The document discusses the critical skills and techniques required for effective interviewing in healthcare, emphasizing the need for compassion, cultural competency, and adaptability in communication styles. It identifies client recall challenges, the importance of accurate documentation, and various interviewing techniques, while also covering factors like age, gender, race, and substance abuse that influence health assessments. Additionally, it highlights the significance of building trust with clients to ensure successful health screenings and interventions.

2. Chapter # 02
Introduction to the
Interviewing Process
Dr. Ayesha Ashraf

3. Interviewing
• It is a skill that requires careful nurturing and refinement over
time.
• Even the most experienced health care professional should self
assess and work toward improvement.
• Taking an accurate medical history can be a challenge.

4. Client’s nature
• Clients may forget, underreport, or combine separate health events
into a single memory, a process called telescoping.
• They may even (intentionally or unintentionally) fabricate or falsely
recall medical events and symptoms that never occurred.
• The individual's personality and mental state at the time of the illness
or injury may influence their recall abilities
• Adopting a compassionate and caring attitude, monitoring your
communication style, and being aware of cultural differences will
help ensure a successful interview.
• Everyone has a slightly different interviewing and communication
style. The interviewer may need to adjust his or her personal
interviewing style to communicate effectively.

5. Compassion V/S caring
• Compassion is the desire to identify with or sense something of another's
experience and is a precursor of caring.
• Caring is the concern, empathy, and consideration for the needs and
values of others.
• Interviewing clients and communicating effectively, both verbally and
nonverbally, with compassionate caring takes into consideration individual
differences and the client's emotional and psychological needs.
• Establishing a trusting relationship with the client is essential when
conducting a screening interview and examination
• Illiteracy
• Cultural competency

6. Important goal of our profession
•An important goal of the profession is to
promote recognition that we are the health
profession with the expertise to
appropriately screen, diagnose, and then
develop treatment programs that are safe
and effective for individuals with all levels
of movement system dysfunction.

8. Types of Documentation

9. Reasons for documentation

11. Interviewing list for Do’s

12. Interviewing list for Dont’s

15. Interviewing techniques:
• The most basic skills required for a physical therapy
interview include:
1. • Open-ended questions
2. • Closed-ended questions
3. • Funnel sequence or technique
4. • Paraphrasing technique

16. Open Ended & Close Ended Questions:

17. Advantages and limitations
• Each question format has advantages and limitations.
• The use of open-ended questions to initiate the interview may allow the
client to control the interview, but it can also prevent a false-positive or
false-negative
• False responses elicited by closed-ended questions may develop from the
client's attempt to please the health care provider or to comply with what
the client believes is the correct response or expectation.
• Closed-ended questions tend to be more impersonal and may set an
impersonal tone for the relationship between the client and the therapist.

18. Funnel Sequence or Techniques
• Moving from the open ended line of questions to the closed-ended
questions is referred to as the funnel technique or funnel
sequence.

19. Funnel – FUPs (follow up questions)

20. Paraphrasing Technique
• A useful interviewing skill assisting in synthesizing and integrating the
information obtained during questioning is the Paraphrasing technique.
• When using this technique, the interviewer repeats information presented
by the client.
• This technique can assist in fostering effective, accurate communication
between the health care recipient and the health care provider.
• For example, once a client has responded to the question, "What makes
you feel better?" the therapist can paraphrase the reply by saying, "You've
told me that the pain is relieved by such and such, is that right? What other
activities or treatment brings you relief from your pain or symptoms?"

21. Outcome management/measures
• Documenting the effectiveness of intervention is called outcomes
management.
• Using standardized tests, functional tools, or questionnaires to relate
pain, strength, or range of motion to a quantifiable scale is defined
as outcome measures.
• The information obtained from such measures is then compared with
the functional outcomes of treatment to assess the effectiveness of
those interventions.
• Pain assessment is often a central focus of therapist’s interview

22. Interviewing tools:
• There are a wide variety of anatomic region, function, or disease-specific
assessment tools available.
• Each test has a specific focus whether to assess pain levels, level of
balance, risk for falls, functional status, disability, quality of life, and soon.
• Some tools focus on a particular kind of problem such as activity
limitations or disability in people with low back pain (e.g., Oswestry
Disability Questionnaire, Quebec Back Pain Disability Scale, Duffy-Rath
Questionnaire.
• The Simple Shoulder Test, and the Disabilities of the Arm, Shoulder, and
Hand Questionnaire (DASH) may be used to assess physical function of
the shoulder.

