Chapter 7

1. Chapter 7 The Concept of Function

2. Overview • Perhaps one of the most important developments in health care in the past decade has been the increased recognition of the importance of the patient's perception of health and functional outcomes

3. Disablement Model • Pathology/Pathophysiology (the presence of disease) which may lead to • Impairments (anatomic and structural abnormalities) which may in turn lead to • Functional limitations (restrictions in basic physical and mental actions), which may then lead to • Disability (difficulty doing activities of daily life)

4. External modifiers • External modifiers are those secondary conditions that may influence the level of disability but are not directly related to the disease process itself. Specific examples include: • The patient’s level of activity • The patient’s reaction to the illness • The patient’s educational background • The compensatory and coping strategies of the patient • The patient’s pain tolerance and motivation • The patient’s personal and health habits • The patient’s level of social support • The patient’s marital status • The extent to which the patient is involved in litigation and compensation

5. Pathology • The term pathology refers to any diagnosed disease, injury, disorder, or abnormal condition that is: • Characterized by a particular cluster of signs and symptoms and • Recognized by either the patient or clinician as abnormal

6. Pathology • The severity of the pathology, and thus the impact that it has on a patient’s functional status depends on a number of factors which include: • Co-morbidity • The patient’s general physical health • The age of the patient • The patient’s nutritional status

7. Impairment • An impairment can be defined as any loss or abnormality of anatomical, physiological, mental, or psychological structure or function that both: • result from underlying changes in the normal state and • contribute to illness

8. Impairment • Impairments can be manifested objectively, for example by reduced range of motion, articular deformity, abnormal gait, and the loss of strength, power, endurance, or proprioception • Impairments can also be manifested subjectively, for example through pain

9. Impairment • It is important to note that physical impairment and physical functioning appear to be separate constructs that do not necessarily have a clear linear relationship • The Guide to Physical Therapist Practice uses preferred practice patterns to group clusters of musculoskeletal impairments that occur together

10. Functional limitations • Functional limitations are restrictions in performing expected basic physical and mental actions. Examples include: • Difficulty with walking • An inability to put on shoes • It is important that clinical measurements assess the patient’s ability to perform tasks that the patient feels are important

11. Functional limitations • The following steps are recommended to identify functional goals: • Determine the patient’s desired outcome of the intervention • Develop an understanding of the patient’s self-care, work, and leisure activities and the environments in which these activities occur • Establish goals with the patient that relate to the desired outcomes

12. Functional limitations • Functional goals should contain the following elements: • Who (the patient) • Will do what (activities) • Under what conditions (the home or work environment) • How well (the amount of assistance, or number of attempts required for successful completion) • By when (target date)

13. Disability • Disability may be defined as difficulty in the performance of social roles and tasks within a sociocultural and physical environment (from hygiene to hobbies, errands, to sleep) due to a health or physical problem • Disability, which may be temporary or permanent, is the gap between what a person can do and what the person needs or wants to do

14. Disability • Disability is not necessarily related to any health impairment or medical condition; although a medical condition or impairment may cause or contribute to disability • For example, associations between pathology and disability have been found for several health conditions. These include: • Diabetes • Cardiovascular diseases • Musculoskeletal diseases • Vision related diseases

15. Disability • Impairments and functional limitations are not related to disability in a linear fashion • Thus, it is even possible for two patients who have the same disease and similar impairments and functional limitations to have two different levels of disability

16. The Measurement of Functional Outcomes • Functional outcomes measurement is a process that describes a systematic method to gauge the effectiveness and efficiency of an intervention in daily clinical practice • The efficiency of an intervention is a factor of utilization (number of outpatient visits, length of inpatient stay) with the costs of care and outcome

17. The Measurement of Functional Outcomes • The ideal functional measurement tool is one that recognizes and classifies impairments, functional limitations and disability using clinical measurements that qualify and quantify the impairments