Universitat Internacional de Catalunya

Clinical Reasoning and Evidence-Based Practice

Clinical Reasoning and Evidence-Based Practice
4
13888
1
Second semester
OB
Main language of instruction: Spanish

Other languages of instruction: Catalan, English

Teaching staff


Dra. PÉREZ GUILLÉN, Silvia - sperezgu@uic.es

Introduction

Clinical reasoning is based on a decision-making process aimed at optimizing specific communication with the patient. Numerous factors related to the therapist, the patient and the environment influence this reasoning and it is necessary to consider the individual context of each patient, and understand that each situation must be interpreted differently. In this subject the student will learn to consider the factors that can influence these interactions and to guide the clinical reasoning process based on the most updated evidence.

Pre-course requirements

No prerequisites are specified.

Objectives

  1. Use advanced clinical reasoning to integrate scientific evidence, clinical data, and biopsychosocial factors related to the clinical context of OMPT.
  2. Develop patient-centered clinical reasoning in all aspects of clinical practice.
  3. Critically apply hypothetical-deductive, systematic and pattern recognition clinical reasoning processes using the different categories of hypotheses in relation to diagnosis, treatment and prognosis.
  4. Critically evaluate and effectively prioritize the collection of clinical information to ensure the reliability and validity of the data and the quality of clinical reasoning processes.
  5. Correlate the findings obtained from the evaluation with the patient's symptoms, tissue irritability and the most frequent clinical presentations.
  6. Conform and efficiently implement evaluation and treatment strategies within the biopsychosocial model of OMPT.
  7. Critically assess through sensitivity to change, the influence of the OMPT physiotherapist's behavior on the patient's behavior and vice versa.

Competences/Learning outcomes of the degree programme

Basic and general competencies:

  • CB8: To have the skills to integrate knowledge and face the complexity of formulating judgments based on information that, being incomplete or limited, includes reflections on the social and ethical responsibilities linked to the application of their knowledge and judgments.
  • CG2: To know how to effectively manage professional and clinical situations that require the integration of knowledge of biomedical, clinical and behavioral sciences in the area of specialization of Manual Orthopedic Physiotherapy.

Transversal competencies:

  • CT1: Being able to communicate effectively and to carry out an anamnesis, an evaluation and treatment of arthro-neuro-muscular dysfunctions, in interpersonal relationships so that they lead to enhancing the health status of the patient/user and the collaboration of the multidisciplinary team.

Specific competencies:

  • CE1: To determine and apply the most appropriate treatment, taking into account the indications, contraindications, precautions and effects of Manual Orthopedic Physiotherapy in the framework of the management of pain mechanisms and dysfunctions of the arthro-neuro-muscular system.
  • CE2: That students know the indications, contraindications, precautions and effects of OMPT in the framework of the management of pain mechanisms and dysfunctions of the arthro-neuro-muscular system.
  • CE3: Students demonstrate the ability to select the most appropriate tools and techniques in terms of reliability, validity and diagnostic accuracy for the evaluation and treatment of pain and the function of the arthro-neuro-muscular system.
  • CE5: Students demonstrate the ability to integrate, apply and evaluate the principles of mobilization, manipulation, motor learning, exercise physiology, ergonomic strategies, among other therapeutic modalities, as multimodal elements of the OMPT therapeutic approach.

Learning outcomes of the subject

Students will:

  • Use advanced clinical reasoning to integrate scientific evidence, clinical data, and biopsychosocial factors related to the clinical context of OMPT.
  • Demonstrate patient-centered clinical reasoning in all aspects of clinical practice.
  • Critically apply hypothetical-deductive, systematic, and pattern recognition clinical reasoning processes using the different categories of hypotheses in relation to diagnosis, treatment, and prognosis.
  • Critically evaluate and effectively prioritize the collection of clinical information to ensure the reliability and validity of data and the quality of clinical reasoning processes.
  • Correlate the findings obtained from the evaluation with the patient's symptoms, tissue irritability and the most frequent clinical presentations.
  • Efficiently shape and implement evaluation and treatment strategies within the biopsychosocial model of OMPT.
  • Critically evaluate through sensitivity to change, the influence of the OMPT physiotherapist's behavior on the patient's behavior and vice versa.
  • Critically use information from outcome measures to assess behavioral aspects of the patient/user's clinical presentation.
  • Demonstrate empathetic and efficient use of active listening interpersonal skills, questioning strategies, and other verbal and non-verbal communication skills that allow obtaining reliable information from the patient while avoiding communication errors.
  • Demonstrate sensitivity to changes in the patient's behavior.

Syllabus

  1. Types of clinical reasoning in OMPT: systematic, hypothetical-deductive and pattern recognition.
  2. Indications, absolute and relative contraindications and precautions in the practice of OMPT. Red flags, yellow flags and interprofessional referral situations.
  3. Typical errors of clinical reasoning.
  4. Model of somatic dysfunction and mechanosensitivity.
  5. Role of the biopsychosocial model in OMPT.
  6. Behavioral principles in the evaluation and treatment in OMPT.
  7. Communication skills and empathy.
  8. Clinical reasoning in the orientation exam and specific exam in OMPT:
    1. Symptom localization test and selective tissue tension tests that should be used with a patient depending on the place where they appear, type of symptoms and movements that aggravate or relieve symptoms:
      1. Regional, segmental, structural (muscular, articular, neural).
      2. Orthopedic tests
      3. Muscle location on contraction
      4. Muscle location during stretching
      5. Muscle location during stretching
    2. Joint function test: clinical reasoning in the tests of active and passive rotational movement and joint play and classification of dysfunction (hypomobility, hypermobility, intra-articular or extra-articular dysfunction)
    3. Muscle function test: clinical reasoning in the classification of muscle findings of reflex, structural hypomobility, evaluation of physiological mobility, accessory intra and intermuscular.
    4. Neural function test: clinical reasoning in the classification of the neurodynamic response
  9. Physiotherapy diagnosis, trial treatment and definite diagnosis.
  10. Clinical reasoning in the progression of techniques.
  11. Questionnaires and CIF.
  12. How to explain to the patient the clinical presentation, diagnosis and treatment.

