CCR theory Flashcards
Clinical Reasoning
The thinking and/or decision-making processes that are used in clinical practice
- The ability to select and use information effectively in solving problems, a teachable,
cognitive skill that is independent of specific clinical knowledge.
HOAC II
Hypothesis Oriented Algorithm for Clinicians
ICF
International Classification of Functioning Disability and Health
RPS
Rehabilitation Problem Solving form
Hypotheses
Proposed, testable explanations (cause + effect) of the complaints of the patients = Target problem + target mediator
Primary Prevention
Preventing anticipated / future problems
Secondary Prevention
Preventing existing / current problems
Tertiary Prevention
Preventing longer term, lasting effects i.e) linked to the problem - depression
PIPS
Patient Identified Problems
NPIPS
Non-patient Identified Problems
Body Functions
Physiological functions of body systems
Body Structures
Anatomical parts of the body i.e.) organs, limbs
Impairments
Problems in body function or structure
Participation
Involvement in a life situation
Activity Limitations
Difficulty an individual may have in executing activities
Participation Restrictions
Problems an individual has in involvement in life situations
Environmental Factors
External to the patient. Make up the physical, social and attitudinal environment in which people live and conduct.
Personal Factors
Internal to the patient. Influence how disability is experienced by the individual.
Target Problem
“Effect”
Difficulties the patient has
Identified in activities and participation section of RPS
Target Mediator
“Cause”
Supposed to have the highest potential to solve the target problem Identified in the body functions section of RPS
Existing problem
A current problem (secondary-tertiary prevention)
Anticipated problem
Nearby future (primary prevention)
Observed Pain Behaviour
Guarding, bracing, rubbing, grimacing and sighing
Clinical Outcomes
Strength, swelling, range of motion, pain, proprioception, psychological overlay and endurance (muscular)
Functional Outcomes
Power, speed, agility, activity specific, kinesthetic awareness, pain, endurance (muscular and cardiovascular), skill level required for activity, psychological preparedness and daily living skills
Screening process
Early identification of a health problem, not yet diagnosed, through a process that can be quickly executed.
Medical Diagnosis
A 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 facilitating factors for biological and behavioural recovery and adaptation processes within the boundaries of physical therapy.
“Gut Feeling”
The 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 it is not taken by the PT as objective.
Pattern Recognition
“Screening”
Patient Profile
“Patient History”
Personal story of the patient about perceived health problems, in their own language, in its own context, with its own history and with its own dynamics.
Red Flags
The problem is not a musculoskeletal one.
Biomedical risk factors (Serious pathology - Cancer, infection, fracture, etc.) Red flag findings in patient history indicate a need for referral to physician.
Orange
Psychological risk factors (Psychiatric issues - Major depression, schizophrenia, etc.)
Yellow Flags
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.)
Or overlying psychosocial or cognitive risk factors (Distress, anxiety, etc.) Yellow flag findings indicate a more extensive examination may be required.
Blue Flags
Social and economical (work related) risk factors (Job dissatisfaction, lack of support, etc.)
Black Flags
Societal and insurance related factors (Limitations imposed by legislation, conflict with the insurer or workplace)
SMART Goals
Specific, Measurable, Attainable, Relevant, Time
Long-term goals
Related to patients target problem
Short-term goals
Steps taken to meet the long term goal
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
- Contextualisation of patient
- Interview (patient history) + problem list+ hypotheses
- Examination Strategy
- Examination Findings = accept/reject hypothesis
- Goals/Actions to take
- Intervention Strategy
- Reassessment
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
Clinical Reasoning Systems
System 1 = subconscious CR of pattern recognition, quick, narrow view (Exp. Health prof) System 2 = conscious CR which is analytical, slow, systematic, reflective, broad view (Student)
