Intro to UQ Eval

Health Condition

Disease, disorder, injury, or trauma and may include other circumstances (etiology, aging, stress, congenital anomaly, genetics)

Body Functions

Physiological functions of body systems including psycho

Body structures

anatomical parts of the body such as organs, limbs, and components.

Impairments

problems an individual may have in body structure or function (abnormal tests and measures in objective)

Activity

execution of a task or action by an individual; cognitive and learning, comm, functional mobility, and ADL skills

Participation

an individuals’ involvement in a life situation (societal perspective of functioning)

Environmental factors

Physical, social, attitudinal factors where a person lives and conducts their lives (transportation, relationships with doctors, attitudes with life)

Personal factors

Gender, age, coping, background, education, profession, behavior pattern, character (how disability is influenced)

What are the components of the patient management model?

Examination, evaluation, diagnosis, prognosis, intervention, outcomes

Examination

ID and defining pts impairments, limitations, restrictions, and resources available to determine intervention (S - chart review and pt interview, O - systems review, tests, measures)

Evaluation

Analysis of data gathered from examination to develop problem list (referral or plan of care)

ID causal relationship between impairment, limitations, restrictions

Diagnosis

reflection of the professional body of knowledge, expertise, and clinical reasoning of the PT

PT dx (refers to impairment, limitation, restriction level) and Medical dx (ID disease, disorder, condition at tissue level)

PT vs Medical dx

PT: L shoulder movement coordination deficit characterized by scapular dyskinesis resulting in subacromial pain during OH activity

Medical: L subacromial impingement

Prognosis

predicted optimal level of improvement in function and amount of time needed to reach that level (excellent, good, fair, poor) (weeks vs months) → guides length of POC

Intervention

interaction between PT and pt; procedures and techniques that produce change in condition and are consistent with the dx and px

Outcomes

describe the predicted level of optimal improvement attained at the end of the episode of care

SMART goals (short and long term)

In 3 weeks, the pt will improve stg of the L SA and L lower trap to 5/5 for decreased pain with OH tasks

What influences clinical decision making?

Problem solving strategies

Knowledge and experience, interpersonal skills, patient factors

Hypothesis oriented algorithm (guides decision making)

Determine hypothesis at the end of subjective exam (2-3 based on LOCIDA and SINSS) → test out during objective exam (goal is to rule in top hypothesis)

SINSS

Severity (at rest, worst, best), Irritability (AA time to resolve or aggravate, impact on ADLs), Nature (source: ligamentous, mobility, motor control, nerve, muscle), Stage (acute, chronic), Stability (progressive? unpredictable)

EBP (guides decision making)

Best available evidence (clinical practice guidelines, test and measures, clinical prediction rules)

Experience, patient values

Clinical practice guidelines

dx-specific; recommendations designed to assist clinicians in making decisions about specific clinical conditions (systematic review)

Reference point for all components of the POC; non-prescriptive

Dx accuracy of subjective measures

MDC (minimum detectable change) - min amt of change before measurement error can be ruled out

MCID (minimally clinically important difference) - min amt of measured change that signifies an important different in pt’s condition

Sensitivity (SN)

probability of a positive test result in someone with the pathology (SNout)

high SN means negative rules out dx

ex. hawkins-kennedy (see if pt tests negative)

Specificity (SPin)

probability of a negative test result in someone without the probability

high SP means a positive test rules in the dx

Likelihood ratio

Positive (LR+) indicates how much a positive test result increases the probability of a pathology present

Negative (LR-) indicates how much a negative test result decreases the probability of a pathology present

Want extreme numbers for each

Clinical prediction rules

clusters of findings

What is the highest level of evidence?

Level 1 with grade A

What is the purpose of examining the scapula at rest?

To ID muscle imbalance, weakness, ST mechanics

What is the capsular pattern of the GHJ?

ER most limited, abduction next, and IR least limited 3:2:1

Consistent with contracture; with hypomobility IR is most limited

RIM purpose

eval stg and contractile tissue integrity (muscle and tendon)

If AROM is limited but PROM is full, what impairment category is most likely involved?

Contractile tissue (muscle wkness or tendon dysfunction)

If both AROM and PROM are limited in a similar pattern, what does this suggest?

Capsular tightness or joint restriction (non-contractile)

What information does AROM provide?

Willingness to move, reproduction of pain, quantity/quality of movement, painful arc, presence of capsular pattern, end feel with passive OP