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LEARNING OBJECTIVES
Describe an integrated framework for making clinical decisions and identify factors that affect clinical decision-making.
Describe the International Classification of Function (ICF) and its relationship to physical therapy.
Describe the key steps in the Guide to Physical Therapist Practice of the patient/client management process.
Map a participation goal into its relevant activities (ICF) and tasks (movement science).
Explain the role of movement observation of tasks in physical therapist examination.
Discuss strategies to promote shared decision-making to develop goals and the plan of care (POC).
Identify potential problems that could adversely affect the physical therapist's clinical decision-making.
Identify key elements of physical therapy documentation.
Discuss the importance of evidence-based practice in examination and developing the POC.
Analyze and interpret patient/client data, formulate realistic goals and outcomes, and develop a POC when presented with a clinical case.
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CLINICAL REASONING AND CLINICAL DECISION-MAKING
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Clinical reasoning refers to the thinking and decision-making processes that are used in clinical practice.1 Reasoning is a context-dependent way of thinking and making decisions in professional practice to guide practice actions.2 It is a multidimensional, nonlinear cognitive process that involves synthesis of information and collaboration with the patient, caregivers, and health-care team. The clinician integrates information about the patient, the task, and the setting to reach decisions and determine actions in accordance with best available evidence. Clinical decisions are the outcomes of the iterative clinical reasoning process and form the basis of patient/client management. Numerous factors influence a clinician's decision-making, including their goals, knowledge base and expertise, psychosocial skills, problem-solving strategies, and procedural skills.
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Decision-making is a shared process between the clinician and patient. Each of them brings their characteristics including their beliefs and biases, preferences, and values. The agreed upon goals between the therapist and the patient will be influenced by physical, psychosocial, educational, and cultural factors and overall resources, time, and level of financial and social support.
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Frameworks and models may be used to organize the clinical reasoning process. Those frameworks may change over time based on the evolution of the field of physical therapy or the conceptualization of health. For example, the World Health Organization (WHO) used a disablement model (the International Classification of Impairments, Disabilities, and Handicaps [ICIDH]) that evolved into an enablement model called the International Classification of Functioning and Health (ICF).3 This resulted in changes in vocabulary and perspectives on how to view health (e.g., the term disease was replaced with health condition). Frameworks can be specific to the profession. In physical therapist practice, the American Physical Therapy Association's (APTA) Guide to Physical Therapist Practice is organized using the patient management system. In its third edition,4 the APTA changed from using the Nagi disablement model5 to using the enablement model of the ICF.6 Algorithms are also used to guide decision-making. Physical therapy–specific algorithms include the Hypothesis-Oriented Algorithm for Clinicians (HOAC) ...