Week 3: History Taking and Intro to Evidence-Based Practice

Demographic Information

- also called the identifying information
- this part helps us get a quick overview/picture of the patient
- the details noted here tells us about the possible causes of the patient's injury

Patient's Name

- usually written in full in the patient's chart
- written in initials when used as part of teaching to protect the privacy of the patient

Age

- helps us identify possible diseases that the patient have based on prevalent diseases of their generation
- is the most common primary risk factor for disease

Sex

some diseases are more common in one gender than the other or occuring only in one gender.

Height, Weight, and BMI

- this information is sometimes not included when getting demographic information
- it is on the mandate of the hospital whether it should be recorded
- are also indications for diseases which they play as risk factors

Occupation

tells the PT about the working environment of the patient as well as different actions and postures associated which could be causes of injury.

Handedness

gives an idea on the possible functional impairments during an injury.

Nationality

some races and ethnicities are at greater risk for diseases than other.

Attending Physician

this is the main doctor of the patient which refers them for rehab.

Physiatrist in Charge

this is the doctor in the rehab department which is in-charge of prescribing the patient's rehab plan

Chief Complaint

- this is the symptom or concern that caused the patient to seek the treatment
- most common in outpatient physiatric practice are: pain, weakness, or gait disturbances of various musculoskeletal or neurological origins
- have the patient rank problems from "most bothersome" to "least bothersome"

Patient's Goal

to establish these may require the family or caregiver of the patient to step in during cases where the patient cannot speak for themselves or incapable of setting goals during their condition.

History of Present Illness

- this section details the chief complaints for which the patient is seeking medical attention as well as any related or unrelated function deficits
- should also explore other information relating to the chief complaint such as recent and past medical or surgical or procedures, complications of treatment, and potential restrictions or precautions
- tells us the story of how the present complaint happen
- primarily relates the sequence of events from the onset of the health problem up to the time
- arranged in a chronological order

Mechanism of Injury

MOI

Ancillary Procedures

- includes laboratory or radiology tests, and the dates and the findings of those tests
- usually tabulated

Drug Hx

- medications that the patient is currently taking
- usually tabulated

Past Medical History

- discusses all the other diseases related to the patient that was diagnosed before in his/her past
- involves all pertinent and non-pertinent diseases
- can also have a major impact on the rehabilitation outcomes

Family Medical History

- for diseases related to the family/heredity
- knowledge to know the general health of the family members can provide insight into their ability to provide functional assistance to the pt.

Red Flags

can be used to note the pt. for appropriate referral.

Personal, Social, and Environmental History

- deals with knowing what the patient does outside the questions that were asked regarding diseases and medications.

Evidence Based-Practice

- evidence-based medicine
- the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
- evidence is used to inform more fully a decision-making process in which expertise provides one perspective to the clinical problem
- means integrating the individual clinical expertise with the best available clinical evidence from systematic research

Traditional Practice

- based on local or regional norms
- "this is what i have always done for patients like this one"

1. Ask the Question
2. Aquire the Evidence
3. Appraise the Evidence
4. Apply the Evidence
5. Assess the Results

steps of evidence based-practice.

Ask the Question

- by formulating an answerable question, you are able to focus your effort specifically on what matters
- e.g. PICO, PEO, SPIDER, SPICE, etc.

PICO

is a question format that is useful for clinical and quantitative research topics.

Patient/Population/Problem
Intervention
Comparison
Outcome

PICO

Clinical Practice Guidelines

- statements that include recommendations intended to optimize your patient care
- informed by a systemic review of evidence and an assessment of the benefits and harms of alternative care options
- should follow a sound transparent methodology to translate best evidence into clinical practice to improve patient outcomes
- are key aspects of a patient-centered care

Systematic Reviews

- focuses on a specific clinical question and conducts an extensive literature search to identify studies with sound methodology
- the studies are reviewed, assessed, and the results are summarized according to pre-determined criteria of the review question

Meta-analysis

takes a systematic review one step further by combining all the results using accepted statistical methodology .

Randomized Control Trial

- a prospective, analytical, experimental study using primary data generated in the clinical environment
- individual similar in the beginning are randomly allocated to two or more groups or the treatment or controlled group and then follow to determine the outcome of the intervention

Case Control Study

- a study which patients who already have a specific condition or outcome are compared with people who do note
- researchers look back in tome (retrospective) to identify possible exposures
- often relies on medical records and patient recall for data collection

Cohort Study Prospective

a study of a group of individuals, some of whom are exposed to a variable of interest, in which participants are followed up over time to determine who develops the outcome of interest and whether the outcome us associated with the exposure.

Cohort Study Retrospective

- when data is gathered for a cohort that was formed sometime in the past
- exposures and outcomes have already occurred at the at the start of the study
- you are studying the risk factor and see if you can associate a disease to it
- individuals split by exposure

Cross-sectional Study

- the observation of a defined population at a single point in time or during a specific time interval to examine associations between the outcomes and exposure to interventions
- exposure and outcome are determined simultaneously and it often relies on data originally collected for other purposes

Survey Study

- an epidemiologic study that produces survey results, and will consist of simultaneous assessments of the health outcome, primary risk exposure and potential cofounders and effect modifiers
- e.g. cross-sectional and longitudinal studies

Case Series and Case Reports

descriptive study/studies that consist of collection of reports on the treatment of individual patients or a report on a single patient.

Descriptive Statistics

- used to describe the study population using calculations, tables, and/or graphs

Mean

- the sum of all values in a group/items in the group
- average

Median

the value in the middle of a group of values.

Mode

the value that appears the most in a group of values.

Range

- the simplest way to describe variation in a set of values - very sensitive to data that doesn't fit the typical pattern.

Interquartile Range

- identifies variation in a set of values after removing outliers
- reported as a range of numbers

Standard Deviation

identifies variation in a set of values by estimating the average distance of each score from the mean.

P-value

evaluates the statistical significance of the differences between the tow study groups or the relationships between two study variables.

T-test

evaluates the difference in means between 2 study groups for a specific thing (called variable).

Analysis of Variance

- ANOVA
- evaluates the difference in means between 3+ study groups for a specific variable

Confidence Interval

- provides a level of certainty about the chance of error by identifying the range of values where the true population values lies
- a 95% CI provides a 95% certainty that the true value lies within that range

Inferential Statistics

use data to make judgements about the difference between study groups for generalizing to the overall population.

Sensitivity

percentage of patients with disease who have a positive test for the disease in question.

Specificity

percentage of patients without disease who have a negative test for the disease in question.

Pre-test Probability

probability of disease before a test is performed.

Post-test Probability

probability of disease after a test is performed.

Likelihood Ratio

indicates an increase or decrease in the likelihood of disease.

Construct Validity

evaluates whether a measurement tool really represent the thing we are interested in measuring. it's central to establishing the overall validity of a method.

Content Validity

assess whether a test is representative of all aspects of the constrict.

Face Validity

considers how suitable the content of a test seems to be on the surface.

Criterion Validity

evaluates how well a test can predict a concrete outcome, or how well the results your test approximate the results of another test.

Critical Appraisal

- is the process of carefully and systematically examining research evidence to judge its trustworthiness, its value and relevance in a particular context
- allows clinician to use research evidence reliably and efficiently