Low back pain and physiotherapy use of red flags: the evidence from Scotland

Ferguson, Fraser; Holdsworth, Lesley; Rafferty, Danny

doi:10.1016/j.physio.2010.01.001

Cited by 35 publications

(17 citation statements)

References 14 publications

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“…Consequently, there is a lack of evidence supporting the accuracy of using red flags to identify serious pathologies, which are typically of low prevalence. 12,13,22,28,43 For example, a primary care inception cohort of acute low back pain in Australia recorded serious pathology in only 11 (0.9%) of 1172 patients. 22 At initial consultation, clinicians identified 11 patients with suspected pathology, but only 5 of those were confirmed.…”

Section: T T Conclusionmentioning

confidence: 99%

“…Because prior studies involving red flag symptoms have been conducted in primary care settings in other countries, they may have limited application to physical therapy practice in the United States. 22,32 Furthermore, studies in physical therapy settings have primarily included patients with low back pain 13,28 but not patients with neck, shoulder, or knee pain. More information on indications for further review of systems or systems-review assessment in a range of musculoskeletal conditions is needed, because patients are commonly seen and present to physical therapy with a similar number of comorbidities when compared to patients with low back pain.…”

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confidence: 99%

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Development of a Review-of-Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort

George¹,

Beneciuk²,

Bialosky³

et al. 2015

J Orthop Sports Phys Ther

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Physical therapists are gaining recognition as first-line health care providers in the treatment of musculoskeletal pain. This increased autonomy necessitates greater responsibility in determining appropriateness of T T STUDY DESIGN: Literature review and crosssectional study. T T BACKGROUND:Direct access to physical therapy necessitates greater responsibility to determine appropriateness of care by recognizing the potential for concomitant disease or systemic involvement. Recent research has identified excessive variability in the reporting of red flag symptoms. An initial step to improve the identification of red flag symptoms is the development of a standardized screening tool. T T OBJECTIVE:To describe the development of a review-of-systems screening tool appropriate for use by orthopaedic physical therapists. T T METHODS:First, a red flag symptom item bank was compiled from a systematic literature review to allow for further psychometric testing and development of a screening tool. Second, physical therapists in 11 outpatient clinics recruited patients presenting with primary complaints of neck, shoulder, low back, or knee pain. Patients completed the red flag symptom item bank and standard questionnaires for comorbidities, negative mood, quality of life, pain, and function. The development of the screening tool involved identifying and combining different 3-item sets that characterized the highest number of patients reporting at least 1 positive symptom response (operationally defined as "red flag symptom responder"). T T RESULTS:The literature search yielded 103 studies that met the inclusion criteria, and the final item bank consisted of 97 items representing 8 body systems. Four hundred thirty-one patients with primary complaints of neck (n = 93), shoulder (n = 108), low back (n = 119), or knee (n = 111) disorders contributed to the cross-sectional study. The number of red flag symptom responders was 393 of 431 (91.2%). These patients were older, more likely to be female, had lower income, and were more likely to report neck or back pain (all, P<.05). A 10-item review-of-systems screening tool correctly identified 372 of 393 (94.7%) responders, and a 23-item version identified all 393 (100%) responders. The review-of-systems screening tools and the complete 97-item bank had similar correlations with concurrent clinical measures, except for depressive symptoms. T T CONCLUSION:Concise red flag symptom identification appears to be feasible in outpatient orthopaedic physical therapy settings. Future research will determine how this reviewof-systems screening tool needs refinement for different patient populations and whether it predicts clinical outcomes or the need for referral to other providers.

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Section: T T Conclusionmentioning

confidence: 99%

mentioning

confidence: 99%

Development of a Review-of-Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort

George¹,

Beneciuk²,

Bialosky³

et al. 2015

J Orthop Sports Phys Ther

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“…Screening for UI in patients with back pain is recommended in order to rule out medical red flags, including cancer or cauda equina syndrome (Ferguson, Holdsworth, and Rafferty, 2010). However, the Eliasson, Elfving, Nordgren, and Mattsson (2008) study suggests that UI may not just be a red flag but also a comorbid disorder associated with one of the most commonly treated conditions in ambulatory care settings.…”

Section: Introductionmentioning

confidence: 99%

Urinary incontinence symptoms and impact on quality of life in patients seeking outpatient physical therapy services

Alappattu

Neville

Beneciuk

et al. 2016

Physiotherapy Theory and Practice

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Objective The objective of this study was to examine the frequency and types of urinary incontinence (UI) in patients seeking outpatient physical therapy for neuro-musculoskeletal conditions. Design Retrospective cross-sectional analysis. Patients A convenience sample of patients that positively responded to a UI screening question were included in this study. Methods Data were collected for age, sex, and primary treatment condition classified into one of the following (i.e. urinary dysfunction; fecal dysfunction; pelvic pain; spine; neurological disorders; or extremity disorders); UI type (i.e. mixed, urge, stress, or insensible); UI symptom severity; and quality of life impact. Main Outcome Measures Frequency of UI type, symptom severity, health-related quality of life (HRQoL) impact, and pad use were compared between treatment groups. Results The mean age of the sample (n=599) was 49.8 years (SD=18.5) and 94.7% were female. The urinary dysfunction group comprised 44.2% of the total sample, followed by the spine group with 25.7%, and pelvic pain with 17.2%. The urinary dysfunction group scored significantly higher on UI symptom severity and impact on quality of life compared to the pelvic pain and spine groups, but not compared to the extremity disorders, fecal dysfunction, or neurological disorders group. Conclusion These preliminary data indicate that UI is a condition afflicting many individuals who present to outpatient physical therapy beyond those seeking care for UI. We recommend using a simple screening measure for UI and its impact on HRQoL as part of a routine initial evaluation in outpatient physical therapy settings.

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“…Ferguson and colleagues [60] have highlighted the need for ongoing education of physiotherapists in the systematic recording of red flags. The evidence for specific interventions offered by musculoskeletal practitioners such as exercise and manual therapy varies from trial to trial; although the results of these trials may be attributed, at least in part, to the heterogeneous populations of patients recruited [58], the varying effectiveness of practitioners and their interventions needs to be considered also.…”

Section: Arguments For Considering Other Models Of First-contact Carementioning

confidence: 99%

Taking responsibility for the early assessment and treatment of patients with musculoskeletal pain: a review and critical analysis

2012

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Musculoskeletal pain is common across all populations and costly in terms of impact on the individual and, more generally, on society. In most health-care systems, the first person to see the patient with a musculoskeletal problem such as back pain is the general practitioner, and access to other professionals such as physiotherapists, chiropractors, or osteopaths is still either largely controlled by a traditional medical model of referral or left to self-referral by the patient. In this paper, we examine the arguments for the general practitioner-led model and consider the arguments, and underpinning evidence, for reconsidering who should take responsibility for the early assessment and treatment of patients with musculoskeletal problems.

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Low back pain and physiotherapy use of red flags: the evidence from Scotland

Cited by 35 publications

References 14 publications

Development of a Review-of-Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort

Development of a Review-of-Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort

Urinary incontinence symptoms and impact on quality of life in patients seeking outpatient physical therapy services

Taking responsibility for the early assessment and treatment of patients with musculoskeletal pain: a review and critical analysis

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