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Physiotherapy 94 (2008) 150–157

Goals of physiotherapy interventions can be described using theInternational Classification of Functioning, Disability and Health

Rene Mittrach a, Eva Grill a, Monika Walchner-Bonjean a, Monika Scheuringer a,Christine Boldt a, Erika Omega Huber b, Gerold Stucki a,c,d,∗

a ICF Research Branch, WHO FIC Collaborating Center (DIMDI), IHRS, Ludwig-Maximilians-University, Munich, Germanyb Department of Rheumatology and Institute for Physical Medicine, University Hospital Zurich, Switzerlandc Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany

d Swiss Paraplegic Research, Nottwil, Switzerland

bstract

bjective To provide an example of how goals of physiotherapy interventions and their typical patterns can be described using the Internationallassification of Functioning, Disability and Health (ICF).esign Cross-sectional study.etting Acute hospital.articipants One hundred patients with neurological, musculoskeletal or cardiopulmonary conditions requiring physiotherapy interventions

n University Hospital Zurich between January 2003 and October 2003.ain outcome measures The case record form consisted of two parts: a standardised questionnaire for functioning and health of the patient;

nd a standardised record form for physiotherapy interventions. Both parts were based on the ICF.esults The mean age of the subjects was 58.2 years (standard deviation 15.9), the median age was 60.5 years and 44% were female. The most

requent intervention goals in patients with neurological conditions were: muscle power functions; muscle tone functions; control of voluntaryovement functions; changing basic body position; maintaining a body position; and transferring oneself. The most frequent intervention

oals for cardiopulmonary patients were: functions of the cardiovascular system; and respiration functions. The most frequent interventionoals in patients with musculoskeletal conditions were: sensation of pain; stability of joint functions; muscle power functions; muscle tone

unctions; and muscle endurance functions.onclusion By using the ICF as a framework and linguistic support, intervention goals can serve as standardised documentation forhysiotherapy interventions, their evaluation and planning.

2007 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

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eywords: Physical therapy (speciality); Documentation; Rehabilitation; T

ntroduction

The outcome of an acute illness or injury depends notnly on appropriate medical and surgical care, but also on

he recognition of patients’ needs during rehabilitation. Inhe acute setting, rehabilitation relates mainly to interven-ions by nurses and physiotherapists that accompany the

∗ Correspondence: Department of Physical Medicine and Rehabilitation,udwig Maximilians University Munich, Marchioninistr. 15, 81377 Munich,ermany. Tel.: +49 89 7095 4050; fax: +49 89 7095 8836.

E-mail address: gerold.stucki@med.uni-muenchen.de (G. Stucki).

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031-9406/$ – see front matter © 2007 Chartered Society of Physiotherapy. Publisoi:10.1016/j.physio.2007.08.006

t outcome; Goals; ICF

ourse of acute medical care [1]. The goals of physiotherapynterventions in the acute setting are to maintain and restoreunctioning and to prevent functional decline. Typical goalsepend on individual patient characteristics such as age, psy-hosocial factors, health condition and environmental factors.n early onset of interventions and their appropriate manage-ent has been demonstrated to improve functional outcome

nd to prevent the need for long-term care [2–9].

Physiotherapy interventions are integrated into a con-

inuous and cyclic process. This process involves thedentification of problems and needs, the relation of the prob-ems to relevant factors of the person, definition of goals,

hed by Elsevier Ltd. All rights reserved.

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Interviewers were advised to record limitations or impair-ments as present or absent due to the condition that had beenthe reason for hospitalisation.

R. Mittrach et al. / Phys

lanning of interventions, and assessment of the effects [10].oal setting and re-evaluation allows measurement of the

esult of any intervention. However, one major barrier to theppropriate evaluation of treatment effects is the challengef describing interventions, namely physiotherapy interven-ions, in a standardised way. At present, there is no commonlynderstood terminology that qualifies for the description ofnterventions [11,12]. One approach to classify and stan-ardise physiotherapy interventions is to relate them to theirndividual goals [13].

The International Classification of Functioning, Disabil-ty and Health (ICF) [14] may provide a framework andlassification for such a standardised documentation. TheCF provides a model of functioning and a classification toescribe and classify functioning, health and disability. Whilehe medical model sees disability as a problem of the indi-idual, caused by injury or disease, the social model definesisability as lack of integration of individuals into society.he ICF unifies these two models by looking at function-

ng not only in association with morbidity, but also in thenteraction with personal factors and the environment. Simul-aneously, one of the key objectives of the ICF is to provide aniversal language for all health professionals. It is likely thathe ICF, with its components ‘Body functions and structures’,Activities and participation’ and ‘Contextual factors’, willecome a universal framework in medicine and, particularly,n rehabilitation.

