Patient management process

THEPROCESSOFPATIENTMANAGEMENT
DR. QURATULAIN MUGHAL
DPT (2019)
ISRA UNIVERSITY
1

CONTENTS
Examination
Evaluation
Diagnosis
Prognosis and plan of care
Interventions
Outcomes
2

Examination
Examination is the systematic
process by which a therapist
obtains information about a
patient’s problem(s) and his or
her reasons for seeking physical
therapy services
The examination process
involves both comprehensive
screening and specific
diagnostic testing..
3

Therearethree
distinctelementsofa
comprehensive
examination
1. The patient’s health history
2. A relevant systems review
3. Specific tests and measures
4

1. Information
Generated from
the Initial History
 Demographic Data
• Age, sex, race, ethnicity • Primary language • Education
 Social History
• Family and caregiver resources • Cultural background •
Social interactions/support systems
 Occupation/Leisure
• Current and previous employment • Job/school-related
activities • Recreational, community activities/tasks
 Growth and Development
• Developmental history • Hand and foot dominance
5

CONTINUE……
Living Environment
• Current living environment • Expected
destination after discharge
• Community accessibility
General Health Status and Lifestyle Habits
and Behaviors: Past/Present (Based on Self
or Family Report)
• Perception of health/disability • Lifestyle
health risks (smoking, substance abuse) • Diet,
exercise, sleep habits
6

CONTINUE…..
Medical/Surgical/Psychological History
Medications: Current and Past Family
History
• Health risk factors • Family illnesses
Cognitive/Social/Emotional Status
• Orientation, memory • Communication
• Social/emotional interactions
7

CONTINUE….
 Current Conditions/Chief Complaints/Concerns
• Conditions/reasons physical therapy services sought
• Patient’s perceived level of disability
• Patient’s needs, goals
• History, onset (date and course), mechanism of injury, pattern and
behavior of symptoms
• Family or caregiver needs, goals, perception of patient’s problems
• Current or past therapeutic interventions
• Previous outcome of chief complaint(s)
 Functional Status and Activity Level
• Current/prior functional status: basic ADL and IADL related to self-
care and home
• Current/prior functional status in work, school, community- related
IADL DR. QURATULAIN MUGHAL
8

Key Questions to
Consider During
the Initial
Examination
 What are the most complete and readily available sources for
obtaining the patient’s history?
 Is there a need to obtain additional information about the
patient’s presenting pathology or medical diagnosis if one is
available?
 Based on initial working hypotheses, which of the patient’s
signs and symptoms warrant additional testing by physical
therapy or by referral to another health-care practitioner?
 Do the patient’s problems seem to fall within or outside the
scope of physical therapy practice?
 What types of specific tests and measures should be selected
to gather data about the patient’s impairments, functional
limitations, or disability?
 Based on scientific evidence, which diagnostic tests have a
high level of accuracy to identify impairments, functional
 What are the most important tests to do first? Which could be
9

2.AreasofScreening
forthe
SystemsReview
System Screening
Cardiovascular/
pulmonary
Heart rate, respiratory rate, and blood
pressure; pain or heaviness in the chest
or pulsating pain; lightheadedness;
peripheral edema
Integumentary Skin temperature, color, texture,
integrity, scars, lumps, growths
Musculoskeletal Height, weight, symmetry, gross ROM,
and strength
Neuromuscular General aspects of motor control
(balance, locomotion, coordination);
sensation, changes in hearing or vision;
severe headaches
Gastrointestinal/
genitourinary
Heartburn, diarrhea, vomiting, severe
abdominal pain, problems swallowing,
problems with bladder function,
unusual menstrual cycles, pregnancy
10

CONTINUE….
System Screening
Cognitive and
social/ emotional
Communication abilities
(expressive and receptive),
cognition, affect, level of
arousal, orientation, ability
to follow directions or learn,
behavioral/emotional
stressors and Responses
General/
Miscellaneous
Persistent fatigue, malaise,
unexplained weight gain or
loss, fever, chills, sweats
11

3. Specific Tests
and Measures
Assessment of pain
Goniometry
Joint mobility, stability, and integrity
tests (including ligamentous testing)
Tests of muscle performance (manual
muscle testing, dynamometry)
Posture analysis
Gait analysis
Assessment of assistive, adaptive, or
orthotic devices
12

Guidelines for
Selection of
Specific Tests and
Measures
 Consider why particular tests are performed and how the interpretation of
their results may influence the formulation of a diagnosis.
 Select tests and measures that provide accurate information and are valid
and reliable and whose efficacy is supported by evidence generated from
sound scientific studies.
 Administer tests that target multiple levels of disablement: impairments,
functional limitations, the patient’s perceived level of disability.
 Prioritize tests and measures selected to gather in-depth information about
key problems identified during the history and systems review.
 Decide whether to administer generic tests or tests that are specific to a
particular region of the body.
 Choose tests that provide data specific enough to support or reject working
hypotheses formulated during the history and systems review and to
determine a diagnosis, prognosis, and plan of care when the data are
evaluated.
 Select tests and measures that help determine the types of intervention
that most likely are appropriate and effective.
 To complete the examination in a timely manner, avoid collecting more
information than is necessary to make informed decisions during the
evaluation, diagnosis, and treatment planning phases of management.
13

