Subjective examination

• Neuro-musculoskeletal examination - Subjective examination methods:

  • The interview
  • Communication
  • Rapport
  • Establishing what needs to be assessed
• Subjective examination:

  • AIMS - To obtain information from patient
  • Determine:
  • severity
  • irritability
  • nature
  • Make a hypothesis
  • Plan a safe objective exam to prove/disprove your hypothesis
• After subjective examination we should know:

  • What is the problem?
  • Why is there a problem?
  • How did it come about?
  • What impact is the problem having?
  • What factors may influence recovery?
• Communication

  • Body language
  • Tone of voice
  • Motivational attitude – build a therapeutic alliance
  • Questioning style very important
• Interview technique

  • Structured: physiotherapist leads
  • Unstructured: patient leads
  • This balance is an art form - don’t let it be an interrogation!
• A suggested order:

  • Who: Personal details, occupation & hobbies
  • What : Determine main problem
  • Where: Site, depth, type, relationship of symptoms
  • When/ How: History Current and Past
  • Context: Social History/ General Medical History
• Severity:

  • The degree to which symptoms affect function / pain intensity
  • Could use VAS to score out of 10
• Irritability:

  • the degree to which the symptoms increase with provocation and how quickly they ease
  • How long to aggravate/ease