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 been present when they saw their physician

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

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

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 range stretch, compression, distraction)

Associated Signs / Symptoms

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

Systems Review
General questions indicative of systemic involvement Followed by system specific questions depending on the location and behavior of symptoms

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

System- Specific Questions

Rheumatologic Neurologic Cardiovascular Pulmonary Gastrointestinal Hematologic Genitourinary Endocrine Gynecologic Psychologic

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 ?

Trial Intervention
Use evidence-based interventions Does the intervention produce the expected result within the expected timeframe ? If the prognosis doesnt happen reevaluate the diagnosis

PT Diagnosis
Not a medical diagnosis in the sense of identifying specific pathologies Rather it is usually defined in terms of categories of impairments, functional limitations & disabilities Key phrase in PT standards is within the scope of PT practice

Scope of PT practice
Can the diagnosis be made based on client interview, observation, palpation, manual testing, functional tests, non-invasive measurements ? Or does the diagnosis require tests or measures that only an MD can order ?

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 PT scope of practice Clients may have both

Multiple Pathologies
May have problems both within and outside of PT scope of practice e.g. Older patient with DDD and /or spinal stenosis may also have prostate cancer and PVD Do we refer, or refer and treat ?