Physical Therapy Practice Model and Diagnostic Process

Why does physical therapy need a practice model?

• PT had no practice model until the guide to physical therapy was published

• dangerous due to the fact that non-PT’s were attempting to define the scope of physical therapy

• improve quality of care

• enhance patient satisfaction

• promote appropriate utilization of services

• reduce unwarranted variation in services

• allows others to understand the practice and scope of physical therapy

The Medical Model

attempts to identify a disease or disease process. Then it attempts to eliminate the pathology that is causing the patient a particulaar set of signs and symptoms

PT model

attempts to identify impairments caused by a disease process and develop interventions to eliminate or decrease functional limitations and/or disability

disease

the intrinsic pathogen or active pathology (i.e. cancer, IDDM, arthritis)

impairment

loss of normal anatomical, physiological, psychological status of an organism (i.e. decreased MMT, ROM, sensory changes)

Functional limitation

limitation of performance of an organism as a whole (i.e. inability to ambulate, inability to feed oneself)

disability

limitation or disadvantage to perform socially defined roles within a culture, as it relates to age and gender (i.e. quadriplegic patient)

statistical approach/Al

• does not consider mental process of the clinician

• only considers mathematical probabilities and input and output derived from the patient

process tracking

• opposite of statistical approach

• evaluates the mental processes of arriving at a diagnosis

• most often approach used

example of process tracking

• obtain critical data (history)

• generate a hypothesis list from memory

• perform exam or order tests based on hypothesis (avoid shot-gun approach)

• based on your level of knowledge rank order and prune the hypothesis list

• select a preliminary or primary diagnosis

• treat your patient based on hypothesis

• re-evaluate preliminary diagnosis based on patient response

• validate diagnosis

Case Study

• obtain history

• hypothesis (list)

• perform examination

• rank order and prune hypothesis list

• intervention

• re-evaluate

• validate

• learn pattern recognition

hypomobility

• restricted AROM/PROM

• no radiculopathy

• somatic referred pain

radiculopathy

• radicular symptoms

• myotome, dermatome, reflex changes

• spurling’s test

• distraction test

• ULNT

• <60 rotation ipsilateral

acute pain

• high pain and disability scores

• recent trauma

• somatic referred pain

• poor tolerance to exam and intervention

cervicogenic headache/Dizziness

unilateral headache, may be associated with neck pain, neck motion, elicited by posterior neck palpation/pressure (especially in C1-3 region)

clinical instability

• remote hx. of trauma

• symptoms increase with upright postures, decreased with recumbent postures

• hypermobility with ROM and PIVM

• poor MMT (2/5 deep cervical muscles)

• shaking or aberrant motion

Increase the accuracy of our PT diagnosis and develop EB interventions

• understand and recall from memory various disease processes and their clinical manifestations

• obtain a full and accurate patient examination

• select tests and measures that are reliable, valid, specific, and sensitive. understand likelihood ratios

• select interventions from EB clinical guidelines