Physiotherapy Assessment Principles

Principles of Assessment

• Assessment is a key part of physiotherapy, focusing on observation, judgment, and reflection throughout the therapeutic process.
• Assessment goes beyond the initial examination and continues throughout all interactions between the therapist and patient.
• During each session, the therapist and patient collaborate to assess progress toward treatment goals.
• Treatment interventions such as mobilizations and manipulations are carefully monitored for their effects and adjusted as needed
• Assessment procedures have an automatic transition into treatment procedures and vice versa.
• The therapeutic process involves complex clinical reasoning where therapists need to perceive and interpret multiple patient cues.
• Clinicians need to simultaneously perceive and interpret physical, psychological, and social patient cues.
• Treatment and responses are tailored throughout sessions as needed.
• Contemporary physiotherapy descriptions include examination and evaluation as integral parts of the process.
• It is vital to have thorough physiotherapy-specific examinations, and assessment is a continuous critical appraisal.
• Continuous assessment involves examining findings, evaluating effects, and reflecting decisions to solve movement dysfunctions and enhance movement.
• Communication, through precise wording and careful observation, plays an essential role in assessment.
• Skilled therapists balance technical procedures with social interactions, and the technical procedures and social interactions with the patient are in balance.
• It is also important to find a balance between therapist-centered and client-centered approaches.
• It is important to use half-open questions instead of fixed questionnaires to develop a therapeutic relationship. Half-open questions allow clarifications and delving into relevant topics.
• Therapists should keep a certain flexibility and integrate other forms of clinical reasoning.

Purposes of Assessment

• Physiotherapy assessment serves to diagnose, define objectives, determine interventions, and define parameters to monitor effects.
• World Confederation of Physical Therapists (WCPT) defines physiotherapy diagnosis as the outcome of clinical reasoning based on examination and evaluation expressed in terms of movement dysfunction.
• Physiotherapy interventions aim at enhancing movement functions, and passive methods serve as kick-starts to active movements.

Forms of Assessment:

• At initial consultation(s) that include and welcome the information phase
• Reassessments during various phases of each treatment session
• Assessment during the application of treatment interventions
• Periodic retrospective and prospective assessments to monitor the overall process
• Final analytical assessment that includes enhancement of long-term compliance

Assessment at Initial Examination:

• The therapist has to sort out complex information from the patient and shape a treatment plan.
• The important information includes biomedical, psychological, social, and cultural cues.
• Improvisation is often necessary to adapt to the patient's needs.
• An algorithm of information, procedures, reflection, and planning is recommended for this. The algorithm includes:
  • Welcoming and information phase
  • Subjective examination
  • Planning of the physical examination
  • Physical examination, including first treatment and reassessment
  • Summary of first session:
    • Reflection/summarizing
    • Hypotheses
    • Planning of next session
• Initial session objectives include gathering information on the causes and contributing factors, treatment goals, active patient integration, and precautions.
• Complex clinical reasoning skills and paradigms are also a necessity.
• Considerations:
  • Causes follow a biomedical model.
  • A neurophysiological model of pain mechanisms is considered.
  • A biopsychosocial movement models is considered.
  • Analysis of factors that cause or contribute to the patient's movement disorder.
  • Evaluation of treatment interventions that address cognitive and emotional goals.

Treatment Planning:

• Collaborative with the patient, while considering precautions and contraindications.
• Treatment objectives should be defined in terms of impairments/functions and activity levels.
• Cognitive and affective goals include addressing psychosocial risk factors.
• Therapists should encourage movement, and passive movements may be a first step.
• Physiotherapists should pursue educational strategies and address patient paradigms and beliefs.
• Treatment procedures should occur collaboratively providing var- ious possibilities for the patient. Therapeutic Relationship:
• The first session aims to gather information for diagnosis and treatment planning

Precautions and Contraindications:

• Requires initial treatment decisions and select therapeutic interventions
• Clinician diagnoses according to possibilities and consult on other interventions.
• Physiotherapists may positively search for movement dysfunctions.
• It is important to be aware of the fact that serious pathobiology may be present.
• It is important the physiotherapist is alert to serious pathobiological processes.
• Physiotherapists increasingly take the status of direct-contact and responsibility/accountability increases. The practitioners need other specialists to refer to.
• Various conditions define certain precautions to particular interventions.

