Supplement to the Standards Document
GLOSSARY OF TERMINOLOGY
Revised March 2010
Members of the IFOMPT Standards Committee 2010: Dr Karen Beeton, Mr John Langendoen, Mrs Lorrie Maffey, Dr Jan Pool, Dr Ann Porter-Hoke, Dr Darren Rivett, and Dr Alison Rushton (Chairperson)
The purpose of the glossary is to supplement the meaning of the terminology used within the Standards Document. The purpose is not to set 'in stone' definitions for any of the terms. The intent is to expand on the meaning of words or expressions, to facilitate understanding of the Standards Document and facilitate translation into other languages (including all versions of English).
Each Member Organisation (MO) has their own internal documents on manual Physical Therapy/Physiotherapy (Orthopaedic Manipulative Therapy - OMT) standards of training and practice and scope of practice. Each MO may need to modify the definition of some IFOMPT Standards Document words or expressions to provide an accurate translation and/or provide an accurate representation of the meaning in their country.
The content of this section has been developed through the use of many international resources, and in particular existing glossaries from the American Physical Therapy Association and the Canadian Physiotherapy Association as well as using input from Member Organisations and RIGs of IFOMPT. The Glossary and Standards Document have been written in UK English.
GLOSSARY OF TERMS
Ability to respond to new/changing information and think ‘in action’ to modify the approach to assessment or management appropriately.
Adult Learning Theory
A body of knowledge that relates to the theory of teaching and learning as it applies to adults and describes recommended practices to optimise adult learning.
Professional behaviours and expertise in clinical knowledge, judgement, level of practice, and total patient/client management/handling (e.g. patient/client education).
The concept of supporting or speaking on behalf of others.
Assessment of student performance: the measurement or quantification of a student’s performance against criteria.
Assessment of the patient/client: examination or evaluation of the patient/client.
Best (available) Evidence
Best available evidence draws upon the best research evidence, clinical expertise and patient/client values.
A technique or approach to management that is supported by evidence and clinical reasoning to lead to the best outcome.
A person who is unpaid and looks after or supports someone else who needs help with their day-to-day life.
A non-medically trained layperson such as a family member or friend as well as medically trained individuals, such as a physician, nurse, or social worker, and in this context a Physical Therapist/Physiotherapist, who assists in the identification, prevention, or treatment of an illness or disability.
Cervical Artery Dysfunction
Problems within the cervical arteries of the neck that can present with symptoms similar to cervical spine NMS dysfunction or may present a risk factor to aspects of OMT.
The person, group, community or organisation receiving Physical Therapy/Physiotherapy professional services, products or information. Clients can also include businesses, schools and others to whom Physical Therapists/Physiotherapists offer services.
Is a continuum along multiple dimensions of which clinical reasoning is a critical component including clinical outcomes, personal attributes such as professional judgement and empathy, technical clinical manual skills, communication and interpersonal skills.
Expertise should involve the patient / client and others in decision making and consider the patient’s/client’s perspectives. It should also be based on a sound knowledge base, and cognitive and metacognitive proficiency.
Clinical Physical Diagnosis
A clinical mentor provides professional advice and direction in the clinical setting through a partnership with the student. The mentor should possess clinical expertise, act as a role model and create a highly supportive learning environment conducive to individual learning and the application of clinical reasoning.
Clinical physical diagnosis is based on the medical history and physical examination of the patient/client. It may be supported by imaging and the results of imaging and laboratory tests. The examination includes the subjective examination (history and systems review) and development of possible hypotheses that are tested in the physical examination and leads to formation of a clinical physical diagnosis or diagnoses.
The cognitive processes, or thinking used in the evaluation and management of a patient/client. Clinical reasoning is central to professional autonomy.
Domains of knowledge that are primarily relevant for assessment of the neuromusculoskeletal (NMS) systems and management of recognised NMS dysfunctions. This would include anatomy, physiology, biomechanics, movement science, pathology, pathophysiology, neuroscience, behavioural science and the effect of dysfunction on the aforementioned.
