Fundamentals of the Physical Therapy Examination: Patient Interview and Tests & Measures 2nd Edition
It’s now been 12 years since I embarked on my journey into academia and took on the course sequence titled Generic Examination I and II in the Doctor of Physical Therapy program at the University of Indianapolis. The name of those courses drove me crazy (until we changed them several years later), but I was thrilled to have the opportunity to teach that content: the “generic” skills required to conduct a basic physical therapy examination with a wide variety of patients. Teaching the clinical stuff is fun, right? But then came the realization that I was responsible for teaching content that would affect each student’s ability to perform one of the most vital components of a physical therapist’s practice: a thorough, concise, and meaningful patient examination. Despite an extensive search for a textbook I could use in these courses, not one title emerged. Not one. There were several texts that covered advanced tests and measures, and others that dealt with examination techniques specific to a certain genre of patients. But it seemed as though nothing existed that covered the skills necessary for a novice student to learn the art and science of conducting both the interview and the tests/measures components of an initial examination with a variety of patients. So, I simply started creating my own. What began as a 38-page course packet aimed at providing students with rudimentary “how to” information gradually evolved into something that loosely resembled a
textbook (always with a purple cover, for those who are curious). And then—this part is blurry—the first edition of Fundamentals of the Physical Therapy Examination happened. Let me tell you how odd it is to reference your own textbook while you’re teaching—to see students leaf through the pages of text and pictures you somehow put together. That said, it is a hair comforting to know that no one knows the content of the textbook you’re using better than you! The feedback (both positive and less) I got from my students about the first edition was incredibly valuable. I also received great input about the content, layout, and utility of the text from students and faculty across the country, and every bit of that feedback was considered when the second edition was written. The essential purpose of Fundamentals of the Physical Therapy Examination: Patient Interview and Tests & Measures has not changed from the first edition: provide noviceto-intermediate students of physical therapy with a resource that can be used both in the classroom and in the clinic to help them learn methods of collecting meaningful verbal, observational, and measured data from any patient, regardless of setting or diagnosis. It is also designed as a resource for physical therapy faculty who, like me, had been searching for a text that covers this broad content in a classroomfriendly way. This text is intended for active use! Students are encouraged to highlight content, write notes in it, frequent the online resources to watch the how-to videos, and take it along during clinical experiences. Faculty are encouraged to use the multitude of short case examples as classroom talking points, utilize the step-by-step instructions of how to perform each test/measure (while emphasizing the need to adapt based on individual patient needs), and show the accompanying technique-based videos to complement classroom instruction. What makes this text different from most is that it does not ask the reader to learn methods of examining a particular body region or a specific condition. Instead, common interview questions and a myriad of physical tests/measures are described, and the reader is asked to consider which questions and which tests/measures are appropriate for any given patient. As experienced clinicians well know, “textbook” patients are few and far between. Physical therapists must have the knowledge and confidence to assess problems or conditions that may be outside any given patient’s presenting diagnosis. This text encourages students to understand that it is never too early to learn this essential skill of clinical decision making. The first chapter of this text describes the global concepts and content of the remaining chapters, which are presented in two interrelated parts. Part I (Laying a Solid Foundation) focuses on what many clinicians would argue is the most important part of the patient examination: the initial interview. Chapters 2 and 3 discuss the vital aspects of creating rapport and an environment of trust, using a variety of communication tools, understanding the influence of biopsychosocial and cultural factors, recognizing personal biases, and appreciating the need to meet patients where they are. Chapter 4 then provides a thorough description of categories, types, and examples of interview questions. A “priority/ possible/pointless” clinical decision-making system is introduced, encouraging and empowering students to embrace this essential component of an autonomous profession. Part II (Building on the Foundation) begins with a chapter describing the transition from patient interview to performance of tests and measures. Emphasis is placed
on the importance of using information gathered from the interview to guide decisions about which tests/measures are appropriate. The remaining chapters describe the purposes and techniques of fundamental tests and measures commonly utilized in patient examinations, organized in a combined body system/patient condition manner. The priority/ possible/pointless system is carried through each chapter, encouraging even novice clinicians to make clinical decisions about which tests/measures are essential and which ones may be unnecessary. Brief case examples, accompanied by sample documentation, enable the reader to understand each test/measure in the context of a patient scenario. These cases, provided after each test/measure, are purposefully short and focused to help the reader learn how information gathered from the patient leads to the selection of particular tests/measures and documentation of the findings. Novice learners, in my experience, benefit from small, manageable examples that can later be understood in a broader sense. Even so, it is sometimes helpful to see the big picture. Therefore, I’ve included three complete cases, each describing a different genre of patient, which are woven through this edition. Most students of physical therapy are visual or kinesthetic learners. The most requested study aid from my students has been pictures and videos of the techniques covered in class. Therefore, this text is laden with photos, and its online resources house multiple videos that demonstrate most of the tests/measures described. In addition, videos of two complete initial examinations are provided. Students may find these helpful to obtain a “big picture” view of the examination process; instructors may find it helpful to use portions of these videos to highlight particular aspects of a typical patient examination.
Finally, my love and enthusiasm for teaching this content has only grown in the past 12 years, and I hope this is conveyed throughout the text. I also hope you find this text easy and enjoyable to read and, above all, one that is truly an asset on your journey toward becoming a confident, skilled, and successful physical therapist who finds as much reward in this profession as I have.
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