Principles of Examination - Subjective and Physical

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Questions and Answers

Which of the following best describes the construct of irritability in the context of physiotherapy examination?

  • The sharpness and intensity of pain experienced by the patient.
  • The objective measures of pain threshold during physical tests.
  • The amount of pain experienced relative to the activity that provokes it, and how long the pain lasts. (correct)
  • The patient's emotional response to pain during examination.

During the initial interview, a patient reports that they have to cease activity due to intense pain although the pain may settle quickly after stopping. This most likely aligns with which construct?

  • Pathobiological mechanisms
  • Irritability
  • Severity (correct)
  • Nature factors

Which of the following is the MOST relevant reason for a physiotherapist to determine precautions and contraindications before interventions?

  • To adhere to standardized physiotherapy practices.
  • To establish a rapport with the patient by discussing their concerns.
  • To prepare the patient mentally for the examination process.
  • To fulfill their role as direct-contact practitioners. (correct)

During an initial assessment, which aspect of the patient's condition is MOST informed by the 'Welcoming and Information Phase'?

<p>The patient's beliefs and expectations regarding treatment. (C)</p> Signup and view all the answers

What is the primary purpose of using open and half-open questions during subjective examination?

<p>To allow detailed analysis of the patient's account of their illness. (D)</p> Signup and view all the answers

A patient presents with vague and inconsistent symptoms. What type of factors might the physiotherapist consider as being involved?

<p>Central nervous system (C)</p> Signup and view all the answers

During questioning, a patient is unable to isolate one precise spot of pain, and can only indicate a large vague area. What could this indicate?

<p>The possibility of referred symptoms. (B)</p> Signup and view all the answers

What is the MOST important element to consider when determining precautions during a subjective examination?

<p>The constructs of 'irritability' and 'severity'. (A)</p> Signup and view all the answers

What is the MOST appropriate action when a patient has a longstanding history and many complaints?

<p>First establishing the current main problem. (D)</p> Signup and view all the answers

A patient describes that their pain is constant, as every time I lift my arm, it hurts. What does this likely indicate?

<p>An intermittently occurring symptom. (C)</p> Signup and view all the answers

Why is it helpful to determine if each of the patient's complaints could be localized to a specific structure?

<p>To more easily connect findings with theoretical knowledge and biomedical diagnosis. (B)</p> Signup and view all the answers

A patient reports pain that is worse at night and is severe enough to make them get out of bed. What could this indicate?

<p>More serious pathology (C)</p> Signup and view all the answers

Why is it important for the physiotherapist to be aware of 'new use', 'misuse', and 'overuse' categories in the patient's history?

<p>They set the background in relationship with the onset of their symptoms (B)</p> Signup and view all the answers

A patient says 'physiotherapy did not help'. What considerations should be made regarding its relevance?

<p>The intervention may have helped short term (C)</p> Signup and view all the answers

All of the answers below describe a 'significant word' that may be marked with an asterisk, EXCEPT:

<p>Can be used to identify the specific words which should not be used. (A)</p> Signup and view all the answers

If the physiotherapist does not find a structural diagnosis what would be the next course of action?

<p>Other possibilities regarding causes and treatment options. (D)</p> Signup and view all the answers

An initial test is found to be very painful, and has a high risk of exacerbating a patient's condition. What would be the follow-up action?

<p>Perform other tests as able (B)</p> Signup and view all the answers

With all the tests below being important to do under all examination procedures, which is MOST beneficial in relation to the patient?

<p>Ensure comfort and safety (A)</p> Signup and view all the answers

With a patient able to bring themselves to the site of their pain, and that joint now needs examination, what examination is MOST effective?

<p>Active motion (A)</p> Signup and view all the answers

In the setting of finding a "comparable sign", what combination can it be?

<p>Pain, and stiffness (B)</p> Signup and view all the answers

When can test procedures which reproduce the patient's symptoms be MOST significant?

<p>The reassessment parameters and the definition of treatment objectives on 'impairment' levels (B)</p> Signup and view all the answers

Why are differentiation tests useful, for which the patient can be tested, for?