The capacity to apply judgement and purposeful action to work with patients/clients and carers to achieve and maintain desired health outcomes
A cluster of related knowledge, skills and attributes that comprises a major part of the Physical therapist’s/Physiotherapist’s role or responsibility and correlates with performance and that can be measured against accepted standards.
(Implying depth and breadth of knowledge)
The capacity of grasping or understanding the full sum of the of meanings and corresponding implications inherent in a concept
Management using means other than surgical procedures.
Current, modern, up-to-date.
A clinical indication or finding that a particular examination procedure or treatment intervention is inadvisable/ inappropriate as it may produce an adverse reaction and / or cause harm to the patient / client.
Inventiveness to develop originality in patient/client assessment and management.
A critique of a topic with respect to the evidence base, including the research methodologies and analyses of the studies reviewed. The review provides a synthesis to identify conflict or agreement in the literature and gaps in the literature.
Articulation of the philosophy, content, learning outcomes, assessment and evaluation of a programme of study.
The diagnostic process: the integration and evaluation of data obtained during the examination to analyse the patient’s/client’s condition in terms that will inform the prognosis, the plan of care and intervention strategies.
Physical Clinical Diagnosis: Physical Therapists/Physiotherapists use diagnostic labels that identify the impact of a condition on function at the level of the system (especially the movement system) and at the level of the whole person in order to develop the appropriate ‘clinical physical diagnosis’ (see glossary definition).
Possible diagnoses that must be considered and systematically evaluated as possibilities in understanding the patient’s/client’s presentation.
Dimensions [of OMT practice]
Major functions of performance for OMT Physical Therapists/Physiotherapists.
Impairments, activity limitations and participation restrictions in the context of what an individual can do in their environment.
A pathological condition or abnormal entity with a characteristic group of signs and symptoms affecting the body with known or unknown aetiology.
Category of a construct, for example quality of life that consists of several domains e.g. pain, physical function and psychological components.
Disturbance or impairment of function (anatomic or physiologic).
The benefit of treatment or intervention.
For example. This abbreviation is used before a list that is intended to be representative of a preceding statement but is not to be assumed to be exhaustive or limiting.
The sensations imparted to the hand at the limit of possible range, when the examiner tests passive movement at a joint.
Movement of a joint complex that occurs towards the end of the available range, with or without pain. That range can be normal, any degree of excessive mobility (hypermobility) or, oppositely, any degree of limited mobility (hypomobility) in relation to the average mobility.
Episode of Physical Therapy / Physiotherapy care
All Physical Therapy/Physiotherapy services that are 1) provided by a Physical Therapist / Physiotherapist, 2) provided in an unbroken sequence debatable perhaps, and 3) related to the Physical Therapy / Physiotherapy intervention for a given condition or problem or related to a request from the patient/client, family, or other health care providers.
The dynamic process of determining the result, impact or effectiveness of Physical therapy/Physiotherapy management in relation to the patient’s/client’s needs, goals and outcomes established with the patient/client.
Evidence-based practice is the integration of best research evidence with clinical expertise and patient/client values.(Sackett et al 2000).
Evidence-based practice application has a theoretical body of knowledge, and uses the best available scientific evidence in clinical decision making and standardised outcome measures to evaluate the Physical therapy/Physiotherapy service/ management provided.
Integrating individual clinical expertise with the best available external clinical evidence from systematic research. Individual clinical expertise incorporates the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice.
A comprehensive and specific testing process (in this situation performed by a Physical Therapist / Physiotherapist) that leads to a physical clinical diagnosis or, as appropriate, to a referral to another Physical Therapist / Physiotherapist or other health care practitioner. The examination has three components: the patient/client history, planning the physical examination, and the physical examination.
Expected outcomes are the intended results of patient/client management, based on the changes of impairments/functional limitations, and disabilities and the changes in health, wellness, and fitness needs that are expected as a result of implementing the plan of care. The expected outcomes in the plan should be measurable and time limited.
