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Child's Pose

Not a Frozen Hip:

Utilizing the Clinical Reasoning Process to Thaw the Physical Therapy Diagnosis

The purpose of this case report is to emphasize the iterative nature of clinical reasoning to integrate emerging data into evidence-based patient care.

 

This welcomes opportunities to be more specific in treatment for tissue type or stage of healing as well as to better distinguish the source of symptoms vs. contributing factors.

 

Patients receive better care when clinical reasoning is not a one-and-done part of the episode of care.

Abstract

Background

The Patient/Client Management Model aims to enable optimal patient care, and provide structure to the clinician’s reasoning process. Clinicians gather data at every encounter including referral information, subjective history, tests, and measures. By synthesizing these unique examination findings, the Physical Therapist’s clinical reasoning process tailors the provisional Physical Therapy Diagnosis and interventions to create sustainable change for patients who have persistent or new impairments through the episode of care.

Purpose

The purpose of this case report is to emphasize the iterative nature of clinical reasoning to integrate emerging data into evidence-based patient care.

Case Description

A 33-year-old female with a medical diagnosis of right hip adhesive capsulitis presented to physical therapy with right anterior hip pain. The initial physical therapy examination revealed a negative hip capsular pattern, motor control deficits, and muscle inhibition/weakness. The plan of care emphasized motor control of the right gluteal and core musculature. The Lower Extremity Functional Scale (LEFS) was used before interventions and during the plan of care to assess function. During the episode of care, the patient responded to motor control progression with neuropathic symptoms. The re-evaluation revealed neural tension reproduced patient symptoms and decreased lumbopelvic mobility. The patient saw mobility improvements with peripheral desensitization within sessions.

Results

Without affecting pain levels, the patient increased activity with hip and abdominal motor control training and range of motion with neural mobilizations. The patient self-assessed utilizing the Lower Extremity Functional Scale [LEFS] where a higher score is indicative of increased function. She obtained a pre-treatment score of 68/80 and 65/80 after a thirty-six-day plan of care. This was not within a detectable range for LEFS which has a MDC of 9. The patient subjectively reported a functional improvement of 15% due to her increased capacity to walk and exercise without affecting her pain level. Additionally, she increased her hip flexion strength and improved the quality of her lumbar and hip movement.

Clinical Impact

With an effective examination at each encounter, a clinician is empowered to evaluate the patient’s unique presentation and provide evidence-based interventions to address their specific impairments throughout the episode of care.

Interventions Include

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References

  • Zimerman AL. Evidence-based medicine: a short history of a modern medical movement. Virtual Mentor. 2013;15(1):71-76. doi:10.1001/virtualmentor.2013.15.1.mhst1-1301

  • APTA Guide to Physical Therapist Practice 4.0. American Physical Therapy Association. Published 2023. Accessed September 2, 2024. https://guide.apta.org.

  • Jones M, Edwards I, Gifford L. Conceptual models for implementing biopsychosocial theory in clinical practice. Man Ther. 2002;7(1):2-9. doi:10.1054/math.2001.0426

  • Riley SP, Petrosino C, Cleland JA. Do you have the only, right, or best evidence-based approach to treat your patients? J Man Manip Ther. 2020;28(5):251-253. doi:10.1080/10669817.2020.1847413

  • Chellamuthu G, Sathu S, Jeyaraman N, Jeyaraman M, Khanna M. Adhesive capsulitis of hip–a systematic review of literature. Indian J Orthop. 2023;57(2):238-244. doi:10.1007/s43465-022-00808-z

  • de Sa D, Phillips M, Catapano M, et al. Adhesive capsulitis of the hip: a review addressing diagnosis, treatment and outcomes. J Hip Preserv Surg. 2015;3(1):43-55. Published 2015 Nov 27. doi:10.1093/jhps/hnv075

  • Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 5th ed. New York: McGraw Hill; 2019.

  • Shanmugaraj A, Shell JR, Horner NS, et al. How useful is the flexion–adduction–internal rotation test for diagnosing femoroacetabular impingement: a systematic review. Clin J Sport Med. 2020;30(1):76-82. doi:10.1097/JSM.0000000000000575

  • Enseki KR, Bloom NJ, Harris-Hayes M, et al. Hip pain and movement dysfunction associated With nonarthritic hip joint pain: a revision: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Academy of Orthopaedic Physical Therapy and American Academy of Sports Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302

  • Shirley Ryan AbilityLab. Lower extremity functional scale. Published November 27, 2013. Accessed September 9, 2024. https://www.sralab.org/rehabilitation-measures/lower-extremity-functional-scale.

  • Aron A, Cunningham S, Yoder I, Gravley E, Brown O, Dickson C. Diagnostic momentum in physical therapy clinical reasoning. J Eval Clin Pract. 2024;30(1):73-81. doi:10.1111/jep.13884

  • Shirley Ryan AbilityLab. Patient specific functional scale. Published April 4, 2013. Accessed October 2, 2024. https://www.sralab.org/rehabilitation-measures/patient-specific-functional-scale.

  • Berry JW, Arends N, Hoglo H, Rubado A, Lundwall H, Ludwick M. Work engagement among physical therapists and physical therapist assistants. J of allied health. 2023;52(4):193E-199E.

  • Rotem-Lehrer N, Singer N, Reshit O, Springer S. Measuring up to expectation: cognitive bias in wrist range-of-motion measurement. J Orthop Sports Phys Ther. 2016;46(12):1037-1041. doi:10.2519/jospt.2016.6845

  • Featherston R, Downie LE, Vogel AP, Galvin KL. Decision making biases in the allied health professions: A systematic scoping review. PloS one. 2020;15(10):e0240716-e0240716. doi:10.1371/journal.pone.0240716

  • Scheper MC, van Velzen M, L U van Meeteren N. Towards responsible use of artificial intelligence in daily practice: what do physiotherapists need to know, consider and do? J Physiother. 2024;70(2):81-84. doi:10.1016/j.jphys.2023.07.012

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