HOAC II / HOPFA Flashcards
HOAC II / HOPFA
Hypothesis-Oriented Algorithm for Clinicians II (HOAC-II)
Hypothesis:
“a supposition or proposed explanation made on the basis of limited evidence as a starting point for further investigation.”
Algorithm:
“a process or set of rules to be followed in calculations or other problem-solving operations, especially by a computer.”
HOAC II:
> 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
HOAC II KEY FEATURE:
Prevention
HOAC II- a need for what?
> based on the notion that PTs can make diagnoses (functional)
> Holistic biopsychosocial approach (ICF)
> State of the field: clinical practice guidelines
Bottomline- key concepts in HOAC II
> Prevention (i.e. risk factors)
> Patient-centered clinical decision making
> Evidence-based practice
> A problem is always a functioning deficit
Types of Problems:
> 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
Two ways to identify problems
PIPs (existing or anticipated)
NPIPs (existing or anticipated)
Identification can be theory-based or evidence / data based***
Hypothesis will be generated to guide intervention
PIPs (existing or anticipated) =
Functional limitations and disabilities (think of ICF)
Can be an existing problem or an anticipated problem
NPIPs (existing or anticipated)
Can be from a family member (e.g. Cerebral palsy, stroke)
Typically from a heathcare provider (i.e. PT)
PIPs and NPIPs combined
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
PIPs are generated ___ the examination
___ problems are generated later
BEFORE
Combined
HOAC II- part 1
Has the 5 elements of the PCMM:
exam, eval, diagnosis, prognosis, intervention
HOAC II- part 1
- Collect initial data (including history)
- Generate a PIPs list stop… and think!
- Formulate examination strategy
- Conduct the examination and analyze the data
- Add NPIPs to problem list (existing and anticipated)
- Refine problem list stop… and think!
- Collect initial data (including history):
-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
- Formulate examination strategy:
requires a working hypothesis
- Conduct the examination and analyze the data:
-the examination approach must be dependent on the hypothesis
-accept or refute hypothesis
- Add NPIPs to problem list (existing and anticipated):
-done after the exam stop… and think!
- Refine problem list stop… and think!
- Elimination of problem vs. modification of problem
HOAC- II
Generating hypothesis:
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
Rationale can be from:
-Evidence-based (preferred)
-Theory-based
Problems:
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
Establish a plan:
to reassess testing and predictive criteria
to assess problems and goals
Intervention must be specific to the problem (existing and anticipated)
Strategies vs tactics
Why is pediatrics unique?
child’s family
age
developmental level
environment
Hypothesis-Oriented Pediatric Focused Algorithm:
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
Step 1a: Initial hypothesis
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
Step 1b: Anticipate impairments
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
Step 2: Initial data collection
-review of available medical and educational records
-patient/family interview, their goals and expected outcomes
-patient/family behavior during the interview
Step 3: problem statement
Answer the question: “Why is the family seeking services for their child”
Step 4: hypothesize goals
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
Step 5: examination planning
Use the ICF or the appropriate ICF Core Sets for pediatrics
Measures are heavy on the activities and participation domain
STOP and THINK
Step 6: examination
STOP and THINK
Step 7: evaluation
Synthesize and interpret data collected from exam
Consider contextual factors
Step 8: diagnosis and prognosis
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.”
Step 9: general intervention planning
strategy
Step 10: intervention session planning
tactics
