The diagnostic value of Red Flags in thoracolumbar pain: a systematic review

Maselli, Filippo; Palladino, Michael; Barbari, Valerio; Storari, Lorenzo; Rossettini, Giacomo; Testa, Marco

doi:10.1080/09638288.2020.1804626

Cited by 56 publications

(82 citation statements)

References 74 publications

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“…By doing so, the enhanced standards of physical therapy may provide the profession with a unique opportunity to promote as physician extenders with a neuromusculoskeletal specialty aimed to become the standard providers of conservative care. That is, preliminary evidence suggests that post-professional specialization is a mainstay for developing advanced clinical, decision making, and reasoning skills level [ 39 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Direct Access to Physical Therapy: Should Italy Move Forward?

Maselli

Piano²,

Cecchetto³

et al. 2022

IJERPH

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Direct access to physical therapy (DAPT) is the patient’s ability to self-refer to a physical therapist, without previous consultation from any other professional. This model of care has been implemented in many healthcare systems since it has demonstrated better outcomes than traditional models of care. The model of DAPT mainly focuses on the management of musculoskeletal disorders, with a huge epidemiological burden and worldwide healthcare systems workload. Among the healthcare professionals, physical therapists are one of the most accessed for managing pain and disability related to musculoskeletal disorders. Additionally, the most updated guidelines recommend DAPT as a first-line treatment because of its cost-effectiveness, safety, and patients’ satisfaction compared to other interventions. DAPT was also adopted to efficiently face the diffuse crisis of the declining number of general practitioners, reducing their caseload by directly managing patients’ musculoskeletal disorders traditionally seen by general practitioners. World Physiotherapy organization also advocates DAPT as a new approach, with physical therapy in a primary care pathway to better control healthcare expenses. Thus, it is unclear why the Italian institutions have decided to recognize new professions instead of focusing on the growth of physical therapy, a long-established and autonomous health profession. Furthermore, it is unclear why DAPT is still not fully recognized, considering the historical context and its evidence. The future is now: although still preliminary, the evidence supporting DAPT is promising. Hard skills, academic paths, scientific evidence, and the legislature argue that this paradigm shift should occur in Italy.

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Section: Discussionmentioning

confidence: 99%

Direct Access to Physical Therapy: Should Italy Move Forward?

Maselli

Piano²,

Cecchetto³

et al. 2022

IJERPH

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“…Among these, it must be considered AMI [51], which usually refers pain to chest or upper limb [9,38,40,41]. For that reason, physicians and healthcare professionals must be alert in differential diagnosis process during the physical examination of the shoulder [5,23,40,41], especially when palpation of the painful areas does not reproduce the patient symptoms [52], or in presence of autonomic signs as fever, diaphoresis, nausea and respiratory complaints which frequently occurring in presence of heart related visceral pain [7,53,54]. Those signs, within musculoskeletal context are defined as Red Flags (RF) (e.g.…”

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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“…To properly frame the diagnostic process of seizures, in order to distinguish between idiopathic or glioma-related epilepsy, it is necessary to perform a comprehensive history-taking, detailed physical examination and the most suitable imaging [ 45 ] within the assessment of patients complaining of TOS-like symptoms. Unfortunately, the etiology of seizures, similar to most of the red flags [ 46 ], is tough and often manifold to identify among acute or remote causes [ 47 ], but brain tumors as glioblastomas, which are the most common malignant type of CNS tumor [ 14 ], commonly determine such episodes [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report

Storari¹,

Signorini

Barbari³

et al. 2021

Medicina

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Background: Glioblastoma is the most frequent and aggressive malignant brain tumor among adults. Unfortunately, its symptoms can vary considerably depending on the size, location and the anatomic structures of the involved brain. Case report: A 58-year-old male amateur cyclist who suffered from sharp arm pain was examined for a thoracic outlet syndrome due to a previous clavicle fracture. Because of ambiguous results of the neck and nerve plexus imaging, he was referred to a neurosurgeon who properly suspected a brain tumor. The neuroimaging of the brain shown a 3 cm disploriferative mass with a blood enhancement within the left parietal lobe. The mass was urgently removed, and its histologic analysis stated a grade 4 glioblastoma. Conclusion: This case report highlights the differential diagnosis process and the teamwork approach needed to diagnose a rare presentation of a brain glioblastoma, which started its symptoms mimicking a thoracic outlet syndrome caused by a previous bone fracture.

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The diagnostic value of Red Flags in thoracolumbar pain: a systematic review

Cited by 56 publications

References 74 publications

Direct Access to Physical Therapy: Should Italy Move Forward?

Direct Access to Physical Therapy: Should Italy Move Forward?

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

A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report

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