Imagine you sprained your ankle a few weeks ago and now you are sitting in a physical therapist’s office for your first visit. After providing the PT with a thorough history, instead of looking at your ankle, your PT starts his examination at your neck and shoulder. This would probably seem pretty strange to you since your neck and shoulder are fine but your ankle hurts. However, if students follow what we teach them, this is exactly what they would do.
In line with the APTA’s suggestion, we teach students to perform a systems review on every patient . Don’t get this confused with a review of systems which is a general screen of the major systems of the body. A systems review (as laid out in the Guide to Physical Therapy Practice) is a review of “(1) the anatomical and physiological status of the cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular systems and (2) the communication ability, affect, cognition, language, and learning style of the patient.”
The APTA suggests that this systems review should include:
• For the cardiovascular/pulmonary system, the assessment of heart rate, respiratory rate, blood pressure, and edema
• For the integumentary system, the assessment of pliability (texture), presence of scar formation, skin color, and skin integrity
• For the musculoskeletal system, the assessment of gross symmetry, gross range of motion, gross strength, height, and weight
• For the neuromuscular system, a general assessment of gross coordinated movement (eg, balance, gait, locomotion, transfers, and transitions) and motor function (motor control and motor learning)
• For communication ability, affect, cognition, language, and learning style, the assessment of the ability to make needs known; consciousness; orientation (person, place, and time); expected emotional/behavioral responses; and learning preferences (eg, learning barriers, education needs)
I struggle with my opinion of the systems review. On one side I understand the intention and it makes sense that as direct access practitioners we should look at patients more broadly. On the other hand, it is a process which is likely to identify lots of unimportant noise. This is very similar to the general annual health evaluation at your physician. It sounds like a good idea but unless there is a specific target, the information gained is rarely useful. So are we simply having students perform unreliable, time consuming and distracting tasks, or is the systems review actually useful?
Here is the specific systems review that we teach students at our institution(Systems Review). I am interested to hear what you think about this particular systems review and about systems reviews in general. Do you perform a systems review on patients or do you get right to the primary complaint? If you do perform a systems review, what are the components and why do you find it useful?