Ongoing Revision of Balance Dysfunction Diagnoses: Pilot Survey of Clinical Physical Therapists

The American Physical Therapy Association's (APTA) vision of transforming society by optimizing movement to improve the human experience must include a reduction in the unwarranted variation in physical therapist practice. The APTA proposed that the profession adopt the movement system as a basis for developing diagnoses to classify movement dysfunction so that treatment is more consistent and specific. In 2021, the Academy of Neurologic Physical Therapy Movement System Diagnosis Task Force developed 10 movement system diagnoses for balance dysfunction, a diagnostic process, and recommended intervention strategies. The purpose of this special interest paper is to report on the ongoing refinement of the balance diagnoses and the diagnostic process based on a pilot survey of practicing clinicians and colleagues' informal feedback.

Pilot survey participants largely agreed on the clarity of the definitions, the accuracy of the key movement observations, and appropriateness of the key findings from tests and measures, but not the mutual exclusivity of the balance diagnoses. Using an iterative process, the authors considered the feedback to arrive at a consensus to address these concerns. The result is an updated set of 12 balance diagnoses, revision of some key definitions, a refined diagnostic process, and an updated summary of the evidence for task-specific balance-related interventions. These updated diagnoses and diagnostic processes must be examined for mutual exclusivity, validity, and reliability prior to clinical adoption.

Until the balance diagnoses are shown to be mutually exclusive, valid, and reliable, we recommend that clinicians conceptualize balance control dysfunction using the well-established postural control strategies and apply well-supported principles of task-specific interventions when managing individuals with balance dysfunction.