CCR Flashcards
Clinical reasoning?
- Thinking and decision-making processes used in clinical practice
- Ability to select and use information effectively in solving problems
- A teachable cognitive skill independent of specific clinical knowledge
HOAC II?
Hypothesis Oriented Algorithm for Clinicians
ICF
International Classification of Functioning Disability and Health
RPS form?
Rehabilitation Problem Solving form
Hypotheses
Proposed, testable explanations of the complaints of the patients involving the cause + effect (target mediator + target problem)
Primary prevention
Preventing anticipated, future problems
Secondary prevention
Preventing existing, current problems
Tertiary prevention
Preventing longer term, lasting effects (linked to the problem / complications)
PIPs
Patient identified problems (upper part of RPS)
nPIPs
non-Patient identified problems (lower part of RPS)
Body functions
Physiological functions of body systems (including psychological functions)
Body structures
Anatomical parts of the body (ex: organs, limbs and their components)
Impairments
Problems in body function or structure
Activity
Execution of a task or action by an individual
Activity limitations
Difficulties an individual may have in executing activities
Participation
Involvement in a life situation
Participation restrictions
Problems an individual may experience in involvement in life situations
Environmental factors
- Make up the physical, social and attitudinal environment in which people live and conduct their lives
- Factors that are external to the patient/not within the person’s control
Personal factors
- Influence how disability is experienced by the individual, may include gender/age/coping styles/social background/education/profession/overall behavior pattern/character etc.
- Factors that are internal to the patient
Target mediator
“Cause”
- Supposed to have the highest potential to solve the target problem
- Identified in the BODY FUNCTIONS section of RPS form
Observed Pain Behavior
Guarding, bracing, rubbing, grimacing, sighing
Target problem
“Effect”
- Difficulties that patient has
- Identified in ACTIVITIES section of RPS form
Cinical outcomes
Strength, swelling, range of motion, pain, proprioception, psychological overlay and endurance (muscular)
Functional Outcomes
Power, speed, agility, activity specific, kinesthetic awareness, endurance, (muscular and cardiovascular), skills level required for activity, psychological preparedness and daily living skills
Screening process
Early identification of health problem, not yet diagnosed, through a process that can be quickly executed
Medical diagnosis
Process in which elements that have been observed will be classified under the name of a pathology
Physiotherapeutic diagnosis
An inventory and analysis of limiting and faciliting factors for biological and behavioral recovery and adaptation processes within the boundaries of physical therapy
“Gut feeling”
Instinctive feeling that there’s something wrong, though concrete evidence is missing
Signs
Clinical information which is taken as objective proof from the PT
Symptoms
Information that the patient gives but is not taken by the PT as objective
Pattern recognition
“Screening process”
Patient Profile
“Patient history taking”
- Personal story of the patient about perceiving health problems, in their own language, in its own context, with its own history and with its own dynamics
SMART goals
- Specific: clear description of the goal
- Measurable: set a measurable goal to track and quantify progress
- Attainable: a reasonable yet attainable goal to achieve
- Realistic: align the desired goal the overall goal (HSQ)
- Time: time-bound, time-oriented, time-specific (start with the time of tissue healing, 4-6weeks)
Long-term goals (LTG)
Related to patient’s target problem (HSQ health seeking questions)
Short-term goals (STG)
Steps taken to meet the long term goal
Red flags
- Indicate a need for referral to physician.
Indication that:
- the problem is not a musculoskeletal one
- biomedical risk factors (serious pathology - cancer, infection fracture etc.)
Yellow flags
Yellow flag findings indicate a more extensive examination may be required
- Signs and symptoms that denote problems may be more severe or may involve more than one area requiring a more extensive examination, or they may relate to cautions and contradictions to treatment that the examiner have to consider (ex: abnormal signs/symptoms, bilateral symptoms, drop attacks, vertigo, abnormal sensation, patterns etc.)
- Overlying psychosocial or cognitive risk factors (ex: distress, anxiety etc.)
Orange flag
Psychological risk factors (ex: psychiatric issue, depression, schizophrenia, etc.)
Blue flags
Social and economic (work related) risk factors (ex: job dissatisfaction, lack of support etc.)
Black flags
Societal and insurance related factors (limitations imposed by legislation, conflict with the insurer or workplace)
Strategies in Clinical Reasoning
- Trial and error
- Following protocol
- Rule-in / rule-out (diseases)
- Hypothetico-deductive reasoning (research)
- Pattern recognition (experienced practitioners)
7 Steps of HOAC II (Physiotherapeutic Process)
- Contextualization of patient
- Interview (patient history) + problem list + hypotheses
- Examination strategy
- Examination findings = accept/reject hypotheses
- Goals/actions to take
- Interventions strategy
- Reassessment
Clinical Reasoning System 1
Subconscious clinical reasoning of pattern recognition, quick, narrow view (ex: health professional)
Clinical Reasoning System 2
Conscious clinical reasoning, which is analytical, slow, systematic, reflective, broad view (student view)
ICD10 vs ICF
- ICD10: deals with disease and limitation giving a medical diagnosis (objective)
- ICF: deals with overall functioning ability and perspective of the patient (subjective)
Body function measurements
VAS
Activities/participation measurements
PSC (patient specific complains)
AROM/PROM measurements
Goniometer
Common rps and ICF
RPS is constructed similarly to the ICF, designed to distinguish between patient and PT perspective, enhances the patient’s participation in the decision making process
Benefits of rps form for PT
(1) easy to indentify modifiable factors and target problems, (2) collaboration of the PT vs. patient, (3) focusing on the health seeking question of the patient
