manuelletherapie 2010; 14(5): 184-192
DOI: 10.1055/s-0029-1245907
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Erkennen deutsche Physiotherapeuten anhand von Fallbeispielen Risikofaktoren (Red Flags) für die Behandlung?[1]

Do German Physiotherapists Recognise Risk Factors (Red Flags) by Means of Case Studies?C. Beyerlein1 , A. Stieger2 , J. von. Wietersheim3
  • 1physiotherapie beyerlein, Ulm
  • 2Johannes-Gutenberg-Universität Mainz, Institut für Physikalische Therapie, Prävention und Rehabilitation
  • 3Medizinische Fakultät, Klinik für Psychosomatische Medizin und Psychotherapie, Universität Ulm
Further Information

Publication History

Manuskript eingetroffen: 14.6.2010

Manuskript akzeptiert: 23.8.2010

Publication Date:
10 January 2011 (online)

Zusammenfassung

Im Rahmen der Diskussionen zum Erstzugang in der Physiotherapie in Deutschland kommen zunehmend größere Herausforderungen auf alle Physiotherapeuten zu. Im Zuge dessen von Physio-/Manualtherapeuten erwartete Kompetenzen sind das Erkennen von Risikofaktoren für die Behandlung.

Ziel dieser Arbeit ist herauszufinden, inwieweit Physiotherapeuten in Deutschland Red Flags erkennen und anhand von ausgewählten Fallbeispielen (Fallvignetten) die richtige Entscheidung im Management ihrer Patienten treffen.

Abstract

Within the scope of the discussion about direct access to physiotherapy in Germany all physiotherapists are increasingly confronted with growing challenges. As a consequence physiotherapists/manual therapists are expected to be able to recognise therapeutical risk factors.

Through the use of selected case studies this article aims to find out to what extent physiotherapists in Germany recognize red flags and come to a relevant decision in patient management.

1 Die Arbeit entstand im Rahmen der Dissertation des Erstautors zum Doktor in Humanbiologie (Dr. biol. hum.) an der Medizinischen Fakultät der Universität Ulm.