23. Subjective examination:
• The subjective examination must be conducted in a complete and
organized manner.
• Evaluation forms are used. The order of flow may vary from therapist
to therapist and clinic to clinic
•Sequence of interviewing process

24. Key components of subjective examination:

25. STEP 1
SUBJECTIVE EXAMINATION

26. Family/Personal History form

27. • The therapist may need to make a qualifying statement to the
client regarding the need for such detailed information.

28. Age & Aging
• Age is the most common primary risk factor for disease, illness, and
comorbidities.
• It is the number one risk factor for cancer.
• The age of a client is an important variable to consider when evaluating
the underlying neuro-musculoskeletal pathologic condition and when
screening for medical disease.
• Human aging is best characterized as the progressive constriction of
each organ system's homeostatic reserve. This decline, often referred to
as "homeostenosis,"
• Begins in the third decade and is gradual, linear, and variable among
individuals.
• Each organ system's decline is independent of changes in other organ
systems and is influenced by diet, environment, and personal habits.

29. Gender
• In the screening process, gender may be an important issue.
• To some extent, men and women experience some diseases
that are different from each other.
• When they have the same disease, the age at onset, clinical
presentation, and response to treatment is often different.

31. Race/Ethnicity
• "race" as a sociopolitical way of categorizing a population.
• race is used epidemiologically as a medical profiling for risk of
disease based on genetically defined differences.
• An individual's ethnicity is defined by a unique sociocultural heritage
that is passed down from generation to generation but can change as
the person changes geographical locations or joins a family with
different cultural practices.
• Ethnicity looks at geographical origins, cultural differences in diet, and
other habits.

32. Example:
• A child born in Korea but adopted by a Caucasian
American family will grow up speaking English, eating
American food, and studying U.S. history.
• Ethnically, the child is American but will be viewed
racially by others as Asian.

33. Past medical/personal history
• It is important to take time with these questions and to ensure
that the client understands what is being asked.
• Ensure for any kind of allergies, other systemic sign and
symptoms.
• ‘yes’ response lead to further follow up questions
• Some time ‘No’ response may also need follow up questions

34. Eating disorders/disordered eating
• This have an impact over client’s health and recovery
• The therapist must consider the potential for a negative impact of anorexia on bone
mineral density
• In male eating disorders remains under reported.
• Athletes participating in sports that use weight classifications such as wrestling and
weightlifting are at greater risk for anorexic behaviors such as fasting, fluid restriction,
and vomiting.
• A form of body image disturbance in male bodybuilders and weightlifters referred to
as muscle dysmorphia. Previously referred to as "reverse anorexia"
• This disorder is characterized by an intense and excessive preoccupation or
dissatisfaction with a perceived defect in appearance, even though the men are
usually large and muscular.
• The goal in disordered eating for this group of men is to increase body weight and
size. The use of performance enhancing drugs and dietary supplements is common
in this group of athletes.
• Gay men tend to be more dissatisfied with their body image and may be at greater
risk for symptoms of eating disorders compared to heterosexual men.

37. General Health
• Self-assessed health is a strong and independent predictor of
mortality and morbidity.
• People who rate their health as "poor" are four to five times
more likely to die than those who rate their health as "excellent’’.
• Self-assessed health is also a strong predictor of functional
limitation.
• The therapist should consider it a red flag anytime a client
chooses "poor’’ to describe his or her overall health.

38. Medication/Substance abuse
• Over the counter drugs/medication usage should be asked
• Substances refer to any agents taken non-medically that can
alter mood or behavior
• Addiction refers to the daily need for the substance in order to
function
• Addiction is based on physiologic changes associated with drug
use but also has psychologic and behavioral components.

