Ethics, the ICF and EBP

Introduction[edit | edit source]

Future healthcare professionals are very often driven by the wish to help suffering people and contribute to a worthy lively society. Our aim is to do good, and not to produce harm to our patients, who are vulnerable to exploitation because of their need to receive our help. The consequences of our decisions will affect our patients' lives and their families' as well. We need to bear in mind that good choices will produce good results, whereas poor choices will lead to poor results. We are free to choose, but we are not free from the consequences of the choices we make.

In light of these facts, providing physical therapy services to individuals and society demands we ensure a sound, fair and safe decision-making throughout the whole therapy process. Ethical and clinical decision-making do go hand-in-hand. This includes observing current rules and laws as well as respecting and acknowledging ethical standards. For developing a deep understanding of a patient's life-situation, the ICF-Model is crucial in the same way that evidence-based practice is to guarantee a high-quality of the provided services reflecting the current state of science.

Evidence-based Practice and ICF Working Frame[edit | edit source]

Beneath professional guidelines, we need scientific results to justify how we would proceed in treating patients with specific diagnoses. But a diagnosis is not just a diagnosis, it is usually meant to be an understandable and comparable working-hypothesis between medical experts. However, these persisted into limiting descriptions of one's illness and physical problems. To address people's needs, recognising and acknowledging the unified expression of their suffering and situation they live with all their burdens and resources, the ICF-model covers all the necessary fields to understand a disease's impact on a person's life. And vice versa, all the contributions of someone's lively circumstances that might be contributing to a manifestation of a disease or also possible resources that could help to cope the boundaries of being ill.

The International Classification of Functioning, Disability and Health[edit | edit source]

More commonly known as ICF, the International Classification of Functioning, Disability and Health is a classification of health and health-related domains. When initially introduced, it was considered a breakthrough model that enabled two competing models to be considered (i.e. the medical model and the social model).[1] As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors. ICF is the WHO framework for measuring health and disability at both individual and population levels. ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001 as the international standard to describe and measure health and disability.[2]

The ICF framework focuses on 3 perspectives: body, individual, and societal. These three perspectives encompass the influence of both internal and external factors to each individual’s condition of well being.[3] This framework was developed to provide a practical tool and common language to describe an individual's function that focuses on their positive abilities rather than negative aspects which would be described as disabilities.

Evidence-Based Practice[edit | edit source]

The physical therapy profession recognizes the use of evidence-based practice (EBP) as central to providing high-quality care and decreasing unwarranted variation in practice. EBP includes the integration of best available research, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision-making. Since its implementation, there have been major advances in the quality of healthcare that is delivered, as well as patient outcomes.[4]

Although evidence-based practice encompasses more than just applying the best available evidence, many of the concerns and barriers to using EBP revolve around finding and applying research.[5] A qualitative study from 20201 looked at perceived barriers to evidence-based practice among student physiotherapists.[6] Identified barriers were: insufficient time; lack of understanding of statistical analysis; insufficient research skills; insufficient formal training; inadequate access to paid articles; an inability to critically analyse articles, and a lack of infrastructure facilities.[6]

Components of Evidence-Based Practice[edit | edit source]

Best Available Evidence

Evidence-based practice encompasses more than just applying the best available evidence, but many of the concerns and barriers to using EBP revolve around finding and applying research. National PT-organisations are committed to help physical therapist develop, synthesize and use evidence[5].

Clinician's Knowledge and Skills

The physical therapist knowledge and skills are a key part of the evidence based process. This personal scope of practice consists of activities undertaken by an individual physical therapist that are situated within a physical therapist's unique body of knowledge where the individual is educated, trained, and competent to perform that activity. Using clinical decision-making and judgment is key[5].

Patient's Wants and Needs

The patient's wants and needs are a key part of the evidence-based process. As described in guiding principles to achieve the Vision under "Consumer-centricity", patient/client/consumer values and goals will be central to all efforts in which the physical therapy profession will engage. Incorporating a patient's cultural considerations, needs, and values is a necessary skill to provide best practice services[5].

Implementing Evidence-Based Practice[edit | edit source]

Explore courses, recommended readings, and multimedia presentations to help you understand and narrow the gap between the best available evidence and current practice[5].

References[edit | edit source]

  1. Mitra S, Shakespeare T. Remodeling the ICF. Disabil Health J. 2019;12(3):337-9.
  2. International Classification of Functioning, Disability and Health (ICF) (accessed 6 August 2019)
  3. Atkinson HL, Nixon-Cave K. A tool for clinical reasoning and reflection using the international classification of functioning, disability and health (ICF) framework and patient management model. Physical Therapy. 2011;91(3):416-30.
  4. Albarqouni L, Hoffmann T, Straus S, Olsen NR, Young T, Ilic D et al. Core Competencies in Evidence-Based Practice for Health Professionals: Consensus Statement Based on a Systematic Review and Delphi Survey. JAMA Netw Open. 2018;1(2):e180281.
  5. 5.0 5.1 5.2 5.3 5.4 American Physical Therapy Association APTA, Evidence Based Practice & Research, (accessed 6 August 2019)
  6. 6.0 6.1 Nair SP, Panhale VP, Nair N. Perceived barriers to evidence-based practice among Physiotherapy students. J Edu Health Promot 2021;10:17.