L5 - Assessment Principles Flashcards
define a clinical assessment
A process of information gathering, mixed with sound clinical reasoning to help guide physiotherapy management towards a patient centred goal.
what is the goal for a clinical assessment
- Help identify and formulate a Problem List
- or identify that Physiotherapy is not what is needed at present
- or identify other MDT needs / referral
- potential diagnosis
what are basic components of a clinical assessment
- Referral or medical information
- Subjective Assessment
- Objective Assessment
- Ongoing assessment i.e. during treatment, after treatment, retrospective assessment.
Where does the assessment start?
Referral.
- First Point of Contact. Provides direct access to physiotherapists.
- Referral Letter.
- GP or Self referral.
- Medical notes in acute care (Hospital In-Patient setting).
- Electronic Notes in Community Care e.g. System One.
- Referral from a previous Physio in the acute or intermediate care setting.
Role of Subjective and Objective Assessment.
- Helps to identify problem(s) and salient issues. This facilitates the creation of patient goal(s) based on patient centred care and shared decision making.
- Helps to identify if physiotherapy management is appropriate for the patient, or if they require referral to another service or urgent medical/psychological assessment.
- Helps to identify other patient needs; e.g. collaborative working with another profession.
Is it possible to complete all aspects of a subjective and objective assessment in the initial session?
No, it may not be possible to complete all aspects in the initial session.
What is part of the clinical reasoning process during the first session?
Identifying the essential components of the subjective and objective assessment to complete in the first session.
How can certain aspects of the assessment be handled for future sessions?
Some aspects, such as cognition, sensation, or vision, may be covered as a screening process and assessed further in future sessions or by other MDT members.
What should be the main priority when conducting an assessment?
Patient safety should be the main priority.
What examples illustrate the prioritisation of patient safety during assessment?
Examples include asking red flag questions in MSK, conducting a transfer assessment in an inpatient setting, and performing a home assessment in a community setting.
What should be assessed regarding a patient’s current activity levels?
Their current activity levels and intentions for exercise.
What health risks or disease history should be evaluated before starting exercise?
Cardiovascular, metabolic, renal risk factors, and disease history.
Why is it important to assess a patient’s current symptoms before exercise?
To determine if any current symptoms could affect exercise safety or performance.
What additional factors may need to be considered for assessing exercise suitability?
Possible examinations and investigations related to their health condition.
What should be considered regarding the need for supervision during exercise?
Whether the patient requires supervision, monitoring, or assistance while exercising.
How should activity levels be adjusted for a patient new to exercise?
By gradually increasing their activity levels over time.
How can exercise be adapted for patients who prefer home-based workouts?
Home exercise adaptations should be considered for those unable to attend external facilities.
What other options should be considered for exercise referrals?
Suitability for an exercise referral scheme or group exercise class.
What functional movements should be assessed before beginning an exercise program?
Movements such as lying to sitting, sit to stand, standing balance, and gait.
Why are formal outcome measures important in assessing suitability for exercise?
They provide objective data to track progress and guide treatment adjustments.
How can graded progression of treatment be both an assessment and treatment method?
Starting at a low level and progressing to higher-level balance activities allows for both treatment and assessment.
how can we assess someons balance in a safe way
Progression of balance assessment:
What subjective information do we need prior to a stairs assessment?
- Subjective questioning essential;
- Steps in and out of property +/- rails
- Property type (If a bungalow is it a dormer, if a terrace, stairs likely to be steep and narrow)
- Stairs type (straight flight, bend)
- Steps type (shallow, deep)
- Handrail (all the way or part way, one side/bilateral)
- How did they previously manage stairs (be mindful of unwise decisions, i.e. people who have previously come down backwards, or on their backside!)
what information is needed to complete a stair assessment
- Ideally at least 3/5 oxford scale quads strength
- Ideally 90 degrees active knee flexion
- Consider single step or up and down bottom step before full flight
- Exercise tolerance and fatigue levels
- Mimic own home set up as much as possible
- Home visit to practice own stairs for complex discharges e.g. from rehab settings/long hospital stay
Does the assessment process stop once patient management begins?
No, the assessment process continues even after patient management starts.
What aspects of the patient should be re-assessed on an ongoing basis?
The patient’s physical health, mental health, and social situation (biopsychosocial model).
How does ongoing assessment relate to patient goals?
Ongoing assessment helps track progress and re-evaluate any goals that have been set.
