Orthopaedic Physical Therapy Practice
Study Design: Case series.
Subjects: Two patients referred to physical therapy with a diagnosis of lower back pain (LBP).
Background: The increasing role of physical therapists in primary care settings highlights the skills needed to determine the appropriateness of physical therapy for patients. A hypothesis-oriented algorithm for symptom-based diagnosis was developed for use by physical therapists. The goal of this process is to determine a diagnostic impression to guide decisions regarding patient disposition and physical therapist management. This case series demonstrates the process in two individuals with LBP referred to a community-based outpatient physical therapy clinic.
Diagnosis: Despite the fact that both patients presented to physical therapy with a similar referral diagnosis, the hypothesis-oriented algorithm revealed a difference in diagnostic impressions formed by the physical therapist, and resulted in divergent decisions regarding the appropriateness of physical therapy betvveen patients. Clinical findings based on the hypothesis-oriented algorithm directed treatment and case management.
Discussion: A symptom-based diagnostic process was used to determine the appfopriateness of physical therapy for the patients described in this case series. The described approach is intended to provide physical therapists with a process to arrive at a diagnostic impression regarding the pathology underlying patients' presentations, in order to determine the appropriate disposition and treatment for individuals presenting to physical therapy. Additional research will assist in validating this approach and assess its effectiveness to prepare student physical therapists in entry-level, postprofessional, and residency programs.
Few, CE, Davenport, TE, Watts, HG. A hypothesis-oriented algorithm for symptom-based diagnosis by physical therapists: description and case series. Orthopaedic Physical Therapy Practice. 2007;19(2):72-79. © 2007, Orthopaedic Section, APTA, Inc.