Subjektif Değerlendirme
Özet
Bu bölüm, ortopedik rehabilitasyonda subjektif değerlendirmenin klinik akıl yürütme ve kişi-merkezli rehabilitasyondaki rolünü ele almaktadır. İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırması (ICF) çerçevesinde yürütülen subjektif değerlendirme; hasta anlatısı, anamnez, klinisyen izlenimleri ve hasta bildirimine dayalı sonuç ölçümleri aracılığıyla kişinin sağlık durumu ile bağlamsal etmenleri arasındaki etkileşimin gerçek yaşam deneyimine nasıl yansıdığının anlaşılmasına zemin hazırlar. Bölümde, subjektif değerlendirmede ICF çerçevesinin nasıl kullanılabileceği ve bireyin vücut yapıları ve işlevleri, aktivite, katılım, çevresel ve kişisel etmenler açısından biyopsikososyal bir bütün olarak değerlendirilmesine katkısı ele alınmaktadır. Ayrıca hasta anlatısının, numerik sonuç ölçümlerini tamamlayarak ağrının tipi ve olası mekanizmalarına ilişkin klinik ipuçları sunmadaki önemi vurgulanmaktadır. Anamnezin yapılandırılması, aktif dinleme, demografik özellikler, özgeçmiş, soygeçmiş ve yaşam alışkanlıklarının klinik açıdan değerlendirilmesi ile kırmızı bayrakların sorgulanması açıklanmaktadır. Son olarak, subjektif değerlendirmeden elde edilen bilgilerin klinik hipotezlerin oluşturulması, uygun objektif testlerin seçilmesi, hasta öncelikleri ve tedavi hedeflerinin belirlenmesi ile kişi-merkezli rehabilitasyon planının yapılandırılmasındaki katkısı ele alınmaktadır.
This chapter addresses the role of subjective assessment in clinical reasoning and person-centred rehabilitation within orthopaedic rehabilitation. Subjective assessment conducted within the framework of the International Classification of Functioning, Disability and Health (ICF) provides a basis for understanding how the interaction between a person’s health condition and contextual factors is reflected in real-life experience through the patient narrative, history taking, clinician impressions, and patient-reported outcome measures. The chapter discusses how the ICF framework can be used in subjective assessment and its contribution to evaluating the individual as a biopsychosocial whole in terms of body functions and structures, activities, participation, environmental factors, and personal factors. It also emphasizes the importance of the patient narrative in complementing numerical outcome measures and providing clinical clues regarding the type and possible mechanisms of pain. The structuring of history taking, active listening, and the clinical evaluation of demographic characteristics, past medical history, family history, lifestyle habits, and red flag screening are also described. Finally, the contribution of information obtained through subjective assessment to clinical hypothesis generation, selection of appropriate objective tests, identification of patient priorities and treatment goals, and development of a person-centred rehabilitation plan is addressed.
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