HOAC II / HOPFA

Question 1

HOAC II / HOPFA

Answer 1

Hypothesis-Oriented Algorithm for Clinicians II (HOAC-II)

Question 2

Hypothesis:

Answer 2

“a supposition or proposed explanation made on the basis of limited evidence as a starting point for further investigation.”

Question 3

Algorithm:

Answer 3

“a process or set of rules to be followed in calculations or other problem-solving operations, especially by a computer.”

Question 4

HOAC II:

Answer 4

> Guide for decision making and clinical reasoning

> Documentation guide

> Compatible with The Guide (PCMM)

> Applied to any health condition or age or setting

> A tool for communication, not only process

Question 5

HOAC II KEY FEATURE:

Answer 5

Prevention

Question 6

HOAC II- a need for what?

Answer 6

> based on the notion that PTs can make diagnoses (functional)

> Holistic biopsychosocial approach (ICF)

> State of the field: clinical practice guidelines

Question 7

Bottomline- key concepts in HOAC II

Answer 7

> Prevention (i.e. risk factors)

> Patient-centered clinical decision making

> Evidence-based practice

> A problem is always a functioning deficit

Question 8

Types of Problems:

Answer 8

> Existing or current problems = require remediation

> Anticipated problems = require prevention

> A distinction must be made between the two because they lead to different clinical management and assessment of outcomes

Question 9

Two ways to identify problems

Answer 9

PIPs (existing or anticipated)

NPIPs (existing or anticipated)

Identification can be theory-based or evidence / data based***

Hypothesis will be generated to guide intervention

Question 10

PIPs (existing or anticipated) =

Answer 10

Functional limitations and disabilities (think of ICF)

Can be an existing problem or an anticipated problem

Question 11

NPIPs (existing or anticipated)

Answer 11

Can be from a family member (e.g. Cerebral palsy, stroke)

Typically from a heathcare provider (i.e. PT)

Question 12

PIPs and NPIPs combined

Answer 12

Who the source of the problem at this point does not matter

What matters is how to manage existing problems and anticipated problems because approach to each would be different and would be re-assessed separately later

Question 13

PIPs are generated ___ the examination

___ problems are generated later

Answer 13

BEFORE
Combined

Question 14

HOAC II- part 1
Has the 5 elements of the PCMM:

Answer 14

exam, eval, diagnosis, prognosis, intervention

Question 15

HOAC II- part 1

Answer 15

1. Collect initial data (including history)
2. Generate a PIPs list stop… and think!
3. Formulate examination strategy
4. Conduct the examination and analyze the data
5. Add NPIPs to problem list (existing and anticipated)
6. Refine problem list stop… and think!

Question 16

1. Collect initial data (including history):

Answer 16

-hypothesis generation and testing is implicit

-experience differs between novice and experienced in hypothesis making

-does not specify what type of info needs to be collected, depends on clinician but needs to generate PIPs before exam

Question 17

3. Formulate examination strategy:

Answer 17

requires a working hypothesis

Question 18

4. Conduct the examination and analyze the data:

Answer 18

-the examination approach must be dependent on the hypothesis

-accept or refute hypothesis

Question 19

5. Add NPIPs to problem list (existing and anticipated):

Answer 19

-done after the exam stop… and think!

Question 20

6. Refine problem list stop… and think!

Answer 20

• Elimination of problem vs. modification of problem

Question 21

HOAC- II
Generating hypothesis:

Answer 21

Justification for hypothesis (existing problems and anticipated problems)

PTs must know why the problems exist (need to know testing/diagnostic criteria and risk factors)

Must have a rationale for each anticipated problem that will occur unless there is intervention of the risk factors

Question 22

Rationale can be from:

Answer 22

-Evidence-based (preferred)

-Theory-based

Question 23

Problems:

Answer 23

Establish one or more goals for each problem

Goals must be in terms of functional activities (think ICF)

STG and LTG

Goals must not be impairment oriented but rather functioning-oriented

Question 24

Establish a plan:

Answer 24

to reassess testing and predictive criteria

to assess problems and goals

Intervention must be specific to the problem (existing and anticipated)

Strategies vs tactics

Question 25

Why is pediatrics unique?

Answer 25

child's family age developmental level environment

Question 26

Hypothesis-Oriented Pediatric Focused Algorithm:

Answer 26

Step 1a: Initial hypothesis Step 1b: Anticipate impairments Step 2: Initial data collection Step 3: problem statement Step 4: hypothesize goals Step 5: examination planning Step 6: examination Step 7: evaluation Step 8: diagnosis and prognosis Step 9: general intervention planning Step 10: intervention session planning Step 11: reflection Step 12: formal re-examination

Question 27

Step 1a: Initial hypothesis

Answer 27

Consider child’s chronological age, anticipated gross motor function Also the social, educational, and family activities Think broadly of the ICF Example of activities to consider: - later preschool -> early elementary (play dates) - organized team sports

Question 28

Step 1b: Anticipate impairments

Answer 28

Anticipate primary and secondary impairments associated with medical dx ex) Spina bifida -> lack of sensation Down syndrome -> cardiac problems Spastic quadriplegia cerebral palsy -> feeding issues

Question 29

Step 2: Initial data collection

Answer 29

-review of available medical and educational records -patient/family interview, their goals and expected outcomes -patient/family behavior during the interview

Question 30

Step 3: problem statement

Answer 30

Answer the question: “Why is the family seeking services for their child”

Question 31

Step 4: hypothesize goals

Answer 31

Hypothesize STG and LTG to guide the examination process Engage family in goal development hypothesized goals are not necessarily the goals that ultimately will be written into a plan of care The hypothesized goals only help prioritize the tests and measures used in the hands-on examination process

Question 32

Step 5: examination planning

Answer 32

Use the ICF or the appropriate ICF Core Sets for pediatrics Measures are heavy on the activities and participation domain STOP and THINK

Question 33

Step 6: examination

Answer 33

STOP and THINK

Question 34

Step 7: evaluation

Answer 34

Synthesize and interpret data collected from exam Consider contextual factors

Question 35

Step 8: diagnosis and prognosis

Answer 35

Specific movement dysfunction Functioning based Need for referral or co-referral to other professionals? Child’s needs related to wellness and prevention Adaptive equipment needs due to growth “If PT concludes that the child has reached capacity for physical function and that the child’s needs related to wellness and prevention are being met, PT interventions are not indicated, and a plan or care would not be developed for.”

Question 36

Step 9: general intervention planning

Answer 36

strategy

Question 37

Step 10: intervention session planning

Answer 37

tactics