The Impairment You Might be Missing

In our world of physical therapy, the word “impairment” is one that is used throughout DPT curriculum and clinical discussions with coworkers and colleagues. Most of these conversations involve the terms weakness, hypomobility, hypermobility, etc. We can all attest to finding these at play in the patients we evaluate day in and day out. However, there is another important impairment that many PTs may be missing: patient perception.

Think back to the patient that came to you dead set that the findings from their MRI are contributing to their pain. Or the patient that feels that their pain is causing harm or damage. These perceptions can truly affect one’s prognosis and must be addressed early in the plan of care.

The question then becomes, how do we objectively measure patient perception with good validity? One can argue that patient specific outcome assessments quantify patient perception to some degree, but may not be specific enough to assist in breaking down perceptual barriers. Another potential way to assess patient perception is utilizing the Fear Avoidance Beliefs Questionnaire (FABQ), the Pain Catastrophizing Scale (PCS) or the Tampa Scale of Kinesiophobia (TSK). Although validated questionnaires, these are only specific to pain beliefs or perceptions.   We must acknowledge the vast amount of perceptions that a patient can bring to the clinic—think about patient expectation as reported by Bialosky et al as one example.

Given this, I feel there are several ways to help determine patient perception:

  1. Follow the four habits model of eliciting the patient’s perspective by exploring the patient’s ideas behind their presentation.
  1. Utilize motivational interviewing skills. This is key in allowing the patient to help come to an understanding of their beliefs and perceptions. Doing this will also allow you to understand why they may have certain perceptions.
  1. Investigate patient expectations. A simple question on an intake form can help address this. This may be: “what do you think will help you feel better/improve function?” or “At the end of physical therapy, what do you expect your ability to [insert functional limitation] will be?” Using a rating scale, with 0 indicating no worse/no better and 10 indicating completely worse/completely better can help quantify these expectations.

Whatever your strategy may be, it is imperative for PTs to address the perceptual impairment; identifying inaccurate perceptions may improve prognosis. On the flip side, maximizing or reinforcing positive perceptions will only magnify one’s interaction and outcomes of care.

So my question to you is: are you identifying this potential impairment and how?

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