EBP FISIOTERAPI - ICF

(International Classification
Functioning Disability and Health)
 ICF
(Interntional Classification of Functioning, Disability and Health)

• KERANGKA KERJA UNTUK MENGGAMBARKAN

FUNCTIONING AND DISABILITY DALAM KAITANNYA
DENGAN KONDISI KESEHATAN.
• KLASIFIKASI UNIVERSAL TENTANG DISABILITY AND
HEALTH DAN HUBUNGANNYA DENGAN SEKTOR
KESEHATAN LAINNYA.
• PENDOKUMENTASIAN INFORMASI
• KONSEP DASAR DEFINISI, PENGUKURAN DAN
FORMULASI KEBIJAKAN.
• PERENCANAAN DAN ALAT BAGI PENGAMBIL
KEBIJAKAN
 ICF Applications
• Health sector
• Social security
• Education sector
• Labour sector
• Economics & development sector
• Legislation & law
• Other ….
 ICF
(International Classification of Functioning, Disability and Health)
Integrated Model of Physical
Therapist Clinical Reasoning
incorporating WHO-ICF Model
 User
Perspective

National &
Health Body
International Condition Function Community
Policy

Enviromen
-tal Factor
Person Activities

Standar
Guidance & Personal Inter agency
Factor
Documentation Participati Integrated
on
Practice

Evidence
Based
Practice
 Interaction of Concepts

Health Condition
(disorder/disease)

Body Activities Participation

function&structure (Limitation) (Restriction)
(Impairment)

Environmental Personal
Factors Factors
 Definitions
Impairment Loss or abnormality in body structure
or function (including mental function)

Activity Limitations Difficulties individual may have in

executing activities in terms of quantity
or quality

Participation Problems an individual may experience

Restrictions in involvement in life situations

Facilitators & Environmental factors may be a

Barriers facilitator for one person & barrier
for another

18
 ICF Components
Body functions Physiological functions of body
systems
Body Structures Structural or anatomical parts of the
body
Activities Execution of a task or action by an
individual (individual perspective)
Participation Persons involvement in a life situation
(societal perspective)
Environmental Factors
All aspects of the external world that
impact on the person’s functioning

19
Classification of Activities and
Participation

1 Learning &Applying Knowledge

2 General Tasks and Demands
3 Communication
4 Movement
5 Self Care
6 Domestic Life Areas
7 Interpersonal Interactions
8 Major Life Areas
9 Community, Social & Civic Life
 Function/Task Analysis
• Assessment:
– Start with identifying loss of function/task specific
movement and then determine what impairments
are causing the loss of function.
• Treatment:
– Address impairment level limitations and
functional loss at the same time.
– Modify the environment to allow for successful
completion of specific task (functional).
INDONESIA : HEALTH PROFILE
INDONESIA : HEALTH PROFILE
 FISIOTERAPI
• Fisioterapis adalah tenaga Kesehatan profesional yang
bertujuan meningkatkan dan menjaga kemampuan
gerak dan fungsi seseorang sepanjang daur kehidupan.
• Dengan pemahaman mendalam tentang bagaimana
tubuh bergerak dan hal apa yang menjaga tubuh agar
tetap bergerak dengan baik.
• Fisioterapis mempromosikan hal-hal seputar
kebugaran, mobilitas dan kemandirian.
• Fisioterapis menangani dan mencegah masalah-
masalah yang disebabkan adanya nyeri, kesakitan,
impairmen, penyakit, cidera yang berhubungan
ketidakaktifan dalam jangka waktu yang panjang.
• Kurangnya bergerak dan berlatih merupakan
faktor resiko yang signifikan bagi penyakit tidak
menular kronik (non-communicable disease-
NCDs) seperti penyakit jantung, stroke, kanker,
penyakit paru kronik, dan diabetes- yang mana
saat ini mencapai 60% dari seluruh penyebab
kematian di dunia dan (64% - Indonesia).
• Tidak hanya itu, kurangnya latihan dapat
menyebabkan kecacatan berkepanjangan.
RPS - FORM
CASE 1
HEALTH CONDITION
CVA -STROKE

BODY ACTIVITIES PARTICIPATION

FUNCTION
/STRUCTURES Activity Limitations : Participation
Impairments : Mobilitas di tempat tidur Restrictions:
Kelemahan otot Menegakkan badan Tidak dapat berbelanja dengan
Kontrol trunk
Ambulansi keluarga
Tonus Abnormal
ADL Tidak dapat berolahraga bersama

Environment Factors Personal Factors

Toilet Jongkok Usia 70 th
Rumah dengan tangga Motivasi
TEMUKAN KODE
ICF
 Nama : Tn Rado Diagnosis medis : Tujuan utama fisioterapi :
Umur : 75 Th CVA/Stroke Mengembalikan Fungsioal mandiri
Perspektif Pasien

Kelemahan tubuh sisi kanan
Sulit menggenggam
Tidak bisa mengontrol
gerakan kaki
merubah merubah posisi Tdk bisa makan malam bersama
Tdk dapat memegang gelas keluarga
Sulit berjalan Sulit sholat berjamaah
Tidak bisa bermain kartu
Tidak bisa Bermain dengan keluarga

Body Structure/function Activity Participation

Power of muscle one side of the Changing basic body position Recreation and leisure (d920)
body (b7302) (d410) Religion spirituality (d930)
Perspektif Profesi FT

Control of voluntary movement

function (b760) Doing housework (d640)
Gait pattern function (b770) Eating (d550), Drinking (d560)

Walking (d450)