Red Flags:

• Certain risk factors for serious disease aiding referral decisions or medical investigations

• Features of cauda equina syndrome should be examined in particular Other features are:

  • Significant trauma
  • Systematically not feeling well or unwell, weight loss
  • A History of cancer and fever
  • Intravenous drug use and steroid use
  • Patients that are <20 or >50 years has first episode of pain
  • If the pain is severe, unremitting and nighttime
  • Marked morning stiffness
  • ESR >25
  • X-ray, vertebral collapse or bone destruction

• In these instances screen body systems to determine if specialists should also see patient

• Basic examination highlights situations that need medical referral (for pain):

  • Any severe unremitting pain worsened by rest/analgesia
  • Severe paint with little movement disturbance or non-mechanical behavior
  • Reactions – severe muscle reactions prior to current symptoms

Physical Examination:

• Physical planning considerations that determine safe examination
• Not necessarily standard procedures, determined by hypotheses.
• Mostly determined by processes by 'severity and irritability' and by 'nature' of the factors the disorder is
• Precautions determined by:
  • Irritability and severity
  • Mechanisms and stages
  • Neurophysiological and general health status
  • Behavior, perspectives, and expectations

Precautions in Treatment Planning:

• Beforehand consider "Which objectives should I want to achieve with this intervention but what shouldn’t I want to happen?"
• Important element for 'assessment during treatment'
• During treatment:
  • Monitor inflammatory signs and NCV; assess reflexes, sensation, strength, and occurrence Reassessment of cognitive information:
  • Monitored that the given information was both clear and there wasn’t new confusion.

Reassessment:

• The effects of the various interventions are continuously monitored and the treatment is adopted to the actual situation needed by the patient.
• As a process, it was first described in 1968 and nowadays it has become a part of the declarative knowledge of the profession (WCPT 1999). Reassessment procedures should take place during each treatment session:
  • During initial phase and exam of various active and passive movement tests
  • Begin each with pretreatment assessment to reflect reactions to the past treatment for last session to last time prior to therapy After: the interventions (include education and information) Then at the very End

Reassessment Purposes:

• Helps in seeing selected values and interventions
• Treatment aids make a differential diagnosis in sources of movement
• It helps to reflect by reassessing to modify confirmed reasons
• Application is how clinicians understand patterns to the intervention.
• Supports development to improve the base.

Indicators of change -

• In application have clear picture in mind as changes occur via interventions
• Possible at first has not learned of improvements it is key to educate the patient
• Both that something has made a change or they can learn of needed improvements.

Communication:

• Be able to successfully reassess what patient learns and if there are changes
• A crucial understanding of the use of words.

Reassessment Subjectively:

• At start is good but ask directly of morning feeling to understand what matters
• Provide most useful in combination nature seeks to improve the overall newly learned strategies

Statements - convert facts to comparisons

• Essential process with comparisons to make sure there needs to be recorded notes
• Clinicians can be aware when facts are regularly mentioned and convert for them.

Some Techniques of Reassessment Procedures are:

• The importance of Questions for patient comments that need clear information to understand the answers that are coming The most helpful ways to respond • Parallel information - Adaptions make sure to get appropriate questions that line up • Collaboration - Goals to set and specify

• Length (in terms of pain is possible) for certain objectives is always an option

• Clarify if a clearer picture if it can be determined if something important/better/changing the parameters The parameters should always be:

• Expressive or direct

• Functional

For Balanced Approach –

In Reassessments, the Key to Understand is the Following:

• Be clear on the needs

• Objectives need to be more refined.

• Impress changes Clinicians shouldn’t make tests as they have test

• Sub, objective factors need to be looked at to combine tests and also the combined tests. Make sure it isn’t mechanical

Changes -

Are expected to appear over 2 weeks to patient.

• Frequent are: neurological exam of those indications The parameters

Should be:

• The potential in change
• Behavioral

Factors:

• Observe changes and other indicators Important:
• Emotional level (the smile.)
• What the face is.
• The words say

Should

• The changes in first 25 hrs are that which include what to expect

• Therapist to show why change is positive.

• Reassess - as the 'art' or ability of interventions to make changes

Some Interventions -

Influence to the patient for positive outcomes.

• To look a the whole and perform many as interventions as they do occur
• Must say so for the reasons for changes to be found
• Reassessment with the patient does the actual process occur
• Cognitive with process and relation to the patient and that there is clear ability for

Patients Viewpoint:

• Should help to be more comfortable even if the levels feel high

• Cognitive is essential to take step forward.

• Check how the patient is saying

• Have a discussion with the person to figure out

• Important to give

With:

• Information
• With this is time to have questions or to give time
• Take the needed time

When:

• As the view to adapt that all has great commuication and to the cognitive level
• Remember that the pain is great with that coping and to the coping level
• From pain the view will be used

Before Reevaluating:

• As a session it’s essential that the patient to:
• Know it
• Guide perception
• Explain

That Will and Must Provide the Better:

• Will improve with what the patient will then change the other

With:

• *Function from cope
• *In that to cope and what is.
• Many state at the end is important to find with that in all will have impact

What to do -

Over several decades many must feel that may occur/ or may happen as different

• In to help

• *Reassess and may make in help to all as is the right ways.

• All things to keep and also to all This = more skill

• As what should guide as if they show what there for well set by that

• To those that make in get

View- Points

• Has the goal will help? • Is that or does to know/as much? • What as good - will with this • What can be as great also with more help - great set.

The Goal -

To as is the time and

• That for the reasons as show if good is known then find the way, if know and do to to get

Is The: - Process Is the: A balance To: Look over how with those the help to the that The Best - Set.

Conclusion:

• A continuous process to view skill

• Help on path with more help for that the other • Set has what if and look if the reasons