Use of the HOAC II in the management of a complex patient with osteoporosis and multiple traumatic fractures
Type of Presentation
Event
Location
Hall of Governors
Start Date
4-7-2017 4:00 PM
End Date
4-7-2017 6:00 PM
Abstract
This study uses the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II) to describe the physical therapy (PT) management of a patient with osteoporosis is and multiple delayed healing traumatic fractures.
Case Description: A 59-year-old female presented with multiple pain areas after a motor vehicle accident that resulted in vertebral, pelvic, rib, and radial fractures. At initial presentation, the fractures had not fully healed, and the patient had a diagnosis of post-concussion syndrome with some cognitive deficits as measured by the Montreal Cognitive Assessment. The patient was limited in functional ability according to the Functional Gait Assessment and the Modified Oswestry Lower Back Pain Questionnaire (OSW). Interventions: The patient received PT intervention as reasoned via the HOAC II method in order to determine the best approach given the hypothesized cause of the patient's impairments.
Outcomes: Some improvements in strength and subjective reports of improved mobility were noted, however, the patient showed no clinically important change in level of disability according to the OSW.
Discussion: The HOAC 11 model is a useful means of approaching the clinical decision making process of a complex patient because it provides a step-by-step guide for handling multiple patient problems and accounting for changes in patient presentation throughout an episode of care. In a patient case with less than optimal outcomes, the model is a framework in which the student therapist can reason through the weaknesses in the approach and propose specific changes that could improve the patient's quality of life.
Use of the HOAC II in the management of a complex patient with osteoporosis and multiple traumatic fractures
Hall of Governors
This study uses the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II) to describe the physical therapy (PT) management of a patient with osteoporosis is and multiple delayed healing traumatic fractures.
Case Description: A 59-year-old female presented with multiple pain areas after a motor vehicle accident that resulted in vertebral, pelvic, rib, and radial fractures. At initial presentation, the fractures had not fully healed, and the patient had a diagnosis of post-concussion syndrome with some cognitive deficits as measured by the Montreal Cognitive Assessment. The patient was limited in functional ability according to the Functional Gait Assessment and the Modified Oswestry Lower Back Pain Questionnaire (OSW). Interventions: The patient received PT intervention as reasoned via the HOAC II method in order to determine the best approach given the hypothesized cause of the patient's impairments.
Outcomes: Some improvements in strength and subjective reports of improved mobility were noted, however, the patient showed no clinically important change in level of disability according to the OSW.
Discussion: The HOAC 11 model is a useful means of approaching the clinical decision making process of a complex patient because it provides a step-by-step guide for handling multiple patient problems and accounting for changes in patient presentation throughout an episode of care. In a patient case with less than optimal outcomes, the model is a framework in which the student therapist can reason through the weaknesses in the approach and propose specific changes that could improve the patient's quality of life.