Primary Care Week 9

What is health according to the WHO?

A state of physical, mental, and social well-being, not just absence of disease.

What is wellness?

A multidimensional concept measuring how successfully a person functions within their environment.

What is health promotion?

The process of helping people increase control over and improve their health.

What is the ecological model of health?

A model showing health is influenced by individual choices and surrounding environmental systems.

What ecological factors influence a patient's physical activity?

Safe exercise space, family support, work/childcare duties, transportation, community resources, and culture.

What is social responsibility in health care?

Recognizing healthcare providers have duties beyond treating disease, including addressing broader environments.

What are the six dimensions of wellness?

Physical, social, psychological, intellectual, emotional, and spiritual.

Why is wellness not simply the absence of disease?

A person with a chronic condition can still progress toward greater overall wellness.

How do different dimensions of wellness interact?

They are interconnected; issues in one dimension (like stress) affect others (like sleep and energy).

What is a physical therapist's role in health promotion?

Screen health behaviors, provide wellness education, support behavior change, and refer when appropriate.

What key health behaviors should physical therapists screen for?

Physical activity, nutrition, smoking, alcohol use, stress management, sleep, and drug use.

What should a PT do for health concerns outside their scope?

Understand the impact, provide basic within-scope education, and refer to appropriate specialists.

What are examples of basic health screening questions?

Questions asking overall health rating, recent major life changes, alcohol consumption, and smoking.

What is the primary purpose of the Transtheoretical Model?

To assess a person's readiness to change a behavior.

What are the five stages of change in the Transtheoretical Model?

Precontemplation, Contemplation, Preparation, Action, and Maintenance.

Why must PT interventions match the patient's stage of change?

Providing actionable plans to patients who aren't ready to change leads to ineffective outcomes.

What is self-efficacy?

A person's belief in their ability to successfully perform a specific behavior.

What four strategies build a patient's self-efficacy?

Successful experiences, observational learning, encouragement, and correct interpretation of physical signals.

How does educating patients on post-exercise soreness improve self-efficacy?

It prevents them from misinterpreting normal soreness as harm, encouraging continued exercise.

What is motivational interviewing?

A client-centered approach helping patients discover their own motivations for behavior change.

What are the four principles of motivational interviewing?

Resist righting reflex, understand motivations, listen with empathy, and empower the patient.

What is the righting reflex?

The automatic tendency of healthcare providers to tell patients how to fix their problems.

Why is understanding personal motivation essential for behavior change?

It connects health actions to goals that are personally meaningful to the patient.

How do physical therapists empower patients for sustainable change?

By helping them set personal goals, overcome barriers, and take ownership of their change.

What are the three takeaways regarding PTs in health promotion?

Wellness is multidimensional, PTs can promote health, and recognizing unhealthy behaviors differs from changing them.

What is the main objective of the lecture regarding the initial visit from a primary care physical therapy standpoint?

To discuss how primary care PT visits differ from referral visits, emphasizing red flag screening and serious pathologies.

What is the biggest difference between a primary care PT visit and a typical non-primary care PT visit?

Primary care patients may lack recent physician evaluations, requiring greater PT emphasis on identifying red flags and serious pathologies.

Why is screening for red flags particularly important when seeing patients in a primary care PT setting?

Patients may not have seen a physician recently and medical conditions can change rapidly, requiring careful evaluation for serious conditions.

What additional information should a primary care physical therapist obtain during the patient's health history?

Patient demographics, social history, health history, social habits, and relevant medical history affecting the condition.

Why is access to and review of the patient's medical record important in primary care physical therapy?

It helps understand medical history and relevant complaints, though access varies across settings (EMR, private practice, hospital consults).

How does the amount of screening in primary care PT compare with the examination of a patient who has a physician referral?

Interaction is mostly similar, but primary care requires extra emphasis on screening non-PT and potentially serious pathologies.

What are the three possible courses of action a physical therapist may choose after evaluating a patient in a primary care setting?

1. Treat only; 2. Treat and refer; 3. Refer only.

What factors help determine whether a patient should be treated, treated and referred, or referred only?

Findings from history, systems review, physical exam, safety assessment, red flags, and scope of practice concerns.

