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After completion of this chapter, the physical therapist should be able to do the following:

  • Describe components of The Guide to Physical Therapist Practice, and its relationship to the 4 elements of the disablement model as described by Saad Nagi.

  • Compare and contrast the disablement model, the medical model, and a functional movement model of dealing with the effects of injury and dysfunction.

  • Identify the components of the examination process as defined by The Guide.

  • Describe the components of and sequence of steps in the clinical decision-making process related to evaluation, diagnosis, prognosis, and intervention.

  • Contrast novice and expert clinical reasoning and decision making in physical therapist practice.

  • Relate clinical reasoning to quality provision of physical therapy, in terms of both diagnosis and selection of interventions.

  • Relate evidence-based practice to clinical reasoning.

  • Describe the algorithmic approach to clinical reasoning for intervention selection.

  • Use sample basic algorithms to examine clinical reasoning for each of the 4 phases of rehabilitation (acute, intermediate, advanced, and return to function).

  • Describe a basic algorithmic decision-making process based upon results of the examination.

  • Articulate a movement-based philosophy upon which to construct plans for intervention in physical therapy practice.

Physical therapists play an exciting and vital role in the provision of health care. As a profession, physical therapists contribute in a variety of ways to the health care system. No longer are physical therapists seen only as providers of rehabilitation, but also as participants in the processes of patient education, disease prevention, and promotion of health and wellness. Physical therapists of the 21st century must have a united voice with regard to our scope of practice, our models of health care delivery, and the types of patients and clients we serve, as well as the types of examination measures and interventions we use to remedy or prevent impairments, functional limitations, and disabilities in our patients and clients. We must be active, knowledgeable educators of the public, other health care providers, third-party payers, and health policy makers as we advocate for the profession of physical therapy.

The Guide to Physical Therapist Practice

The Guide to Physical Therapist Practice (The Guide) was first published in the November 1997 issue of Physical Therapy as a document to describe the practice of physical therapy.1 It was developed by consensus of an expert clinician panel, whose members were chosen from across the United States and who represented perspectives from a variety of practice settings. Prior to its publication, the document underwent extensive clinician review and repeated edits. The Guide is not a static document, rather it is a “living” document that is intended to grow and change with the profession of physical therapy. A revision to the original The Guide was published in 2001.2 This evolution represented the culmination of input from the panels, educators, and clinicians, and attempted to improve the utility of The Guide. ...

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