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Ch. 1: Introduction to Screening for Referral in Physical Therapy (reasons…
Ch. 1: Introduction to Screening for Referral in Physical Therapy
need to screen
ensure a candidate for PT
identify S&S of systemic
it can mimic
neuromuscular
musculoskeletal
screening is an
ongoing process
3 key factors
comorbidities
visceral pain mechanisms
induce neuroendocrine immune response
regain homeostasis
pain patterns
shoulder
, chest/breast/rib,
back/neck
hip/groin
sacroiliac/sacrum/pelvis
Side effects of meds
common w/ pts who think its neuromusculoskeletal
reasons for screening
signed prescription
MD refer w/ out seeing pt based on complaints
med. specialization
MD overlooks underlying systemic
Quicker/ sicker
hospitals push pts out faster
comorbidities
delayed care -lack of access
disease progression
disease current?
previous diagnosis
familiarity of risk factors for early detection
Direct access
first contact w/ pt
refer if needed
pt/client disclosure
fear
embarrassment
forgetfulness
yellow/ red flags
yellow
caution
red
refer
bilateral
night pain
weight change
greater than 10%
symptoms unaffected by mvmt
pain worse w/ activity
affected by eating
cannot provoke symptoms in exam
Medical Screening vs. Screening for Referral:
Medical Screening
detection of disease before seeking care
analysis of risk factors
pts don't have symptoms
do have high risk for
certain health outcomes
ex. colonoscopy , mammogram
Screening for Referral
determining
condition for PT
condition for MD
Screening vs. Differential Diagnosis:
screening
identifying a sign
requires further workup
requires referral
review systems and tests and measures
differential diagnosis
distinguishing one condition from another with similar S&S
done in overall evaluative
PT Role in Disease Prevention
tertiary
progressed stage
good prognosis
limit degree of disability
improve function in chronic/irreversible
health promotion and wellness
edu. support
clients make good health choices
conjunction w/ prim,sec,tert.
secondary
PT Screening
diseased
early detection to decrease duration/severity
DOES NOT PREVENT
primary
halting process if DEVELOPING issue
risk reduction
general health promotion
education
Diagnosis by the PT:
identify human mvmt impairments
specific is better
PT MUST
refer
treat
refer & treat
neither refer nor treat
medical vs PT BOTH DIFFERENTIAL
medical
comparison of
similar diseases and diagnostics to assess problem
PT
compare
NMS S&S
identify underlying HUMAN MVMT pattern
Elements of pt client MGMT
diagnosis
prognosis
evaluation
intervention
examination
direct access self referral
primary care
person focused care over time
autonomous practice
self governed, professional judgement
refer to other practitioners
practitioner of choice
Decision-Making Process: The Goodman Screening for Referral Model
risk factor assessment
primary and 2ndary intervention
clinical presentation
pain patterns/types
personal/family history
health habits, living environment
associated(observed) signs and symptoms
indication of disease
past medical history
meds , surgery
review of symptoms
NMS, cardio,intec
Physician Referral:
if they have one or give a list
before sending back to MD get a 2nd PT opinion
try to send client back to MD
call MD for tips to assist
do not suggest medical DX
not qualified
short paragraph of finings/interventions follow with concerns
immediate medical attn?
paint relieved or provoked