Post on 26-Mar-2015
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Chapter 3: Clinical Decision-Making for Massage
Chapter 3: Clinical Decision-Making for Massage
Outcome-Based Massage: From Evidence to Practice
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
ObjectivesObjectives
At the end of this presentation, you will have the information needed to:
• Describe the 4 phases of the clinical decision-making process
• Describe how to formulate and select tests and measures for examination
• List the steps in synthesizing clinical findings and creating a clinical problem list
• List impairments clinicians can treat with massage techniques and the related outcomes
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Objectives (cont.)Objectives (cont.)
At the end of this presentation, you will have the information needed to:
• Formulate outcomes that are relevant to the use of massage techniques
• Outline how to select massage techniques
• Identify how to use findings from the re-examinations to modify, refine, and progress interventions
• Describe how to identify the client’s discharge needs, plan for discharge, and discharge a client
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Clinical Decision-MakingClinical Decision-Making
• The process by which therapists analyze client information and formulate and progress therapeutic regimens for their clients
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Clinical Decision-Making ProcessThe Clinical Decision-Making Process
• Not intended to be used in a linear, sequential manner
• Therapists using clinical decision-making perform several steps of the process concurrently.
• They also cycle through the same steps of the decision-making process several times.
• Each time they repeat the steps, they expand on their information and refine their hypotheses.
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Phases in Clinical Decision-MakingPhases in Clinical Decision-Making
• Evaluative Phase
• Treatment Planning Phase
• Treatment Phase
• Discharge Phase
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Evaluative PhaseThe Evaluative Phase
• Provides the foundation of the clinical treatment process
• The steps revolve around formulating and confirming a clinical hypothesis about the client’s clinical problem or wellness goals.
• Begins with data gathering through the client examination
• Involves confirming the clinical problem or wellness goals, creating summary of clinical findings, and deciding to treat
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Treatment Planning PhaseThe Treatment Planning Phase
• Identifying body structures and functions that are appropriate for treatment
• Selecting treatment techniques to improve the client’s impairments in body structures and functions, functional limitations, or overall wellness
• Begins with the summary of clinical findings from the Evaluative Phase
• Ends with a written plan of care
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Treatment PhaseThe Treatment Phase
• An ongoing cycle of treatment, re-examination, and treatment progression
• Begins after the therapist completes the plan of care
• The end of this phase is not clearly delineated.
• There is a gradual transition from Treatment Phase to Discharge Phase.
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Discharge PhaseThe Discharge Phase
• Discharge: the transition of the client from the therapist’s care to self-care or to treatment by another therapist
• Begins before the client’s discharge date
• Spans the period from the initiation of discharge planning to the actual discharge date
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Evaluative PhaseThe Evaluative Phase
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Steps in the Evaluative PhaseSteps in the Evaluative Phase
• 1: Conduct Subjective Examination
• 2: Generate Preliminary Clinical Hypothesis
• 3: Conduct Objective Examination
• 4: Confirm the Clinical Hypothesis
• 5: Summarize Pertinent Clinical Findings
• 6: Determine Appropriateness for Treatment
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Treatment Planning PhaseThe Treatment Planning Phase
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Steps in the Treatment Planning PhaseSteps in the Treatment Planning Phase
• 7: Analyze Findings and Generate the Clinical Problem List
• 8: Identify Functional Outcomes
• 9a: Identify Treatable Impairments and Relevant Outcomes
• 9b: Plan Compensatory Strategies
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Steps in the Treatment Planning Phase (cont.)Steps in the Treatment Planning Phase (cont.)
• 9c: Identify Impairments Appropriate for Massage Techniques
• 10 a,b: Select Treatment Techniques
• 11: Generate the Plan of Care
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Treatment PhaseThe Treatment Phase
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Steps in the Treatment PhaseSteps in the Treatment Phase
• 12 a,b: Select Treatment and Re-Examination Techniques
• 13: Carry Out Initial Intervention
• 14: Conduct Client Re-Examination
• 15: Assess Client Progress
• 16 a-d: Address Lack of Change
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
The Discharge PhaseThe Discharge Phase
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Steps in the Discharge PhaseSteps in the Discharge Phase
• 19: Identify Post-Discharge Needs
• 20, 21: Initiate Post-Discharge Education and Referrals
• 22, 23: Progress Plan of Care and Determine Readiness for Discharge
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
Steps in the Discharge Phase (cont.)Steps in the Discharge Phase (cont.)
• 24, 25: Finalize Discharge Plans and Review Home Program
• 26, 27: Conduct Discharge Examination and Discharge Client
Outcome-Based Massage: From Evidence to Practice © 2009 LWW
ReferencesReferences
• The references for the material in this PowerPoint presentation are found in Chapter 3: Clinical Decision-Making for Massage.