Teaching and learning activities

In person



  • TC (Theoretical classes): The teacher is the one who exposes in a systematic and orderly manner the information corresponding to the different subjects and the student has a role mainly as a receiver. The scenario in which the teacher transmits knowledge is the classroom and he does it to the entire group of students. The theoretical class format allows the introduction of group activities in the classroom and the development of strategies that encourage the active participation of students.
  • PC (Practical classes):  It includes any type of classroom and/or laboratory practice (practices among students, case studies, problems, activities in the computer room, search for information,...)
  • SLA (Self-learning activities: These activities are designed so that the student solves problems on their own with the help of the material provided and the information from the face-to-face activities and/or available in the virtual environment in which the online subjects are developed.
  • SIS (Student independent study): It is a process aimed at the formation of an autonomous student capable of learning to learn; It consists of developing study skills, establishing educational goals and objectives based on the recognition of the weaknesses and strengths of the individual, which will respond to the needs and expectations of each one. It implies the possibility that each student makes their own decisions in relation to the organization of their time and their learning pace, which is why it requires a high degree of responsibility to make the most of resources.Includes study of contents related to "theoretical classes" and "practices" (studying exams, carrying out individual and group theoretical work, library work, complementary reading, etc.).
  • MC (Master Class): Transmission of knowledge and activation of cognitive processes in the student.
  • CL (Cooperative learning): Development of active and significant learning cooperatively.
  • FL (Flipped learning): Systems based on new technologies as basic knowledge tools outside the classroom, so that when students arrive to class they put their ideas and impressions together, giving teachers the opportunity to personalize their instruction according to the needs of each one.
  • PBL (Problem based learning): Development of active learning through problem solving.

Evaluation systems and criteria

In person



  • Theoretical evaluation: 20%
  • Practical evaluation: 40%
  • Self-assessment: 15%
  • Co-assessment: 15%

The grading system will be used in accordance with current legislation.

Actually, according to RD 1.125/2003 del 5 de septiembre.

  • 0-4,9 Fail.
  • 5,0-6,9 Pass.
  • 7,0-8,9 Notable.
  • 9,0-10 Outstanding.

The Honor Roll mention may be awarded to students who have obtained a grade equal to or greater than 9.0. Their number may not exceed 5% of the students enrolled in a subject in the corresponding academic year, unless the number of students enrolled is less than 20, in which case a single Honors may be awarded.

Bibliography and resources

  • Manual Mobilization of the Joints, Volume III: Traction-Manipulation of the Extremities and Spine: Amazon.es: Kaltenborn, Freddie.
  • Manual Mobilization of the Joints. Volume II : joint examination and basic treatment : Spine
  • Shacklock MO, Neurodynamic Solutions. Biomechanics of the nervous system : Breig revisited. 2007;218.
  • Hing W, Hall T, Rivett D, Vicenzino B, Mulligan B. The Mulligan Concept of Manual Therapy: Textbook of Techniques, 1e : Hing PhD MSc(Hons) ADP(OMT) DipMT Dip Phys FNZCP, Wayne, Hall PT PHD MSc FACP, Toby, Mulligan FNZSP (Hon.) Dip MT, Brian.
  • Maitland GD (Geoffrey D, Hengeveld E, Banks K, Newton M. Maitland manipulación vertebral : tratamiento de los trastornos neuromusculoesqueléticos. 2015
  • Netter. Exploración clínica en ortopedia: Un enfoque basado en la evidencia eBook: Cleland, Joshua, Koppenhaver, Shane, Cleland, Joshua, Koppenhaver, Shane, Su, Jonathan, DRK EDICION, SL.Simons DG, Travell JG, Simons LS. Dolor y disfuncion miofascial V.1: El manual de los puntos gatillo, mitad ... - David G. Simons, Janet G. Travell.
  • Travell JG, Simons DG. Dolor y disfunción miofascial. El manual de los puntos gatillo. Volumen 2: extremidades inferiores. Medica Panam. 2004;752. 
  • Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J oral facial pain headache [Internet]. 2014 Jan [cited 2021 Jul 27];28(1):6–27. Available from: https://pubmed.ncbi.nlm.nih.gov/24482784/
  • Rushton AB, Rivett DA, Carlesso L, Flynn T, Hing W, Kerry R. International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention. Man Ther [Internet]. 2014 [cited 2021 Jul 22];19(3):222–8. Available from: https://pubmed.ncbi.nlm.nih.gov/24378471/
  • Heneghan N, Pup C, Koulidis K, Rushton A. Thoracic adverse events following spinal manipulative therapy: a systematic review and narrative synthesis. J Man Manip Ther [Internet]. 2020;28(5):275–86. Available from: https://pubmed.ncbi.nlm.nih.gov/32148185/
  • Fernández-de-las-Peñas C, Piekartz H Von. Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review. J Clin Med [Internet]. 2020 Nov 17 [cited 2021 Jul 27];9(11):3686. Available from: /pmc/articles/PMC7698332/
  • Wietlisbach C. Cooper’s Fundamentals of Hand Therapy: Clinical Reasoning and Treatment- Christine M. Wietlisbach
  • Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, et al. Shoulder pain and mobility deficits: Adhesive capsulitis: Clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the american physical therapy association. J Orthop Sports Phys Ther. 2013;43(5).
  • Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American physical therapy association. J Orthop Sports Phys Ther. 2017;47(7):A1–83.
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