Evaluation
Evaluation is a process
characterized by the
interpretation of collected
data.
The process involves
analysis and integration of
information to form
opinions by means of a
series of sound clinical
decisions. DR. QURATULAIN MUGHAL
14

Diagnosis
The term diagnosis can
be used in two ways; it
refers to either a
process or a category
(label) within a
classification system.
15

Diagnostic
Process
begins with:
(1)the collection of data
(examination);
(2)the analysis and interpretation of all
relevant relevant data collected,
leading to the generation of working
hypotheses (evaluation); and
(3)organization of data, recognition of
clustering of data (a pattern of
findings), formation of a diagnostic
hypothesis, and subsequentDR. QURATULAIN MUGHAL
16

Diagnostic
Classifications for
the
Musculoskeletal
System
 Primary prevention/risk reduction for skeletal demineralization
(pattern 4A)
 Impaired posture (pattern 4B)
 Impaired muscle performance (pattern 4C)
 Impaired joint mobility, motor function, muscle performance, and
range of motion (ROM) associated with connective tissue
dysfunction (pattern 4D)
 Impaired joint mobility, motor function, muscle performance, and
ROM associated with localized inflammation (pattern 4E)
 Impaired joint mobility, motor function, muscle performance,
 ROM, and reflex integrity associated with spinal disorders (pattern
4F)
17

CONTINUE…
 Impaired joint mobility, muscle performance, and
ROM associated with fracture (pattern 4G)
 Impaired joint mobility, motor function, muscle
performance, and ROM associated with joint
arthroplasty
 (pattern 4H)
 Impaired joint mobility, motor function, muscle
performance, and ROM associated with bony or soft
tissue surgery (pattern 4I)
 Impaired motor function, muscle performance, ROM,
gait, locomotion, and balance associated with
amputation (pattern 4J)
18

Key Questions to
Consider During the
Evaluation and
Diagnostic Processes
 What is the extent, degree, or severity of impairments, functional
 What is the stability or progression of dysfunction?
 Is the current condition(s) acute or chronic?
 What actions/events change (relieve or worsen) the patient’s signs and
symptoms?
 How do preexisting conditions (co-morbidities) affect the current
condition?
 How does the information from the patient’s medical/ surgical history
and tests and measures done by other health-care practitioners relate
to the findings of the physical therapy examination?
 Have identifiable clusters of findings (i.e., patterns) emerged relevant
to the patient’s dysfunction)?
 Is there an understandable relationship between the patient’s extent of
impairments and the degree of functional limitation or disability?
 What are the causal factors that seem to be contributing to the
patient’s impairments, functional limitations, or disability?
19

Prognosis and
plan of care
A prognosis is a prediction of a
patient’s optimal level of function
expected as the result of a course of
treatment and the anticipated
length of time needed to reach
specified functional outcomes
20

Factors That
Influence a
Patient’s
Prognosis/Expec
ted Outcomes
 Complexity, severity, acuity, or chronicity and expected
course of the patient’s condition(s) (pathology),
impairments, and functional limitations
 Patient’s general health status and presence of
comorbidities and risk factors
 Patient’s and/or family’s goals
 Patient’s motivation and adherence and responses to
previous interventions
 Safety issues and concerns
 Extent of support (physical, emotional, social)
21

Theplanofcare,an
integral
componentofthe
prognosis,
delineatesthe
following
 Anticipated goals
 Expected functional outcomes that are meaningful, utilitarian,
sustainable, and measurable
 Extent of improvement predicted and length of time
necessary to reach that level
 Specific interventions
 Proposed frequency and duration of interventions
 Specific discharge plans
22

Key Questions
to Establish
Patient-
Centered Goals
and Outcomes
in
the Plan of
Care
 What activities are most important to you at home, school, work, or
during your leisure time?
 What activities do you need help with that you would like to be able
to do independently?
 Of the activities you are finding difficult to do or cannot do at all at
this time, which ones would you like to be able to do better or do
again?
 Of the problems you are having, which ones do you want to try to
eliminate or minimize first?
 In what areas do you think you have the biggest problems during the
activities you would like to do on your own?
 What are your goals for coming to physical therapy?
 What would you like to be able to accomplish through therapy?
 What would make you feel that you were making progress in achieving
your goals?
 How soon do you want to reach your goals?
23

Interven
tion
Intervention, a component of
patient management, refers to any
purposeful interaction a therapist
has that directly relates to a
patient’s care.
 There are three broad areas of intervention:
Coordination, communication, and
documentation
Procedural interventions
Patient-related instruction
24

Outcomes
 Simply stated, outcomes are results.
 There are several broad areas of outcomes.
• Level of a patient’s physical function, including impairments,
functional limitations, and perceived disability
• Extent of prevention or reduced risk of occurrence or recurrence of
future dysfunction related to pathology, impairments, functional
limitations, or disability
• Patient’s general health status or level of wellness and fitness
• Degree of patient satisfaction
25

REFERENCE
26

Patient management process

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