A restriction of the ability to perform a physical action, activity, or task in a typically expected, efficient, or competent manner.
Restoration and optimisation of functioning of the neuromusculoskeletal system (NMS) in relevant movement patterns and postures using exercises and/or training.
Grades of Joint Mobilisation
Joint mobilisation means mobilising the joints of the spine, periphery or limbs. There are a range of grading systems for mobilisations e.g. Maitland grades of mobilisation are on a 5-point scale, Kaltenborn grades of mobilisation are on a 3-point scale. The grading system is based on how much joint play is available.
Health Care System
The organisation of healthcare in a particular country.
A systematic gathering of data-from both the past and the present-related to why the patient/client is seeking services of the Physical Therapist/Physiotherapist. The data that are obtained (e.g. through interview, through review of the patient/ client record, or from other sources) include demographic information, social history, employment and work (job/school/play), growth and development, living environments, general health status, social and health habits (past and current), family history, medical/ surgical history, current conditions or chief complaints, functional status and activity level, medications, and other clinical tests. While taking the history, the Physical Therapist/Physiotherapist also identifies needs for health restoration and prevention and identifies coexisting health problems that may have implications for intervention and prognosis.
Consideration of the ‘whole’. A comprehensive consideration of all aspects of the patient/ client and their problem.
Involves the generation of hypotheses based on clinical data and knowledge, and testing of these hypotheses through further inquiry.
International Classification of Functioning, Disability and Health
The ICF is World Health Organization’s framework for measuring health and disability at both individual and population levels. www.who.int/classifications/icf
Translated means ‘that is’. This abbreviation is used in the context of "that is (to say)" or "that means" or "in other words".
A loss or abnormality of physiological, psychological, or anatomical structure or function.
Individual Learning Needs
The ability of a therapist to be able to reflect on their current level of knowledge, skills and attributes and identify gaps that need to be addressed with further learning.
The voluntary and revocable agreement of a competent individual to participate in a therapeutic or research procedure, based on an adequate understanding of its nature, purpose and implication.
Creative and contemporary.
The provision of comprehensive care to patients/clients by multiple health care professionals who work collaboratively to deliver the best quality of care in all health care settings. Interprofessional care encompasses partnership, collaboration and a multi-disciplinary approach to enhancing outcomes.
The purposeful interaction of the Physical Therapist/Physiotherapist with the patient/client, and when appropriate, with other individuals involved in patient/client care such as using various Physical Therapy/Physiotherapy procedures and techniques to produce changes in the condition.
The entire articular joint and all associated soft tissues related to the function of that joint.
Management (of patient/client)
The complete Physical therapy/Physiotherapy present and future care of the patient/client with regards to the initial assessment and subsequent assessments and treatments as well as advice and exercise for their condition.
A systematic consideration of short and long term goals for management of the individual patient / client.
A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/or to reduce pain.
*anatomical limit: Active and passive motion occurs within the range of motion of the joint complex and not beyond the joint’s anatomic limit.
Manual Therapy Techniques
Skilled hand movements intended to produce any or all of the following effects: improve tissue extensibility; increase range of motion of the joint complex; mobilise or manipulate soft tissues and joints; induce relaxation; change muscle function; modulate pain; and reduce soft tissue swelling, inflammation or movement restriction.
Proficiency and expertise to enable efficient and effective practice.
Domains of knowledge centred around medical investigation and management.
Mentored Clinical Practice
The undertaking of clinical practice under the direct supervision of a clinical mentor with the specific goal of learning and improving clinical skills. Learning can result from a constructive evaluation of the student's clinical practice by the mentor and by observation and discussion of a student’s practice. The process usually involves substantial and regular discussion involving ongoing feedback from the mentor regarding clinical reasoning as well as manual skills.
