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52 APPENDICES Physiotherapy KCE reports vol. 40 APPENDICES OF CHAPTER III: LITERATURE REVIEW ON FUNCTIONAL ASSESSMENT IN PHYSIOTHERAPY A: PROCEDURE FOR LITERATURE SEARCH This appendix describes the procedure followed to search the medical literature for the purpose of the study and presents the number of retrieved references. The literature search focused on four specific areas: i) the identification of functional tests, ii) psychometric qualities of the tests, iii) the ICF dimensions covered by functional test and iv) the use of functional tests in health care policy. The literature search was carried out in 4 steps. STEP 1: KEYWORDS The following list of keywords was preliminarily identified in order to cover the scope of the study: physical therapy, functional, evaluation, assessment, outcome, disability, impairment, handicap, participation, quality of life, life satisfaction, validation, reliability, psychometrics, health care financing, ICF, ICIDH. STEP 2: MESH TERMS The keywords were entered into the Medical Subject Headings (MeSH, http://www.nlm.nih.gov/mesh/2005/MBrowser.html) in order to find their most relevant counterpart in the MeSH terms. The first MeSH term identified allowed the field of investigation to be specified. Physiotherapy / Physical Therapy. The auxiliary health profession which makes use of physical therapy techniques to prevent, correct, and alleviate movement dysfunction of anatomic or physiologic origin. Additional MeSH terms were selected in order to cover each focal domain of the literature search: i) functional evaluation, ii) psychometric qualities, iii) health policy and iv) functional classification (ICF and ICIDH, the former name of the ICF classification). The list and description of each MeSH term is detailed hereunder. Functional evaluation Activities of Daily Living. The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. Disability Evaluation. Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for Social Security and workmen's compensation benefits. Outcome Assessment. Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure). Quality of Life. A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life. Psychometric qualities Evaluation Studies. Studies determining the effectiveness or value of processes, personnel, and equipment, or the material on conducting such studies. For drugs and devices, CLINICAL TRIALS; DRUG EVALUATION; and DRUG EVALUATION, PRECLINICAL are available. Psychometrics. Assessment of psychological variables by the application of mathematical procedures. Reproducibility of Results. The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.
KCE reports vol. 40 APPENDICES Physiotherapy 53 Validation Studies. Works consisting of research using processes by which the reliability and relevance of a procedure for a specific purpose are established. Functional classification ICF (International Classification of Functioning, Disability and Health) and ICIDH (International Classification of Impairments, Disability and Handicap). These keywords were not found in the MeSH terms but they kept anyway for the literature search. Health Policy Delivery of health care. The concept concerned with all aspects of providing and distributing health services to a patient population. Economics. Used for the economic aspects of any subject, as well as for all aspects of financial management. It includes the raising or providing of funds. Health Planning Guidelines. Recommendations for directing health planning functions and policies. Health Policy. Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. Health Services Research. The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. Health Services. Services for the diagnosis and treatment of disease and the maintenance of health. National Health Programs. Components of a national health care system which administer specific services, e.g., national health insurance. Program Evaluation. Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact. STEP 3: SEARCH CRITERIA Each MeSH term was combined with the keyword "physical therapy" and with a fixed list of qualifiers representing psychometric qualities in order to limit the results to a manageable number of references. For example, the literature search criterion for the MeSH term Outcome Assessment was formulated as: "Physical therapy" AND "Outcome Assessment" AND (valid* OR reliab* OR reproducib* OR repeatab* OR responsiv* OR sensitiv* OR specificity OR psychometr*). The latter criterion was used to search all references on outcome assessment in physical therapy that contain any of the following words: valid, validate, validation, validity, validly, reliability, reliable, reliably, reproducibility, reproducible, reproducibly, repeatability, repeatable, repeatably, responsive, responsiveness, sensitive, sensitively, sensitiveness, sensitivity, specificity, psychometric, psychometry and psychometrics. An analogous criterion was formulated for each MeSH term. STEP 4: SEARCH OF PEDRO DATABASE Step 1 to 3 were used for the search of Medline (see below). However, when adopted to PEDro, a physiotherapy evidence database, it appeared unsuccessful, probably due to the structure of this database. PEDro has been developed to give rapid access to randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy, and is mostly focussed on evidences of therapeutic procedures rather than on functional evaluation (www.pedro.fhs.usyd.edu.au). Hence, a second search strategy was adopted. In another chapter of this study, a selection of therapists are asked about the functional scales they are using to evaluate their patients, but also about the treatments they adopt for five selected diagnoses: bronchiolitis in infants, knee arthroplasty, hemiplegia secondary to stroke, aspecific gait difficulties in the elderly and low back pain. The five diagnoses selected for this survey, were taken as a starting point for the PEDro search. The following search combinations were used: bronchiolitis (15 hits), knee arthroplasty (52 hits), hemiplegia (63 hits), hemiplegic stroke (53 hits), gait impairment AND elderly (7 hits), gait
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