Thinking back to my days as a new grad, I remember viewing evaluations as windows of time designed to gain as much objective information as possible. Goniometers, tape measures, pain scales, if you could put a number to it, it had to be measured during that initial encounter. Fast-forward almost six years, and while I still note objective measures during an eval, my understanding that we are treating a human, not just tissues, has brought about a more subjective approach. To that end, I wanted to share with you, in no particular order, what I consider to be the five best PT evaluation questions I ask my patients.
Asking the right questions can change the course of your prescribed treatment, so make sure you're asking the most important ones!
5 Best PT Evaluation Questions
1. What do you think caused your injury/symptoms?
If your patient is seeing you for some sort of acute trauma, this will be a pretty straight-forward answer. But for those folks seeing you for a chronic condition or something with a seemingly insidious onset, the answer they provide could clue you in to more effective and efficient treatment strategies. Take for example a recent patient who came to me with complaints of persistent quadratus lumborum and glute medius pain with a prescription that referenced low back pain. However, when I asked her what she thought initially caused her symptoms, she stated that she believed it was secondary to a fall she sustained almost a year ago during which she landed on her tailbone. Might a thorough physical assessment have revealed this? Perhaps. But in asking her that question I saved myself a ton of time trying to determine what was the cause versus what were merely symptoms.
2. What do you think is going on?
Asking this question gives me some insight into the person’s understanding of their pathology, and also provides initial information regarding their general outlook on how much control they feel they have over the situation. The person who uses anatomically correct terms and appears to have done their online research might be better connected with via more in-depth explanations regarding the treatment plan and techniques utilized. The person who uses verbiage such as “I’m broken,” or “my body hates me” could likely benefit from some extra information regarding pain science and other treatment strategies aimed at improving some of those thought viruses.
3. What do you feel needs to be done to improve your symptoms?
One of my professors in PT school once told me that, if you ask the right questions, your patient will tell you exactly what you need to do to help them get better. I couldn’t agree more. When you ask this question to your patient you might need to elaborate a bit, following up with something like “Do you feel like X needs to be pressed, or Y needs to be stretched?” Sometimes your patient might say something extreme like, “I feel like I want to stab something sharp deep into my hip.” Now, before you go calling psych, try to use their response as a clue. Asking for something to be ‘stabbed’ often translates into a desire to have tissue 'released.' Asking for something to be ‘opened up’, such as a hip, can translate into a request for a joint mobilization. Feeling like something needs to be ‘cracked’ can warrant a joint manipulation. In many cases, your patient knows what needs to be done; they just need a little help expressing it.
4. What can I do for you?
This might sound a bit like you’re a waiter at Outback, so feel free to phrase this question in whatever way you want. The basic premise here is ascertain the patient’s expectations of your role, and to then, if needed clarify your role. All too often, patients expect therapists to ‘fix’ them. That’s not how it works. This is the perfect time to inject some pain science into the encounter and explain that, as a PT, you can help facilitate change, but you’re not going to ‘fix’ them. Yes, you will likely help them improve their situation and decrease their symptoms, but verbal acuity is important when it comes to managing pain, especially in chronic pain patients. Pain is complex and multifactorial in nature, often requiring lifestyle and mindset changes on the part of the patient in order to see full resolution of symptoms. Using verbiage such as ‘fix’ places the patient in a very passive role, which will never help bring about the change that is required for continued improvement.
5. What are you hoping to get out of our time together?
This is one of my favorite questions to ask my patients, because it ensures that our goals are in sync. All too often I see new grads who want to get their patients back to playing basketball when all the patient wants is to be able to walk up and down the stairs without pain. Aligning your plan of care with the patient’s wants, needs, and expectations is one of the best ways to ensure successful outcomes. Additionally, this time can be used to better understand why the patient is in your office in the first place. Back when I worked in a more traditional setting I used to hear patients say, “I’m here because my doctor told me I need to go to physical therapy.” Until your patient is on board with treatment and actually wants to be there, getting them on board the "gains train" will be very difficult.
As previously stated, the above list is presented in no particular order. However, in reading through this list you should note the underlying theme of putting the patient at the center of the treatment plan, and looking at them as human, not simply a collection of tissues that needs to be treated. This is why I consider these to be the best pt evaluation questions. When it comes to that initial patient encounter, obtaining objective values is helpful, but empowering and actively involving the patient is imperative.