Clinical Practice Guidelines: Examination and Intervention for Rehabilitation,
C. Schunk & K. Reed, Gaithersburg, MD, Aspen Publishers, Inc., 2000, softcover, 493 pp. $99.00.
Katherine T. Ratliffe PT, PhD, Honolulu, Hawaii
The authors’ purpose in writing Clinical Practice Guidelines is to provide “parameters to assist therapists in providing the optimal therapeutic intervention assuring maximal outcome for the patient” (p. xv). This text, first published in 1995 (Schunk C, Reed K. Therapeutic Associates Rehabilitation Guidelines, Therapeutic Associates, Inc. 1996), is intended to be a resource for therapists, third-party payers, and internal quality assurance. The authors suggest that it may also be a tool for marketing services. However, it is primarily a text written by clinicians, for the benefit and use of clinicians in the treatment of their patients with orthopedic, medical, and neurological conditions that can benefit from physical therapy. The authors worked with 52 contributors, although no specific attribution was given for specific sections or guidelines.
The book is organized with 12 sections: foot and ankle, knee, hip, lumbar spine, cervical/thoracic spine, TMJ/headache/stress, shoulder, elbow, wrist/hand, return to sport, general medicine, and neurological conditions. Each section contains guidelines for about six to 25 different disorders or diagnostic categories organized around a body system or condition. First, a summary overview of each guideline is presented for quick reference, including the number of visits needed in the acute and subacute phases for each disorder and circumstances requiring visits in excess of the range presented. Subsequently, more detailed information about the disorder is presented, including information about examination for each particular disorder and a selection of tests needed. Goals and outcomes that are specific, quantifiable, and functional are listed. Interventions are described in four sections: a) coordination, communication, and documentation, b) patient instruction, c) direct intervention, and d) functional carryover. Finally, discharge planning and patient responsibility is discussed including discharge criteria, home programs, and activities to monitor the recovery of an individual with the disorder.
This second edition of the guidelines has been expanded to include 13 diagnostic categories not presented in the first edition. Its most important change, however, is the inclusion of references, language related to, and integration of the 1997 APTA Guide to Physical Therapist Practice (APTA. Guide to physical therapist practice. Phys Ther. 1997:77). An appendix integrates the information presented in the text with the APTA guide and includes ICD-9 codes, language, and references to both texts. The references to APTA guide make this text an especially useful guide for physical therapists who now can reference their recommendations and treatments to their professional association’s guidelines, rather than to those of third-party payers or other guidelines from special-interest groups.
The didactic information presented in the guidelines is enhanced by exercise sequences and patient handouts for most disorders presented in the “Return to Sport” section. Other teaching material includes an illustrated handout on wrapping technique for lower extremity amputations, and objective techniques for measurement or evaluation, for example a patient information sheet on “Objective Measurement of Forward Head Posture.”
This text would be a strong addition to the libraries of PT departments in acute care, outpatient, and rehabilitation facilities. Physicians and nurses may find this text useful in understanding the decision-making process of physical therapists, including the sequence of rehabilitation and selection of appropriate goals and outcomes.
Although the text meets its objectives well, the strengths of the guidelines are in the orthopedic rather than the neurologic areas of rehabilitation. Key areas not addressed include traumatic brain injury, spinal cord injury, cerebral palsy and other developmental disabilities, and the physical therapy needs of persons with chronic illnesses including cancer. The text emphasizes a model of deficit remediation, although it also includes improving functional skills. Coordination with other members of the rehabilitation team is not addressed, even in those areas where it is essential to the optimal outcome of the person with the injury or disability. The emphasis on the term “patient” and the pervasive use of clinical jargon limits the appeal of this text to those in clinically based medical fields. Finally, this text is an excellent clinical resource for physical therapists working with adults, and for physicians and nurses working alongside the physical therapists.