Physical Therapy Evaluation and Health Examination
Evaluation and Health Examination In Physiotherapy
Evaluation and Examination Process
The evaluation process broadly involves interviewing the patient and reviewing medical and test reports such as X-rays, MRI CT scan reports. Any medical evaluation involves a series of interrelated steps that help a physiotherapist to make clinical decisions and set a goal for treatment. A physical therapist’s plan based on this data is an effective treatment suited to the patient’s needs and goals.
The evaluation procedures are as follows:
- Basic information
- Major Complaint
- History
- History of Present Illness
- History of Treatment
- History of Past Disease
- Family History
- Overview
- Examination
- Provisional Diagnosis
- Advice
Basic information
Collection of basic information such as name, age, gender, address and occupation is important for documentation.
But, address and occupation have their other values because it gives us an idea of what could be the possible cause of the current disease. We can also correlate current illness or disability with the occupation of the person.
Major complaint
The main complaint is the most important complaint that a patient is presenting to us. It should be documented in the exact words or ideas presented by the person.
History
- How old is the problem or illness?
- How was it started?
- Is it involuntarily or related to injury.
- What kind of injuries were sustained?
- What makes it comfortable or uncomfortable? Does sleep make him comfortable to sit in a particular pose?
History of Physiotherapy Treatment
We ask if he/she has received any medicines, any kind of treatment or underwent any physiotherapy treatment. What type of physiotherapy treatment was received?
Then review all the medical reports of the previous treatment, its X-ray report, MRI report, CT scan report.
History of previous illness
In many cases, we have to go through the ills of the past to make connections with the present complaints. We may need to ask for a similar illness or related illness in the previous year / previous years, and treatment can be obtained for it.
Family history
Many cases like rheumatoid arthritis, osteoarthritis, osteoporosis all travel in the family. So it is sometimes worth looking at family history.
Overview
Under observation, we have to document everything that we have seen for a patient since entering the department.
Advice
We have to develop a target treatment plan based on the diagnosis, patient complaints, need of the patients.
We classify targets into two types:
Short-term goals – A goal that patients want to meet soon, which means today, this week, this month or even this year.
Long-term goals – A long-term goal is something you want to achieve in the future which requires time and proper planning.
Pain assessment
Pain is assessed by: detecting and describing pain to help in the diagnosis process; Understand the cause of pain to help determine the best treatment; We monitor pain to determine whether the disease or disorder is improving , remaining the same or worsening, and whether pain treatment is working.
Pain is personal and subjective differing from person to person; Therefore, the patient’s self-report of pain is the most reliable gauge of experience. The components of pain assessment include:
- History and Physical Assessment
- Functional Evaluation
- Psychosocial Evaluation
- Multidimensional Evaluation
History and Physical Assessment
Areas of focus include pain, the site of the musculoskeletal system and the neurological system. Other components of history and physical assessment include:
- patient self-report of pain
- The patient's behavior and gestures that indicate specific aspects of pain: onset, duration, location, quality of pain (intensity, aggravating and reducing factors)
- Drug history
- History of disease or injury
- History of pain relief measures including medicine, supplements, exercise, massage, complementary and alternative medicine
Functional and Psychosocial Evaluation
- Reported prior level of patient work
Overview of Patient's Behavior while Performing Functional Tasks
- Patient or family report of the effect of pain on daily living activities including work, self-care, exercise and leisure
- Patient's goal for pain management and level of functioning
- Report the effect of pain on the quality of life of the patient or family
- Cultural and developmental ideas
- History of pain in relation to depression, abuse, psychotherapy, chemical or alcohol use
- Effect of pain on the patient's cognitive abilities
Multidimensional Evaluation
Several tools are available for an intensive, multidisciplinary pain assessment. It is specifically important with patients who have chronic pain, mixed pain (both acute and chronic), or complex
Common examples of these devices include:
- Brief pain list: Provides information about patient's pain, including psychosocial components.
- McGill Pain Questionnaire: Patients can use descriptors for their pain, which provide information about experience and intensity.
General Pain Scale
For patients with newborns through advanced age, there are varieties of pain scales for pain assessment.
Era of Pain
When assessing pain, it is important to differentiate between acute and persistent / chronic pain and the implications of patient assessment and management:
A comprehensive evaluation using reliable and validated instruments to prevent the onset of acute chronic disease is of extreme importance in acute pain stage performance.
