Treatment Evaluation

1. Treatment Evaluation

2. Learning Objectives • Evaluate patient’s response to selected treatment by: • Evaluation of patient response during treatment • Conducting re-evaluation of patient status subjectively and objectively • Evaluation of treatment effectiveness and need for progression or regression • Recognize declines in patient status and report to supervisors • Charting procedures for patient treatment

3. Medical evaluation & Re-evaluation Evaluation: a dynamic process in which the physical therapist makes clinical judgments based on data gathered during the examination It is the process that necessitates re-examination for the purpose of evaluating outcomes to identify progression to goal achievement or need for modification and change of plan of care Includes both subjective and objective measures

4. Why Re-Evaluation Is Important? Re-Evaluation: is the process of performing selected tests and measures after the initial examination to evaluate progress and to modify or redirect interventions Methodical reassessment is used to justify treatment progression Important to have both subjective and objective measures to get full picture

5. Treatment Implementation • The junior PT tech will implement the treatment plan by: • Confirming patient diagnosis and chief complaint • Screening for precautions and contraindications for specified treatment • Select appropriate treatment, modality or exercise • Prepare patient for treatment • Applying selected treatment procedure • Verifying patient’s comfort level during treatment • Evaluate patient response during treatment • Re-evaluating patient status

6. Evaluation During Treatment • Evaluation of patient status during treatment can include: • Evaluating the patient’s performance of exercises • Are they having pain? • Do they feel it where they should? • Are they able to do what you showed them? • Providing corrective feedback to technique to exercise therapy • Can they self correct? • Can they do the exercise properly? If not why? • Determining patient satisfaction with the treatment • Patient comfort level? Adverse effects? • VAS score?

7. Re-Evaluation of Patient Status • Performed at the beginning of each treatment session to determine overall patient status • Also performed at the completion of a specific treatment to verify effectiveness • Post modality use or exercise prescription • Requires subjective and objective measures • Re-test what was initially a problem • VAS score overall? Post-treatment? When doing aggravating activity? • Re-test concordant sign

8. Concordant Sign An activity, movement, position, etc, that aggravates the patient the most by producing the worse symptom the most consistently Usually associated with patients daily activities Used as an objective measure to evaluate treatment effectiveness and overall patient status and should be retested each visit and after treatment Can be used as a discharge criteria

9. Example • A 25 year old ANA driver presents for PT after he injured his neck from a motor vehicle accident 3 days ago. He was seen by a doctor who diagnosed him with whiplash and was referred to PT for treatment. The senior PT tech assessed him and found the following: • 2/10 pain in the upper C/S area, right>left • Reduced C/S extension and left rotation with “stiffness and pulling” • 6/10 pain consistently with left shoulder checking while driving • Headaches especially usually in the late afternoon • Difficulty with sleeping • Occasional right shoulder pain with prolonged sitting

10. What is the Concordant Sign? • “Severe pain consistently with left shoulder checking while driving” • Most persistent symptom (always with left shoulder checking) • Highest pain producing symptom (6/10 =moderate pain) • Important task in patients daily routine • Easily re-testable and measurable

11. Evaluating Patient Status • Subjective methods: • What the patient says • What the patient feels • What the therapist sees • Objective methods: • Range of motion (ROM) • Strength • Swelling • Function • Outcome measures

12. Outcome Measures • Reliable and valid assessment and reassessment tools • Specific to condition or area of the body • Taken at initial assessment to determine the baseline function of a patient • Re-taken at discharge to determine progress and treatment efficacy

13. Assessing Treatment Effectiveness • Re-evaluation is used to determine weather or not the treatment provided is making a change • Changes can be: • Improvement = requires progression or discharge • Worsening = requires re-evaluation and possible regression • No change = requires more time to assess treatment and possible re-evaluation of treatment plan • Necessary to relay information to the supervising PT tech in order to adjust treatment plan accordingly

14. Change in Patient Status • Remember “Red Flags” • MUST be reported to supervising PT tech or doctor immediately • Sinister signs and symptoms indicate the need for re-evaluation or close monitoring • Sinister signs and symptoms are those that are potentially dangerous or threatening

15. Sinister Signs of Decline • The following include general signs and of possible patient decline: • Fever • Heart rate <60 or >100 beats per min • Respiratory rate <15 or >20 breaths per min • Abnormal blood pressure • Changes in mental state • Shortness of breath • Tightness or discomfort in the chest • Acute pain in the abdomen

16. Charting Standards • Charting should be done after every treatment session to track patient progress • Chart notes for each treatment session should include: • Patient demographics • Patients initial status • Treatment procedures • Response to treatment • Any adverse effects • Re-assessment of patient status

17. Medical Charting It is important to remember the basics for good documentation to be able to provide good care to your patient Recording all relevant information of a patient's care helps clinicians monitor what's been done and minimizes the risk of errors Careful attention to detail also reduces the likelihood of patients returning for additional treatment

18. Reasons for Good Charting • Gives written evidence of care given, the patient’s response, and the effect of the care • Plans for the future care and changes in plan of care so all members can be kept current • Serves as a communication tool. You are responsible for noting what was done, and observed • Allows for continuity of care and focuses on clients needs and goals from all those involved in their care

19. QUESTIONS?

20. Comprehension Check What is evaluation? What is re-evaluation? What is a concordant sign? When should this be evaluated? What are objective methods to evaluate a patient? What is an outcome measure? What are the signs and symptoms of decline? What information should a chart note include?

21. Answers Evaluation is a dynamic process in which the physical therapist makes clinical judgments based on data gathered during the examination Re-evaluation is the process of performing selected tests and measures after the initial examination to evaluate progress and to modify or redirect interventions

22. Answers • A concordant sign is an activity, movement, position, etc, that aggravates the patient the most by producing the worse symptom the most consistently. It is usually associated with patients daily activities.It is used as an objective measure to evaluate treatment effectiveness and overall patient status. Concordant sign should be evaluated: • On initial assessment • On each return visit • After the application of treatment

23. Answers • The objective methods to evaluate a patient are: • Range of motion (ROM) • Strength • Swelling • Function • Outcome measures • An outcome measure is a reliable and valid assessment and reassessment tool that is specific to a condition or area of the body

24. Answers • The signs and symptoms of decline are: • Fever • Heart rate <60 or >100 beats per min • Respiratory rate <15 or >20 breaths per min • Abnormal blood pressure • Changes in mental state • Shortness of breath • Tightness or discomfort in the chest • Acute pain in the abdomen

25. Answers • What information should a chart note include? • Patient demographics • Patients initial status • Treatment procedures • Response to treatment • Any adverse effects • Re-assessment of patient status