Clinical reasoning has been described as “a process in which the therapist, interacting with the patient, structures meaning, goals & health management strategies based on clinical data, client choices, professional judgment & knowledge ” (Higgs and Jones 2000, Edwards et al 2004). While the most comprehensive means of developing and implementing clinical reasoning in practice is the use of hypothetic-deductive approach and diagnostic sieves, as physiotherapists gain experience and skills, they are able to use clinical pattern recognition to aid their clinical reasoning and decision making.

Brain

Learning about brain, its areas, different structures and their functions is usually a challenging task for students in any medical stream. Neuroanatomy books provide vivid descriptions of each area but visualizing those areas and their spatial relationship or connections with other areas would help students develop a better understanding of the structure and function of brain. 3D Brain app provides an opportunity for students and even health professionals to remind themselves of the complex and yet logical structure of the human brain. In this article, I will review this app based on Android platform.

 

Medical Apps

As per Department of Health UK, people could soon be directed to free or cheap apps by their GPs to allow them to monitor and manage their health more effectively. The latest innovations in smartphone technology will help patients and the public to find and use NHS services, manage conditions and make better lifestyle choices in a way that is very convenient for them. It follows a call to find new ideas and existing smartphone apps that help people and doctors better manage care which received nearly 500 entries and over 12,600 votes and comments.

HEP2GO

Therapeutic exercise is arguably the most important clinical tool available to Physiotherapists (PTs) and other rehabilitation medicine professionals. It plays a key role in the treatment and rehabilitation of various medical or health related conditions. Exercises vary in types (eg aerobic, anaerobic) and components (eg. strength training, endurance training) and are often tailor-made according to the needs of the patients/clients.

Exercise prescription or recommendation may be bothersome to some PTs especially those at the outset of their career. Other experienced and astute clinicians might too find it inconvenient designing an exercise protocol for a given joint or joints especially at busy times. With background knowledge, information and expertise, they might want to have a quick glance at something that will give them easy and reliable source of information and that information could perhaps be printed out and handed over to the patient. While looking at academic books or search-engines can be time consuming, a cookbook website featuring exhaustive contents could well serve the purpose and make the job relatively easier. Today we will review one such website – HEP2go.

Physiotherapy Evidence DatabasePEDro is the Physiotherapy Evidence Database. PEDro is a free database of over 23,000 randomised trials, systematic reviews and clinical practice guidelines in physiotherapy. For each trial, review or guideline, PEDro provides the citation details, the abstract and a link to the full text, where possible. All trials on PEDro are independently assessed for quality. These quality ratings are used to quickly guide users to trials that are more likely to be valid and to contain sufficient information to guide clinical practice. PEDro is produced by the Centre for Evidence-Based Physiotherapy at The George Institute for Global Health. In this article, we review the PEDro website.

As physiotherapists, our success is measured by how happy and satisfied our patients are with our treatment and whether we are able to get them to engage with the recommended physiotherapy program. I list below 6 qualities which a physiotherapist must possess to be able to develop a great therapeutic relationship with patients and keep them happy. These have been extracted from a research conducted by Potter et al (2003) to identify the characteristics of a good physiotherapist.  Check how many of these you already possess and get working on others as these are not rocket science.

 

The Australian Physiotherapy Association (APA) has announced that from 2014, Journal of Physiotherapy will be adopting an online open-access model and will move to a new website.

For the last 60 years, the Journal has strived to produce ground-breaking research, engage its readers, and be the leading physiotherapy publication world-wide. In order to continue to deliver such results in this fast-paced technologically-driven environment, a new model has become imperative.

‘‘Musculoskeletal disorders’’ include a wide range of inflammatory and degenerative conditions affecting the muscles, tendons, ligaments, joints, peripheral nerves, and supporting blood vessels. These include clinical syndromes such as tendon inflammations and related conditions (tenosynovitis, epicondylitis, bursitis), nerve compression disorders (carpal tunnel syndrome, sciatica), and osteoarthrosis, as well as less well standardized conditions such as myalgia, low back pain and other regional pain syndromes not attributable to known pathology. Body regions most commonly involved are the low back, neck, shoulder, forearm, and hand, although recently the lower extremity has received more attention. The below infographic provides details about WRMSD's and some tips for prevention.

Juvenile Idiopathic Arthritis (JIA), Juvenile Rheumatoid Arthritis (JRA) and Juvenile Chronic Arthritis (JCA) are interchangeable terms used to define idiopathic inflammation of synovial joint(s) persisting for a minimum period of six weeks in children less than sixteen years of age. JIA is an umbrella term that represents seven or more patterns of childhood arthritis and is essentially a diagnosis of exclusion [Petty RE, 2004; Kathleen A, 2007]. 

It probably results due to a combination of genetic, infectious, and environmental factors [Ringold S, 2005]. Its pathogenesis is complex, incompletely understood and involves both articular and extra articular (eg. uveitis) clinical manifestations. JIA is the most common form of chronic rheumatic disease in childhood characterised by periods of flare and remission [Bowyer S, 1996]. It affects girls more than boys; however in some disease patterns (eg. enthesitis type onset), boys are more affected [Peterson LS, 1996; Minden K, 2002]. A large multi-ethnic cohort study on JIA [Saurenmann RK, 2007] suggests that children of European origin are at higher risk of developing JIA as compared with children of black, Asian, or Indian subcontinent origin.

In my previous blogs I had discussed the need for action research, steps to undertake action research and practical implications of undertaking action research that mainly focused on ethical issues. I shall now discuss an example of an action research study relevant to physiotherapy. The authors of this study have used this unique form of systematic enquiry that enabled them to investigate, evaluate and improve their work (Whitehead and McNiff 2011).

Lateral Epicondylitis (Tennis elbow) is the most commonly diagnosed elbow condition affecting 1-3% of population (Hong et al 2004). It is characterised by pain over the lateral epicondyle which presents during digital palpation, resisted extension of the wrist (sometimes middle finger extension) and gripping (Stasinopoulos & Johnson 2005). The peak incidence is at the age of 45-54 years (Shiri et al 2006). Vicenzino et al (1996) reported a prevalence of 19% in 30-60 years old. Even though tennis elbow leads to considerable economic burden on the society due to lost work days and residual impairments (Silverstien 1998), there is little high level evidence for the non-operative management of tennis elbow. (Bisset et al 2006).

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