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Clinical Reasoning - Final > HOAC II / HOPFA > Flashcards

HOAC II / HOPFA Flashcards

1
Q

HOAC II / HOPFA

A

Hypothesis-Oriented Algorithm for Clinicians II (HOAC-II)

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2
Q

Hypothesis:

A

“a supposition or proposed explanation made on the basis of limited evidence as a starting point for further investigation.”

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3
Q

Algorithm:

A

“a process or set of rules to be followed in calculations or other problem-solving operations, especially by a computer.”

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4
Q

HOAC II:

A

> Guide for decision making and clinical reasoning

> Documentation guide

> Compatible with The Guide (PCMM)

> Applied to any health condition or age or setting

> A tool for communication, not only process

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5
Q

HOAC II KEY FEATURE:

A

Prevention

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6
Q

HOAC II- a need for what?

A

> based on the notion that PTs can make diagnoses (functional)

> Holistic biopsychosocial approach (ICF)

> State of the field: clinical practice guidelines

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7
Q

Bottomline- key concepts in HOAC II

A

> Prevention (i.e. risk factors)

> Patient-centered clinical decision making

> Evidence-based practice

> A problem is always a functioning deficit

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8
Q

Types of Problems:

A

> Existing or current problems = require remediation

> Anticipated problems = require prevention

> A distinction must be made between the two because they lead to different clinical management and assessment of outcomes

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9
Q

Two ways to identify problems

A

PIPs (existing or anticipated)

NPIPs (existing or anticipated)

Identification can be theory-based or evidence / data based***

Hypothesis will be generated to guide intervention

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10
Q

PIPs (existing or anticipated) =

A

Functional limitations and disabilities (think of ICF)

Can be an existing problem or an anticipated problem

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11
Q

NPIPs (existing or anticipated)

A

Can be from a family member (e.g. Cerebral palsy, stroke)

Typically from a heathcare provider (i.e. PT)

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12
Q

PIPs and NPIPs combined

A

Who the source of the problem at this point does not matter

What matters is how to manage existing problems and anticipated problems because approach to each would be different and would be re-assessed separately later

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13
Q

PIPs are generated ___ the examination

___ problems are generated later

A

BEFORE
Combined

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14
Q

HOAC II- part 1
Has the 5 elements of the PCMM:

A

exam, eval, diagnosis, prognosis, intervention

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15
Q

HOAC II- part 1

A
  1. Collect initial data (including history)
  2. Generate a PIPs list stop… and think!
  3. Formulate examination strategy
  4. Conduct the examination and analyze the data
  5. Add NPIPs to problem list (existing and anticipated)
  6. Refine problem list stop… and think!
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16
Q
  1. Collect initial data (including history):
A

-hypothesis generation and testing is implicit

-experience differs between novice and experienced in hypothesis making

-does not specify what type of info needs to be collected, depends on clinician but needs to generate PIPs before exam

17
Q
  1. Formulate examination strategy:
A

requires a working hypothesis

18
Q
  1. Conduct the examination and analyze the data:
A

-the examination approach must be dependent on the hypothesis

-accept or refute hypothesis

19
Q
  1. Add NPIPs to problem list (existing and anticipated):
A

-done after the exam stop… and think!

20
Q
  1. Refine problem list stop… and think!
A
  • Elimination of problem vs. modification of problem
21
Q

HOAC- II
Generating hypothesis:

A

Justification for hypothesis (existing problems and anticipated problems)

PTs must know why the problems exist (need to know testing/diagnostic criteria and risk factors)

Must have a rationale for each anticipated problem that will occur unless there is intervention of the risk factors

22
Q

Rationale can be from:

A

-Evidence-based (preferred)

-Theory-based

23
Q

Problems:

A

Establish one or more goals for each problem

Goals must be in terms of functional activities (think ICF)

STG and LTG

Goals must not be impairment oriented but rather functioning-oriented

24
Q

Establish a plan:

A

to reassess testing and predictive criteria

to assess problems and goals

Intervention must be specific to the problem (existing and anticipated)

Strategies vs tactics

25
Q

Why is pediatrics unique?

A

child’s family
age
developmental level
environment

26
Q

Hypothesis-Oriented Pediatric Focused Algorithm:

A

Step 1a: Initial hypothesis
Step 1b: Anticipate impairments
Step 2: Initial data collection
Step 3: problem statement
Step 4: hypothesize goals
Step 5: examination planning
Step 6: examination
Step 7: evaluation
Step 8: diagnosis and prognosis
Step 9: general intervention planning
Step 10: intervention session planning
Step 11: reflection
Step 12: formal re-examination

27
Q

Step 1a: Initial hypothesis

A

Consider child’s chronological age, anticipated gross motor function

Also the social, educational, and family activities

Think broadly of the ICF

Example of activities to consider:
- later preschool -> early elementary (play dates)
- organized team sports

28
Q

Step 1b: Anticipate impairments

A

Anticipate primary and secondary impairments associated with medical dx

ex)
Spina bifida -> lack of sensation
Down syndrome -> cardiac problems
Spastic quadriplegia cerebral palsy -> feeding issues

29
Q

Step 2: Initial data collection

A

-review of available medical and educational records

-patient/family interview, their goals and expected outcomes

-patient/family behavior during the interview

30
Q

Step 3: problem statement

A

Answer the question: “Why is the family seeking services for their child”

31
Q

Step 4: hypothesize goals

A

Hypothesize STG and LTG to guide the examination process

Engage family in goal development

hypothesized goals are not necessarily the goals that ultimately will be written into a plan of care

The hypothesized goals only help prioritize the tests and measures used in the hands-on examination process

32
Q

Step 5: examination planning

A

Use the ICF or the appropriate ICF Core Sets for pediatrics

Measures are heavy on the activities and participation domain

STOP and THINK

33
Q

Step 6: examination

A

STOP and THINK

34
Q

Step 7: evaluation

A

Synthesize and interpret data collected from exam

Consider contextual factors

35
Q

Step 8: diagnosis and prognosis

A

Specific movement dysfunction

Functioning based

Need for referral or co-referral to other professionals?

Child’s needs related to wellness and prevention

Adaptive equipment needs due to growth

“If PT concludes that the child has reached capacity for physical function and that the child’s needs related to wellness and prevention are being met, PT interventions are not indicated, and a plan or care would not be developed for.”

36
Q

Step 9: general intervention planning

A

strategy

37
Q

Step 10: intervention session planning

A

tactics

38
Q
A

Clinical Reasoning - Final (10 decks)

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