Red Flags: To Screen or Not to Screen?

Ross, Michael D.; Boissonnault, William G.

doi:10.2519/jospt.2010.0109

Cited by 31 publications

(20 citation statements)

References 27 publications

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“…red flags) (Figure 1). Various red flags associated with MSK pain have been described and are well understood (Downie et al, 2013;Leerar, Boissonnault, Domholdt, and Roddey, 2007;Ross and Boissonnault, 2010;Sizer, Brismee, and Cook, 2007). Screening for red flags in accordance with direct access standards has also warranted an increased use of review of systems, to allow for a more comprehensive screen prior to interview, let alone physical examination and treatment (Goodman, 2010;Leerar, Boissonnault, Domholdt, and Roddey, 2007;Ross and Boissonnault, 2010).…”

Section: Screening Patientsmentioning

confidence: 97%

Listening is therapy: Patient interviewing from a pain science perspective

Diener

Kargela

Louw

2016

Physiotherapy Theory and Practice

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The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain mechanism assessment.

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Section: Screening Patientsmentioning

confidence: 97%

Listening is therapy: Patient interviewing from a pain science perspective

Diener

Kargela

Louw

2016

Physiotherapy Theory and Practice

View full text Add to dashboard Cite

show abstract

“…This finding may be important, as Haggman et al 9 found that physical therapists often missed signs of clinical depression in patients presenting with low back pain and suggested implementation of a simple screening device that would alert them to this common malady. In a recent editorial, Ross and Boissonnault 16 identified clinical depression as a condition that can adversely influence the prognosis of individuals seen by physical therapists but may not receive the attention of clinicians, who may be otherwise focused on screening for red flags that suggest more serious pathology.…”

Section: Discussionmentioning

confidence: 99%

Five-Position Grip Strength Measures in Individuals with Clinical Depression

Phillips

Biland²,

Costa³

et al. 2011

J Orthop Sports Phys Ther

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“…1,6,26,57 There are several reasons to recommend screening in the outpatient setting, including direct access by physical therapists, referral by other providers without examination or attention to red flags, and development or progression of symptoms associated with disease over time. 25,54 Important historical information such as presence of severe medical comorbidity should be routinely obtained, and our data suggest equal importance of screening for total number and severe comorbidities among patients with spine and extremity conditions. This screening may assist in decision making related to therapeutic interventions or referral to a physician for further medical workup or diagnostic imaging.…”

Section: Discussionmentioning

confidence: 99%