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Evaluation Tips and Tricks
998 Plays2 years ago
Josh and Miranda talk about evaluation tips and tricks.
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Transcript
Introduction and Efficient Hand Therapy Evaluations
00:00:06
Speaker
Hi, I'm Josh McDonald. And I'm Miranda Matryri, and we are Hand Therapy Academy. We're going to talk a little bit about some eval tips and tricks, some of our favorite things that we, whether it's teaching a new hire or students or someone who's kind of new to doing hand therapy evaluations, to kind of make the best use of your time because we don't always get to block big chunks of time for evals. So let's maybe go over some of our things to kind of make our evaluations more effective and more efficient.
Tailoring Evaluations to Patient Complexity
00:00:31
Speaker
Yeah, and I think this depends on the patient too, right? So we can have a very simple patient, like a distal rate of structure, which we know can be more complicated, or we can get into something very complex, like some of our patients with hypermobility disorders and things like that. So how do you know what to focus on, Josh, or when they have so many complaints, where do you go?
Creating Priority Lists for Patient Concerns
00:00:55
Speaker
One of the things I like to do, and we talked about this ahead of time, is making a list of things and getting that person to kind of consolidate. Maybe they've got five things or 10 things. If it's maybe an Ehlers-Danlos eval and they're talking about hand pain and range of motion and
00:01:10
Speaker
Kitchen stuff and and make it like a priority list and say okay We can get through some of these things, but we can't necessarily get through all of them today So let's maybe let's pick our top three to four for today and we'll start giving you some ideas But let's keep that list going for future visits Yeah, and then are you doing like special tests on every single joint? You know, like how how do you do that when they have elbow pain shoulder pain hand pain? How are you gonna get that eval done in an hour?
00:01:40
Speaker
Yeah, there's so many provocative tests. If I have a patient that's got this systemic upper quarter arm hand, I'm going to focus on some of my clinical reasoning skills that allow me to say, you know, I'm only going to need to do like three or four, maybe shoulder tests and a couple of elbows and kind of go with this history and presentation and really kind of
Tracking Measurements and Flow for New Therapists
00:01:58
Speaker
focus in. And if it's a rotator cuff pain patient, I'm going to do several tests there. But if it's a more diffuse thing, I may have to kind of target in and say, I'll do one thing for
00:02:09
Speaker
a torn labrum test and one thing for a lateral epicondylalgia test and really kind of focus in so I'm not getting lost in provocative tests. Right. Yeah, yeah. How about, let's see, talking about what your flow looks like or how do you teach someone who's brand new to it to keep track of what their measurements are and do you do any kind of special documentation for that?
The Importance of Interviews and Cheat Sheets
00:02:35
Speaker
Yeah, I think this is where students or new therapists really struggle is how to get everything in and during that evaluation, right? So there's certain things like I'll give them a little cheat sheet of these are the top things you're going to look for, you know, your new range of motion strength, if it's appropriate sensory test.
00:02:50
Speaker
And then really a good solid interview, right? A lot of times your patients will tell you, hey, I'm having a lot of pain reaching up into my cupboard and doing those things. And you can really gather a lot just from doing the interview, asking them what really bothers them. So I think getting that portion done and then having the cheat sheet that they can look at as they're doing the evaluation. Because some of the documentation systems that we use have so many things to check off and look at. It's so overwhelming.
00:03:19
Speaker
Yeah. Yeah. And we've all done an eval probably within the last couple of weeks where we finished and like, darn it, I didn't test for monofilament or two point, or I forgot to do the whole rotation stuff or TFCC.
Conducting Provocative Tests Efficiently
00:03:32
Speaker
So having a cheat sheet helps make sure you don't miss anything. But again, like you said, focusing on that conversation and that history, that can give you way more information if you're getting the right questions asked. Yeah. And it can save your time on doing special tests, right?
00:03:47
Speaker
Oh, yeah. Yeah. Weed out some of the things. Okay. Don't need to worry about that. They're not talking about elbow pain like the, maybe the script said, elbow and shoulder. They're just talking about shoulder or not both sides or those kinds of things. And another things I'll tell students too is when you're going through and you're deciding on these provocative tests,
00:04:03
Speaker
If you do the one that you think it is and it makes them hurt, then all the other special tests are going to be positive as well. So what I tell them is if you have some suspicions, do the things that you suspect the least and then work your way up to the thing that you think it definitely is. So that way you're not causing these false positives on all these other special tests.
00:04:22
Speaker
Yeah,
Functional Tests to Show Progress and Justify Treatment
00:04:23
Speaker
yeah. I'll save, like for a carpal tunnel evaluation, I'll save Durkin's test, that compression to the median nerve for a prolonged time, 30, 60 seconds. I'll save that for the last of those things, because tonnels, that usually passes quickly. A positive test usually passes quickly. And maybe a compression with the phalons, those things can persist a little longer, and now everything's flared up, so they all look positive.