The objective of this study was to describe goals of phys-otherapy interventions and their typical patterns using theCF. Specific objectives were: (1) to identify and quantify theoals of physiotherapy interventions in the acute setting usingCF categories; (2) to describe their most frequent combina-ions; and (3) to examine the association between limitationsnd impairment in functioning, expressed as ICF categories,nd the corresponding physiotherapy intervention goals.

ethods

tudy design and study population

This cross-sectional study on physiotherapy interventionsas part of a larger multicentre, cross-sectional study thatas been described in detail elsewhere [15]. In brief, thetudy population consisted of all patients with neurological,usculoskeletal or cardiopulmonary conditions requiring

hysiotherapy interventions at University Hospital Zurichetween January 2003 and October 2003 who gave informedonsent. Patients were recruited from predefined acute andntensive care wards.

easures

The case record form used in this study consisted of twoarts: a standardised questionnaire for functioning and healthf the patient; and a standardised record form for physiother-

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py 94 (2008) 150–157 151

py intervention goals. Both parts are based on the ICF andts notation.

The ICF describes the human within his/her physical,ocial and psychological environment. By including all theseactors, the ICF complements the International Classificationf Disease-10 [16] which provides a classification system foriagnoses and causes of death. The ICF consists of four com-onents. The first component refers to body functions andody structures as physiological functions, such as mobilityf joints and anatomical parts such as tendons. The secondomponent is about activity and participation, and refers toask execution by individuals. Activity is the execution of aask, e.g. using a telephone, and participation describes thenvolvement of individuals in real-life situations, e.g. in theommunity, at home or at the workplace. The third compo-ent is about environmental factors and describes externalnfluences on functioning, e.g. food, devices, policies, orora and fauna. The fourth component, personal factors,escribes internal influences on functioning, e.g. gender, ager lifestyle, but is not yet classified. The ICF has two parts,ach containing two separate components. Part 1 covers func-ioning and disability, and includes the components ‘Bodyunctions’ (b), ‘Body structures’ (s) and ‘Activities and par-icipation’ (d). Part 2 covers contextual factors and includeshe components ‘Environmental factors’ (e) and ‘Personalactors’ (Fig. 1).

In the ICF classification, the letters b, s, d and e, whichefer to the components of the classification, are followed bynumeric code starting with the chapter number (one digit)

ollowed by the second level (two digits), and the third andourth level (one digit each). ICF categories are ‘nested’ [14]o that ICF chapters are defined to include the more detailedecond-level ICF categories (Box 1 ).

Twenty-six ICF second-level categories, included in allhree condition-specific acute ICF core sets, were used toocument functioning and health of the patients [17–19].hese core sets are selections of second-level ICF categories

hat have been developed in a comprehensive consensus pro-ess [20], and which are the most relevant components of

ig. 1. International Classification of Functioning, Disability and Healthodel.

152 R. Mittrach et al. / Physiothera

Box 1: Example for the International Classifica-tion of Functioning, Disability and Health hierarchy:muscle power function

b7 Neuromusculoskeletal and movement-related func-tions

b730 Muscle power functionsb7300 Power of isolated muscles and muscle groupsb7301 Power of muscles of one limbb7302 Power of muscles of one side of the bodyb7303 Power of muscles in lower half of the bodyb7304 Power of muscles of all limbsb7305 Power of muscles of the trunkb7306 Power of all muscles of the body

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Physiotherapy interventions

Ninety-seven percent of the patients received physio-therapy. Patients with neurological conditions had a higher

Table 1Most frequent diagnoses responsible for inpatient stay (International Clas-sification of Disease-10) (n = 100)

Condition responsible Diagnosis Patients (%)

Neurological (n = 50) Cerebrovascular disease(I60–I69)

41

Malignant neoplasms(C00–C97)

25

Cerebral palsy and otherparalytic syndromes(G80–G83)

10

Injuries to the head andunspecified multipleinjuries (S00–S09, T07)

10

Cardiopulmonary (n = 20) Diseases of thecirculatory system(I10–I59, I70–I99)

