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Why do PTs need to do

Medical Screening ? Direct Access exists in most states Clients may obtain scripts for PT

without having seen their physician Signs / symptoms may not have been

reported to their physician

Signs / symptoms may not have beenpresent when they saw their physician

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Screening Process

History Pain patterns Associated signs & symptoms Systems review Tests & measures Trial Intervention

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History The most important aspect of clinical

examination

Should be an interactive interview Starts with chief complaints Includes whatever systems review

questions that become appropriate

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Pain Patterns Dull, non-localized vs. Sharp, Localized Constant, present at rest and at night

vs. intermittent, present with activity Mechanical pattern means the

symptoms correlate with mechanical

loading (weight bearing, end rangestretch, compression, distraction)

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Associated

Signs / Symptoms

Constitutional symptoms ? Bilateral symptoms ? Observed nail / skin changes ? Proximal muscle weakness ?

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Systems Review

General questions indicative ofsystemic involvement

Followed by system specific questionsdepending on the location andbehavior of symptoms

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General Questions

Fevers, chills, sweating Unexplained weight loss (or gain) Appetite loss, nausea, vomiting Fatigue, weakness Insomnia, irritability, depression

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System- Specific

Questions

Rheumatologic Neurologic Cardiovascular Pulmonary Gastrointestinal

Hematologic Genitourinary Endocrine Gynecologic Psychologic

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Tests & Measures Use reliable and valid tests What are the sensitivity and

specificity of each test used ? Diagnosis is probability based Which is more important sensitivity

or specificity ?

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Trial Intervention Use evidence-based interventions Does the intervention produce the

expected result within the expectedtimeframe ?

If the prognosis doesnt happen re-evaluate the diagnosis

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PT Diagnosis Not a medical diagnosis in the sense

of identifying specific pathologies

Rather it is usually defined in termsof categories of impairments,functional limitations & disabilities

Key phrase in PT standards is withinthe scope of PT practice

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Scope of PT practice

Can the diagnosis be made based onclient interview, observation,

palpation, manual testing, functionaltests, non-invasive measurements ?

Or does the diagnosis require tests ormeasures that only an MD can order ?

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PT Examination First determine if the patient is

appropriate for PT screen for

problems outside PT scope of practice Second determine the PT diagnosis -

the problem that is within the PTscope of practice

Clients may have both

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Multiple Pathologies May have problems both within and

outside of PT scope of practice

e.g. Older patient with DDD and /orspinal stenosis may also haveprostate cancer and PVD

Do we refer, or refer and treat ?