Functional Ability Description Tool
The challenge of measuring and recording effectiveness of service delivery, particularly for children with long-term disability is a challenge. In NHS Leeds Community Paediatric Physiotherapy Service, we have developed a method of recording Patient Related Outcomes. The outcome recording is used in conjunction with the ‘Functional Ability Description Tool for Children with Physical Disabilities.’ The service won a "Leading Edge Award for Clinical Service Re-design" in Leeds PCT in July 2008.
- A simple tool has been designed to describe the functional ability of children with long-term neurological conditions.
- The clinicians within the paediatric physiotherapy service have combined aspects from well researched validated and reliable assessment tools. Eight statements have been produced to describe the children’s functional abilities. This is unique to Leeds Community Children’s Physiotherapy service.
- The tool is used in conjunction with Education Leeds to allocate funding and assist in the placement and support for children in the school settings.
- The tool is easily understood by parents, carers and professionals and therefore a common ‘language’ can be used when discussing a child’s level of physical ability and the resources required to support that child in the school setting.
- The tool is very simple and quick to use. It has therefore been used in clinical audits and to profile service caseloads. This has resulted in more qualitative information in the management of resources within the service
With a method of describing the caseload validated over three years, a method for recording clinical outcomes was clearly required. McBurney et al  used the International Classification of Functional Disability (ICF) framework to theme perception of benefits of muscle strength training. By combining the ICF framework and the 5 principals of Every Child Matters, (ECM) the service developed usable documentation to record the outcomes and measure effectiveness.
By setting ‘SMART’ objectives in areas of Participation and Activity as well as Body Structure and Function and linking them with ECM, we are able to record measurable objectives that previously we would have not recorded. The historic perception that physiotherapists only have a ‘body structures and functions' role can be challenged. The discussions relating to effectiveness and value for money of children’s community physiotherapy with commissioners become clearer. This method of recording outcomes has also been piloted in the children’s MSK service in LTHT, an acute setting, and results have been encouraging.
To describe the functional ability of children with long-term neurological conditions.
Children with long-term neurological conditions.
Method of Use
Our next challenge is working with Care Services to record the documentation electronically on Systmone. A meaningful quarterly report of quality activity can then be produced. The number of children on the caseload in each Functional Descriptor Band can be correlated with percentage of outcomes achieved in each section. Critically the reasons for not achieving outcomes (e.g. child ill, poor adherence etc) can be recorded in a few simple statements of a drop down list. This method of outcome collection could be suitable for many services, as a quick usable clinical tool to evaluate service effectiveness.
- Helen Dowden (2007) The Functional Ability Description Tool. NHS Leeds Community Healthcare, Children’s Physiotherapy.
- PALISANO R,ROSENBAUM P, WALTER S, RUSSELL D, WOOD E, GALUPPI B. (1997) Developmental Medicine and Childhood Neurology 39 pp214-223.
- POUTNEY T, MULCAHY C, CLARKE S, GREEN E. (2004) Chailey Approach to Postural Management. Active Design Witton Birmingham 2nd Edition.
- McBURNEY H, TAYLOR N, DODD K, GRAHAM H KERR. (2003) A Qualitative analysis of the Benefits of Strength Training for Young people. Developmental Medicine and Childhood Neurology 45 : pp 658-663