Differential Diagnosis: Intro to DD

goals for patient interview when obtaining their history

- build rapport -identify barriers to communication -identify patients learning styles -establish their goals -use info to screen, determine severity, stability of symtpoms -enable planning of exam and eval -establish baselines

limitations in primary care PT

-few documented roles with operational definition that include PT in the primary care role -Payment policies -societal perception does not include PT as a primary care practitioner

when do we refer?

-lack of positive response by PT -not neuro-musculoskeltal in nature -pos red flags for cancer, infection, or life threatening conditions -undiagnosed systemic involvment -psychological issues need to consult for determining best course for PT management

what is the prognosis of success with PT intervention?

-positive change in patient condition during an evaluation

benefits of PT

-reduces over prescription of opioids- 50 percent of opioid use starts because of low back pain. early PT reduces opioid use by 10 percent -reduced frequency of unnessesary imaging -shorter episodes -faster recovery -fewer healthcare dollars spent

our intervention should be (4)

1) evidence based from clinical practice guidelines, systematic review and recent RCTs 2) matched with the patients goals 3) regularly and systematically measured 4) focus on successful discharge

Our responsiblity for people who fall outside of our scope of practice (2)

1) our first task is to identify patients who fall outside of our scope of practice 2) we are not qualified to diagnose non neuromuscular diseases, but we are obligated to refer them to someone who can make appropriate diagnosis

if we determine that the patient is appropriate for PT.... management will look like (6)

1) patient interview 2) systems review 3) test and measures 4) special test 5) intervention 6) outcome

how can we refer them safely? (5)

1) screen the patient (medical history, patient history, systems review) 2) use sound clinical reasoning skills 3) have knowledge of various systems 4) recognize non musculoskeletal complaints 5) keep our eyes wide open

in the virigna mason medical model of care. it demonstrated that pTs involved in the initial triage of patients with low back pain there was a _________ percent reduction in healthcare cost. how?

50 percent reduction in healthcare cost. old approach: go to physician- sends to specialist- sends to get mir-must come back for review of Sri- then PT. co pay after co pay after co pay New approach- go to PT- general we can help if not then we send to get imaging. single co pay

in direct access, PTs have shown to correctly refer imaging more than ________.

80 percent of the time.

up to _______ percent of patients will have a red flag.

80 percent will have a red flag but that does not mean that we need to refer them.

3 ways of PT in primary care

Emergency room- isn't technically direct access but it is primary care cause the nurse may see an issue and contact us to exam and figure out what's going on military- if they get hurt a lot of times they send them directly to PT Direct access- laws vary by state

we must know the patterns and recognition of what with neuromuscular problems

MS, stroke, Parkinson's disease

common GI disorders

Ulcers cholecystitis appendix cancers

what is screening

a preliminary process of gathering and integrating information to determine the need for further examination and intervention

screening answers what question

can PT help? is PT appropriate? What are the general areas in which PT can help? what are the areas that are out of the scope of practice? to refer/not to refer?

where do we start when seeing a patient

chart review physical referral reported symtpsom patient interview

examples of red flags

clinical presentation-bilateral symtpoms pain pain that is not altered with a change or position of movement confusion, constitution symptoms, proximal muscle weakness are all big ones as well!

we much be able to look for

common color changes (jaundice, erythema) scars hair growth patterns skin tumors nail trophic changes temperature edema

when we do screen a patient?

continuously! examination evaluation diagnosis prognosis outcome

common psychologic disorders

depression anxiety substance use stress-impacts symtpms sleep history chronic pain- mechanical or non mechanical?

patient history we can look t

family and person history of disease co-morbities pain behaviors work environemtn home environemnt participation restrictions signs and symptoms risk factors medication

what are constitutional symtpoms

fever diaphorsis night sweats nausea vomiting diarrhea pallor dizziness fatique weight loss

we must take ______ into consideration when dealing with urogenital problems

gender

neuromuscular disorders deal with general

gross coordinated movements balance locomotion transfers

what helps with prognosis

if your patient buys in and you two form a consensus as to plan of care knowledge of your anatomy and healing times

CVD slide summary

know normal ranges for age, ranges for borderline or actual disease conditions, abnormal and normal responses to activity heart rate respiratory rate blood pressure edema pulse rate in extreme its

How to influence our practice

master skills relevant to inter professional practice effective engage in the public incorporate strategies that reduce health disparities advocacy research

however, a visceral source will non always follow a

non-mechanical pattern so we must be aware of that

the evaluation is

our analysis of your examination. combine and analyzed all of the following - data from PT exam -information from clinical lab results -info from patient history -information

we must correlate their findings of the movement exam with what

patient history and symptoms

where do we get 80 percent of our info for the source of their symtpoms

patient interview

the screening is __________ focused _____________ gathering opportunity

problem focused information gathering opportunity

possible urogenital disorders

prostate, ovaries, uterus kidney disease kidney stone UTI cancer menstrual cycle

what does screening consist of

reviewing medical records, patient history and interview, systems review

for the integumentary system we must know

skin integrity and the stages of healing recognition of common skin conditions

if symtpoms were not altered with movement or position changes, we should assume what

that a visceral source of symptoms should be suspected

what is the biggest concern others have about PT direct access?

that we will not be able to detect patients with serious pathologies that mimic neuromuscular complaints BUT, that is our job anyways! regardless on when we see them early on or later. we are trained to detect those things to refer them when needed

when it comes to pain we have to consider

the elements of pain (sharp, dull, achy) is it continuous or does it come and go? location their response to movement, time of day, what makes it worse, what makes it better

define wellness

the optimal state of health of individuals and groups... the realization of the fullest potential of an individual physically, psychologically, socially, spiritually, economically, and the fulfillment of ones role expectations in the family, community, place of worship, workplace and other settings

what is differential diagnosis

the process of differentiating between 2 or more conditions which share similar signs or symptoms

examination inclues

the test and getting information -demographics -patient interview -patient itnake -systems review -screening -test and measures -observations -special test

GI disorder can have similar symptoms as

thoracic and limbo pelvic pain

what Is the purpose of screening

to determine if an examination of a patient by PT is indicated. does this person need PT and is this problem in our scope of practice?

Red flags are there to do what

warn us.

PTs are the _________. We may assist practitioners and pick up ______

we are the gatekeepers. we assist physicians and pick up the symptoms as they evolve

PT are apart of the ________ team

wellness

what is the top 5 method

when someone comes in with shoulder pain, think of hypothesis that has to do with each of the following -bony strucutre -musculo-tendinous -ligament -neural -visceral/organ consider what patterns would present with each hypothesis and rule out