<p>Where the symptoms appear to have a 'stimulus-response' character. (D)</p> Signup and view all the answers

What question is most likely to be asked as the physiotherapist is preparing to complete tests, having performed them the session before, and which goals does the patient consider?

<p>Will your examination in the first session mainly be concerned with determining possible sources of movement impairments? (A)</p> Signup and view all the answers

With passive movement testing, why perform the physiological movements before the assessment?

<p>Determine how much handling to perform in other movements (A)</p> Signup and view all the answers

If a comparable sign is not able to be found, what should the examiner focus next on?

<p>The exact movement that caused the injury (D)</p> Signup and view all the answers

What actions are useful to evaluate for the determination of the sources of that joint, following passive movement testing?

<p>Accessory movements (A)</p> Signup and view all the answers

If all treatment procedures are not improving the patients range of movement and decreasing pain long term what may need follow up?

<p>A further assessment of the factors in that history (B)</p> Signup and view all the answers

To what does "The art of passive movement" relate?

<p>Details make up &quot;The art of passive movement&quot; (B)</p> Signup and view all the answers

Why are so many test measures and the variety with different patients, is the first step to the start to being, what?

<p>Well put first step on the path to clinical expertise (B)</p> Signup and view all the answers

Before starting the physical exam what must the therapist verify, and why?

<p>If the examination is far enough to start and for the exam that will start from the body and can start the body part of the test (C)</p> Signup and view all the answers

What is the best use of the asterisks?

<p>Those points to be able to use so that the the patient will be able to progress (B)</p> Signup and view all the answers

When do you want to screen possible involvement Of other area (joints)?

<p>Screened for when there is an indication of another (A)</p> Signup and view all the answers

What is the component analysis with passive movements?

<p>Serve in the analysis with how to see what the components have helped (A)</p> Signup and view all the answers

Which of the the best way for the physiotherapist to do so to all times takes all ranges of time is better is the patients be better and what?

<p>It will be the to do in the detail to better understand (A)</p> Signup and view all the answers

Who to take care who the patient may find in their problems to start?

<p>With of of the with with with with test with of of to see with have well with to for to there are a side for more with of with there if see all the problems in if there (D)</p> Signup and view all the answers

A patient reports experiencing a 'burning' sensation in their lower leg that is inconsistent and widespread. Which of the following underlying mechanisms should the physiotherapist consider MOST likely?

<p>Dominant central nervous system mechanisms modulating pain (B)</p> Signup and view all the answers

In which scenario would a 'Treatment plan – determination of short- and long-term treatment objectives, and selection of meaning-ful interventions in a collaborative process with the patient.' be MOST appropriate?

<p>After the examination has started (A)</p> Signup and view all the answers

A physiotherapist is determining whether or not to proceed with a particularly provocative movement-based assessment. Which pair of constructs BEST informs this decision?

<p>Irritability and severity (D)</p> Signup and view all the answers

When a patient describes their pain as a deep ache, it is MOST important to gather more information about

<p>the position of the aggravating activities (C)</p> Signup and view all the answers

A patient reports an injury occurred 3 months ago. They state, some days are good, but others I can barely move, it is difficult to predict'. What should be considered due to the duration and behaviour of symptoms?

<p>There may be psychosocial elements (B)</p> Signup and view all the answers

Flashcards

Irritability

A construct which determines precautions to examination and treatment procedures. A little activity causing severe pain, discomfort, paraesthesia or numbness, which takes relatively long to subside.

Nature Factors

Various factors in the 'nature' of the disorder may determine precautions to examination and treatment procedures with active and passive movements.

Physical Examination

Related to the specific manipulative physiotherapist's analysis of movement disorders and includes active and passive movement testing, muscle testing, soft tissue examination and other tests.

Severity

A construct which determines precautions to examination and treatment procedures: Activity which provokes the pain needs to be interrupted and usually cannot be taken up again due to the intensity of the pain.

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Subjective Examination

Refers to the patient's account of the disorder and its past history; includes information on the kind of disorder, site of symptoms, behaviour of symptoms, history.

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Diagnosis (Physiotherapy)

expressed in terms of impairments of movement components, activity limitations and resources, and participation restriction; may also encompass elements from the individual illness experience.

