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General Health Screening

 
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General Health Screening - March 21, 2006 5:28:00 PM   
Andrew M. Ball PT PhD

 

Posts: 922
Joined: July 29, 2002
From: Charlotte, NC
Status: offline
I've been asked by several PT's in recent weeks to go into some depth and detail as to what I mean by the terms "General Health Screening," "Review of Systems," and "Systems Review"

The General Health Screening that I use is woven into the subjective portion of my evaluation. I will generally ask the following questions:

Fatigue?

Malaise?

Weakness?

Chills/Sweats/Fever?
(Low-grade fever of 100 degrees or higher for 2 or more weeks are significant)

Unexplained Weight Loss/Gain (5% increase or decrease over a period of 4 weeks are significant)

Nausea?

Paresthesia/Numbness?

These questions alone won't tell us much, but cross-referenced with additional subjective information and objective findings, serve to raise and eye-brow regarding CONSIDERATION for possible need for referral such as (in order of likelihood in the PT department):

Fatigue:
Depression, Anxiety, Infection, Malignancy, Endocrine Disorders, Rheumatic Disorders, Heart Failure, Chronic Lung Disease, Chronic Liver Disease, Chronic Kidney Disease, Anemia, Nutritional Deficits, ADR?s, Electrolyte Imbalances

Malaise:
Systemic illnesses

Weakness:
Neurological Disorders
Endocrine Disorders
Muscular Injury/Disease
Rheumatic Disorders

Fever/Chills:
Occult Infection
Metastatic CA
Rheumatic Disorders

Unexplained wt gain/loss
Infection
Metastatic CA
Rheumatic Disorders
Depression
Endocrine Disorders

Nausea:
Infections
ADR?s
Gastrointestinal Disorders

Parathesia/Numbness:
Neurologic Disorders
Endocrine Disorders
Renal Disease
ADR?s

____________________________

The next step is to understand viceritome patterns, so as to know what organ systems to subjectively screen based upon presenting signs and symptoms.

_____________________________

Andrew M. Ball, PT, DPT, Ph.D.
Orthopedic Physical Therapy Resident
Carolinas Rehabilitation
Post #: 1
RE: General Health Screening - February 10, 2009 3:54:17 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
I'm sure Bill Boissonnault's "Screening for Medical Disorders" and "Screening for Medical Disorders, Part 2" would be an exellent option for anyone interested in this topic.... APTA has them both as CD-ROMS: audio-plus.  He's great to listen to in person too.
Post #: 2
RE: General Health Screening - February 10, 2009 5:20:15 PM   
Diane

 

Posts: 1536
Joined: March 10, 2001
From: Vancouver, B.C., Canada
Status: offline
I hope someone removes the spam links from div2001's post.

(in reply to SJBird55)
Post #: 3
RE: General Health Screening - February 12, 2009 6:28:20 PM   
jma

 

Posts: 2639
Joined: August 25, 2000
From: NY
Status: offline
"Differential Diagnosis for Physical Therapists: Screening for Referral"< by Goodman and Synder is also another good one.

(in reply to Diane)
Post #: 4
RE: General Health Screening - February 13, 2009 10:21:01 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
Goodman's most recent version/book of Diff Dx is great.  Her first one isn't as user friendly.  I have her book in the clinic to help me drill down my questions when someone appears to have something other than musculoskeletal.  I met her the other night too!  I told her I liked her second book and it was organized WAY better than the 1st one.

(in reply to jma)
Post #: 5
RE: General Health Screening - April 12, 2012 10:22:26 AM   
Tim RIchardson, PT

 

Posts: 4
Joined: April 19, 2009
Status: offline
I have also looked at differential diagnosis by physical therapists. I treat a lot of dizzy patients using Canalith Repositioning Maneuvers (Epley's) and I get my referrals from Family Practice. Needless to say, many of these patients are presenting with medically complex conditions - including pathology.

I have used Level 1 impact analysis Clinical Decision Rules that were designed for physicians that improve patient safety AND lower cost.

This chart have the rule name, year first published and level of evidence development:

Pathology Table

Thank you,

Tim Richardson, PT
PhysicalTherapyDiagnosis.com

_____________________________

Tim Richardson, PT

Get your free tutorial for improved physical therapist decision making at...
www.BulletproofPT.com

Learn about physical therapists' diagnosis at...
www.PhysicalTherapyDiagnosis.com

(in reply to SJBird55)
Post #: 6
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