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Differential Diagnosis for Physical Therapy: Introduction: Summary
• Key Factors to Consider: ○ If medical diagnosis not available, then correct diagnosis is eventually made when: patient does not get better with intervention, gets better then worse, or other associated signs and symptoms eventually develop ○ Side Effects of medications ○ Co-morbidities ○ Visceral pain mechanisms Nagi Model • A conceptual process of how disease or injury impacts a person’s ability to function (perform their expected role in society) • Limitations: ○ Unidimensional and unidirectional model of disability ○ Doesn’t account for impairments and functional limitations not due to pathology ○ Dose not consider societal barriers: architectural, attitudinal Medical Model of Disability • 1970 • Limitations: very diseased based and it does not serve to look at personal, environmental or contextual factors; all things that impact patient outcomes International Classification of Functioning, Disability and Health - ICF Model • Overview: ○ This model moves away from being a “consequences of disease” classification to become a “component of health” classification ○ 2 parts: ■ Functioning and Disability – Body Functions and Structures – Activity – Participation ■ Contextual Factors – Environmental Factors – Personal Factors
INTRODUCTION Introduction to Screening / Diagnostic Interview Definition of Differential Diagnosis (DD) Process of examination, evaluation, and medical screening to determine appropriateness of intervention within scope of practice - or need for referral to other practitioner • Provider responsibility is to determine what biomechanical or neuromusculoskeletal problem is present and then provide treatment and must be able to identify signs and symptoms of systemic disease • Example of narrowing down DD by knowing organ pain referral patterns for systemic diseases: Shoulder or back pain= peptic ulcer, gallbladder disease, liver disease and myocardial ischemia Definition of Evidence Based Practice • Peer-reviewed literature reporting • Using EBP will allow for provider to build own screening tools based on type of practice Primary Care Provider • Physical therapist is not considered a primary care provider • As a clinician you must know the red flags the would warrant a referring back to provider for additional medical investigation to reason for initial referral for therapy • Patient access without referral is based on a state regulations Reasons for Medical Screening • Quicker and sicker client base – early discharge/ baby boomers/chronic disease states • Signed prescription – past complaints • Client disclosure- under reporting of symptoms • Detect presence of yellow/red flags
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