a success, the clinician ought to focus on the needs of the patient. Most of the patients seek physiotherapy hoping to attain the relevant level of functionality. However, this is only a part of the needs of the patients (Higgs, 2008). In some of the cases, the patients have other needs that are intrinsic and not easily recognized. Most of the problems may emanate from the experiences of the patients with the physiotherapy (Tempest and Mcintyre, 2006, pp. 663--667). In some of the cases, the patients may have a negative approach towards the effectiveness of the therapy session. This will make the patients be unresponsive to the treatment approaches that the teams of practitioners use. In the event that this is the case, the success of the therapy is always at stake (Ford, 2000). The practitioners have to work hard in order for them to attain the desired levels of rehabilitation. The patients that have this approach to therapy often end up failing to attain the therapy goals. The cycles needed to have a slight indication of improvement are also more than when the patient is receptive to the therapy. Therefore, the success of the rehabilitation process depends on the ability of the patient to accommodate the therapy sessions (Frew and Joyce et al., 2008, pp. 68--72). It is not a fault of the patient to be unreceptive to the therapy. In fact, it is a common phenomenon in the treatment process. The best approach that the practitioners can have it to look into the reservations held by the patient on the success of the therapy. The therapists ought to change these perceptions in order for the patient to be receptive to therapy. Some of the elements that may affect the effectiveness of the therapy approach include the past of the patients. In some of the cases, the patients could have the inhibitions owing to the feeling of worthlessness (Delany and Molloy, 2009). The patients that have this feeling often see themselves in a different light than they did prior to the accident. This is a common phenomenon in the patients that have had accidents. The rehabilitation of such victims calls for adoption of approaches that affirm their sense of importance in the society. Some of the patients may not disclose their reservations on the therapy. They may be coming for the therapy in the right time and display mild enthusiasm. In this case, the patients often undertake the therapy session as a way of appeasing some people in their lives. Parents could be pleasing their children while the children may be pleasing the parents or the people that have authority over them. This makes it hard for the therapists to come up with an effective approach to the treatment. The therapists may be inexperienced in the assessment of the motivations or drivers for action (Dcruz and Jacobs et al., 2009). This means that the therapy session depends on the expertise of a person such as a psychologist. The behavioral scientist will be able to relate certain behavior of the patient with a psychological attribute. This is the reason that the sufficiency of any rehabilitation process calls for the adoption of a multidimensional team approach (Ford, 2000). The inability of the physiotherapist to decipher all the behavioral indicators means that the clinical reasoning part ought to be undertaken by all the professionals in the interdisciplinary team. The use of the interdisciplinary team helps in the identification of all the elements that may need to be addressed (Crist and Scaffa, 2001). The team can meet the patient during the first visit and may ask the questions. The team members ought to have the impeccable interpersonal skills. The interpersonal skills facilitate the creation of rapport with the patient. Once there is a rapport, the identification of the issues to be addressed is easily attained. In some instances, the knowledge and skills of the practitioners may be insufficient. Some of the patients are unreceptive to the physiotherapy since they have given up entirely on the process. In these cases, the patients seek to reduce the level of contact with the professionals. They will be avoiding the meeting and they will be indifferent to the attempts to create contact. When the patients lack the intrinsic drive to work with the interdisciplinary team, the synergy or the abilities of the team members are rendered irrelevant. The fact that the team may not reach the patient or may fail to establish rapport may translate into failure of a team (Ford, 2000). In conclusion, the ICF framework provides the interdisciplinary teams with the relevant knowledge on the approaches that they should use to provide the best therapy. The framework