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LEARNING OBJECTIVES

LEARNING OBJECTIVES

  1. Define clinical reasoning and identify factors that affect clinical decision making.

  2. Identify the components of the International Classification of Functioning, Disability, and Health.

  3. Describe the key steps in the patient/client management process.

  4. Define the major responsibilities of the physical therapist in planning effective treatments.

  5. Identify potential problems that could adversely affect the physical therapist’s clinical reasoning.

  6. Discuss strategies to ensure patient participation in developing the plan of care (POC).

  7. Identify key elements of physical therapy documentation.

  8. Discuss the importance of evidence-based practice in developing the POC.

  9. Discuss the importance of clinical practice guidelines (CPGs).

  10. Analyze and interpret patient/client data, formulate realistic goals and outcomes, and develop a POC when presented with a clinical case study.

CLINICAL REASONING/CLINICAL DECISION MAKING

Clinical reasoning is a multidimensional, non-linear 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 in order 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 decision making, including the clinician’s goals, knowledge base and expertise, psychosocial skills, problem-solving strategies, and procedural skills. Decision making is also influenced by patient/client characteristics, including goals, values, and beliefs; physical, psychosocial, educational, and cultural factors; and overall resources, time, and level of financial and social support.

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 by the World Health Organization (WHO). For example, the 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). Frameworks can be specific to the profession. In physical therapist practice, the Guide to Physical Therapist Practice is organized using the patient management system and more recently incorporating the ICF.

Physical therapists practice in a variety of clinical environments, including acute, rehabilitation, and chronic care facilities. Therapists have many different roles in these settings, including direct patient care and case management as a member of a collaborative team, with referral to and consultation with other providers and supervision of personnel (e.g., physical therapist assistants, other support staff). Decision making is influenced by interaction and involvement of other providers,1 as depicted in Figure 1.1. Decision making is also influenced by the clinical practice environment. In primary care, therapists provide integrated, accessible health care services that address a large majority of personal health care needs, develop a sustained partnership with patients, and practice within the context of family and community. Primary care is also provided in school, industrial, or workplace settings.

Figure 1.1

Physical therapist decision ...

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