Intro to physiotherapy evaluation and management Flashcards
Why do PT need to assess a pt?
Identify possible causes of dysfunction &/ source of symptoms or movement impairments.
Make clinical PT hypothesis/ diagnoses.
Problem list (impairments of move components, act limitations and resources, participation restrictions - ICF)
define therapy objectives
ID precautions or contra-indications
ID contributing factors to condition, e.g. environ, behaviour, emotion, physical or biomedical
select treatment interventions
manage each individual pt (unique traits)
define parameters and ID appropriate outcome measures to monitor effect of therapeutic interventions.
How does clinical decision making process occur?
process of :
assessment
re-assessment
management
How can clinical decision making or clinical reasoning enable a PT to plan an effective treatment/management according to needs of pt:
Interrelated steps:
- interview and plan of physical examination, inclu. determining precautions and contra-indications to physical exam.
- physical exam of pt
- problem list which entails the following: analysis of findings to ID functional problems and underlying reasons according to ICF, & P&C’s to interventions.
- formulating a clinical hypothesis/ diagnoses
- management plan: determine prognosis, management goals (S&L term), comprehensive management plan according to ICF, selecting appropriate techniques/ interventions, and determining of parameters and appropriate OM to monitor the results of management in a collaborative process with pt, and criteria for discharge.
- implementation of management plan/ interventions
- re-assessment to determine the effect of management of appropriate OM and adaptations to management plan accordingly.
What do components of skilled clinical decision making include?
adequate knowledge (base and experience)
cognitive processing strategies (inclu. clinical reasoning and decision making)
self-monitoring strategies (continuous critical reflection on YOUR thoughts, feelings and decisions, as well as the capacity to react adequately to the reflections, thus determining effectively YOUR input and making appropriate adaptations to techniques, management plan)
communication (with pt family members, employers, public, funders, and team members)
teaching skills (inlcuding advice, teaching exercises, home program, group sessions for pt family members, public and other team members)
effective documentation (record keeping to monitor the pt’s progress, and for medico-legal implications, as well as communication between team members and funders)
what is the AIM of interview? (subjective exam)
info about pt’s problem, symptoms, and or complaints (from the pt’s perspective) so as to be able to generate a preliminary hypothesis (or list of multiple hypothesis) and tp plan efficient, effective and safe physical exam to support or negate the hypothesis.
this step involves:
ID possible causes of neuromuscular dysfunction
define pt’s problem in terms of ICF
resources available to determine appropriate intervention.
assessment is ongoing process
therefore re-exam- to evaluate progress and modify interventions and goals.
Where can the info of the interview be obtained?
directly from patient medical records family significant other (work/sport) care-givers
What should the interview data include?
pt’s primary complaint, including fn limits/ restrictions, symptoms like pain and other, weakness, shortness of breath
for symptoms complete a body chart
determine behavior of symptoms (SIN)
special questions
history of present illness/ injury
past medical history and knowledge of medical condition
social and family
personal goals and expectations and motivation
Why must the interview be thorough?
fully ID, describe and record pain/ symptomatic areas
understand the behaviour and relationship of symptoms and their implications
be familiar with, understand, the implications of response to special questions to help identify P&C’s
conduct a full investigation into the history of the patient’s present condition and past medical & surgical history (med, special investigation), general health, social (occupation, sport & living) & social habits.
What does the clinician need to decide on after the interview?
the sources of symptoms and/dysfunction i.e. structure at fault
what factors are contributing to the condition e.g environmental, behavioural, emotional, physical or biomedical
whether there are any precautions or contraindications to the physical exam and treatment
the prognosis of the condition which can be affected by the stage and extent of the injury as well as the pt’s expectations, personality and life-style
how best to manage the condition and set up a management plan
How should PT deal with movement disorders?
patient-centred approuch
what is the central theme or core of assessment?
a positive personal commitment to understand the person is enduring.
Maitland suggests placing the pt and their main problems at the centre of everything the PT will do or say.
what does the key component around a personal commitment to the pt mean?
develop a level of concentration such that the PT feels mentally & physically challenged throughout each episode of care. The PT must see each price of info and think how to reply or ask a relevant follow-up question, carry out another exam procedure, or select an appropriate treatment technique in order to solve the problem each time the pt is seen
being prepared to revisit the pt’s sensory, cognitive and emotional world until the info that the pt provides makes sense
being totally non-judgemental at all times, actively listening to the pt and believing that everything the PT is told is true.
develping a skilled understanding of verbal and non-verbal communication and being prepared to critically appraise one’s own communication skills.
using the pt’s own terminology
endeavouring to understand the ‘frame of reference’ from which the pt expresses the effects of disorder
knowing what the clinician should know
creating an interpersonal environment in which the patient feels comfortable, confident and trusting in the clinician.
what must the interview additionally establish?
effective communication
mutual trust
what helps with accuracy for info gained during the interview?
quality of communication between the pt and PT
patient co-operation serves to make the PT’s observations more valid and becomes crucial to the success of any management programme.
the usefulness of the info gained depends on the PT’s understanding the relevance and pertinence of all the questions asked.
What are some considerations?
effective time managment
the management and assessment is pt specific
Appropriateness can be enhanced: by appropriate questioning through the interview, by selecting appropriate physical exam techniques and applying appropriate intervention techniques and giving appropriate home advice.
what are the principles of the interview?
pt should be comfortable and relaxed, since interview (20-30 min)
the PT must be seated in position to maintain good eye contact with the pt during the interview and to observe the pt
inform the pt about the procedure that will be followed
PT listen actively, stay focused and direct the interview in such a way in order to stick to the pt’s problem
questions must not be closed, rather structure in order for the pt to give his/her interpretation of the problem
when planning a physical exam, consider:
collaberative manner with pt
P&C’s :
various body systems should be screened in the first PT consultation in order to ID any pathological processes which require special attention and diagnoses e.g CVS, Pulm system, GIT system, Urongenital, endocrine, NS, M-skeletal, Rheumatic disease, psychiatric disorders and skin disorders.
Physical exam sub-categories
observation functional abilities/ activities joint tests muscle tests neurological tests balance and co-ordination cardio-pulmonary & vascular special tests palpation OM
