Editor's Note: Confused About Physical Therapy Diagnosis and Differential Diagnosis?

Journal of Neurologic Physical Therapy, Dec 2004 by Deutsch, Judith E

Last year in my home state of New Jersey, direct access became a reality and the relevance of the physical therapy diagnosis became paramount. Fortunately, the distinction between the medical and physical therapy (PT) diagnosis was clear to me. Unfortunately, I was and frankly still am confused about PT differential diagnosis.

The primary aim of a medical diagnosis is to identify the pathophysiology of the condition and its subsequent treatment. OK, that is easy the patient has a right middle cerebral artery ischemie cerebrovascular accident. The PT diagnosis as stated in the Guide to Physical Therapist Practice (2nd cd) and the American Physical Therapy Association's Normative Model of Physical Therapist Professional Education defines diagnosis as both a process and a label in which physical therapists perform an evaluation in order to provide a diagnosis that identifies the impact that a condition has on function.1,2 OK, that is easy, although not that helpful, in the case of the patient with CVA, they would fall under practice pattern 5D. And at a task level I would say the patient had a gait dysfunction, which is associated with a constellation of impairments (such as impaired force generation and balance).

The PT diagnosis is the end point of the examination and evaluation process and then is used to guide the plan of care. So what happens if the patient presents with a different clinical picture on a subsequent day? I would need to re-examine and evaluate the patient. Sullivan and colleagues, in their article in this issue of JATTJ label this process as one in which physical therapists' findings lead the physician to re-examine the original diagnosis as a differential diagnosis. It is a collaborative process between the PT and the physician. OK, that is a novel characterization for differential diagnosis.

But what happens when I determine that the constellation of impairments identified in the initial exam are not the essential ones related to the diagnosis of gait dysfunction. Do I re-evaluate the client? Am I performing a differential diagnosis. According to Goodman,3(p4) the comparison of neuromusculoskeletal signs and symptoms to identify the underlying movement dysfunction is a PT diffrential diagnosis.

So perhaps I am not as confused as I thought. It seems then that the term PT diffential diagnosis can be used in 2 very different forms: one is in collaboration with the physician to modify the medical diagnosis and the other is solo in order to refine the etiology of the PT diagnosis. Is that right?

REFERENCES

1 American Physical Therapy Association. Guide to Physical Therapist Practice. 2nd ed. Alexandria, Va: American Physical Therapy Association; 2001.

2 A Normative Model of Physical Therapist Professional Education: Version 2004. Alexandria, Va: American Physical Therapy Association; 2004.

3 Goodman CC], Snyder TEK. Differential Diagnosis in Physical Therapy. 3rd ed. Philadelphia, Pa: WB Saunders; 1990.

Judith E. Deutsch, PHD, PT, Editor JNPT