A clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists: its multiphase development and validation

Elvén, Maria; Hochwälder, Jacek; Dean, Elizabeth; Söderlund, Anne

doi:10.3109/09593985.2014.994250

Cited by 40 publications

(51 citation statements)

References 88 publications

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“…It has also been shown that a focus on pain, rather than on progress, can result in increased time to return to prior level of function [7]. Additionally, Elven et al reported that a patient with a greater perception of self-worth is more likely to recover from an injury [47]. Conversely, fear and anxiety related to pain from the injury, work, or other external influences can contribute to the deleterious factors preventing healing and returning to prior level of function [7] [46].…”

Section: Discussionmentioning

confidence: 99%

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A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report

Shinost¹,

Pratt²,

Smith³

2017

OALib

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Background and Purpose: Peripheral nerve injuries can result from a multitude of causes including trauma, poor posture, and altered movement patterns. Adverse neural tension is a possible consequence to insult to the nervous system which can lead to dysfunction and fear avoidance behaviors. The purpose of this case report is to demonstrate the use of a multimodal approach in the physical therapy treatment of a patient who sustained an occupational upper extremity injury which resulted in adverse neural tissue tension of multiple peripheral nerves. Case Description: The patient was a 40-year-old female who sustained an injury to the second right metacarpophalangeal joint. Impairments included joint hypomobility, decreased muscle function, and movement system dysfunction. The patient was treated six times over a two-week period. Intervention: The physical therapy treatment administered to the patient included manual therapy, exercises focused on improving movement systems impairment, exercise focused on improving neural excursion, and patient education based on the biopsychosocial model. The treatments were focused on improving function of work-related activities to decrease disability to promote regular and full job duties. Outcomes: Outcome measures include the Numeric Pain Rating Scale (NPRS), Fear Avoidance Beliefs Questionnaire of Work and Physical Activity (FABQ-W and FABQ-PA, respectively), and the Quick Disability of the Arm, Shoulder and Hand (QuickDASH). After six visits there was an NPRS rating of 0/10 with rest and activity; the FABQ-W improved from 17/42 to 10/42; the FABQ-PA improved from 15/24 to 3/24; the QuickDASH improved from 22% symptom 2/28OALib Journal related disability to 9% and improved from 75% disability with work-related tasked to 0% disability. Discussion: Interventions of joints mobilization, neuromuscular reeducation using the movement systems approach, and concepts focused on the biopsychosocial approach were determined to be an integral combination in the patient's successful return to full work-related duties.

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Section: Discussionmentioning

confidence: 99%

“…Fear as the result of pain has been shown to decrease function and increase avoidance of activities that may provoke pain [7] [48]. Accurately determining a patient's FABs can be critical in knowing how to appropriately provide external motivation [47] [48].…”

Section: Discussionmentioning

confidence: 99%

A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report

Shinost¹,

Pratt²,

Smith³

2017

OALib

View full text Add to dashboard Cite

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“…Furthermore, the proposed strategy to clinical reasoning for exercise therapy in complex cases is not exclusive. Other approaches, for example the clinical reasoning model by Elven et al integrating behavioral change into physiotherapy, can be complementary [24]. Behavior change strategies are an integral part of the application of exercise therapy.…”

Section: Case Knee Osteoarthritis 64 Years Old Womanmentioning

confidence: 99%

“…Behavior change strategies are an integral part of the application of exercise therapy. Specific goal setting and reviewing of goals, shaping knowledge, and promoting feedback and reinforcement are some examples of strategies for behavior change [24]. Patients' ability to change their exercise behavior and adhere to an exercise regimen is highly dependent on psychological and social factors.…”

Section: Case Knee Osteoarthritis 64 Years Old Womanmentioning

confidence: 99%

Structured clinical reasoning for exercise prescription in patients with comorbidity

Leeden

Stuiver

Huijsmans

et al. 2018

Disability and Rehabilitation

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Purpose: Exercise therapy is an effective intervention in a variety of chronic diseases. The prescription of exercise therapy is usually directed toward an index disease. The presence of comorbidity may require adaptations to the exercise program as intended for the index disease. This paper aims to structure the clinical reasoning process of health professionals when prescribing exercise therapy for the individual patient with an index disease and comorbidity. Methods: We adapted the previously published strategy for developing guidelines and protocols on comorbidity-adapted exercise to a version that can be used for individual exercise prescription. Results: Essential steps and considerations involved in prescribing an exercise program to an individual patient with comorbidity are described. A case description is used as an example of how the proposed strategy leads to clinical decisions. Conclusions: The proposed strategy may have a role in educational and professional development. The advanced clinical expertise needed for safe and effective exercise therapy in patients with a complex health status is emphasized.The presence of comorbidity may require adaptations to exercise therapy. We describe the essential steps and considerations involved in prescribing an exercise program to an individual patient with an index disease and comorbidity. The proposed strategy can be used to structure the clinical reasoning process of health professionals. ARTICLE HISTORY

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“…In addition, the evidence for applying cognitive and behavioural methods in client management (Brunner et al, 2013;Linton and Shaw, 2011;Williams, Eccleston, and Morley, 2012;Åsenlöf, Denison, and Lindberg, 2009) supports the incorporation of these methods also in the clinical reasoning process. Thus, the client's behaviours and goals as well as the use of behaviour change strategies are features of a theory-and evidence-based clinical reasoning process (Elvén, Hochwälder, Dean, and Söderlund, 2015). To support investigations of physiotherapists' clinical reasoning abilities, in accordance with theory-and evidence-based methods that promote health behaviour change, a new instrument should reflect the characteristics of such an approach.…”

Section: Introductionmentioning

confidence: 99%

Development and initial evaluation of an instrument to assess physiotherapists’ clinical reasoning focused on clients’ behavior change

Elvén

Hochwälder

Dean

et al. 2018

Physiotherapy Theory and Practice

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A clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists: its multiphase development and validation

Abstract: This unique model, theory- and evidence-informed, has been developed to help physiotherapists to apply clinical reasoning systematically in the process of behaviour change with their clients.

Cited by 40 publications

References 88 publications

A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report

A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report

Structured clinical reasoning for exercise prescription in patients with comorbidity

Development and initial evaluation of an instrument to assess physiotherapists’ clinical reasoning focused on clients’ behavior change

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