provides a set of tools for the assessment, assignment, intervention and evaluation of the therapy in a bid to attain sustainable therapy (Atkinson and Nixon-Cave, 2011, pp. 416--430). However, in some cases, the tools may fail in the provision of the adequate therapy that they are purported to provide. References Allan, C. M., Campbell, W. N., Guptill, C. A., Stephenson, F. F. and Campbell, K. E. 2006. A conceptual model for interprofessional education: The International Classification of Functioning, Disability and Health (ICF). Journal of Interprofessional Care, 20 (3), pp. 235--245. Allet, L., B"Urge, E. and Monnin, D. 2008. ICF: Clinical relevance for physiotherapy? A critical review. Advances in Physiotherapy, 10 (3), pp. 127--137. Atkinson, H. L. and Nixon-Cave, K. 2011. A tool for clinical reasoning and reflection using the International Classification of Functioning, Disability and Health (ICF) framework and patient management model. Physical Therapy, 91 (3), pp. 416--430. Bilbao, A., Kennedy, C., Chatterji, S., "Ust"Un, B., Barquero, J. L. V. and Barth, J. T. 2003. The ICF: Applications of the WHO model of functioning, disability and health to brain injury rehabilitation. NeuroRehabilitation, 18 (3), pp. 239--250. Bornman, J. and Murphy, J. 2006. Using the ICF in goal setting: Clinical application using Talking Matstextregistered. Disability & Rehabilitation: Assistive Technology, 1 (3), pp. 145--154. Boshuizen, H. and Schmidt, H. G. 1992. On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cognitive science, 16 (2), pp. 153--184. Conti-Becker, A. 2009. Between the ideal and the real: Reconsidering the International Classification of Functioning, Disability and Health. Disability & Rehabilitation, 31 (25), pp. 2125--2129. Crist, P. A. H. and Scaffa, M. E. 2001. Education for occupational therapy in health care. New York: Haworth Press. Dalen, H. E., Nyquist, A., Saebu, M., Roe, C. and Bautz-Holter, E. 2013. Implementation of ICF in goal setting in rehabilitation of children with chronic disabilities at Beitostolen Healthsports Centre. Disability and rehabilitation, 35 (3), pp. 198--205. Darrah, J. 2008. Using the ICF as a framework for clinical decision making in pediatric physical therapy. Advances in physiotherapy, 10 (3), pp. 146--151. Dcruz, H., Jacobs, S. and Schoo, A. M. M. 2009. Knowledge-in-practice in the caring professions. Farnham: Ashgate. Delany, C. and Molloy, E. 2009. Clinical education in the health professions. Chatswood, N.S.W.: Elsevier Australia. Ford, G. G. 2000. Ethical reasoning in the mental health professions. Boca Raton, FL: CRC Press. Frew, K. M., Joyce, E. V., Tanner, B. and Gray, M. A. 2008. Clinical reasoning and the International classification of functioning: a linking framework. Hong Kong Journal of Occupational Therapy, 18 (2), pp. 68--72. Furze, J., Nelson, K., Ohare, M., Ortner, A., Threlkeld, A. J. and Jensen, G. M. 2013. Describing the clinical reasoning process: Application of a model of enablement to a pediatric case. Physiotherapy theory and practice, 29 (3), pp. 222--231. Higgs, J. 2008. Clinical reasoning in the health professions. Amsterdam: BH/Elsevier. Hoffmann, T., Bennett, S. and Del Mar, C. 2013. Evidence-based practice across the health professions. Chatswood, N.S.W., Australia: Elsevier Churchill Livingstone. Kellett, D., Mpofu, E. and Madden, R. 2013. Reflective action assessment with a prospective clinical problem solving tool in the context of rehabilitation medicine: an illustrative case study. Disability and rehabilitation, 35 (13), pp. 1048--1054. Molenaers, G., Calders, P., V, Erstraeten, G., Himpens, E. and Others. 2012. The Evidence-base for Conceptual Approaches and Additional Therapies Targeting Lower Limb Function in Children with Cerebral Palsy: A Systematic Review Using the International Classification of Functioning, Disability and Health as a Framework. Journal of Rehabilitation Medicine, 44 (5), pp. 396--405. Power, E., Anderson, A. and Togher, L. 2011. Applying the WHO ICF framework to communication assessment and goal setting in Huntingtons Disease: A case discussion. Journal of communication Disorders, 44 (3), pp. 261--275. Ravenek, M., Skarakis-Doyle, E., Spaulding, S., Jenkins, M. and Doyle, P. 2013. Enhancing the conceptual clarity and utility of the international classification of functioning, disability & health: the potential of a new graphic representation. Disability and rehabilitation, 35 (11), pp. 1015--1025. Tempest, S. and Mcintyre, A. 2006. Using the ICF to clarify team roles and demonstrate clinical reasoning in stroke rehabilitation. Disability & Rehabilitation, 28 (10), pp. 663--667. Read More