88

Musculoskeletal (n = 30) Diseases of themusculoskeletal systemand connective tissue(M00–M99)

70

b7308 Muscle power functions, other specifiedb7309 Muscle power functions, unspecified

A standardised case record form based on the ICFategories was developed by four experienced thera-ists (physical therapist, occupational therapist, nutritionist,peech therapist) from University Hospital Zurich to recordhe goals of physiotherapy interventions. Based on the aver-ge number of prescribed physiotherapy interventions overhe last 6 months, the most frequent and common interven-ions were identified. An ICF category was included as anntervention goal if there was a specific intervention aimed atrevention or therapy of this specific category, e.g. respiratoryherapy with its many therapeutic possibilities all aiming atespiration functions. The final questionnaire comprised 73ntervention goals, expressed as second-level ICF categories.ll intervention goals could be found within the ICF frame-ork, and all were ICF categories of the components ‘Body

unctions’ and ‘Activities and participation’.

ata collection and quality assurance

The interviews were held and the patients were treatedy health professionals trained in the application and princi-les of the ICF. Interviewers were trained during a structured-day meeting and provided with a manual. Before eachnterview started, the medical record sheet was checked.f information was not obtainable from the patient, healthrofessionals of the relevant wards or relatives were asked.ach interviewer was asked to check the data-collection form

mmediately after the interview to correct unclear statementsnd to add comments. All data forms were checked by aecond person for completeness and plausibility.

ata analysis

Absolute and relative frequencies were reported to quan-

ify the goals of physiotherapy interventions. Absoluterequency is the observed number of goals for the sample,nd relative frequency is the observed proportion of goalsmong all goals.

py 94 (2008) 150–157

In order to analyse the association between perceivedmpairments and limitations in functioning and the preva-ence of intervention goals, the absolute and relativerequencies of patients reporting an impairment or a limita-ion in the 26 ICF categories, and receiving or not receiving anntervention aimed at these categories, was calculated. Like-ise, the absolute and relative frequencies of patients not

eporting an impairment but receiving an intervention aimedt these categories were also calculated.

Only those intervention goals that had a relative frequencyf 50% or more were taken into account to describe the mostrequent combinations.

esults

One hundred patients were included; 50 with neurologi-al conditions, 20 with cardiopulmonary conditions and 30ith musculoskeletal conditions. The mean age was 58.2ears (standard deviation (SD) 15.9), the median age was0.5 years, and 44% were female. For the neurological con-itions, the mean age was 55.3 years (SD 16.9), the mediange was 58.0 years, and 36% were female. For musculoskele-al conditions, the mean age was 57.1 years (SD 14.9), the

edian age was 58.5 years, and 63% were female. For car-iopulmonary conditions, the mean age was 65.1 years (SD3.2), the median age was 68.5 years, and 35% were female.he mean number of days since the event was 19.8 (SD 23.9).eading diagnoses are shown in Table 1.

Injuries (exclusiveinjuries to the head) andunspecified multipleinjuries (S10–S99, T07)

26

R. Mittrach et al. / Physiotherapy 94 (2008) 150–157 153

Table 2Median of intervention goals per patient

Neurological conditions (n = 50) Cardiopulmonary conditions (n = 20) Musculoskeletal conditions (n = 30)

Body functions (min., max.) 11 (0, 28) 8.5 (3, 30) 7 (3, 17)Activities and participation (min., max.) 7 (0, 15) 3.5 (0, 9) 3 (0, 5)Total (min., max.) 18 (0, 43) 12.5 (4, 36) 10 (3, 22)

Table 3Therapeutic intervention goals expressed as International Classification of Functioning, Disability and Health (ICF) categories (body functions): relativefrequency of patients receiving physiotherapy interventions aimed at the corresponding ICF category

ICF code ICF code description Neurological conditions Cardiopulmonary conditions Musculoskeletal conditionsn = 50 (%) n = 20 (%) n = 30 (%)

b114 Orientation functions 38 30 –b130 Energy and drive functions 28 10 7b140 Attention functions 46 15 –b144 Memory functions 10 – –b152 Emotional functions 8 5 7b156 Perceptual functions 72 20 37b160 Thought functions 8 10 –b167 Mental functions of language 16 – –b172 Calculation functions – – –b176 Mental function of sequencing complex

