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CHAPTER OBJECTIVES

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At the completion of this chapter, the reader will be able to:

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  1. Describe the various models of disablement and their similarities and differences

  2. List the components of the examination process

  3. Conduct a thorough history

  4. Understand the importance of the systems review

  5. Describe the various components of the tests and measures portion of the examination

  6. Discuss the importance of the physical therapy evaluation

  7. Describe the purposes of documentation and the different types of documentation

  8. Have an understanding of the common medical abbreviations used in healthcare

  9. Describe the difference between short-term and long-term goals

  10. Describe the components and importance of patient/family/client-related instruction

  11. Discuss various strategies to improve patient adherence and compliance

  12. Understand the importance of the physical therapist's role in the promotion of health, wellness, and physical fitness

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OVERVIEW

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A profession's scope of practice is directly dependent on the education and skill of the provider, the established history of the practice scope within the profession, supporting evidence, and the regulatory environment.1 For the physical therapist, the profession has outlined the following six steps involved in the management of a typical patient/client2: (1) examination of the patient; (2) evaluation of the data and identification of problems; (3) determination of the diagnosis; (4) determination of the prognosis and plan of care (POC); (5) implementation of the POC; and (6) reexamination of the patient and evaluation of treatment outcomes (Figure 5-1). Through accomplishment of this process, the physical therapist determines whether physical therapy services are needed and develops the plan of care in collaboration with the patient/client/caregiver.

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FIGURE 5-1

Elements of patient management leading to optimal outcomes

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MODELS OF DISABLEMENT

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The Guide to Physical Therapist Practice, 2nd Edition (The Guide), promotes the practice of physical therapy based on a disablement model. A number of theoretical frameworks, or disablement models, have been proposed to describe the path from disease to disability (Table 5-1).3, 4, 5, 6, 7, 8 and 9 A disablement model is designed to detail the functional consequences and relationships of disease, impairment, and functional limitations. The Guide10 employs an expanded version of the terminology from the Nagi disablement model (see Table 5-1),6 but also uses components from other disablement models.11 For example, The National Center for Medical Rehabilitation Research (NCMRR) devised a modification to Nagi's model by adding a fifth concept, that of societal limitation (see Table 5-1). In 1980 the Executive Board of the World Health Organization published a document for trial purposes, the International Classification of Functioning, Disability and Health (ICFDH-I or ICF) (see Table 5-1). In 2001, a revised edition was published (ICFDH-II) that emphasized "components of health" rather than "consequences of disease" (i.e., participation rather than disability) and ...

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