What is the approach for PT (Physical Therapy)/OT (Occupational Therapy) evaluation and treatment?

PT/OT Evaluation and Treatment Approach

Physical therapy (PT) and occupational therapy (OT) evaluations should be comprehensive, condition-specific, and focus on improving functional outcomes, with treatment plans tailored to address identified impairments and activity limitations to improve morbidity, mortality, and quality of life. 1

Initial Evaluation Components

Comprehensive Assessment Framework

• Use occupation-based conceptual models of practice such as the Model of Human Occupation or Canadian Model of Occupational Performance and Engagement 1
• Conduct evaluation based on the International Classification of Functioning Disability and Health (ICF) core set for the specific condition 2
• Screen for "red flags" that may indicate need for medical referral 2

Key Assessment Elements

1. Symptom history and impact assessment:

   • Onset, progression, and variability of symptoms 1
   • Exacerbating and easing factors for each symptom 1
   • Impact of symptoms on daily function and participation 1

2. Functional evaluation:

   • Global and fine functional abilities 1
   • Balance assessment 1
   • Range of motion measurements 1
   • Muscle strength testing 1
   • Observation of daily activities (personal care, meal preparation, transfers) 1

3. Contextual factors:

   • Social history including roles, responsibilities, and meaningful activities 1
   • 24-hour routine to identify symptom perpetuating factors 1
   • Environmental assessment (home, work, education) 1
   • Current use of adaptive equipment or environmental modifications 1

4. Patient understanding and goals:

   • Patient's understanding of their condition 1
   • Identification of patient-centered goals for treatment 1
   • Expectations of therapy 1

Recommended Assessment Tools

• Patient-Specific Complaints Instrument 2
• Numeric Pain Rating Scale 2
• Condition-specific outcome measures (e.g., Hip Disability and Osteoarthritis Outcome Score for hip OA) 2
• Functional performance measures (e.g., Six Minute Walk Test) 2

Treatment Approach

Core Interventions

1. Physical rehabilitation through guided activity practice 1:

   • Restorative exercises for muscle weakness and low physical performance 1
   • Pain management techniques 1
   • Retraining normal movement within functional activities 3

2. Self-management support 1, 3:

   • Education about the condition and rationale for interventions 1, 3
   • Development of internal locus of control 1
   • Interactive workbooks or therapy journals 1

3. Practical management of contributing factors 3:

   • Fatigue management and energy conservation 1, 3
   • Pain management strategies 1, 3
   • Sleep hygiene techniques 3
   • Activity pacing to prevent boom-bust cycles 1

4. Functional activity focus 3:

   • Graded reintroduction to daily activities 3
   • Establishment of structure and routine 3
   • Integration of specific techniques into functional activities 3

Treatment Phases

1. Initial phase 3:

   • Comprehensive education about the condition
   • Establish therapeutic rapport
   • Agree on treatment parameters
   • Introduce self-management concepts

2. Active rehabilitation phase 3:

   • Implement interventions focused on function
   • Address unhelpful thoughts, beliefs, and behaviors
   • Use variability of symptoms positively in treatment
   • Integrate specific techniques into functional activities

3. Maintenance phase 3:

   • Complete relapse prevention planning
   • Develop ongoing self-management strategies
   • Gradually reduce clinical support

Special Considerations by Condition

Cancer Rehabilitation

• For pediatric leukemia: Evaluate global and fine functional abilities, balance, range of motion, and muscle strength 1
• For bone cancer: Conduct rehabilitation evaluation before surgery and at regular intervals after surgery (1,3,6,9,12,24 months) 1
• For CNS tumors: Preoperative PT/OT assessment and swallow assessment 1
• For patients with amputations: Address prosthetic needs, functional abilities, and peripheral deficits 1

Functional Neurological Disorder (FND)

• Avoid using splints or immobilizing devices that can lead to muscle deconditioning 3
• Prevent overreliance on compensatory aids that may interrupt normal automatic movement patterns 3
• Focus on education that FND is a real condition with symptoms resulting from potentially reversible miscommunication between brain and body 1

Rheumatoid Arthritis

• Include joint protection techniques, activity pacing, and energy conservation 1
• Consider appropriate assistive devices and adaptive equipment 1
• Incorporate environmental adaptations as needed 1

Implementation Considerations

• Ensure open and consistent verbal and written communications with the patient and other healthcare professionals 3
• Provide family education to reinforce therapeutic approaches 3
• Support work/study modifications and graded return plans as needed 3
• Coordinate PT and OT services when both are indicated 4

By following this structured approach to PT/OT evaluation and treatment, clinicians can develop comprehensive, evidence-based intervention plans that address functional limitations and improve quality of life for patients with various conditions.