One of our Physical Therapists’, Angela Listug-Vap, is attending the annual American Academy of Orthopedic Physical Therapists (AAOMPT) conference in San Antonio. She will be blogging for the next week on up-to-date topics being discussed by some of the top Physical Therapists in the nation.
It is obvious to all of us that our Primary Care Physician (PCP) will diagnose a medical condition and rule out any signs and symptoms of a more serious medical condition. You may not recognize that many (if not all) healthcare providers should have some working knowledge on screening out serious medical conditions. This makes sense for a lot of different reasons. The most obvious is that other healthcare providers get the opportunity to spend a lot more time with you. Think of how long you spend with your Physical Therapist, Massage Therapist, or Nurse in the hospital.
Today one of the topics discussed is diagnosing for “red flags”. Physical Therapists must do this to ensure that the symptoms their patient is complaining about is actually musculoskeletal in origin and not just appearing that way on the surface. A perfect example is a heart attack. If someone comes in with left sided arm pain that began for no apparent reason but when asked they have also been short of breath and have pressure in the chest, you can bet a Physical Therapist is going to refer them on the Emergency Room and not waste valuable time trying to treat arm pain. These algorithm’s might seem simple, but they are based on a lot of research, and when used to help make clinical decisions reduce errors in diagnoses, ensure the people needing further testing are referred on quickly and not overtesting individuals that do not need it. Below are a few more examples.
DVT: Deep Vein Thrombosis (Wells et al, JAMA 2006)
If the person scored 3 or more there is a high risk for DVT and should be referred for further diagnostic testing. A score of 1-2 is moderate risk. A score of 0 or less is low risk and does not need to be referred on for more testing.
- active cancer (treatment ongoing, w/in previous 6 mos. or palliative) +1
- paralysis, paresis or plaster immobilization of the lower extremities +1
- bedridden 3-days or more or major surgery in last 12 mos. requiring anesthesia +1
- localized tenderness along distribution of deep venous system +1
- entire leg swelling +1
- calf swelling 3cm larger than uninvolved side +1
- pitting edema on symptomatic leg only +1
- collateral superficial veins (nonvaricose) +1
- previous history of DVT +1
- alternative diagnosis at least as likely -2
Vertebral Compression Fractures (Roman et al, JMMT 2010)
If the person has 2 or less positive tests out of 5 it is unlikely that their back pain is related to a compression fracture. If the person has 4 or more positive tests there is a high suspicion of a compression fracture and would warrant further testing.
- age > 52 years
- no presence of leg pain
- BMI < or = 22 (thin framed)
- does not exercise regularly
- female gender
The take home message: our PTs at Alpine Physical Therapy are using the best evidence to help make our clinical decisions and ensure you get excellent musculoskeletal care right from the beginning – even if that means referring you on to rule something else out .