A Tool for Clinical Reasoning and Reflection Using the International Classification of Functioning, Disability and Health (ICF) Framework and Patient Management Model

The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104-4399, USA.
Physical Therapy (Impact Factor: 2.53). 03/2011; 91(3):416-30. DOI: 10.2522/ptj.20090226
Source: PubMed


Professional development is a cornerstone of physical therapist practice. As the profession moves toward the ideals of Vision 2020, more emphasis is being placed on the process of clinical decision making. Although reflection and mentorship are widely regarded as important instruments to facilitate the progression of clinical reasoning skills, little guidance exists in the postprofessional arena to assist clinicians with these essential needs. As more organizations develop formal mentoring programs, a need arises for a tool that will engage mentors, protégés, and clinicians of all abilities in thoughtful reflection and discussion that will help develop clinical reasoning skills.
The process of developing reflective clinical decision-making skills in physical therapist practitioners is described, and how this process was used at one institution is illustrated. A tool for clinical reasoning and reflection is proposed that incorporates the existing conceptual frameworks of the Guide to Physical Therapist Practice and the International Classification of Functioning, Disability and Health (ICF).
This case report discusses how the tool was implemented by staff with varying levels of expertise, their outcomes in regard to the development of their clinical reasoning skills, and how the tool facilitated mentoring sessions around patient cases to improve care.
This case report describes a practical application of a postprofessional educational process designed to develop reflective and patient-centered clinical reasoning skills. Although this process has shown some preliminary success, more research is warranted. By cultivating reflective thinking and critical inquiry, the physical therapy profession can help develop autonomous practitioners of physical therapy and promote the ideals of Vision 2020.

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    • "All outcome measures were classified according to domains of the International Classification of Functioning (ICF) [27], in order to provide a clear description of all outcome measures and their inter-relationship. The ICF is multidimensional model of functioning with activities and participation as the key construct. "
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    ABSTRACT: Background Generalized Joint Hypermobility (GJH) has been found to be associated with musculoskeletal complaints and disability. For others GJH is seen as a prerequisite in order to excel in certain sports like dance. However, it remains unclear what the role is of GJH in human performance. Therefore, the purpose of the study was to establish the association between GJH and functional status and to explore the contribution of physical fitness and musculoskeletal complaints to this association. Methods A total of 72 female participants (mean age (SD; range): 19.6 (2.2; 17-24)) were recruited among students from the Amsterdam School of Health Professions (ASHP) (n = 36) and the Amsterdam School of Arts (ASA), Academy for dance and theater (n = 36) in Amsterdam, The Netherlands. From each participant the following data was collected: Functional status performance (self-reported Physical activity level) and capacity (walking distance and jumping capacity: side hop (SH) and square hop (SQH)), presence of GJH (Beighton score ≥4), muscle strength, musculoskeletal complaints (pain and fatigue) and demographic characteristics (age and BMI). Results GJH was negatively associated with all capacity measures of functional status. Subjects with GJH had a reduced walking distance (B(SE):-75.5(10.5), p = <.0001) and jumping capacity (SH: B(SE):-10.10(5.0), p = .048, and SQH: B(SE):-11.2(5.1), p = .024) in comparison to subjects without GJH, when controlling for confounding: age, BMI and musculoskeletal complaints. In participants with GJH, functional status was not associated with performance measures. Conclusion GJH was independently associated with lower walking and jumping capacity, potentially due to the compromised structural integrity of connective tissue. However, pain, fatigue and muscle strength were also important contributors to functional status.
    BMC Musculoskeletal Disorders 07/2014; 15(1):243. DOI:10.1186/1471-2474-15-243 · 1.72 Impact Factor
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    • "Clinical reflection and clinical reasoning are important aspects of a therapist's professional skill development. However, there is often little or no structure as to how this complex process can be achieved [31]. The data acquired from the sensing array can definitely be used to augment the therapists observation and assessment. "
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    ABSTRACT: This paper describes the outcomes of a clinical study to assess the validity of a stand-alone sensor package and algorithms to aid the assessment by an occupational therapist (OT) whether a person has the capacity to safely and effectively operate a powered mobility device such as a wheelchair in their daily activities. The proposed solution consists of a suite of sensors capable of inferring navigational characteristics from the platform it is attached to (e.g. trajectories, map of surroundings, speeds, distance to doors, etc). Such information presents occupational therapists with the ability to augment their own observations and assessments with correlated, quantitative, evidence-based data acquired with the sensor array. Furthermore, OT reviews can take place at the therapist's discretion as the data from the trials is logged. Results from a clinical evaluation of the proposed approach, taking as reference the commonly-used Power-Mobility Indoor Driving Assessment (PIDA) assessment, were conducted at the premises of the Prince of Wales (PoW) Hospital in Sydney by four users, showing consistency with the OT scores, and setting the scene to a larger study with wider targeted participation.
    IEEE International Conference on Rehabilitation Robotics : [proceedings] 06/2013; 2013:1-8. DOI:10.1109/ICORR.2013.6650452
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    ABSTRACT: Sexual violence has been identified as one of the most common predictors of posttraumatic stress disorder (PTSD). This case report describes the emergence of delayed PTSD symptoms, disclosure of history of sexual trauma, and the influence of re-experiencing, avoidance, and hyperarousal symptoms on physical therapy treatment. A 60-year-old woman was seen for treatment of low back pain. of a discord between fear of falling and no balance impairments led to disclosure of sexual assault by a physician at 19 years of age. The patient's PTSD symptoms emerged after 10 weeks of physical therapy. The physical therapists monitored somatic responses and body language closely and modified and planned treatment techniques to avoid PTSD triggers and limit hyperarousal. Collaborative communication approaches included reinforcement of cognitive-behavioral strategies introduced by her psychotherapists. Trauma-cognizant approaches supported the patient's efforts to manage PTSD symptoms sufficiently to tolerate physical therapy and participate in a back care class. Nonlinear psychological healing is illustrated. Symptoms of PTSD may emerge during physical therapy treatment, and patient-sensitive responses to disclosure are important. The trauma-cognizant approach (2-way communication, patient-centered management, and integration of psychological elements into clinical decision making) helped identify and respond to triggers. The physical therapists reinforced cognitive-behavioral strategies introduced by psychotherapists to manage PTSD symptoms. Patient-centered care with further refinement to a trauma-cognizant approach may play an important role in assisting patients with PTSD or a history of sexual trauma to manage symptoms while addressing rehabilitation needs.
    Physical Therapy 12/2011; 92(2):339-51. DOI:10.2522/ptj.20100344 · 2.53 Impact Factor
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