Ankle consultation and evaluation

Anatomy of physiotherapy consulation

1. Mechanism of injury

2. Consultation

3. Subjective info

4. Objective exam

5. Treatment plan (including ICF)

6. Cycle: treat, test, home programme

7. either refer or discharge

Goals of subjective evaluation

• level of functioning (considering ICF)

• source of symptoms (structures involved)

• pathobiological mechanisms (inflammatory/mechanical/combo, stage of healing, type of disorder (acute/overuse injury)

• precautions + contraindications

• contributing/predisposing factors

• some insight regarding management and prognosis

Subjective exam

• Kind of disorder

  • Establish main problem & level of disability; may include pain, stiffness, loss of function, weakness, etc.

• Body chart

  • Area of symptoms; nature/quality, depth & severity of symptoms; constant/intermittent; abnormal sensation; relationship between areas; clear unaffected areas with a tick

• Behaviour of symptoms

  • aggravating and easing factors

• 24 hr behaviour of symptoms

  • The behaviour of the patients over a 24-hour period as they engage activities of daily living and participation in other activities such as work and sport

• Interpretation of symptom behaviour (SIN)

  • severity, irritability, nature

• present history

  • date of onset; details of onset; progression since onset

• Social history

  • home environment; occupation; hobbies; socio-economic factors; smoking; alcohol

• Medical and Surgical hx

  • Past medical & surgical history; medication; general health

• Special questions (red flags)

  • night pain; weight loss; unexplained fatigue; night sweats; cord signs; cauda equina signs; etc.

• Special questions (yellow flags)

  • psychosocial risk factors – attitudes; behaviours; compensatory; diagnostic; emotional; family; work

• other resources

  • X-rays, MRI, blood tests

Outcome Measures

outcome measures are standardised tools or assessments used to evaluate the baseline level of function or a particular symptom the effectiveness of treatments and interventions.

• What: assess balance, strength, pain, function, ROM, and quality of life

• When: used at different stages of the patient's treatment process. (initial treatment to get baseline, thru course of treatment + at end of treatment to evaluate

• Where: hospitals, outpatient clinics, CHC’s

• How:

  • choose based on patient condition, goals, purpose

  • administer using standardised protocol

  • interpret results in clinical context

  • use results to guide/adjust treatment

  • document in records

Purpose of outcome measures

• assess + track progress over time

• guide treatment decisions

• improve team + patient communication

• show treatment effectiveness

• support research + evidence-based practice

Objective Evaluation

• posture assessment

• functional demonstration

• functional testing

  • muscle balance

  • muscle control

  • neuromuscular function

  • co-ordination of mvnt