DEVELOPING AN ACTIVITY THERAPY FORMULARY
The model for this is that wonderful publication the British National Formulary
WHAT IS THE SCOPE OF ACTIVITY THERAPY?
The long list of diseases in the ICD, the International Classification of Diseases may however be divided into two groups when considering the potential benefits of activity therapy.
Firstly there are those diseases which people with the disease are clearly able to be distinguished clearly from people who do not have the disease. To take a very simple example, either a person’s neck of femur is fractured or it is not fractured. Then there is a second class of disease, sometimes called a condition, in which the distinction between having the disease and not having the disease is not decided unequivocally by a diagnostic test but which are defined by some test which has a certain level that some group of experts have agreed is the upper, or lower, level of “normal.”
Examples of this type of condition are given below:
Condition Measure
Type 2 diabetes Blood sugar
Obesity BMI
Hypercholesterolaemia Blood cholesterol
High Blood Pressure Blood Pressure
Depression No single measure agreed
What is important for people given such a diagnosis to understand is that the level chosen as the limit of ‘normal’ is an arbitrary point on a continuous distribution of values. Unlike TB infection which people either have or do not have everyone has a blood pressure, and has sugar and cholesterol in their blood stream, everyone has a Body Mass Index and if anyone said they were never depressed that in itself would raise questions. the Formulary wi cover with types of disease and we need a taxonomy and for classifying the therapies and the most widely used is the ICD, the WHO International Classification of Diseases and the core set of classes is reproduced below.
The WHO ICD Taxonomy
01 Certain infectious or parasitic diseases
02 Neoplasms
03 Diseases of the blood or blood-forming organs
04 Diseases of the immune system
05 Endocrine, nutritional or metabolic diseases
06 Mental, behavioural or neurodevelopmental disorders
07 Sleep-wake disorders
08 Diseases of the nervous system
09 Diseases of the visual system
10 Diseases of the ear or mastoid process
11 Diseases of the circulatory system
12 Diseases of the respiratory system
13 Diseases of the digestive system
14 Diseases of the skin
15 Diseases of the musculoskeletal system or connective tissue
16 Diseases of the genitourinary system
17 Conditions related to sexual health
18 Pregnancy, childbirth or the puerperium
19 Certain conditions originating in the perinatal period
20 Developmental anomalies
21 Symptoms, signs or clinical findings, not elsewhere classified
This will be part of the taxonomy of the NATS but does not cover three populations which benefit greatly from Activity Therapy
Activity Therapy for people with Multimorbidty
One of the consequences of population ageing is the growth in the number of people with more than one health problem, and this poses a particular challenge for people in single disorder specialties although specialisation has brought many benefits. This is now recognised and NHS England is using a new taxonomy called bridges to health which includes multi morbidity as well as the ICD single disease categories and we too will use the term Multimorbidity.
Activity Therapy to enable people to increase their functional Ability
The WHO had for many years a taxonomy for Impairment , Disability and Handicap but this has been replaced by a more
positive International Classification of Functioning, Disability and Health (ICF). Here are the key concepts:
In the ICF, functioning and disability are multi-dimensional concepts, relating to:
• the body functions and structures of people, and impairments thereof (functioning at the level of the body); • the activities of people (functioning at the level of the individual) and the activity limitations they experience;
• the participation or involvement of people in all areas of life, and the participation restrictions they experience (functioning of a person as a member of society);
and
• the environmental factors which affect these experiences (and whether these factors are facilitators or barriers).
Activity Therapy has a vitally important part to play in helping people function better, what ever the cause of their disability so we will include Disability in our taxonomy
Activity Therapy for people in the last year of life
Terms such Palliative Care tend to give the impression that the most important features of care in the last year of life are to encourage rest and quietness this is not the case. Palliative care is certainly effective at controlling distressing symptoms such as pain but also encourages engagement and interaction, and it is important to remember that Activity Therapy means activity that is not only physical but also stimulating cognitively and emotionally. this might mean enabling a person to return to walks in green settings which they used to enjoy or it could be moving to music they love or singing which has considerable benefits, physical, cognitive and emotional.Increasingly use is being made of Virtual Reality to enable people to revisit places they love with people they love even if those people are not even in the same country.
