BGS Autumn Conference 2015

Transcription

1 Jolly Barrow Specialist Physiotherapist in Acute Rehabilitation Manchester Royal Infirmary Vicky Johnston Specialist Physiotherapist Cumbria Partnership NHS Foundation Trust

2 Mrs Smith has no rehab potential. Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination. WHO

3 Aims Explore the issues around the assessment of rehab potential Describe a process for assessing potential Stimulate discussion and reflection on the issues raised

4 REFLECTION Own judgement/ QOL/ if it was me. Motivation Priorities Low patient mileage Rehab potential Environment Lack of skills/fear of failure Resources Genuinely no potential for any improvement

5 Case examples Friends and family (rehab potential) test would you recommend this decision for friends and family in a similar position?

6 Why? A flexible assessment Suitable for a mixed cohort of patients Support clear and equitable decision making Determine the need for rehabilitation and the most suitable setting for this.

7 Background to the assessment 1. Definition of Physiotherapy 2. Model of practice 3. Model of functioning 4. Theory of motor control 5. Clinically reason through the assessment findings

8 Definition of Physiotherapy Physiotherapy is a profession that works with people to identify & maximise their ability to move & function. Functional movement is a key part of what it means to be healthy. This means that physiotherapy plays an important role in enabling people to improve their health, wellbeing & quality of life. Chartered Society of Physiotherapy (2013)

9 Conceptual Model of Practice APTA Patient / Client Management Model: Examination Evaluation Diagnosis Prognosis Intervention Outcomes American Physical Therapy Association, 2001 (cited in Quinn & Gordon 2013, p.37)

10 Model of functioning World Health Organisation, International Classification of Functioning. World Health Organisation (2002) This provides a conceptual basis for the definition and measurement of disability and integrates medical and social models.

11 ICF Model of disability WHO, 2002

12 Systems Theory of Motor Control Systems theory of motor control proposed by Shumway-Cook and Woollacott. Movement emerges from the dynamic interplay between multiple systems and is organised around a task and constrained by the environment. Shumway-Cook, A. and Woollacott, M.H. (2001)

13 Systems Theory of Motor Control Systems assessed are those which physiotherapists, with their set of skills, are ideally placed to assess and influence including: Musculoskeletal system Sensory system Central nervous system Neuromuscular system Psychological function Other systems including skin, elimination and energy supply systems.

14 Clinical reasoning The two models we focus on are: The hypothesis orientated algorithm for clinicians: a method for evaluation and treatment planning proposed by Rothstein and Echternach (1986). Perry s model of clinical reasoning. Watson (1999).

15 Following the assessment the physiotherapist should be able to: Provide information on: the presence and extent of movement problems. Impact on physical function and performance. Give a professional opinion of the likely development / prognosis of the identified movement problem. Provide a clinical judgement in whether an individual will benefit from physiotherapy intervention. Give a qualified predication to the expected outcome of physiotherapy intervention.

16 References CSP (2011) Physiotherapy Framework: putting physiotherapy behaviours, values, knowledge & skills into practice [updated Sept 2013] Quinn, L. and Gordon, J. (2013) Documentation for Rehabilitation: A Guide to Clinical Decision Making. 2 nd ed. Elsevier Health Sciences. Rothstein, J.M. and Eternach, J.L. (1986). Hypothesis orientated algorithm for clinicians: a method for evaluation and treatment planning. Physical Therapy 66: Watson, M.J. (1999). Clinical reasoning in neurology: Perry s model. Physiotherapy, 85 (5): World Health Organisation (2002) International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organisation.