Title : Clinical reasoning of airway clearance physiotherapeutic techniques and their documentation for improved efficacy
Abstract:
The study presents a clinical reasoning and documentation framework for chest physical therapy techniques for pulmonary patients. The gap addresses a lack of confirmatory evidences or clinical care pathways, and a need to do the bedside analysis and creation of treatment plan for patients with specific pulmonary presentation like dyspnoea or retention of secretions. Techniques like positioning and knowledge of surface anatomy of the lungs are crucial for the success of the therapy. There are many equivocal findings about the chest physical therapy and adverse effects and many no effect studies are also available. The background of such findings may be a discordance emerging from different clinical pathologies, diagnosis and the lack of exact focus of the scope and role of the physiotherapist in the presentation. The topographical anatomy of the lungs impair the simple application’ success if the reasoning aspect is missed. The physiotherapy as distinct from the routine pulmonary care deals with improved activity and participation. This requires matching presentations with interventions at physical and physiological levels. Moreover routine care may provide a preventive and promotive therapy but lacks the curative aspect as specific to the presentation.
Hereby a framework for clinical reasoning including the pulmonary pathology and the involvement of the structure and function with exact focus in the oxygen carrying pathways and oxygen transport variables is given. This aspect highlights the possible role for the physiotherapist. It is followed with the evidence based inclusion of the chest physical therapy technique, with a clear dose dependent protocol. Finally a valid and reliable outcome measure with follow-up and clear documentation is proposed for the efficacy of the therapy. This approach may facilitate development of the physiotherapy care pathways in a given setting where we have more of a single disease presentation. This is called as a clinical reasoning and documentation framework for pulmonary physiotherapy.
