title: Clinical reasoning and advanced practice privileges enable physical therapist point-of-care decisions in the military health care system: 3 clinical cases.
abstract: OBJECTIVE
  Physical therapists frequently make important point-of-care decisions for musculoskeletal injuries and conditions. In the Military Health System (MHS), these decisions may occur while therapists are deployed in support of combat troops, as well as in a more traditional hospital setting. Proficiency with the musculoskeletal examination, including a fundamental understanding of the diagnostic role of musculoskeletal imaging, is an important competency for physical therapists. The purpose of this article is to present 3 cases managed by physical therapists in unique MHS settings, highlighting relevant challenges and clinical decision making.
  
  
  METHODS
  Three cases are presented involving conditions where the physical therapist was significantly involved in the diagnosis and clinical management plan. The physical therapist's clinical privileges, including the ability to order appropriate musculoskeletal imaging procedures, were helpful in making clinical decisions that facilitate timely management. The cases involve patients with an ankle sprain and Maisonneuve fracture, a radial head fracture, and a pelvic neoplasm referred through medical channels as knee pain.
  
  
  RESULTS
  Clinical pathways from point of care are discussed, as well as the reasoning that led to decisions affecting definitive care for each of these patients. In each case, emergent treatment and important combat evacuation decisions were based on a combination of examination and management decisions.
  
  
  CONCLUSIONS
  Physical therapists can provide important contributions to the primary management of patients with musculoskeletal conditions in a variety of settings within the MHS. In the cases described, advanced clinical privileges contributed to the success in this role.
authors: Department of Physical Medicine & Rehabilitation, Madigan Army Medical Center, Fort Lewis, Washington 98431, USA. daniel.rhon@us.army.mil
authors: Daniel I
authors: DI
authors: Rhon
authors: Gail D
authors: GD
authors: Deyle
authors: Norman W
authors: NW
authors: Gill
mesh_terms: D000058:Accidental Falls; D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis / Q000628:therapy; D001859:Bone Neoplasms / Q000175:diagnosis / Q000628:therapy; D019091:Critical Pathways; D003657:Decision Making; D003952:Diagnostic Imaging; D005260:Female; D005360:Fibula / Q000293:injuries; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008889:Military Personnel; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000628:therapy*; D018317:Nerve Sheath Neoplasms / Q000175:diagnosis / Q000628:therapy; D059825:Physical Therapists; D024382:Professional Role; D011885:Radius Fractures / Q000175:diagnosis / Q000628:therapy