ICF ASSESSMENT IN
ORTHOPAEDICS
LUNELLE L PIENAAR
MSC PHYSIOTHERAPY (US),
BSC PHYSIOTHERAPY (UWC)
FACULTY OF HEALTH SCIENCES
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UNIVERSITY OF CAPE TOWN
APPLICATION OF THE ICF
ASSESSMENT
Orthopaedics relate to disorders/ disease that occurs within the musculoskeletal system.
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•
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Use of the ICF in orthopaedic assessment:
The ICF framework provides a useful assessment format as it recognizes the
influence of the environment and personal factors on the health condition of the
patient.
The ICF is used for assessment and documentation of a patient’s level of function
after sustaining an orthopaedic injury that requires medical intervention.
Functional problems can occur due to any of the following orthopaedic conditions:
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1. Fracture of the bone either pathological or traumatic and ruptures of muscles,
ligaments or tendons.
2. Congenital and metabolic disease that results in skeletal deformities requiring
surgery to correct the deformity.
3. Arthritic and rheumatologic disease.
FUNCTIONAL
PROBLEMS
Orthopaedic conditions can affect either the daily
activities and/or participation of the patient, therefore
resulting in the following functional problems:
o Limited ability of the patient to walk
independently.
o Limitations in moving around in bed and the
ability to get in and out of the bed.
o Decreased independence with self care personal
hygiene activities like washing, toilet use, dress
and undress and performing household tasks.
o As well preventing the involvement of the patient
in their work, sporting and other activities.
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
The procedure followed when conducting a physiotherapy
orthopaedic assessment in a hospital:
1.
Review of patient’s medical folder and X-rays to
determine which structure sustained injury and
how it has affected the function of that structure.
2.
Conduct an interview with the patient to establish
the patient’s baseline activities prior to the injury.
3.
Physical examination of the affected area.
 In the physical examination the involved area is assessed
through observation and palpation, testing range of
movement and muscle power.
 Using the ICF the patient’s current functional ability will be
tested to determine how the injury has contributed to the
problems within activity and participation domains.
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PHYSIOTHERAPY ORTHOPAEDIC
ASSESSMENT
CASE SCENARIO
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Mrs Moses is a 45 year old female who sustained a midshaft
tibiofibular fracture on the right as a result of a motor vehicle
accident 3 days ago. She is day 1 post ® Open Reduction
Internal Fixation.
CASE SCENARIO CONTINUED
Social history
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The patient lives with her husband and 1 child in an informal
housing structure. Her husband is unemployed and she is
the sole breadwinner in the house. She is eager to return to
work, where she works as an admin clerk. However, she fears
that she will not be able to negotiate the two flights of stairs
at work after 6 weeks when she is scheduled to return to
work. Prior to the accident she was very active; she did all
the cooking and house work. Mrs Moses enjoys reading and
watching TV. She does not smoke, but drinks socially. She
relies on public transport to go to work and the shops.
The sandy terrain that the patient needs to
negotiate to her informal dwelling
The communal toilets that the patient has to access.
These are situated on the periphery of the settlement
area.
Outside the House
The exterior of her dwelling
The communal tap used for drawing water for
cooking and washing.
Top-right image by John Charalambous on Flickr (CC BY-ND). All other images used with permission from Ad van Zeeland (AaVeeZet onYoutube)
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THE HOUSE
THE HOUSE
Vinyl flooring is often used in
informal dwellings
Inside the House
The confined space that the patient uses
for cooking, watching TV and sleeping
Top-left image by Mark Blacknell on Flickr (CC BY-NC-SA). All other images used with permission from Ad van Zeeland (AaVeeZet onYoutube)
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The child’s bed used to store blankets during the day
PHYSICAL ASSESSMENT
Observation:
• Swelling visible on (R) lower leg, measure mid calf 45 cm
(L), 60 cm (R).
• Bandage over anterior surface of patellar tendon, slightly
blood stained, but dry at present.
• Increased temperature on the right compared to the left
(L) leg.
Bed function:
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• The patient relies on the assistance of the nursing staff to
reposition her up/down and sideways in bed as the leg is
very painful.
Transfers
• She is able to sit up in bed, but needs help to lift leg
sideways to sit upright over the edge of the bed.
• She can stand up from sitting with assistance of one
person.
Balance
• Walked about 5m with the assistance of physiotherapist
using the walking frame yesterday then had to sit down
to rest complaining of feeling very tired.
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• Static and dynamic sitting balance is good.
• In standing the patient has good static balance,
although dynamic balance is fair.
Mobility
Body Function & Structure
Fracture of the tibiofibular
resulted in damage to muscles
surrounding the fracture site
Impairment is the
inability to fully weight bearing
on right leg
Activities
Limitation
Participation
Restriction
Problem with
independent bed
mobility, transfer out
of bed and walking
with frame
Unable to work or
perform house work
Environmental Factors
Personal Factors
Loss of income, husband unemployed, stairs at
work; these are considered as barriers to the
rehabilitation process
Patient is motivated and this can
facilitate her rehabilitation process
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Health Condition = Fracture
WHAT IS THE ROLE OF THE PHYSIOTHERAPIST IN MANAGING
PROBLEMS OF ACTIVITY LIMITATION AND PARTICIPATION
RESTRICTION
Activity limitation:
• Prescribe strengthening exercises for the muscles of the lower limbs and
upper limbs that assist transfers in and out of bed.
• Correct the method of getting in and out of bed if this is incorrect and
practice the technique with the patient.
• Perform balance exercises to assist mobility with walking frame then
progress to crutches as she will be unable to weight bear fully on the
affected leg and this will affect her balance.
• Progressively increase distance walked so she can get to mobilise in her
house, then shops and eventually work.
• As soon as she’s able, the patient needs to be taught how to climb up
and down stairs as she needs to be able to do this to get to work, get in
and out of a bus, taxi or train.
Participation restriction
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• Refer to other health professionals e.g. social worker to assist with
financial support.
• Provide continuity of services by referral to community health center
physiotherapist and occupational therapist.
REFERENCES
Jelsma Jennifer. 2009 Use of the international classification of
functioning,disability and health: A literature survey. J rehabil med; 41:
1–12
Resnik Linda, Allen Susan . 2007 .Using international classification of
functioning, disability and health to understand challenges in
community reintegration of injured veterans .Journal of rehabilitation
research & development;44 (7) :991-1006
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Grill Eva, Ewert Thomas, Chatterji Somnath, Kostanjsek Nenad, &
Gerold Stucki. 2005. ICF core sets development for the acute hospital
and early post-acute rehabilitation facilities. Disability and
rehabilitation,; 27(7/8): 361 – 366
CREATIVE COMMONS LICENSE
ICF Assessment in Orthopaedics
by Lunelle Pienaar, Physiotherapy Division,
Department of Health and Rehabilitation Sciences, University of Cape Town (2010)
is licensed under a
Creative Commons Attribution-NonCommercial-ShareAlike 2.5
South Africa License. Please see http://creativecommons.org/licenses/by-nc-sa/2.5/za/
for terms and conditions. All images created by external parties retain their original licenses
(see image references on slides).
Source work available at vula.uct.ac.za
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