movements40 5 13

b210–b229 Seeing and related functions 22 15 –b230–b249 Hearing functions 32 15 –b250–b279 Additional sensory functions 52 5 17b280 Sensation of pain 16 15 80b310 Voice functions 10 – –b320 Articulation functions 8 – –b330 Fluency and rhythm of speech functions 4 – –b340 Alternative vocalisation functions 4 – –b410–b429 Functions of the cardiovascular system 14 85 10b440 Respiration functions 26 80 17b445 Respiratory muscle functions 16 65 7b450 Additional respiratory functions 16 60 3b460 Sensations associated with cardiovascular

and respiratory functions4 65 –

b510 Ingestion functions 12 5 –b515 Digestive functions 2 5 –b525 Defaecation functions 2 5 –b530 Weight maintenance functions 8 10 –b535 Sensations associated with the digestive

system– 5 –

b540 General metabolic functions 2 15 10b620 Urinary functions 2 – –b630 Sensations associated with urinary functions 2 – –b710 Mobility of joint functions 26 45 70b715 Stability of joint functions 70 35 83b720 Mobility of bone functions 8 30 13b730 Muscle power functions 80 55 77b735 Muscle tone functions 82 45 77b740 Muscle endurance functions 64 55 77b750 Motor reflex functions 8 15 3b755 Involuntary movement reaction functions 56 15 3b760 Control of voluntary movement functions 84 10 37b765 Involuntary movement functions 38 10 3b770 Gait pattern functions 60 30 50b780 Sensations related to muscles and movement

functions44 15 50

b810–b849 Functions of the skin 12 10 3b850–b869 Functions of the hair and nails 2 5 3

154 R. Mittrach et al. / Physiotherapy 94 (2008) 150–157

Table 4Therapeutic intervention goals expressed as International Classification of Functioning, Disability and Health (ICF) categories (activity and participation):relative frequency of patients receiving physiotherapy interventions aimed at the corresponding ICF category

ICF code ICF code description Neurological conditions Cardiopulmonary conditions Musculoskeletal conditionsn = 50 (%) n = 20 (%) n = 30 (%)

d310 Communicating with – receiving – spoken messages 36 25 –d315 Communicating with – receiving – non-verbal

messages22 20 –

d320 Communicating with – receiving – formal signlanguage messages

– – –

d325 Communicating with – receiving – written messages – – –d330 Speaking 22 5 –d335 Producing non-verbal messages 6 10 –d340 Producing messages in formal sign language – – –d345 Writing messages 4 – –d350 Conversation 16 15 –d355 Discussion 8 10 –d360 Using communication devices and techniques 2 – –d410 Changing basic body position 80 35 60d415 Maintaining a body position 78 30 63d420 Transferring oneself 78 20 47d430 Lifting and carrying objects 20 15 10d435 Moving objects with lower extremities 18 – 7d440 Fine hand use (picking up, grasping) 28 10 –d445 Hand and arm use 64 20 17d450 Walking 60 55 43d455 Moving around 14 – 10d460 Moving around in different locations 30 30 7d465 Moving around using equipment 18 5 –d510 Washing oneself 6 5 –d520 Caring for body parts 6 – –d530 Toileting 8 – –ddd

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540 Dressing 24550 Eating 6560 Drinking 10

umber of different intervention goals (n = 18) than patients

ith cardiopulmonary (n = 12.5) or musculoskeletal (n = 10)

onditions (Table 2).Thirteen of 73 intervention goals were prevalent in the

hree health conditions in more than 75% of the patients. The

ifit

ig. 2. Two main combinations of International Classification of Functioning, Disa

5 3– –– –

ost frequent intervention goals in patients with neurolog-

cal conditions were: muscle power functions; muscle toneunctions; control of voluntary movement functions; chang-ng basic body position; maintaining a body position; andransferring oneself. The most frequent intervention goals for

bility and Health intervention goals and other frequent combinations.

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hysiotherapy94

(2008)150–157

155

Table 5Association between limitations and impairment in functioning and the corresponding physiotherapy intervention goals

ICF category Content n n impaired (% of impaired receiving intervention for this category) n not impaired (% of not impaired receiving intervention for this category)

