Rothstein J M, Echternach J L
Phys Ther. 1986 Sep;66(9):1388-94. doi: 10.1093/ptj/66.9.1388.
The purpose of this article is to introduce the hypothesis-oriented algorithm for clinicians (HOAC), which is designed to aid physical therapists in clinical decision making and patient management. The HOAC consists of two parts. The first part is a sequential guide to evaluation and treatment planning; the second part consists of a branching program used for reevaluation and the analysis of treatment effectiveness. Problem statements used in the HOAC are similar to those used for problem oriented medical records. The HOAC, however, requires therapists to state hypotheses about why the problems exist and to generate criteria that can be used to test the hypotheses. The benefits of the HOAC are that therapists must clearly state problems in a consistent manner, generate and list hypotheses and test criteria, develop treatment strategies and methods based solely on the hypotheses, and systematically review treatment. The rationale for treatment is identified clearly in the algorithm, facilitating the identification of inappropriate treatments (ie, those not related to the hypotheses). In addition, the branching program is used to identify where in the treatment process failures may be occurring and when a therapist needs to make a referral or seek assistance from a colleague.
本文的目的是介绍面向临床医生的假设导向算法（HOAC），该算法旨在帮助物理治疗师进行临床决策和患者管理。HOAC由两部分组成。第一部分是评估和治疗计划的顺序指南；第二部分是用于重新评估和治疗效果分析的分支程序。HOAC中使用的问题陈述与面向问题的医疗记录中使用的类似。然而，HOAC要求治疗师陈述关于问题存在原因的假设，并生成可用于检验这些假设的标准。HOAC的好处在于，治疗师必须以一致的方式清晰地陈述问题，生成并列出假设和检验标准，仅基于这些假设制定治疗策略和方法，并系统地回顾治疗情况。算法中明确确定了治疗的基本原理，便于识别不适当的治疗方法（即那些与假设无关的方法）。此外，分支程序用于确定在治疗过程中可能出现失败的位置，以及治疗师何时需要进行转诊或寻求同事的帮助。