Persistent / Chronic – When pain is persistent, it is important to gather all the information and understand the factors that contribute to the persistence of pain.
Pain Assessment
When assessing pain we use a biopsychosical approach to the assessment of pain and disability because it accounts for the multidimensional nature of pain in domains relevant to physical therapy practice.
- Receptive
- Exciting
- Cognitive
- Body
- The behavior
- Remedy for Pain
Despite the inherent difficulty in measuring pain, there are several accepted tools for tracking pain-related treatment outcomes. Commonly used measures for various pain dimensions include:
- Numerical Pain Rating Scale (NPRS)
- Visual Analog Scale (VAS)
- Verbal Rating Scale (VRS)
- Self-report measures
- Physical performance measures including Functional Capacity Assessment (FCAs)
- Physical / Autonomic Response measures
Chronic pain has many effects on patients, so the results cover several domains:
- Amount of Pain
- Pain Interference
- Physical activity
- Emotional Function
- Quality of Life
- Patient reported global rating
What is posture
Posture is defined by the approach either by the body with support during muscle activity, or as a result of coordinated action performed by a group of muscles working to maintain stability.
There are two types
Dynamic Posture is something when you are moving your body, like walking, running, or bending over to pick something up. Muscles and non-contractile structures have to work to adapt to changing conditions.
Static Posture is something that you hold yourself when you are not moving, such as sitting, standing, or sleeping. The body segment is aligned and placed in a fixed position. This is achieved by coordination and interaction of muscle groups that are working to counter gravity and other forces.
Optimal Posture
It is important to make sure that you have a good moving and stable posture.
Posture evaluation
When evaluating posture, symmetry and rotation / bending should be seen in anterior, lateral and posterior views.
Assessment
- Head Alignment
- Cervical, Thoracic and Lumbar curvature
- Shoulder level symmetry
- Pelvic Symmetry
- Hip, Knee and Ankle joints
Sitting
- Ears should be aligned with shoulders and shoulders are aligned with hips
- Shoulders should be relaxed and elbows are close to the edges of the body
- The angle of the elbows, hips and knees are approximately 90 degrees
- Feet flat on the floor
- The forearm is parallel to the floor with the wrist straight
- The feet should rest comfortably on one surface
Posture and Health
Poor Posture can be bad for your health. Slouching / slowing can confuse your musculoskeletal system. It increases pressure on the spine, making it at risk of injury and degeneration, all of which cause neck, shoulder and back pain and reduces flexibility. Poor posture affects joint movements, affects balance and increases the risk of a fall. This makes the digestive system to work slowly. It also affects breathing patterns (harder to breathe).
Advice
- Take care of postures during everyday activities, such as watching television, washing dishes or walking.
- Be active. Any type of exercise can help improve your posture, but some types of exercise can be particularly helpful, example, Yoga, Tai Chi, and other exercises that focus on body awareness.
- Maintain a healthy weight. Excess weight can weaken abdominal muscles, cause pelvic and spinal problems, and contribute to low back pain.
- Wear comfortable, low-heeled shoes. Example, Heels can throw off balance and force a person to walk differently. This puts more stress on the muscles and damages the posture.
- Body Alignment - Ensure the work surface is at a comfortable height for you, whether it is sitting in front of the computer, making dinner or eating food.
Physiotherapists can identify the posture and provide hands-on treatments, there are posture correction exercises and helpful home exercises to achieve great alignment of body. Some objectives are listed below:
- Achieve Normal Joint Range of Motion - Required to allow you to achieve good posture alignment
- Achieve Normal Muscle Length - If the muscle is too tight, it will be unable to achieve normal posture.
- Gaining Good Muscle Strength - being able to stretch the body in the correct posture.
- Achieve Excellent Muscle Endurance - Postural muscles must be able to work for hours on end. Poor endurance is the main reason for habitual poor posture.
- Normal Nerve Expansion - Normal posture requires sufficient length of nerve tissue.
- Good Spatial Awareness - where you are in space. Provide verbal and visual feedback and assist with postural taping.
- Perfect Posture Habits - The hardest part is the initial shift, then reinforcing the correct habit.
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