Neurological Cardiopulmonary Musculoskeletal Neurological Cardiopulmonary Musculoskeletal

b114 Orientation functions 91 16 (56%) 6 (33%) – 27 (19%) 13 (8%) 29 (3%)b156 Perceptual functions 91 31 (29%) 2 (0%) 11 (0%) 12 (25%) 16 (25%) 19 (21%)b280 Sensation of pain 99 8 (100%) 3 (100%) 24 (96%) 41 (39%) 17 (65%) 6 (67%)b410 Heart functions 99 7 (0%) 17 (88%) 3 (67%) 42 (12%) 3 (100%) 27 (4%)b440 Respiration functions 100 13 (77%) 16 (75%) 5 (40%) 37 (8%) 4 (50%) 25 (16%)b445 Respiratory muscle functions 99 8 (63%) 13 (77%) 2 (100%) 41 (10%) 7 (0%) 28 (14%)b460 Sensations associated with

cardiovascular and respiratoryfunctions

89 1 (100%) 12 (92%) – 41 (17%) 6 (100%) 29 (14%)

b525 Defaecation functions 100 1 (0%) 1 (100%) – 49 (49%) 19 (32%) 30 (40%)b710 Mobility of joint functions 100 23 (70%) 9 (44%) 21 (100%) 27 (19%) 11 (18%) 9 (100%)b730 Muscle power functions 100 40 (98%) 11 (73%) 23 (100%) 10 (60%) 9 (67%) 7 (86%)b735 Muscle tone functions 100 41 (100%) 9 (56%) 23 (96%) 9 (56%) 11 (18%) 7 (86%)b740 Muscle endurance functions 98 32 (94%) 10 (90%) 23 (87%) 18 (83%) 8 (100%) 7 (71%)b780 Sensations related to muscles and

movement functions91 17 (65%) 3 (33%) 15 (67%) 25 (36%) 16 (44%) 15 (80%)

d410 Changing basic body position 100 40 (78%) 7 (43%) 18 (100%) 10 (20%) 13 (38%) 12 (100%)d415 Maintaining a body position 100 39 (74%) 6 (0%) 19 (95%) 11 (27%) 14 (43%) 11 (91%)d420 Transferring oneself 100 38 (82%) 4 (75%) 14 (86%) 12 (25%) 16 (37%) 16 (87%)d430 Lifting and carrying objects 96 10 (60%) 3 (67%) 3 (100%) 40 (72%) 16 (50%) 24 (92%)d440 Fine hand use (picking up,

grasping)100 14 (86%) 2 (50%) – 36 (69%) 18 (28%) 30 (23%)

d445 Hand and arm use 69 23 (48%) – 4 (25%) 15 (53%) 4 (0%) 23 (9%)d450 Walking 97 30 (83%) 10 (20%) 13 (92%) 20 (85%) 8 (75%) 16 (94%)d510 Washing oneself 100 3 (100%) 1 (100%) – 47 (70%) 19 (42%) 30 (53%)d520 Caring for body parts 100 3 (33%) – – 47 (68%) 20 (30%) 30 (30%)d530 Toileting 100 4 (100%) – – 46 (70%) 20 (30%) 30 (33%)d540 Dressing 100 12 (100%) 1 (100%) 1 (100%) 38 (66%) 19 (37%) 29 (76%)d550 Eating 100 3 (100%) – – 47 (51%) 20 (30%) 30 (20%)d560 Drinking 100 5 (80%) – – 45 (29%) 20 (25%) 30 (10%)

This reads as follows: 16 neurological patients reported impairment in orientation functions, and of those, 56% received physiotherapeutic intervention aiming at this impairment; 27 neurological patients were not impaired in orientation

functions, and of those, 19% received physiotherapeutic intervention aiming at this impairment.

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ardiopulmonary patients were: functions of the cardiovas-ular system; and respiration functions. The most frequentntervention goals in patients with musculoskeletal condi-ions were: sensation of pain; stability of joint functions;

uscle power functions; muscle tone functions; and musclendurance functions (see Tables 3 and 4).

The two most frequent combinations of intervention goalsere: stability of joint functions/muscle power functionsith muscle tone functions; and changing basic body posi-

ion/maintaining a body position with transferring oneself.hese two combinations were also associated with severalther intervention goals. Fig. 2 shows the combinations alongith their frequencies and further associated interventionoals.

The association between limitations and impairment inunctioning, expressed as ICF categories, and the correspond-ng physiotherapy intervention goals is shown in Table 5.ctivities of daily living, such as washing oneself, toilet-

ng, dressing and eating, and the body functions, sensationf pain, muscle power functions and muscle endurance func-ions, were most frequently addressed by interventions whenimited or impaired. There were, however, some patients whoeceived interventions aimed at unimpaired categories suchs muscle power, transfer and mobility issues.

iscussion

This study provides an example of how physiotherapyntervention goals in the acute setting and their typicalatterns can be identified, quantified and analysed usingCF categories. A range of intervention goals plausible foratients in the acute setting was found.

