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Questions and Answers
What should you know at the end of the subjective assessment?
What should you know at the end of the subjective assessment?
- The client's goals and the treatment plan (correct)
- The treatment plan and evaluation method
- The evaluation method and client's goals
- The assessment findings and treatment plan
What should you have at the end of the objective assessment?
What should you have at the end of the objective assessment?
- Treatment plan, initial treatment, and evaluation method
- Client's goals, treatment plan, and evaluation method
- Client's goals, assessment findings, and treatment plan
- Assessment findings, treatment plan, and evaluation method (correct)
What should you know after each reassessment of a treatment?
What should you know after each reassessment of a treatment?
- Client's goals and next treatment component (correct)
- Objective assessment findings and reassessment plan
- Effectiveness of treatment and client's goals
- Initial treatment and reassessment findings
Which phase comes after research in the clinical decision-making model?
Which phase comes after research in the clinical decision-making model?
What does the figure below illustrate?
What does the figure below illustrate?
According to Darrah et al. (2006), what do peripheral and spinal musculoskeletal conditions share?
According to Darrah et al. (2006), what do peripheral and spinal musculoskeletal conditions share?
How is somatic referred pain defined?
How is somatic referred pain defined?
How is somatic referred pain commonly perceived by patients?
How is somatic referred pain commonly perceived by patients?
What is the current literature's stance on the concept of sclerotomes?
What is the current literature's stance on the concept of sclerotomes?
Which nerve roots consistently follow a dermatomal pattern into the lower extremity?
Which nerve roots consistently follow a dermatomal pattern into the lower extremity?
What is the most common quality of radicular pain extending past the ankle?
What is the most common quality of radicular pain extending past the ankle?
What type of characteristics are linked to the types of pain pathways associated with leg pain?
What type of characteristics are linked to the types of pain pathways associated with leg pain?
Based on the text, what does radicular pain projected into the big toe most likely originate from?
Based on the text, what does radicular pain projected into the big toe most likely originate from?
What is the current literature's view on whether L1 and L2 nerve roots cause radicular pain into their respective dermatomes?
What is the current literature's view on whether L1 and L2 nerve roots cause radicular pain into their respective dermatomes?
'An unpleasant sensory and emotional experience associated with actual or potential tissue damage' is a definition provided by which association?
'An unpleasant sensory and emotional experience associated with actual or potential tissue damage' is a definition provided by which association?
'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?
'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?
What is emphasized in the text regarding treatment sessions?
What is emphasized in the text regarding treatment sessions?
What do clinicians target when treating someone with an ACL rupture?
What do clinicians target when treating someone with an ACL rupture?
Which statement best describes the approach in treating non-specific low back pain?
Which statement best describes the approach in treating non-specific low back pain?
What percentage of people with spinal conditions have a specific diagnosis according to the text?
What percentage of people with spinal conditions have a specific diagnosis according to the text?
What kind of pain is common in the remaining 90% of people with spinal conditions?
What kind of pain is common in the remaining 90% of people with spinal conditions?
In treating someone with an ACL rupture, what kind of impairments are typically targeted?
In treating someone with an ACL rupture, what kind of impairments are typically targeted?
What is the main focus when considering treatment for non-specific low back pain?
What is the main focus when considering treatment for non-specific low back pain?
How are muscles described in relation to articulations in the text?
How are muscles described in relation to articulations in the text?
What does the 5D's in the cervical spine assessment help determine?
What does the 5D's in the cervical spine assessment help determine?
Which of the following is NOT considered a cauda equina sign in spinal assessment?
Which of the following is NOT considered a cauda equina sign in spinal assessment?
What does the term 'malaise' refer to in the context of general health assessment?
What does the term 'malaise' refer to in the context of general health assessment?
What type of symptoms are associated with glove and stocking paraesthesia in spinal assessments?
What type of symptoms are associated with glove and stocking paraesthesia in spinal assessments?
What is one of the key elements to be confirmed when reviewing red flags during medical history screening?
What is one of the key elements to be confirmed when reviewing red flags during medical history screening?
'SMART Goal Framework' is used to ensure that goals are:
'SMART Goal Framework' is used to ensure that goals are:
What may help make a patient more comfortable in sidelying?
