Lusardi Michelle M, Hartley Gregory W, Leach Susan J, Gras Laura Z, Larkin Marni, Miller Kenneth L, Quiben Myles
Department of Physical Therapy & Human Movement Science, College of Health Professions, Sacred Heart University, Fairfield, Connecticut, USA.
Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA.
Phys Ther. 2023 Oct 3;103(10). doi: 10.1093/ptj/pzad079.
Leaders and scholars from multiple academies of the American Physical Therapy Association are developing and defining movement system diagnoses to guide practice. However, there is no consensus on the need for or content of such frameworks. This Perspective describes current thought about movement system diagnoses in physical therapy and summarizes the work of the Academy of Geriatrics (APTA Geriatrics) Movement System Diagnosis Task Force (GMS-TF) as it contributes to the movement system diagnosis discussion within the profession. Initially convened to define movement system diagnostic labels unique to older adults, the GMS-TF's developmental process identified the need for a clearer diagnostic framework onto which specific diagnoses will later be added. Although The World Health Organization International Classification of Functioning, Disability and Health model is a strong foundation for the patient-client management model, the GMS-TF proposes formal incorporation of the Geriatric 5Ms (mobility, medications, memory, multi-complexity, and "what matters most") into a movement system framework for older adults. The GMS-TF concurs with the APTA Academy of Neurology Movement System Task Force proposal that observation and analysis of key functional tasks are the foundation of any examination of older adults. The GMS-TF suggests adding several additional movement tasks that are important for older adults. The GMS-TF believes that this strategy highlights the health care needs of older adults and prioritizes physical therapist care for older adults with complex needs. This Perspective is the foundation for a future movement system diagnosis model for older adults that will complement and facilitate the development of models of care to be applied across the lifespan.
美国物理治疗协会多个学会的领导人和学者正在制定和界定运动系统诊断方法，以指导临床实践。然而，对于此类框架的必要性或内容，目前尚未达成共识。本观点阐述了当前对物理治疗中运动系统诊断的思考，并总结了老年病学会（美国物理治疗协会老年病学分会）运动系统诊断特别工作组（GMS-TF）的工作，该工作组为业内关于运动系统诊断的讨论做出了贡献。GMS-TF最初旨在界定老年人特有的运动系统诊断标签，其制定过程发现需要一个更清晰的诊断框架，以便后续添加具体诊断。尽管世界卫生组织的《国际功能、残疾和健康分类》模型是患者-客户管理模型的坚实基础，但GMS-TF提议将老年5M（活动能力、药物治疗、记忆力、多重复杂性以及“最重要的事情”）正式纳入老年人运动系统框架。GMS-TF赞同美国物理治疗协会神经学学会运动系统特别工作组的提议，即对关键功能任务的观察和分析是对老年人进行任何检查的基础。GMS-TF建议增加几项对老年人很重要的额外运动任务。GMS-TF认为，这一策略突出了老年人的医疗保健需求，并将物理治疗师对有复杂需求老年人的护理置于优先地位。本观点是未来老年人运动系统诊断模型的基础，该模型将补充并促进适用于整个生命周期的护理模式的发展。
