MSP UNIT 1
1. PHT 5237C: Pathology - Overview and Introduction
Pathophysiology: Disordered physiological processes associated with disease or injury.
Terminology: Familiarize yourself with these crucial terms:
Etiology: The causes of pathologies.
Intrinsic Causes: Genetic, congenital, neoplastic, immunological.
Extrinsic Causes: Physical or chemical factors.
Pathogenesis: The physiological changes that occur due to a disease.
Risk Factors: Predisposition towards a disease.
Modifiable Risk Factors: Factors an individual can change (e.g., smoking, inactivity, poor diet, excess weight). PTs play a role in education here.
Non-Modifiable Risk Factors: Factors that cannot be changed (e.g., age, gender, family history, ethnicity).
Clinical Manifestations:
Signs: Objective observations made by an observer.
Symptoms: Subjective reports from the individual.
Sequelae: The outcomes or consequences of a disease.
Complications: New or separate processes that arise as a result of the primary disease.
Resolution: Whether the individual returns to normal after the disease/disorder.
Incidence: The occurrence rate or frequency of a disease.
Prevalence: How common a disease is within a population.
Diagnosis: Determined by the examination of signs and symptoms.
Prognosis: The likely course of the disease, including time estimations, progression/regression, quality of life, and activity participation.
Treatments: How a disease or disorder is managed and how the individual is cared for.
Stages of Disease:
Acute: Rapid onset and short duration.
Subacute: A less specific time frame, between acute and chronic.
Chronic: A longer lasting stage of illness.
2. PHT-5237-Introduction to Pharmacology and Nomenclature
Pharmacology: The study of how medicines interact with the body.
Key Divisions of Pharmacology:
Pharmacotherapeutics: Study of drugs used to prevent, treat, or diagnose a disease.
Pharmacokinetics: What the body does to the drug (absorption, distribution, metabolism, elimination/excretion). Focus of significant PT impact.
Pharmacodynamics: What the drug does to the body (its mechanism of action).
Toxicology: The study of the harmful effects of drugs.
Pharmacokinetics Objectives:
Identify the four major processes of pharmacokinetics.
Understand different routes of administration.
Know the importance of the first-pass effect.
Define bioavailability.
Identify factors influencing drug absorption and distribution.
Be aware of new techniques for drug delivery.
Role of Physical Therapists in Pharmacology:
Understanding pharmacology is crucial for rehabilitation professionals, even without prescribing.
Timing of Medications: Knowing peak concentrations (e.g., Sinemet for Parkinson's, approx. 1 hour post-administration) helps schedule therapy for maximal patient mobility.
Exercise Impact: Exercise can increase sensitivity to insulin, requiring dosage adjustments for diabetic patients.
Side Effects Awareness: Recognize important side effects (e.g., corticosteroids causing thin skin, bruising, slow wound healing).
Age-Related Changes: Circulatory slowing, reduced liver/kidney function affect drug breakdown and removal.
Body Weight and Disease States: Influence drug dosage and efficacy (e.g., Parkinson's impacting swallowing/intestinal motility).
Drug-Food Interactions: Certain foods (e.g., Vitamin K-rich vegetables with warfarin) can impact drug effectiveness and safety.
Race and Ethnicity: Can influence drug effectiveness (e.g., COVID-19 susceptibility studies).
Patient Education: Educate patients to take medication as prescribed, watch for side effects, and refer as necessary.
Required Skills: Review medical records, list medications in interviews. APTA emphasizes integrating medication understanding into patient management. ("Patient examination includes medication.")
3. PHT 5237C : Why Imaging
Imaging for PT Clinical Decision-Making: Essentially, radiology is "anatomy in another format," evaluating anatomy and macroscopic pathology.
Radiologist's Process: Involves perception, analysis (cognition, background knowledge), and systematic search (e.g., radiographic ABCs).
Barr's Priorities for PTs regarding Imaging:
Understand radiographic reports and terminology.
Make appropriate recommendations for imaging based on physical examination and history.
Explain imaging findings in layman's terms to patients.
Communicate effectively with other professionals using correct imaging terminology.
Recognize precautions/contraindications, and modify treatment plans based on reports/images.
Identify radiographic features of altered function based on PT evaluation.
Key Questions for Recommending Imaging:
Is imaging truly needed?
Which imaging modality is most appropriate (e.g., ultrasound vs. MRI for tendon inflammation)?
What is the sensitivity of imaging for the suspected problem?
Sensitivity: Probability of a positive test result in an individual who has the condition (e.g., Ottawa Ankle Rules should not miss a fracture).
(Note: Radiographs for stress fractures may be negative for 2-3 weeks).
What is the specificity of imaging for the suspected problem?
Specificity: Probability of a negative test result in an individual who does not have the condition (e.g., Ottawa Ankle Rules should not diagnose a fracture when none exists).
Will imaging make a difference in patient management? (67-80% of studies do not alter treatment).
Clinical Decision-Making Rules:
Can reduce the need for imaging (e.g., Canadian C-spine Rule, Ottawa Ankle Rules).
PTs are capable of applying these rules, shown to decrease unnecessary radiographs.
Challenges and Considerations:
Overutilization: Imaging is often overused.
False Positives: Common; PTs must help patients interpret findings that may not be clinically relevant.
Patient Education: Prepare patients for potential findings and discuss the value of imaging before ordering/interpreting.
Communication: PTs need to discuss imaging with physicians, requiring a basic understanding of images and decision rules.
Correlation: Ability to correlate imaging findings with clinical presentation to inform treatment.
Should Physical Therapists Order Imaging? Yes.
Responsibility: Direct access to PT services places a responsibility to diagnose, which may require imaging referrals (APTA Vision 2020).
Reduced Delays: PT referral can reduce unnecessary delays in patient care.
Scope of Practice: PTs are mandated to determine when conditions fall outside their scope (e.g., fractures, dislocations, tumors require definitive diagnosis via imaging).
State Legislation: Wisconsin, DC, Colorado, Maryland, New Jersey, and Utah currently allow PTs to order imaging.
Military Model: Successful since the 1970s, demonstrating feasibility and reduced imaging utilization with no loss of quality.
PT Training: DPT programs include imaging courses (required by normative model and CAPTE), focusing on identifying need, comparing methods, and using results in management.
Evidence of Conservative Use: Studies show trained PTs make appropriate referrals and use imaging conservatively (e.g., Keil et al. 2019).
NPTE & Guide to PT Practice: Imaging is a core component, emphasizing its non-peripheral role in physical therapy.