Role of Physiotherapy in ADL (activities of daily living)

Role of physiotherapy in ADL

Activities of daily living (ADLs or ADL) is a term used in healthcare to a refer to people's daily self-care activities. The concept of ADLs was proposed by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, Ohio in 1950s and has been added to and refined by a variety of researchers since that time.

According to the National Health Interview survey in the USA conducted in 2016 in USA found that 20.7% of adults 85 or older, 7% of those aged 75 to 84 and 3.4% of those aged 65 to 75 needed help with ADLs. Overall, 6.4% of adults aged more than 65 years needed help with personal care in 2016.

Common ADLs mostly include feeding, bathing, dressing, grooming, work, homemaking, cleaning oneself after defecating and leisure. Data collected by a number of national surveys on the ADL status of the USA population suggested that ADL for each individual may vary. Some adaptive equipment and devices may be used to enhance and increase independence in performing ADLs. ADLs refer to the most basic functions of living. A clear trend is emerging of increased care giving due to rapid growth in number of older adults and because of the faster growing cohort of older adults are those age 80 and older. More than half of 85-89 year old (59%) need caregiving because of health or functioning reasons. From age 90 on, only a minority of of individuals do not need help from other.

Basic and instrumental ADLs

ADLs are activities of daily living generally, older adults need to be able to manage ADLs and IADLs in order to live independently without the feeling of being burdened or assistance of another person.

Basic ADLs- These are the basic self-care tasks to improve ability to achieve activities daily living. Tasks are-

• Walking ability to move around home or outside.
• Feeding ability to get food from the utensil into one's mouth.

Dressing up ability to select clothes, putting them on in an adequate manner and managing one's personal appearance.

• Toileting, ability to get to and from toilet, using it appropriately and maintaining hygiene.
• Bathing ability to wash one's face and body in bath or shower.
• Transferring ability to move from one position to other this include being able to move from chair to bed, or from bed to a chair/wheelchair this can include ability to stand up from a chair or bed to grasp assistive device or a walker.

Instrumental ADLs-  It require more complex thinking skills, including organisational skills.

• Managing finances, such as paying bills and managing financial assets.
• Driving , managing transportation or by organising other means of transport.
• Shopping and meal preparation. It covers shopping for clothing and other items required for daily life.
• Housecleaning and home maintenance. Cleaning kitchens, living areas, reasonably clean and tidy, and keeping up with home maintenance.

Managing communication, eg telephone and mail.

Physiotherapy

Physiotherapy helps in maintaining activities in daily living and physiotherapists assess ADLs and IADLs as a part of assessing an older person's "function". Identifying functional difficulties can help us diagnose and manage problems affecting their everyday life.

Goals of PT-

• Improving strength and joint mobility.
• Improving gait speed, grip strength.
• Pain reduction.
• Improving balance.
• Improve ability to perform ADLs.
  

Goals of physiotherapy are achieved through exercise therapy-

Strengthening exercises- These exercises help in providing strength to the muscles.

• Gait training- These exercises help in gait cycle.
• Re-education- Re-educating the subject for a particular movement.

Physiotherapy on ADL status of elderly persons demonstrated the high effectiveness of physical therapy in terms of reducing the risk of falls, improving physical ability, increasing handgrip strength and improving subjective parameters such as pain intensity, self-reported well-being and mobility.

In the guidance of,

Dr Rajesh Gautam (PT)