Neuromusculoskeletal and movement-related functionsnd activities are the first goals of early interventions forll patients in the acute setting because these functions arehe first to suffer from immobilisation. A Delphi processmong physiotherapists gave similar results [13]. At theame time, these functions are preconditions for self-carectivities. Additionally, most patients with neurological con-itions received interventions aimed at mental functions suchs attention and perceptual functions. This is in line withhe complex effects of physiotherapy interventions describedreviously [21–23].

Two major patterns of intervention goals could beetected. One dealt with power and stability of muscles andoints, and the other dealt with postural control and trans-er. Both are sound descriptions of physiotherapy ‘packages’.n combination with further typical goals, such as musclendurance or control of voluntary movement functions, theyive a good impression of patterns and the purpose of phys-otherapy in the acute setting [24,25].

Most patients reporting a specific problem did receive theorresponding physiotherapy intervention. To give an exam-le, in more than 90% of the neurological patients, functionsf muscle power, muscle endurance, muscle tone and the

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py 94 (2008) 150–157

ensation of pain were reported intervention goals if theseunctions were a problem. Patients reporting problems inultifaceted issues such as walking or lifting/carrying objects

ut not receiving the corresponding intervention may haveeen too frail or still in a very acute stage of disease.

A moderate proportion of patients received interventionsimed at goals that were not reported as problems. Muscleower and muscle endurance functions are most likely to bereated to prevent further damage or loss in functioning, evenithout a prevalent problem [25–27]. It is of great impor-

ance to keep track of functions at risk and of preventiventerventions. Thus, physiotherapeutic records are vital tocknowledge not only the impairment but also the potentialor loss of functioning. Additionally, some intervention goalsay be secondary effects inseparable from the main goal. To

ive an example, an exercise such as improving hip and kneeobility with the help of the hands will also strengthen the

rm muscles. Clinical stereotypes and routines in prescribinghysiotherapy interventions can serve as another explanationor interventions.

Several limitations of this study need to be considered.nterviewer bias may have been an issue, since evaluation ofoals and functioning is subject to error. Appropriate train-ng and supervision of interviewers, however, was providedefore and during the study, so the authors are confident thathis source of bias was minimised. Pretests showed that reli-bility of ICF category coding is good. Interviewers reportedntervention goals, not interventions. Different therapists per-orming the same intervention, however, may have differentoals in mind [11]. Translation of physiotherapy interven-ions into a common standardised language still remains a

ajor challenge. However, this study demonstrated that goalsf physiotherapy interventions can be documented plausiblyith the help of ICF categories.This study may have captured intervention goals with-

ut the necessary precision. The second-level categories ofhe ICF, used throughout this study, may not be sufficientlyetailed for daily and profession-specific documentation.ith the use of the third and fourth levels of the ICF cate-

ories, however, a more detailed and specific documentations possible. To give an example, the combination of thewo ICF codes b7100.3 (mobility of a single joint – severempairment) and s75011.371 (structure of the knee joint –evere impairment – qualitative changes in structure – rightide) can describe a severe mobility impairment of the rightnee exactly. With the code b28016.1 (pain in joints – mildmpairment), information about pain is added. Routine use,owever, of the deeper levels of the ICF is not possible inlinical settings and should be reserved for situations wherehe most detailed description is actually warranted.

onclusion

Focusing on intervention goals to classify physiothera-eutic interventions and using the ICF as a classification tool

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R. Mittrach et al. / Phys

as several advantages. First, if an intervention is insepara-le from its goals, there may be several interventions withhe same goal, and every health professional will choosehe most appropriate intervention depending on the goal toe achieved. Second, a commonly understood taxonomy ofntervention goals can be a start for improved goal settingnd communication between health professionals in the acuteetting. Third, detailed documentation of intervention goalselps to unravel the ‘black box’ of physiotherapy [11] andmprove evidence-based clinical practice.

By using the ICF as a framework and linguistic support,ntervention goals can serve as standardised documentationor interventions, their evaluation and planning. Simultane-usly, because of the universality of the ICF as a commonlyccepted classification, intervention goals can also be com-unicated to all health professionals working in the acute

etting.

thical approval: None required.

onflict of interest: None.

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