Past History in physical therapy

The physiotherapist should identify the following:

1. Is this the first episode?

2. Is it recurrent?

3. Is it getting better or worse?

Previous treatments

Has the patient received any treatment for this condition in the past and, if so, was it effective? Was the improvement partial or total, and did it provide permanent or temporary relief? If the treatment has been effective in the past it may well help again. Be careful not to repeat unsuccessful interventions as they are unlikely to be therapeutic.

Investigations

Record the results of any investigations that the patient has undergone. Case notes, radiographic films and reports can be ordered and read, as patients may not always be a reliable source of the results of their investigations.

X-rays, MRI scans, CAT scans and bone scans

Scans are now commonly used to aid the diagnosis of musculoskeletal disorders. X-rays are useful in that they show the degree or extent of arthritis present at a joint. They are also useful in determining the extent of osteomyelitis (bone infection) and some malignancies and osteoporosis. Moreover, they are valuable following trauma to identify fractures or dislocations. Be aware, however, that there is a poor correlation between X-rays and spinal symptoms for non-specific low back and neck pain. What

is identified as pathological on these tests may not always be the structure responsible for the patient’s signs and symptoms. Routine X-rays are not helpful in non-specific degenerative spinal disease (CSAG 1994). Computerised axial tomography (CAT) scans may be used to identify the precise level and extent of disc prolapse and subsequent nerve impingement prior to discectomy. Magnetic resonance imaging (MRI) may be used to

identify ligamentous and muscular injuries, particularly in athletes, as well as discogenic prolapse. Bone scans are sensitive to ‘hot spots’ or areas of inflammation present in bone and may detect malignancy or diseases such as ankylosing spondylitis, some fractures and infection sites.

Blood tests

These are used extensively for the confirmation of the diagnosis of particular diseases such as rheumatoid arthritis, ankylosing spondylitis, osteomyelitis and malignancy.

Other investigations

The patient may be undergoing investigations for other pathologies that could possibly relate to the musculoskeletal condition. These should be noted and recorded.

Past medical history

Determine whether or not the patient is suffering, or has suffered, any major operations or illnesses. These may affect the vitality of the tissues and be a contraindication to particular treatments. Examples are respiratory or cardiac disease, diabetes, rheumatoid arthritis and epilepsy. The prolonged use of oral steroid medication should be noted, as this affects bone density and produces a tendency towards bruising. This is commonly found in patients suffering chronic respiratory diseases, inflammatory bowel diseases or rheumatoid arthritis. Always identify cases of unexplained weight loss and general debility.

Medication

Record the type and dosage of medication prescribed for, or taken by, the patient. Commonly prescribed drugs for use in musculoskeletal conditions are:

analgesics (painkillers), e.g. paracetamol and co-codamol;

non-steroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen;

skeletal muscle relaxants, e.g. diazepam and

baclofen.

Medications being taken should alert you to pathologies that the patient may have forgotten to inform you about. For example, a person may tell you that she/he has no significant medical history, but then later in the assessment

say that she/he is currently taking anticoagulation therapy for a recent deep vein thrombosis.

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