A new study brings the experience of physical therapists to a developing "Core Set" of criteria to guide evaluation and treatment for patients with osteoporosis, reports the April/June issue of the Journal of Geriatric Physical Therapy, official journal of the Section on Geriatrics of the American Physical Therapy Association. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
Part of an international validation project, the study adds the unique perspective of physical therapists to a new classification system for assessing functional status and disability in patients with osteoporosis. The lead author of the study is Barbara Koehler, P.T., M.P.T.Sc., of Zurich University of Applied Sciences, Winterthur, Switzerland.
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The study used a formal three-step Delphi process to validate the "Comprehensive ICF Core Set for Osteoporosis." A project of the World Health Organization, the ICF (International Classification of Functioning, Disability and Health) is designed to provide a comprehensive understanding of patients' functioning and health. The ICF Core Set uses an "integrative biopsychosocial model" of functioning and disability in various diseases to promote understanding and communication among health professionals involved in patient care and research.
Fifty-seven experienced physical therapists in 25 countries provided input into the patient problems, patient resources, and environmental factors affecting their work with osteoporosis patients. Osteoporosis is a major public health problem worldwide, causing major functional and social limitations and disability for older adults—especially women. Because physical therapists play a central role in the management of osteoporosis, it was important to get their input in developing and validating the ICF Core Set.
The results "largely supported" the previously developed ICF Core Set. However, the physical therapists identified several ICF concepts as important for inclusion in the osteoporosis Core Set. Several concepts fell into the category of "Body Functions"—including mental functions such as confidence, energy and motivation, which may affect how well patients follow recommended physical therapy treatments. "Patients with osteoporosis require high levels of attention and motivation when being treated and educated by physical therapists over a long period," the researchers write.
The physical therapists also identified concepts related to balance problems and dizziness, which contribute to the risk of falls in patients with osteoporosis. Additionally, they targeted problems related to muscle tone and control and co-ordination of voluntary movements. "Restoration of muscle balance using exercise therapy is a central task of physical therapists," Dr. Koehler and co-authors note.
Other factors fell under the ICF category of "Personal factors," reflecting patients' independence in managing their disease, which physical therapists seek to improve through education. Some concepts identified as important by physical therapists—such as posture, alignment, and ergonomics—weren't previously included in the ICF classification at all. These require "further investigation," the researchers write.
The findings provide valuable input on what factors physical therapists deem important in maximizing function and reducing disability among their patients with osteoporosis. When finalized, the ICF Core Set "can be used as a starting point in the assessment of osteoporosis providing a common standardized language for all health professions," Koehler and colleagues conclude. The criteria included in the Core Set will provide the world healthcare community with a valuable new tool for planning and evaluating treatment and monitoring progress in patients with this common and disabling disease.
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