Clinical Reasoning Flashcards
Clinical reasoning
Thinking and decision-making process associated with practice
Wise action
Making the best decision with in a specific context
Three components of the physical therapy context
therapist perspectives patient’s perspective external environment
Hypothetico-deductive inquiry
Process where clinician initially farms multiple generalized hypotheses that guide subsequent questioning and examination
Pattern recognition
Compare patient problem with expected patterns of diagnosis familiar to clinician
Components of clinical patterns
Symptom distribution, potential sources of symptoms, behavior of symptoms, responses to particular types of treatment, predisposing and contributing factors, prognosis, and other related information
Australian approach
Provides a template for organization of patient information with an emphasis on signs and symptoms that helps develop critical patterns that are clinically relevant and therefore more accessible for future encounters.
Hypotheses categories.
Steps of clinical reasoning model
Initial impressions, multiple generalized hypotheses, collect data based on individual patient presentation, interpret data/make measures fit, dx and management decision, asses, intervention, reasses
Make features fit
Incorporate previously unrecognized variations into existing clinical patterns
Maitland concept
PATIENT CENTERED: Focused on patient’s perspectives,Body’s ability to inform, Good communication skills, effective inquiry. Superior manual skills, pt specific physical exam,
Analytical assessment
Clinical reasoning (most important in promoting effective management of patients and counters)
Patient centered communication
Understanding the patient’s perspective including psychosocial issues
Factors influencing clinical reasoning
Knowledge cognition and self-monitoring,
Knowledge types
Facts, procedures(exam/tx), concepts(severity,stability,irritability), principles(rationale), and clinical pattern presentations(knowledge)
Participation restrictionsHypotheses
Inability to perform or a limitation in the performance of actions, tasks, and activities
Activity limitations Hypotheses
Restriction of the ability to perform a physical action task or activity in an efficient, typically expected, competent manner
Impairment hypotheses
Any Loss or abnormality of anatomical, physiological, mental, or psychological structure
Contributing/predisposing factors hypotheses
Any factors involved in the development or maintenance of the patient’s problem including environmental, emotional, physical and or biomechanical factors
Precautions and contraindications hypotheses
Determine the extent of physical examination that may be perform safely
Management and treatment hypotheses
Facilitated by clues gained in analysis of patients main problem, site of symptoms, behaviors symptoms, precautionary questions, On set and progression, mechanism of injury, past treatment and effect, pain threshold, personality, physical exam and ongoing management
Prognosis hypotheses
Whether or not the patients presentation will respond to physical therapy and an estimate of time frame within recovery can be expected
Unfavorable vs favorable findings
Mechanical versus inflammatory presentation, irritability, ability to centralize symptoms with repeated movement, degree of potential damage/injury to tissue, Length of history and progression, pre-existing disorders, patients personality and lifestyle
Metacognition
Self-monitoring. Clinicians awareness and ability to think about her thinking
Cognition
Thinking processes such as data analysis, inquiry strategies and hypothesis testing
