Physiotherapy Assessment/Introduction

The assessment is probably the most important aspect of your work because without a good assessment, there is almost no way for you to get a handle on what's actually wrong with your patient. Many therapists will have many different ideas on what constitutes a good assessment and there are many different variations on what to do and when to do it.

This is an attempt to lay out a few basic principles of assessing patients. I'm going to use the ‘patient’ label because most of the people reading this book will probably be students who work in an acute hospital setting. I’ve also used the term ‘physiotherapist’ as opposed to ‘physical therapist’, the distinction being mainly a grammatical one with the United States using the latter and everyone else the former. Along the same lines, it may be important to note that physiotherapists are physical therapists who have respiratory therapy included in their training, while in the US, this is a separate profession.

You may find that the order of questions/techniques is different from what you've been shown before. You may find that I've left questions out, or included ones you've never seen. You should therefore bear in mind that this is only a guideline, something that you can use while you get comfortable with the idea of performing an assessment.

I was always told that in your subjective examination (interview), the answers you get should be used to initiate or guide the direction of the next question. It's not about learning the questions off by heart and then sitting down with a pen and saying, "Right, number one...” Your patient’s answers should be clues in your search for the cause of their pain or stiffness.

I've divided the book into several chapters, each focusing on a particular type of assessment. For example, Chapter 5 is a Respiratory assessment. I've divided them up for the sake of simplicity and ease of explanation. In reality there is no hard and fast dividing line for what type of assessment you'll use. In fact, you'll generally use a combination of all of them. Think about the 83 year old lady who's just had a stroke and also has a history of chronic obstructive pulmonary disease (COPD). You'll be doing a neurological assessment while taking note of her respiratory system, while possibly mentally scoring her on an Elderly Mobility Scale.

Note: While the subjective assessment is examined in detail in it's chapter, the objective assessment will be dealt with separately in each following chapter, as they will all be slightly different depending on the type of condition being assessed. Therefore each chapter after the subjective assessment will actually be an objective assessment of that type of condition i.e. the chapter on Respiratory assessments is actually a description of the objective assessment performed on a respiratory patient.