Edwards Physical Therapy Approach

Clinical Reasoning in Physical Therapy

• Clinical reasoning is a mental process and decision-making that takes place during the evaluation, diagnosis, and treatment of a patient's pathology.
• Autonomous clinical decisions are crucial for professional autonomy, adopting responsible, timely, accurate, and independent clinical decisions.

Diagnostic Reasoning

• Edwards' model (2000-2004) consists of functional and narrative reasoning.
• Functional reasoning involves diagnosing impairments, while narrative reasoning involves understanding the patient's interpretation of their condition.

Treatment Reasoning

• Reasoning of the procedure involves defining therapeutic procedures.
• Interactive reasoning involves establishing the PT-patient relationship.
• Collaborative reasoning involves PT-patient treatment decision-making.
• Teaching reasoning involves explaining the treatment plan to the patient for higher implication.

Pain Assessment

• Nociception is the encoding and processing of harmful stimuli in the nervous system.
• Nociceptors are high-threshold sensory receptors that transduce and encode noxious stimuli.

Initial Models

• Hypothetical-deductive reasoning (HDR) is based on the relationship between clinical patterns and diagnosis.
• Jones' (1992) Category Hypothesis System involves seven categories:
  • Functional limitation or disability
  • Pathobiologic mechanisms
  • Physical and psychological disorders
  • Contributing factors
  • Precautions and contraindications
  • Management and treatment
  • Prognosis

Collaborative Models

• Patient-Centered Model highlights the importance of the patient's specific problem context within the clinical reasoning process.
• Collaborative Clinical Reasoning Model involves patient cooperation in the clinical reasoning process.

Mobility and Muscle Strength Exploration

• Active mobility involves physiological movements and combined movement scanning.
• Passive mobility involves evaluating the inert components of the musculoskeletal system.
• Muscle testing is performed to evaluate muscle strength and pain during contraction.

Palpation

• Palpation involves searching for sensations, painful points, and tissue temperature at the end of the scan.

Pain Assessment

• Onset of pain can be sudden or insidious and may be associated with trauma.
• Clinical features of pain include:
  • Neuropathic pain: caused by nerve root irritation, characterized by high-intensity, throbbing, electrical, or burning sensations.
  • Somatic pain: dull, non-electric, diffuse, and difficult to locate.
  • Visceral pain: deep, diffuse, and often mislead with somatic pain.
• Pain behavior can be continuous, intermittent, or persistent.
• Previous treatments, signs, and symptoms are crucial to focus on new treatment and prognosis establishment.

Red Flags

• Red flags include:
  • Severe or minor trauma (if there is history of osteoporosis)
  • History of cancer/tumors
  • Older than 50 or younger than 20
  • Recent infection
  • Fever
  • General asthenia
  • Sudden weight loss
  • Immunosuppression
  • Night or constant pain not associated with clearly varying relief
  • Saddle pareses or anesthesia
  • Bilateral neurological symptoms involving the lower limb + back pain
  • Sudden decrease in muscle strength
  • Dorsal or lumbar pain associated with particular food or diet

Psychosocial Factors

• Psychosocial factors that increase the risk of developing long-term disability include:
  • Belief that the injury is harmful
  • Fear of specific movements and avoidance behaviors
  • Tendency to despair and social isolation
  • Expectations that passive treatments are more helpful than active training