5 Bonus Tips for a GREAT subjective assessment

1. Take detailed clinical notes on every session including warnings given, treatment provided, and explanations. Apart from being a medico-legal requirement, they are very useful for reflection on successes and failures.

2. Always ask if your patient has any P&N or Numbness, and followup with a neurological examination

3. Aim to make a provisional diagnosis and differential diagnoses from your subjective assessment PRIOR to performing your objective examination. You can then plan what you wish to test/exclude before you move onto the objective examination

4. Follow up answers with further questions. Eg if your patient reports they have pain on stairs, find out if it is walking upstairs, downstairs, worse on bigger stairs, worse when the knee is more bent or straight. Increased pain with larger stairs and with increased knee flexion combined with pain around or under the patella may lead you towards diagnosing PFJ pain. Anterior knee pain closer to knee extension rather than with increased knee flexion may be more indicative of fat pad impingement. The more detailed followup questions will help you make your provisional diagnosis.

5. Ask your patients about their weekly physical activity and any sporting interests eg they like to run 3x/week and surf. This will help identify potential areas of load, and help you set goals at each treatment session to keep your patient motivated to continue their rehabilitation/ treatment plan.

6. (Bonus point) Verbally summarise for your patient the key points you extracted from their history – pain location, when it started, aggravating activities and other relevant information. Your patient will feel listened to, and assured you have taken in the key points, and build trust with you as their therapist. This often jogs their memory and helps them to remember further relevant information.

Courtesy of David Pope @ Clinical Edge

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