Physicians spend the majority of their time diagnosing, treating, and preventing disease. Physical therapists, in contrast, spend most of their time diagnosing, treating, and preventing the consequences of disease. We are the go-to health-care experts for identifying and quantifying disease consequences and applying treatments to reduce or eliminate disease consequences to restore functional status. This chapter introduces (for those unfamiliar) or reviews (for those who are already familiar) two conceptual frameworks that go right to the heart of disease consequence diagnosis and outcome assessment.
Two conceptual frameworks described in our literature are valuable tools for conceptualizing and then systematically addressing disease consequences in the course of physical therapy care. These frameworks are, in our opinion, useful to even the most seasoned clinicians. The frameworks have been around for many years and the current versions reflect state-of-the-art approaches to conceptualizing patient problems and how to solve them. Therapists spend many hours not only working with patients but also thinking about patients' disorders and how these disorders contributed to the patients' disablement. Restoring function (a key concept in the disablement process) is, after all, how we spend most of our professional time. The word disablement essentially describes the impact that disorders have on the functioning of body systems/organs, on basic person-level performance, and on functioning within society.1 Even if you are familiar with these two frameworks, we urge you to review this chapter for an update. If these frameworks are new to you, we urge you to take some time to study this chapter more thoroughly because the remaining chapters in the book will build on many of the concepts introduced here.
The purpose here is to review two conceptual frameworks that address a variety of issues related to outcome and the assessment of change in a patient's status. The first framework is the International Classification of Functioning, Disability and Health, or, if you prefer the much quicker version, the ICF.2 The description of the disablement process in this framework has garnered worldwide acceptance, and for that reason, it is a framework that we should pay close attention to and, in our opinion, incorporate into our practices to the extent that we can. There is a lot to be said for a framework that describes the process by which patients seek medical care that has been accepted by all 191 member countries of the World Health Organization. There are very few issues that 191 countries could possibly agree on! Given this almost worldwide consensus, the ICF deserves our serious consideration.
The second framework that we will review in this chapter is the Hypothesis Oriented Algorithm for Clinicians (HOAC II).3 This algorithm (or framework, if you like) has been in our literature under a previous name (HOAC) since 1986.4 The original algorithm was introduced by Rothstein and Echternach in the following way: