Functional assessment in physiotherapy. A literature review

The present literature review on functional assessment in physiotherapy was carried out for the following reasons: 1) to identify the functional instruments used in the field of physiotherapy that were supported by published evidence of their psychometric qualities; 2) to investigate how these instruments relate to the International Classification of Functioning, Disability and Health (ICF); and 3) to investigate the use of functional instruments in the financing of physiotherapy. A search of Medline from 1990 to December 2005, in the domains of functional evaluation, psychometric qualities, functional classification, and health policy in relation to physiotherapy resulted in a list of 1,567 studies. Two reviewers examined the resulting references on the basis of their title and abstract, in order to select the studies that presented data on the psychometric qualities of functional evaluation tests, leading to a final selection of 44 such studies. A selection of functional tests was identified in four major diagnostic groups treated in community physiotherapy: musculoskeletal disorders (including lower back pain), stroke, the elderly, and traumatic brain injuries. The functional tests authors identified essentially cover the body and activities dimension of the ICF. The selected tests could be used as a basis for the standardisation of functional evaluation of the major diagnostic groups treated in community physiotherapy. This means that standards are available for reporting and following the evolution of patients both longitudinally and transversally. Nevertheless, in the current literature review no attempt at using functional outcomes as a rationale for financing physiotherapy could be found to date.