Literatur

  • 1 Arnold P, Dolder van R, Mutsaers B et al. Red flags bei Patienten mit Schmerzen im Lendenbereich.  manuelletherapie. 2009;  13 64-72
  • 2 Boissonnault W G, Bass C. Pathological origins of trunk and neck pain, part II: disorders of the cardiovascular and pulmonary systems.  Journal of Orthopaedic and Sports Physical Therapy. 1990;  12 208-215
  • 3 Brox J I, Gjengedal E, Uppheim G et al. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2,5 years follow-up.  Journal of Shoulder and Elbow Surgery. 1999;  8 102-111
  • 4 Buchberger M. Erkennen von Red Flags bei Patienten mit Low Back Pain.  manuelletherapie. 2007;  11 206-211
  • 5 Calmbach W L, Hutchens M. Evaluation of patients presenting with knee pain, part II: differential diagnosis.  American Family Physician. 2003;  68 917-922
  • 6 Cates J R. Abdominal aortic aneurysms: clinical diagnosis and management.  Journal of Manipulative and Physiological Therapeutics. 1997;  20 557-561
  • 7 Childs J D, Whitman J M, Sizer P S et al. A description of physical therapists’ knowledge in managing musculoskeletal conditions.  BioMed Central Musculoskeletal Disorders. 2005;  6 32
  • 8 Crout K L, Tweedle J H, Miller D J. Physical Therapists’ opinions and practices regarding direct access.  Physical Therapy. 1998;  78 52-61
  • 9 Daker-White G, Carr A J, Harvey I et al. A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments.  Journal of Epidemiology and Community Health. 1999;  53 643-650
  • 10 Della-Guistina D, Nolan R. Evaluation and management of acute low back pain.  Emergency Medicine. 2004;  36 20-28
  • 11 Deyle G D, Henderson N E, Matekel R L et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial.  Annals of Internal Medicine. 2000;  132 173-181
  • 12 Deyle G D, Allison S C, Matekel R L et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.  Physical Therapy. 2005;  85 1301-1317
  • 13 Deyle G D. Direct Access physical therapy and diagnostic responsibility: the risk-to-benefit ratio.  Journal of Orthopaedic and Sports Physical Therapy. 2006;  36 632-634
  • 14 FitzSimmons C R, Wardrope J. Assessment and care of musculoskeletal problems.  Emergency Medicine. 2005;  22 68-76
  • 15 Garber M B. Diagnostic Imaging and Differential Diagnosis in 2 Case Reports.  Journal of Orthopaedic and Sports Physical Therapy. 2005;  35 745-754
  • 16 Goodman C C, Snyder T EK. Introduction to Screening for Referral in Physical Therapy. In Goodman C C, Snyder T EK, (eds) Differential Diagnosis for Physical Therapists – Screening for Referral.. 4th ed. St. Louis: Saunders Elsevier; 2007
  • 17 Guhse A, Steiffert D. Behandeln ohne Rezept?.  pt_Zeitschrift für Physiotherapeuten. 2007;  59 248-257
  • 18 Holdsworth L K, Webster V S, McFadyn A K. The Scottish Physiotherapy Self Referral Study Group. Self-referral to physiotherapy: deprivation and geographical setting. Is there a relationship? Results of a national trial.  Physiotherapy. 2006;  92 16-25
  • 19 Holdsworth L K, Webster V S, McFadyn A K. The Scottish Physiotherapy Self Referral Study Group: Are patients who refer themselves to physiotherapy different from those referred by GPs? Results of a national trial.  Physiotherapy. 2006;  92 26-33
  • 20 Hoving J L, Vet H CW, Koes B W et al. Manual Therapy, Physical Therapy, or Continued Care by the General Practitioner for Patients with Neck Pain. Long-Term Results from a Pragmatic Randomized Clinical Trial.  Clinical Journal of Pain. 2006;  22 370-377
  • 21 Jackson J L, O’Malley P G, Kroenke de K. Evaluation of acute knee pain in primary care.  Annals of Internal Medicine. 2003;  139 575-588
  • 22 Jarvik J G, Deyo R A. Diagnostic and evaluation of low back pain with emphasis of imaging.  Annals of Internal Medicine. 2002;  137 586-597
  • 23 Jette D U, Ardleigh K, Chandler K et al. Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral.  Physical Therapy. 2006;  86 1619-1629
  • 24 Jull G. Persönliche Mitteilung. 2009
  • 25 Korthals-Bos I BC, Hoving J L, Tulder van M W et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.  British Medical Journal. 2003;  326 911
  • 26 Leemrijse C J, Swinkels I CS, Veenhof de C. Direct Access to Physical Therapy in the Netherlands: Results from the First Year in Community-Based Physical Therapy.  Physical Therapy. 2008;  88 1-11
