Physiotherapy: Complex Case Management

• Physiotherapy complex case management uses a holistic approach for patients who have multiple or complex health conditions.
• Effective patient assessment is critical for successful management.
• Assessment techniques used are subjective history, objective examination, and functional analysis.

Subjective History

• Gathering a thorough patient history is essential to understanding the patient's condition, limitations, and goals.
• Gathering a patient history incorporates collecting information about the patient's current condition, past medical history, medication, and lifestyle.
• Pain assessment requires understanding the location, onset, duration, intensity, aggravating and easing factors, and nature of pain.
• Functional history explores the patient's ability to perform daily activities, work, and recreational activities.
• Understanding the patient's goals and expectations assists in tailoring the treatment plan.
• A patient's social history including their support system, living situation, and occupation is important.
• Psychological factors and mental health are important when taking a subjective history.
• Communication skills are vital for gathering relevant information.

Objective Examination

• Objective examination uses hands-on assessment of physical impairments.
• Observation begins as the patient enters the clinic, noting their posture, gait, and movements.
• Posture assessment evaluates alignment in different planes.
• Gait analysis examines the patient's walking pattern, including stride length, cadence, and stability.
• Palpation involves feeling for tenderness, swelling, muscle spasm, and temperature changes.
• Range of motion (ROM) assessment measures the extent of joint movement using goniometry.
• Muscle strength testing evaluates the strength of individual muscles or muscle groups using manual muscle testing (MMT) or dynamometry.
• Neurological assessment includes testing sensation, reflexes, and nerve function.
• Special tests involve specific movements or maneuvers to assess particular structures or pathologies.
• Cardiopulmonary assessment measures heart rate, blood pressure, respiratory rate, and oxygen saturation.
• Wound assessment requires evaluating wound size, depth, exudate, and surrounding skin.

Functional Assessment

• Functional assessment evaluates a patient’s ability to perform specific tasks and activities.
• Balance and coordination tests are the Romberg test, Berg Balance Scale, and Timed Up and Go test.
• Assessing the ability to perform activities of daily living (ADLs) like dressing, bathing, and eating helps determine the level of independence.
• Evaluating the ability to perform work-related tasks involves assessing strength, endurance, and movement patterns.
• Assessing the ability to participate in recreational activities helps to understand the impact of the condition on the patient's lifestyle.
• Standardized outcome measures such as questionnaires or performance-based tests can quantify functional abilities and track progress.

Pain Assessment

• Visual Analog Scale (VAS) requires patients to mark a point on a 10-cm line representing their pain intensity.
• Numerical Pain Rating Scale (NPRS) asks patients to rate their pain on a scale of 0 to 10.
• McGill Pain Questionnaire (MPQ) assesses the sensory, affective, and evaluative aspects of pain.
• Pain drawings allow patients to mark the location and type of pain on a body diagram.

Outcome Measures

• Patient-Reported Outcome Measures (PROMs) capture the patient's perspective on their health status, symptoms, and functional abilities.
• Disease-specific outcome measures are designed to assess specific conditions.
• Generic outcome measures can be used across a wide range of conditions.
• Performance-based outcome measures involve observing and measuring the patient's performance of specific tasks.
• Range of motion measurements, strength testing, and balance tests provide quantitative data on physical impairments.

Assessment of Specific Populations

• Pediatric assessment requires modification of techniques to accommodate the child's developmental stage and cognitive abilities.
• Geriatric assessment involves considering age-related changes, comorbidities, and cognitive impairments.
• Neurological assessment requires specific techniques to assess sensory, motor, and cognitive function.
• Musculoskeletal assessment involves a detailed examination of joints, muscles, and bones.
• Cardiopulmonary assessment involves measuring heart rate, blood pressure, respiratory rate, and oxygen saturation.
• Cognitive impairments require using simple language, visual cues, and involving caregivers.
• Communication barriers require using interpreters, visual aids, and non-verbal communication techniques.

Clinical Reasoning

• Clinical reasoning is the process of gathering information, analyzing data, and making decisions about patient care.
• Hypothesis generation involves developing possible explanations for the patient's condition based on the initial assessment.
• Differential diagnosis involves comparing and contrasting different possible diagnoses.
• Treatment planning involves setting goals, selecting interventions, and developing a plan of care.
• Evaluating treatment effectiveness involves reassessing the patient's condition and modifying the treatment plan as needed.
• Considering the patient’s values, preferences and beliefs is important for ethical practice.

Documentation

• Accurate and thorough documentation is essential for communication, legal protection, and reimbursement.
• Documentation requires the subjective history, objective examination, and functional assessment findings.
• Recording the patient's goals, treatment plan, and progress is important.
• Using standardized terminology and abbreviations ensures clarity and consistency.
• Protecting patient confidentiality is a legal and ethical responsibility.
• Documentation should be timely, accurate, and legible.

Ethical Considerations

• Informed consent involves explaining the assessment and treatment procedures to the patient and obtaining their permission.
• Patient confidentiality involves protecting the patient's personal and medical information.
• Cultural sensitivity involves respecting the patient's cultural beliefs and values.
• Maintaining professional boundaries is important for ethical practice.
• Avoiding conflicts of interest ensures objectivity and integrity.
• Ensuring equitable access to care for all patients is an ethical responsibility.

Communication

• Effective communication is essential for building rapport, gathering information, and educating patients.
• Active listening involves paying attention to the patient's verbal and nonverbal cues.
• Using clear and concise language ensures understanding.
• Providing patient education about their condition, treatment plan, and self-management strategies is important.
• Communicating with other healthcare professionals such as physicians, nurses, and occupational therapists ensures coordinated care.
• Documenting communication with the patient and other healthcare professionals is important.
• Appropriate communication strategies for patients with cognitive impairments or communication barriers ensures understanding.

Interdisciplinary Collaboration

• Working with other healthcare professionals to provide comprehensive care ensures holistic care.
• Communicating with physicians, nurses, occupational therapists, and other specialists ensures coordinated care.
• Participating in team meetings and case conferences facilitates collaboration.
• Sharing assessment findings and treatment plans with the interdisciplinary team is important.
• Coordinating care to address the patient's physical, psychological, and social needs ensures holistic care.
• Understanding the roles and responsibilities of other healthcare professionals is important for effective collaboration.