Clinical Impression & Recommendation Flashcards
If the case clearly states a Dx
Provide a clinical impression of the patient’s current status and recovery
E.g. 3 weeks post grade 2 non-surgical ACL tear
- What are the Pt’s impairmenet and how have they impacted function?
- Are the S&S presented in the case indicative of someone who is recovering on a normal timeline/someone who is delayed in their recovery?
If Dx has not been provided and you need to determine your phyiosthrapy diagnosis
E.g. A Pt who injured their knee while playing soccer
- Explain your primary physiotherapy diagnosis and rationale based on information in the case & any additional information provided
- MOI/(family Hx of the condition)
- Risk factors
- S&S
- Objective findings (e.g. special test)
- Lab/Scan result
- State the differential diagnosis
If asked for a differential Dx, consider the following
- Red flags: are there any red flag concerns that could indicate something sinister causing the symptoms?–>If so, where should you refer them (e.g. emergency vs family doc)
- Local antaomy: what other sturcutres are local in the area that could cause symptoms?
- Referrals: what structures could refer to this area?
- Systemis: Are there any systemic conditions that could cause these symptoms?
–>E.g. RA, AS
If asked for a differential Dx, state 2-3 differential Dx in the order that you feel is most likely
- verbalize why this is a possible differential Dx (e.g. pain presentation) + why you do not consider to be your primary PT Dx (e.g. special test–>do not indicate this Dx)
Use your clinical reasoning to explain why you have chosen the differential diagnosis (i.e. highlight specific findings in the case)
After giving Dx…
- Discuss whether you feel the Pt will benefit from physiotherapy intervention
- If so, include a few recommendations of what you would include in your plan
- Create a plan to address returning to their meaningful task
- Explain general Rx recommendations and why you have chosen those treatments
2-3 general treatment recommendation
Definition of Physiotherapy Scope
- Assessment of neuromuscular, musculoskeletal and cardiorepsiratory systems
- Diagnosis of diseases or disorders associated with physical dysfunction
- Treatment & rehabilitation and prevention or relief of physical dysfunction, injury or pain to develop, maintain, rehabilitate or augment function and promote mobility
Making a physiotherapy Dx
When diagnosing, PT must use the term Physiotherapy Dx
- Within their SOP, PT are limited in what they can diagnose through clinical assessment
- PT are often the first people to see a Pt and should be diligent when performing their clinical Ax–>identify if a Pt requires a referral for further investigations, to obtain a Dx, and receive any necessary medical/pharmaceutical intervention
Scope of knowledge and skills
- PT should only diagnose conditions for whick they possess the necessary knowledge, skills and judgmnet to diagnose–>can vary depending on clinical experience, mentorship & education
- Many conditions that PT treat but cannot diagnose–>gold standard for Dx can’t be ordered by PT (e.g. blood test, imaging, ECG)
Making a physiotherapy Dx
Competency and Referral
- If a PT suspect a Dx that is under the SOP but can’t confirm it through clinical assessment–>refer the Pt to appropriate healthcare practitioner
- If a PT makes a physiotherapy Dx and believes that aspects of the patient’s condition require collaborative management with a physician or nurse practitioner–>refer the Pt accordingly
E.g. Pt with pneumonia and PT is concern about the severity of pneumonia/Pt overall health status–>refer the Pt to their family physician (e.g. CXR, antibiotics) - If a PT suspects a condition that is outside their SOP to diagnose–>refer the Pt to the appropriate healthcare profesional who is regulated to diagnose that condition
Referral is essential–>certain aspects of the Pt’s condition may require medical management (medications, surgery)
However, PT still can treat the impairment associated with the condition if no CI based on what the PT suspects
E.g.1 Pt come for an initial Ax & Rx of hand pain–>PT observe red, swollen joint, deformities in both hands–>suspect RA
Action of PT
- Refer Pt to family Doc for further investigations & liaise via email, phone call
- Provide care that is safe, clinically indicated & within SOP e.g. pain management, activity modification
E.g.2 Pt with LBP showing red flags
Action of PT
- refer Pt to family Doc for further investigations
- Not appropriate to initiate PT Rx due to sinister nature of Pt’s presentation
- Once the Pt has the medical Dx–>collaborate with Pt’s physician to ensure they are safe to participate in a PT program
E.g.3 Pt with LBP showing cauda equina syndrome
- refer Pt to emergency departmetn for immediate medical care
- Once the Pt is medically stable–>collaborate with the Pt’s physicians to ensure they are safe to participate in PT program
If a diagnosis has been established (e.g. RA, TBI, ALS)
PT can treat the impairment within their SOP
E.g. Pt Dx of ALS
PT can…
- assess the Pt and provide treatment recommendations–>manage mobility & strength-related issues
PT cannot…
- provide Rx for swallowing or speech-related issue–>refer to speech-language pathologist for Rx (out of SOP)
Overview of conditions that should be sent to emergency
- Cauda equina syndrome
- Circulation issues with a cast
- DVT
- Hemarthrosis
- Pulmonary embolism
- Vertebrobasilar insufficiency
- Cervical facture (from high speed MVA, fall from significant height)
- Autonomic dysreflexia (SCI above T6)
–>only if the source of the noxious stimulus could not be located & the Pt’s BP could not be controlled
Overview of conditions that should be ref
- Red flags for cancer
- Fracture
- Infection
- Myositis ossificans
- Pancoast tumor
Low back pain/injury
Associated Signs & Symptoms
- Bil. widespread LL numbness/weakness/pain
- Saddle paresthesia
- Loss of bowel and/or bladder control
Serious pathology
- Cauda equina syndrome
Anyone with a cast
Associated Signs & Symptoms
- Change in colour of distal extremity (pale, cyanotic)
- Change in temperature of distal extremity
- Difficulty moving fingers, toes, or joints of the affected limb
- Numbness & tingling
- Severe/inc. in pain of the affected limb
- Abnormal capillary refill of toe/fingers
Serious pathology
Circulation issue with a cast
Post surgical who has not mobilized
Associated Signs & Symptoms
- Dull ache
- Tightness/pain in calf and tenderness on palpation
- Swelling
- Warmth
- May have a fever
- Pain with DF
Serious pathology
Deep vein thromobosis
Traumatic injury to a joint
Associated Signs & Symptoms
- Significant swelling
- Warm around joint
- Joint stiffness
- Severe pain
- Tingling sensation
Serious pathology
Hemarthrosis
- Hx of DVT
- Post surgical
- Not mobilized in several days
Associated Signs & Symptoms
- Bloody sputum
- Dyspnea
- Inc. RR & work of breathing
- Cyanosis
- Tachycardia
- New chest pain
- Decrease oxygen saturation
Serious pathology
Pulmonary emoblism
Whiplash
Associated Signs & Symptoms
- 5D: Dizziness, Dysarthria, Dysphagia, Diplopia, Drop attacks
- 3N: Nystagmus, nausea, perioral numbness
Serious pathology
Vertebrobasilar insufficiency
