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Domains and Performance Indicators

what are domains and performance indicators?

Candidate performance in the Clinical Assessment is assessed according to the following Domains and Performance Indicators:

 

1A Collect Patient Information and Form a Preliminary Hypothesis

 1A.1 Collect Patient Information

  • Obtained consent from the patient to conduct Assessment
  • Collected patient information and history
  • Explored presenting signs and symptoms
  • Obtained relevant measurable data (including supplementary information, for example radiological or pathological reports or reports from other service providers)
  • Identified goals, values and expectations of the patient

1A.2 Form a Preliminary Hypothesis

  • Analysed the information collected
  • Identified potential influencing presentations and hypothesised differential diagnoses
  • Identified assessment needs including priority
  • Checked the patient’s needs against his/her scope of expertise

 

1B Design and Conduct a Safe Assessment

1B.1 Design an Assessment

  • Prioritised and ordered assessment and included tests to measure impairment and activity limitation
  • Identified potential problems and contraindications to assessment
  • Selected tests and assessment instruments appropriate to the patient’s presentation, and according to the reliability, validity, accuracy and availability of the tests

1B.2 Conduct an Assessment

  • Physical examination of appropriate depth and breadth (eg. relevant observational, manual and analytical testing, appropriate sequence for procedures, modifications according to patient response, completed in a timely manner)
  • Modified assessment in recognition of factors such as patient’s age, occupation, pain, co-morbidities, communication ability and the assessment environment
  • Used tests and assessment instruments correctly
  • Progressively interpreted findings as guide the nature and extent of the assessment
  • Compared assessment findings against the preliminary hypothesis

1B.3 Safely Assess

  • Identified and assessed risks
  • Made modifications to address risks for the patient and self

 

2 Interpret and Analyse the Assessment Findings

2.1 Compare Findings with ‘Normal‘ Status of Patient

  • Identified normal status of the patient and compared the assessment findings against these
  • Determined extent of pathology/disorder and discussed with the patient to develop a course of action

2.2 Compare Findings with what is Expected for the Condition, and Include or Exclude Alternative Diagnoses

  • Defined clinical expectations of presenting condition including aetiology, signs, symptoms, clinical course; relationship of signs and symptoms to stage of disorder.
  • Related symptoms to pathology/disorder
  • Considered other features of the patient including patient environment, psychosocial and psychological elements when comparing presenting symptoms and expected clinical findings
  • Compared actual and expected findings and considered differential diagnoses

2.3 Prioritise Patient Needs and Identified Problems and Priorities in Collaboration with the Patient

  • Identified presenting symptoms and interrelationships
  • Considered possible sources/mechanisms of presenting symptoms and compared with preliminary diagnosis

2.4 Re-evaluate as Required to Develop a Justifiable and Sustainable HJypothesis

  • Outlined in order of probability the differential diagnoses
  • Refined diagnoses on appropriate tests performed
  • Reinforced and negated clinic diagnostic hypotheses
  • Reached justifiable conclusions and correlated with additional information to reach justifiable conclusions on Physiotherapy assessment findings
  • Incorporated current scientific argument and clinical reasoning into the decision making process

2.5 Where Indicated, Identify Areas That are Outside their Own Skills and Expertise and Discuss Appropriate Referral

  • Identified conditions not amendable to physiotherapy or are beyond own skills and knowledge
  • Made appropriate referrals to other practitioners including physiotherapists, based on knowledge of presenting condition and management options

 

3 Develop a Physiotherapy Intervention Plan

3.1 Develop a Logical Rationale for Physiotherapy Intervention Based on the Assessment Findings

  • Identified significant features of the assessment findings and determined implications for the intervention
  • Identified potential impact of patient lifestyle, culture, values and attitudes plus environment on a plan of intervention
  • Developed rationale for intervention

3.2 Set Realistic Short and Long Term Goals with the Patient

  • Provided appropriate education of the patient concerning the assessment findings
  • Determined patient expectations
  • Acknowledged the goals of referring practitioner
  • Where appropriate, discussed the lack of intervention
  • Established realistic goals in consultation with the patient
  • Implemented strategies for modifying the goals developed with the patient

