60 Questions
What should you know at the end of the subjective assessment?
The client's goals and the treatment plan
What should you have at the end of the objective assessment?
Assessment findings, treatment plan, and evaluation method
What should you know after each reassessment of a treatment?
Client's goals and next treatment component
Which phase comes after research in the clinical decision-making model?
Evaluation
What does the figure below illustrate?
Physiotherapy practice structure and logic
According to Darrah et al. (2006), what do peripheral and spinal musculoskeletal conditions share?
Core principles of assessment and treatment
How is somatic referred pain defined?
Pain felt in a region innervated by nerves different from the actual source of pain
How is somatic referred pain commonly perceived by patients?
Dull and cramp-like
What is the current literature's stance on the concept of sclerotomes?
Not supported
Which nerve roots consistently follow a dermatomal pattern into the lower extremity?
L5 and S1
What is the most common quality of radicular pain extending past the ankle?
Sharp and localized
What type of characteristics are linked to the types of pain pathways associated with leg pain?
Both nociceptive and neuropathic characteristics
Based on the text, what does radicular pain projected into the big toe most likely originate from?
L5 nerve root
What is the current literature's view on whether L1 and L2 nerve roots cause radicular pain into their respective dermatomes?
'More research is needed'
'An unpleasant sensory and emotional experience associated with actual or potential tissue damage' is a definition provided by which association?
'International Association for the Study of Pain'
'An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage' is a revised definition provided in what year?
'2020'
What is emphasized in the text regarding treatment sessions?
Knowing where to start in the next session
What do clinicians target when treating someone with an ACL rupture?
Person's impairments
Which statement best describes the approach in treating non-specific low back pain?
Addressing patterns of impairments across various elements
What percentage of people with spinal conditions have a specific diagnosis according to the text?
< 10%
What kind of pain is common in the remaining 90% of people with spinal conditions?
Mechanical back or neck pain
In treating someone with an ACL rupture, what kind of impairments are typically targeted?
Motion impairment
What is the main focus when considering treatment for non-specific low back pain?
Targeting impairments based on patterns
How are muscles described in relation to articulations in the text?
Muscles span one or two joints
What does the 5D's in the cervical spine assessment help determine?
Risk of vertebral artery involvement
Which of the following is NOT considered a cauda equina sign in spinal assessment?
Night sweats
What does the term 'malaise' refer to in the context of general health assessment?
Feeling of general discomfort and uneasiness
What type of symptoms are associated with glove and stocking paraesthesia in spinal assessments?
Tingling and numbness in the extremities
What is one of the key elements to be confirmed when reviewing red flags during medical history screening?
Client's goals
'SMART Goal Framework' is used to ensure that goals are:
Client-centered and achievable
What may help make a patient more comfortable in sidelying?
A pillow under their knees
What is better for a patient: standing or walking?
Walking
What behavior is common and not indicative of a red flag regarding night pain?
Pain wakes the patient at night but eases after changing position
What is typically true about back pain in the morning according to the text?
It is worse at the end of the day
What type of onset is not typical for canal stenosis as mentioned in the text?
Sudden onset
What type of history may vary depending on a client's specific situation?
Social history
What section of a client history includes information about their housing situation and family support?
Social/Environmental history
Which factor may suggest certain diagnoses or clinical patterns in individuals with low back or pelvic symptoms?
"Sudden onset" and predisposing factors
What might be advised for individuals who need to stand for long periods according to the text?
Keeping one foot up, adjusting work height, etc.
What is typically true about leg pain by the end of the day according to the text?
It becomes more constant by the end of the day
Why is having a clear structure to history-taking important in physiotherapy practice?
To ensure all necessary information is obtained
What is the purpose of an open-ended question during information gathering in physiotherapy practice?
To efficiently gather important information and make the client feel listened to
Why is asking about the location of a patient's symptoms important in physiotherapy assessment?
To determine potential pain referral patterns
What does a neuroanatomically plausible structure or location help determine in physiotherapy assessment?
The source of the client's symptoms
Which area is NOT typically asked about when reviewing symptom location in physiotherapy assessment?
Shoulders
What is an example of information that can be gathered from an open-ended question during a physiotherapy session?
Insights into the client's goals and expectations
What is the purpose of using body charts in patient assessments?
To indicate where pain is located and describe the type of symptoms experienced
Why is knowledge of potential pain referral patterns crucial in physiotherapy assessment?
To identify whether a given structure could produce symptoms in the described area
What is true about the locations of symptoms shown on a body map?
They can increase or decrease the likelihood of specific conditions
What is an important benefit of having a structure to history-taking in physiotherapy practice?
To provide a framework for obtaining all necessary information
What caution should be taken when asking questions related to symptom behavior?
Be wary of assuming certain activities make the symptoms worse
Why is it important to gather preliminary information before starting a conversation with a client in physiotherapy practice?
To have an idea of what to ask during the conversation with the client
Which factor is typically indicative of people with Non-Specific Low Back Pain (NSLBP) according to the text?
Experiencing increased leg pain after sneezing
Why should questions about symptom location be specific in physiotherapy assessment?
To obtain accurate information on the extent and distribution of symptoms
According to the information provided, what can be a possible cause of increased back and leg pain after sneezing?
