"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Monday, February 13, 2012

Pathology Screening by Physical Therapists

Here are the clinical prediction rules I routinely use in the clinic.

They are included as a separate chapter in my new book Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting available by AuthorHouse publishers.

Please let me know if you see any omissions. Do you use any rules that I have not included here?

A separate table of decision rules used to to predict treatment, called Treatment Based Classification, was published December 28th, 2012.

Rule Author Year Level of Rule Development
Presence of Community Acquired Pneumonia Heckerling et al 1990 Level 1 Impact Analysis
Ottawa Ankle and Foot Rules Stiell et al 1992 Level 1 Impact Analysis
Well's Criteria for Deep Vein Thrombosis Well's et al 1995 Level 1 Impact Analysis
Ottawa Knee Rule Stiell et al 1996 Level 1 Impact Analysis
Canadian Cervical Spine Rule for Alert and Stable Trauma Patients Stiell et al 2001 Level 1 Impact Analysis
Cancer Rule in Lower Back Pain Patients Joines et al 2001 Cost Effectiveness study
Carpal Tunnel Syndrome Wainner et al 2005 Derivation
Elbow Fracture in Trauma or Sports patients Appelboam et al 2008 Level 2 Narrow Validation
Screening for Vertebral Fractures in Patients with Lower Back Pain Henschke et al 2009 Derivation
Stroke in Dizzy Patients Kattah et al 2011 Derivation

The "take away" I get from this table is that the low-hanging fruit has already been picked.

There doesn't seen to be an new impact study in screening for pathology using clinical decision rules in the last decade.

Do we know if clinical decision rules actually influence clinician behavior, improve patient outcomes or lower costs?

Let me know.

Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.