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.
    Full-text · Article · Jul 2014 · BMC Musculoskeletal Disorders
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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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    No preview · Article · Dec 2011 · Physical Therapy
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