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In this era of health care accountability, a need exists for a new decision-making and documentation guide in physical therapy. The original Hypothesis-Oriented Algorithm for Clinicians (HOAC) provided clinicians and students with a framework for science-based clinical practice and focused on the remediation of functional deficits and how changes in impairments related to these deficits. The HOAC II was designed to address shortcomings in the original HOAC and be more compatible with contemporary practice, including the Guide to Physical Therapist Practice. Disablement terminology is used in the HOAC II to guide clinicians and students when documenting patient care and incorporating evidence into practice. The HOAC II, like the HOAC, can be applied to a patient regardless of age or disorder and allows for identification of problems by physical therapists when patients are not able to communicate their problems. A feature of the HOAC II that was lacking in the original algorithm is the concept of prevention and how to justify and document interventions directed at prevention. [Rothstein JM, Echternach JL, Riddle DL. The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): a guide for patient management. Phys Ther. 2003;83:455-470.]
Key Words: Decision making; Diagnosis; Physical therapy profession, professional issues.
In 1986, Rothstein and Echternach1 published a clinical decision and documentation guide called the Hypothesis-Oriented Algorithm for Clinicians (HOAC), which they contended offered clinicians a pragmatic, scientifically credible approach to patient management. Since that algorithm was first published, radical changes have occurred in the health care system. For example, there is now widespread discussion of the importance of physical therapists making diagnoses,2 and there is also general acceptance of the need to view patients and clients within the context of one of the disability models.3,4 In addition, therapists often have to relate to practice guides and guidelines.5 We argue that what is needed is a patient management system that involves the patient in decision making and can be used to provide payers with better justifications for interventions, including occasions when therapists may disagree with practice guidelines. Compatibility with the Guide to Physical Therapist Practices (Guide's) patient management model, including the formulation of diagnoses, is also desirable.6
The purpose of this article is to present HOAC II, a revised algorithm designed to meet the needs of contemporary...