Clinical decision making is the thinking processes & strategy we use to understand data with regard to identifying patient problems in preparation for diagnosis & selecting outcome & intervention

1. CLINICAL DECISION
MAKING
SHUBHANGI MUKUND
1ST MPT
GUIDED BY- DR. SUVARNA S. GANVIR
PROFESSOR & HOD OF
DEPARTMENT OF NEUROPHYSIOTHERAPY
DVVPF’S COLLEGE OF PHYSIOTHERAPY

2. CONTENT
 INTRODUCTION
 THE CORE SKILLS OF CLINICAL DECISION MAKING
 FACTORS INFLUENCING DECISION MAKING
 PATIENT/CLIENT MANAGEMENT
 RECENT ADVANCE

3. Introduction
 Clinical decision-making refers to a dynamic, complex process of reasoning and analytical
(critical) thinking that involves making judgments and determinations in the context of
patient care.
 Clinical decisions are the outcomes of the clinical reasoning process and form the basis of
patient/client management.
 Decision making can range from fast, intuitive, or heuristic decisions through to well reasoned,
analytical, evidence-based decisions that drive patient & client care.
 It is a balance of experience, awareness, knowledge and information gathering, using
appropriate assessment tools, your colleagues and evidence-based practice to guide you.
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4. The Core Skills of Clinical Decision Making
Good, effective clinical decision making requires a combination of experience and skills. These
skills include:
Critical
Thinking
Pattern
recognition
Communicati
-on Skills
Evidence-
based
approaches
Team work Sharing Reflection
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5. FACTORS INFLUENCING DECISION
MAKING
• Goals,
• Values
• Beliefs
• Physical, Cultural
• Psychosocial & Educational factors
Patient/client
characteristics
• Level of financial support,
• level of social support.
• Clinical practice environment
• Overall resources, time
Environmental
factors
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6. PATIENT/CLIENT MANAGEMENT
 Steps in patient/client management
include,
Examination
Evaluation
Diagnosis
Prognosis
Intervention
Outcome
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7. Examination
 Examination involves identifying and defining the patient’s problem(s) and the resources
available to determine appropriate intervention.
 Examination begins - initial entry & continues as an ongoing process throughout the episode of
care.
 It consists of three components:
Patient history Systems review
Tests &
measures
Key information to obtain during an examination of function is the level of independence or
dependence, as well as the need for physical assistance, external devices, or environmental
modifications.
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8. EVALUATION
 Data gathered from the initial examination must then be organized and analyzed.
 The therapist identifies & prioritizes the patient’s impairments, activity limitations, &
participation restrictions & develops a problem list.
Primary
disorder Co-morbid
conditions
Clinical problems
For example, shoulder pain in the patient with hemiplegia
may be due to several factors, including hypotonicity & loss
of voluntary movement, which are direct impairments, or soft
tissue damage/trauma from improper transfers, which is an
indirect impairment, resulting from an activity.
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9. Diagnosis
Diagnosis - identification of a disease, disorder, or condition (pathology/pathophysiology) by
evaluating the presenting signs, symptoms, history, laboratory test results, & procedures.
Physical therapists use the term diagnosis to “identify the impact of a condition on function at
the level of the system (especially the movement system) & at the level of the whole person
Medical diagnosis Cerebrovascular accident (CVA)
Physical therapy diagnosis: Impaired motor function & sensory integrity associated with
nonprogressive disorders of the CNS—acquired in adolescence or adulthood
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10. Prognosis
 The term prognosis refers to “the predicted optimal level of improvement in function & amount
of time needed to reach that level.
 Most of patients - at the onset of treatment
 Severe TBI accompanied by extensive disability & multisystem involvement- prognosis
determined during the course of rehabilitation
 Knowledge of recovery patterns (stage of disorder) is sometimes useful to guide decision
making
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11. Plan of Care
 A major focus of the POC is producing meaningful changes at the personal/social level by
reducing activity limitations & participation restrictions.
 Essential components of the POC include,
Anticipated goals and expected outcomes
The predicted level of optimal improvement;
Specific interventions including type, duration& frequency;
Criteria for discharge.
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12. Goals and Expected Outcomes
 An important first step in the development of the POC is the determination of anticipated goals
and expected outcomes, the intended results of patient/client management.
 There are four essential elements:
1. Individual 2. Behaviour/Activity 3. Condition 4. Time
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14. Interventions
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15. Discharge Planning
Discharge planning is initiated early in the rehabilitation process-
Elements of an effective discharge plan are
If the patient refuses further treatment or becomes medically or
psychologically unstable
Goals & expected outcomes are close to being reached.
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17. Implementation of the Plan of Care
The therapist must take into account a number of factors in structuring an effective treatment
session.
Patient’s comfort & optimal performance should be a priority, environment, he patient’s
pretreatment level of function or initial state should be carefully examined.
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18. Recent Advance
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19. Evaluating the clinical decision making of physiotherapists in the
assessment and management of paediatric shoulder instability -
Fraser Philp etal - 2021
To elicit what information and clinical decision-making processes physiotherapists use in the
assessment and management of paediatric shoulder instability.
Qualitative study
Thematic analysis. The initial round of coding was used to draw up a quantitative
assessment of the diagnoses and map information used for clinical decision-making
against the International Classification of Functioning (ICF) framework.
The themes identified related to ‘Differences in diagnoses, classification and diagnostic
processes’, ‘Diagnostic process occurs over a long period of time’, ‘Management and
prognosis are influenced by a number of factors’ and ‘Diagnostic test choices and
prognosis influenced by factors beyond the patient injury’.
Design 25 physiotherapists, (18F:7M), ranging from 2 to 29 years post
qualification.
Outcomes measures
Results
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20. REFERENCES
1. Susan O’Sullivan, Schmitz, George Fulk. Physical rehabilitation. 6th edition
2. An Outline of Clinical Decision Making for Physiotherapists - Auwal Abdullahi -2019
3. Louise Bate etal – How clinical decisions are made – 14 May 2012
4. Robert J. Palisano, PT, ScD, FAPTA – Campbells Physical Therapy for children
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21. THANK YOU
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