Specialisms within the interprofessional

setting

Psychosomatic Physiotherapy
Case referral
• Patient is a 19-year-old, healthy Dutch Moroccan woman. She lives with a
younger sister (14year) at her divorced mother. Patient follows the 1th
year of a secondary vocational training in the hotel and catering industry.
• She visited in 2 weeks 3 times the genera practitioner with severe pain in
her extremities. This increasing pain developed in a number of days. There
occurred to be no accidents or trauma.
• She is not able to walk without crutches and she sometimes uses a
wheelchair. Because of this she failed at school.
• The physical examination showed not rheumatic, orthopedic or
neurological abnormalities. From additional laboratory and x-ray
examinations not deviations were found
HOAC II
• What are your initial
hypothesis?
Discussion
After discussion
New information
• The patient came in the 1st time with her mother for the meeting with her own
doctor. She could barely walk. She limped, heavy drawing on crutches. There was
already an appointment at a rheumatologist made but the waiting time was 4
months. Mother was terribly worried and patient told that she could only lay down
on the cough but could not sleep of the pain. Mother stated that the mood of her
daughter had been changed from a cheerful into a gloomy girl.
• The doctor did the history taking according to the SCEGS method.
• This method implies that the complaints in 5 dimensions are explored somatic (S),
the corresponding cognitions (C) and emotions (E), the resulting behavior (G) and
the social consequences (S).
• It emerged that patient had fear she was not able to accomplish her education
and that she avoided difficult situations regularly. The physical examination
showed no abnormalities. The explanation that her body looked healthy had a
reassuring force on the patient. Hereinafter the doctor organized follow-up
arrangements in accordance with a two-track policy.
• 1st the somatic analysis was continued. Patient was quickly seen by a neurologist
with whom the doctor all general work appointments had made on patients with
unexplained complaints. This conclusion of the consultation was discussed by the
doctor with patient. It reassured the patient to a certain extend
• 2th: in the same period conversations took place with the practice
supporter mental care.
• An inventory of all matters that may influence on the complaints (so-called
maintaining factors) by exploring the psychological and social situation
took place.
This info changes your hypothesis?

A simple hypothesis is often written like this:

“If…..then…..”or “Due to……not able to

Example: “If the sky is blue, then it propably is not raining”.

• This is a hypothesis you can test by recording whether or not it is raining

when the sky is blue
What’s new now?
• What are your hypothesis now?
Assignment WG-1 HOAC

How are you going to investigate

your hypothesis and what diagnostic
resources would you use?
Additional Bibliography
Rothstein (2003) The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): a guide for patient
management, Physical Therapy. 2003 May;83(5):455-70