++
CHAPTER OBJECTIVES
At the completion of this chapter, the reader will be able to:
Understand the principles and considerations of a comprehensive examination.
Outline the various disablement models and the strengths and weaknesses of each.
Explain the difference between impairment and functional limitation.
List the components involved in the continuum of care.
Take a complete history.
Explain the importance of the systems review.
List the components of the tests and measures portion of the examination.
Understand the value of the information that can be gleaned from a complete observation assessment.
Describe the differences between a traditional examination and a postsurgical examination.
Explain the differences between the examination and the evaluation.
Explain how to determine whether a technique is clinically useful.
Outline the components of clinical documentation.
++
OVERVIEW
The examination process involves a complex relationship between the clinician and the patient. Physical therapists are expected to provide services within the evidence-based practice (EBP) paradigm using the best available research integrated with clinical and patient values.1 The examination process aims to provide an efficient and effective exchange and develop a rapport between the clinician and the patient. The success of this interaction involves a myriad of factors. Successful clinicians demonstrate effective communication, sound clinical reasoning, critical judgment, creative decision-making, and competence.
The primary responsibility of a clinician is to make decisions in the best interest of the patient. Although the examination approach should vary with each patient and from condition to condition, there are several fundamental components to the examination process.
++
Increased recognition of the importance of the patient’s perception of health and functional outcomes has shifted the focus of the physical therapy examination, evaluation, and subsequent diagnosis to recognizing impairments and their relationship to any functional limitation or disability.
++
Physical therapy has long recognized that the traditional biomedical approaches to pain have been problematic in describing patient functioning because there is an inconsistent relationship between pain and functioning, and the fact that pain may not be the patient’s chief concern. Ideally, a disablement model is designed to detail the functional consequences and relationships of pain, disease, impairment, and functional limitations. The assessment of pain is described in Chapter 3.
++
The Guide to Physical Therapist Practice2 employs terminology from the Nagi disablement model, but it also describes its framework as consistent with other disablement models, including the International Classification of Functioning, Disability and Health (ICF), a classification of health and health-related domains. The ICF is the World Health Organization’s (WHO) framework for measuring health and disability at the individual and population levels. A biopsychosocial model of health implies that a person’s health status is determined by interplaying the person’s status in the biological, psychological, and social domains.
++
An examination refers to gathering information from ...