Screening for health, fitness and wellness

ScreeningScreening 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.

ExaminationExamination 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.

EvaluationEvaluation, according to the Guide to Physical Therapist Practice,* is "the process in which the physical therapist makes clinical judgments based on data gathered during the examination

Interviewing the Client

nonverbal communicationAppropriate 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 communicationFive 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 communicationNonverbal 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.

ContAwareness 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.

ContProjecting 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 HealthMental 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 values. 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 AssessmentDuring 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 AbusePhysical 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 AbuseOftentimes, 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.

ContThe 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, relationship?"3. "Is there a partner from a previous relationship who is making you feel unsafe now?" A positive screen is a "yes" answer to any of the three questions.

Screening for a Balanced LifestyleA 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 screeningFamily HistoryDo you hove o family history of:__Blood pressure__Stroke__Concer__Diabetes__Allergies__Arthritis__Alcoholism__Mental illness__Seizure disorders__Kidney disease__OtherGeneral HealthWeight:__(normal range __, overweight__, underweight. __Fatigue ___Weakness __Malaise __Fever __IllnessImmunizations.No_Are immunizations current? Yes.. What is your travel history? __Birth HistoryVaginal:____ C-seclion:_________Full-term? Yes__ No_ Any complications:__Medicationslist prescription and over-the-counter drugs:Medical HistorySerious 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 visionEars___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 smellMouth and Throat___Pain___Toolhoche__Lesions or sores on the mouth or throat__Changes in the mouth or throat__Altered taste__Jaw painNeck____Neck pain__Limitations in neck movement__Lumps, swelling, tenderness, or other discomfort

Respiratory System____History of asthma __Chest pain/Shortness of breath LCougri ___WheezingCardiovascular System____Pain near heartwith or without exertion __Dizziness when standing up ;__Personal history of any heart problems __Problems breathing when sleepingkPeripheral Vascular System' ____Coldness __Numbness '.^Tingling__Swelling of legs or hands ' Pain in legs __Discolored hands or feel ____Voricose veins __History of vascular problemsGastrointestinal 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 SystemFrequency of urination.____Problems with urgency__Pain with urination__Unusual color__.Other problems__For women: Kegel exercises post-pregnancyMale Genital System__Penis or leslicular pain __Sores or lesions __Discharge __Lumps __.HerniaFemale Genital SystemMenstrual history (last period, duration; cycle): _Pregnancy history: ___________________ ___Vaginal itching __DischargeAge of menopause __Menopausal signs or symptoms __Postmenopausal bleeding.

Musculoskeletal System__History, of arihrilis; gout; joint poin, swelling, orstiffness, deformity __Range of motion limitations __Muscular poin __Muscle cramps __Muscle weakness __Gait problems (problems with walking) __Problems with coordination __Bock pain ___Joint stiffness __Limitations in movement __History of bock problems or disc diseaseNeurological System___History ot seizures, blackouts, strokes, fainting;headaches __Motor problemstics, tremors, paralysis, orcoordination problems ___Sensorynumbness, tingling ._.Memory: loss, disorienlalion __Mood changes __Depression _._History of mental health dysfunctionHematologlc 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

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