CONTEXT FACTOR Environment : tinggal di lantai 1, toilet jongkok, membutuhkan alat bantu jalan
Personal : Usia lanjut
 EVIDENCE BASED PRACTICE
• Saat ini penyakit kardiovaskular merupakan
penyebab utama kematian diseluruh dunia.
Secara global, 17,3 juta orang meninggal akibat
penyakit kardiovaskular di tahun 2008, yaitu 30%
dari total kematian. Sebanyak 7,3 juta
disebabkan oleh penyakit jantung koroner dan
6,2 juta akibat stroke. Diperkirakan pada tahun
2030, hampir 23,6 juta orang akan meninggal
akibat penyakit kardiovaskular, terutama
penyakit jantung dan stroke.
– Sumber: World Health Organization
www.who.int/mediacentre/factsheets/fs317/en/
 EVIDENCE BASED PRACTICE
• Diperkirakan bahwa jika setiap orang berjalan 3-4 mph hampir di setiap
harinya, sekitar 30% kematian per tahun akibat penyakit kardiovaskular
dapat dicegah.
Sumber:
– Pate R et al. Physical activity and public health. JAMA.1995;273(5):402-407.
www.ncbi.nlm.nih.gov/pubmed/7823386
– Wei M, Kampert et al. Relationship between low cardiorespiratory fitness and
mortality in normal-weight, overweight, and obese men. JAMA.
1999;282(16):1547-1553. www.ncbi.nlm.nih.gov/ pubmed/10546694
– Manson JE et al. A prospective study of walking as compared with vigorous
exercise in the prevention of coronary heart disease in women. NEJM.
1999;341(9):650-658. content.nejm.org/cgi/content/ abstract/347/10/716
– Tully M et al. Brisk walking, fitness, and cardiovascular risk: a randomized
controlled trial in primary care. Prevent Med. 2005;41:622-628.
www.ncbi.nlm.nih.gov/pubmed/15917061
 EVIDENCE BASED PRACTICE
• Diperkirakan bahwa jika setiap orang berjalan 3-4 mph dengan dosis
terukur hampir di setiap harinya, sekitar 30% kematian per tahun akibat
penyakit kardiovaskular dapat dicegah.
Sumber:
– Pate R et al. Physical activity and public health. JAMA.
1995;273(5):402-407. www.ncbi.nlm.nih.gov/pubmed/7823386
– Wei M, Kampert et al. Relationship between low cardiorespiratory fitness and
mortality in normal-weight, overweight, and obese men. JAMA.
1999;282(16):1547-1553. www.ncbi.nlm.nih.gov/ pubmed/10546694
– Manson JE et al. A prospective study of walking as compared with vigorous
exercise in the prevention of coronary heart disease in women. NEJM.
1999;341(9):650-658. content.nejm.org/cgi/content/ abstract/347/10/716
– Tully M et al. Brisk walking, fitness, and cardiovascular risk: a randomized
controlled trial in primary care. Prevent Med. 2005;41:622-628.
www.ncbi.nlm.nih.gov/pubmed/15917061
• Beberapa ulasan menunjukan bahwa rehabilitasi
jantung berbasis latihan bagi pasien dengan penyakit
jantung memberikan perubahan secara siginifkan pada
status kesehatan dan angka kematian.
– Sumber: Clark et al. Meta-analysis: secondary prevention
programs forpatients with coronary artery disease. Ann
Intern Med. 2005; 143:659-672.
www.annals.org/cgi/content/abstract/143/9/659
– Taylor RS et al. Exercise-based rehabilitation for patients
with coronary heart disease: systematic review and meta-
analysis of randomized controlled trials. Am J Med. 2004;
116:682– 692. www.ncbi.nlm.nih.gov/pubmed/15121495
• Peningkatan tekanan darah, yang mana
merupakan faktor resiko serangan jantung dan
stroke, dapat dikendalikan oleh latihan. Satu
studi telah mengindikasikan bahwa latihan daya
tahan memberikan penurunan rata-rata 10
mmHg dalam pembacaan tekanan darah baik
sistolik maupun diastolik.
– Sumber: American College of Sports Medicine’s
Guidelines for Exercise Testing and Prescription. 6th
Ed. Baltimore MD: Lippincott Williams & Wilkins 2000.
www.exrx.net/Store/Other/ACSMGuidelinesExTesting
Rx.html
• Tipe latihan penguatan yang diresepkan oleh
fisioterapis secara efektif dapat menurunkan tekanan
darah bagi pria dan wanita lanjut usia.
– Sumber: Martel GF et al. Strength training normalizes
resting blood pressure in 65- to 73-year- old men and
women with high normal blood pressure. J Am Geriatr Soc.
1999 Oct;47(10):1215-21.
www.ncbi.nlm.nih.gov/pubmed/10522955
• Tipe penurunan tekanan darah ini telah dihubungkan
dengan 5-9% penurunan morbiditas jantung, dan 8%
hingga 14% penurunan resiko stroke.
– Sumber: Whelton et al. Primary prevention of
hypertension: clinicaland public health advisory from The
National High Blood Pressure Education Program. JAMA.
2002 Oct 16;288(15):1882- 8.
www.ncbi.nlm.nih.gov/pubmed/12377087
CASE 2
HEALTH CONDITION
CRONIC LOW BACK PAIN

BODY FUNCTION ACTIVITIES PARTICIPATION

/STRUCTURES
Impairments :
Pain in Back (b28013)
Lumbal Vertebra Column (s76001)
Muscle of Tight (s75002)
Mobility of joint function (b710)
Activity Limitations : Participation
Maintaining a lying position (d4150)
Restrictions:
Maintaining a standing position
Assisteve product and technology
(d4154)
for culture, recreation and sport
Bending (d4108)
(e1401)
Lifting and carrying objects (d430)

Environment Factors Personal Factors

Product and technology for employment (e135) Temprament and personality function (b126)
Design constraction and building product and
technology of building for privat use (e155)
Labor employment services and policies (e590)
 Nama : Ny. rina Diagnosis medis : Tujuan utama fisioterapi :
Umur : 50 Th Cronic Low Back Pain Menghilangkan nyeri dan mengembalikan
Perspektif Pasien aktivitas kerja

