L5 - Assessment Principles

Question 1

define a clinical assessment

Answer 1

A process of information gathering, mixed with sound clinical reasoning to help guide physiotherapy management towards a patient centred goal.

Question 2

what is the goal for a clinical assessment

Answer 2

• 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

Question 3

what are basic components of a clinical assessment

Answer 3

• Referral or medical information
• Subjective Assessment
• Objective Assessment
• Ongoing assessment i.e. during treatment, after treatment, retrospective assessment.

Question 4

Where does the assessment start?

Answer 4

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.

Question 5

Role of Subjective and Objective Assessment.

Answer 5

• 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.

Question 6

Is it possible to complete all aspects of a subjective and objective assessment in the initial session?

Answer 6

No, it may not be possible to complete all aspects in the initial session.

Question 7

What is part of the clinical reasoning process during the first session?

Answer 7

Identifying the essential components of the subjective and objective assessment to complete in the first session.

Question 8

How can certain aspects of the assessment be handled for future sessions?

Answer 8

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.

Question 9

What should be the main priority when conducting an assessment?

Answer 9

Patient safety should be the main priority.

Question 10

What examples illustrate the prioritisation of patient safety during assessment?

Answer 10

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.

Question 11

What should be assessed regarding a patient’s current activity levels?

Answer 11

Their current activity levels and intentions for exercise.

Question 12

What health risks or disease history should be evaluated before starting exercise?

Answer 12

Cardiovascular, metabolic, renal risk factors, and disease history.

Question 13

Why is it important to assess a patient’s current symptoms before exercise?

Answer 13

To determine if any current symptoms could affect exercise safety or performance.

Question 14

What additional factors may need to be considered for assessing exercise suitability?

Answer 14

Possible examinations and investigations related to their health condition.

Question 15

What should be considered regarding the need for supervision during exercise?

Answer 15

Whether the patient requires supervision, monitoring, or assistance while exercising.

Question 16

How should activity levels be adjusted for a patient new to exercise?

Answer 16

By gradually increasing their activity levels over time.

Question 17

How can exercise be adapted for patients who prefer home-based workouts?

Answer 17

Home exercise adaptations should be considered for those unable to attend external facilities.

Question 18

What other options should be considered for exercise referrals?

Answer 18

Suitability for an exercise referral scheme or group exercise class.

Question 19

What functional movements should be assessed before beginning an exercise program?

Answer 19

Movements such as lying to sitting, sit to stand, standing balance, and gait.

Question 20

Why are formal outcome measures important in assessing suitability for exercise?

Answer 20

They provide objective data to track progress and guide treatment adjustments.

Question 21

How can graded progression of treatment be both an assessment and treatment method?

Answer 21

Starting at a low level and progressing to higher-level balance activities allows for both treatment and assessment.

Question 22

how can we assess someons balance in a safe way

Answer 22

Progression of balance assessment:

Question 23

What subjective information do we need prior to a stairs assessment?

Answer 23

• 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!)

Question 24

what information is needed to complete a stair assessment

Answer 24

• 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

Question 25

Does the assessment process stop once patient management begins?

Answer 25

No, the assessment process continues even after patient management starts.

Question 26

What aspects of the patient should be re-assessed on an ongoing basis?

Answer 26

The patient’s physical health, mental health, and social situation (biopsychosocial model).

Question 27

How does ongoing assessment relate to patient goals?

Answer 27

Ongoing assessment helps track progress and re-evaluate any goals that have been set.