International Framework for Red Flags for Potential Serious Spinal Pathologies

Finucane, Laura; Downie, Aron; Mercer, C. F.; Greenhalgh, Susan; Boissonnault, William G.; Pool-Goudzwaard, Annelies; Beneciuk, Jason M.; Leech, Rachel L.; Selfe, James

doi:10.2519/jospt.2020.9971

Cited by 147 publications

(161 citation statements)

References 68 publications

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“…(Jones et al, 2019) A recently published Red Flag International Framework provides more detail about the relationship of a number of Red Flags to specific serious spinal conditions. It gives clear guidance on timely management and supports the safety netting approach (Finucane et al, 2020).…”

Section: Introductionmentioning

confidence: 76%

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Safety netting; best practice in the face of uncertainty

Greenhalgh

Finucane

Mercer³

et al. 2020

Musculoskeletal Science and Practice

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Safety netting is a recognised General Practitioner (GP) diagnostic strategy often used in the face of uncertainty to help ensure that a patient with unresolved or worsening symptoms knows when and how to access further advice. It is an important way of reducing clinical risk. In the context of the COVID-19 pandemic and the rapid move to mainly remote consultations within the musculoskeletal field, safety netting is an important strategy to embed within all consultations. Only those presenting with potentially serious conditions are offered face to face consultations. Screening for Red Flags and any indication of a serious cause of symptoms is always first line in any consultation, however, clinical presentations are not always black and white with patients falling into a clear diagnostic category. With patients minds more focussed on COVID-19 symptoms this can be problematic. With the additional ramifications of public health social restrictions, onward management can be a conundrum. Many people with risk factors of serious pathology are also as a consequence, vulnerable to contracting COVID-19. In situations of uncertain clinical presentations, to avoid unnecessary social contact, safety netting can help to monitor symptoms over time until the clinical context becomes more certain. Embedding safety netting within physiotherapy best practice could be a silver lining in this pandemic black cloud.

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Section: Introductionmentioning

confidence: 76%

“…� People with cancer and currently having active treatment. � BMI of 40 or over (Public Health England, 2020. Finucane et al, 2020.…”

Section: Introductionmentioning

confidence: 99%

Safety netting; best practice in the face of uncertainty

Greenhalgh

Finucane

Mercer³

et al. 2020

Musculoskeletal Science and Practice

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“…Those signs, within musculoskeletal context are defined as Red Flags (RF) (e.g. clinical indicators of possible serious pathologies ) [40,41] and, notwithstanding RFs as selfcontained screening tools seem to be weak during the physical examination of the patients with some MSK diseases [52], the combination of multiple RFs for the screening for referral process is promising [55,56]. Furthermore, clinical decision making in patients with MSK pain conditions can be supported using validated tools [42][43][44][45], in order to perform or not a review-of-systems [5,23] and for medical referral [42][43][44][45].…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, screening of personal and family medical history, assessment of the risk factors (e.g. smoking, body mass index, congenital or hereditary diseases), screening for RFs [55], watchful waiting [52], and linking RFs symptomology directly with health status and vital parameters, are mandatory professional skills for PT in direct access clinical settings [5,9,23], as it has been clearly stated from a widespread clinical practice guideline [58]. From the patient perspective, the physical examination conducted by the PT demonstrated the professional skills needed to decision-making process for differential diagnosis and medical referral.…”

Section: Discussionmentioning

confidence: 99%

An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report

Storari¹,

Barbari²,

Brindisino

et al. 2021

Arch Physiother

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Background Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral. Case presentation A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction. Conclusion This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.

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“…72 Importantly, clinicians are encouraged to evaluate the presence of differential diagnoses and serious pathologies (red flags) masquerading as entrapment neuropathies (Table 1 ). 56 …”

Section: Assessmentmentioning

confidence: 99%