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Journey of a DPT Student

Tests in the PT Clinic

Published September 19, 2011 6:29 PM by Lauren Rosso

I'm starting to find some conflict between what I am learning in class and what people actually do in the clinic. Not that I'm surprised it's happening, but the inconsistency is something I struggle with at times.

In class, we've covered goniometry, manual muscle testing and the basics of the lower quarter screen. We are obviously instructed to perform each test in a specific position, but I am quickly starting to realize that this does not translate to the clinic. Which brings me to two different issues. First, if these tests are not practiced in the "correct" manner, whether it's due to time constraints or patient comfort, how useful is it to learn them in the first place? On the other hand, if the slight changes that come about with patient positioning really do improve the tests, why are we not doing them?

However, the most challenging aspect is being a student, and not knowing which road to take. I feel slightly ridiculous when I'm having a patient move around five different times for five different muscle tests (most of which, as I'm seeing, can be performed from one or two positions). I just don't know how to walk the fine line between the gold standards we are learning and practicality in the clinic.

Does this all really matter? Does a hamstring test change between sitting and prone? These are the current issues I'm struggling with.

2 comments

Connie- thank you for your insight.  So much of this is going to come with experience, but that's obviously the last thing I have right now.  I'm just not confident enough in my clinical judgment to choose a test position that I haven't been taught.  

You sound like an excellent PT.  Please keep the feedback coming!  I need all the help I can get.

Lauren Rosso September 25, 2011 8:29 AM

Hi Lauren,

Reading your comments on positioning patients for goni/MMT took me back to when I was a student and wondered why things weren't always done in the real world the way we were taught in school.  It's best to know the basics then as you gain experience you will find ways of saving time by learning to identify through gross screening of a patient's movement and the patient's diagnoses which tests you need to perform and in what position.  Although it's best to place patients in the standard testing position for replication, sometimes you may have to vary the position to avoid increased pain or because of weakness (less than a 3-/5 strength)or contraindications (e.g. a patient with COPD or CHF may not be able to lie prone for a hamstrings test). One way around this is to document what position you had the patient in when you tested them.  That way you or someone else can replicate the test and your results/progress will be more reliable/accurate.

Unfortunately it is also true that we don't always have time to test patients in the standard positions at initial eval.  Sometimes you might have to choose what's most important (functional tests or specific tests) in order to give you the critical data you need to build a plan for achieving a patient's long term (functional goals).  Goniometry and MMT might only play a small role in the treatment plan for one patient and a larger role for another (e.g. orthopaedic patient).  

A student's role is to learn all those skills well and know the positions and alternate positions as well as what is normal for each joint range of motion and build from there. As far as repositioning the patient multiple times, if you are not already doing this, try to do all the tests you need in one position before having the patient change to another position.  I would encourage you to continue to do the standard testing positions where appropriate while still a student.  Don't be afraid to talk to your clinical instructor about your concerns. It's ok to ask others to please document their testing positions for you if not standard so that you can replicate their tests better when you treat their patient.

Hope this helps.

Connie Sutherland, acute/IRF - PT, Odessa Regional Medical Center September 24, 2011 1:42 PM
Odessa TX

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