Dysfunction Before Diagnosis: A Case for Symptom-Based Approach to Patient Care

Background: Direct access has allowed physical therapists to evaluate and treat patients potentially in the absence of a clear medical diagnosis. The purpose of this study is to show that physical therapy can improve patient outcomes by using symptomology to drive treatment rather than a diagnosis. Case Description: The patient was a 52 year old female with an idiopathic systemic muscular fibrosis primarily affecting her bilateral lower extremities. She had several tendon releases throughout her BLE with subsequent physical therapy to improve functional capabilities and quality of life. Outcomes: Outcomes were assessed using the lower extremity subscale of the Care Connections Functional Index. The patient improved from 70 to 25 over the course of 7 months of physical therapy, well beyond the MCID of 11. Discussion: This case highlights the use of symptomology to drive patient care in the absence of a clear medical diagnosis. Physical therapy interventions can improve functional outcomes and quality of life by addressing range of motion restrictions, strength deficits, and tissue mobility dysfunctions.