Chapter 3: Clinical Decision-Making for Massage Outcome-Based Massage: From Evidence to Practice

Objectives 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

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

Clinical Decision-Making The process by which therapists analyze client information and formulate and progress therapeutic regimens for their clients

The 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.

Phases in Clinical Decision-Making Evaluative Phase Treatment Planning Phase Treatment Phase Discharge Phase

The 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

The 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

The 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.

The 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

The Evaluative Phase

Steps 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

The Treatment Planning Phase

Steps 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

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

The Treatment Phase

Steps 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

The Discharge Phase

Steps 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

Steps in the Discharge Phase (cont.) 24, 25: Finalize Discharge Plans and Review Home Program 26, 27: Conduct Discharge Examination and Discharge Client

References The references for the material in this PowerPoint presentation are found in Chapter 3: Clinical Decision-Making for Massage.