School of Allied Health Sciences, Griffith University, Gold Coast, Australia.
Division of Physical Therapy, Center for Rural Health, University of Kentucky, Hazard, Kentucky, USA.
Physiother Theory Pract. 2021 Jul;37(7):775-786. doi: 10.1080/09593985.2019.1650405. Epub 2019 Aug 6.
Most literature on decision processes within physiotherapy relates to "reasoning that results in action" - decisions based on information including assessments that are gathered prior to treatment decisions. A process of "reasoning in interaction" that is often used, particularly by expert clinicians, has received less attention. To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient's active impairments and functional limitations, then moment-to-moment changes in the targeted impairment can be used as feedback to guide real-time treatment modification before formal reassessment of functional limitations and other impairments. Applying the theory to manual therapy results in parameters of techniques such as force, speed, direction and duration no longer being pre-determined, but rather being continually adjusted in real-time according to feedback from the patient through both therapist perception (changes in movement quantity or quality) and patient verbal responses. A process of continuous decision-making is described that the authors believe is used by many experienced clinicians but has not previously been adequately described in the literature. .
大多数关于物理治疗决策过程的文献都涉及“推理导致行动”——基于治疗决策前收集的评估等信息做出的决策。一种经常被专家临床医生使用的“互动推理”过程，却较少受到关注。本文旨在为在肌肉骨骼环境中应用互动推理提供一种理论和实践方法。理论依据是：如果治疗可以直接针对的损伤（即疼痛或被动运动受限）与患者的主动损伤和功能限制有关，那么针对损伤的即时变化可以作为反馈，在正式重新评估功能限制和其他损伤之前，指导实时治疗调整。将该理论应用于手法治疗会导致技术参数（如力量、速度、方向和持续时间）不再预先确定，而是根据患者通过治疗师感知（运动数量或质量的变化）和患者口头反应提供的反馈，实时进行持续调整。本文描述了一个连续决策的过程，作者认为许多经验丰富的临床医生都在使用这个过程，但之前文献中并没有充分描述。
