A commonly asked question: What Does A Physiotherapy assessment entail?
Arranging for a physiotherapist to come out to see you is taking the first step towards forming a strong relationship whereby a professional with knowledge and skills works along with you, the specialist in your own body!
An initial assessment by a physiotherapist forms the foundation on which a detailed treatment programme can be set and tailored to your specific needs. The physiotherapist is often arriving with a blank canvas of knowledge about your condition. They are ready for you to detail (under their guidance) all the information that is needed to create the bigger picture of what will work for you.
A subjective history is taken first. Here the physiotherapist will ask you for some basic demographics (name, contact details, NHS number, date of birth, height, weight).
It is then important for the physiotherapist to know the nature of why you have sought out a physiotherapist opinion. A description of your diagnosis, how the presenting condition has developed and who had recommended you have some physiotherapy are all discussed. It might be that there are other agencies involved in your care like other health care professionals, voluntary organisations, specialist nurse or medical teams and details of these are often helpful to physios as they build the bigger picture of who is involved in your condition management.
The physiotherapist needs to know what medications you are taking. Understanding medications is an important skill for physios to have as some medications may influence things like movements, levels of wakefulness or co-ordination of movements just to name a few!
Pain is often a reason people seek out the help of a physio. The physio will want to know where your pain is, and they will chart this on a body map in their notes. They will ask you about the nature of the pain: Is it sharp and stabbing? Is it dull and constant? How would you rate the pain on a visual scale of 0-10? Are there factors that aggravate the pain or factors that ease the pain? What type of medications do you use to manage the pain? Are you managing to get some good quality sleep? If your sleep is affected in what way, does it leave you tired and easily fatigued?
It is important to know how your condition impacts on your day to day life. The Physio will ask you about what matters to you in your life. Have you got people around you to support you? Do they live with you? What help do they offer you (carers / companionship / financial management?) What is the environment like that you live in (is it all on one level, is there a lift, can you manage climbing stairs?) What hobbies do you have and how do you spend your time? How does your condition impact on you completing your hobbies and daily activities?
You may be asked whether you have had any falls. This gives the physio an idea of your balance needs. You may be asked what the nature of the falls have been (mechanical e.g. slips or trips vs medical e.g. blacking out due to a cardiac problem or neurological event). How frequently have the falls occurred? Did the falls happen when you were unwell with something else? Is your blood pressure stable or does it drop when you stand making you feel dizzy and faint? If you fall how do you call for help? How do you get up? The falls may be multifactorial in nature so much of the information in other parts of the physiotherapist’s assessment will help build a picture of why you may be falling and what could be done to treat it!
What are you hopes from undergoing physiotherapy? What are your goals and time frames to achieve them in? How do you best like to learn? What approach works best for you (some people like a physio to guide them through all of their exercises every time they do them, others like to receive education and advice on a variety of things that they can do so that they may feel empowered to self-manage their condition under occasional ‘check ins’ with the physiotherapists to see that they remain on the right track!)
The physio may ask you about your hearing and vision. Whether you wear any hearing aids or glasses as impairments to these senses can affect balance and contribute to your movement safety.
Anything else that you think might be relevant to tell you physiotherapist is worth bringing up! There’s nothing worse than wishing you’d said something but not feeling at the time that it would make a difference to do so! You are the expert in your own body, the physio needs to know what you are thinking so that they may tailor the intervention to suit you!
This is where the physiotherapist will want to see you move! They may want to feel some of your movements! They may ask you to discreetly move some clothing so that posture etc. can be assessed. The physiotherapist will ask for your consent to treatment. If there is anything that you do not feel happy about, you must let them know!
The physiotherapist will ask you to demonstrate some movements. The range of your movement is assessed, and the strength is checked by the physiotherapist physically resisting some of your movements. A muscle power scale (0-5) is used to grade each muscle group.
A postural assessment is completed. The Physiotherapist will adapt the postural assessment to whatever position is suitable for you. For some people who have limited mobility this is looking at how their limbs and trunk are positioned in bed, for others it may be looking at your posture up against gravity (in sitting or standing). The physio is looking for symmetry in positioning and muscle mass. They are checking for any compensated movements which may cause secondary muscle imbalance and resultant pain.
The physiotherapist may move your joints quickly through their range, here they are looking for any catch to the movement assessing the tone of the muscle and looking for the impact this may have on your posture.
A sensory assessment may be completed. Here the physiotherapist will check what sensation you can detect. Sensory assessment takes different forms – it might be assessing whether you can detect light touch, whether you can discriminate between two different areas, whether you can detect hot and cold or whether you can detect the difference between sharp and blunt. The outcome of sensory testing is helpful as it helps explain why someone moves in the way that they do if their sensation is impaired. Physiotherapists can give guidance on how to manage particular issues which arise due to hypersensitivity (treatment techniques might be exposure to different textures or weight bearing as just two examples).
Assessment of Co-ordination and Proprioception (awareness of what position a joint is in) is often a helpful tool in the physio assessment kit! It helps the physio to understand how neurological impairment causing these issues may impact on achieving activities of daily living. Here the physio
may ask you to complete basic co-ordination movements with your hands or feet. A visual field test is also helpful at ascertaining the cause of co-ordination deficits.
The physiotherapist may like to look at your balance. This might be in sitting or in standing. You may be asked to complete some balance tests (stand without support feet apart, stand unsupported feet together, repeat each with eyes closed). Assessment of your balance will be pitched at the right level based on how the physiotherapists observes you moving in different postural sets (sitting vs. standing).
The physiotherapist may observe your walking. Here they will ask you to repeatedly walk up and down a given space. They may ask to see you walking inside and outside or up and down stairs. Throughout the assessment the physiotherapist is looking at how you move through each component of the gait cycle.
Is the assessment ever complete?
The initial assessment gives a large volume of information to the therapist and allows the basis for guided conversations with you to be formed in order to help you to set realistic goals to be achieved through physiotherapy intervention. The physiotherapist will work with you to establish what treatment method would work best for you. The physiotherapist will use the assessment outcomes during conversation with you to ascertain what frequency and duration of physiotherapy would honestly be right for you.
In every subsequent physiotherapy session, the physio is always assessing and reassessing to ensure that therapy is goal orientated and targeted specifically for your changing needs.
Physiotherapists use outcome measures to help mark progress. As an example, in someone who has a balance impairment a Berg Balance score may be used. This is where a person is asked to complete a series of balance tasks and a score is given to each one, the total score at the end is used as a baseline. After physiotherapy intervention targeted at improving balance is completed the Berg score may be completed again and the therapist is looking for an improvement in the score. Outcome measures are researched and validated tools which work as a great measure for physios to reference their intervention against and a great motivator for patients to see how well they are progressing! There are outcome measures for all sorts of impairments (in balance, in movement, to score pain etc.) The physiotherapist will choose the most relevant for your condition.
It’s important to remember that an open dialogue between you and the physiotherapist is essential to achieving the best results. You are the expert in your body, and you know what approach works best for you. The physio’s job is to be there to provide expert skills and guidance in order to help you achieve your goals!