Table 5: Summary of Atypical Findings for a Patient with Mechanical Low Back Pain 1. Insidious onset of pain of unknown etiology, especially if pain is in the back and/or shoulder.
10. Pain that changes with food intake. 11. Symptoms that last beyond 2-4 weeks. 12. Symptoms associated with a change in cognition, especially confusion in the elderly. 13. Presence of bilateral proximal muscle weakness. 14. New onset of bowel or bladder incontinence. 15. Signs and/or symptoms of inadequate ventilation without exertion [shortness of breath]. 16. Presence of fresh, red blood in urine, feces, or sputum. 17. Signs and/or symptoms of hypotension: lightheaded, dizzy, and/or confused. 18. Recent and significant increase or decrease in weight. 19. Self-reported rating of health status is “poor.”
2. Signs and/or symptoms that do not respond to physical therapy interventions or the patient feels better initially following physical therapy interventions but then feels worse. 3. Rest and/or a change in position have no impact on the symptoms. 4. No aggravating nor relieving factors can be found. 5. Pain that is not consistent in location and/or is migratory. 6. Pain, edema, and/or numbness/tingling that is distributed in a bilaterally symmetrical pattern. 7. Night pain that is the worst pain in a 24-hour cycle. 8. Pain that is constantly present and intense. 9. Pain that is throbbing.
Note : Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders; The Increasing Predictive Validity of Self-Rated Health, by J. Schnittker and V Bacak, 2014, PLoS ONE, 9 (1): e84933. Retrieved from: https://doi.org/10.1371/journal.pone.0084933 REVIEW OF PHYSIOLOGICAL SYSTEMS Purpose of the review A review of physiological systems is essentially a screening examination. in addition to the patient’s primary complaints that caused him or her to seek help).
The term screening means to find the suggestion of a disorder in a patient without overt signs and symptoms of the disorder or before the patient seeks medical attention for the disorder. The purpose of performing a review of physiological systems is to identify any symptoms that may be related to the primary disorder, as well as any adjunct symptoms (i.e., those symptoms Components of the review There are typically two parts to the review of physiological systems (Boissonnault, 2005; Boissonnault & Umphred, 2013). The first part consists of asking the patient a series of questions regarding his or her general health. This portion consists of ten questions concerning constitutional symptoms such as fever, fatigue, and malaise. The general health questions should be asked of every patient at the time of the initial evaluation because they serve the function of screening for constitutional and adjunct symptoms that may be related to the primary problem, a comorbidity, and/or an adverse drug reaction. General health questions General health questions are designed to query the patient about his or her whole body sense of health – that is, their constitutional symptoms. For example, does the patient experience or have recently experienced fatigue, malaise, or a fever? Each constitutional symptom is associated with a large number of disorders. On the other hand, diseases often present with one or more constitutional symptoms, resulting in one or more affirmative answers to the general health questions. The general health questions are not designed to determine the presence of a specific disorder but instead are intended to be screening tools designed to identify the suggestion of an occult disorder or problem. As a result, any affirmative answer to a general health question requires one or more follow-up questions to place the information in context and to determine the need for screening of one or more specific physiological systems. The general health questions may be included in an intake questionnaire or asked specifically as part of the investigation of symptoms. The general health questions are placed in the context of the patient’s health status within the past six to twelve months. Generally, ten targeted questions are sufficient to cover most constitutional symptoms.
The healthcare provider and patient’s focus on the primary problem may cause adjunct symptoms to be neither reported nor investigated. However, adjunct symptoms can be used to help rule in or out comorbidities, occult disorders, and adverse drug reactions (Goodman et al., 2018) that can have a negative effect on the patient and the plan of intervention. The second phase is the review of specific physiological systems such as the cardiovascular, neurological, or integument system (Boissonnault 2005; Boissonnault & Umphred, 2013). The review of specific physiological systems is indicated for those patients in whom the cluster of findings from the general health questions, symptom presentation, and patient history indicate that a specific physiological system is potentially impaired. When a review of physiological systems is indicated, only the physiological system that has been implicated is screened. The responses to the general health questions are integrated with the information obtained through the patient’s health history and the symptom investigation to help the therapist identify the extent of the patient’s chief complaint as well as adjunct symptoms that may result from a comorbidity, occult disorder, or adverse drug reaction. If the patient answers “No” to all of the general health questions, then the review of specific physiological systems is not indicated. If the patient answers “Yes” to one or more of the general health questions, then the therapist must determine if: a. There is a reasonable explanation for the symptoms. b. The physician is aware of the symptom(s). c. The situation has changed since the patient last met with the physician. The answer to these three questions is vital to the interpretation of any affirmative answer. If the patient provides a reasonable explanation for the symptoms, then the need for the review of specific physiological systems is a low priority and there is little need to contact the physician. However, if the patient answers “Yes” to one or more of the general health questions and does not offer a reasonable explanation, then the review of specific physiological systems becomes a high priority.
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Book Code: PTOH1324
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