Ch1-4: DDx & Screening for Referral

yellow flags

s/s signaling to proceed with caution but keep in mind during treatment; may be atypical for the pt’s presumed current condition

EX: fear avoidance/kinesiophobia, catastrophizing, anxiety, depression, work/family/financial/social stressors, sleep disturbance, maladaptive coping

orange flags

suspected psychiatric disorder that PTs don’t diagnose → document & refer

EX: escalating depression/mania/psychosis/substance-related impairment, suicidal ideation

red flags

s/s that may be associated with serious medical conditions; can require urgent medical attention or a change in PT plan

red flags PTs need to be aware of

1. PMH & Family Hx

2. risk factors

3. clinical presentation

4. pain pattern

5. associated s/s

key red flags in relation to progress in PT

screening for referral

part of patient/client management model to distinguish systemic diseases that can mimic NMS dysfunction

process of screening for referral

hxs, risk factors, pain/symptom behavior pattern, associated s/s, ROS, clinical presentation/onset

outcome possibilities of screening for referral

team comms, caregiver training, skilled PT no longer needed

constitutional symptoms

weakens NMS hypothesis; fever, chills, disphoresis, fatigue, unexplained weight change

key final questions to ask the pt

“Are there any other symptoms or problems anywhere else in your body that may not seem related to what brought you here today?”

most common s/s or complaints associated with medical conditions

most common visceral pain referral sites

back/neck, shoulder, chest/breast region, ribs, hip/groin, pelvis/sacrum/SI region

cluster s/s characteristics of pulmonary system

dyspnea, cough, chest pressure/pain, pelpitations, orthopnea, edema, syncope

cluster s/s characteristics of hepatic/liver system

nausea, vomiting, altered bowel pattern, abdominal symptoms, jaundice

cluster s/s characteristics of integumentary/hematologic system

rash, wounds, unusual bruising/bleeding, lymph-node or mass changes

screening for communication, cognitive, or other psychosocial problems

situations that require immediate medical attention & guidelines

general systemic situations/presentations that require physician referral

unexplained pelvic/groin/low-back symptoms with systemic features; new pelvic pain accompanied by systemic illness/hemodynamic symptoms

women’s systemic situations/presentations that require physician referral

postmenopausal vaginal bleeding; unexplained menstruation symptoms; pregnancy-related bleeding/HTN

abnormal VSs situations/presentations that require physician referral

BP; HR, heart rhythm, recovery after activity; RR; O₂ saturation; temperature when infection/systemic illness is suspected; dizziness; chest symptoms; dyspnea; pallor; diaphoresis

cardiacvascular situations/presentations that require physician referral

chest pressure/pain at rest; new/worsening dyspnea, orthopnea, exercise intolerance; unexplained syncope; palpitations; abnormal vital-sign response/hemodynamic instability; new edema or signs of decompensations

pulmonary situations/presentations that require physician referral

worsening SOB; hemoptysis; persistent cough with systemic symptoms; chest/shoulder pain related to respiration/unexplained dyspnea; hypoxemia; new respiratory distress/inability to speak comfortably/inadequate ventilation

GI situations/presentations that require physician referral

abdominal pain; GI symptoms with back/shoulder pain; bloody stools/unexplained GI bleeding/major bowel-pattern change; pain linked to meals/visceral function instead of movement/loading

GU situations/presentations that require physician referral

hematuria; dysuria; change in urinary flow or flank symptoms; urinary incontinence with neurologic symptoms; systemic symptoms with unexplained pelvic/groin/back pain

MSK situations/presentations that require physician referral

sudden worsening limb ischemic symptoms; new unilat swelling, warmth, pain, venous thromboembolism; severe chest/back/abdominal pain with hemodynamic/pulsatile features concerning vascular pathology; syncope/hypotension; new exertional symptoms outside of NMS pattern

cancer situations/presentations that require physician referral

hx of malignancy; new unexplained/progressive pain without a convincing mechanical pattern; unexplained weight loss/constitutional symptoms in context; persistent/enlarging mass or lymph-node change; unexplained bleeding; new bone pain at night/rest

precautions to PT

contraindications to PT

constitutional symptoms → systemic conditions, not NMS symptoms