Patient Case
A 50 year old, fit and healthy appearing, female patient crutches into your physical therapy clinic via direct access for an acute ankle sprain. She skipped going to the emergency room because she knew it was “just an ankle sprain”. Her suspicions are right, she presents with no indication of fracture (per the Ottawa ankle rules) and will likely do great with a few PT visits to address pain, swelling, mobility, strength, and balance. Prognosis is great and the plan is for her to be back on her mountain bike in a few weeks. But on her third appointment she presents with paleness, mild shortness of breath, and reports a sensation of a “racing heart”; all of which she downplays with the explanation that she slept poorly last night. What’s going on - is it a bad night's sleep, or something else?
Systems Review
The answer to that question lies in the information from her first two visits. What was her heart rate, blood pressure, sleep quality, and stress at the first two sessions? Did the intake cover information related to recent blood work, nutrition, or lifestyle habits? If there is not an immediate answer to these questions, you are failing your patient. As physical therapists we are responsible for musculoskeletal ailments as well as the whole patient and their overall well-being. We can achieve this by performing a thorough systems review for all patients, at every visit.
All physical therapists should be familiar with thorough systems review and skilled in differential diagnoses; these are both covered extensively in physical therapy doctoral programs and are key components on the national licensure exam. But it doesn’t stop there. Utilizing systems review and differential diagnosis serve as a great foundation for becoming a primary care physical therapist; this requires knowledge and skills across specialties to address complete patient care effectively.
Musculoskeletal Experts
Military health systems and other select hospital systems have utilized physical therapists in primary care roles for decades, and have shown objective information on improvements in patient care and reduction in costs. When physical therapists, as experts in conservative musculoskeletal care, can independently care for these patients, it allows other disciplines the opportunity to increase capacity for other non-MSK medical cases. This allows for improved care all around.
Learn more here: https://www.jabfm.org/content/jabfp/34/4/866.full.pdf
At Redefine Health Education, we believe that every individual should have the opportunity to address their health concerns and achieve their goals by working with a specialized care team at the primary care level.
Learn More About Primary Care PT
All physical therapists, in all settings, should be capable and confident in treating the complete patient. To learn more, join Redefine Health Education at the ‘Foundations of Primary Care PT: A Hands-On Workshop’ course on on July 17 & 18, 2022 in South Carolina or August 27 & 28, 2022 in Chicago, Illinois. You will enhance your skills in medical screening, clinical decision making, assessment and management of adults presenting with functional limitations or pain related to any pathology. Instructors will cover how to properly identify signs & symptoms that may be outside the scope of physical therapist management, including cardiovascular & pulmonary, gastrointestinal, urogenital, neurologic, traumatic orthopedic, & psychiatric conditions. Skills lab include how to effectively triage, covering essential skills of heart & lung auscultation, abdominal examination, basic management of non-communicable diseases, and interdisciplinary communication. This is an essential course for any physical therapist looking to provide better care.
Sign up here for Orangeburg, South Carolina Primary Care course on 7/14/2022: https://www.redefinehealthed.com/event-details/foundations-for-the-primary-care-therapist-a-hands-on-workshop
Sign up here for the Glenview (Chicago), Illinois Primary Care course on 8/27/22:
Case Report Wrap-Up
Returning to the ankle case above; after ruling out the potential of a blood clot, a review of her recent blood work revealed that this patient had borderline low iron levels 6 months ago. These low iron levels were likely exacerbated by the patient’s new vegan diet she started 3 weeks ago to lose weight. Additional questions about fatigue, headaches, and cramping, leads to the hypothesis that she might be anemic. In addition to communicating this information to the patient's physician and requesting additional blood work, the patient is provided with information about anemia and its relationship with female sex, exercise, and nutrition. Physical therapy treatment does not stop at the ankle for this patient, it includes whole body care.
Being a primary care physical therapist does not mean being the first point of contact via direct access. It involves seeing the whole patient, screening all systems, and communicating with other providers as needed, whether the PT is the first to see the patient or not. Physical therapists play an essential role in healthcare. It is time we educate ourselves, embrace our role as first contact providers, and improve patient care.
Now What?
It's time to build on the master and doctorate level physical physical therapy education from school, and learn how to be a better a better physical therapist!
Learn more about what Redefine Health Education is offering here: https://www.redefinehealthed.com/about
Author: Dr Jessica Klain, PT, DPT, OCS, COMT, CSCS, CNPT, CYT