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Screening for health,

fitness and wellness

Screening

Screening is essentially checking for pathology when


there are no symptoms of disease. A screening often
includes simple measures to identify risk factors for
illness and is used to determine the need for further
examination.
According to the Guide to Physical Therapist
Practice,1 common screening activities include (1)
screening for lifestyle factors (eg, amount of
exercise, stress, weight) leading to increased risk for
serious health problems, (2) screening posture for
scoliosis, (3) identifying high risk factors for slipping,
tripping, or falling of older adults, and (4) performing
prework screenings to identify risk factors in the
workplace and the health status of potential workers.

Examination
Examination

in physical therapy
practice includes taking the client's
history, reviewing the body systems
for potential pathology, and
performing specific tests and
measures guided by the initial
screening, patient/client history,
professional judgment, and relevant
clinical findings.

Evaluation
Evaluation,

according to the Guide to


Physical Therapist Practice,* is "the
process in which the physical thera
pist makes clinical judgments based
on data gathered during the
examination

Interviewing the Client

nonverbal communication
Appropriate

interpersonal skills are


essential to developing rapport with
an individual during the screening
process. The interviewer must be a
good listener and have the ability to
focus energy, attention, and
thoughts on what the individual is
saying.

nonverbal communication
Five

skills, if used effectively, can


improve the enjoyment and outcome
of interpersonal communication: (1)
eye contact, (2) body position, (3)
proper distance between the
interviewer and interviewee, (4)
gestures, and (5) facial expression

verbal communication
Nonverbal

communication plays a
key role in jthe . interview process,
but verbal communication is critical
for eliciting responses needed for a
medical history and identification of
health risks
Open ended questions/ closed ended.

Cont

Awareness of the individual's cultural background is


critical to understanding the other person's point of view
and relevant issues; the LEARN model, which
emphasizes listening and sharing similarities and
differences, can be used to effectively used to overcome
cultural communication barriers.5 The acronym LEARN
represents the following key components of the model:
L Listen with sympathy and understanding to the
client's perception of the problem.
E = Explain your perceptions of the problem.
A ~ Acknowledge and discuss the differences and
similarities.
R Recommend a course of action. N Negotiate an
agreement.
Using the LEARN model enables the interviewer to
effectively communicate with various individuals.

Cont

Projecting professionalism and clinical competence


increases the sense of assurance during the
interview process. Characteristics of professionalism
include effective communication, professional
appearance, timeliness, respect, and 'displaying
tactful and courteous behavior. Evidence of
academic degrees, professional degrees, clinical
specialist certifications, and professional
memberships gives the individual more confidence
in the interviewer's clinical competence and
professionalism. A private area for the interview and
a well-organized space for the screening process
further provide the interviewee with a positive
impression.

Screening for Mental Health


Mental

health is directly or indirectly


influenced by multiple factors, including
memory, interpersonal relationships at work
and at home, coping and stress management,
social support, financial support, education,
vocation, leisure activities, and personal val
ues.
Depression is a significant psycho-social
problem affecting individuals' health, fitness,
and wellness and, ultimately, their quality of
life. A two-question initial screening test for
depression has

Cont
.

During the past month, have you


often been bothered by feeling down,
depressed, or hope-, less?
2. During the past month, have you
often been bothered by little interest
or pleasure in doing things?

Stress Assessment
During

the interview, it is important


to note stress-ors commonly
affecting health status. Stressors
include recent life changes or losses
(eg, loss of family or friends,
relocation of home and/or business),
changes in marital status, or
significant financial concerns.

Screening for Substance


Abuse

Physical therapists may note stress behaviors in


their clients and suspect abuse or violence.
screening test involves only two questions:
"In the past year, have you ever drunk or used
drugs more than you meant to?" and "Have you
felt your wanted or needed to cut down on your
drinking or drug use in the past year?" In one
study, at least one positive response detected
current substance-use disorders with nearly 80%
sensitivity and specificity. As with all screening
tests, performance varies with the prevalence of
substance abuse in the particular population
screened.

Screening for Physical Abuse


Oftentimes,

individuals come to a
screening to get help but are
embarrassed to admit that they are
experiencing significant psychosocial
problems. It is important to screen
for possible violence since an
individual may be experiencing
significant stress in personal
relationships.