What may help make a patient more comfortable in sidelying?
What is better for a patient: standing or walking?
What is better for a patient: standing or walking?
What behavior is common and not indicative of a red flag regarding night pain?
What behavior is common and not indicative of a red flag regarding night pain?
What is typically true about back pain in the morning according to the text?
What is typically true about back pain in the morning according to the text?
What type of onset is not typical for canal stenosis as mentioned in the text?
What type of onset is not typical for canal stenosis as mentioned in the text?
What type of history may vary depending on a client's specific situation?
What type of history may vary depending on a client's specific situation?
What section of a client history includes information about their housing situation and family support?
What section of a client history includes information about their housing situation and family support?
Which factor may suggest certain diagnoses or clinical patterns in individuals with low back or pelvic symptoms?
Which factor may suggest certain diagnoses or clinical patterns in individuals with low back or pelvic symptoms?
What might be advised for individuals who need to stand for long periods according to the text?
What might be advised for individuals who need to stand for long periods according to the text?
What is typically true about leg pain by the end of the day according to the text?
What is typically true about leg pain by the end of the day according to the text?
Why is having a clear structure to history-taking important in physiotherapy practice?
Why is having a clear structure to history-taking important in physiotherapy practice?
What is the purpose of an open-ended question during information gathering in physiotherapy practice?
What is the purpose of an open-ended question during information gathering in physiotherapy practice?
Why is asking about the location of a patient's symptoms important in physiotherapy assessment?
Why is asking about the location of a patient's symptoms important in physiotherapy assessment?
What does a neuroanatomically plausible structure or location help determine in physiotherapy assessment?
What does a neuroanatomically plausible structure or location help determine in physiotherapy assessment?
Which area is NOT typically asked about when reviewing symptom location in physiotherapy assessment?
Which area is NOT typically asked about when reviewing symptom location in physiotherapy assessment?
What is an example of information that can be gathered from an open-ended question during a physiotherapy session?
What is an example of information that can be gathered from an open-ended question during a physiotherapy session?
What is the purpose of using body charts in patient assessments?
What is the purpose of using body charts in patient assessments?
Why is knowledge of potential pain referral patterns crucial in physiotherapy assessment?
Why is knowledge of potential pain referral patterns crucial in physiotherapy assessment?
What is true about the locations of symptoms shown on a body map?
What is true about the locations of symptoms shown on a body map?
What is an important benefit of having a structure to history-taking in physiotherapy practice?
What is an important benefit of having a structure to history-taking in physiotherapy practice?
What caution should be taken when asking questions related to symptom behavior?
What caution should be taken when asking questions related to symptom behavior?
Why is it important to gather preliminary information before starting a conversation with a client in physiotherapy practice?
Why is it important to gather preliminary information before starting a conversation with a client in physiotherapy practice?
Which factor is typically indicative of people with Non-Specific Low Back Pain (NSLBP) according to the text?
Which factor is typically indicative of people with Non-Specific Low Back Pain (NSLBP) according to the text?
Why should questions about symptom location be specific in physiotherapy assessment?
Why should questions about symptom location be specific in physiotherapy assessment?
According to the information provided, what can be a possible cause of increased back and leg pain after sneezing?
According to the information provided, what can be a possible cause of increased back and leg pain after sneezing?
How do most people with Non-Specific Low Back Pain (NSLBP) feel when sitting according to the text?
How do most people with Non-Specific Low Back Pain (NSLBP) feel when sitting according to the text?
What is a potential easing factor for leg pain after sitting according to the information provided?
What is a potential easing factor for leg pain after sitting according to the information provided?
Why is it important to inquire about how a person gets up from sitting according to the text?
Why is it important to inquire about how a person gets up from sitting according to the text?
'Crook lying' and 'crook sitting' positions are mentioned in relation to what type of condition?
'Crook lying' and 'crook sitting' positions are mentioned in relation to what type of condition?
Which activity often worsens sitting symptoms for people with Non-Specific Low Back Pain (NSLBP)?
Which activity often worsens sitting symptoms for people with Non-Specific Low Back Pain (NSLBP)?
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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
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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
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