Module 1 GQ's

• Purposes of history and interview

  Enables the PT to gain an understanding of the patient as an individual, the pt's lived experience since the symptom onset, & what the patient expects to achieve with physical therapy intervention
• Characteristics of an effective therapeutic rapport

  • Verbal and nonverbal communication skills that include active listening, empathy, friendliness, encouragement, and confidence
• Main categories of interview questions that promote shared decision-making

  • Reasons patient is seeking care
  • Patient's goals
  • Patient's Role in Society
  • Patient's resources and constraints
  • Patient's preferences for solutions
• Chief complaint


  Major concerns that led the patient to seek PT services
• Information to find out about the patient's chief complaint


  • History of the chief complaint
  • Complete history of current symptoms
  • Possible risk factors or other causes of the current illness as well as detailed chronological description of all symptoms and prior care obtained for this problem
• General demographic information to collect on the patient

  • Age
  • Gender
  • Education
  • Race
  • Ethnicity
  • Religion
  • Spirituality
  • Hand dominance
  • Primary language
  • Preferred method of communication
• Information to collect on the patient's medication

  • Medications taken regularly
  • What they are taken for
  • What side effects they have had
• Medication reconciliation


  Process of comparing a patient's medication orders to all of the medications that the patient has been taking to avoid medication errors such as omissions, duplications, dosing errors or drug interactions
• Information to find out about the patient's general health status

  • Patient's perception of their general health status
  • Physical function such as mobility
  • Cognitive function: includes memory and reasoning ability
  • Behavioral health: depression and anxiety
• Information to collect on the patient's past medical history

  • Past medical history covering all the systems and preexisting medical or other health-related conditions
  • Any surgeries
  • Has the pt been treated w/ chemo or radiation
  • Prior hospitalizations
• Diagnostic or clinical tests


  The findings and if the patient has the reports
• Review of systems

  Help determine the presence of symptoms that indicate the need for referral for additional medical evaluation and helps bring attention to any signs or symptoms the patient has not recognized
• Importance of asking about family history of health conditions

  Reveals any potential risk factors the patient may have and educating the patient's about their risk factors is a key element in risk factor reduction
• Importance of asking about a patient's activities and participation

  Provides information about the pt's prior and current function and life roles and assists in determining the patient's needs in terms of participation and activity
• Information to ask about concerning the patient's living environment

  • Resources available such as assistive technology and equipment, accessibility, the level of assistance available at home, and community resources
• Importance of inquiring about a patient's health and social habits


  Assess the pt's behavioral health risks which can impact prognosis and the POC and factors such as nutrition, attitudes toward exercise and physical activity, and other modifiable risk factors are usually the focus of primary and secondary prevention
• Enablement perspective

  Displaying the pt's role and participation in society & abilities
• Disablement perspective


  Neuropathology, impairments, activity limitations & participation restrictions
• Health conditions categorized by ICF

  Disease, disorder, injury or trauma
• Body structure/function and impairments categorized by the ICF


  • Body structures: anatomical parts of the body
  • Body function: physiological functions of body systems
• Activities and activity limitations categorized by the ICF

  Basic activities of daily living (BADL) include self-care activities
• Participation and participation restrictions categorized by the ICF

  Categories of life roles includes home management, work (job/school/play), community/leisure
• Contextual factors


  Environmental and personal factors that represent the entire background of an individual's life and living situation and can be facilitators or barriers to getting better impacting the patient's prognosis
• Differences between environmental versus personal factors


  • Environmental: Factors range from products and technology & physical factors to social support and relationships, attitudes and institutions and laws
  • Personal: Particular background of an individual's life, including gender, age, coping styles, social background, education, profession, past and current experience, overall behavior pattern, character and other factors that influence how disability is experienced by an individual
• Purpose of formulating an initial hypothesis on the patient/client's movement limitations based on information collected from the history and interview

  PT approaches each pt with a set of hypotheses and collect data to confirm or refute these hypotheses throughout the pt management processing. PT generates both patient-identified and non-patient problems to formulate hypotheses about the patient's problems and the underlying factors, particularly body structure/function impairments most likely contributing to the problems.
• How a physical therapist formulates an examination strategy


  Formulates based on a initial set of hypotheses generated from available data and the nature of the patient-identified and non-patient identified problems
• Purposes of the systems review

  Rule out those body structures with which the PT need not be concerned, identify systems that are resources for the patient, guide choices regarding which aspects of the remaining systems to examine in detail and determine whether the PT should proceed or should refer the patient to other health care providers
• Importance for physical therapists to perform a systems review

  Must know how to recognize systemic disease mimicking the clinical presentation of mechanical or movement dysfunction
• Components of the systems review for the cardiovascular pulmonary systems


  • HR, respiratory rate, BP, oxygen saturation levels, pedal pulse, breathing batter, color of nail beds and lips & inspection and palpation for temperature and edema in hands and feet
• Components of the systems review for the musculoskeletal systems

  • Posture and symmetry, Joint alignment, gross AROM, gross strength palpate joint to access temperature, height and measures of lean body mass, body fat percentage, bone density
• Components of the systems review for neuromuscular systems


  • General assessment of gross coordinated movement, Sensation, balance, gait, locomotion, transfers, and transitions
• Components of the systems review for the integumentary system


  • Inspection and palpation of skin for pliability (texture), integrity, color, lesions, scar formation
• Components of the systems review for the movement system

  • Detect movement impairments during functional tasks and activities, Observe quality of movement, Activity/task
• Components of the systems review for communication ability, affect, cognition, language, literacy, and learning style

  • Ability to make needs known, consciousness, orientation, expected emotional and behavioral responses, learning preferences
• Differences between approaching the systems review from an enablement vs. disablement point of view

  Enablement: Physical therapist's mindset is on the physiologic reserves that may be resources for the patient.

  Disablement: Attention is drawn to systems that are likely to be compromised with specific diseases, injuries or disorders.
• Outcomes of the systems review

  Synthesizes information from the history and interview and the systems review to confirm, reject, refine or generate new hypotheses related to the patient's movement limitations and makes preliminary decisions regarding specific tests and measures or activities to include
• Differences between red and yellow flags

  Red flags: Warning symptoms that requires immediate attention to either pursue further screening or make an appropriate referral.

  Yellow flag: Cautionary symptom that signals the PT to consider the need for screening.
• Objective of performing tests and measures regarding hypotheses on the patient's movement dysfunction


  Confirm or reject a clinical hypotheses made based on factors postulated to be contributing to the patient's movement dysfunction
• How a physical therapist generally determines what to measure during the examination

  Can use the guide to physical therapist practice and the ICF to enhance patient management when making clinical decisions on what to measure
• Discriminative outcome measures


  Distinguish between persons or groups on the basis of a specific characteristic or predefined categories, but are limited in their ability to detect small changed after intervention