Bahrain NHRA Physiotherapist cheat sheet

Consent in Bahrain requires valid capacity, adequate information, and voluntariness; documented refusal must be respected and recorded in the clinical file.

Physiotherapy documentation follows the SOAP structure: Subjective, Objective, Assessment, Plan; entries are dated, timed, signed, and legible.

Infection control uses standard precautions for all patients; hand hygiene follows WHO's five moments and alcohol rub is first-line when hands are not visibly soiled.

Outcome measures must be valid, reliable, and responsive; the minimal detectable change (MDC) is the smallest change beyond measurement error, while the MCID is the smallest patient-perceived benefit.

Clinical reasoning follows a hypothesis-driven cycle: cue collection, hypothesis generation, testing, interpretation, and re-evaluation; it is not a linear checklist.

Scope of practice is set by NHRA professional licensing; tasks outside the licensed scope require delegation to an appropriately licensed professional and documented supervision.

Evidence hierarchy ranks systematic reviews and randomised controlled trials above cohort, case-control, and expert opinion for questions of intervention effect.

Adverse event reporting is mandatory and should be completed as soon as practicable after identification; near misses are also reportable events.

Ottawa Ankle Rules: X-ray is indicated if there is malleolar or midfoot pain plus inability to bear weight four steps, or bone tenderness at the posterior malleolus, navicular, or fifth metatarsal base.

Ottawa Knee Rules: X-ray is indicated for acute knee injury with age 55 or over, isolated patellar tenderness, fibular head tenderness, inability to flex to 90 degrees, or inability to bear weight four steps.

Cervical radiculopathy with progressive motor deficit, gait disturbance, or bowel/bladder change is a red flag requiring urgent medical referral, not manipulation.

Rotator cuff tendinopathy is managed with progressive loading; corticosteroid injection gives short-term relief but repeated injections may impair tendon quality.

Lateral epicondylalgia is a tendinopathy, not inflammation; eccentric or isometric loading and load management are first-line, and the pain provocation test is resisted wrist extension.

Anterior cruciate ligament injury is assessed with the Lachman test (highest sensitivity at about 85%), the pivot shift (highest specificity), and the anterior drawer test (least sensitive).

Low back pain without red flags is managed with reassurance, activity maintenance, and education; bed rest beyond short periods is not recommended.

Osteoarthritis management combines exercise, weight management, education, and self-management; intra-articular corticosteroid provides short-term symptom relief only.

Fracture healing phases are inflammation (days), repair/soft callus (weeks), and remodelling (months); loading progression must respect the stage and the surgeon's instructions.

Upper motor neuron signs include hyperreflexia, spasticity, clonus, and a positive Babinski sign; lower motor neuron signs include atrophy, fasciculation, hypotonia, and areflexia.

The Glasgow Coma Scale scores eye opening (1-4), verbal response (1-5), and motor response (1-6); the total ranges 3-15, and a score of 8 or less indicates severe impairment.

Stroke thrombolysis window is commonly up to 4.5 hours from symptom onset; thrombectomy may extend to 24 hours in selected patients with imaging-confirmed salvageable tissue.

The Berg Balance Scale has 14 items scored 0-4 (total 0-56); scores of 41-56 indicate low fall risk, 21-40 medium risk, and 0-20 high risk.

The Modified Ashworth Scale grades resistance to passive movement from 0 (no increase) to 4 (rigid); grade 1+ indicates catch then minimal resistance through less than half the range.

The 10-metre walk test measures gait speed; a speed below 0.8 m/s is associated with limited community ambulation and increased fall risk.

Neuroplasticity is experience-dependent; task-specific, repetitive, and salient practice drives cortical reorganisation, while non-use leads to maladaptive change.

Parkinson's disease cardinal features are bradykinesia, resting tremor, rigidity, and postural instability; cueing and dual-task training target festination and freezing.

Multiple sclerosis fatigue is managed with energy conservation, pacing, cooling, and graded exercise; exercise does not increase relapse rate in stable disease.

Normal resting values in adults: respiratory rate 12-20 breaths/min, tidal volume about 500 mL, and arterial oxygen saturation 94-100% on room air.

The six-minute walk test measures functional exercise capacity; a distance under 300 m predicts increased mortality risk in chronic respiratory disease.

The Borg 6-20 scale rates perceived exertion; a rating of 12-14 corresponds to moderate intensity and is a common target in pulmonary rehabilitation.

Pursed-lip breathing prolongs expiration and reduces dynamic hyperinflation in obstructive disease; it is indicated when the patient reports breathlessness on exertion.

Active cycle of breathing technique combines breathing control, thoracic expansion exercises, and the forced expiration technique to mobilise and clear secretions.

Postural drainage positions use gravity to drain specific lung segments; contraindications include uncontrolled hypertension, recent haemoptysis, and raised intracranial pressure.

A fall in systolic pressure of 20 mmHg or more, or diastolic of 10 mmHg or more, on standing defines orthostatic hypotension and warrants a modified mobilisation plan.

Cardiac rehabilitation after myocardial infarction improves functional capacity and reduces mortality; exercise prescription uses a percentage of the measured peak heart rate or the heart rate reserve formula.

Incentive spirometry targets prevention of atelectasis post-operatively; sustained maximal inspiration is the key mechanism, not the device itself.