Why should the physical examination framework discussed in the lecture not replace the examination framework students have already learned?

It highlights primary care considerations without replacing core examination and evaluation frameworks learned in PT training.

What are the initial steps a physical therapist should take when evaluating a patient who presents without a physician referral?

Review medical history, interview chief complaint, investigate health history, perform systems review, and complete physical examination.

What types of chief complaints might bring a patient to a primary care physical therapist?

Pain, neurological deficit, weakness, or health and wellness concerns.

Why should a physical therapist investigate health history information throughout the examination rather than only during the initial interview?

Relevant health concerns emerge as new examination data becomes available, developing a complete clinical picture.

What is the purpose of performing a systems review during the initial examination?

To assess related and unrelated symptoms that may require investigation outside the scope of physical therapy.

Why is evaluating the collected examination data especially important in primary care physical therapy?

Without a physician referral, the therapist must evaluate data to decide whether to treat, treat and refer, or refer only.

What should a physical therapist consider before deciding to treat a patient without a physician referral?

Examination findings, safe treatability, and requirements of the state's physical therapy practice act.

What requirements regarding physician notification and referral does the lecture identify for physical therapists practicing in Ohio?

Notify patient's physician within 5 days of starting treatment; refer back to physician if no progress within 30 days.

What should a physical therapist consider when deciding whom to refer a patient to?

Condition severity and urgency determine whether to refer to PCP, specialist, emergency department, or 911.

Under what circumstances might a physical therapist refer a patient to the emergency department or call 911?

When the severity or emergent nature of the patient's condition warrants urgent medical evaluation.

What are the different purposes for which a physical therapist might refer a patient for additional evaluation?

Additional physical examination by another provider, diagnostic imaging, or blood/laboratory testing.

How might a physical therapist communicate the reason for referring a patient back to their primary care physician?

Describe chief complaint, present non-musculoskeletal findings, and request further medical evaluation.

Why might a physical therapist refer a patient for imaging, and what examples are provided in the lecture?

To investigate conditions requiring imaging (where permitted by state law), such as suspected fractures, meniscal tears, or ACL tears.

How might the initial visit differ depending on the primary care practice setting?

Varies between ED, urgent care, and outpatient clinics, but identifying non-PT issues remains critical in every setting.

Why is identifying conditions outside the scope of physical therapy particularly critical in primary care?

Patients may lack recent physician evaluation or referral for their current complaint.

How do red flags influence the physical therapist's plan of action after the initial examination?

They indicate potential non-PT issues and guide the decision to treat only, treat and refer, or refer only.

What is the difference between deciding whom to refer a patient to and deciding what to refer the patient for?

Whom: target provider/service (PCP, ED, specialist); What: type of evaluation needed (physical exam, imaging, labs).

Why must physical therapists understand their state's practice act when providing primary care services?

State practice acts govern direct access permissions, physician notification rules, referral timelines, and imaging privileges.

What are the main take-home messages regarding the initial examination in primary care physical therapy?

Exam structure is similar; emphasize red flags; choose treat/refer path; identify proper referral target and evaluation type.

After completing the initial examination of a patient without a physician referral, what questions should guide the physical therapist's next steps?

Can I treat safely? Treat and refer? Refer only? Who is the best referral target? What evaluation is needed?

What is a health risk factor?

Information providing context about overall health that may alter concern for specific diagnoses.

What are the main objectives of collecting patient health history?

Identify relevant health history and integrate it into clinical decision-making and differential diagnosis.

Why are health risk factors important in evaluating neuromusculoskeletal symptoms?

Medical conditions can mimic neuromusculoskeletal symptoms; risk factors help identify non-PT medical issues.

How do age and medical history alter the thoracic pain differential diagnosis?

Older age or history of cancer/osteoporosis increases concern for fractures or malignancy.

What six categories should be included in a patient's health history?

Demographics, social history, medical history, medications, social habits, and family history.

How do patient demographics influence clinical reasoning?

They inform disease prevalence and pretest probability without independently establishing a diagnosis.

How are sex, race, and ethnicity relevant in clinical decision-making?

They influence disease prevalence but must be considered alongside all other clinical findings.