Cont
The

following three questions can open up


discussion about potentially life-threatening
situations and address the issue of intimate
partner violence:
1. "Have you been hit, kicked, punched, or
otherwise hurt by someone in the past year?"
2. "Do you feel safe in your current, relation
ship?"
3. "Is there a partner from a previous relation
ship who is making you feel unsafe now?" A
positive screen is a "yes" answer to any of
the three questions.

Screening for a Balanced


Lifestyle
A

wellness screening includes a


broad range of questions reviewing
social wellness, physical wellness,
emotional wellness, career/leisure
wellness, intellectual wellness,
environmental well-ness, and
spiritual wellness.

physical health screening

Family History
Do you hove o family history of:
__Blood pressure
__Stroke
__Concer
__Diabetes
__Allergies
__Arthritis
__Alcoholism
__Mental illness
__Seizure disorders
__Kidney disease
__Other
General Health
Weight:__
(normal range __, overweight__, underweight.
__Fatigue ___Weakness __Malaise __Fever
__Illness
Immunizations
.No_Are immunizations current? Yes.. What is your
travel history? __
Birth History
Vaginal:____ C-seclion:_________
Full-term? Yes__ No_ Any complications:__
Medications
list prescription and over-the-counter drugs:
Medical History
Serious accidents (date, injury, length of care):.
Hospitalizations (date, injury, length of care):
Surgeries (dale, injury, length of core):.
Serious illness (date, injury, length of care):

Vision

____Glasses
__Any problems with vision
Ears
___Earaches __Infections __Discharge
from ear __Ringing (tinnilis) __Dizziness
(vertigo)
Nose and Sinuses
__Discharge from the nose or sinuses
__Sinus pain
__Unusual and frequent colds __Change
in sense of smell
Mouth and Throat
___Pain
___Toolhoche
__Lesions or sores on the mouth or throat
__Changes in the mouth or throat
__Altered taste
__Jaw pain
Neck
____Neck pain
__Limitations in neck movement
__Lumps, swelling, tenderness, or other
discomfort

Respiratory System
____History of asthma __Chest pain
/Shortness of breath LCougri ___Wheezing
Cardiovascular System
____Pain
____Pain near heartwith or without exertion __Dizziness
when standing up ;__Personal history of any heart problems
__Problems breathing when sleeping
k
Peripheral Vascular System
' ____Coldness
____Coldness __Numbness '.^Tingling
__Swelling of legs or hands '
Pain in legs __Discolored
hands or feel ____Voricose veins __History of vascular
problems

Gastrointestinal System
__Changes in appetite
__Food intolerance
__Heartburn
__Abdominal pain
__Nausea and vomiting
__Flatulence (gas)
Frequency of bowel
movement ___
__Recent changes in stool
__Constipation or diarrhea
__Rectal bleeding
__Rectal conditions
__Use of antacids or
laxatives
__High fiber in diet

Urinary System
Frequency of urination.__
__Problems with urgency
__Pain with urination
__Unusual color
__.Other problems
__For women: Kegel exercises post-pregnancy
Male Genital System
__Penis or leslicular pain __Sores or lesions __Discharge
__Lumps __.Hernia
Female Genital System
Menstrual history (last period, duration; cycle): _
Pregnancy history: ___________________ ___Vaginal itching
__Discharge
Age of menopause __Menopausal signs or symptoms
__Postmenopausal bleeding.

Musculoskeletal System
__History, of arihrilis; gout; joint poin, swelling, or
ss __Gait problems (problems with walking) __Problems with coordinatio
Neurological System
___History ot seizures, blackouts, strokes, fainting;
headaches __Motor problemstics, tremors, paralysis, or
ess, tingling ._.Memory: loss, disorienlalion __Mood changes __Depressi
Hematologlc System
____Bleeding problems
__Excessive bruising
__Lymph node swelling
__Exposure to toxins and radiation
__Blood transfusions and reactions_________
Endocrine System
__History of diabetes
__Thyroid disease
/
__Intolerance to heat and cold
__Change in skin pigmentation and texture
__Excessive sweating
__Abnormal relationship between appetite and weight (describe)
.Abnormal hair distribution '
.Nervousness
.Tremors
.Need for .hormone therapy

s
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