subjective assessment
Introduction
The ability to effectively examine and asses patients is an essential skill for physiotherapist to possess. Assessment is the keystone of effective treatment without which success and failures lose all of their value as learning experiences . so in this , we will discus.
•To identify the appropriate questions to include in a subjective muskuloskeletal assesment
•To discuss the use of regional and specific questions for particular joints
•To explain the use of appropriate subjective and objective markers
•To explain the use of specific and regional tests at particular joint
•To recognise the need for continious reassessment
When shuould physiotherapists assess patients ?
On first patient contact, it is essential to perform an initial assessment to determine the patient's problems and to establish a treatment plan .
During the treatment, assessment is particularly appropriate while performing treatments such as mobilisation exercises when the patient's sign and symptoms may vary quite repidly.
following each treatment, the patient should be reassessed using subjective and objective markers in order to judge the efficacy of the physiotherapy innervations.
At beginning of each new treatment , assessment should determine the lasting effects of treatment .
Aims of subjective assessment
Aim are to gather all relevant information about the site, nature, behaviour, and onset of symptoms , and past treatments .
Aims of objective assessment
•Reproduce all or parts of the patient's symptoms
•Determine the pattern, quality, range, resistance and pain response foe each other
•Identify factor that have prediposed or arisen form of diseorder
•Obtains sign on which to assess the effectiveness of treatment
subjective assessment
Subjective Assessment
Initial questions
Including Name , address, contact number, patient's hospital number , age , sex, date of birth , is the patient currently working? , what patient had perform any heavy lifting, repititive movements .
identify the patient's hobbies or intrest, able to participate in sports? .
Present Condition
1- Area of symptoms :-
Area of pain must be recorded . the patient may have more than one symptoms , so symptoms may be recorded or indicate with some latter like P1 or P2 .
2- Severity of symptoms :-
of pain may be recorded on a visual analogue scale {VAS} .or on numerical scale of 0-10 to quantify of pain , where 0 stands for no pain at all and 10 stands for worst pain.
3- Duration of symptoms :-
Record that the pain is constant or intermittent, pain present all time or does it come and go depending on activities or time of day ?
Aggravating and easing factors
1- Positional factors
Most musculoskeletal pain is mechanical in origin and is therefore made better or worse by adopting particular positions or postures that either stretch or compress the structure that is giving rise to the pain.
it may provide a clue to the physiotherapist.various body or limb positions place diffrent structures on stretch and the resultant deformation produces an increase severity of the pian.
2- Time factors
Be careful not to confuse time of day with the performance of particular activities that the patient may undertake at that time. certain pathological tend to be more painful at charecterstics times of the day.
For example osteoartritis changes are painful and stiff initially on arising from sleep, intervertebral , disc related pain is often more painful on arising owing to the disc imbibing water during sleep and thus exerting pressure on pain-sensitive structures .
Determine the SIN (severity/ irritability/nature) factors
Once the severity of the symptoms and the aggravating and easing factors have been noted , it is then possible to determine SIN factor of the condition.
1-Severity
This can be quantified by the VAS , Numerical scale or other valid pain questionnaire. it can be recorded as high ( pain score on scale aroun 7-10) , moderate ( Score around 4-6) and low ( score around 1-3).
2-Irritability
subjective assessment
This is the time that the person has to perform the activity to increase pain and , conversely , how long it takes before the pain setteles to its former intensity.
3-Nature
It is possible to hypothesise the nature of the condition following the subjective history i.e. whether the patient's conditions has a predominantly inflammatory , traumatic, degenerative or mechanical cause.
History of present condition
1- Insidious cause
Insidious onset means that the patient,s symptoms appear without any obvious cause. example of this would be degenerative condition such as osteoarthritis.
2- Traumatic cause
subjective assessment
Can the onset of symptoms be related to a particular injury? for example a valgus strain of the knee may stretch the medial collateral ligament of the knee, whereas forced rotation of the knee joint when in a semi-flexed weight-wearing positions may tear the menisci.
3- Progression of the condition
progression of the patient may indicate how quickly the patient's symptoms will subside .soft- tissue injury normally undergo a period of inflammation and repair.
4- Chronicity or age of the condition
How long has the patient experienced the symptoms ? is condition is chronic or acute? physiotherapist may ask?
•Is this the first episodes ?
•Is it recurrent ?
•Is it getting better or worse ?
Previous threatments
•Is it getting better or worse ?
•Has the patient received any treatment for this condition in the past and, if so , was it effective ?
•was the improvement partial or complete ?
Investigation
Record the result of any investigations that the patient was undergone. case notes, radiographic films and report can be ordered and read, as patients may not always be a reliable source of the result of their investigations.
X-ray assessment
a- MRI scans
b- X-rays
c- CAT ( computerised axial tomography) Scans
d- Bones scans
Blood Tests
Past medical history
Determine wheater or not the patient is suffering , or has suffered , any major operations or illness.
Proonged used of oral steroids medication should be noted, as this affect bone density and produces a tendency towards bruising.
Medication
Record the type and dosage of medication prescribed for, or taken by , the patient Commonly prescribed drugs for muskuloskeletal conditions are:-
• Analgesic
•NSAIDs
•Skeletal muscle relaxants
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physiotherapy