Red flag rules for knee and lower leg differential diagnosis

Area of Science:

• Orthopedics
• Physical Therapy
• Primary Care

Background:

• Physical therapists (PTs) are increasingly the initial healthcare provider for patients with lower extremity injuries.
• Direct access to physical therapy without a physician's referral is prevalent in the United States (over 65% of providers in 2017).
• A significant portion of the American population manages multiple chronic conditions, highlighting the need for comprehensive patient assessments.

Purpose of the Study:

• To emphasize the critical role of physical therapists in the initial evaluation of lower extremity injuries.
• To outline the essential components of a comprehensive physical therapy examination.
• To stress the importance of identifying red flag symptoms and signs indicative of serious pathology.

Main Methods:

• Review of current practices and guidelines for physical therapists.
• Emphasis on the components of a comprehensive patient examination: history, systems review, and objective tests.
• Discussion of clinical decision-making processes for patient management.

Main Results:

• Physical therapists are well-positioned to serve as the first point of contact for lower extremity injuries.
• A thorough examination by physical therapists is crucial for identifying potential serious pathologies.
• Clinical decision-making involves determining the need for treatment, referral, or a combination of both.

Conclusions:

• Physical therapists must be adept at performing comprehensive evaluations, including recognizing red flags.
• Prompt and appropriate referral to other healthcare practitioners is essential when serious pathology is suspected.
• Effective clinical decision-making by physical therapists ensures optimal patient outcomes and safety.