A sudden onset of discogenic origin back pain
How do most people with Non-Specific Low Back Pain (NSLBP) feel when sitting according to the text?
Often worse when sitting in flexion
What is a potential easing factor for leg pain after sitting according to the information provided?
'Crook lying' position after sitting for a few minutes
Why is it important to inquire about how a person gets up from sitting according to the text?
'Extension' movements may guide management plans
'Crook lying' and 'crook sitting' positions are mentioned in relation to what type of condition?
'Piriformis syndrome'
Which activity often worsens sitting symptoms for people with Non-Specific Low Back Pain (NSLBP)?
Sitting in a straight chair for extended periods
Study Notes
History Taking
- A structured approach to history taking is essential in physiotherapy practice
- It ensures all necessary information is obtained, reduces cognitive load, and provides a structure for the client
- The assessment starts with preliminary information, including:
- Referral
- Previous investigations
- Client-completed screening form
- Introduction (including who you are, your role, and your expectations of the session)
- Open-ended question (90-second rule) to gather information about the client's concerns and goals
Body Chart
- The body chart is a useful tool to document the location and type of symptoms
- It helps to identify the source of symptoms and potential pain referral patterns
- Components of the body chart include:
- Symptom location (specific and detailed)
- Type of symptoms (e.g., pain, paraesthesia, anaesthesia)
- Spatial continuity (i.e., connections between symptoms)
- Relevant areas (e.g., low back, upper back, neck, abdomen, groin, legs, feet)
- Saddle paraesthesia/anaesthesia (potential cauda equina lesion)
Behaviour of Symptoms
- Behaviour of symptoms includes:
- Constant or intermittent symptoms
- Relationship between symptoms
- Open questions to gather more information (e.g., when symptoms are better or worse)
- Functional activities/work/sport
- Coughing/sneezing
- Standing
- Sitting
- Walking
- Lying
- Irritability
- Red flag questions (if necessary)
Clinical Reasoning
- Clinical decision-making model involves:
- Theory
- Assessment
- Intervention
- Research and evaluation
- The model helps guide physiotherapy practice and ensures a structured approach to treatment
Somatic Referred Pain
- Somatic referred pain is defined as pain perceived as arising from a region of the body innervated by nerves or branches of nerves other than those that innervate the actual source of pain
- It occurs due to convergence of afferent neurons from different areas of the body onto a common interneuron before being relayed to higher centers
- Characteristics of somatic referred pain include:
- Deep, achy, diffuse, and poorly localized
- Dull and cramp-like
- Not necessarily following a segmental pattern into the lower extremity
Radicular Pain
- Radicular pain refers to pain that originates from a spinal nerve root
- Patterns of radicular pain are not always clear-cut and may not follow a dermatomal pattern
- Radicular pain from L5 and S1 nerve roots consistently follows a dermatomal pattern into the lower extremity, while pain from L3, L4, and S2 nerve roots is less consistent
Diagnosis in Spinal Conditions
-
Less than 10% of people with low back pain have a specific diagnosis such as spinal canal stenosis, spondylolisthesis, or fractures
-
The remaining 90% have non-specific low back pain or mechanical back pain
-
Diagnosis is not essential for treatment, as physiotherapists target impairments across the four elements (motion, force, motor control, and energy) in the context of personal and environmental factors### General Health Screening
-
Special questions include:
- Other relevant medical history and regular medication
- Other relevant surgical history
- Other relevant family medical history
- Other relevant lifestyle: exercise and physical activity
- Other relevant habits: smoking, alcohol, etc
- Night sweats, night pain, weight loss, confusion, fatigue
- Malaise: Feeling of general discomfort, uneasiness, being “out of sorts”
Cervical Spine
- 5D’s to determine risk of vertebral artery involvement:
- Dizziness
- Dysarthria (speech)
- Dysphagia (swallow)
- Diplopia (vision)
- Drop attacks
Spine
- Cord signs:
- Glove and stocking paraesthesia
- Balance problems
- Postural hypotension
- Cauda equina signs:
- Bowel or bladder changes (urinary retention, unable to control anal sphincter)
Cognitive Impairment
- In older person:
- Depression
- Delirium
- Dementia
Goals
- Confirm client goals using the SMART Goal Framework
- Ensure goals are client-centered
Social History
- Obtain information on:
- Housing situation and other members of the household
- Family or friend support
- Employment (demands of work and relationship with employer)
- Hobbies
Red Flags and Yellow Flags
- Review screening form for red flag questions
- Identify yellow flags (psychosocial factors)
Physical Assessment
- Plan for physical assessment:
- What to assess
- How to assess
- Consider limiting assessment due to irritability
- May need to adjust techniques for comfort (e.g., pillow under knees)
Client History
- Cover past medical history, including:
- Onset of symptoms
- Mechanism of injury (if applicable)
- Predisposing factors
- Behaviour/progress of symptoms since onset
- Functional status
- Perception of primary symptoms
- Current and previous examinations/tests/treatments
Learn about the similarities and differences in assessment and treatment principles for individuals with peripheral and spinal musculoskeletal conditions. Explore a clinical decision-making model and elements of collecting cues and information.
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