Being aware of one’s cognitive processes and exerting control over these processes, and the cognitive skills that are necessary for the management of knowledge and other cognitive skills. In other words, metacognition involves thinking about your thinking and the factors that limit this thinking.
A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, that may include a small-amplitude/high velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/or to reduce pain.
Mobility of the nervous system
The ability of the nervous system to adapt to tensile loads including, 1) gross movements of elements of the nervous system in relation to anatomic interfaces with other structures, and 2) intraneural movements consisting of neural tissue elements moving in relation to the connective tissue components of nerve tissue (e.g. endoneurium, perineurium).
An obstruction to motion; a factor that tends to restrict free motion.
The ability of the central nervous system to control or direct the neuromotor system in purposeful movement and postural adjustments by selective allocation of muscle tension across appropriate joint segments.
A set of processes associated with practice or experience leading to relatively permanent changes in the capability for producing skilled action.
A lack or deficiency of normal motor function (motor control and motor function) that may be the result of pathology or other dysfunctions. Weakness, paralysis, abnormal movement patterns, abnormal timing, coordination, clumsiness, involuntary movements, or abnormal postures may be manifestations of impaired motor function (motor control and motor learning).
Motor Function (motor control and motor learning)
The ability to learn or demonstrate the skilful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns.
Domains of knowledge that predominantly deal with the analysis, function and training of the neuromusculoskeletal (NMS) system.
Management utilising more than one modality of treatment / intervention.
Multi-Professional Team / Multi Disciplinary Team
See interprofessional team
Introduction and withdrawal of needles, lifting and thrusting, twirling, and combinations of the three basic movements.
Of the skeleton and associated systems responsible for coordination normal movement and function.
Problematic abnormal functioning of the neuromusculoskeletal system (NMS).
Criteria for evaluation of the progress of management.
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
/ Limit of Range
The perceived limitation due to pain/ resistance/ spasm to passive range of motion and their inter-relationships through range and at end range.
Patients / Clients
Individuals who are the recipients of Physical Therapy/Physiotherapy examination, evaluation, diagnosis, prognosis, and intervention and who have a disease, dysfunction, condition, impairment, functional limitation, or disability for which they are seeking treatment.
Refers to an approach to clinical practice in which the patient / client is at the centre of all clinical decision-making and in which their understandings, beliefs and feelings are recognised within the therapeutic relationship with the Physical therapy/Physiotherapy. The patient/client is recognised as an equal partner in their management and is encouraged to actively participate in their treatment and management.
Patient/Client values are the unique preferences, concerns and expectations that each patient/client brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient/client (Sackett et al 2000).
Direct or intuitive automatic retrieval of information from a well-structured knowledge base with reference to the recognition of a clinical pattern of symptoms and signs.
Licensed/ registered health care professionals who diagnose and manage movement dysfunction and enhance physical and functional status in all age populations.
Physical Therapy/Physiotherapy Scope of Practice
The management of physical dysfunction or injury intended to restore or facilitate normal/optimal Function and development of wellness.
Defined by the Physical therapist’s/Physiotherapist’s regulatory body.
Statements that specify the anticipated goals and expected outcomes, predicted level of optimal improvement, specific physical examinations and interventions to be used, and proposed frequency and duration of the interventions that are required to reach the goals and outcomes.
Instruction in the theoretical and practical skills prior to utilising them in the clinical setting
A clinical indication or finding that a particular examination procedure or treatment intervention has the potential to produce an adverse reaction and/or cause potential harm to the patient/client. An action taken in advance can protect against possible harm.
Activities that are directed toward (I) achieving and restoring optimal functional capacity, (2) minimising impairments, functional limitations, and disabilities, (3) maintaining health (thereby preventing further deterioration or future illness), (4) creating appropriate environmental adaptations to enhance independent function.
Primary prevention: Prevention of disease in a susceptible or potentially susceptible population through specific measures such as general health promotion efforts.
Secondary prevention: Efforts to decrease the duration of illness, severity of diseases, and sequelae through early diagnosis and prompt intervention.
