Ladeira Carlos E
Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA.
J Man Manip Ther. 2018 May;26(2):66-77. doi: 10.1080/10669817.2017.1390652. Epub 2017 Nov 20.
Physical therapists (PTs) may practice in direct access or act as primary care practitioners, which necessitate patients' screening and management for red, orange and yellow flags. The objective of the project was to assess the American PT's ability to manage red, orange and yellow flags in patients with low back pain (LBP), and to compare this ability among PTs with different qualifications.
The project was an electronic cross-sectional survey. The investigators contacted 2,861 PTs. Participants made clinical decisions for three vignettes: LBP with red flag for ectopic pregnancy, with orange flag for depression and with yellow flag for fear avoidance behaviour (FAB). The investigators used logistic regression to compare management of warning flags among PTs with distinct qualifications: orthopaedic clinical specialists (PTOs), fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and PTs without clinical specialization (PTMSs).
A total of 410 PTs completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs and 84 PTMSs). Two hundred and seventeen PTs (53%) managed the patient with LBP and symptoms of ectopic pregnancy correctly, 115 PTs (28.5%) of them managed the patient with LBP and symptoms of depression correctly, and 177 (43.2%) managed the patient with LBP and FAB correctly.
In general, PTs with specialization performed significantly better than PTMSs in all three clinical vignettes. PTs ability to manage patients with warning flags was relatively low. Based on our results, further education on patients with LBP and warning flags is needed. The survey had the potential for non-response and self-selection bias.
3b.
物理治疗师（PT）可以直接开展诊疗工作或担任初级保健从业者，这就需要对患者进行红色、橙色和黄色警示信号的筛查与管理。本项目的目的是评估美国物理治疗师对腰痛（LBP）患者红色、橙色和黄色警示信号的管理能力，并比较不同资质的物理治疗师之间的这种能力。
该项目是一项电子横断面调查。研究人员联系了2861名物理治疗师。参与者针对三个病例 vignettes 做出临床决策：伴有异位妊娠红色警示信号的腰痛、伴有抑郁症橙色警示信号的腰痛以及伴有恐惧回避行为（FAB）黄色警示信号的腰痛。研究人员使用逻辑回归比较不同资质的物理治疗师对警示信号的管理情况：骨科临床专家（PTO）、美国骨科物理治疗学会会员（PTF）、PTO 和 PTF（PTFO）以及无临床专科资质的物理治疗师（PTMS）。
共有410名物理治疗师完成了调查的所有部分（142名PTO、110名PTFO、74名PTF和84名PTMS）。217名物理治疗师（53%）正确管理了伴有异位妊娠症状的腰痛患者，其中115名（28.5%）正确管理了伴有抑郁症症状的腰痛患者，177名（43.2%）正确管理了伴有FAB的腰痛患者。
总体而言，在所有三个临床病例 vignettes 中，具有专科资质的物理治疗师表现明显优于PTMS。物理治疗师对伴有警示信号患者的管理能力相对较低。根据我们的结果，需要对腰痛患者和警示信号进行进一步教育。该调查存在无应答和自我选择偏差的可能性。
3b。