3.3 Select Appropriate and Effective Interventions to Address the Patient Problems that are Identified

  • Considered patient needs
  • Considered indications, contraindications and risks associated
  • Considered assessment findings from other providers
  • Considered up to date, best evidence and followed best practice

3.4 Plan for Possible Contingencies that may Affect the Intervention Plan

  • Identified factors about the patient that may affect their motivation or ability to participate in the intervention
  • Took appropriate precautionary action
  • Developed a contingency plan
  • Gave appropriate warnings to the patient
  • Evaluated the environment to determine impediments to intervention

3.5 Prioritise the Intervention Plan in Collaboration with the Patient

  • Established priorities
  • Set realistic timeframes

3.6 Determine Plan of Evaluation Using Valid and Reliable Outcome Measures

  • Specified relevant evaluation procedures
  • Selected suitable functional outcomes

 

4 Implement Safe and Effective Physiotherapy Interventions

4.1 Obtain Informed Consent for the Intervention

  • Identified appropriate consent giver
  • Ensured consent giver had sufficient understanding of the interventions including risks and benefits, realistic expectations
  • Obtained consent

4.2 Prepare Equipment and the Treatment Area

  • Checked that appropriate equipment was selected and that it was safe and ready for operation
  • Prepared the treatment area to maximise effectiveness, efficiency, safety and privacy of the patient

4.3 Implement Safe and Effective Physiotherapy Interventions for the Patient and for the Physiotherapist

  • For the patient:
    • Interventions were safe and effective
    • Identified and managed risks to the patient
    • Applied appropriate precautions
    • Used appropriate mechanical equipment to assist in patient transfer and handling
    • Implemented infection control
    • Minimised distress to the patient; including understanding the effect of pain relief or other medications relevant to patient care during and after intervention, aspects of intervention that may impact on co morbidities
    • Intervention was consistent with agreed program
    • Used strategies to motivate the patient to participate: including communication throughout the intervention, gave accurate instructions and feedback related to performance
    • Monitored the patient throughout the intervention and appropriate modifications were made for patient comfort and the patient’s condition
  • For the physiotherapist:
    • Identified and managed risks to self
    • Positioned self for safety and comfort
    • Exhibited effective psychomotor skills

4.4 Where Indicated, Manage Adverse Events

  • Identified potential adverse events, relevant precautions were taken
  • Considered strategies for managing the therapist’s personal safety
  • Appropriately recognised, managed and reported

4.5 Provide Strategies for Patient Self-Management

  • Gave the patient clear instructions and where necessary, demonstrated to the patient to ensure they understood the intervention
  • In terms of defined goals, gave regular feedback on performance and progress
  • Developed a realistic self-management program
  • Used effective motivation strategies to encourage active participation by the patient

4.6 When Indicated, Implement Health Promotion Activities

  • Advocated self-management of health and wellbeing (includes early identification of disease, risk avoidance, principles of health care, health promotion and ergonomics)
  • Where appropriate, made the patient aware of links to community networks

 

5 Evaluate the Effectiveness and Efficiency of Physiotherapy Intervention(s)

5.1 Monitor the Outcomes of the Intervention

  • Measured changes safely, accurately and appropriately (used specific and relevant outcomes)

5.2 Evaluate the Outcomes of the Intervention and Determined the Effectiveness and Efficiency of Intervention

  • Determined relative contribution of change to function, health status etc
  • Identified factors limiting or confounding effectiveness

5.3 Determine Modifications to the Intervention

  • Modifications to the intervention:
    • were based on outcomes of intervention
    • reflected changes in patient status, and
    • were made in consultation with the patient
  • Referral was made to other professionals as indicated by outcomes

 

6 Communicate Effectively

 6.1 Communicate Effectively with the Patient

  • Established a rapport with the patient
  • Adapted verbal and nonverbal communication to the needs and profile of the patient
  • Communicated In a manner and environment that ensured confidentiality, privacy and sensitivity
  • Discussed and agreed the goals, nature, purpose and expected outcomes of the physiotherapy intervention
  • Employed appropriate strategies to address communication difficulties, eg. use of written communication, other technology or other persons

6.2 Demonstrate Effective English Language Ability

  • Demonstrated the ability to use the English language effectively when communicating with the patient (and any person acting as a consent giver or interpreter) and the assessors.

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