Editorial
Objectivity in physiotherapy
assessment
hysiotherapists are clear about the meaning
P of objective and subjective information
when assessing a patient. Objective data are
considered to be a set of ‘facts’ representing
the patients current status; the blood gas results, X-
ray changes, goniometry measurements or lung func-
tion tests. Subjective information is used to embellish
the objective facts: the patients’ attitudes, opinions,
social history and the physiotherapists interpretation
of the facts (Goldberg, 1994; O’Shaughnessy, 1994).
Objectivity and subjectivity
Objective data are useful because of their clarity and
simplicity; an oxygen partial pressure of 6 Kpa is bad
in anyone’s language. Objective information also
allows you to see clearly how the patient is pro-
gressing, judging the patients’ health against a
learned set of normal values.
Conversely, subjective data are riven with bias and
personal interpretation, and so are only used for
background information. There are few clinical deci-
sions that are made on the a basis of such subjective,
informal, unprovable assumptions.
Objective data represent no such thing. They repre-
sent a narrow, positivist view that all patient informa-
tion can be reduced to a finite number of interlinked
variables, i.e. material that exists in the real world that
is waiting to be perceived by you. Some perceived
experiences become so universally understood that
they become known as ‘objective reality’. So in most
areas of the world a green traffic light means ‘go’.
Higgs and Titchen (1995) stated that:
‘An important aspect of the development of
higher cognitive skills and clinical reasoning abil-
ity is the ability to construct and use knowledge.
The construction of knowledge requires the indi-
vidual to process experience and to develop a rep-
resentation of reality. This could be described as
developing constructs which help to explain or
interpret reality, or engaging in mental abstrac-
tion and interpretations based on experience.’
There are very few objective features of the world
that are universal. What you experience of the world
is a social reality. Everything you see, do or have an
effect on requires your brain to interpret the inter-
acting. You then interpret this and place meaning
upon it. No two people will look at the same X-ray
the same way (Hughes, 1990) — ‘what is food to one
man is bitter poison to another’ (Titus Lucretius
Carus, 99–55BC).
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So the objective data given on an X-ray, i.e. the pat-
terns of light and dark, can be interpreted by a skilled
therapist as meaning that the patient has a large left
pneumothorax with some mediastinal shift, probably
secondary to traumatic rib fractures. Taking the objec-
tive information and applying subjective interpreta-
tion to it is a core skill of the therapeutic assessment.
Perception
Objective information requires perception. In
humans perception comes from the senses. You take
the objective data in and from then onward it
becomes a subjective experience. It becomes framed
by your experiences as a therapist, your eduction,
prejudices, opinions, etc.
In essence there is nothing that can be perceived by
the therapist that does not require subjective evalua-
tion. Blood gases, for instance, are numerical repre-
sentations of objective data, but they are worthless
unless the therapist recognizes when they are abnor-
mal and relates them to the patient and the therapists
prior experience of respiratory problems.
When therapists are trained, the successful ones are
those that can perceive information, filter that which
is useless to them, subjectively interpret the informa-
tion and develop solutions (Caws, 1988).
Pain has always been perceived as a subjective
human experience (Warga, 1987; May, 1992), but
most therapists are aware of only quantitative meth-
ods of assessing pain. To assess pain and its daily
variability is an essential part of the therapeutic
process and most therapists make subconscious
interpretations of a patients pain.
When it comes to interpreting the patients pain the
physiotherapist first needs to give meaning to it.
Normally the physiotherapist listens to the patient
telling them how it feels, and may see the pain on
their face. It will mean something to the physiother-
apist because of his/her own pain experience,
although he/she can’t feel the pain him/herself.
Going on to assess this pain it seems ludicrous then
that the physiotherapist should try to add the com-
plicated, unnecessary mental step of translating a
perceived feeling, rooted in emotion, experience and
empathy into a numerical pain scale (Mattingley and
Falconeralhindi, 1995; Waterfield and Sim, 1996).
Conclusion
Physiotherapy is not the only profession having to
come to terms with its duality: nursing and the social
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 Objectivity in physiotherapy assessment
professions have for some 20 years attempted to
address these problems and there is a great deal that
we can learn from their experience (Porter, 1993;
Schutz, 1994; Playle, 1995).
Physiotherapists consider the terms objective and
subjective every time they assess a patient and yet
few appreciate how misused they are as a core con-
struct of physiotherapy. Physiotherapists feel that
KEY POINTS
● Therapists believe that they understand the
difference between objective and subjective
information.
● When assessing patients, therapists believe
that they use both types of information.
● Therapy assessments are, however, entirely
subjective.
● Subjectivity is the basis of our decision making.
● Effective decision making relies on the
assimilation of subjective interpretations of
events for effective action.
British Journal of Therapy and Rehabilitation, May 1996, Vol 3, No 5
they can be objective about assessment, but most are
failing to acknowledge the difference between
robotic data collection and skillful, subjective deci-
sion making.
David Nicholls
Senior Lecturer
School of Health and Community Studies
Sheffield Hallam University
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