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

2. 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

3. 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

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

5. 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.

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

7. 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

8. 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

9. 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.

10. 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

11. The Evaluative Phase

12. 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

13. The Treatment Planning Phase

14. 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

15. 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

16. The Treatment Phase

17. 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

18. The Discharge Phase

19. 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

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

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