Nyeri pada pinggang bawah

Rasa Tidak nyaman tegang Sulit untuk mencari posisi saat tidur Tidak bisa bekerja di kantor
dan pegal Tdk bisa duduk lama >20 mnt Tidak bisa Bermain dengan keluarga
Badan Sulit untuk digerakkan Tidak dapat membungkuk
Kaki terasa kesemutan Sulit untuk berjalan lama

Body Structure/function Activity Participation

Sensation related to muscles Maintaining a lying position

Perspektif Profesi FT

and movement function (b780) (d4150) Remunerative employment (d850)

Reduced muscle power function (b730) Maintaining a standing Recreation and leisure (d920)
Reduced mobility of joint function (b710) position (d4154)
Touch function (b265) Bending (d4108)
Lifting and carrying objects
(d430)

CONTEXT FACTOR Environment : Product and technology for employment (e135),

Design constraction and building product and technology of building for privat use (e155),
Labor employment services and policies (e590)

Personal : Temprament and personality function (b126)

CASE 3
HEALTH CONDITION
COPD

BODY FUNCTION ACTIVITIES PARTICIPATION

/STRUCTURES
Activity Limitations : Participation
Impairments : Carrying out daily routine (d230)
Restrictions:
Respiration function (b440) Doing housework (d640)
Lumbal Vertebra Column (s76001)
Assisteve product and technology
Walking (d450)
Muscle of Tight (s75002) for culture, recreation and sport
Moving around(d455)
Mobility of joint function (b710) (e1401)

Environment Factors Personal Factors

Product or substances for personal consumtion (e110) Temprament and personality function (b126)
Air quality (e260)
Product and technology for personal use in daily living
(e115)
 Nama : Tn. Dino Diagnosis medis : Tujuan utama fisioterapi :
Umur : 50 Th Cronic Low Back Pain Menghilangkan nyeri dan mengembalikan
Perspektif Pasien aktivitas kerja

Gangguan pernafasan Sulit untuk mencari posisi saat tidur Tidak bisa bekerja di kantor
Tdk bisa duduk lama >20 mnt Tidak bisa Bermain dengan keluarga
Tidak dapat membungkuk
Sulit untuk berjalan lama

Body Structure/function Activity Participation

Maintaining a lying position
Perspektif Profesi FT

Sensation related to muscles (d4150)

and movement function (b780) Maintaining a standing Remunerative employment (d850)
Reduced muscle power function (b730) position (d4154) Recreation and leisure (d920)
Reduced mobility of joint function (b710) Bending (d4108)
Touch function (b265) Lifting and carrying objects
(d430)

CONTEXT FACTOR Environment : Product and technology for employment (e135),

Design constraction and building product and technology of building for privat use (e155),
Labor employment services and policies (e590)

Personal : Temprament and personality function (b126)

 EVIDENCE BASED PRACTICE PT
• Terapi latihan yang diberikan oleh fisioterapis
memberikan manfaat bagi individu dengan
penyakit jantung koroner, gagal jantung dan
penyakit paru obstruksi kronik.
– Sumber: Taylor, NF et al. Therapeutic exercise in
physiotherapy practice is beneficial: a summary of
systematic reviews 2002–2005. Australian Journal
of Physiotherapy. 2007, Vol 53(1): 7-15.
www.ncbi.nlm.nih.gov/pubmed/17326734
Efisiensi
data dan
informasi
sbg
pijakan
program
dan
kebijakan
Aplikasi ICF di Berbagai Lini
 Kesimpulan
• Dengan ICF Model maka membangun
“Thinking out of the Box” pelayanan FT
• Cakupan pelayanan yang lebih komprehensif
• Bahasa universal memungkinkan keterlibatan
dan pengakuan atas pelayanan/tindakan FT
• Formulasi – Terukur – Sistematis
– Dalam proses fisioterapi profesional
• Pengembangan Evidance Based Practis PT