Subjective Assessment

The subject assessment should form the majority of your fact finding, this will inform what you do in the objective, possible treatment plans and is a crucial part of assessing a patient. Spend a good amount of time during the subjective discovering possible patterns to symptoms, finding out more about the patient as a person and trying to start forming a possible treatment plan by finding out what would work for them.

Past Medical History (PMH) - #THREADSOCS

Fractures, Thyroid, Heart, Rheumatoid, Epilepsy, Asthma, Diabetes, Steroids, Osteoporosis, Cancer, Surgery

It’s important to find out about peoples past medical history to find any trends or patterns when diagnosing or assessing a patient. Past medical history can also throw up possible precautions like osteoporosis and having to be a bit more carful on palpation due to the patient having more brittle bones, or a blood clotting disorder could cause a patient to become bruised more easily therefore this would need to be taken into consideration during objective.

Medication

Taking someone current medication intake can give you an idea of lots of things such as:

· Potential stress load – due to dealing with multiple conditions.

· Anything missed from PMH – questioning what certain drugs are for is a good idea if you don’t know what they are

· Any precautions – such as blood thinners and someone’s ability to bruise much easier

History of presenting issue

This makes up the main bulk of your subjective assessment and includes some of the other sections in the subjective assessment.

Aggravating and Easing factors

Knowing more about what aggravates and eases symptoms may give you clues as to what the diagnosis is, this will also help you form some of your education when it comes to possible pain relief.

Functional daily issues

This will allow you to break down movements to discover possible weaknesses or mechanical issues that might be the source of your patients’ symptoms.

24-hour pain pattern

This is important because it can help towards your working hypothesis as certain conditions present with pain patterns throughout the day. This was also tell you a lot about home the patient is coping and useful information about sleep which will affect patient recovery, mood, energy levels and general health.

Special Questions

These are questions that are changeable depending on what you’ve found out already that are specific to certain presentations and might give you some clearer answers to inform your object assessment and investigations. These include the following:

· Clicking

· Locking

· Giving way

· Clunking

· Bi-lateral small joint swelling

· EMS

· Waking 2nd half on the night

Social History

This forms a large part of your subjective as finding out about this person’s social life and day to day activities can help you builds a better picture on how they might be being affective by their symptoms. You should look to find out about some of the following:

· Where they live?

· Who they live with?

· House? Bungalow? Flat?

· How are they coping with Personal Activities of Daily Living (PADL)

· How are the coping with Domestic Activities of Daily Living (DADL)

· What hobbies do you do? How are symptoms affecting these (Goal Setting)

· What do they get up to day to day

· Employment

· Work conditions

Yellow Flags

During the assessment you’ll want to try and discover about any of the patients beliefs around there symptoms or anything that affects this such as pain, surgery, investigations etc. this will help you form possible education as well as changing perceptions on common misconceptions.

ICE (Impressions, Concerns and Expectations)

Impressions – finding out from the patient what they think is going on with their symptoms, you can find out how much they know about what’s going on and this will feed how you deliver information.

Concerns – finding out about any concerns the patient has will be important to deliver possible reassurance and therefore answer and be aware about what the y are worrying about.

Expectations – these are important, finding out about what would be a good outcome for the patient from physiotherapy allows you to tailor the treatment plan to match what they want from physiotherapy.

Red Flag Questions

These are important questions that you should ask on certain presentations, you should ask these differently depending on the presentation and the information that you’ve found out during the rest of the subjective. Here are the red flag questions you should ask for different reasons:

· CES

· Cx

· Cancer

· Trauma

Summery

Summarising with the patient allows you to put across to them and check whether your perceptions are correct, it also gives them the opportunities to add anything they might have missed when they hear their story back to them.