Clinical Cases in Physical Therapy. 2nd ed.Brimer Mark A, Moran Michael L. Philadelphia, Pa, Butterworth-Heinemann, 2004, softcover, 206 pp, $32.94.
With the growing emphasis on primary care in physical therapy and independent practice, clinical decision making has become a primary focus in physical therapy education. This book by Brimer and Moran provides a rich supply of case studies that can be used throughout a curriculum for physical therapists—professional (entry-level) or postprofessional, or physical therapist assistants. The text of each case presentation is organized according to the components of the patient management model from the Guide to Physical Therapist Practice, 2nd edition.
Each case includes learning objectives and begins with examination data including history and systems review. Guiding questions then help to focus the learner's attention toward issues that are pertinent to the case, including measurable examination data that should be gathered and how those data contribute to the cerebral evaluation process by the physical therapist. Diagnosis includes primary and often secondary physical therapy diagnoses that are delineated using the practice pattern numbering system and terminology of the Guide to Physical Therapist Practice. Prognosis, in the context of the case, is discussed including goals, expected outcomes, and discharge planning. Potential interventions are introduced as well as a common outcome that might be seen in such a case. Each case ends with a reference section that includes useful recommended readings.
A total of 46 cases are presented in the book, sequentially numbered without a medical or physical therapy diagnosis designated in the title. In total, the cases cover 21 different practice patterns from the Guide, including all four clinical system areas—musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary—in a variety of practice settings. To assist the instructor in selection of appropriate cases for any particular course, the appendix includes an organized list of the cases according to the Preferred Physical Therapist Practice Patterns of the Guide. Within each practice pattern, the cases are ordered from lowest complexity to highest complexity to facilitate progression in learning.
There are only a few weaknesses I identified in the book. The references and recommended readings include as many books and Web sites as evidence-based references. The examination section and, in some cases, the intervention section could be better illustrated and that student interest would be better maintained by using more photos and illustrations. Instructors who use the book will need to emphasize to learners the wide variety of intervention strategies that may be possible, and alternative outcomes which can vary extensively within a particular medical diagnosis or practice pattern. In the preface, the authors do encourage readers to “evaluate the efficacy of intervention provided and determine if it aligns with the clinical and functional goals presented.”
Overall, this second edition contains all new cases that are actually drawn from real-life situations in physical therapy practices and are well organized. The cases can be a helpful resource for instructors or a learning tool used by students. Each case provides an excellent format to encourage independent thought and clinical reasoning in a “real-life” patient during the didactic portion of a physical therapy curriculum.
Dennis W Fell PT, MD
Associate Professor and Chair, Department of Physical Therapy, College of Allied Health Professions, University of South Alabama, Mobile, AL