Chapter 1: Why Should Physical Therapists Know About Diagnosis?

In this Chapter

• Development of professional responsibility and education in physical therapy

• Role of diagnosis in the professional vision for the future of physical therapy

• Definition of diagnosis

• Conceptualization of diagnosis by physical therapists

Introduction

The close of physical therapy's first 100 years marks a new direction in its history as a young profession—establishing the autonomy necessary to ensure patients can benefit from safe, efficient, and universal direct access to physical therapy. Direct access to physical therapy is a central tenet of the American Physical Therapy Association's Vision 2020 statement, which looks forward to physical therapists being "recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health."¹ One clear assumption of Vision 2020, with its emphasis on direct access, is that physical therapists must be able to engage in the diagnostic process as part of their overall evaluation, in order to develop a well-reasoned intervention plan for addressing the patient's problems. This process must lead to a decision regarding the probable pathological or pathophysiological cause of the patient's problem, followed by a determination of whether physical therapy intervention is the most appropriate to address the underlying pathology of the patient's condition. Again, it must be emphasized that Vision 2020, with its emphasis on direct access, presupposes that the physical therapist will be able to reach that decision without provision of a diagnosis beforehand by a physician or other health care professional.

The development of diagnostic skills by physical therapists is a critical step to establishing the autonomy necessary for universal direct access to physical therapy. Since the introduction of a groundbreaking textbook on medical screening in 1990,² physical therapists have made considerable progress toward the development of systematic approaches to the consideration of pathology. Despite these advances, however, the profession lacks a strong tradition of diagnosis.³ Many experienced physical therapists have developed excellent diagnostic skills, but they have succeeded the hard way—by independent study, on-the-job training, and trial and error. To reach the goal of direct access, the physical therapy profession must continue to develop systematic, evidence-based approaches for diagnosis that are taught in entry-level curricula, so that all physical therapists can be presumed to have adequate skill in diagnosis.

This textbook adds to the effort to develop physical therapists' diagnostic skills for recognizing pathologies in a significant and unique way. The purpose of this book is to present a framework for physical therapists to become more skilled diagnosticians of pathology and provide a ready resource to support the work of physical therapists in direct access environments. It proposes a detailed symptom-based approach for diagnosis based on the notion that, in starting the process of diagnostic investigation, the physical therapist must begin with the ...