This study proposes a novel clinical reasoning-based schematic model for physiotherapeutic treatment of patients with fractures. The model considers not only musculoskeletal impairments but also neuromuscular dysfunction, psychosocial factors, and patient-centered care, as guided by the International Classification of Functioning, Disability, and Health (ICF).
The model was built by reviewing literature on bone and soft tissue healing, neuromusculoskeletal consequences of immobilization, psychosocial factors associated with fractures, and the ICF framework. The schematic model was stratified according to the type of orthopedic treatment (surgical or nonsurgical) and the phases of bone healing to determine the most appropriate interventions over time.
The schematic model was designed around the phases of bone healing. In the inflammatory phase, interventions include patient and family education, pain control, edema management, functional joint positioning, prevention of secondary conditions, and early sensorimotor training. During the fibroblastic phase, the interventions depend on the type of orthopedic treatment. Protective strategies involve mobilizing free joints around the fracture and employing movement representation and cross-education techniques. Controlled interventions focus on soft tissue mobilization, direct strategies to motor learning processes, while controlling the loads applied to the fractured site. In the remodeling phase, rehabilitation shifts towards regaining the full range of motion, especially if stiffness is present, and progressively strengthening the muscles around the fracture site. Functional training progresses to more demanding activities as the patient’s condition improves, aiming for the restoration of activities and participation based on patient goals.
This is the first schematic model for physiotherapy treatment of fractures that addresses not only musculoskeletal changes but also neuromusculoskeletal dysfunctions and psychosocial factors. The model can assist physiotherapists in guiding clinical reasoning and decision-making during rehabilitation, promoting the restoration of function, activity, and participation.
This schematic model offers a comprehensive, standardized approach to fracture rehabilitation that includes musculoskeletal, neuromusculoskeletal, and psychosocial elements. The model's effectiveness must be tested in clinical settings to determine its impact on rehabilitation outcomes and patient recovery.
physiotherapy
clinical reasoning
