Why the HOAC II?

We have very good reasons to use the HOAC II as the clinical reasoning framework on getPTsmart.com. Here are the most important ones:

HOAC II in clinical practice

  • The HOAC II is a conceptual framework. As a conceptual framework it provides a logical structure and a guideline that helps PTs develop comprehensive and coherent plans for patient management (Schenkman et al. 2006, Shumway-Cook et al. 2012).
  • The HOAC II provides a way to engage in the conscious, process-like, systematic and effective practice as advocated for instance by the Royal Dutch Society for Physical Therapy – KNGF (Pistorius et al. 2006).
  • The HOAC II represents contemporary, evidence-based physical therapy practice that incorporates the concept of prevention, a topic receiving much attention in physical therapy (Pistorius et al. 2006).
  • The HOAC II aids problem-solving in clinical practice (Engelbert 2011).

HOAC II in the PT world

  • The HOAC II, in part or whole, is a component of several clinical reasoning frameworks developed for specific areas of physical therapy. These include for instance the task-orientated approach advocated by Shumway-Cook et al. (2012), the integrated framework for neurological physical therapy by Schenkman et al. (2006) and the clinical reasoning framework developed for neonatal physical therapy (Sweeney et al. 2009).
  • The most recent KNGF Evidence Statement for children with writing problems (Nijhuis-van der Sanden et al. 2011) converted its conclusions into recommendations for clinical reasoning using the HOAC II as the clinical reasoning framework.

HOAC II in education

  • In the Netherlands the HOAC II is the cutting edge clinical reasoning framework. Currently six physical therapy programmes are in the process of further implementing the HOAC II in their curriculum (Engelbert 2011).
  • The Dutch National Diploma for Physical Therapy (2008) establishes the HOAC II as one of the two profession-specific models of clinical reasoning covered in the Dutch PT progreammes. The other one is the Rehabilitation Problem Solving-model (RPS).

No consensus on the best clinical reasoning framework across all forms of PT practice has been established (Shumway-Cook et al. 2012). Based on literature and the communication we have had with HOAC II experts and those making decisions in physical therapy education, we believe the HOAC II offers an efficient way to structure your mind for clinical reasoning and clinical problem solving. The well-structured thoughts then allow for efficient communication between clinicians and give depth and quality to documentation.


  • Dutch association for Physiotherapy education (SROF), Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF). National diploma supplement and national transcript physical therapy. SROF; Heerlen: 2008. URL: http://www.fysionet.nl/ckr-joke-ploos/beroepsprofielen/nationaltranscript_eng_190608.pdf.
  • Engelbert R. Director of education in Physiotherapy (Hogeschool van Amsterdam, the Netherlands). Personal communication. 6 December 2011.
  • Nijhuis-van der Sanden R, Overvelde A, van Bommel I, Bosga I, van Cauteren M, Halfwerk B, Smits-Engelsman B. KNGF Evidence Statement Motorische schrijfproblemen bij kinderen. Nederlands Tijdschrift voor Fysiotherapie. 2011;121(2):1-65.
  • Pistorius MF, Ramaekers SP, Verhoeven AL, Becht MJ, Bloo JK et al. The professional profile of the physical therapist. Amersfoort: Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF); 2006.
  • Schenkman M, Deutsch JE, Gill-Body KM. An integrated framework for decision making in neurologic physical therapist practice. Phys Ther. 2006;86:1681-702.
  • Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. 4th ed. Baltimore: Lippincott Williams & Wilkins; 2012.
  • Sweeney JK, Heriza CB, Blanchard Y. Neonatal physical therapy – part I: clinical competencies and neonatal intensive care unit clinical training models. Pediatr Phys Ther. 2009;21(4):296-307.
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