ICF Model and Goal Writing in Paediatrics

Introduction

ICF which stands for the International Classification of Functioning, Disability and Health is a World Health Organization classification of health and health-related arenas. This framework measures health and disability at both the individual and population levels while also looking at environmental factors. This framework emphasises function, impact and health rather than disability and cause. Understanding the functional deficits afflicted by the health condition promotes better patient management. ICF incorporates a more holistic model of health utilising goal setting, evaluation of outcomes and communication among colleagues.

ICF Model

The ICF framework recognises that one's health is shaped by environmental and personal factors is composed for four divisions:

1. body functions
2. activities and participation
3. environmental factors
4. body structures

Body functions refers to the physiologic function body systems. Activities and participation refer to involvement in life events and implementation of various tasks. Environmental factors consist of attitudinal, social and physical environments where people conduct and live their lives. Lastly, body structures are referencing the anatomical aspect of the body.

Physical Therapy Diagnosis

A medical diagnosis and a physical therapy diagnosis are two distinct entities. A medical diagnosis provides cause and prognosis, whereby a physical therapy diagnosis identifies functional limitations and quality of life. The objective of the physical therapy diagnosis is establish movement system impairments. According to Jiandani, et al., 2018, the key diagnostic questions are:

1. what are the impairments, their nature and source?
2. What impairments are related to patients functional limitation?
3. Which amongst these can be remedied by interventions?
4. What is the influence of the contextual (environment and personal) factor of a person in his function?
5. Can the contextual factors be changed or remedied to maximize performance?
6. What is the diagnostic label?

Physical therapy focuses on treatment of dysfunction versus the physician model which focuses on differential diagnosis and treatment of disease. Physiotherapists connect similar dysfunctional movements to create a diagnosis.

Functional Limitations

It is important during the physical therapy evaluation to determine what functional limitations the individual has. Specifically, physiotherapists are interested in learning how the individual's functional limitations are inhibiting or restricting their:

1. activity: ability to execute a task or action
2. participation: ability to fulfill the socially defined role

Participation can relate to activities within their family, work and/or peer groups. ICF framework considers factors whether immediate or distant that might facilitate or hinder overall functioning including:

• Environmental Factors
  • setting at home
  • setting at school
  • motivation of the individual
  • amount of family support
  • accessibility to assistive devices
• Personal Factors
  • age
  • gender
  • lifestyle
  • fitness
  • coping styles
  • cultural beliefs
  • pain experience

Interventions

The plan of care is created once the impairments, functional limitations and activity limitations have been identified. Interventions are targeted at minimizing disability and using function as an outcome.Within the paediatric population, the ICF emphasises the importance of a child's environment on their functional outcomes. The environment encompasses not just the physical world, but the values and attitudes of the family and community. Accessibility to services and support will affect overall daily function for a child with functional impairments.

Goal-Setting

The ICF framework can be helpful for goal-setting. Goals are created to increase activity and participation caused by the functional impairments. . Goal creation favors the strengths of the child and how to build on those strengths to accomplish new tasks. . Within the paediatric population, goal-setting is done with a family-centred approach.Collaboration in this manner permits the patient and family to highlight their interests and assistance in intervention planning. Research has shown that this family/patient centred approach has increased patient motivation and improved the outcome for therapy.

SMART GOALS

When creating meaningful functional goals, the SMART method is recommended. The SMART method is an acronym standing for:

• S: specific
• M: measurable
• A: attainable
• R: realistic
• T: time-limited

Using the SMART acronym, physiotherapists can ensure they have made a thorough realistic goals for the child that are attainable. Goals are typically geared for the short term or long term depending on the particular task.

Resources

• Introduction to the International Classification of Functioning, Disability and Health (ICF)

• ICF Educational and Clinical Resources

• ICF and RPS within Cerebral Palsy

• International Classification of Functioning, Disability and Health (ICF)

• Overview of the ICF in Clinical Practice