What instruments do physiotherapists use to assess older people in hospital? An observational study using the ICF...

Hospitalization in older adults is associated with functional decline and reduced mobility. Physiotherapists (PTs) play an important role in maximizing function and minimizing activity limitations or participation restrictions. However, the range of instruments used to assess older patients in hospital remains unclear, as does whether these tools comprehensively address all domains of physical functioning. We aimed to identify the instruments, related domains, and subdomains of the International Classification of Functioning, Disability and Health (ICF) used by PTs when evaluating the physical functioning of older patients in hospital. Methods: An observational study using an online survey of PTs working in public and private hospitals in Brazil who cared for older adults. PTs were asked to select physical functioning instruments from a list and to provide an open-ended response. Instruments were classified by a committee of nine expert PTs with expertise in the ICF approach across various areas of practice, according to ICF domains.

Responses from 397 PTs showed that most were women working in general inpatient wards in public hospitals, and that they reported using 33 different instruments to assess older patients. The top three instruments used were the Medical Research Council (MRC) (57.1%), the sit-to-stand test (STS) (53.4%), and handgrip strength (HGS) (40.0%). Most instruments assess the activity and participation domain related to mobility, and the most frequently reported activities were walking and moving (60.6%), changing and maintaining body position (48.4%), and personal care (24.2%).

PTs working in hospital settings use a variety of instruments to assess older adults, predominantly targeting strength and mobility within the ICF activity domain. While this variability allows clinical flexibility, it hampers standardization and underrepresents aspects such as body functions, pain, and participation. There is a need for the systematic use of standardized, sensitive measures to improve clinical decision-making and discharge planning.