● Second, for many disorders, a history of the disorder is a risk factor for future episodes of the same condition. ● Third, therapists should recognize that many of these disorders and the medications taken to control the disorders could adversely affect the intervention plan. The plan of intervention should acknowledge and reflect an understanding of what comorbid conditions are present in the individual and any medications taken to control or manage the conditions. Infections were a separate category of comorbidities in the Boissonnault 1999 study. (See Table 2.) In many instances the patient will report the use of an antibiotic in the treatment of one of these infections. Table 2: Prevalence of Infections Found in Patients Presenting for Outpatient Physical Therapy Services Infection Reported Lifetime Incidence 1. Sinusitis 15% 2. Pneumonia 11% 3. Upper respiratory tract 6% 4. Kidney 5% 5. Urinary tract 5%< 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. Amoxicillin and azithromycin are common antibiotics, and both made the list of the top 25 prescription drugs in the United States in 2017 (Kane, 2017). These antibiotics are used in the treatment of common bacterial infections (e.g., pneumonia, bronchitis, and gastrointestinal ulcers [ H. pylori ]; NIH, 2017c; NIH, 2017e). Infections can result in affirmative answers to some general health questions and produce associated symptoms that complicate the diagnostic process, such as an individual presenting with low back pain due to an infection of renal tissue. Symptom investigation After gathering the medical history, the therapist generally proceeds to an investigation of the symptoms that caused the patient to seek help. Recognition of atypical signs and symptoms assists the therapist in determining whether the entire cluster of findings appears to be related to a condition that is inside or outside his or her scope of practice. The symptom investigation should include a discussion of the location and description of the symptoms. In addition, the therapist should determine how the symptoms behave over the course of a 24-hour period as well as: a. Factors that aggravate and ease the symptoms, b. How the symptoms present at night. c. Whether the symptoms are constant or intermittent. (For more information on the significance of symptom location, refer to Goodman et al., 2018.) This section will describe how to proceed with a symptom investigation using a patient presenting with acute low back pain as the example. In 1996, Boissonnault and Di Fabio published a classic study that described the typical pattern of aggravating and easing factors for 98 patients with low back pain. More than 94% of the subjects with low back pain reported an increase in symptoms with one or more activities that involved loading (weight bearing) of the lumbar spine.
The plan of intervention should acknowledge and reflect an understanding of what type of infection is present in the individual, any medications taken to control or manage the condition and any potential side effects or adverse events associated with the medication. The third category of disorders in the Boissonnault study (1999) was cancer. (See Table 3.) Table 3: Prevalence of Cancers Found in Patients Presenting for Outpatient Physical Therapy Services Cancer Type Lifetime Incidence 1. All types combined <10% 2. Skin [squamous & basal cell only] 4.5% 3. Breast 1.1% 4. Prostate 0.7% 5. Lung and Brain (each) 0.2% 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 most frequent type of cancer reported was skin cancer (mostly basal cell and squamous cell carcinomas), which is unlikely to metastasize and become life threatening (ACS, 2017; Boissonnault, 1999). However, some cancers, (e.g., breast cancer) do have a significant risk of metastasis and are life threatening. Cancer can result in affirmative answers to some general health questions and produce associated symptoms that complicate the diagnostic process. The plan of intervention should acknowledge and reflect an understanding of what type of cancer is present in the individual, any treatments taken to control or manage the condition and any potential side effects or adverse events associated with the interventions. Screening for cancer will be discussed in further detail later in this course. Seventy percent of the subjects reported that their symptoms were never completely absent (i.e., they had symptoms described as constant ). However, various recumbent positions or a change in position were shown to reduce the symptoms in more than 50% of the subjects. Walking was the one weight- bearing activity found to decrease symptoms in about one-third of the subjects. The origin of a patient’s low back pain is more likely to be mechanical in origin if the patient experiences a decrease in symptoms upon walking, changing position, or with assuming a recumbent position. The subjects with low back pain in this study were asked what time of day their symptoms were the worst (Boissonnault & Di Fabio, 1996). While more than 50% of the subjects reported that they experienced night pain, less than 2% of the subjects reported that night pain was their worst pain over a 24-hour period. The isolated finding of night pain is not a red flag (a highly significant finding requiring the therapist to contact the physician) since more than half of the subjects reported night pain. However, if the low back pain experienced by the patient is worse at night than at any other point in a 24-hour period, the significance of the finding is substantially elevated. Although
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Book Code: PTOH1324
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