Assessment and Treatment

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by Chris Heywood
Chartered Physiotherapist
MSc BSc MCSP
Clinical Specialist & Moulton Clinic Manager
We are often asked what we can do to help when patients call us for an appointment query. The first thing is to form a working diagnosis and treatment plan, with you, but to do that we need to undertake an Initial Assessment. So what should you expect?
The perception of a poor assessment is one of the most frequent reasons that I hear my clients citing when coming to team Rehab uk for a second opinion. Patient satisfaction appears rarely to be linked to the potential diagnosis, or actual outcome, but more closely to if they felt they have been listened to and taken seriously. If the patient and professional relationship is poor, the chances of a successful outcome is probably also poor. Newly qualified clinicians take note!

Perhaps the most common of these dissatisfactions is when there has been little or no physical assessment at all. It is very true that an experienced Consultant, GP or practitioner will glean much more than your think by simply having a good interview technique, but having hands on someone can never be substituted. So what sort of things should be involved in a good assessment? We will split this brief guide into three sections, the Subjective the Objective and the Plan: ​

The Subjective Assessment

Firstly you will need to complete your registration form that includes your consent for examination and treatment, along with a simple health questionnaire. Then the subjective assessment will start and can be compared to an 'interview' if you like, conducted between the professional and the client. This is actually quite a skilled technique and helps to build a working diagnosis to take forward into the Objective phase. It is important to try and recall as many details as you can and for some it helps to prepare for this by writing some main points down before attending the consultation (there will be no need to send these to us prior to the assessment, unless specifically asked to do so). Some examples of this may be:
1) Timescales: when did your symptoms start, is this the first episode or one of many, was the pain/symptom sudden or did it increase gradually over time, was there any trauma?

2) ​The pain: is it sharp, aching, burning, catching, is there spasm, is the pain just in one place or does it go anywhere else,  are there any sensory changes such as numbness, are there any pins and needles, is there any muscle weakness.? Does it feel worse at any time of the day or with any particular activities or postures?

​3) Visual: Have you noticed any bruising, redness, heat or swelling? Have you noticed any changes in how the painful areas look e.g. muscle changed in shape, joint looks different etc.

4) Medication: take a list of all the drugs that you are taking if you can't remember them. If you have a few it sometimes helps to bring a copy of your prescription form so that we can scan it into your notes.Work

5) History: This can be important if it has a direct affect on your pain, or if you are off sick, and needing to return to work.  
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6) Heritability: Some complaints, such as certain types of back pain, can have an inherited trait so knowing any other members of your family that have, or have had, similar pain/symptoms, can be helpful.​​
This list is a snap shot and should not be seen as complete. More often than not, the way you respond to a question will then dictate which way the questioning then progress.

The Objective Assessment

This is the physical examination and to be frank and straight to the point, we will need to see the bit of you that hurts, and any other areas that the therapist feel is relevant. This may be a simple case of rolling up a sleeve to expose and elbow but if you have low back pain for example, or hip pain, please be prepared that you may be asked to undress to your underwear. As all of our therapists are very experience you are unlikely to 'shock them', and to be honest we all like a pair of amusing Mr Men boxers, but you must feel comfy and secure to allow a through and meaningful assessment to be undertaken. You would not take you car to a garage when is broken down and expect them to fix it but not allowing them to open the bonnet to have a look!! Females, wear your best Bridget Jones knickers and sports bras and blokes, your best boxers with buttons in tact and no holes!!! If you turn up to an appointment and either you or the physiotherapist is not happy to proceed due to inappropriate clothing, or similar, you will still be invoiced for that session. If in doubt, bring a chaporone.

**(Please note that Team Rehab uk ltd cannot provide an additional chaperone's during any of our sessions. To ensure that everyone is as comfortable as possible, and allow thorough testing, we would advise anyone that requires an additional chaperone, to arrange a friend or family member to accompany them to the appointment.)**

We will look at the site of injury and as necessary, you as a whole, to ascertain any visual problems that we can see. This may give us clues in to the bio mechanics of an injury in the first instance. We are going to ask you to do specific movements, relevant to your complaint, be it a simple wrist bend for a tennis elbow or perhaps a more complex series of movements for a running injury. These are normally fairly standard tests that are done to give the practitioner a baseline for you and your presentation and these can act as a comparable for later consultations to measure progress.  

After this we will being to be a lot more ' symptom specific' with our special tests and the choice of these will be based upon your presentation, history and initial examination. Throughout these stages the therapist will also be palpating (feeling the tissue) the injury site and other relevant areas to ascertain what may be occurring such as over activity of muscles, spasm, scar tissue etc. We tend to develop and very keen sense of touch through our years of treating which means we will often pick up on discrete tissue changes that you will not. some may be relevant, some may not.

The Plan

After all of this information is gathered, we will further analyse it before formulating a working diagnosis. Your physiotherapist will then discuss both the findings and treatment options with you, should it be needed, so that you can fully understand the details and a mutually agreeable plan can be put in place. This should include agreeing goals and expectations with you as well as the types of treatments you may need and what they entail to ensure that we are all singing from the same hymn sheet from the start.  ​

​You should always be happy and comfortable with any treatment that will be undertaken. The Physiotherapists at Team Rehab uk are all very skilled and will guide you through any techniques that they may undertake to ensure that there are no surprises. You will then be able to make an informed decision on whether you wish to refuse or stop any treatment if you feel unhappy or uncomfortable.

Follow Up Sessions

It may be necessary for you to return for follow up treatments sessions or exercise progression. These will largely follow the same format as the initial assessment but are much more biased towards active interventions given that we have already assessed you. You will be asked to report reactions to prior treatment and exercises, along with a summary of your symptoms to date. Your physiotherapist will then be able to review the working diagnosis and progress you in most appropriate way, after discussing the options with you.

On the rare occasions where we feel it is in your best interests to seek further investigations by a consultant specialist, we can help to arrange this for you. This will normally involve us writing to your GP, regardless of whether you are seeking private or NHS treatment, as they will normally need to instigate the process.