title: Practical use of the HOAC II for clinical decision making and subsequent therapeutic interventions in an elite athlete with low back pain.
abstract: METHODS
  Resident's case problem.
  
  
  BACKGROUND
  This case report describes the diagnostic process, based on the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II), and subsequent interventions in an elite athlete with subacute low back pain. It also demonstrates the clinical application of the HOAC II and shows how disablement terms, as used in the World Health Organization's International Classification of Functioning, Disability and Health model, can be integrated into patient management in a manner that we believe enhances clinical practice. It also demonstrates the practical use of validated questionnaires and how these can be used to gather necessary information for the algorithm.
  
  
  METHODS
  A structured, evidence-based assessment led to a multifaceted, activity limitation-based diagnosis of being unable to (1) remain in a deep squat position during speed skating, (2) accelerate in turns while speed skating, and (3) rise from a slouched position without pain. We believed that these dysfunctions were due to local limited lumbar segmental mobility, concurrent with an inability to properly and functionally stabilize the lumbopelvic area.
  
  
  CONCLUSIONS
  The HOAC II requires the therapist to develop an evidence-based strategy for the examination that is based on initial hypotheses developed from the medical history and other data obtained prior to the examination. The examination was tailored to identify and quantify activity limitations and participation restrictions that we believed could help to explain why this patient had his health problem. The case demonstrates how all elements of the HOAC II can be used for what we consider to be relatively common types of patients. We believe that by applying the HOAC II on an individual-patient basis, therapists will be ideally positioned to apply evidence to patient care and to defend their interventions to colleagues and third-party payers.
  
  
  METHODS
  Differential diagnosis, level 4.
authors.affiliation: Centre for Education in Musculoskeletal Therapies SOMT, Amersoort, The Netherlands. erikthoomes@gmail.com
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Thoomes
authors.forename: Maarten S
authors.initials: MS
authors.lastname: Schmitt
mesh_terms: D000328:Adult; D000465:Algorithms; D056352:Athletes; D003657:Decision Making; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D026201:Musculoskeletal Manipulations; D010147:Pain Measurement; D010808:Physical Examination; D012861:Skating / Q000502:physiology