Examination, Evaluation, Diagnosis, Prognosis, & Treatment Interventions

Organization Prior to Patient Visit

Allow enough time for the treatments Learn to manage time efficiently Gather all equipment; any safety equipment such as gait belt Provide a private area if possible Bring appropriate supportive personnel when necessary Review medical chart if available

Other Health Settings: Assisted living, Rehabilitation Facility, home care, outpatient,

Assisted Living: some assistance required, Rehabilitation Facility: Extensive therapy services are provided Home care: needs to be justified, less control, able to treat patient in their own environment Outpatient: least expensive, least control over patient compliance

EBP guidelines 2

Based upon physical therapy education background, continuing education courses attended, prior review of clinical research, and prior clinical experience of the therapist or therapist's colleagues, a plan of care is established. Evidence based practice guidelines should be implemented

Evaluation

Based upon the examination findings Consider clinical prediction rules and Clinical Practice Guidelines Determine which "hypothesis" is likely May need to perform additional tests and measures Evaluation leads to prognosis, goals, and interventions, and assessment through evaluating outcomes May lead to further "focused questions" which requires searching for best evidence

Setting realistic time frames

Consider the severity of the pathology Healing time of tissue: bone 6-8 weeks Desired functional outcomes ( may not always WNL=withing normal limits )

Examination

Critical for proper diagnosis and intervention Important to make clinical judgments on which examination techniques to perform

Clinical Decision Making Process (Evidence Based Practice Guidelines)

Focused questions are developed by the clinician based upon the particular patient presentation of the client Clinician searches for the best available evidence The evidence is critically appraised The evidence is applied (choice of interventions are implemented) Outcomes are evaluated (are goals achieved?)

Parts of the Examination

History/Outcome Tools( measures function ex: TUG test & Questionnaire) Systems review(how does it affect the rest of the body)/review of systems if necessary Determine what body regions need to be evaluated Musculoskeletal Screening Exam (determine the location of the problem): ROM of all joints either upper or lower quarter: Optional Specific Tests and Measures: Swelling

Health Settings

In-patient: expensive, limited time allowed, more controlled environment Long term acute care: used for patients who need a higher level of care but no longer can stay in the hospital Skilled Nursing Facility: may be temporary residency or permanent residency

SYSTEMS

Integumentary: Bruising, edema Cardiovascular: Pulses (bloodflow), & Vital signs (baseline) Cardiopulmonary Neurological Respiratory GI Genitourinary

Provide a professional atmosphere and maintain professional rapport

Introduce yourself to the patient Explain the purpose of PT (especially in PT) Speak clearly and at the appropriate comprehension level Provide adequate instruction and demonstrations Insure patient confidentiality Properly position and drape patient for dignity and comfort

Other tests/measures

Is imaging necessary? Any lab test necessary? Is this client/patient appropriate for physical therapy or should they be referred to another health professional?

Specific Examination Techniques

Observation: gait, pain, guarding, posture, transfers, assisted devices Mobility: ROM, muscle length, joint mobilization, assisted devices Stability: MMT Palpation: location, sensitivity

Measurable Outcomes

Outcome measurements must be utilized to determine if the patient goals have been meet Determine if plan of care needs to be altered Are additional focused questions developed?

What are the possible interventions?

Patient education / caregiver education Exercise Physical agents ( modalities) Manual therapy Home programs Referral to other professionals Adaptive equipment Gait training, functional training

what 4 interventions should we know very well?

Patient education / caregiver education (ALWAYS) Exercise Physical agents ( modalities) (Biophysical agents) Manual therapy

What is the prognosis?

The potential for the patient to improve. Based upon the exam findings, degree of involvement, stage of healing, age, and any other contributing factors.

What are the anticipated goals?

These are what you want to accomplish with the patient. It is the level of functional ability the patient will achieve by the end of the treatment sessions. Time frames are projected based on clinical experience and prognosis.

You want to begin with

history History guides which exam techniques to perform Formulate "working hypotheses"

Medical diagnosis

identify the disease, disorder or condition

PT Diagnosis

impact of this condition on function (movement impairments) Based on the ICF model

DRAW ICF Model and understand the points & Look at the examples

yes! YOU CAN DO IT!! KEEP GOING BRITT!