In order to complete an assessment, it is important to carry out a proper and thorough examination. A correct diagnosis depends upon a knowledge of functional anatomy, an accurate patient history, diligent observation and a thorough examination. The purpose of the assessment is to fully and clearly understand the patient’s problems and the physical basis for the symptoms that cause the patient to complain.
Initially, the physiotherapist, massage therapist, or chiropractor will conduct a subjective examination whereby information regarding the mechanism of injury is obtained. Any history of previous injuries or conditions, the patient’s occupation or hobbies that may aggravate or be affected by the condition is also obtained. Questions will be asked to determine the type and character of pain, and an effort will be made to quantify this pain. You will be asked to rate this pain on a scale from 0 to 10, 0 being no pain, and 10 being so severe that you would seek out an emergency room. This is a validated scale that provides outcome data unique to your condition and can be used as a measure to determine quantitatively if your pain is getting better or worse. The subjective examination is guided by the presenting system and complaint.
The objective assessment is guided by the history and the findings of the subjective exam. In an orthopaedic assessment the physiotherapist will observe posture, patterns of movement, any swelling, deformity, or asymmetry. Highly developed skills of palpation will identify crepitus (noise with the joints or tendons), areas of heat, tenderness, or palpable deformity. The objective examination will use quantifiable measures to establish baseline measurements to monitor progress, establish a diagnosis and guide treatment intervention. Tests will be used to determine the type of tissues involved, hypothesize a pathologic process, and guide the selection of exercise. Therapists will use their clinical judgment with consideration of severity, irritability, acuity, and patient’s medical history when selecting tests. Often the outcome of one test will be a crucial factor in the selection of additional assessment tools.
Accurate clinical decision making is the result of a thorough assessment and a central component of patient care. As the volume of our research continues to grow, we are increasingly incorporating these findings with unique patient presentations to make the most informed clinical decisions. Part of this decision making involves the use of clinical prediction rules whereby combinations of clinical findings that have demonstrated to be statistically significant and meaningful can be used to predict the likelihood of the presence of a condition or a response to a particular treatment.
We also use validated and reliable outcome measures to assess function, performance, and the interaction of psychosocial factors on wellness. Outcome measures are tests to objectively measure baseline function at the beginning of treatment. This same measure can then be used later during treatment to assess progress, treatment efficacy and effectiveness. With the adoption of evidence based practice it is necessary to provide credible and valid justification of treatment.
Through the use of all the assessment tools at our disposal, our physiotherapists in Ajax, and Whitby can paint an accurate picture of the patient’s status and monitor progress and treatment planning.