A thorough medical history collects a variety of information, including demographic characteristics, social history, health habits, and medication usage. In terms of demographic characteristics, the age of the patient is highly significant in terms of his or her relative risk of various disorders, such as arthritis, heart disease, and many forms of cancer. Therapists should keep in mind that two-thirds of older Americans have multiple chronic medical conditions with a variety of associated symptoms that may complicate the diagnosis of the condition for which they are seeking healthcare services (Goodman et al., 2018). The risk of having certain cancers is related to age, with the risk of most cancers becoming more significant when the patient is older than age 50, while the risk of some other forms of cancer decreases after age 50 (Goodman et al., 2018). For example, testicular cancer is most common in 20- to 40-year-old males, and the risk of testicular cancer decreases as the patient exceeds the age of 50. The patient’s race and ethnicity are collected as part of his or her demographic information because some disorders, such as Risk factor assessment The medical history is collected to help determine the presence or absence of a variety of risk factors in an effort to determine a risk factor profile for the patient. The information gathered is used to rule out or implicate potential sources of problems (e.g., comorbidities that may adversely affect the patient). The medical history should include a personal and family history of medical conditions, as well as any surgical procedures the patient has had. This information, commonly collected through the use of an intake questionnaire, is an important part of determining if the patient’s presentation of signs, symptoms, and clinical findings is within the practitioner’s scope of practice. The information gained from taking the medical history should be used to determine the presence of one or more risk factors for a variety of illnesses and disorders that can adversely affect the health of the individual. A risk factor is any clinical test, measure, or behavior that has been shown to be associated with an elevated risk of developing a disorder. While the term risk factor is commonly associated with cardiovascular disease, the therapist should not limit his or her determination of risk factors simply on the basis of cardiovascular risk. The therapist should try to determine the presence or absence of risk factors for a variety of disorders that could be present in the patient (e.g., ulcers, hypertension, cancer, diabetes, depression, and other comorbidities). Risk factors associated with a variety of common disorders include age, frequent use of ulcerogenic drugs, high body mass index, tobacco use, alcohol abuse, sedentary lifestyle, race/ ethnicity, hypercholesterolemia, and occupation (ACS, 2017; Goodman et al., 2018). In 1999, William G. Boissonnault published a survey of 2,433 adults seeking outpatient physical therapy services. The purpose of this classic study was to determine the lifetime prevalence of various comorbidities in these patients. The multi-site study included patients from more than 20 different states, with survey data collected over the course of all four seasons to minimize seasonal effects. The large number of subjects, the geographic breadth, and the efforts to minimize seasonal effects reasonably allowed the results to be generalized to many outpatient settings. The survey was used to determine the lifetime prevalence of various comorbidities in the participants presenting for outpatient physical therapy services. A common risk factor for many disorders is a history of the disorder. For example, a history of depression significantly increases the likelihood that the person will have another
diabetes and hypertension, are more common in some racial and ethnic groups. Thus, the age and race of a patient help the therapist develop a more accurate risk factor profile. (For additional information on this topic, see Goodman et al., 2018.) Social history and health habits are part of the patient information collected during an initial evaluation (APTA, 2014; Boissonnault, 2005; Goodman et al., 2018). Social history and health habits include, but are not limited to, a history of smoking and physical activity patterns. Smoking is known to be a risk factor for lung cancer, but smoking also increases the risk for heart disease, stroke, and other disorders that may play a role in the patient’s presentation. A sedentary lifestyle has a strong association with an increased risk of developing heart disease, stroke, obesity, breast cancer, insulin resistance, and colorectal cancer (American Cancer Society [ACS], 2017; Goodman et al., 2018; Pedersen & Saltin, 2006). As a result, the collection of information regarding social history and health habits, as noted above, is imperative for accurately assessing the patient’s risk factor profile. episode of depression in the future compared to someone who has never suffered from the disorder (Burcusa & Iacono, 2007). Since a history of some disorders is a significant risk factor for reoccurrence of the disorder, the importance of taking a thorough history must be underscored. The significance of this study is that, if the therapist is aware of what comorbidities are likely to be present, he or she can ask specific targeted questions designed to confirm the presence or absence of various specific risk factors and comorbid conditions that may adversely affect the patient. In the Boissonnault 1999 study, comorbidities were operationally classified into one of three groups: cancers, infections, and other illnesses. In the “other illnesses” category, the two comorbid conditions with the highest lifetime prevalence were headache (22%) and hypertension (21%). (See Table 1). These conditions were followed by osteoarthritis and depression, with a prevalence of 18% and 15%, respectively. Table 1: Prevalence of Comorbidities Other than Cancer and Infections Found in Patients Presenting for Outpatient Physical Therapy Services Comorbidity Reported Lifetime Incidence 1. Headache 22% 2. Hypertension 21% 3. Osteoarthritis 18% 4. Depression 15% 5. Asthma and anemia 10% (for each comorbidity) 6. Ulcers, heart disease, and hypothyroidism 7% (for each comorbidity) Note . Adapted from “Prevalence of Comorbid Conditions, Surgeries and Medicine Use in a Physical Therapy Outpatient Population: A Multicentered Study,” by W. G. Boissonnault, 1999, Journal of Orthopaedic & Sports Physical Therapy, 29 (9), pp. 506-525. The significance of this information is manifold: ● First, many of the disorders reported in Table 1 (e.g., hypertension, hypothyroidism, and osteoarthritis) are chronic and will continue to be present in the individual throughout his or her lifetime and may require medication to control or manage the disorder.
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