Physical therapy in Brazil ha been recognized and regulated as a higher education profession since 1969 (Decree-Law 938/69, Law 6316/75, COFFITO Resolutions, Decree 9640/84, Law 8856/94).1 The Federal Council of Physiotherapy and Occupational Therapy (Conselho Federal de Fisioterapia e Terapia Ocupacional - COFFITO) is a Federal Autarchy created by Law No. 6316, of December 17, 1975; with constitutional objectives of standardizing and exercising ethical, scientific, and social control of the physical therapy and occupational therapy professions.

Although the definition of the profession in Brazil makes clear the role of the physical therapists in determining a diagnosis of human movement disorders to guide the prescription and application of physical therapy procedures, there is no specific resolution offering guidance about physical therapy diagnoses through a standardized system of classification. The aim of the physical therapy diagnosis classification is to synthesize a health problem or risk of impairments from a functional perspective, to guide the definition of therapeutic objectives, and to monitor the response to interventions.2–5

Despite the International Classification of Functioning, Disability and Health (ICF) being used to describe functional outcomes,6 the ICF was not developed to group the assessment tools used by physical therapists. Although efforts have been made,7–9 there appears to be no standardization of the aspects that should be included in physical therapy diagnoses. A specific classification with a coding system may provide a standardized way for physical therapists to improve diagnostic accuracy and help define physical therapy objectives. Furthermore, this classification can strengthen the professional identity and autonomy, contributing to the clinical reasoning of physical therapists in clinical practice.

Given the lack of a specific classification to provide a physical therapy diagnosis in Brazil, a working group of the COFFITO was created to develop the Brazilian classification of physical therapy diagnosis. In this article, we described the process, rationale, and standardization proposal of the Brazilian Classification of Physical Therapy Diagnosis. The purposes of the Brazilian Classification of Physical Therapy Diagnosis are: (1) to identify and classify the individual's kinetic-functional health condition; (2) to define the therapeutic goal and the respective physical therapy prescription; and (3) to monitor epidemiological data on the individual's clinical-functional evolution.

The members of the working group were appointed by COFFITO based on the criteria of expertise in the different professional specialties of the organic systems included in the Brazilian Classification of Physical Therapy Diagnosis, and were from different regions of the country, with academic and clinical practice experience. Over a 5 year period, COFFITO hosted face-to-face and online meetings of the working group periodically, totalling more than 30 meetings of about 10 h, totalizing around 300 h. The determination of the variables included in the classification made by the experts was based on the main outcomes related to organic systems. The first version of the classification was published by the COFFITO, following resolution 555/2022 (Fig. 1).10 Furthermore, an online application was developed to enable the use of the classification in an easy, standardized, and free manner for all physical therapists in Brazil. The Brazilian Classification of Physical Therapy Diagnosis can be accessed via the link https://cbdf.coffito.gov.br

Fig. 1.

Description of the process to create the Brazilian Classification of Physical Therapy Diagnosis.

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Every two years, professionals will be consulted for suggestions and updates will be made as necessary by the COFFITO. The Brazilian Classification of Physical Therapy Diagnosis Commission is continously working to disseminate the classification and to provide training to the professionals in Brazil. The development of part 2 of the classification, which includes the description of changes in patients mobility and social participation, is in progress.

In March 2022, a resolution was published by COFFITO establishing the Brazilian Classification of Physical Therapy Diagnosis. In this document, the Brazilian Classification of Physical Therapy Diagnosis based on the domains of body function and structure was detailed, with the physical therapists being able to code physical therapy diagnoses of people with good kinetic-functional health (S), to identify risks of changes in structure and/or function of the body, as well as to diagnose functional-kinetic deficiencies (D), using 10 different characterizers based on body systems, including central and peripheral nervous, musculoskeletal, respiratory, cardiovascular, integumentary, urinary, digestive, genital, and metabolic systems. The description of all variables included in each system is in Table 1.

To quantify changes in function and/or structure in the physical therapy diagnosis classification, the use of a 0–4 Likert scale was proposed. In this scale, zero (0) means a change of 0–4% , one (1) indicates a change of 5–24 %, two (2) indicates a change of 25–49 %, three (3) indicates a change of 50–95 % and four (4) indicates a change of 96–100 %. For some variables, the change is rated as dichotomous as zero (0) for no change and four (4) for any amount of change. To identify the risk of physical deficiency, the scale is also dichotomous where zero (0) means no risk and one (1) means a risk of developing physical deficiency. The phases of the physical therapy work process using the diagnosis classification are described in Fig. 2.

Fig. 2.

Phases of the physical therapy diagnostic concept work process using the Brazilian Classification of Physical Therapy Diagnosis.

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The Brazilian Classification of Physical Therapy Diagnosis is a milestone in the history of physical therapy as it fills an existing gap in our profession, by providing an important contribution to defining the physical therapy scope of action, through the description of our outcomes of interest, which are related to our professional specialties and normative documents. This will help the health system, as well as society, to understand the unique role of the physical therapist as a first-contact health professional in primary care, a specialist in human movement working in various specialties with full autonomy to conduct clinical assessment using specific outcome measures. This would allow the prescription of treatment based on a unique physical therapy diagnosis.2–5,10

Another relevant point is that the Brazilian Classification of Physical Therapy Diagnosis has the potential to guide clinical decision-making. The use of this classification tool with validated and reliable diagnostic assessment tools may improve the delivery of care by physical therapists in different healthcare settings.

This diagnostic classification has the potential to expand stakeholder views beyond the biomedical model, increasing the understanding that the individual is much more than a disease or change in health condition. It may expand the care provided based on the ability to perform human movement, from the most basic tasks to those of greater complexity, such as sports, work and leisure.2,5 This is also related to the principle of integrality in health that is part of the Brazilian unified health system, which describes that care must be integral to the individual. Future research related to its validation, reliability, and adherence of the physical therapist to the classification, as well as the identification of the barriers and facilitators for using the classification should be conducted in the future by researchers of different physical therapy specialties.

The Brazilian Classification of Physical Therapy Diagnosis system is an important advance for the physical therapy profession in Brazil, allowing physical therapists to identify structural and/or functional alterations in a simplified and standartised way. This classification may help to consolidate the autonomy of Brazilian physical therapists by establishing a clearer pathway between the diagnosis and interventions.

All authors declare no specific funding for this contribution.