Principles & Concepts of

Assessmentin Physiotherapy

Part - I

Dr. D. N. BidThe Sarvajanik College of Physiotherapy, Rampura, Surat – 395003.

• To complete a musculoskeletal assessment of a patient, a proper and thorough systematic examination is required.

• A correct diagnosis depends on a knowledge of functional anatomy, an accurate patient history, diligent observation, and a thorough examination.

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• The differential diagnosis process involves the use of:• clinical signs and symptoms, • physical examination, • knowledge of pathology and mechanisms of

injury, • provocative and palpation (motion) tests, and • laboratory and diagnostic imaging techniques.

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• The purpose of the assessment should be to fully and clearly understand the patient's problems, from the patient's perspective as well as the clinician's, and the physical basis for the symptoms that have caused the patient to complain.

• As James Cyriax stated, "Diagnosis is only a matter of applying

one's anatomy." 4

• One of the more common assessment recording Methods used is the problem- oriented medical records method, which uses "SOAP" notes.

• SOAP stands for the four parts of the assessment: • Subjective, • Objective, • Assessment, and • Plan.

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• Regardless of which system is selected for assessment, the examiner should establish a sequential method to ensure that nothing is overlooked.

• The assessment must be organized, comprehensive, and reproducible.

• In general, the examiner compares one side of the body, which is assumed to be normal, with the other side of the body, which is abnormal or injured.

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Patient History

• Often, the examiner can make the diagnosis by simply listening to the patient.

• Even if the diagnosis is obvious, the history provides valuable information about the disorder, its present state, its prognosis, and the appropriate treatment.

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• The history also enables the examiner to determine the type of person the patient is, any treatment the patient has received, and the behavior of the injury.

• In addition to the history of the present illness or injury, relevant past history, treatment, and results should be noted.

• Past medical history should include any major illnesses, surgery, accidents, or allergies.

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• In some cases, it may be necessary to delve into the social and family histories of the patient if they appear relevant.

• Lifestyle habit patterns, including sleep patterns, stress; workload, and recreational pursuits, should also be noted.

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• It is important that the examiner keep the patient focused and discourage irrelevant information; this should be done politely but firmly.

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• In addition, the examiner should listen for any potential "red flag" signs and symptoms (Table 1-1) that would indicate the problem is not a musculoskeletal one and that the problem should be referred to the appropriate health care professional.

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• The history is usually taken in an orderly sequence.

• It offers the patient an opportunity to describe the problem and the limitations caused by the problem as he or she perceives them.

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• In any musculoskeletal assessment, the examiner should seek answers to the following pertinent questions.

• 1. What is the patient's age?

• Certain diseases happen at particular age.• Perthes dz• OA, Osteoporosis

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• 2. What is the patient's occupation?

• Laborer : muscle strain• Office worker : ’’

• 3. Why has the patient come for help?• History of present illness or chief complaint

• 4. Was there any inciting trauma (macro-trauma) or repetitive activity (micro-trauma)?

• Mechanism of injury,• Predisposing factors

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• 5. Was the onset of the problem slow or sudden?

• 6. Where are the symptoms that bother the patient?

• Symptoms are localized or generalised

• 7. Where was the pain or other symptoms when the Patient first had the complaint?

• Pain intensity• Irritable,• Trigger points• Peripheralization, centralization,• Referred pain

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• 8. What are the exact movements or activities that cause pain?

• Gives idea about irritability of condition

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• 9. How long has the problem existed? What are the duration and frequency of the symptoms?

• ? the condition is acute, subacute, chronic, or acute on chronic.• Acute 7-10 days• Sub-acute 10 days to 7 weeks• Chronic - > 7 weeks

• 10. Has the condition occurred before?• If so, what was the onset like the first time? • Where was the site of the original condition, and has there been any

radiation (spread) of the symptoms?• If the patient is feeling better, how long did the recovery take? • Did any treatment help to relieve symptoms? • Does the current problem appear to be the same as the previous

problem, or is it different? • If it is different, how is it different?

• Answers to these questions, determine the location and severity of the injury.

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• 11. Are the intensity, duration, and/or frequency of pain or other symptoms increasing?

• Getting worse• Improving.

• Use of pain questionnaire or scales..

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• 12. Is the pain constant, periodic, episodic (occurring with certain activities), or occasional?

• Constant pain: chemical irritation, tumors, visceral lesions…• Periodic pain: mechanical or movement related and stress…• Episodic pain: specific activities …………..

• 13. Is the pain associated with rest? Activity? Certain postures? Visceral function? Time of day?

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• 14. What type or quality of pain is exhibited?• Nerve pain, Bone pain,• Vascular pain, Muscle pain,• Neuropathic pain, Somatic pain

• 15. What types of sensations does the patient feel, and where are there abnormal sensations?

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• 16. Does a joint exhibit locking, unlocking, twinges, instability, or giving way?

• Locking, Pseudolocking, Spasm locking….

• Giving way…

• Hypermobility..

• Translational instability

• Anatomical instability

• Functional instability..

• Voluntary instability & involuntary instability.. ..

• Circle concept of instability……………….

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• 17. Has the patient experienced any bilateral spinal cord symptoms, fainting, or drop attacks?

• Severe neurological problems

• 18.Are there any changes in color of the limb?• ? Circulatory problems/ RSD/ Raynaud’s dz

• 19. Has the patient been experiencing any life or economic stresses?

• ? Psychological stress 35

• 20. Does the patient have any chronic or serious systemic illnesses that may influence the course of the pathology or the treatment?

• 21. Is there any thing in the family history that may be related, such as tumors, arthritis, heart disease, diabetes, and allergies?

Some disease processes and pathologies have a familial incidence.

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• 22. Has the patient undergone an x-ray examination or other imaging techniques?

• 23. Has the patient been receiving analgesic, steroid, or any other medication?

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• 24. Does the patient have a history of surgery?

• If so, when was the surgery performed, what was the site of operation, and what condition was being treated?

• Sometimes, the condition the examiner is asked to treat is the result of the surgery.

• Has the patient ever been hospitalized? If so, why?38

• It is evident that the taking of an accurate, detailed history is very important.

•Listen to the patient- he or she is telling you what is wrong!

• With experience, the examiner is often able to make a preliminary "working“ diagnosis from the history alone.

• The observation and examination phases of the assessment are then used to confirm, alter, or refute the possible diagnoses.

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•Never underestimate:

HISTORY TAKING.

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End of episode- 1

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