39. Substance abuse
• Dependence is the physiologic dependence on the substance so that
withdrawal symptoms emerge when the drug is stopped abruptly.
• Once a medication is no longer needed, the dosage will have to be
tapered down for the client to avoid withdrawal symptoms.
• Tolerance refers to the individual's need for increased amounts of the
substance to produce the same effect.
• Among the substances most commonly used that cause physiologic
responses but are not usually thought of as drugs are alcohol, tobacco,
coffee, black tea, and caffeinated carbonated beverages.

40. Key factors for substance abuse
Behavioral and physiologic responses to any of these substances
depend on:
1. Characteristics of the chemical itself,
2. The route of administration,
3. Adequacy of the client's circulatory system

42. Alcohol abuse
• It is also becoming a problem in Pakistan, so considering it
in screening process is necessary.

43. Cont..
The RAFFT Questionnaire (Relax, Alone,Friends, Family, Trouble) poses
five questions that appear to tap into common themes related to
adolescent substance use, such as peer pressure, self-esteem, anxiety,
and exposure to friends and family members who are using drugs or
alcohol.
• R: Relax—Do you drink or take drugs to relax, feel better about yourself,
or fit in?
• A: Alone—Do you ever drink or take drugs while you are alone?
• F: Friends—Do any of your closest friends drink or use drugs?
• F: Family—Does a close family member have a problem with alcohol or
drugs?
• T: Trouble—Have you ever gotten into trouble from drinking or taking
drugs?

45. Assessment of alcohol abuse
There are several tools used to
assess a client's history of
alcohol use, including the
1. Short Michigan Alcoholism
Screening Test (SMAST),
2. The CAGE questionnaire,
3. Separate list of alcohol
related screening questions
4. AUDIT (Alcohol Use
Disorders Identification Test)
• When administered during the
screening interview, it may be
best to use a transition
statement

46. Tobacco abuse

47. Cont…
• Smoking has been linked with disc degeneration and acute
lumbar and cervical intervertebral disc herniation.
• Nicotine interacts with cholinergic nicotinic receptors, which
leads to increased blood pressure, vasoconstriction, and
vascular resistance.
• These systemic effects of nicotine may cause a disturbance in
the normal nutrition of the disc

48. Caffeine abuse:
• Caffeine is a substance with specific physiologic (stimulant) effects.
• Caffeine ingested in toxic amounts has many effects, including
1. Nervousness,
2. Irritability,
3. Agitation,
4. Sensory disturbances,
5. Tachypnea (rapid breathing),
6. Heart palpitations (strong, fast, or irregular heartbeat),
7. Nausea,
8. Urinary frequency,
9. Diarrhea, and
10. Fatigue.

49. Cont…

50. Aspartame abuse:

51. Working & Living environment:

52. Common occupational exposure
• Conducting a quick survey may
be helpful when a client
presents with puzzling,
nonspecific symptoms including
myalgias,
arthralgias,headaches, back
pain, sleep disturbance, loss of
appetite, loss of sexual interest,
or recurrent upper respiratory
symptoms.

54. History of fall:

56. STEP 2
CORE INTERVIEW

57. Core interview
• Once the therapist reviews the results of the
Family/Personal History form and reviews any available
medical records for the client, the client interview (referred
to as the Core Interview in this text) begins

58. Components of core interview

59. History of present illness:
• During this initial phase of the interview, allow the client to
carefully describe his or her current situation.
• Follow-up questions and paraphrasing can be used in
conjunction with the primary, open-ended questions.

