PHTY102 Lecture Notes - Lecture 10: Knee Replacement, Patient Participation, Physical Therapy
PHTY week 10 Clinical Reasoning
Clinical Decisions in Physiotherapy
- Who needs treatment and why?
- What are the expected outcomes of intervention?
- How should outcomes be measured and documented?
- What intervention, instructions, services, etc. are necessary to meet these
outcomes?
- How should the patient/caregivers be included in the decision-making process?
- How should be ‘success’ of the intervention be measured?
What is clinical reasoning?
- The decision-making process used to determine the diagnosis and management of
patient’s problems
- The thinking and decision-making associated with clinical practice that enables
therapists to take the best-judged action for individual patients
- Related terms clinical decision-making, problem solving, professional judgement
Clinical Reasoning
- The sum of the thinking and decision-making processes associated with clinical
practice
What is clinical reasoning?
- The who, what, when, why, how’s of physiotherapy practice
- What questions do you need to ask?
- Where are the client’s major problems?
- What assessment(s) need to be done? Is there a diagnosis/prognosis?
- What is the client hoping to gain from intervention?
- Do you know enough at this point to help this client?
- What physiotherapy intervention will be appropriate?
- Do you need to seek advice from a colleague?
- Do you need to find more information from research, texts, etc.?
- Clinical reasoning in physiotherapy is more appropriately viewed as a process of
making decisions that are optimal given the situation and circumstances rather than
as a single ‘right’ process to be enacted regardless of context
- Text/journals/research knowledge may be insufficient to solve a problem
Why is Clinical Reasoning important?
- Effective clinical reasoning and its communication are essential to health
professional practice
- Increasing legal requirements for comprehensive, relevant and appropriate
information exchange between health professionals and patients (including their
caregivers)
find more resources at oneclass.com
find more resources at oneclass.com
- Drive for active consumer involvement collaborative decision-making patient-
centred care
- Health professionals are accountable for their decisions and service provision to
patients, health sector managers, policy-makers and colleagues
- Goal of clinical reasoning is wise action, ie. Making the best judgement in a specific
context
Models of Clinical Reasoning
- Hypothetico-deductive
oHypothesis = provisional diagnosis
oOngoing process of data acquisition, interpretation, hypothesis generation
and evaluation continuous cycle
- Pattern recognition
oHappens with more experienced practitioners
- Narrative
oPersonal interaction with patients
oUnderstanding how their social history maps in with them
Hypothetico-deductive Model
- Most common clinical reasoning model
- Hypothetico-deductive or diagnostic reasoning clinician generates hypothesis
based on data from patient history taking, physical examination, medical test
- Data tested, further hypotheses generated until management pathway clearly
defined
- Quantitative investigation
Pattern recognition Model
- Clinician associates problems of current patient with previously seen clinical
problems adopts a previously-successful management strategy
- Drawing upon existing practice-based knowledge
- Typical clinical presentations
- Downside decisions may be made on poor knowledge base
Narrative Model
- Process of enquiry, examination and reflective management
- Clinician attempts to understand patient’s problem, perspective, and the context of
problem
- Collaborative reasoning between patient and clinician, effective communication by
the clinician, and on-going reasoning until a plan of management is agreed upon
- Interpretive or qualitative investigation
Clinical reasoning in physiotherapy practice
- Assessment physical examination of impairment, activity, participation parameters
- Diagnosis working hypothesis – not static
- Treatment planning what does the patient/client want?
- Implementation and evaluation (outcome measures) of treatment
- Prognosis based on previous experience with the condition
International Classification of Functioning, Disability and Health (ICF)
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
The decision-making process used to determine the diagnosis and management of patient"s problems. The thinking and decision-making associated with clinical practice that enables therapists to take the best-judged action for individual patients. Related terms clinical decision-making, problem solving, professional judgement. The sum of the thinking and decision-making processes associated with clinical practice. The who, what, when, why, how"s of physiotherapy practice. Do you need to find more information from research, texts, etc. Clinical reasoning in physiotherapy is more appropriately viewed as a process of making decisions that are optimal given the situation and circumstances rather than as a single right" process to be enacted regardless of context. Text/journals/research knowledge may be insufficient to solve a problem. Effective clinical reasoning and its communication are essential to health professional practice. Increasing legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) Drive for active consumer involvement collaborative decision-making patient- centred care.
