Abstract
In this perspective, we argue that social constructs are integral to physical therapy research, education, and practice. Unfortunately, social construction is frequently misunderstood or misrepresented as unscientific. On the contrary, we argue that understanding social construction is important for a scientific understanding of disease/injury risk, prognosis, and the efficacy and effectiveness of treatment. We begin with examples of construction in the International Classification of Functioning, Disability, and Health (ICF) model. We then extend these ideas to explain how sex, although grounded in important biological variables, has a layer of social construction when that biological variation is reduced to a small number of categories assigned at birth. Similarly, gender is distinct from sex and can be separated into gender identity, gender expression, and social norms to best understand how sex and gender affect health outcomes. We then review how race has no coherent genetic basis and is most accurately understood as a social construct. That is, racial categories refer to individuals who share superficial biological traits (e.g., skin color) that a society considers important; similarly, ethnic categories refer to individuals who share cultural traits (e.g., languages, religious traditions) that a society considers important. As such, racial and ethnic labels differ from society to society and within societies over time. Our focus is on understanding social construction as a process and a problem of measurement (i.e., what do socially constructed labels really measure?) to complement other work in physical therapy (e.g., identifying social and structural determinants of health and closing gaps that result from systemic racism, sexism, cisnormativity, and ableism). Although not an exhaustive treatment of social constructs in rehabilitation, we provide a conceptual framework for understanding how socially constructed categories influence scientific and clinical reasoning about risk, prognosis, and treatment effects in physical therapy.