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Classification

Developing a Taxonomy of Indexing Categories to Identify Need in Parkinson’s Disease

Diana Jones C S Chandler R D Plant Faculty of Health, Social Work and Education, University of Northumbria at Newcastle

The principal focus in the management of Parkinson’s disease is the pharmacological treatment of the motor symptoms of the condition. However, several features of the disease are resistant to drug therapy, response fluctuations may develop and side effects are common. This impairment-led approach does not address the wider issues of disability and handicap.

Group discussions in a variety of settings were used to explore the reality of living with Parkinson’s disease. These discussions were undertaken with members of Parkinson’s Disease Society groups. A total of 54 individuals contributed; approximately half had Parkinson’s disease, the rest were carers. Transcripts of discussions were analysed for thematic content using

the Non Numerical Data Indexing Searching and Theo- rising Package (NUD.IST).

Results of this analysis produced an hierarchical taxonomy of indexing categories. Tremor, rigidity and akinesia, the focus of the majority of medical manage- ment, represented only part of the overall picture. Difficulties within the psychosocial domain such as carer stress, reduced socialisation and fulfilling roles within the family and wider society were evident. A wide range of endocrine, autonomic and other physical symptoms were seen as problems by this group. These included excess sweating, fatigue, pain, constipation and difficulty with micturition. Night-time problems caused considerable distress for both subjects and carers. Restlessness, vivid dreaming, pain, sweats and problems turning in bed were common. Such problems often appear invisible t o formal health care while having a profound impact on quality of life for the subject and carer.

The power of this taxonomy of categories is to identify the range of need which must be met for optimal health and social care. An integrated multi-disciplinary management model could ensure that best use is made of the benefits of medication while addressing these wider disease management issues.

Adaptation of the Classification of (Dis)abilities for Physical Therapy

C Dorine van Ravensberg Y F Heerkens J W Brandsma National Institute for Research and Postgraduate Education for Allied Health Professions, Amersfoort, The Netherlands

In 1980 the World Health Organisation published the International Classification of Impairments, Disabili- ties and Handicaps (ICIDH). With this classification it is possible to describe the health status of an individual on three levels:

0 Impairments: the level of organ systems or individual organs.

0 Disabilities: the level of personal activities.

0 Handicaps: the level of disadvantage for the individual within society.

The ICIDH is now widely used in different fields of health care (such as rehabilitation and mental health) and by different professions, including physical thera- pists. Although there is much support for the ICIDH, there is also much criticism. For this reason a revision process was started in 1992. Within this revision process the Dutch Collaborating Centre of the ICIDH plays an important role by co-ordinating the revision of the classification of disabilities.

An adaptation of the classification of impairments and the classification of disabilities was developed to make them more appropriate for use by five different health professions (including physical therapy). With this adaptation, in which account has been taken of much of the criticism of the ICIDH, it is possible to classify impairments and disabilities at a very detailed level. Important changes are the chapter division, a more logical structure of the classifications, the possibility of using the classification of disabilities as a classification of abilities, and the inclusion of new impairments and disabilities missing in the ICIDH-1980. An English translation of the adaptation has been made which is slightly less detailed than the Dutch version. This translation is playing a major role in the revision of the classification of disabilities.

In literature the (wrong) impression is sometimes given that physical therapists are focused only on impair- ments (such as pain, decreased range of motion, hypertony), while occupational therapists are focused on disabilities. More and more it is recognised that disabilities are very important for physical therapy as well; the complaints of patients (problems with bicy- cling), the findings of physical therapists (problems with reaching, carrying, sitting), the treatment itself (training of abilities like writing, rolling over), treat- ment goals (the possibility of transfer rising from bed to wheelchair) and the treatment results can be described according to (dis)ability level.

As the adaptation of the classification of disabilities is used for example for recording assessments, protocols,

Physiotherapy, July 1996, vol82, no 7