  • 27 Leerar P, Boissonnault W G, Domholt E et al. Medical screening by physical therapists for patients with low back pain.  Journal of Orthopaedic and Sports Physical Therapy. 2005;  35 A29
  • 28 Leerar P, Boissonnault W G, Domholt E et al. Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain.  The Journal of Manual and Manipulative Therapy. 2007;  15 42-49
  • 29 Leinich T. Physiopolitik. Schweden: Behandeln ohne ärztliche Verordnung.  physiopraxis. 2007;  5 10-14
  • 30 McPherson K M, Reid D A. New roles in health care: what are the key questions?.  Medical Journal Australia. 2007;  186 614-615
  • 31 Mitchell J M, Lissovoy de G. A Comparison of Resource Use and Cost in Direct Access versus Physician Referral Episodes of Physical Therapy.  Physical Therapy. 1997;  77 10-18
  • 32 Moore J H, McMillian D J, Rosenthal M D et al. Risk determination for patients with direct access to physical therapy in military healthcare facilities.  Journal of Orthopaedic and Sports Physical Therapy. 2005;  35 674-678
  • 33 Moore J H, Goss D L, Baxter R E et al. Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers.  Journal of Orthopaedic and Sports Physical Therapy. 2005;  35 67-71
  • 34 Nordeman L, Nilsson B, Möller M et al. Early Access to Physical Therapy Treatment for Subacute Low Back Pain in Primary Health Care. A Prospective Randomized Clinical Trial.  Clinical Journal of Pain. 2006;  22 505-511
  • 35 Oldmeadow L B, Bedi H S, Burch H T et al. Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care.  The Medical Journal of Australia. 2007;  186 625-628
  • 36 Pinnington M A, Miller J, Stanley I. An evaluation of prompt access to physiotherapy in the management of low back pain in primary care.  Family Practice. 2004;  21 372-380
  • 37 Repschläger U. Für mehr Autonomie des Berufsstandes kämpfen.  Physiotherapie. 2007;  25 7-11
  • 38 Repschläger U. Direct Access – Der Weg ist das Ziel.  Physiotherapie. 2008;  26 6-7
  • 39 Riddle D L, Hillner B E, Wells P S. Diagnosis of lower-extremity deep vein thrombosis in outpatients with musculoskeletal disorders: a national survey study of physical therapists.  Physical Therapy. 2004;  84 717-728
  • 40 Robert G, Stevens A. Should general practitioners refer patients directly to physical therapists?.  British Journal of General Practice. 1997;  47 314-318
  • 41 Ross M D, Bayer E. Cancer as a Cause of Low Back Pain in a Patient Seen in a Direct Access Physical Therapy Setting.  Journal of Orthopaedic and Sports Physical Therapy. 2005;  35 651-658
  • 42 Rothstein J M. Direct Access: Beyond the Diatribes.  Physical Therapy. 1991;  71 181-182
  • 43 Scheel K. Berufspolitik. Prue Galley zu Besuch beim IFK.  Physiotherapie. 2009;  27 6-9
  • 44 Scherfer E. Akademisierung der Ausbildung in Physiotherapie – Bestandsaufnahme und Orientierungshilfe. In Hüter-Becker A, Dölken M, (Hrsg) Beruf, Recht, wissenschaftliches Arbeiten.. Stuttgart: Thieme; 2004
  • 45 Slipman C W, Patel R K, Botwin K et al. Epidemiology of spine tumors presenting to musculoskeletal physiatrists.  Archives of Physical Medicine and Rehabilitation. 2003;  84 492-495
  • 46 Snow B L, Shamus E, Hill C. Physical therapy as primary health care: public perceptions.  Journal of Allied Health. 2001;  3 35-38
  • 47 Winters M E, Kleutz P, Zilberstein J. Back pain emergencies.  Medical Clinics of North America. 2006;  90 505-523
  • 48 Zalpour C. Der First-Contact-Practitioner in Deutschland.  pt_Zeitschrift für Physiotherapeuten. 2008;  60 105-111
  • 49 Zukunftsinitiative Physiotherapie (ZiPT) .AG-FCP. Screeningbogen. http://www.zipt.de/images/fbfiles/files/SCR_beta_100823_1116.pdf (08.09.2010)
  • 50 Zukunftsinitiative Physiotherapie (ZiPT) .Konferenz der Zukunftsinitiative Physiotherapie (ZiPT) am 5./ 6. März 2010 in Ulm. http://www.zipt.de

1 Die Arbeit entstand im Rahmen der Dissertation des Erstautors zum Doktor in Humanbiologie (Dr. biol. hum.) an der Medizinischen Fakultät der Universität Ulm.

Dr. biol. hum. Claus Beyerlein,

PT/OMT-DVMT MManipTh (Curtin University/Australien), physiotherapie beyerlein

Michel-Erhart-Weg 10

89081 Ulm

Email: info@physiotherapie-beyerlein.de