Research in Motion

Physiotherapists need assessment to identify existing impairments and to design an appropriate, individualized treatment program. The assessment allows us to gather information about the patient and guide us to structured management strategies.

As physiotherapists, we make some common errors in our process of assessment which needs to be looked after to allow more credibility to our assessment. This blog is not an exhaustive list of all the errors we commit during the assessment procedure. It’s a first-hand experience of physios that are seeing patients day in and out.

The first error which a budding physio commit is sticking to the whole assessment protocol irrespective of the nature of the illness. We must understand that PT is a medical profession if we merely learn and follow protocols, without putting our brains into the procedure it won’t do justice to the assessment procedure too. We need to learn the “Why” we are assessing a particular variable.

The assessment should be centered towards the patient’s complaints and in order to find out impairments and causes behind those impairments. We propose to follow a shared decision-making paradigm, where the patient is also an important component of the overall procedure.

The second common error in daily opd basis is when patients come with X rays and referrals from other medical professionals. A lot of budding physiotherapists follow their assessment and divert our decisions either on their diagnosis or as declared by the imaging/diagnostic tests. We should always start with our communication about their complaints and not start our assessment with their assessment.

The MRI, X-rays and other diagnostic procedures should always be clinically correlated with the patient’s clinical presentation. There are various cohorts and longitudinal studies suggesting that changes in imaging are not associated with pain. So we need to check our steps before reaching conclusions.

The third error is we fail to correlate history (subjective) and assessment (objective) findings. And sometimes even fail to generate hypothesis at the end of the assessment. The other important aspect we miss is identifying the functional problems of the patient.

We rarely take into account outcome measures to be used as a part of our assessment. They can provide sometimes useful insights into the patient’s problem. I personally use patient-specific functional scale that tells me what the patient cannot do, and helps set the patient-centred goals.

The fourth mistake is that we seldom do a systemic review. We do not analyse or review the red flags or yellow flags that may warrant a referral to another healthcare provider. Sometimes the patient might be having a systemic issue which may warrant additional care.

The fifth error is in pain assessment. We commonly stick to the biomedical model, with recent studies suggesting the use of a biopsychosocial approach or an enactive pain assessment approach.

In totality, I consider that clinical assessment should be more rational and an open approach rather than being a closed approach.

The last is to remember that different patients can tell you a different story to the same disorder or same considerate cause of impairment. Let’s listen to our patients!