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Decision Making in
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Physical Therapy
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Objectives:
At the end of this lecture the student should be able to:

1. Define decision making.

2. Identify the types of decision making.
3. Differentiate between decision making and problem-solving processes.
4. List the common techniques used in decision making.
5. Explain the steps of the process of decision making.
6. List the types of biases to decision making process.

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 Decision making in Physical Therapy
Good decision making is an essential skill for career success and effective leadership.

Definition:
1. Decision making: is an outcome of mental or cognitive processes leading to the
selection of a course of actions among several alternatives.

OR
2. Decision making: is the process of identifying and choosing alternatives based on
the values and preferences of the decision maker.

Types of decisions:
1. DECISION WHETHER:
a. This is the (YES/NO), (EITHER/OR) decision which involve doing or not doing
an option.
b. This type of decision requires weighing the advantages and disadvantages of
each choice.
c. Examples;
i. Should I buy a new TV? YES/NO.
ii. Can I apply paraffin wax on acute ankle sprain? YES/NO.
iii. Can I apply ultrasound on knee joint stiffness? YES/NO.

2. DECISION WHICH:
a. It involves choosing one or more alternative from a number of possibilities.
b. The choice is based on how much each alternative fulfills our needs.
c. Examples;
i. What is the best modality for knee joint stiffness, Ultrasound, cryotherapy,
underwater exercise, infrared, LASER, Ultraviolet OR paraffin wax?

3. CONTINGENT DECISION:
a. These are decisions that are ALREADY MADE but put on HOLD until some
condition is met.
b. Examples;
i. I will do paraffin wax when the inflammation subsides.
ii. I will do the second phase of the program when the patient can do active free
contraction of quadriceps muscle.

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Problem-solving Vs Decision making:
1. Problem-solving and decision-making are completely different from each other.
2. Problem solving or analysis must be done first then the information collected in that
process is used in making decisions.
Problem solving Decision making

1. Problem solving involves 1. Decision making DO NOT involve listing

identification of patient's problems.
2. Problem is a deviation from normal
performance.
3. Problems are described and analyzed
to;
a. Identify changes from normal
performance.
b. Identify the cause of the
problem.
as much choices as possible.
2. Decision making means that we try to
choose the best choice based on;
a. Highest effectiveness.
b. Our goals, objectives, lifestyle, and
values.

Process of decision making:

1. Logical decision making is very important for all medical professions, which uses
knowledge to make the proper decision e.g., medical decision-making involves the
selection of the most appropriate treatment for the case presented.

2. Steps of decision making process are; (Figure: 11.01)

a. Identify OR define the objectives:
i. Define logic objectives:
 What is the problem to be solved? Patient can't walk because he has
knee pain.
 Why it should be solved? Pain affects the patient's function.
ii. Objectives must be classified and arranged according to importance:

b. Collect all relevant information: e.g.,

i. We collect relevant data NOT all available data, e.g.,
 Past, present and medical history of the patient.
 Results of medical examination.
 Results of Physical Therapy assessment.

c. Generate feasible options through:

i. Identify the principles and criteria to judge the alternatives.
ii. List different possible choices or options.
iii. List the best choices based on their advantage and disadvantage.

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 d. Make the decision:
i. Evaluate all alternatives against the objectives: assess if the chosen alternative
can achieve all objectives.
ii. Asses the BENEFIT/RISK ratio. It is very important to select the choice that
has more benefits than risks.
iii. Every decision has some risks that we have to manage when it happens.

e. Put the decision into action:

i. Apply the action plan you made.
ii. Evaluate the outcome of your decision.

N.B.:
a. If there are no different choices or alternatives, we DO
NOT have a decision; we have an ALGORITHM.

b. Algorithm is a set of fixed steps that are followed to

reach a fixed result.
Fig. 10.01: Decision Making steps.

Techniques of decision making:

1. Listing the advantages and disadvantages of each option
2. Choosing the alternative with highest effectiveness.
3. Satisficing: accepting the first option that seems possible.
4. Complying to a person in authority or an "expert", i.e., just following orders of
seniors.
5. Flipism: flipping a coin and other random methods.
6. Prayer, astrology, revelation or other forms of divination.

Biases in decision making process:

1. Selective search for evidence: we collect facts that support our opinions but ignore
other facts that support different opinions.
2. Premature termination of search for evidence: we accept the first alternative that
looks possible.
3. Selective perception: we actively ignore information that we think it is not
important.
4. Inertia: we are unwilling to change old thinking patterns, e.g., we apply the same
old program and we don't want to change it.
5. Optimism bias: we see things in a positive light which can affect our perception and
thinking.
6. Recency: we give attention to more recent information and ignore older information.
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References:
1. Adair J.: Decision Making and Problem Solving Strategies, The Sunday Times, London,
2010; Pp: 17-33, 45-53.
2. http://en.wikipedia.org/wiki/Decision_making

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