Welcome to a series of articles dedicated to teaching you how to pass the NPTE based on your clinical experience and NOT long hours of studying in a dusty library.
The FSBPT stresses that the purpose of the NPTE is to make sure that physical therapists are not only competent in knowledge, but also know how to keep patients safe while treating them. It is tempting for a physical therapist to focus on the musculoskeletal and neurological systems, which is why many went into the field to begin with. However, physical therapists are gaining more responsibility in health care, and with that responsibility comes the need to be able to better see the patient’s medical complexities as a whole. This is even more imperative since more parts of the country are allowing direct access to physical therapy; knowing potentially serious medical problems a patient has cannot be missed.
In this article, let’s discuss what the FSBPT wants you to know about client assessment and information gathering.
After formal introduction, the first step of the evaluation involves taking an accurate history from the patient.
The goal of the history of present illness is to determine the source of a patient’s complaint and to ensure an accurate diagnosis and treatment plan. While it is tempting to focus only on the primary complaint, the physical therapist must always look at the big picture. Other medical problems should be reviewed and the physical therapist must determine their relevance. For example, a referral for abdominal wall pain from a Sports Medicine physician, may be Barrett’s Esophagus. Recognizing that a patient has a history of heart burn may lead you to recognize that GERD may be the etiology of abdominal pain. For the NPTE, they may present a question set up as a patient with abdominal pain and ask how to treat. They may tempt you to pick “core exercise” but the correct answer may be to refer to their PCP for GERD treatment. Be sure to read the entire question stem and look at everything in its entire context.
Establishing a prior level of function and comparing to the current level of function is important primarily for prognostic purposes and for designing a proper treatment plan. Also, more and more payer sources are using this data to determine further continuation of therapy services. On the NPTE, they may ask what a likely outcome will be for a hip fracture, and present a history of “CVA” in the question stem. Knowing that a patient has a history of a CVA may limit his probable outcome measure.
There will be questions on the NPTE that force you to recognize red flags. Do not take for granted the information presented in the question. Back pain at night with abnormal weight loss, think cancer. Difficulty with swallowing and speech with muscle spasms and a foot drop without sensory changes, think ALS. Read and understand the stem. Don’t forget to look for the red flags.
Determine if medications may be an issue. An example question may be that you are using the tilt-table, and a patient with an SCI commonly develops symptomatic hypotension. You should be able to recognize that the patient is on Flomax and Zanaflex, which may be contributing to hypotension.
Know your standardized pain and assessment scales. The NPTE will test this for sure.
Finally, you should be able to recognize emergency situations. In the hypotensive SCI patient presented above, you should recognize that the appropriate next step is to lower the table and check vitals. If no improvement, you should recognize that 911 should be called, for example. The FSBPT will definitely test your responsiveness to potentially worsening situations. Just recall how you learned to handle these situations during your training.
Take Home Point
Read the question stem. Do not take for granted that the NPTE will offer you a patient’s medical history. It is probably relevant to the question. See each question as a real patient, and treat the whole patient (or question), not just the presenting complaint.