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Treatment plan

Determination of short- and long-term treatment objectives, and selection of meaningful interventions in a collaborative process with the patient.

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Behaviour of Symptoms

Determining what makes the pain worse, which movements aggravate it and which movements ease it.

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'Kind' of disorder

Used to establish the kind of disorder from the patient's perspective.

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Course over 7 days

To give the examiner an idea of the frequency of the symptoms over the past week.

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Special Questions

Indicates precautions from manipulative treatment or factors that may limit treatment.

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Previous History

The more garrulous patient can make this process irksome for the novice, sorting out the original onset needs doing so the understanding occurs.

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Present history

Where a patient may have a new problem overlapping with a longstanding one.

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Is it constant?

Can be used to determine if the problem is a constant variable or constant, giving clues to the examiner to plan the rest of the assessment.

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Verbal and non-verbal communication

Pain presents in many ways as well as at many sites, the examiner needs to remember each structure may respond to the injury with different intensities.

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Theoretical knowledge

Includes anatomical structures etc. to be considered as factors to the clinical information at hand.

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Other Morning Symptoms

Symptoms occur in the morning at waking up before rising from bed, may be indicative of a disorder is needing to build up tone.

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Determine the Pre-disposing Factor

Used to gather more information on when/where the damage is occurring.

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Making Hypotheses before Action

Can be determined from observation, history, body chart, and communication during assessment as well as clinical skills to narrow down testing and source of issue.

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Consider the "Point of Discomfort"

A point during movement at the level pain will be considered an onset range indicator. A process that will also create valuable re evaluation during the active test.

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Finding the right tests

Important as a reminder to look for more than the obvious injury, there may be more at play with the patient that you are only gleaning pieces of during assessment.

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Study Notes

  • Chapter 6 looks at the principles of examination, including subjective and physical procedures.
  • Includes planning, reflecting, and key words.

Glossary of Terms

  • Irritability is a construct that determines precautions for examination and treatment procedures which a little activity causes severe pain, discomfort, paraesthesia, or numbness for a relatively long time as defined by Maitland et al in 2001.
  • Various factors determine irritability like reported pain sensation, activity provoking symptoms and reaction to it.
  • Nature factors are various aspects of a disorder that determine precautions to examination/treatment procedures with active and passive movements.
  • Physical examination includes active/passive movement testing, muscle, and soft tissue examinations to reproduce the patient's symptoms and determine movement impairments.
  • Severity is a construct determining precautions to examination and treatment procedures which provoke pain and cease immediately.
  • Subjective examination relates to a patient's disorder account and its past history by including information on the disorder, site of symptoms, behavior, disability level, special questions, and history.

Introduction

  • Starting the physiotherapy process requires examination procedures.
  • Successful treatment needs reassessment of results.
  • Examination procedures generally aim at diagnosis from a movement perspective.
  • Determination of precautions and contraindications to physiotherapy interventions is more relevant as physiotherapists become direct-contact practitioners.
  • Treatment includes short and long-term objectives and intervention selection through collaboration with the patient.
  • Assessment and treatment are guided by clinical reasoning.
  • Physiotherapists generate hypotheses, test them, and use pattern recognition in decision-making.
  • Manipulation involves sources of symptoms, pathobiological mechanisms, precautions, contributing factors, level of disability, individual illness experience/behavioral factors, management, and prognosis
  • Fulfilling successful examination procedures requires a knowledge base, interviewing skills, clinical skills, and clinical reasoning skills, all accessible and well-organized.

Welcoming and Information Phase

  • The welcoming and info phase are essential for patients and therapists.
  • Therapists should be informed about the scope and procedures of the physiotherapy process.
  • It can develop a therapeutic relationship and determines the barriers of the patient.
  • Includes introduction/joining, therapist explanation of movement examination, expectation clarification, setting explanation (therapist, room, sessions, etc.) and first session sequence of procedure.

Subjective Examination

  • The subjective examination relays the patient's account of the disorder and past experiences.
  • The therapist sees and records the problem in the patient's words.
  • Therapists should ask open and half-open questions, rather than a list/questionnaire.
  • Communication skills are essential, consider individual differences between the patients.
  • It consists of five sections such as kind, site, behavior and level of disability, history and special questions.

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