Tertiary prevention: Efforts to limit the degree of disability and promote rehabilitation and restoration of function in patients/ clients with chronic and irreversible diseases.
The provision of integrated, accessible health care services by clinicians, in this context this refers to Physical therapists/Physiotherapists who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients / clients and practicing within the context of family and community and outside the hospital setting.
Rating and justifying the importance of one aspect over another.
University based education received/ undertaken after successful completion of an entry level programme in Physical Therapy/Physiotherapy.
Education received after receiving a professional degree i.e. ones Physical Therapy/Physiotherapy degree
The alignment and positioning of the body in relation to gravity, centre of mass and base of support.
The determination by the Physical Therapist/Physiotherapist of the predicted optimal level of improvement in function and the amount of time needed to reach that level.
Qualitative research is often said to be naturalistic
. That is, its goal is to understand behaviour in a natural setting. Two other goals attributed to qualitative research are understanding a phenomenon from the perspective of the research participant and understanding the meanings people give to their experience.
Research methods that reduce phenomenon and related data to measurable units that may be subject to statistical analysis.
(Best) Research Evidence: clinically relevant research, often from the basic sciences of medicine, but especially from patient-centered / client-centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative and preventative regimes.
New evidence from clinical research both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer(Sackett et al 2000).
A physical reaction or answer of the patient/client to a position, movement and or test procedure.
A feature that increases a person’s chance of experiencing a problem.
Scope of Practice
See also Physical Therapy/Physiotherapy Scope of Practice.
A process to determine the need for further examination or consultation by a Physical Therapist / Physiotherapist or for referral to another health care professional. Questions used in the patient/client history or physical tests may be performed to determine the indications or contraindications for subsequent assessment or treatment interventions
i) In a research context: The extent to which a test identifies those individuals who have the condition i.e. true positives.
ii) In a skills / performance context: The degree of sensitiveness; reacting quickly to slight changes.
A practitioner recognised as working at a high level of practice demonstrating expertise. The word has different meanings in different countries.
A term describing the formal recognition reserved for, in this case Physical therapy/Physiotherapy, individuals who successfully complete an approved programme/process that acknowledges the possession of a higher standard of competence within a recognsed area of practice.
These are assessment procedures that are not performed routinely. They are additional tests may be indicated based on clinical reasoning and findings from the examination at specific biomedical diagnoses and/or decided upon by clinical reasoning.
i) In a research context: The extent to which a test fails to identify those who do not have the condition i.e. true negatives.
ii) In a skills/performance context: Preciseness or having a special effect
Means by which individuals are compared and judged. The level, competence or delivery of services that should be achieved in practice.
Any subjective evidence of disease or of a patient’s/ client’s condition.
Means of achieving aims.
A form of individualised patient/client exercise prescription by the Physical therapy/Physiotherapy with the intent to optimise the function and health of the neuromusculoskeletal system (NMS).
Based on theory.
The word thrust is interchangeable with the word manipulation or manipulative. At times it is expressed as a manipulative thrust – implying the skilled force (energy) imparted to the patient/client by the clinician during the act of a manipulative technique.
Tests and Measures
Specific standardised methods and techniques used to gather data about the patient/client after the history (subjective assessment) and systems review have been performed.
The therapeutic use of manual or mechanical tension created by a pulling force to produce a combination of distraction and gliding to relieve pain and increase range of movement and improve function i.e. achieve the desired effects of manual therapy techniques.
The management/handling of a patient/client by the sum of all interventions provided by the Physical Therapist/Physiotherapist to a patient/client during an episode of care.
A clinical state in which there is inadequate blood flow through the vertebro-basilar arterial system resulting in hindbrain hypo-perfusion, potentially stroke and death. Signs and symptoms of vertebro-basilar insufficiency are normally a contraindication to manual therapy of the cervical spine.
Concepts that embrace positive health behaviours that promote a state of physical and mental health and fitness.