Measuring physical disablement: the contextual challenge

Context is a fundamental consideration in physical therapy assessment and in the interpretation of physical disablement. Specification of context may include physical requirements of a task such as the demands for speed or a specific degree of accuracy, or the social context in which an activity is performed such as dressing for work versus dressing for leisure activities. Context also encompasses individual factors such as the importance of particular activities within the person's culture or value system, or the specific types of roles requiring physical functioning that a person resumes upon discharge from physical therapy. Data are presented to illustrate the differences in performance across related physical tasks and between self-care and mobility tasks in home and school settings in children with severe functional delays. These data highlight the potential impact of context on performance. Implications for future development of functional assessments are discussed, particularly in light of the importance of incorporating contextual information in the clinical interpretation of disablement outcomes for patient groups and individual patients.