What is pretest probability in physical therapy evaluation?

The estimated likelihood of a condition existing before completing the full diagnostic examination.

What occupational factors should a physical therapist investigate in social history?

Actual physical demands like computer sitting, repetitive lifting, overhead work, or trauma exposure.

Why ask about leisure activities if a patient reports no exercise?

Strenuous weekend activities or landscaping can contribute to symptoms despite reported lack of exercise.

How do living environment, social support, and cultural factors affect care?

They influence health, participation in rehabilitation, ability to follow care plans, and outcomes.

Why is knowing a patient's medical condition only the start of history-taking?

Therapists must determine how it is controlled, managed, medicated, and if complications exist.

What details should a therapist gather when a patient reports diabetes?

Disease control, current management, medications taken, and presence of diabetes-related complications.

What information should be collected regarding a history of cancer?

Cancer type, date of diagnosis, treatment received, and current oncological status.

Why is recent illness or infection clinically relevant to musculoskeletal symptoms?

Infection history combined with new musculoskeletal symptoms suggests possible non-musculoskeletal systemic involvement.

How does surgical history affect physical therapy examination and treatment?

Recent surgery increases risk for DVT or infection; past surgeries may limit movement or interventions.

Why must physical therapists understand medication effects?

Medications can alter symptoms, examination findings, risks, or required modifications to exercise plans.

How do beta blockers affect exercise prescription in physical therapy?

They blunt heart rate response, requiring alternative methods to assess exercise intensity.

Why is long-term corticosteroid use significant following minor trauma?

Corticosteroids increase fracture risk, heightening concern for fracture even with minor trauma.

What non-prescription items must physical therapists specifically ask patients about?

Over-the-counter medications, dietary supplements, and herbal products.

According to FDA guidelines, what daily caffeine intake is generally non-harmful for healthy adults?

Up to 400 milligrams per day.

What symptoms can result from excessive caffeine intake?

Nervousness, insomnia, gastrointestinal issues, palpitations, and tachycardia.

What symptoms are associated with caffeine withdrawal?

Headache, fatigue, lethargy, muscle discomfort, and mood changes.

How does the NIAAA define heavy drinking for men and women?

Women: ≥4 drinks/day or ≥8/week; Men: ≥5 drinks/day or ≥15/week.

What constitutes binge drinking according to the lecture?

Consuming ≥4 drinks (women) or ≥5 drinks (men) within 2 hours, raising BAC to 0.08%.

What is a physical therapist's responsibility regarding patient alcohol screening?

Ask routinely and non-judgmentally to identify health relevance and determine if referral is needed.

How should questions about alcohol use be asked to ensure accuracy?

Routinely, professionally, and non-judgmentally, avoiding leading phrasing that communicates expected answers.

How does tobacco use impact physical therapy recovery?

It impairs tissue and bone healing, potentially slowing recovery and altering prognostic expectations.

How should information on tobacco use influence treatment planning?

Adjust expectations for prognosis, rate of healing, progression speed, and goals.

How should a positive family medical history affect clinical decision-making?

It modifies patient risk profile and requires detailed investigation integrated with current symptoms.

What key follow-up details are needed when family cardiovascular history is reported?

Specific family member affected, type of disease, and age at diagnosis.

Which hereditary conditions are highlighted as strongly dependent on family history?

Huntington's disease and Charcot-Marie-Tooth disease.

How does health history collection differ between inpatient and outpatient settings?

Inpatient relies on medical records verified with patient; outpatient relies on questionnaires followed by interview.

Why is a health history questionnaire insufficient on its own?

A checked box lacks context; positive responses require interview follow-up to determine clinical relevance.

What is the PHQ-2 and what does it assess?

A two-item depression screening tool measuring anhedonia and depressed/hopeless mood over the past two weeks.

Does a positive PHQ-2 screening confirm a diagnosis of depression?

No; it indicates a need for further clinical assessment, not a formal diagnosis.

How should health risk factors be integrated into clinical reasoning?

Evaluate whether risk factors, symptoms, and exam findings fit together to decide on treatment or referral.

What is the central take-home message regarding health risk factors?

Risk factors provide context and guide further investigation, but are not automatically red flags or referral triggers.