Physiotherapy Assessment and Examination
What you must understand
Assessment is a hypothesis-generating process, not a checklist. Know the sequence: subjective history (presenting complaint, irritability, 24-hour behaviour, past medical history, red flags), objective examination (observation, active and passive range of motion, resisted testing, special tests, neurological screening, functional tasks), and interpretation. Understand reliability concepts: intra-rater vs inter-rater reliability, sensitivity (rules a condition in when positive) versus specificity (rules out when negative), and likelihood ratios. Know that special tests rarely stand alone; they modify a pre-test probability built from history.
Traps in questions
- Confusing sensitivity with specificity, or assuming a highly sensitive test confirms a diagnosis.
- Choosing a special test before establishing irritability and baseline function.
- Missing red flags: night pain unrelieved by position change, unexplained weight loss, fever, bladder or bowel change, progressive neurological deficit, history of cancer, trauma in an osteoporotic patient.
- Forgetting that outcome measures need validated, condition-specific tools and documented baseline scores.
Rule of thumb
Spend the first third of the assessment on history. If a question offers a plausible physical test and a question about red flags, the safer answer screens first. Use the 'irritability' concept: high irritability means short, gentle examination and fewer provocation tests.
Worked example
A patient reports low back pain radiating below the knee, worse with coughing, with numbness in the foot. The best next step is a structured neurological examination (dermatomes, myotomes, reflexes, neural tension) rather than lumbar range-of-motion testing alone, because the history suggests nerve root involvement.