Physiotherapy Assessment, Evaluation, and Clinical Reasoning
What is tested
Structured assessment, measurement accuracy, and reasoning that leads to a defensible working diagnosis and plan.
Core rules
- SOAP and ICF. Subjective, objective, assessment, plan; map findings to body function and structure, activity, and participation.
- Hypothesis-oriented assessment. Form two or three hypotheses from the history, then pick tests that discriminate between them rather than repeating similar tests.
- Goniometry. Stabilise the proximal segment, align the fulcrum over the axis, record active and passive range separately; keep the same tester and method when measuring change.
- MMT. 0 no contraction, 1 flicker, 2 gravity-eliminated, 3 against gravity, 4 against gravity plus some resistance, 5 normal.
- Reflexes. 0 absent, 1+ diminished, 2+ normal, 3+ exaggerated, 4+ clonus.
- Test characteristics. Sensitivity rules out when negative; specificity rules in when positive; likelihood ratios above 10 or below 0.1 are strong.
- Outcome measures. NPRS, ODI, WOMAC, DASH, Berg Balance Scale, 6MWT, Barthel - chosen for the construct you intend to change and repeated at defined intervals.
Worked example
A 45-year-old reports anterior knee pain after starting a squat programme. Reasoning: hypotheses are patellofemoral pain, patellar tendinopathy, meniscal pathology, and referred hip weakness. Gradual onset, pain on squatting and stairs, no locking or swelling make patellofemoral pain or tendinopathy more likely. Test with single-leg squat observation, resisted knee extension, patellar tendon palpation and hip abductor strength. Document what changed your probability, not just what you found.
Traps
Anchoring on the first diagnosis; confirming only findings that fit; reporting an impairment score without a functional measure; not screening red flags before treating; failing to record consent and baseline measures.