Appendices - KCE

154 APPENDICES Physiotherapy KCE reports vol.40
It is relatively common to treat psychological and gait disorders with other conditions, especially with
musculoskeletal and neurological disorders.
Oldest people are mainly treated for cardiovascular, neurological, gait disorders as well as for the
presence of orthopaedic joints implants. Youngest people are mainly treated for psychological,
endocrine/metabolic/nutritional, pregnancy/childbearing disorders.
A higher prevalence of females is found in the pathology categories that mainly affect older people
presumably due to their higher life expectancy.
Pathologies usually treated in physiotherapists office are musculoskeletal, psychological and urological
disorders. On the contrary, neurological and respiratory disorders are mainly treated in patients
home.
Almost no sessions are allocated for written report.
A high prevalence of common pathologies is observed in musculoskeletal and urological disorders.
Heavy pathologies are generally encountered in neurological and cardiovascular disorders. Perinatal
pathologies logically concern pregnancy/childbearing conditions. Pathologies of acute FA list mainly
refer to the presence of orthopaedic joint implants and injuries such as fractures or sprain/strain of
knee. Finally, pathologies of chronic FB list primarily concern psychological and gait disorders.
Although the two classifications lead to the same results, the ICPC-2 seems easier and more adequate than the
ICD-10 to classify the reasons of physiotherapeutic consultation.
First, the ICPC-2 classification has a more basic but easier structure than the more complicated ICD-10
classification. The ICPC-2 has 17 chapters, mainly based on body systems (e.g., digestive, cardiovascular,
musculoskeletal etc.) with an additional chapter for broad, non-disease conditions (e.g., feeling tired, general ill
feeling etc.), another for psychological problems and one for social problems. Each condition classified in a
given chapter may also be specified according to seven components (i.e., process codes such as physical
function test or consultation, symptoms/complaints, infections, neoplasms, injuries, congenital anomalies, and
other diagnoses). The ICPC-2 is small to handle, having less than 700 condition rubrics. On the contrary, the
ICD-10 has much more condition rubrics (more than 5000). Thus, it allows a higher precision to document all
individual patients diagnoses to be obtained but cannot be realistically used in the context of an everyday
routine.
Second, the ICD-10 classification has 21 chapters that are sometimes based on body systems (chapters III, IV,
V, VI, VII, VIII, IX, X, XI, XIII and XIV), sometimes on aetiology (chapters I, II, XVII, XIX, XX), or sometimes
on other general status (chapters XV, XVI, XVIII, XXI). This mixture creates confusion since diagnostic entities
can, with equal logic, be classified in more than one chapter. Instead of conforming to this format, the ICPC
chapters are all based on body systems, following the principle that localization has precedence over aetiology.
The ICPC-2 includes only one general and unspecified rubric for the most common conditions managed in
general ambulatory practice. The less common conditions are place into ragbag codes such as other
musculoskeletal diseases or other neurological diseases . As a result, every condition has only one logical
place in the ICPC-2.
Examples:
1) Acromial plastic surgery following a rotator cuff rupture may be classified in the ICD-10 as
follow-up care involving plastic surgery of upper extremity in the factors influencing health
status and contact with health services chapter or as injury of tendon of the rotator cuff of
shoulder in the injury, poisoning and certain other consequences of external causes
chapter. On the contrary, it is easily classified as shoulder syndrome in the ICPC-2
musculoskeletal chapter.
2) Neoplasm of the central nervous system responsible to an hemiplegia may be classified in
the ICD-10 as neoplasm of uncertain or unknown behaviour of brain, unspecified in the
neoplasms chapter or as hemiplegia in the diseases of the nervous system chapter. In
such situation, the condition is classified in two different ICD-10 chapters. This occurs
because ICD-10 chapters are based on both the body systems and the aetiology. The biaxial
structure of the ICPC-2 (i.e., 17 chapters based on body systems and 7 inside-components)
avoids this problem. Indeed, the condition would be classified in the ICPC-2 as Neoplasm
nervous system unspecified in the neurological chapter, that is, in the same chapter than if
hemiplegia was encoded.