1. Intake Forms
The evaluation starts with intake forms. These forms are outcome measures in the outpatient
clinic. Outcome measure forms are very important for the provider. This helps to guide the examination and treatment.
2 . The Interview
During the interview, the physical therapist will ask questions about the patient’s pain and activity limitations. The goal is to understand any problems; physical, emotional, and lifestyle factors that may be contributing to the symptoms. The patient will be screened for conditions that require referral for additional testing as well as establishing a baseline of risk factors for lifestyle and psychosocial factors. The most important goal during the interview is for the physical therapist and patient to create a mutual alliance based on established values and expectations.
Nonexclusive sample list of question that may be asked:
- How long have you been expereince pain ?
- When did they pain first begin?
- What makes the pain better and what make it worse?
- Can you discribe the pain ( Dull ache, burning, ichying, constant ,throbbing)?
- Why do you think you still hurt?
- How has your pain impacted your friends and family?How has your pain impacted your friends and family?
3. Hypothesis
After the interview, a working hypothesis is established regarding the type of pain. This is to help guide the physical examination and to identify the best patient-focused treatment plan.
Pain is categorized into three distinct types :
- Nociceptive
- Peripheral
- Central sensitization
4. Physical Examination
During the physical examination, the therapist will need to do testing and functional movements that may aggravate the symptoms that the patient is experiencing. Therapists collect this information to understand the behavior of symptoms. The patient is not in any danger, and pain does not always equal hurt or damage.
Based on the interview, the physical therapist will decide if a high-tech or low-tech examination is warranted.
- A low-tech examination will look at larger movements with a neurological screen just to rule out any concern with the neurological system.
- A high-tech examination may be chosen based on symptoms or mechanism of injury. Overall, the physical examination should assist in confirming or refuting the hypothesis.
All examinations include an assessment of vitals and a screen of the major systems. Cardiopulmonary things like Blood pressure, pulse rate, and respiration rate are checked. These screen check for any contributing factors or potential concerns.
Screens include:
- Neurological Screen
- Integumentary Screen
- Muscklolsketal Screen
- Cardiopulmonary Screen
- Postural Screen
- Functional movement screen
Any abnormal result found on a screen may indicate a more in-depth examination of that system or a potential referral.
Other areas that can be tested or assessed for a more in-depth can include any of the following:
- Any Special tests (condition-specific testing)
- Strength
- Endurance
- Balance
- Presence of central sensitization
- Cognition
- High fear-avoidance
- Sensation (temperature, fine, pressure, conductivity)
- Range of motion
- Flexibility
- Joint assessment
- Mobility
- Coordination
- Muscle function
5. Results
Once the examination is finished, the physical therapist will review the result with the patient and explain any abnormalities found. The therapist will then determine if the patient is eligible for treatment or if a referral is needed for another provider. The therapist could also determine that treatment is warranted, but another provider is needed on the team to help the patient reach the full potential of recovery. The therapist will answer any questions and discuss the treatment plan. This plan is created with the collaboration of the patient.
6. Treatment
Once a treatment plan is agreed on, the therapist will provide an appropriate first treatment followed by pain neuroscience education. Then any at-home treatment may be given, and appointments moving forwards are scheduled.
Want to learn more?
- GOT PAIN?: Introduction
- The Opioid Crisis: The History
- The Science of Pain: Knowledge & Education
- Pain Management in Healthcare: The Team
- Physical Therapist 6 Steps to Evaluating Pain!: The Process
- Know Pain, KNOW GAIN!: 8 Common Initial Treatments for Pain: The Treatment
References:
- Louw A. Pain Neuroscience Education: Teaching People about Pain: A Clinical Guide. Minneapolis, MN: Orthopedic Physical Therapy Products; 2018.