The ICF Model and the Many Foci of Clinical Reasoning

Mark uses the WHO model to separate the clinical presentation, made up of impairments in body function and structure, activity limitations and participation restrictions, from the factors that shape it: the health condition, personal factors and environmental factors. Personal factors include age, education, culture, beliefs, coping style, self-efficacy and resilience. Less supportive physical and social environments are linked to greater disability. He then describes the foci of reasoning. Diagnostic reasoning categorizes the problem. Psychosocial reasoning examines psychological and social contributors. Interactive reasoning builds rapport and therapeutic alliance, which affects participation and outcomes. Collaborative reasoning, or shared decision making, explains findings, options and risks to the patient. Ethical reasoning handles moral aspects, such as discontinuing therapy or patient preferences without evidence. Procedural reasoning covers the detailed choices of which impairments to target, how to dose and progress treatment and what to reassess. Prognostic reasoning answers whether the problem can be helped and how long that will take.