An integrated framework for decision making in neurologic physical therapist practice.
Decision-making frameworks are used by clinicians to guide patient management, communicate with other health care providers, and educate patients and their families. A number of frameworks have been applied to guide clinical practice, but none are comprehensive in terms of patient management. This article proposes a unifying framework for application to decision making in the management of individuals who have neurologic dysfunction. The framework integrates both enablement and disablement perspectives. The framework has the following attributes: (1) it is patient-centered, (2) it is anchored by the patient/client management model from the Guide for Physical Therapist Practice, (3) it incorporates the Hypothesis-Oriented Algorithm for Clinicians (HOAC) at every step, and (4) it proposes a systematic approach to task analysis for interpretation of movement dysfunction. This framework provides a mechanism for making clinical decisions, developing clinical hypotheses, and formulating a plan of care. Application of the framework is illustrated with a case example of an individual with neurologic dysfunction.
Schenkman
Margaret
M
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262, USA. margaret.schenkman@uchsc.edu
Deutsch
Judith E
JE
Gill-Body
Kathleen M
KM
D000465:Algorithms; D003657:Decision Making; D006801:Humans; D008959:Models, Neurological; D009422:Nervous System Diseases / Q000628:therapy*; D026761:Physical Therapy Specialty / Q000458:organization & administration*; D013647:Task Performance and Analysis