61. Pain & Symptom assessment

65. History of trauma
• When the symptoms seem out of proportion to the injury, or when
the symptoms persist beyond the expected time for that condition,
a red flag should be raised in the therapist's mind.
• Even if the client has a known (or perceived) cause for his or her
condition, the therapist must be alert for trauma as an etiologic
factor.
• Emotional overlay, trauma, assault or undiagnosed cancer may b
the reason for such symptoms

66. Types of trauma:
• Intrinsic trauma (occurring within the body) or
• Intrinsic trauma can also occur secondary to extrinsic (external)
trauma.
• Extrinsic trauma(external accident or injury, especially assault or
domestic violence)
• The therapist must remain aware that some motor vehicle "accidents"
may be reported as accidents but are, in fact, the result of domestic
violence in which the victim is pushed, shoved, or kicked out of the car
or deliberately hit by a vehicle.

67. ASSAULT
• Domestic violence is a serious public health concern that often goes
undetected by clinicians.
• Women, children, and older adults are at greatest risk, regardless of
race, religion, or socioeconomic status.
• Each question must be presented in a sensitive, respectful manner
with observation for nonverbal cues.
• Violence against women is more prevalent and dangerous than
violence against men

68. ABUSE:
• encompasses the terms physical abuse, mental abuse,
sexual abuse, neglect, self-neglect, and exploitation.
ASSAULT
• it is by definition any physical, sexual, or psychologic attack.
This includes verbal, emotional, and economic abuse.
DOMESTIC VIOLENCE (DV)OR INTIMATE PARTNER
VIOLENCE (IPV)
• It is a pattern of coercive behaviors perpetrated by a current or
former intimate partner that may include physical, sexual,
and/or psychologic assaults.

71. Child abuse
• It includes neglect and maltreatment that includes physical, sexual, and
emotional abuse.
• Failure to provide for the child's basic physical, emotional, or educational
needs is considered neglect even if it is not a willful act on the part of the
parent, guardian, or caretaker
Elder abuse
• Multiple trips to the emergency department
• Depression
• Falls7fractures
• Bruising/suspicious sores
• Malnutrition/weight loss
• Pressure ulcers
• Changing physicians/therapists often
• Confusion attributed to dementia

75. Medication/Medical treatment

77. 4 Ds associated with OTC medicine

78. Side effects of different drugs

79. NSAIDs

80. Effects of NSAIDs on different systems

82. Current level of fitness
• The level of fitness can be a valuable indicator of
potential response to treatment based on the client's
motivation (i.e., those who are more physically active and
healthy seem to be more motivated to return to that level
of fitness through disciplined self-rehabilitation).

83. Sleep-Related History
• Sleep patterns are valuable indicators of underlying physiologic and
psychologic disease processes.
• The primary function of sleep is believed to be the restoration of
body function.
• When the quality of this restorative sleep is decreased, the body and
mind cannot perform at optimal levels.
• Physical problems that result in pain, increased urination, shortness
of breath, changes in body temperature, perspiration, or side effects
of medications are just a few causes of sleep disruption.
• Any factor precipitating sleep deprivation can contribute to an
increase in the frequency, intensity, or duration of a client's
symptoms.

84. Stress
• Most symptoms (pain included) are aggravated by unresolved
emotional or psychologic stress.
• Prolonged stress may gradually lead to physiologic changes.
• Stress may result in depression, anxiety disorders, and behavioral
consequences (e.g., smoking, alcohol and substance abuse, and
accident proneness).
• The effects of emotional stress may be increased by physiologic
changes brought on by the use of medications or poor diet and
health habits

85. Final Questions
• It is always a good idea to finalize the interview by reviewing the
findings and paraphrasing what the client has reported.

86. Hospital inpatient information
Medical Record
• Treatment of hospital or nursing home inpatients requires a slightly different
interview (or information-gathering) format.
• Important information to look for might include:
• • Age
• • Medical diagnosis
• • Surgery report
• • Physician's/nursing notes
• • Associated or additional problems relevant to
• physical therapy
• • Medications
• • Restrictions
• • Laboratory results
• • Vital signs

87. Nursing assessment
• The essential components of the nursing assessment that are of
value to the therapist may include:
• • Medical status
• • Pain
• • Physical status
• • Patient orientation
• • Discharge plans
• The nursing staff are usually intimately aware of the patient's current
medical and physical status.