The model for this is that wonderful publication the British National Formulary
WHAT IS THE SCOPE OF ACTIVITY THERAPY?
The long list of diseases in the ICD, the International Classification of Diseases may however be divided into two groups when considering the potential benefits of activity therapy.
Firstly there are those diseases which people with the disease are clearly able to be distinguished clearly from people who do not have the disease. To take a very simple example, either a person’s neck of femur is fractured or it is not fractured. Then there is a second class of disease, sometimes called a condition, in which the distinction between having the disease and not having the disease is not decided unequivocally by a diagnostic test but which are defined by some test which has a certain level that some group of experts have agreed is the upper, or lower, level of “normal.”
Examples of this type of condition are given below:
Condition Measure
Type 2 diabetes Blood sugar
Obesity BMI
Hypercholesterolaemia Blood cholesterol
High Blood Pressure Blood Pressure
Depression No single measure agreed
What is important for people given such a diagnosis to understand is that the level chosen as the limit of ‘normal’ is an arbitrary point on a continuous distribution of values. Unlike TB infection which people either have or do not have everyone has a blood pressure, and has sugar and cholesterol in their blood stream, everyone has a Body Mass Index and if anyone said they were never depressed that in itself would raise questions. the Formulary wi cover with types of disease and we need a taxonomy and for classifying the therapies and the most widely used is the ICD, the WHO International Classification of Diseases and the core set of classes is reproduced below.
The WHO ICD Taxonomy
01 Certain infectious or parasitic diseases
02 Neoplasms
03 Diseases of the blood or blood-forming organs
04 Diseases of the immune system
05 Endocrine, nutritional or metabolic diseases
06 Mental, behavioural or neurodevelopmental disorders
07 Sleep-wake disorders
08 Diseases of the nervous system
09 Diseases of the visual system
10 Diseases of the ear or mastoid process
11 Diseases of the circulatory system
12 Diseases of the respiratory system
13 Diseases of the digestive system
14 Diseases of the skin
15 Diseases of the musculoskeletal system or connective tissue
16 Diseases of the genitourinary system
17 Conditions related to sexual health
18 Pregnancy, childbirth or the puerperium
19 Certain conditions originating in the perinatal period
20 Developmental anomalies
21 Symptoms, signs or clinical findings, not elsewhere classified
This will be part of the taxonomy of the NATS but does not cover three populations which benefit greatly from Activity Therapy
- People with multi morbidity
- People with disabling consequences of disease
- People in the last year of life
Activity Therapy for people with Multimorbidty
One of the consequences of population ageing is the growth in the number of people with more than one health problem, and this poses a particular challenge for people in single disorder specialties although specialisation has brought many benefits. This is now recognised and NHS England is using a new taxonomy called bridges to health which includes multi morbidity as well as the ICD single disease categories and we too will use the term Multimorbidity.
Activity Therapy to enable people to increase their functional Ability
The WHO had for many years a taxonomy for Impairment , Disability and Handicap but this has been replaced by a more
positive International Classification of Functioning, Disability and Health (ICF). Here are the key concepts:
In the ICF, functioning and disability are multi-dimensional concepts, relating to:
• the body functions and structures of people, and impairments thereof (functioning at the level of the body); • the activities of people (functioning at the level of the individual) and the activity limitations they experience;
• the participation or involvement of people in all areas of life, and the participation restrictions they experience (functioning of a person as a member of society);
and
• the environmental factors which affect these experiences (and whether these factors are facilitators or barriers).
Activity Therapy has a vitally important part to play in helping people function better, what ever the cause of their disability so we will include Disability in our taxonomy
Activity Therapy for people in the last year of life
Terms such Palliative Care tend to give the impression that the most important features of care in the last year of life are to encourage rest and quietness this is not the case. Palliative care is certainly effective at controlling distressing symptoms such as pain but also encourages engagement and interaction, and it is important to remember that Activity Therapy means activity that is not only physical but also stimulating cognitively and emotionally. this might mean enabling a person to return to walks in green settings which they used to enjoy or it could be moving to music they love or singing which has considerable benefits, physical, cognitive and emotional.Increasingly use is being made of Virtual Reality to enable people to revisit places they love with people they love even if those people are not even in the same country.
