Assessment is a delicate step-by-step process to interview and examine a patient to come to a provisional diagnosis.
To put it simply, assessment is the foundation of a therapist’s treatment and clinical decision-making. The process of assessment begins with a polite self-introduction followed by an open-ended question such as What seems to be the problem? or What brings you to the hospital/clinic today? This is known as a patient interview. After carefully listening to their problem, a clinician moves on to the next steps of assessment which are –
1. Collection of patient’s history of past and present illness
2. Observation of their body
3. Examination
After the entire process, the therapist comes up with a list of problems the patient might have, which is called a provisional diagnosis. With a provisional diagnosis, a therapist makes an educated guess about the diagnosis the patient most likely has. To accurately identify which structures are affected, physiotherapists use special tests and diagnostic imaging if necessary.
Sounds easy, doesn’t it? Then why do 65% of physiotherapists diagnose inaccurately? What seems to be the problem? PT assessment is laid out but the quality of a therapist’s assessment largely depends on his/her student’s life. The rate of diagnostic uncertainty is exceptionally high, especially for newly graduated physiotherapists. What is missing in terms of assessment? Well, the answer is not simple. There are multiple factors influencing the diagnostic procedure. A couple of them are low self-confidence and low workspace support.
Human beings are hardwired to seek certainty. But what are the things that can help reach certainty? Two important facilitators of certainty are – quantification, and evidence-based practice. These are two important things that are most of the time excluded during physiotherapy assessment. Special tests, for example, are not always 100% accurate. What is the chance that the clinical condition will be present or absent in the context of a positive or negative test result? One single special test alone can lead to improper diagnosis and therefore inaccurate treatment protocols. A therapist’s success in treating a patient largely depends on how accurately he carries out a physiotherapy assessment. The assessment also plays a significant role in documentation, which is also an essential aspect of physiotherapy. A literature review showed that professional and standardized documentation is vital for the creation of patient care plans, enhances communication, and is a legal requirement. Everything a therapist does is reliant on a well-taken assessment, so how can we enhance the process? How can we reduce the rate of misdiagnosis?
As mentioned above, normalizing quantification and incorporating evidence-based practice is vital in improving the quality of assessment. Quantification can be improved through the use of technology and data. It is shown that providing numeric data to patients increases their trust in therapists and also gives them a sense of relief as they have the opportunity to understand their problems. Through the use of modern technology and accurate physiotherapy equipment such as dynamometers, quantification will not seem impossible.
Unfortunately, it is not easy to incorporate evidence-based practice as institutions do not focus on it or give it much attention. It has been repeatedly reported that therapists acknowledge the need to change their behavior toward evidence-based practice. The barriers to EBP are but not limited to –
1. Lack of time
2. Inability to understand statistics
3. Lack of support from the employer
4. Lack of resources
5. Lack of interest and
6. Lack of generalization of results
Awareness remains the key factor in incorporating it into physiotherapy assessment.
To put things simply, the various aspects missing in the modern-day assessment are quantification, evidence-based practice, use of technology, and most importantly, normalizing diagnostic uncertainty. Embedding these key missing aspects into therapeutic assessment gains large amounts of credibility and increases the quality of a patient’s rehabilitation process.
