L2 - ICF & Patient-centered care

Question 1

What were the 4 divisions of rehab professionals during WW1?
(+responsibilities)

Answer 1

1. Masseuses & masseurs
   - light, heat, hydrotherapy, electrical treatments
2. Muscle function in trainers
   - mm test, active, resisted
3. Occupational therapists
   -basketry, carpentry
4. Sergeants
   - led gym classes

Question 2

When was the Canadian Association of Massage & Remedial Gymnastics founded? What is it called now?

Answer 2

1920. Now the CPA

Question 3

In 1929, the first diploma program for PT for women at _______.

Answer 3

University of Toronto

Question 4

WW2 & _______ increased the need for physiotherapists

Answer 4

poliomyelitis

Question 5

In 1943, the second diploma in PT at ________.

Answer 5

McGill

Question 6

Original PT & OT programs were combined. These were called _______.

Answer 6

POTS

Question 7

When was the first BSc program at McGill (OT & PT separate, first men admitted at UofT?

Answer 7

1954

Question 8

When was the initiation for first graduate program MSc at McGill for PT?

Answer 8

1972

Question 9

When was the first intake for a PhD program at McGill

Answer 9

1988

Question 10

In ______ the CPA Clinical Specialty program began

Answer 10

2011

Question 11

In ______, were the first graduates from Physiotherapy at Mohawk College. In ______ were the first graduates from MSc(PT) at McMaster.

Answer 11

1974, 1992

Question 12

In ______, all PT programs in Canada were required to become masters-entry degrees

Answer 12

2010

Question 13

What was the general & educational evolution of Physiotherapy in Canada?
Hint: ____ –> ____

Answer 13

Technician –> professional
(following doctors’ orders –> making autonomous decisions)

Diploma –> Bachelors –> entry-level Master’s

Question 14

What is the difference between the Medical & Social Model of disability?

Answer 14

Medical Model:
- disability due to condition/ impairment (ex. broken leg, schizophrenia)
- fix the person/ condition

Social Model:
- disability due to the society & environment
- remove barriers in society

Question 15

What does ICF stand for?

Answer 15

International Classification of Functioning, Disability & Health

Question 16

Provide a brief overview of the ICF model

Answer 16

• Universal framework from the World Health Organization (WHO)
• First version: 1980s
• Helps define disability at an individual & population level
• Recognize that a diagnoses alone doesn’t define level of disability
• More comprehensive & holistic view of health & functioning

Question 17

Key Terms such as:

• Health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
• Functioning: “all body functions, activities and participation”
• Disability: “umbrella term for impairments, activity limitations and participation restrictions”

Are part of what framework?

Answer 17

ICF framework

Question 18

What are the 4 principles underlying the ICF?

Answer 18

1. Universality – for everyone
2. Parity – no separation between mental & physical disability
3. Neutrality - neutral language (includes good & bad)
4. Environmental Factors – included for social model of disability

Question 19

What are the domains of the ICF framework? Provide examples.

Answer 19

1. Health Condition: Disorder or disease
2. Body Functions & Structures: Cognitive function, physical function, etc.
3. Activities: Dressing, bathing, etc.
4. Participation: Going to the mall, role as a friend, etc.
5. Environmental Factors: Laws, work, physical space, etc.
6. Personal Factors: Age, race, religion etc.

Question 20

All category points for ICF domains can be considered “problems” for a management plan (SMART goals).
True or False?

Answer 20

False.
Eg. personal factors (age, gender), & some environmental (like having a partner/ support system) are not considered problems.

Question 21

What are the 4 general steps needed to create an effective management plan for a patient?

Answer 21

1. Identify WHAT you would like to achieve, based on your assessment, theory, and evidence.
   - promote health? restore function? maintain function? prevent further deterioration?
2. Identify HOW you want to achieve your goals. Use the evidence to guide you!
   - Prevention? restore function? compensation/ adaptation?
3. Implement treatment
4. Re-evaluate: measure effectiveness, modify plan, or d/c
   (did we achieve it? how effective was the plan? what worked/ didn’t work?)

Question 22

How do you define disability?

Answer 22

• impairment that alter’s person’s ability to participate in environment
• barriers imposed on someone based on environment that impacts their ability to do things
  -visible vs invisible
• not synonymous to disease
• it’s the absence of health

Question 23

Why is the ICF important to use?

Answer 23

• provides context of different levels of variables & barriers that can impact a patient
• standardized model for different care providers to reference when discussing client goals/ challenges, etc.
• Helps HCP to determine environmental factors to keep in mind

Question 24

What is missing from the ICF framework?

Answer 24

• misses a piece of social stigma that comes along with disability
• doesn’t include piece for psychological barriers (not environment or personal factors necessarily)
  ex. fear of doing exercises
• difficult to combine person with multiple conditions/ disabilities, becomes very complex to account for everything
• puts people into categories
• no space for patients goals/ priorities

Question 25

What are the elements of Patient-centered care?

Answer 25

• care is collaborative, coordinated, accessible
  -physical comfort & emotional well-being are top priorities
  -Patient & family viewpoints respected & valued
• Patient & family always included in decisions
• Family welcome in care settings
• Full transparency & fast delivery of information
• Mission & values aligned with patient goals

Question 26

What are some elements of how you can act to ensure the best patient-centered care?

Answer 26

• Listening
• Friendliness
• Empathy
• Clear explanation at appropriate level
• Answering patients’ questions
  (+ providing opportunities to ask & answering honestly)
• Instructions about self-help/exercise/giving alternate options.

Question 27

According to Hamilton Health sciences, what are the 3 behaviours we stand behind?

Answer 27

1. Communicate
2. Collaborate
3. Respond

Question 28

What’s a better way to ask “Any questions?” based on patient-centered practice?

Answer 28

• anything you’re confused about?
• anything you don’t understand?
• anything I can explain better?

“I want to make sure that i’ve helped you understand the findings of my assessment so we can decide on a plan for treatment. patients usually have questions because it can be complicated. Could you tell me what you understand, and then I can help clarify…..?”

Question 29

What’s a better way to say “We’re going to do these exercises to help your shoulder” based on patient-centered practice?

Answer 29

• because your goal was… [mobility] i think it would be beneficial to do XYZ.
• there are many ways to exercise the shoulder…
• is there anything you want to change, do you have any questions/ concerns?

“there are several options to help your shoulder pain. let’s talk about the options, the known risks and benefits and then decide on the approach that makes sense to you. please ask any questions you might have along the way.”

Question 30

According to the CPO, what are the 4 points of Collaborative Care Standard?

Answer 30

1. Responsibility & accountability
2. Collaborating with the patient
3. Collaborating with other relevant service providers
4. Managing collaborative relationships

Question 31

What does CDM stand for?

Answer 31

Clinical Decision-Making Framework

Question 32

Provide an overview of the CDM model.

Answer 32

Theory:
- how to prescribe evidence

Client:
- values & goals
- personal factors
- environmental factors (workplace)

Hypothesis generation/ differential diagnosis:
- What is going on with them that we can help them with?
- what is your hypothesis that is going on with them?
- how do we figure that out?

Assessment:
- impairment, activity limitation, participation, restriction
- outcome measure(s) (psychometrics, interpretability)
- examination, evaluation, diagnosis, prognosis
- therapeutic goals (short term, long term)
- interventions (prevention, restoration, compensation

Evidence:
–> how to ensure we’re collaborating empathy

Re-examination/ Re-evaluation:
–> how are they doing? are we working towards goals? is interpersonal relationship good? are the goals achieved? If i can’t help, maybe someone else can help better

Discharge/ refer on.