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concepts that drive physical therapist practice
ICF/biopsychosocial model
social determinants of health
movement system
evidence-based practice
quality assessment and outcomes
professional values
internation classification of functioning, disability, and health
a way to describe functioning of an individual to allow for identification of a health status and needs of an individual or population
international classification of diseases
common way to categorize people receiving health care by their disease to allow for systematic recording, analysis, interpretation, and comparison of morbidity and mortality data
ICF
components of health classification
each person is effected differently by injury / recovery
interplay with biopsychosocial model
considers impact of environment
ICF model flow chart
functioning and disability exist along a continuum of health
many steps between functioning and disabled
*discuss what body can and cannot do
what guides our interactions
dynamic systems
health and wellness model
body functions
physiological functions of body systems (including psychological functions)
body structures
anatomical parts of the body such as organs, limbs, and their components
impairments
problems in body function or structure such as a significant deviation or loss
activity
execution of a task or action by an individual
participation
involvement in a life situation
activity limitations
difficulties an individual may have in executing activities
participation restrictions
problems an individual may experience in involvement in life situations
environmental factors
make up the physical, social, and attitudinal environment in which people live and conduct their lives
social determinants of health
education access and quality
health care access and quality
economic stability
social and community context
neighborhood and built environment
the movement system
integration of body systems that generate and maintain movement at all levels of bodily function
what is the primary way people interact and engage with their world
movement is the primary way people interact and engage with their world
our work is to optimize that movement and allow participation
parts of evidence based practice
best available evidence
clinical expertise
patient or client values and circumstances
guiding documents for physical therapists
core values
code of ethics
standards of practice
list of core values for the PT
accountability
altruism
collaboration
compassion and caring
duty
excellence
inclusion
integrity
social responsibility
what is the purpose of the core values
guide the behavior of PTs to provide highest quality of PT services
code of ethics for the PT
respect the inherent dignity and rights of all individuals
be trustworthy and compassionate in addressing the rights and needs of patients and clients
be accountable for making sound professional judgments
demonstrate integrity in relationships with patients, families, colleagues, students, etc
fulfill their legal and professional obligations
enhance their expertise through life long acquisition and refinement of knowledge, skills, abilities, and professional behaviors
promote organizational behaviors and business practices that benefit patients and society
participate in efforts to meet health needs of people locally, nationally, and globally
standards of physical therapy practice
ethical / legal considerations
administration of PT service
patient / client management
education
advocacy
research
community responsibility
what else is defined in the guide
role of PT: through lifespan
description of PT workforce
career advancement opportunities: clinical specialization, residency / fellowship, advanced practice
what does the physical therapist do in order to manage
-develops plan of care / management plan
-retains accountability for plan of care
-defines boundaries within which others assisting with service delivery operate
-always has option to perform all elements or to direct and supervise PTAs and techs
-shares info about the management plan with the individual’s provider as indicated
episode of care
the care provided for a specific health condition or conditions in a set period of time
what does an episode of care consist of
visits
-can be short, continual, or series of intervals of care
what must an episode be
provided by a PT or PTA
provided in an unbroken sequence (open plan of care)
related to management of given condition or problem
parts of patient client management model
**CYCLE
examination
evaluation
diagnosis
prognosis / plan of care
intervention
outcomes
review of systems
information relevant to major body systems that suggest the need for referral for additional medical evaluation
informs the physical examination
**always comes in subjective history
systems review
brief examination of major body systems for concerns
sometimes called screening
cardiovascular / pulmonary, integumentary, and neuromuscular systems
communication abilities
movement
clinical measures (can have a range)
diagnostic tests
should you start examination task or impairment oriented
can be either
task oriented examination
screening by functional abilities
ex: can you roll to one side in bed?
what is goal of task oriented examination
figure out what impairment testing you need to do after observing the functional task
determine what is different and what to test next / how to fix it
impairment oriented examination
how can a PT examine impairments
ex: if in a bed, can they lift legs off the surface of the bed?
what is the goal of impairment oriented examination
find what functional examination or task do we need to observe after impairment testing
why do we complete a screen
assists with:
predicting level of assistance needed from the PT to perform a functional task
determining where to focus time and energy with examination
reexamination
includes the application of selected items from the history and physical examination and comparing them to initial examination findings
may be indicated more than once during a single episode of care and often is performed over the course of a disease / condition
can be used to see how progression is going
evaluation
interpretation and synthesis of the findings from the examination in order to
establish a DIAGNOSIS
determine a PROGNOSIS (which includes goals)
develop a MANAGEMENT PLAN / PLAN OF CARE
REFER or CONSULT with another health care provider if indicated
diagnosis
used to encompass the signs and symptoms
with proper conclusion, a management plan and intervention can be pursued
3 major categories of diagnosis
ICD-10
ICF
movement systems
PT diagnosis versus Medical diagnosis
PT: right ankle pain with inability to weight bear. signs and symptoms consistent with a fracture of the right ankle
medical: trimalleolar fracture of right ankle
prognosis
predicted optimal level of improvement
-do this all the time when we write goals
-can be influenced by contextual factors (how often they can come in)
what should every goal be
measurable
functionally driven
time limited
plan of care
part of management care that includes
-goals
-predicted level of optimal improvement (prognosis)
-interventions to be used (including duration and frequency of interventions)
-summary of plan for referral, consultation, co-management
intervention
the things you do throughout your plan of care and during each visit
-educational and procedural
outcomes
the results of implementing the management plan and indicate an impact on functioning
did it work? how do you know?