00:04:45
Speaker
Yeah, it can be overwhelming, I think, when you have all these special tests that are positive. Yeah, yeah. One of the things I like to add when I have the time and it's appropriate is functional testing, whether it's the Moberg pickup test, which is a little bit older test, but very easy to administer and functional and standardized test.
00:05:04
Speaker
A nine-hole peg test may be Purdue, although that one's a little bit more long and complicated. A box and block is less about fine motor dexterity, but more about coordination proprioceptive. Some of those functional tests give us a great window into how it's affecting their function beyond just the quick dash self-reported stuff.
00:05:21
Speaker
It also helps us with justification for insurance because if I can say strength, range of motion, pain, and functional outcomes on a functional test, that gives me just another layer, gives me goals to set. So some of those can take another five or seven minutes or something like that to administer if they're close to get to, but can give you a lot of ammunition for goal writing, justification for plan of care, and insurance.
00:05:44
Speaker
Yeah, that's true. Doing standardized testing can be really helpful. And then if you ever plan to go back and do retrospective chart reviews too, you can kind of see track some of your outcomes a little better. Yeah, yeah. When you're doing progress reports, keep administering those. That gives you a good outcome. I won't use those in treatment if I've used them for pre-test, post-test stuff, because then you're teaching to the test, but good for documentation and justification.
Gaining Insights from Patient Observations
00:06:08
Speaker
The other thing too, I tell students, you can blame a lot of information from how that patient walks into your clinic, right? Are they using that injured hand to carry their purse? Are they writing with that hand? Are they protecting it? Are they guarding it? So just by observing them in what they would naturally be doing, you can get a lot of information without necessarily having to ask.
00:06:29
Speaker
Yeah, I can watch them carry their person, set it down on the table, and then say, I can't lift anything with my hand. And I may not call them out on it and say, hey, what about that? But it gives me more information of maybe there's psychology of this disability. They may not realize, and I can do things with it, or they have more potential available for that. Right, yeah, definitely. Lots of information.
Balancing Evaluation Focus with Rapport Building
00:06:52
Speaker
There's also a part of that interview process. We want to spend good time there, but we want to keep it focused too. And sometimes that's really hard to keep that patient directed and focused on the task at hand. They come in and they're not used to maybe like a doctor will come in for three minutes in and out. We're going to give them more direct one-on-one attention. And so some of our patients will drift conversationally into
00:07:15
Speaker
what they did for work 20 years ago and all this other things that may not be relevant. So it's hard to keep people focused on that task at hand to get through all the check boxes we need to accomplish.
00:07:26
Speaker
Yeah. So I think with those patients, you know, sometimes I'll do is try to be very diplomatic about it, but say, Hey, do you mind if we focus on getting through this about? And then I would love to hear that story with the last few minutes that we have left. So then you're still giving them a chance to share, but also you're telling them, Hey, we need to really focus on what you're actually here for.
00:07:46
Speaker
Yeah. And I think patients are okay with us multitasking and saying, you know, while I've got you in composite flexion, as much as you've got, I'm going to do some measurements. And then while they're kind of explaining the story, you're getting some measurements and jotting things down as you go. So multitasking and not just sitting and waiting for them to finish, but still engaging in the, in the task of evaluation and say, Oh, hold that thought for a minute. I can't think of a number at the same time as I'm listening. And I don't want to, you know, I want to hear your story, but I can't do two things at the same time. And that kind of gives you some leeway.
00:08:15
Speaker
Right. Yeah. Because we know it's important to listen to them, right? You're building rapport and doing those other things too, but also, you know, they're there for a reason. Yeah.
Finding Personal Assessment Flow for Students
00:08:24
Speaker
Another thing we like to help our students or new grads with is letting them find their flow in an assessment. You know, there's things you have to check off on box. You have to get range of motion, strength if it's appropriate for processing, but they can find their own flow and what makes sense to you. So if it's a cheat sheet they're using, it doesn't have to look like every other student's cheat sheet.
00:08:42
Speaker
do you wanna do range of motion first, do you wanna have a conversation first, do you like to do just some palpation, just kinda show me a quick screen. They need to find that flow for them, that's the art side of what we do, is them getting comfortable with their own pathway. Yes, very true.
Conclusion and Contact Information
00:08:57
Speaker
Yeah, so hopefully this helps give you some ideas on ways to make your evals more efficient, more effective, and getting out of the information you need to, hopefully without missing stuff.
00:09:08
Speaker
Yeah, so for more information, you can check us out at handtherapyacademy.com or send us an email, which is info at handtherapyacademy.