Clinical decision making Flashcards
the outcomes of clinical reasoning are ?
clinical decisions
what is clinical reasoning?
the synthesis of information based on evidence
includes patient, caregivers, and care team
what are the three pillars of evidence based practice?
best available evidence
clinical expertise
patient or client values
what are systematically developed statements to guide clinicians in using best available clinical evidence in patient’s care?
CPGs
CPGs bridge the gap between ______ and ________
evidence and recommendation
conceptual framework:
- provides _____
- ______ and ______ data
- influences _______
- guides _______
structure
gathers and organizes
decisions
care
conceptual framework is a tool for ______
example?
organization or model used for decision making
ex: ICF model, Schenkman model
true or false. integrated framework for CDM focuses on patient centered care and hypothesis-oriented algorithm for clinicians
true
Why do we use hypothesis in the clinic and in CDM?
helps to determine the relationship between functional limitations and underlying impairment
clarifying the causes of functional movement problems requires the clinician to?
- generate hypothesis (or multiple)
- determine tests and expected outcomes
- perform the tests
- continue generating and testing hypotheses to refine an understanding of the cause
hypothesis-oriented approach of schenkman model is similar to what other model? what step?
hedman model
step 4: treat the problem
(form hypothesis, implement interventions, evaluate outcomes, repeat)
when do you start forming hypotheses for your patient?
chart review
patient interview
what type of screen would you perform for
- MSK
- neuromuscular
- cardiovascular/pulm:
- cognitive ability
- motor screen
- sensory screen
- vital signs
- cognitive screen
motor control is governed by what three factors?
task
environment
individual
Hedman model step 2:
analyze the task. where in the movement continuum does the problem occur?
what are contextual factors of the ICF model that help to interpret clinical information? (5)
environmental factors
personal factors
body functions and structure
activity
participation
what is the difference between a PT diagnosis and medical diagnosis?
PT: includes level of impairment, activity limitation, participation restrictions
med: identification of disease, disorder or condition
what is a prognosis?
predicted optimal level of improvement in function and amount of time needed to reach
helps determine where they can d/c to
list some aspects of motor learning
goal
learning variables
dosing of treatments
practice schedules
altering the environment
feedback education
compensation vs restoration
progressions vs regression
what are the three stages of learning in order to help with deciding when to progress or regress your patient? describe them
- cognitive
- closed environ., massed practice, constant cues & immediate feedback - associative
- open vs closed, high variability, fading cues, delayed feedback - autonomous
- open, random, bandwidth for safety
how do short term goals differ from long term goals?
short term: should be progressible toward similar long term goal
long term: relates to discharge goals
what is the ABCDE model goals should be written as in physical therapy?
actor
behavior
condition
degree
expected time
is the following an example of a short or long term goal for a patient in inpatient rehab:
patient will perform sit to stand in order to transfer out of bed on level surface similar to home independently in 2 weeks
short term goal
what categories of the ICF model does short term goals fall into?
patient’s body function and activity disabilities
what categories of the ICF model does long term goals fall into?
patient’s participation disabilities
true or false. only one discipline of the care team decides on the discharge plan for a patient
false - everyone on the team
what is PTs role in DC planning?
mobility and safety
if the patient is discharged before outcomes are reached, reasons for discontinuation of services must be _____ ________
carefully documented
what are discharge options from acute care setting?
home (with HHPT or support system)
sub acute rehab
inpatient rehab
what is the flow of the schenkman model?
interview history
systems review
exam
diagnosis/prognosis
plan of care interventions
outcome
when is a neuro screen conducted?
during systems review
a neurological screen is a _______ assessment of neurologic aspects of the ______ ______ for patients with suspected neurologic involvement
gross/broad
physical examination
what are you screening for in a neuro screen of someone with a suspected neurological impairment?
sensation
muscle tone, strength
functional movement
coordination
DTRs (clonus)
UMN signs (babinski, hoffman)
why do we perform a neurological screen?
- screen for _____ _____ and for _____
- differential _______
- establish ______
- observe for ______
red flags and referral
diagnosis
baseline
changes
a screen is ______ to rule ____/rule______
an exam is further ______ into a specific _____
quick, in, out
investigation, system
in your screen, you find that your patient experiences sensory changes in their LEs. what is your next step?
go into more testing of light touch, pin prick and determine exact location
should you perform a neuro screen on a patient with no neurologic diagnosis?
no
when should you complete a neuro screen?
if the patient’s S&S or history guide you to dig deeper by choosing portions or all of the exam
flow of a neuro screen:
_____ review
observations & _____ status
systems review
–> ROM/_____/DTR/______
______ nerve screen
functional ______ screen
chart
mental
strength/sensation
cranial
mobility
