Subjective Assessment

Question 1

Order

Answer 1

> Intro + preferences
> Consent
> PC
> HPC
> SQ
> PMH
> DH
> SH
> goals + expectations

Question 2

Presenting condition

Answer 2

> Pain
- Quality of pain (description can indicate what structure is affected)
- Intensity of pain
- Pattern (24 hrs - inflam/infection/trauma/cancer sensitised)
(am - + 2hrs stiffness = inflam)
(pm - aggs = activity + eased by rest = mechanical)
(night - possible serious pathology)
Altered sensation (dermatomal or peripheral nerve)
Stiffness
Swelling
Weakness
locking/catching
giving way
spasms + cramp

Question 3

Presenting condition (what affects symptoms)

Answer 3

> Linking of symptoms (what happens first or at same time)
Aggs: what + how long to come on/settle
Eases: What + how long

Question 4

HPC

Answer 4

> Patient belief on what’s wrong
When did it start?
How did it start? (sudden/gradual/mechanism)
Progression since it started (worse/better/same)
Previous episodes/injuries
previous treatment/investigations
expectations

Question 5

PMH

Answer 5

> THREADS (thyroid/ heart+bp/ respiratory/ epilepsy/ asthma/ arthritis/ diabetes/ steroids)
> Cancer
> TB
> skin disorder
> fractures/injuries/surgeries
> previous physio (beliefs + experience)

Question 6

SQ

Answer 6

> Routine
- altered sensation? e.g p + n/ numbness
- swelling
- colour
- temperature
- night pain or sudden weight loss = cancer check
lower back or leg pain (Cauda Equina check)
- bladder/ bowel function
- altered sensation around genitals - ‘saddle symptoms’
- effect of cough or sneeze on symptoms (pressure)

Trying to rule out:

• red flags (indicate serious pathology)
• yellow flags (likelihood of persistent pain)

Question 7

DH

Answer 7

> Painkillers (dose/type/working)
NSAIDS (dose/type/working)
Anticoagulants - treatment considerations
Steroids - osteoporosis risk

Question 8

SH

Answer 8

> Work
> Family + Support 
> Home 
> Hobbies 
> Mobility

Question 9

SIN factor

Answer 9

> Severity (mild/moderate/severe)
- pain score 
- impact on life 
> Irritability (m/m/s)
- aggs + eases
> Nature (acute/sub-acute/chronic)
- Source of pain
- pattern of pain

Question 10

Goals

Answer 10

> directed by patient
SMART focussed (short + long term)
IAP model (impairment, activity, participation)