Anticipated problems

These are problems believed to occur in the future if no intervention for prevention is applied. The justification for the problems must be based on research evidence or on sound theoretical arguments.

Contextual factors

In the ICF these include external environmental factors and internal personal factors.

Examination strategy

This is the plan for examination and lists the clinimetrics you decide to use. The examination strategy is directly linked to the identified problems and hypothesised causations.

Existing problems

These are problems that exist when the patient is first seen by the therapist and that require remediation.

Goals

Goals represent measurable and meaningful accomplishments in function, mostly in activity & participation level. They are always patient-centred and have to do with outcomes that have value to the patient’s current quality of life or future quality of life.

Hypotheses

These are explanations for probable causes for a problem. They must be testable and deal with elements that can be affected by interventions. Multiple hypotheses may be attached to one problem and one hypothesis may be attached to multiple problems.

ICF Core Sets

These are lists of the ICF categories that reflect the aspects of functioning most likely affected in specific health conditions.

Impairments

In the ICF these are problems in body function or structure.

Implementer

This is the person who carries out an intervention. For instance, a home exercise programme would be implemented by the patient. Sometimes family members may have a role in implementation of tactics.

Intervention strategy

These state the overall types of interventions used and their purpose.

Non-Patient Identified Problems

These are existing or anticipated problems identified by someone else than the patient (e.g. therapist, family members, caregiver).

Patient-Identified Problems

These are problems the patient identifies. PIPs are usually existing, but they can also be anticipated. They most often concern activity & participation domains of the ICF classification system.

Predictive criteria

These are a set of critical measurement values, usually concerning risk factors, used to monitor anticipated problems. They must relate to an observable behaviour (not only increased knowledge or awereness). If met, they indicate that the problem will most likely be avoided because risk factors were reduced or eliminated.

Rationale

This explains why an anticipated problem (PIP or NPIP) is justified. The rationale must explain as to why impairments or pathologies are believed to lead to activitity restrictions and participation limitations unless an intervention is provided. The rationale can only be based on research evidence or sound theoretical arguments.

Referral

This is when the patient is transferred from one health care professional to another.

Tactics

These are specific elements, including frequency, duration and intensity of an intervention.

Testing criteria

These are a set of critical measurement values, usually at impairment level, used to test the correctness of hypotheses.