Mar 11, 2018 - Addendum 1. Quality indicators for physiotherapy care process of patients with Whiplash-Associated Disorders (WAD). Flowchart of steps of ...
Addendum 1 Quality indicators for physiotherapy care process of patients with Whiplash-Associated Disorders (WAD) Flowchart of steps of clinical reasoning Rob A.B. Oostendorp, Hans Elvers, Emiel Van Trijffel, Emilia Mikolajewska, Geert Rutten, Han Samwel, Jo Nijs, Marcel Heijmans, Margot De Kooning, Marijn Scholte, Marjan Laekeman, Nathalie Roussel, Wendy Scholten-Peeters Nijmegen, The Netherlands - March 11, 2018
Flowchart Clinical Reasoning Process Whiplash Associated Disorders I. Administration. Name . Year of referral . Referring physician - self referral . Medical information . Period since accident . Request for help ... .
II. History Taking
Yes
IIa Sociodemographic characteristics
IIb. Accident related information
IIc. Pre-existent functioning and health status before injury
IId. Previous diagnostics and treatment
IIe. Current health status and recovery rate since accident
III. Objectives of clinical examination Objectives musculoskeletal examination
Objectives neurological examination
Objectives otoneurological examination
Objectives psychological examination
IV. Clinical examination Musculoskeletal examination
Neurological examination
Otoneurological examination
Psychological examination
V. Analysis and conclusion of diagnostic process
Classification WAD 1, 2, 3
Time phase since accident
Recovery since accident Prognostic factors related to recovery after accident Determination of profile A, B or C
Presence of signs of central sensitization Consultation GP in case of insufficiently expected treatment result
Indication physiotherapy
VI. Treatment plan Time phase after accident
Treatment goals
Phase 1 (>=7 days)
Profile A/B/C
Reducing pain; providing information and explaining the functioning consequences and underlying pain mechanisms
Phase 2 (1 - 3 weeks)
Profile A/B/C
See Phase 1 + improving functions
Phase 3a (4 - 6 weeks) normal recovery
Profile A/B/C
See Phase 2 + increasing activities and participation
Phase 3b (4 - 6 weeks) delayed recovery
Profile A/B/C
Explaining underlying pain mechanisms, improving active coping, decreasing fear avoidance, increasin g physical loadability, increasing activities and participation
Phase 4a (7 - 12 weeks) normal recovery
Profile A/B/C
See Phase 3a + minimizing delay in work participation
Phase 4b (7 - 12 weeks) delayed recovery
Profile A/B/C
See Phase 3b
Phase 5 (3 - 6 months)
Profile A/B/C
See Phase 4b
Phase 6 (>6 months)
Profile A/B/C
See Phase 3b
Prognostic duartion of treatment period Prognostic number of treatment sessions Pre-treatemnt outcome measures pain VAS (0-100) and functioning NDI (0-50)
Treatment plan agreement with patient
VII. Treatment Phase 1
Profile A/B/C
Goals
Education, coaching, active exercise therapy
Phase 2
Profile A/B/C
Goals
See Phase 1 + cervical soft collar (< 1 week), massage therap y (< 2 weeks)
Phase 3a
Profile A/B/C
Goals
See Phase 1 + physical loading exercise therapy
Phase 3b
Profile A/B/C
Goals
Pain education, exercise therapy based on cognitive and physi cal principles,
Phase 4a
Profile A/B/C
Goals
See Phase 3a + graded activity
Phase 4b
Profile A/B/C
Goals
See Phase 3b + graded exposure
Phase 5
Profile A/B/C
Goals
See Phase 4b
Phase 6
Profile A/B/C
Goals
See Phase 5
Check for side effects and negative treatment effects
VIII. Evaluation Process evaluation
End evaluation
Treatment goals
Outcomes . Post-treatment outcome measures: . Pain (VAS 0 - 100) . Functioning (NDI 0 - 50) . Global Perceived Effect (GPE 0 - 7)
..
Treatment period (duration) treatment sessions (number)
Returned to work
IX. Discharge Reason for discharge Written report
Post-treatment care
