HYPOTHESIS-ORIENTED ALGORITHM FOR CLINICIANS PART TWO 9. Reassessment: Have goals been met? 7 Discharge patient \~ Are tactics being implemented correctly? (s treatment being implemented as planned?) Yes No Improve intplementation—Go to 8 ‘Are tactics appropriate? eS oo Is stratogy correct? Change tactics—Go to 7 a ee Are hypotheses viable? (e, if testing criteria ave been met and goals are not met. new hypotheses are needed) [= Generate new hypotheses—Go to 4 (Change strategy—Go to 6 Fig. 2. Part Two of the hypothesis-oriented algorithm for clinicians: Branching program. All numbers less than 9 refer to the steps listed in Figure 1 At times, the problem statements must be written in terms of “anticipated problems.” For éxample, the therapist may observe no manifestation of a func- tional or cosmetic deficit during the i itial examinations of the patient, but may find indications that such a deficit may develop in the future. The school- child examined for scoliosis may not demonstrate abnormal spinal curvatute, but the therapist may anticipate the de- velopment of such a problem based on the results of the evaluation. Similarly, the below-knee amputee may not have a knee-flexion contracture, but the ther- apist may anticipate the development of a contracture and, therefore, want to taught, we believe that it is the most logical and that it is consistent with ac- ‘tual practice. Patients seeking physical therapy do so because they have a prob- lem. Sitnilarly, patients are referred to physical therapists because the referring professional has determined that a prob- lem exists, usually at least partly om the basis of input from the patient. In examining existing problem solv- ing schemes, it seemed odd to us that in a profession as humanistic as physical therapy there could be any question that the patient’s problems are those that are identified by the patient—not by the therapist. In our experience, problem lists generated after physical examina- OSESESORBTEBVERE QyvROoEgHs gre QOn4wrPoreee eg no09. 7 eee = Cen we