Jennifer Jelsma1, Des Scott. 1. Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa.
Abstract
OBJECTIVE: To determine if clinical assessment of children with neurological conditions by physiotherapy students was improved through the overt use of the International Classification of Functioning, Disability and Health (ICF). DESIGN AND PARTICIPANTS: A retrospective, pragmatic audit of practice using written patient assessments completed by third-year physiotherapy students. Assessments completed by third-year students in 2008 were compared with assessments completed by third-year students in 2009. The assessment format used in 2008 was very loosely based on the ICF model, while the 2009 assessments made rigorous use of the ICF approach. SETTING: Two schools for children with special needs to which physiotherapy students from the Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, Division of Physiotherapy, University of Cape Town are sent for clinical exposure. METHOD: A score sheet was drawn up to evaluate specific criteria in each assessment, using a five-point marking scheme. The mark sheet was tested for reliability. All assessments were evaluated independently using the score sheet by two external physiotherapists who were blind to the purpose of the exercise. RESULTS: There was a significant difference between the scores obtained on the score sheet for the 2008 group and the 2009 group. The 2009 group obtained a median score of 60, compared with a median score of 50 for the 2008 group (median difference between groups 9.2, 95% confidence interval 4.2 to 14.1). The overall impression mark given to the 2009 group was also higher than that given to the 2008 group, with a median difference between the groups of 5.9 (95% confidence interval 3.2 to 12.7). It would appear that the 2009 students, using the ICF framework for assessing patients, were able to include more function-related information in their assessments, resulting in a more holistic assessment. CONCLUSION: Teaching students to use the ICF framework when assessing paediatric patients encourages clinical reasoning and an improved holistic approach to identifying the patient's problems in context. This, in turn, enables the student to plan a more appropriate intervention treatment, to the patient's benefit.
OBJECTIVE: To determine if clinical assessment of children with neurological conditions by physiotherapy students was improved through the overt use of the International Classification of Functioning, Disability and Health (ICF). DESIGN AND PARTICIPANTS: A retrospective, pragmatic audit of practice using written patient assessments completed by third-year physiotherapy students. Assessments completed by third-year students in 2008 were compared with assessments completed by third-year students in 2009. The assessment format used in 2008 was very loosely based on the ICF model, while the 2009 assessments made rigorous use of the ICF approach. SETTING: Two schools for children with special needs to which physiotherapy students from the Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, Division of Physiotherapy, University of Cape Town are sent for clinical exposure. METHOD: A score sheet was drawn up to evaluate specific criteria in each assessment, using a five-point marking scheme. The mark sheet was tested for reliability. All assessments were evaluated independently using the score sheet by two external physiotherapists who were blind to the purpose of the exercise. RESULTS: There was a significant difference between the scores obtained on the score sheet for the 2008 group and the 2009 group. The 2009 group obtained a median score of 60, compared with a median score of 50 for the 2008 group (median difference between groups 9.2, 95% confidence interval 4.2 to 14.1). The overall impression mark given to the 2009 group was also higher than that given to the 2008 group, with a median difference between the groups of 5.9 (95% confidence interval 3.2 to 12.7). It would appear that the 2009 students, using the ICF framework for assessing patients, were able to include more function-related information in their assessments, resulting in a more holistic assessment. CONCLUSION: Teaching students to use the ICF framework when assessing paediatric patients encourages clinical reasoning and an improved holistic approach to identifying the patient's problems in context. This, in turn, enables the student to plan a more appropriate intervention treatment, to the patient's benefit.