4.1 Monitor, Reassessing and Modifying the Plan Flashcards

1
Q
  1. Monitor
A

Using outcome measures to determine if my Pt is demonstrating change over time

For each impairment in the problem list→select an outcome measure to monitor it

6-8 outcome measure in Case 2

  • You can also use Pt-specific measures based on tasks that are meaningful to the patient

E.g.
- Pt has breathlessness when walking up 5 stairs
→the no. of stairs climbed before breathlessness

  • Pt has difficulty laying flat for more than 10 minutes as they start to feel breathless
    →time supine before feeling breathless
  • Pt has orthostatic hypotension and becomes dizzy when moving from supine to sit
    →use a rating scale out of 10 of dizziness upon sitting
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2
Q
  1. Reassessing
A

State the frequency you would reassess the patient using that outcome measure

How often will you reassess?
* Stage of recover: acute stage→change happen quicker & reassessment at shorter intervals vs chronic stage

E.g.
- Pt with grade 2 ATFL sprain 2 days ago
→change significantly over the course of 6 weeks
→reassessment using outcome measure more regularly (weekly) over the course of those 6 weeks

  • Pt with chronic degenerative Lx spinal stenosis
    →only mild improvement with PT intervention over 6 weeks
    →reassessment less regularly (e.g. monthly)
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3
Q
  1. Modifying the Plan
A

Using the data you’ve collected in your outcome measures through monitoring and reassessing, determine if modification is needed.

  • State a few examples of what you would do to modify your plan. Look back at the treatment plan to help guide your modifications
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4
Q
  • Are they demonstrating an improvement or a decline?
A
  1. Improvement= progress treatment plan
    E.g.
    * Inc. reps/sets/intensity/duration or distance
    * Add a new more challenging exercise
    * Decrease the amount of cueing/assistance required
  2. Decline= regress treatment plan or check in with the care team to see if there is an underlying unaddressed issue
    E.g.
    * Decrease reps/sets/intensity/duration or distance
    * Allow for longer rest breaks between sets
    * Remove an exercise or substitute it for a less challenging one
    * Increase the amount of cueing/assistance required
    * Review exercise program/education with Pt to ensure adherence/proper technique
  3. No change= use your clinical reasoning to determine if a reasonable amount of time has occurred between measurements to allow for a significant change
    * If change should have occurred, adjust the Rx plan to include new treatment options
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5
Q

Refer to the Problem list

A

1. Dyspnea
- Modified Borg scale
- Sing talk gasp scale

2. Decreased functional mobility
- 10 meter walk test
- 6-minute walk test
- Time up and go

3. Currently smoking (Pt-specific measure)
- Time since the last cigarette

4. Presence of secretions
- Auscultation
- Amount of secretions removed
- Strength of cough
- Colour of sputum

5. Co-morbidities: HT & Type II DM
- Blood pressure
- Watch for signs of hypoglycemia during exercise

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6
Q

1. Dyspnea
- Modified Borg scale
- Sing talk gasp scale

A

To monitor the Pt dyspnea

  1. What Outcome measure you will use?
    I would use the modified Borg scale and the sing talk gasp scale.
  2. How is the reassessment frequency?
    Since the patient is in an acute exacerbation, I would monitor dyspnea at the start of our session together, at rest, and during activity such as ambulation or exercise.
    I would reassess dyspnea during each session.
  3. How would you modify the plan?
    Improvment:
    If the Pt demonstrated decreased ratings of dyspnea while ambulating/exercising, I would increase their ambulation distance and reps/sets in their exercise program.

Decline:
If the patient was demonstrating increased ratings of dyspnea while ambulating/exercising,
I would revisit their PLB technique to ensure proper technique and decrease the distance ambulated or the number of reps/sets of the exercise

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7
Q

Decreased functional mobility
- 10 meter walk test
- 6-minute walk test
- Time up and go

A

To monitor their decreased mobility status

  1. What Outcome measure you will use?
    I would use a few different outcome measures.
    - I would use the 10m walk test to look at short-distance endurance and speed.
    - I would use the 6-minute walk test to assess cardiovascular health and endurance
    - I would use timed up and go to assess their ability to move from sit to stand, turning, gait speed and overall balance.
  2. How is the reassessment frequency?
    I would reassess each of these measures once a week in order to give enough time between tests to see a measurable change.
  3. How would you modify the plan?
    Improvment:
    If I noted improvements in all mobility outcome measures, I would progress the Pt endurance by increasing the distance/duration of ambulation.

Decline:
If there was a decrease in mobility outcome measures, I would connect with the Pt to determine if there were any new underlying issues that could be impacting outcomes and then regress distance/duration of ambulation to see if fatigue/overexertion is playing a role in the decline in outcome measures.

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8
Q

3. Currently smoking (Pt-specific measure)
- Time since the last cigarette

A

The issue of the Pt smoking is something that I would want to support them with as mentioned in my treatment plan.

  1. How is the reassessment frequency?
    I would not directly monitor this other than to check in to support them in this journey.
  2. What Outcome measure you will use?
    I could encourage them by keeping track of how many days since their last cigarette.
  3. How would you modify the plan?
    Improvment:
    If the Pt was staying on track with their smoking cessation plan I would continue to provide support/encouragement.

Decline:
If they were struggling and were actively smoking, I would encourage community support groups.

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9
Q

4. Presence of secretions
- Auscultation
- Amount of secretions removed
- Strength of cough
- Colour of sputum

A

To monitor the presence of secretions

  1. What Outcome measure you will use?
    - I would auscultate,
    - look at the volume of secretions removed,
    - the strength of their cough and
    - the colour of the sputum removed.
  2. How is the reassessment frequency?
    - I would reassess this during each session.
  3. How would you modify the plan?
    Improvment:
    If I notice a decrease in the amount of secretions on ausculation, I would decrease the frequency of secretion removal techniques.

Decline:
If I noticed an increase in the amount of secretions on auscultation or the presence of green sputum, I would increase the frequency of secretion removal or try an alternative secretion removal technique and advise the team.

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10
Q

5. Co-morbidities: HT & Type II DM
- Blood pressure
- Watch for signs of hypoglycemia during exercise

A

To monitor the issue of hypertension,

  1. What Outcome measure you will use?
    I would either take their blood pressure or look in their chart to see when it was last taken.
  2. How is the reassessment frequency?
    I would reassess their blood pressure each session, whether that means I take their blood pressure or check to see another practitioners measure.
  3. What Outcome measure you will use?+
  4. How is the reassessment frequency?
    I would not directly monitor their type 2 diabetes other than to ensure I am aware of signs and symptoms associated with hypoglycemia during activity
  5. How would you modify the plan?
    Decline (HT):
    If I noticed an increase in the Pt’s blood pressure, I would advise the team.

Improvment (HT):
If I noted improvements in the patient’s blood pressure, I would encourage ongoing participation in their physiotherapy program

Decline (DM):
If I noticed episodes of hypoglycemia during exercise, I would stop exercising and provide the Pt with glucose and notify the nursing staff.

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